履行我们保护健康免受气候变化影响的责任|J Adv Nurs

Full text

From 6 November to 18 November 2022 nurses, midwives, doctors and other health professionals represented the health community at the 27th Conference of Parties (COP) in Sharm el-Sheikh, Egypt. COP is the apex decision-making body of the United Nations Climate Change Framework Convention (UNFCCC), assembled in 1994 to protect the planet from the impacts of climate change (United Nations, n.d.).

Climate change is the biggest threat and opportunity to global health. Staying under 1.5° of warming—the goal of the 2015 Paris Agreement (United Nations Climate Change, n.d.)—is essential for the health and well-being of all people, especially the world's most at-risk populations, least responsible for, yet most harshly affected by climate change. The ongoing climate-related shifts in temperature, weather patterns, land surface and ice sheets because of human-induced generation of greenhouse gases, are increasingly evident through intense and more frequent catastrophic fires, heatwaves, storms, floods, droughts, famine, social disruptions, ecosystem loss, sea-level rise and species extinctions with brutal health and socioeconomic costs (World Health Organization (WHO), 2021). Collective action is needed to coordinate climate mitigation, adaptation, and health resilience.

Throughout the history of nursing, we have demonstrated our value in providing care, patient advocacy, prevention of injury, health promotion, education, research and policymaking (Thorne, 2021; Wei & Horton-Deutsch, 2022). In the process, we have earned the community's trust -trust that is now needed to help communities adapt to climate change and to prepare climate-resilient healthcare systems. This editorial summarizes interventions for nurses to lead a meaningful change at the individual, local, national and global levels.

1 GLOBAL CHALLENGE

Addressing climate change is a complex, wicked problem as it intertwines health, environmental, social justice and ethical issues, disproportionately affecting historically marginalized and underserved communities encompassing different social, economic and public health impacts (United Nations, n.d.; World Health Organization, 2021). Tackling climate change requires addressing responsibility for climate change as well as social and ecological determinants of health (World Health Organization, 2021). Nurses' worldwide call-to-action stems from being the most trusted profession globally, representing the largest group of health professionals, with significant community outreach including to the most marginalized communities often most affected by climate change-related events (Atwoli et al., 2021; Thorne, 2021). Since climate change is the biggest threat to human health, reversing global warming also presents one of the most significant opportunities to improve global public health (Watts et al., 2018). For nursing, this also means being present at COP27 and advocating for change.

2 INDIVIDUAL CHALLENGE

The challenge for the nursing profession is to increase nurses' capacity to deliver climate-related interventions (Atwoli et al., 2021). On an individual level, knowing something needs to be done but not knowing where to start or what critical skill set is needed to engage may feel overwhelming and paralysing. However, we must remember that any effort at an individual level is precisely the crucial element to a successful collective fight against climate change's impact on our planet's health (Atwoli et al., 2021; Thorne, 2021). Undeniably, different individuals will feel comfortable with different levels of engagement, and everyone will forge a different path in responding to climate change. To help increase nurses' capacity to deliver climate-related interventions, we have compiled a list of interventions to help you engage with our responsibility to protect health from the impacts of climate change.

3 START WITH WHERE YOU ARE, DO WHAT YOU CAN AND WITH WHAT YOU HAVE

Develop knowledge on impact of climate change on health as a critical skill

This means learning about the impacts of climate change on health and then using this information as a skill to educate others to help protect health. To develop knowledge, start with the International Council of Nurses (ICN) position statement on nurses, climate change, and health first adopted in 2008 (ICN, 2018) identifying roles nurses can undertake to tackle the impacts of climate change. Connect with others with an interest in climate change through the WHO's Nursing and Midwifery Global Community of Practice (World Health Organization, 2022a). The international organization Health Care Without Harm hosts the Nurses Climate Challenge to mobilize and educate nurses about the health impacts of climate change (Health Care Without Harm, 2022).

Engage in advocacy and policy development

Nurses are uniquely positioned to steward a paradigm shift in health—given that our philosophy is oriented toward the socio-environmental model, prevention, and a holistic view of health (Wei & Horton-Deutsch, 2022). Our willingness and ability to advocate for climate action, which has direct and indirect impacts on the health of individuals and communities, can be supported by undertaking training programs in policy development to ensure that nurses' expertise and experiences are reflected throughout the healthcare systems (ICN, 2018). Find a seat at health governance tables and influence policy, professional standards, ethical codes, curricula programs and processes. Advocate for environmentally sustainable supply chains, influence the purchasing cycle towards a more circular economy model and advocate for better waste management practices.

Leadership through advocating for patients, health, and the planet

Whilst global geopolitical barriers exist to effective climate change action, we cannot give in to nihilism. Instead, we must ask ourselves what we can do today, where we are, with what we have, to steward the world to a safe and healthy future for future generations. Recognizing that activism takes many forms, at the individual, community, healthcare system or governance level, consider the following options:              

Deliver a presentation to your local community on the health impacts of climate change (and how health can be protected and promoted).

