Climate Change: An Ecocentric Values-Based Caring Approach

Transcription

1 Climate Change: An Ecocentric Values-Based Caring Approach Laura Anderko, PhD Georgetown University Stephanie Chalupka, EdD, RN, PHCNS-BC, FAAOHN Worcester State University Harvard School of Public Health Chris Anderko, BA Big Shoulders/Hombros Grandes Abstract There is a delicate balance between the health of the Earth and the health of the human race. Human activities are contributing to global environmental changes, namely climate change. What is needed to mitigate climate change and its resultant health impacts is different from what has been expected from nursing in any other era. A shift from traditional caring models that are human-centered is needed. The ecocentric values-based caring model provides a broader context for caring by nurses that will help to heal the Earth and ultimately, humanity. Keywords: Earth caring, values based, ecocentric, climate change Background The health of the Earth and the health of the human race exist in a delicate balance. Today, human activities are contributing to global environmental changes, namely climate change. This is presenting a moral challenge, especially for the United States whose population has contributed significantly to climate change, which will ultimately inflict an unprecedented scale of human suffering on future generations across the Earth. Health burdens from climate change vary by geographical region. The United Nations Intergovernmental Panel on Climate Change (IPCC) predicts that global climate change, experienced as extreme weather events such as heat waves, rising sea levels, droughts, flooding and more intense wildfires, hurricanes, and storms, will result in an increase in a wide range of health impacts (Parry, Canziani, Palutikof, van der Linden, & Hanson, 2007). Indeed, there is mounting evidence to support these predictions. For example, as temperatures rise, increases in vector-borne diseases such as malaria are being recorded. Mosquitoes can reproduce more rapidly with increases in temperatures, along with an expansion of its range. This has led to an increase of malaria in highland areas such as Nairobi, Kenya that have historically not experienced the disease (Meehl et al., 2007). Malaria currently accounts for more than 80% of the climate-related disease burden in Africa (Brillant, 2007). In the Northern Hemisphere, global warming has resulted in the alternation of the timing of the last spring frost and the first fall frost. This has resulted in a changing growing season, as well as an increase in seasonal allergies. Research has associated global warming with an increase in pollen production, stronger allergenicity of some plants, earlier pollen season, and a longer pollen season (Beggs & Bambrick, 2005). Respiratory disease, especially asthma has increased particularly when combined with heat waves that result in poor air quality (e.g., ozone). Children, pregnant women, the elderly, and the poor are especially vulnerable to diseases associated with heat and other extreme weather events, as well as waterborne, vector-borne, and food-borne illness (Anderko et al., 2012). Despite this emerging evidence, little has been done to address society s need to use an ecocentric (Earth-centered, nature-based) approach in addressing environmental conditions that are negatively impacting the Earth and ultimately, human health. As a highly trusted profession and one that deals firsthand with health impacts from climate change, nursing has a unique role to play in advocating for initiatives and innovations that will mitigate climate change and its associated impacts. Current caring theories in nursing use a human-centered approach rather than an ecocentric one. For example, the Nightingale Declaration for a Healthy World clearly identifies nursing s role in promoting a healthy world. It states: We declare our willingness to unite in a program of action, to share information and solutions and to improve the health of all humanity. (Nightingale Initiative for Global Health, 2010). However, it falls short of including all forms of life (organic and nonorganic) and therefore, excludes a nature-based, ecocentric perspective. Earth Caring An Ecocentric Values- Based Caring Framework What is needed to mitigate climate change and its resultant health impacts is different from what has been expected from nursing in any other era. A shift from the traditional caring models that are limited to examining human relationships is needed. Calling for a paradigm shift for nurses requires an analysis of the scope of practice along with a broad new reunderstanding of 2014, Vol. 18, No IJHC_Journal 18.2_rev2.indd 33

