From Research to Practice: Climate Change in Nursing

Heather Herdman (00:02.136)

Welcome to the NANDA cast. I'm Dr. Heather Herdman, the Chief Executive Officer of NANDA International. Thank you for your participation. Today I present to you Dr. Rafaela Moreira and Dr. Vanessa Freri. Dr. Rafaela, Dr. Vanessa, I thank you for agreeing to talk with us today. I'm really excited about our conversation. Let me tell you a little bit about our guests. Dr. Rafaela has her doctorate in nursing with a postdoctoral degree from the Universidad Laguna on climate and human health.

She is a professor at the Institute of Health Sciences at UniLab in Ruedencau, Serra, Brazil. She coordinates the graduate program in nursing at UniLab. She's a member of HEPI, which is a Brazilian network on standardized nursing language. She's a member of NANDA International, and she chairs the NANDA International Climate Change Task Force. So we are really excited to have her.

Dr. Vanessa also has her doctorate in nursing. She is a visiting professor at UniLab, also in Serra, Brazil. And she has collaborated in research on the interface between the environment, health, and nursing. So I think we're very, very lucky to have both of you here as experts. I've been lucky to sit in on a couple of meetings of the climate change group.

that's been going on for over a year now, I think, right? And the knowledge base that this group has is just extraordinary. So I think you're going to enjoy our conversation today. So thank you so much for agreeing to be here. And thank you for being willing to speak to us in your second language, English, because Portuguese is obviously your first language. So...

Rafaella Pessoa Moreira (02:01.92)

Yes.

Heather Herdman (02:26.68)

To begin with, can you both just tell us a little bit about your involvement with the theme of climate change? How did that come about? What motivated you to explore the relationship between climate change and nursing, and then specifically nursing diagnosis?

Rafaella Pessoa Moreira (02:46.176)

The other nursing professors from the Unilab Research Group and I work with nursing technologies, diagnosis, outcomes, and interventions in caring for people with chronic diseases. Over the last six years, we began working on climate-sensitive diseases and their impact on human health.

based on pattern and shapes established with researchers from different fields and various national and international teaching and research institutions. In our research group, we have an interdisciplinary network with all the researchers, engineers, hydrologists, climatologists, economists, among others.

As nurses, we always felt the user to bring the results of these studies into the field of nursing. We started getting research projects funded, both in nursing and in interdisciplinary areas, and publishing site articles. As I mentioned earlier, the nursing in the group have always

always worked with the nursing process and the nether nursing diagnosis in research and teaching. So, the idea came up to send a letter to the editor for the Journal of Nursing Knowledge. In the letter, we questioned the need to update nursing classifications to take climate change into account. A few days after the letter to editor was published,

You, Dr. Heder, put out a call on the Nanda International website inviting participants to form a Nanda Climate Change Tax Force. We immediately expressed our interest in participating. I am chair of the Tax Force, which included other members. The complete list to Tax Force members can be found on the Nanda International website.

Heather Herdman (05:07.992)

That's wonderful. And it has been a very active group. It's just been amazing how much, I think, has come out of that group in the past year. Vanessa, maybe tell us a little bit about where you live. Because some of our listeners may not know a lot about the area of Brazil, where you are, and why maybe climate might be really important to you personally.

Vanessa Freire (05:31.342)

Okay, so we live in Ceará, it's a state in northeast Brazil, and the climate here is semi-arid. So we have only basically one season all year round, it's summer all year round, which sounds good, but we have problems with heat waves, for example. So our group always studied cardiovascular responses.

Rafaella Pessoa Moreira (05:47.85)

you

Vanessa Freire (06:01.484)

And we came to notice some changes in the patterns of illness and mortality involving cardiovascular diseases and stroke. there is a connection with heat waves. And we are definitely sure that this is a problem that affects the population here where we live.

Heather Herdman (06:22.916)

Thanks. That gives a nice context for people who don't know Brazil very well. And she's not kidding. It's very hot where they live. So you have developed important research that shows how climate affects health, as in the case of dengue in semi-arid regions, the effects of heat on cardiovascular hospitalizations, as Vanessa, you were just mentioning.

Rafaella Pessoa Moreira (06:30.211)

Yeah, exactly.