Talk to family and friends about risks and skills needed to manage climate change impacts on health.

Write opinion pieces on climate change health in professional magazines and other outlets.

Create and disseminate evidence-based practice on environmentally sustainable healthcare.

Meet with your local member of parliament, elected representatives or other government officials to advocate for climate-resilient sustainable healthcare and related policies.

Boycott companies whose products are not supportive of a sustainable planet.

Join your local environmental or climate action group, sponsor reforestation projects or sign petitions supporting climate action.

If you stand up for public or organizational roles, advocate for developing position statements and organizational policies on climate change.

Join professional organizations such as the Alliance of Nurses for Healthy Environments (ANHE) or Climate and Health Alliance

Start up climate change interest groups in your organizations.

Support First Nations voices

First Nation Peoples protect 80% of the global diversity (World Wild Life, 2022). Seek to learn and consult First Nations Peoples so that Indigenous people participate in the national conversation on addressing climate change and co-lead on nature-based solutions integrating indigenous and local knowledge (HEAL Network & CRE-STRIDE, 2021).

Deliver nursing education and professional development through a climate lens

Leverage our longstanding history of centring the socio-environmental model of health, community health approaches through a preventative and health-promoting orientation (Wei & Horton-Deutsch, 2022). Step up our focus on the impact of climate change threats to health by accentuating and augmenting existing content to ensure climate health literacy is a critical skill set (Shaw et al., 2021). The solution is to ‘take a climate lens’ to existing education—not consider it as an ‘add on’. Thus, when teaching about sustainable development goals, social determinants of health, and impacts of environmental factors on health (i.e., airborne, and waterborne diseases), consider how these evolve with changing climate.

Deliver climate-sensitive patient education

Use your knowledge of climate change impacts on health to initiate patient-centric conversations to tackle climate change and its health consequences, promoting actions that deliver immediate health benefits, and reduce costs to health systems and communities. Examples and guidance on effectively communicating climate change impacts on health and health in an evidence-based way include the ‘Real, Urgent and Now’ guide (Climate and Health Alliance, 2020).

Building climate-resilient healthcare systems

The WHO's operational framework for building climate-resilient health systems can guide these interventions toward health systems that can anticipate, mitigate, respond to, and recover from climate-related impacts (World Health Organization, 2022b). Locally, initiate and share innovative ways to reduce clinical waste and influence purchasing decisions, including digital health technologies, to make more environmentally friendly choices. Engage in developing equitable, gender-sensitive low carbon digital health care models supportive of value-based care.

Engage in climate and health research through multidisciplinary collaborations

Nurses, as the lynchpin of health systems, are equipped to build and walk multidisciplinary bridges, given that we routinely coordinate with different groups in the health system to deliver patient care (Thorne, 2021; Wei & Horton-Deutsch, 2022). Expanding nurse-led research to encompass the growing field of climate change and health research inclusive of at-risk communities to capture authentic stories is essential to build evidence to support the development of resilient communities. Becoming members of interdisciplinary research teams enriches those teams as nurses and midwives bring a unique lens to real-world problems which contributes to better patient and community outcomes (Wei & Horton-Deutsch, 2022). This requires a significant mind shift and short term-discomfort as we move away from the heavy dominance of the medical system towards collaborations with urban planners, engineers, information technology experts and community experts. Purposefully attend multi-disciplinary climate change conferences and submit proposals to add themes on climate change impacts on health to present nurse-led research.

Exercise personal choices

Whilst systemic action is required, personal action and leadership are essential to change social norms favouring low-carbon and environmentally responsible lifestyles. Moving to low-carbon and active transport reduces personal health risks and helps reduce air pollution; reducing meat consumption lowers our risk of bowel cancer and lowers methane emissions; spending time in nature to improve mental health and build a sense of connection and responsibility for the environment in which we live is valuable (WHO, 2021). Other options include reducing our contribution to the problem through composting, responsible consumerism and insisting on climate-friendly choices for our superannuation.

4 CONCLUSION

Nurses came to the climate debate early, uniquely positioned to steward and accelerate climate action (Butterfield et al., 2021; ICN, 2018). We have had some success, but we also have a long way to go. As action-oriented, practical, and evidence-based problem solvers, we can lead when it comes to complex problems involving multiple stakeholders, requiring a system thinking, planet-centred approach. Thinking strategically how to use our knowledge, interests, and diverse skill sets to minimize harm and maximize the benefits of climate action is a meaningful, hopeful way forward.