2 the nurse s role, which has traditionally focused on individual and community relationships. Integral to this shift is to strengthen awareness and appreciation of the Earth and all its life. Nurses must broaden their scope to include animism, an ecological ethical approach, which supports a rekindling of our ancient relationship with the land (Curry, 2011). Animists are people that recognize that the world is full of persons, only some of whom are human and that life is always lived in relationships with others (Harvey, 2005, p. xi). Although historically absent from our traditional caring models, some nurse scholars have acknowledged the importance of an ecocentric approach in nursing practice. Eleanor Schuster (1990) advocated for an ecocentric paradigm and the interconnectedness with all beings. She wrote that this interconnectedness leads the nurse to naturally care for the world (Schuster, 1990). Rather than the traditional environmental focus of nursing that focuses on the patient s immediate surroundings, Kleffel (1996) suggested that nurses become aware of the adverse effects of environmental disasters and degradation and the need for a coordinated effort of people across the planet to address environmental health issues. Nurses have become increasingly cognizant that the narrowly drawn environmental paradigms and egocentric or homocentric approaches do not provide the theoretical foundations and knowledge to address the scope of environmental issues such as climate change. Therefore, the authors posit that using an ecocentric values-based caring approach is essential to addressing climate change through the acknowledgement that the Earth and nature are central to making comprehensive and sustainable changes and to adequately address human health issues. Figure 1 depicts the conceptual model of ecocentric values-based caring that can provide a broad frame of reference for a systematic approach to caring that can address climate change, health impacts, and the needs of all life on Earth. The model is adapted from a human-centric model developed by Georgetown University, Department of Nursing, to inform curricular development, and utilizes a values-based caring approach (Values-Based Caring Model, 2005). This new ecocentric model is composed of two distinct elements: the core, represented by the circle at the center of the model that includes the nurse and her interaction and relationships with the person, community, and the Earth. The complementary processes include critical thinking, evidence-based practice (EBP), and human flourishing, which contribute to the ecocentric values-based caring process. Values inherent in this process include commitment to the common good and social justice: Commitment to the common good: The common good approach regards all living things as part of a larger Figure 1. Conceptual model of ecocentric values-based caring EBP Nurse Value Based Caring community who share certain common conditions upon which their welfare depends. Social justice: A commitment to using education, practice, research, and advocacy efforts to address inequities in the way benefits and burdens are distributed among all inhabitants of the Earth. Complementary processes in the model promote collaborative relationships and interactions and include critical thinking, human flourishing, and evidencebased practice. Critical thinking is a method of problem solving that uses a purposeful, systematic approach to thinking. Critical thinkers are characterized by curiosity and demonstrate an organized approach to assessing, prioritizing, and acting to optimize wellness. Critical thinking skills can help nurses to problem solve, reflect, and make a Earth Community Person Critical Thinking Human Flourishing 34 International Journal for Human Caring IJHC_Journal 18.2_rev2.indd 34

