Accepted Manuscript Nurses’ knowledge and attitudes regarding potential impacts of climate change on public health in central of China Juan Xiao, Wei Fan, Yang Deng, Shaolan Li, Ping Yan PII:
S2352-0132(16)30059-X
DOI:
10.1016/j.ijnss.2016.04.002
Reference:
IJNSS 176
To appear in:
International Journal of Nursing Sciences
Received Date: 15 June 2015 Revised Date:
13 November 2015
Accepted Date: 29 April 2016
Please cite this article as: J. Xiao, W. Fan, Y. Deng, S. Li, P. Yan, Nurses’ knowledge and attitudes regarding potential impacts of climate change on public health in central of China, International Journal of Nursing Sciences (2016), doi: 10.1016/j.ijnss.2016.04.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Nurses’ knowledge and attitudes regarding potential impacts of climate change on public health in central of China Juan Xiao1, Wei Fan1, Yang Deng1, Shaolan Li1, Ping Yan1*
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1. School and Hospital of Stomatology, Wuhan University, Wuhan, China; The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan, 430079, China. * Corresponding author: Ping Yan, Tel: +86-027-87686142. Email:
[email protected]. Fax: +86 027 87873260
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Yan conceived the study, designed the trial, and obtained research funding. Xiao and Fan supervised the conduct of the trial and data collection. Xiao and Li and Deng undertook recruitment of participating centers and patients and managed the data, including quality control. Yan and Deng provided statistical advice on study design and analyzed the data; Xiao drafted the manuscript, and all authors contributed substantially to its revision. Xiao takes responsibility for the paper as a whole.
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Knowledge and attitudes of nurses toward potential effects of climate change on public health in central China 1. Introduction
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Climate change is a worldwide environment problem; this phenomenon refers to changes in climate caused by variations in solar radiation, earth’s orbit, ocean circulation, and human activities, such as deforestation and increased emission of greenhouse gases from burning of fossil fuels [1–3]. Climate
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change causes drought, heatwaves, rain-related floods, storms, and hurricanes, which affect human lives
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and present threats to the health and well-being of populations on earth. These events can increase physical and mental injuries, which could lead to illnesses and even deaths [4]. People with preexisting cardiopulmonary diseases are most likely to be affected by climate change because of poor quality and dry air caused by increased CO2 levels and temperature [5, 6]. For example, dehydration and heat exhaustion
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increased the mortality rates among old people in France in 2005 [7]. All these adverse effects on health severely increase the burden of health service providers and national economists. Nurses are a major part of a health service team because of their critical roles in improving the health
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and well-being of individuals. Nurses are also affected by health issues related to climate change, which
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has intensified in recent decades because of increased human industrial activities. To provide nurses with understanding regarding the effects of climate change on health, nursing schools of some universities in developed countries include climate change-related knowledge in teaching modules [8, 9]. Investigations [10–12] revealed that nurses in developed countries are more knowledgeable regarding climate change than nurses in developing countries; hence, the former could contribute to solving climate change-related health issues by helping patients to adapt to the changing environment. In this regard, knowledge and attitude of nurses toward climate change are fundamental, and many studies on climate change and nurses
ACCEPTED MANUSCRIPT have been published [10, 13, 14]. To date, minimal information is known regarding the perspective of nurses toward climate change and their effects on public health in China. Nurses in China are now concerned on issues and politics related to
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climate change. However, few reports and articles have been presented regarding recognition of nurses concerning climate change in China. To understand the status quo of nurses’ recognition with regard to the relationship between climate change and health care in China, we investigated 330 randomly selected
2. Materials and method 2.1 Definition of climate change
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registered nurses from six public hospitals in central China by using a pre-designed questionnaire.
Climate change refers to changes in climate caused by variations in solar radiation, earth’s orbit,
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ocean circulation, and human activities, such as deforestation and increased emission of greenhouse gases from burning of fossil fuels [1–3]. 2.2 Questionnaire design
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Twenty single-choice questions related to the background of testees and climate change were included
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in the self-administered questionnaire. Only completely filled questionnaires with a clear single-choice answer were considered valid for analysis. 2.3 Testee selection
A total of 330 registered nurses were randomly selected from six public hospitals (No. 3 Hospital of Wuhan, Zhongnan Hospital, Tongji Hospital, Renming Hospital, General Hospital of Guangzhou Military District, and Xiehe Hospital) in central China. Nurses from different hospitals were selected based on the scale of the hospital. The distribution of selected nurses is shown in Table 1.
ACCEPTED MANUSCRIPT The study protocol was approved by the Ethics Committee of the School and Hospital of the Stomatology of Wuhan University (Wuhan, China).
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3. Results 3.1. Characteristics of participants
All nurses under investigation were female. Most of them (70%) obtained a bachelor’s degree in
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nursing. About 91% of the participants worked as nurses for less than 5 years, and 78% held a junior
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position. The distribution characteristics of nurses from the six hospitals are shown in Table 2.