全文翻译（仅供参考）

2022年11月6日至11月18日，护士、助产士、医生和其他卫生专业人员代表卫生界参加了在埃及沙姆沙伊赫举行的第27届缔约方大会。缔约方会议是联合国气候变化框架公约（UNFCCC）的最高决策机构，于1994年成立，旨在保护地球免受气候变化的影响（联合国， N. D。）.

气候变化是全球健康的最大威胁和机遇。保持在1.5°的升温-2015年巴黎协定的目标（联合国气候变化， n. d. ）-对所有人的健康和福祉至关重要，特别是世界上最危险的人群，他们对气候变化的责任最小，但受气候变化影响最严重。由于人类引起的温室气体的产生，温度、天气模式、地表和冰盖正在发生与气候有关的变化，这些变化越来越明显，表现为严重和更频繁的灾难性火灾、热浪、风暴、洪水、干旱、饥荒、社会破坏、生态系统丧失、海平面上升和物种灭绝，造成严重的健康和社会经济代价（世界卫生组织（世卫组织）， 2021年）。需要采取集体行动来协调气候减缓、适应和健康恢复力。

纵观护理的历史，我们已经证明了我们在提供护理，患者宣传，预防伤害，健康促进，教育，研究和政策制定方面的价值（索恩， 2021年;魏&霍顿-多伊奇， 2022年）。在这个过程中，我们赢得了社区的信任-现在需要帮助社区适应气候变化并准备气候弹性医疗系统。这篇社论总结了护士在个人，地方，国家和全球层面领导有意义的变化的干预措施。

1全球挑战

应对气候变化是一个复杂而邪恶的问题，因为它交织在一起的健康，环境，社会正义和道德问题，不成比例地影响历史上被边缘化和服务不足的社区，包括不同的社会，经济和公共卫生影响（联合国， 未注明日期）。;世界卫生组织， 2021年）。应对气候变化需要解决气候变化的责任以及健康的社会和生态决定因素（世界卫生组织， 2021年）。护士在全球范围内的行动号召源于其是全球最值得信赖的职业，代表着最大的卫生专业人员群体，具有重要的社区外展，包括最边缘化的社区，这些社区往往受气候变化相关事件的影响最大（Atwoli等人，& nbsp; 2021; Thorne， 2021）。由于气候变化是对人类健康的最大威胁，因此逆转全球变暖也是改善全球公共健康的最重要机会之一（Watts等人，& nbsp; 2018年）。对于护理，这也意味着出席COP 27并倡导变革。

2个人挑战

护理专业面临的挑战是提高护士提供与气候相关的干预措施的能力（Atwoli等人，& nbsp; 2021年）。在个人层面上，知道一些事情需要做，但不知道从哪里开始或需要什么关键技能来参与可能会让人感到不知所措和瘫痪。然而，我们必须记住，个人层面的任何努力都是成功应对气候变化对地球健康影响的集体斗争的关键因素（Atwoli等人，& nbsp; 2021; Thorne， 2021）。不可否认，不同的人会对不同程度的参与感到满意，每个人都会在应对气候变化方面走上不同的道路。为了帮助提高护士提供气候相关干预措施的能力，我们编制了一份干预措施清单，以帮助您履行我们保护健康免受气候变化影响的责任。

3从你现在的位置开始，做你能做的和你拥有的

发展关于气候变化对健康影响的知识，将其作为一项关键技能

这意味着了解气候变化对健康的影响，然后利用这些信息作为一种技能来教育他人帮助保护健康。要发展知识，请从国际护士理事会（ICN）关于护士，气候变化和健康的立场声明开始，该声明于2008年首次通过（ICN， 2018），确定护士可以承担的应对气候变化影响的角色。通过世界卫生组织的护理和助产全球实践社区（世界卫生组织，2022a）与对气候变化感兴趣的其他人建立联系 。国际组织“无伤害医疗保健”（Health Care Without Harm）主办了护士气候挑战赛，以动员和教育护士了解气候变化对健康的影响（Health Care Without Harm， 2022）。

参与宣传和政策制定

护士处于独特的地位，以管理健康的范式转变，因为我们的理念是面向社会环境模型，预防和健康的整体观（魏&霍顿-Deutsch， 2022）。我们倡导气候行动的意愿和能力对个人和社区的健康有直接和间接的影响，可以通过开展政策制定培训计划来支持，以确保护士的专业知识和经验在整个医疗系统中得到反映（ICN， 2018）。在卫生治理桌上找到一个座位，并影响政策，专业标准，道德规范，课程计划和流程。倡导环境可持续的供应链，影响采购周期，使其更加循环经济，并倡导更好的废物管理做法。

通过倡导患者、健康和地球来发挥领导作用

尽管全球地缘政治障碍阻碍了有效的气候变化行动，但我们不能向虚无主义给予。相反，我们必须问自己，我们今天能做些什么，我们在哪里，用我们所拥有的来管理世界，为子孙后代创造一个安全和健康的未来。认识到行动主义在个人、社区、医疗保健系统或治理层面有多种形式，请考虑以下选项：              