3 conclusive decision about a current situation such as climate change. According to Craddock (1996), it is not what they know that makes nurses advanced practitioners, but how they use what they know. Climate change challenges nurses to broaden professional curiosity and to more fully consider the natural world as integral to human health. To address the issues posed by climate change, the traditional focus of nursing interventions for the individual will prove ineffective. The multidimensional nature of climate change requires the nurse to consider the economic, environmental, social, and political influences that shape the health of a society, as well as the ecological connections to health. This holistic approach provides nurses with a broader understanding of the richness and complexity of the broad determinants of health that are essential for analyzing problems and finding solutions for climate-health issues (Butterfield, 2013). Evidence-based practice is the conscientious, explicit, and judicious use of current research findings in making decisions about the provision of care. It is the practice of integrating an evaluation of the effectiveness of nursing interventions through scholarly inquiry and research utilization. Nurses are exceptionally well positioned to conduct climate change and health research. As a profession, we practice in a variety of settings (emergency rooms to public health) and with all age groups including those most vulnerable to the impacts of climate change. Nurses can explore urgent care needs and emergency preparedness as well as evaluate public health interventions involving adaptation and mitigation efforts. Hospitals, second highest energy guzzlers and contributors to climate change, are moving toward more energy efficient, climate friendly operations (World Health Organization and Health Care Without Harm, 2013). Nurses have a unique opportunity to evaluate the health benefits of these initiatives such as improved air quality in the community and the potential for reduced hospital admissions from asthma. Given the scale of the predicted effects of climate change on human health and implications for practice, there are many opportunities for nurse researchers including: a) surveillance and tracking of climate change and health impacts, such as the relationship between heat events, air quality, and asthma; b) evaluating efforts to communicate health risks associated with certain changes in climate change (such as heat and poor air quality) and adaptation strategies to vulnerable populations; c) community-based participatory research that engages underserved communities in emergency preparedness planning and mitigation efforts; d) measuring associated health benefits of energy efficient, climate friendly hospitals and communities; and e) exploring how a relationship with nature can positively impact our health (leading to human flourishing). The third complementary process of the ecocentric values-based caring model is human flourishing. Human flourishing supports the philosophy that all persons have potential and that nurses can optimize conditions on Earth that maximize the possibilities for each human being to fulfill their potential. It is important for nurses to support human flourishing in harmony with the Earth s capacity. Living well should provide for sufficient resources for every living creature (e.g., clean air and water). Climate change presents significant obstacles to human flourishing globally. Climate change threatens economic growth and national security, human rights, agriculture, food security, and health (Jarvis et al, 2011; Caney, 2010; Haines et al., 2007; McMichael, Friel, Nyong, & Corvalan, 2008). Greenhouse gases continue to increase as global socioeconomic development and global population climbs. Without preventive measures, the process of generating greenhouse gases will accelerate with more people, more consumption, and more production of goods. In this unfolding climate-health crisis, the nursing profession needs to advocate for mitigation and adaptation efforts. To be successful, nurses must recognize and accept that Earth is profoundly complex, whose local and regional particularities are inherent, and that we can only work with these particularities, not try to manage or control them (Curry, 2011). To achieve human flourishing within the context of global warming nurses must consider ecological connections to health. These include not only understanding regional changes in climate and associated health risks, but also advocating for policies that mitigate the causes of climate change so that all living creatures can flourish. The Earth Manifesto Mosquin and Rowe (2004) proposed an Earth Manifesto that lists core and action principles that can guide nursing interventions using an ecocentric valuesbased caring approach. This will require nurses to use an Earth-centered approach, rather than the traditional patient-centered approach, appreciating that the health of the Earth is central to the health of humanity. Core principles were presented by Mosquin and Rowe (2004): The Earth Manifesto: Core Principles (Mosquin & Rowe, 2004). 1. The Ecosphere is the Center of Value for Humanity 2. The Creativity and Productivity of Earth s Ecosystems Depend on their Integrity 3. The Earth-Centered Worldview is Supported by Natural History 4. Ecocentric Ethics is Grounded in Awareness of our Place in Nature 5. An Ecocentric Worldview Values Diversity of Ecosystems and Cultures 6. Ecocentric Ethics Supports Social Justice The earth manifesto core principles by Mosquin and Rowe (2004) also provide action principles to guide nursing interventions in addressing climate-health issues: 1. Defend and Preserve Earth s Creative Potential Advocacy in support of 2014, Vol. 18, No IJHC_Journal 18.2_rev2.indd 35

