While the link between climate change and the surge in natural disasters has garnered significant media attention in recent years, a nurse researcher explored the health impact of a different type of natural disaster: extreme heat events, or heat waves.
In a recent literature review in Nursing Economics$, Adrienne Wald, EdD, MBA, RN, CNE, MCHES, examined data on the volume and cost of emergency room visits for heat-related illnesses because of extreme weather-related events in the United States due to climate change.
The review describes how heat waves have been the deadliest of extreme weather-related events in the U.S. — more than hurricanes, tornadoes and floods combined.
By drawing attention to this lesser-known consequence of climate change, Wald hopes to increase awareness about the critical need for hospitals and communities to collaborate with public health professionals to prepare for and respond to the evolving health needs of people affected by extreme heat events.
“Nurses need to be involved in understanding how extreme heat and other climate changes are affecting patient health, especially the most vulnerable populations like the elderly, children, people with chronic conditions and people in specific occupations like outdoor work,” said Wald, an associate professor of nursing at the College of New Rochelle (N.Y.).
Wald is among a growing cadre of nurses launching research projects, nursing education and advocacy efforts to prepare for what they expect to be an increasing number of climate change-related health needs.
Nurses have a valuable role in the pre-clinical setting, said Wald, where they can educate communities about how to avoid more serious heat-related illnesses and recognize early warning signs of heat exhaustion.
“The idea is to prevent these illnesses rather than treating them in the ER,” Wald said.
The literature review describes one heat wave in California in 2006 that led to more than 16,000 excess ED visits for heat-related illnesses in 58 counties. Studies also showed links between heat waves and increased ED visits in North Carolina, New York, Texas, Florida and Georgia.
To reduce the risk of heat stroke, public health nurses can reach out to schools, home health facilities and occupational groups about the importance of watching for early warning signs of heat exhaustion, such as headache, nausea and malaise. If left untreated, heat exhaustion can progress to heatstroke, which can cause more serious neurologic symptoms, including confusion, disorientation, delirium and coma, as well as multi-organ failure and ultimately death.
Wald is also an active member of the Alliance of Nurses for Healthy Environments, an organization focused on helping nurses understand the relationship between human health and the environment. Members of the group are involved in advancing research, evidence-based practice, education and policies.
To advocate against the repeal of the Clean Power Plan, Wald recently testified before a hearing in New York City about how nurses are seeing the impact of climate change.
Wald will also serve as a regional mentor for 30 nurses as part of a new year-long nursing fellowship program offered by the alliance. Participants will learn how environmental risks impact human health and how to organize and engage the community to address this issue.
How to prepare for climate change and health
At Massachusetts General Hospital, the importance of responding to the impact of climate change was compelling enough to motivate several nurses to launch the Center for Climate Change, Climate Justice and Health within the MGH Institute of Health Professions in the spring of 2018.
“We realized that there are many health professionals who do not understand the negative health consequences of climate change, and our goal is to educate nursing students, practicing nurses and nurse executives about this issue and motivate them to respond,” said Patrice Nicholas, DNSc, MPH, MS, RN, ANP, FAAN, director of the new center.
She hopes to educate more nurses about how the increase in greenhouse gases is linked to a rise in the number of respiratory illnesses such as asthma. The warmer temperatures are also increasing the number of vector-born illnesses such as Lyme disease.
The new center is also committed to achieving climate justice, the concept that those who contribute the least to climate change are the most vulnerable to its impact.
Tener Goodwin Veenema, PhD, MPH, MS, RN, FAAN, a professor at Johns Hopkins School of Nursing, is eager to see nurses get involved in efforts to help vulnerable populations prepare for the disasters resulting from climate change.
Veenema, an internationally recognized expert in disaster nursing and public health emergency preparedness, was bothered by the fact that the healthcare community was not better prepared for the hurricanes that devastated Puerto Rico and the U.S. Virgin Islands in 2017.
In response, she conducted a literature review to understand how to support communities like this in the future. She discovered that even before the storms, the communities were at greater risk of economic and health damage because these regions were already fragile. Poverty and unemployment rates were high and the populations had high rates of poor health, including diabetes, heart disease, depression, disability and infant mortality.
“The major lesson learned from this is that the social determinants of health can be used to help us create better plans and policies to prevent such devastation,” Veenema said. “And nurses are in a great position as advocates to work with communities and non-governmental organizations to prepare for these situations.”
She encourages nurses to participate in emergency planning committees in hospitals, local Red Cross teams and state and federal organizations.
“Nurses who are working in at-risk communities can work to ensure that there is a plan to establish essentials like satellite healthcare facilities if a clinic has been damaged,” she said. “Communication systems are also critical to maintain during these events.”
How to support the aging population during disaster
Older adults are another group at risk of health complications during extreme weather-related events, said Jasmine Travers, PhD, AGPCNP-BC, CCRN, a postdoctoral fellow in the Yale University Schools of Medicine and Nursing.
She is studying how to better prepare nursing homes to keep residents safe in such emergencies. Her research was motivated in part to prevent tragedies such as the deaths of 12 nursing home residents during Hurricane Irma in Florida.
In September 2017, the hurricane caused the home’s electricity to fail, and the temperature inside soared to 99 degrees during three days with no air conditioning.
To increase awareness among nurses about the impact of climate change, Travers is helping promote the Climate Health and Nursing Tool (CHANT), a 10-minute survey for nurses with questions about awareness, motivation and behaviors related to climate change and health.
Organizations can use the survey, which was developed by the alliance, to assess what nurses know about climate change and develop interventions based on the gaps in knowledge.
“My hope is that we can offer resources to nurses that will help them become more aware of how climate change is affecting the world,” Travers said. “We hear about it in the media, but now the goal is to help nurses understand how they can be part of the solution.”
Take these courses about the effects of climate change:
Too Hot to Handle: Excessive Heat-Related Conditions
(1 contact hr)
Healthcare providers as a team are instrumental in recognizing heat-related illnesses and teaching people about the dangers of such illnesses; young children and older people are especially vulnerable. Healthcare providers across all disciplines must be aware of the symptoms and common treatment for heat illness. This course informs readers about risk factors for heat-related injuries, signs and symptoms, appropriate interventions, and patient education measures to help prevent heat-related conditions.
Lyme Disease: It’ll ‘Tick’ You Off
(1 contact hr)
Lyme disease is a systemic bacterial infection that can be transmitted through the bite of an infected tick and causes illness ranging in severity from mild and self-limiting to chronic and debilitating. It commonly attacks the skin and cartilage, but it may also target cardiovascular and neurological organs. Lyme disease is concentrated heavily in the Northeast and upper Midwest, but it has been reported in all states and the District of Columbia. Healthcare professionals may encounter patients infected with Lyme disease in almost any clinical setting, as well as in patients’ homes. Updated clinical knowledge about this disease will enable healthcare practitioners to confidently provide the best care possible to this patient population.
For a Healthy Environment, Clinicians and Hospitals Have to Go Green(er)
(1 contact hr)
The environment has now become everyone’s responsibility, including healthcare professionals across disciplines. Trash is contributing to global warming, and U.S. hospitals generate 5.9 million tons of waste per day, equating to 29 pounds of waste per staffed bed in just one day. Healthcare professionals as a team can make a difference by working to reduce waste at their work sites. If medical waste is not disposed of properly, not only can it threaten the local environment, but it may lead to disease.