向当地社区介绍气候变化对健康的影响（以及如何保护和促进健康）。

与家人和朋友谈论管理气候变化对健康影响所需的风险和技能。

在专业杂志和其他媒体上撰写关于气候变化健康的观点文章。

创建和传播环境可持续医疗保健的循证实践。

与当地议会议员、民选代表或其他政府官员会面，倡导气候适应性可持续医疗保健和相关政策。

抵制那些产品不支持可持续地球的公司。

加入您当地的环境或气候行动小组，赞助重新造林项目或签署支持气候行动的请愿书。

如果你支持公共或组织角色，倡导制定气候变化方面的立场声明和组织政策。

加入专业组织，如护士健康环境联盟（ANHE）或气候与健康联盟

在你的组织中建立气候变化兴趣小组。

支持第一民族的声音

原住民保护着全球80%的生物多样性（World Wild Life， 2022）。寻求学习和咨询原住民，使土著人民参与应对气候变化的国家对话，并共同领导基于自然的解决方案，将土著和地方知识相结合（HEAL网络&CRE-STRIDE， 2021）。

通过气候透镜提供护理教育和专业发展

利用我们长期以来以健康的社会环境模型为中心的历史，通过预防和促进健康的方向（Wei& Horton-Deutsch， 2022）社区健康方法。加强我们对气候变化威胁对健康的影响的关注，强调和增加现有内容，以确保气候健康素养是一项关键技能（Shaw et al.，& nbsp; 2021年）。解决的办法是对现有的教育进行“气候透镜”，而不是将其视为“附加”。因此，在讲授可持续发展目标、健康的社会决定因素和环境因素对健康的影响（即：空气传播和水传播疾病），考虑这些疾病是如何随着气候变化而演变的。

提供对气候敏感的患者教育

利用您对气候变化对健康影响的了解，发起以患者为中心的对话，以应对气候变化及其健康后果，促进立即带来健康益处的行动，并降低卫生系统和社区的成本。以循证方式有效沟通气候变化对健康和健康的影响的例子和指导包括“真实的、紧迫和现在”指南（气候与健康联盟， 2020）。

建立适应气候变化的医疗保健系统

世卫组织关于建立具有气候适应力的卫生系统的业务框架可以指导这些干预措施，使之能够预测、减轻、应对和恢复气候相关影响的卫生系统（世界卫生组织， 2022b）。在本地，倡导和分享减少医疗废物和影响购买决策的创新方法，包括数字医疗技术，以做出更环保的选择。参与开发公平、对性别敏感的低碳数字医疗保健模式，以支持基于价值的护理。

通过多学科合作参与气候和健康研究

护士，作为卫生系统的关键，有能力建立和走多学科的桥梁，因为我们经常与卫生系统中的不同群体协调，以提供患者护理（索恩， 2021;魏&霍顿-多伊奇， 2022）。扩大护士主导的研究，以涵盖不断增长的气候变化和健康研究领域，包括风险社区，以捕捉真实的故事，是建立证据，以支持有弹性的社区的发展至关重要。成为跨学科研究团队的成员丰富了这些团队，因为护士和助产士为现实世界的问题带来了独特的透镜，这有助于更好的患者和社区成果（Wei& Horton-Deutsch， 2022）。这需要一个重大的思想转变和短期的不适，因为我们从医疗系统的沉重统治转向与城市规划师，工程师，信息技术专家和社区专家的合作。有目的地参加多学科气候变化会议，并提交建议，以增加气候变化对健康影响的主题，以呈现护士主导的研究。

行使个人选择权

虽然需要采取系统性行动，但个人行动和领导力对于改变有利于低碳和对环境负责的生活方式的社会规范至关重要。转向低碳和积极的交通方式，降低个人健康风险，有助于减少空气污染;减少肉类消费可以降低我们患肠癌的风险，并减少甲烷的排放;花时间在大自然中改善心理健康，建立对我们生活的环境的联系和责任感是有价值的（世卫组织， 2021年）。其他选择包括通过堆肥减少我们对问题的贡献，负责任的消费主义以及坚持为我们的退休金选择气候友好型。

4结论

护士很早就参加了气候辩论，在管理和加速气候行动方面处于独特的地位（Butterfield et al.，& nbsp; 2021; ICN， 2018）。我们取得了一些成功，但我们还有很长的路要走。作为以行动为导向，务实和以证据为基础的问题解决者，我们可以在涉及多个利益相关者的复杂问题上发挥领导作用，需要系统思考，以地球为中心的方法。战略性地思考如何利用我们的知识，兴趣和多样化的技能来最大限度地减少气候行动的危害并最大限度地提高其效益，这是一个有意义的，充满希望的前进方向。

END