Rafaella Pessoa Moreira (06:34.349)

You

Heather Herdman (06:51.576)

and also the relationship between access to water and the reduction of diarrheal diseases. So can you share some of the main results of this research and what is the relevance to nursing practice?

Vanessa Freire (06:59.02)

Yes.

Vanessa Freire (07:06.486)

Yes, definitely. So our group is studying how climate change is already impacting health. And our findings regarding the dengue articles, we have published two articles. These are epidemiological time series analysis. And we found that the pattern, the way how the disease behave is going to change. So

So far we know that we have more cases of dengue during the rainy seasons. But epidemiological studies show that we have to expect more cases in the dry months too. So this changes everything for nurses. We need to watch for symptoms. We need to educate communities all year round, not just in the rainy season.

because it is expected that in the upcoming years, we will have more cases of dengue, even in the dry months. Concerning the relationship between heat and heart disease, we found that heat waves are a major risk for heart attacks and strokes, as I mentioned, and especially for older adults. So if you are nursing, work with older adult patients,

you have to check for environmental risks. And this means teaching patients about hydration, staying cool, and knowing the signs of heat stress. So we think education is key here. And concerning the relationship between drought and diarrhea, this is a story of hope, actually, because we studied a long period, an 11-year period.

of drought that we had here in the Northeast. And we were expecting to notice an increase in the cases of diarrhea because people usually use unsafe water, unclean water during the droughts. But what we noticed was a reduction in hospitalizations for diarrhea, almost 5 % per year. And why did this happen? So because of public health

Vanessa Freire (09:29.014)

water supply measures that were coincidentally implemented during the same period. So this shows that the negative impacts of climate can be found if we act.

Heather Herdman (09:41.945)

That's wonderful. And I think, I just want to say before you go on, I think it's going to be more more important this kind of work, not just in Brazil. So I want people to not be thinking, well, this is only relevant to Brazil because we're seeing climate change occurring across many, many countries, obviously, but we're seeing places that didn't have diseases such as dengue.

Rafaella Pessoa Moreira (09:42.751)

Okay.

Bye.

Rafaella Pessoa Moreira (09:58.958)

Mm-hmm.

Heather Herdman (10:09.742)

that are now starting to see dengue. Even in the United States, we're starting to see dengue coming up from the South. And nurses in the US have never dealt with dengue. So to have you as a resource and have this kind of information available in terms of what nurses can do is going to be really, really critical. So I didn't mean to interrupt you. But Raphael, give me one second because my plug for some reason is not.

Vanessa Freire (10:16.621)

Yes.

Heather Herdman (10:38.658)

charging and I'm getting an error message. So hang on for me one second.

Rafaella Pessoa Moreira (10:43.639)

Okay.

Heather Herdman (11:50.98)

Okay, sorry about that.

Rafaella Pessoa Moreira (11:55.799)

Okay.

Vanessa Freire (11:55.876)

I'm proud of this.

Heather Herdman (11:56.645)

Apparently that wall plug was dead. All right. Whenever you want to start, Raphael, go ahead.

Rafaella Pessoa Moreira (11:59.648)

No problem.

Rafaella Pessoa Moreira (12:06.755)

In addition to these lessons, one of the things we learned was that in the case of climate change, conducting time series analysis is important to understand the behavior of the disease in each region and which climate factors have the most influence, identifying groups of greater dis-vulnerability and verifying

the need to plan health prevention actions. With our research results, we were able, for example, to suggest how nurses can carry out nurse interventions for various climate sensitive diseases.

Heather Herdman (12:54.072)

Yeah, and again, I think that's really, really important for helping us to think about not just, well, we know the climate is a problem, but what can we do about that? And how do we support patients? Yeah. So how does the climate change group then relate all of this evidence? And you've only touched on just a little bit of what you have found. How do you relate that to the perspective of nursing diagnosis?

Rafaella Pessoa Moreira (12:55.625)

Yes.

Rafaella Pessoa Moreira (13:04.023)

Mm-hmm. Yeah.

Heather Herdman (13:22.198)

especially in the care of populations that are in conditions of greater vulnerability.

Vanessa Freire (13:30.072)

Okay, so this is the key and our meetings are always focused on translating the results of these researches into practice and practical recommendations. So we take this research and connect it directly to nursing diagnosis. And we know that a diagnosis gives a name to a patient's problem. So our research shows that climate is creating new problems or making old problems worse.