3.2. Recognition of climate change and related issues
A total of 293 questionnaires were found valid for analysis. Among these 293 questionnaire answers,
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76% of the participants (group 1) discerned that climate change would affect public health, whereas 24% of the participants (group 2) lack relevant knowledge. In group 1, 39% knew the main cause of climate change, 79% believed that climate change could affect their normal daily lives, and only 44% thought that
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climate change could affect their work. Meanwhile, 72% of the 224 nurses believed that climate change
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would adversely affect public health, and only 39% realized that some actions in their work could reduce the development of climate change (Table 3). Most (83%–96%) of the participants considered the need and were willing to learn knowledge on climate change and sustainable healthcare nursing (Table 4). With regard to questions on where nurses obtained knowledge on climate change and what would be the most suitable method for them to learn about the topic, 32% of group 1 indicated that they obtained their knowledge on climate change from various social media and only 19% of the nurses learned about climate change from school. Among the 293 nurses, 45% thought that the media would be the best method
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4. Discussion Climate change is one of the major threats to global health in the 21st century [15], and health workers are urged to respond to this issue. Nurses, as a major part of healthcare service, are envisioned to
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be at the frontier against the adverse effects of climate change on public health. The status quo of
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recognition among young generations of nurses is important for the adaptation of healthcare service to climate change in the future [16]. In this study, most of the participants were at their junior position with less than 5-year work experience and received a bachelor’s degree in nursing. The participants represented the young generations of nurses working in central China. This investigation provides interesting
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information on young nurses’ knowledge as well as their manner and interest to learn about climate change, including climate change-related healthcare issues.
One of the most interesting and important results in this study is that most nurses possessed
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knowledge on climate change. However, their knowledge is limited only on the idea that climate change
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could affect their daily lives and the public health. More than half of the nurses did not know that climate change would also affect their work, and their activities at work could also affect climate change. This condition suggests that most nurses did not fully recognize and understand the reciprocal influence between climate change and healthcare works. Another important finding in this study is that nurses who possessed knowledge on climate change obtained their knowledge mostly from various social media, followed by colleagues or friends, and only 19% learned climate change from school education. Similarly, nearly half of the nurses who lack
ACCEPTED MANUSCRIPT knowledge on climate change showed interest in learning climate change through the media. However, only 15% preferred the school as the best way to learn climate change. This condition suggests that education programs on climate change in Chinese colleges or universities is still given insufficient
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importance and needs to be emphasized in the future. On the contrary, the role of media and advertisements in knowledge dissemination on climate change has become more influential than before,
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which could be better employed to educate nurses on climate change.
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Trained and competent nurses are imperative to the success of healthcare systems [17] and must be educated regarding public healthcare-related effects of climate change [10, 18]. The present investigation revealed that most young nurses in central China showed interest to learn more about climate change and its related healthcare issues. Consequently, the adaptive ability of healthcare service to climate change in
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China will be improved in the future by integrating knowledge on climate change through the nursing
5. Conclusions
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education system and social media.
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Nurses in China need to fully recognize and understand climate change and its related healthcare issues. Education on climate change in the nursing program of colleges or universities in China is still not given enough importance and needs to be emphasized. The adaptive ability of healthcare service to climate change could be improved in the future by integrating knowledge on climate change through the nursing education system, resulting in more knowledgeable nurses on climate change in China.
ACCEPTED MANUSCRIPT Acknowledgments
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This work was supported by the Natural Science Foundation of Hubei Province of China (No. 304132169).
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ACCEPTED MANUSCRIPT 10. Polivka BJ, Chaudry RV, Mac Crawford J.Public health nurses' knowledge and attitudes regarding climate change. Environmental health perspectives 2012; 120(3): 321-5. 11. Sayre L, Rhazi N, Carpenter H, Hughes NL.Climate change and human health: the role of nurses in
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from denial and catastrophic fatalism to positive action. Philosophical transactions Series A, Mathematical, physical, and engineering sciences 2011; 369(1942): 1866-82. 16. Goodman B.Role of the nurse in addressing the health effects of climate change. Nursing standard 2013;
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ACCEPTED MANUSCRIPT Table 1. Distribution of selected nurses among different hospitals. No. of selected nurses
General Hospital of Guangzhou Military District
72
NO.3 Hospital of Wuhan
26
ZhongNan Hospital
52
TongJi Hospital
66
RenMing Hospital
54
XieHe Hospital
60
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Hospitals
330
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Total
ACCEPTED MANUSCRIPT Table 2 Characteristics of participants. Characteristics
N
%
Sex Male
0
Female
0
293 100%
Technical education Diploma Bachelor’s degree
3
1%
85
29%
205
70%
0
PHD
0
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Master’s degree Position
229
78%
Middle
64
22%
Years of work < 3 years 3–5 years 6–10 years
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10–20 years
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Junior Senior
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Education
0
129
44%
138
47%
19
6%
7
2%
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NOT SURE
Know the main reason of climate change
87 (39%)
63 (28%)
74 (33%)
Climate change could affect their daily life Climate change could affect their work Climate change could adversely affect public health
176 (79%) 99 (44%) 161 (72%)
16 (7%) 60 (27%) 11 (5%)
32 (14%) 65 (29%) 52 (23%)
Activities at work could affect the speed of climate change
87 (39%)
36 (16%)
101 (45%)
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YES
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Willing to learn related knowledge about climate change
280 (96%)
13 (4%)
Willing to learn the knowledge about healthcare related to climate change
243 (83%)
50 (17%)
Necessity of learning the knowledge about climate change
260 (89%)
33 (11%)
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Yes
ACCEPTED MANUSCRIPT Table 5. Approaches to educate nurses regarding climate change, What would be the best way for all participants to
the knowledge on climate change?
learn the knowledge on climate change?
43 34 48 28 71
45(15%) 63(22%) 4(1%) 49(17%) 132(45%)
19% 15% 21% 13% 32%
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School Hospital Colleagues/Friends Medical articles Mass Media
Where the participants of Group 1 obtained
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Approaches