4 identifying and condemning technologies and industries that harm ecosystems can be an important role of nursing. One nursing organization, The Alliance of Nurses for Healthy Environments, has been effective in advocating for legislation that promotes cleaner air, safer chemicals, and clean energy ( For example, members have worked in partnership with the American Lung Association and the Natural Resources Defense Council to support the Clean Air Act and new carbon pollution standards for power plants. Regulating carbon pollution will have a direct impact on reducing greenhouse gases and climate change (U.S. EPA, 2013). 2. Reduce Human Population Size Although seemingly unrelated, population growth is an important contributor to environmental degradation in particular, climate change. The interplay of people, natural resources, and consumption must be addressed. Nurses can and must make this case, advocating for policies that support family planning, as well as encourage thoughtful family planning for patients in their practice. 3. Reduce Consumption of Earth s Parts Deforestation and use of fossil fuels has led not only to climate change, but has created environments that are uninhabitable by other forms of life on Earth. Nurses need to advocate for ecosystems that benefit all species. 4. Promote Ecocentric Governance Establishment of laws and policies that recognize and integrate an Earthcentered philosophy are needed to safeguard the many nonhuman components of the Earth. Nurses need to hold public officials responsible for decisions impacting ecosystems. 5. Spread the Message Nursing has a responsibility to raise awareness and inform the public through education and leadership about relationship to and dependence on the Earth s ecosystems. Earth Caring: Reflections for the Future Climate change is a matter of health. The health effects from climate change are inevitable. Climate change requires the nursing profession to move forward using an Earth-centered caring approach that is values driven. It is time for nursing to broaden its scope of caring and build relationships that will heal the Earth and ultimately, humanity. References Anderko, L., Chalupka, S., & Afzal, B. (2012). Climate change the role of the health professional. Washington, DC: Catholic Health Association. Beggs, P. J., & Bambrick, H. J. (2005). Is the global rise of asthma an early impact of anthropogenic climate change? Environmental Health Perspectives, 113, Brilliant, I. (2007). Climate, poverty and health: Seventh Annual John H. Chafee Memorial Lecture on Science and the Environment. Washington, DC: National Council for Science and the Environment. Butterfield, P. (2013). Thinking upstream: Nurturing a conceptual understanding of the societal context of health. In W. Cody (Ed.). Philosophical and theoretical perspectives for advanced nursing practice (pp ). Burlington, MA: Jones and Bartlett Learning. Caney, S. (2010). Climate change, human rights, and moral thresholds. In S. Gardiner, S. Caney, D. Jamieson, & H. Shue (Eds.). Climate ethics: Essential readings (pp ). Oxford, United Kingdom: Oxford University Press. Craddock, S. (1996). The expert nurse: Clinical specialist or advanced practitioner? In G. Rolfe (Ed.). Closing the theory-practice gap: A new paradigm for nursing (pp ). Oxford, United Kingdom: Butterworth-Heinemann. Curry, P. (2011). Ecological ethics (2nd ed.). Malden, MA: Polity Press. Haines, A., Smith, K. R., Anderson, D. Epstein, P. R., McMichael, A. J., Roberts, I., Wilkinson, P., Woodcock, J., & Woods, J. (2007). Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change. Lancet, 370, Harvey, G. (2005). Animism, respecting the living world (p. xi). New York, NY: Columbia University Press. Jarvis, L., Montgomery, H., & Morisetti, N. (2011). Climate change, ill health, and conflict. British Medical Journal, 342, Kleffel, D. (1996). Environmental paradigms: Moving forward toward an ecocentric perspective. Advances in Nursing Science, 18(4), McMichael, A. J., Friel, S., Nyong, A., & Corvalan, C. (2008). Global environmental change and health: Impacts, inequalities, and the health sector. British Medical Journal, 336, doi: /bmj Meehl, G. A., Stocker, T. F., Collins, W. D., Friedlingstein, A. T., Gaye, A. T., Gregory, J., & Zhao, Z. (2007). Global climate change projections. In S. Soloman, D. Qin, M. Manning, M. Marquis, K. Averyt, & Z. Chen (Eds.). Climate change 2007: The physical science basis. Contribution of Working Group I to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change (pp ). Cambridge, United Kingdom; New York, NY: Cambridge University Press. Mosquin, T., & Rowe, S. (2004). A manifesto for earth. Biodiversity 5(1), International Journal for Human Caring IJHC_Journal 18.2_rev2.indd 36

5 Nightingale Initiative for Global Health (2010). Nightingale declaration for a healthy world. Retrieved from Parry, M. L., Canziani, O. F., Palutikof, J. P., van der Linden, P. J., & Hanson, C. E. (Eds.). (2007). Climate Change 2007: Impacts, adaptation and vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, United Kingdom: Cambridge University Press. Schuster, E. (1990). Earth caring. Advances in Nursing Science, 13(1), U.S. Environmental Protection Agency (2013). Carbon pollution standards. Retrieved from carbon-pollution-standards Values-Based Caring Model. (2005). Unpublished, Department of Nursing, School of Nursing & Health Studies Washington, DC: Georgetown University. World Health Organization & Health Care Without Harm. (2013). Healthy hospitals, healthy planet, healthy people: Addressing climate change in healthcare settings. Retrieved from noharm.org/lib/downloads/climate/ Healthy_Hosp_Planet_Peop.pdf Author Note Laura Anderko, PhD, RN holds the Robert and Kathleen Scanlon Endowed Chair in Values-Based Health Care, School of Nursing & Health Studies, Georgetown University, Washington, DC. Stephanie Chalupka, EdD, RN, PHCNS-BC, FAAOHN is Associate Dean for Nursing, Worcester State University, Worcester, Massachusetts and Visiting Scientist, Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts. Chris Anderko, BA is Communications Consultant, Big Shoulders/Hombros Grandes, Chicago, Illinois. The authors extend many thanks to Dr. Carol Taylor from Georgetown University School of Nursing & Health Studies for her guidance in the area of caring theory. Correspondence concerning this article should be addressed to Dr. Laura Anderko, Georgetown University, School of Nursing & Health Studies, 3700 Reservoir Road NW, Washington, DC USA. Electronic mail may be sent via Internet to la266@georgetown.edu 2014, Vol. 18, No IJHC_Journal 18.2_rev2.indd 37

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