For example, another adult in a heat wave might have ineffective thermal regulation, which is another diagnosis. The cause now is heat exposure or making old problems worse. sorry, I missed that. So the cause now is heat exposure and that changed our care plan. So when you name it, you can care for it. You can be attentive and nurses will have to update their care plans basically.

Another example, since dengue is now a year round, the risk for infection is constant, not just seasonal. And we are seeing new responses to, like climate insight is a new term. And we have to think about how this connects to our work, to our daily practice. So when we add climate to the NANDA taxonomy, we give nurses the official language to name the problem.

And once we can aim it, we can treat it and advocate for policies to fix it.

Heather Herdman (15:03.46)

Absolutely. And I think I just was listening to a program here in my state, which I live in Wisconsin, which is pretty far north in the United States. We tend to be thought of as a very cold climate. And I was listening to parents talking about their anxiety, so their climate anxiety, as they watch climate change for their children and talking about how they grew up skiing every winter.

and being able to go snowshoeing and that they haven't been able to do that in years. And we just aren't getting that kind of snowfall that was characteristic of Wisconsin. And so really talking about, geez, if it's that much warmer here, what must it be like in warmer parts of the country? And so you're hearing that climate anxiety, I think, in people today as well, who maybe don't have the term for it, but you definitely are hearing it.

Vanessa Freire (15:56.939)

Yes.

Rafaella Pessoa Moreira (15:58.852)

and then, mm-hmm, yeah.

Heather Herdman (16:02.052)

Can you tell us how the process of incorporating your findings into the scope of Nanda's nursing diagnosis is going? What are you seeing there? How is it working for you? What are your takeaways?

Rafaella Pessoa Moreira (16:15.603)

Okay, these studies already conducted have allowed us to integrate this relationship between the impacts of climate change and the environmental factors with some of the nursing diagnosis in the NANDE classification. For example, the influence of exposure to high temperatures

and air pollution on the increase of the nursing diagnosis risk for impaired cardiovascular function was identified. But this relationship is not clear in the current edition of NANDA. Just like this example, other phenomena also don't show this relationship. So,

The researchers proposed suggestions for including related factors defining characteristics of populations at risk so that the nursing diagnosis can encompass this influence of climate change. It should be emphasized that this is an international effort and must be depended on and further developed.

by all nurses from a theoretical and practical perspective of their professional practice.

Heather Herdman (17:47.013)

And so you've advanced those recommendations to the Diagnosis Development Group for consideration for inclusion, I believe.

Vanessa Freire (17:56.04)

Yes.

Rafaella Pessoa Moreira (17:56.503)

Yes, yes.

Heather Herdman (17:57.839)

Great. So in your view, what is the importance of including diagnosis related to climate change in the Nanda taxonomy? And what benefits does it bring to patients, but also to nursing professionals and to the discipline itself?

Vanessa Freire (18:16.968)

Well, this is so important. So climate change isn't just for engineers anymore. It's a major health issue. Nurses are in the front line. So when we include climate and climate change related problems in nursing diagnosis, we can identify risks early, especially for vulnerable groups like children and older adults. And we can spot new illness patterns and promote sustainable actions.

This also helps nursing science. So it gives a structured way to teach this to the next generation of nurses. And we believe that a nurse who understands environmental risks can plan safer care plans, more effective care, and it also makes us leaders in addressing this health crisis. So we cannot stay behind, and also our patients need that.

Heather Herdman (19:17.634)

Yeah, I couldn't agree more. And I think it's your comment that nurses are at the front lines. That's so true. And as you're seeing things and as we're starting to identify things, we need to have those terms to represent what we're seeing. So what have been some of the biggest conceptual or methodological, even other challenges that you've identified even in the practical sense?

in the trajectory of incorporating this new and quite complex area of climate change into nursing diagnosis.

Vanessa Freire (19:55.137)

Okay, so I will make a pause here, Heather, your image is not appearing right now. I don't know if...

Rafaella Pessoa Moreira (20:00.13)

Yes, yes.

I don't know if this sound is okay because the sound is okay for me.

Vanessa Freire (20:07.726)

no, now you're back. Now you're back.

Heather Herdman (20:11.716)

How, okay, that's weird. Sorry about that. All right, well, let me just, I'll just go back and start that question again. All right. So what have been some of the biggest challenges either from a conceptual or a methodological or even a practical perspective in your trajectory of trying to incorporate this new and really very complex area of climate change into nursing diagnosis?

Rafaella Pessoa Moreira (20:17.954)

upgrading.

Vanessa Freire (20:42.168)

Okay, so I think the biggest challenge is that this work involves so many different fields, so like physics, hydrology, and health. So it is complex, and it's not something you can do in a quick manner or in a fast forward manner, it involves different areas. Our research group work as a team, so we have experts collaborating from all these areas.

And this partnership helps us connect the dots between, say, a water level problem and clinical health problem. So this is, for me, is the biggest challenge. But there is another challenge which is also really important, which is awareness. So it's about helping all nurses see that climate change is a nursing issue. Many nurses still don't realize they have an active and powerful role in this crisis.

Heather Herdman (21:42.563)

Yeah, I think that's true. We have been experiencing a lot of wildfires and the smoke that's been coming down from Canada. And I was speaking with a group of nurses from our emergency room departments in the local hospitals recently, and they were telling me that they were so surprised how this was affecting people's health and that they had never thought about having to pay attention to how are the fires doing.

And what is that gonna mean for what equipment do they need to have ready? What can they expect in terms of the type of patients that are gonna come into the emergency room? And having to try to change the education that they give to their patients. Because if you know that the smoke is coming and you're asthmatic, you're gonna have more problems. So it's definitely starting to affect us in daily practice. So to conclude,

you know, what message would you both like to leave for students, for nurses, and maybe for even professors and managers about the importance of integrating the issue of climate change into the use of nursing diagnosis?

Rafaella Pessoa Moreira (22:47.981)

you

Rafaella Pessoa Moreira (22:56.515)

Third, we would like to finish by reinforcing that climate change is a current and global reality. No, can you? Yes, Sorry. Oh my God.

Vanessa Freire (23:10.018)

You can start again, no problem.

Heather Herdman (23:10.978)

It's okay.

It's fine. Much better than my Portuguese. Don't worry.

Rafaella Pessoa Moreira (23:19.715)

First, we would like to finish by reinforcing that climate change is a current and global reality. We are all impacted by the effects of climate change in our daily lives and consequently on human health.

We need to adapt and introduce the topic in various ways into our daily lives. Now, answering the question, clinical nurses need to have knowledge on the topic and introduce interventions into their daily work to prevent or minimize the effects of climate change. For this,

The inference of nursing diagnosis whose components take climate change into account is fundamental. For example, in primary care, nurses who infer the nursing diagnosis of risk for impaired cardiovascular function for an older adult person exposed to a heat wave, most instruct them not to perform outdoor activities.

to increase hydration and to use some protection. The nurse in the hospital must understand and consider that a person who is admitted and has the nursing diagnosis of risk for thrombosis may be due to exposure to a heat wave or extreme cold. For the nurse to be able to develop this clinical reasoning, they need training

and managers must be attentive to this. Professors must introduce the topic transversely in the content of their courses in the undergraduate or graduated curriculum for the development of clinical reasoning in professionals in clinical practice. Therefore, we hope that the work of the members of the NANDA Climate Change Tax Force

Rafaella Pessoa Moreira (25:37.421)

can contribute to updating the NANDR nursing diagnosis with introduction of components related to climate change to existing nursing diagnosis and support the development of new diagnosis. Thank you, thank you very much for having us today.

Heather Herdman (25:59.801)

Thank you for joining us on the NANDICAST. It has been really interesting to read all of your work and to listen in on some of the conversations that you've been having, not just about diagnosis, but moving on into what did nurses do for this? What are the actions and interventions that nurses need to take? And what are realistic outcomes that we need to be aiming for in our patients? So it really is the whole process from assessment through evaluation.

Thank you so much for sharing just a little tiny bit of your knowledge here. I really encourage people, if you're interested in this topic, to find the literature that is written by this group, and we will have links to that in our podcast for you, because there's a lot of research that they're putting out and very interesting articles to consume as nurses. I hope you've enjoyed my conversation.

today and don't forget to subscribe to our newsletter at www.nanda.org. Follow us on LinkedIn, on Instagram, Facebook, and you can also find links to purchase the book Nanda International's Nursing Diagnosis, Definitions and Classifications on our website. So until next time, we continue to define nursing knowledge one concept at a time.