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YNEDT-02565; No of Pages 4

YNEDT-02565; No of Pages 4

No of Pages 4 Nurse Education Today xxx (2013) xxx – xxx Contents lists available at

Contents lists available at SciVerse ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/nedt

Education Today journal homepage: www.elsevier.com/nedt Contemporary Issues The use of evidence-informed

Contemporary Issues

The use of evidence-informed sustainability scenarios in the nursing curriculum:

Development and evaluation of teaching methods

Janet Richardson , Jane Grose 1 , Maggie Doman 2 , Janet Kelsey 3

School of Nursing and Midwifery, Faculty of Health, Education and Society, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK

article info

Article history:

Accepted 11 July 2013 Available online xxxx

Keywords:

Sustainability

Nursing

Education

Clinical skills

Climate change

Scenarios

Resource scarcity

summary

Background: Climate change and resource scarcity pose challenges for healthcare in the future, yet there is little to raise awareness about these issues in the nursing curriculum and nurses are poorly equipped to practice in a changing climate. The aims of this paper are to describe how an evidence-informed sustainability and healthscenario based on two sustainability issues (resource depletion and waste management) was introduced into a nursing clinical skills session, and to report the evaluation of the session. Methods: Based on evidence from our own research on waste management, sustainable procurement and resource scarcity, a practical hands-on skill session was delivered to 30 second year student nurses as part of a scheduled clinical skills day. The session was observed by one of the facilitators and interactions recorded and this was followed by a brief questionnaire completed by participants. Findings: Observations of the group sessions and discussion found that students demonstrated limited knowl- edge about natural resources (such as oil) used in the production of items used in healthcare; they engaged in discussions following the use of Internet resources, and were able to segregate waste appropriately. Thirty (100%) students completed the evaluation questionnaire, found the resources used in the skill session helpful, and thought that the scenarios were realistic. Nineteen reported being more aware of peak oil; 30 were more aware of risks to patient experience and service delivery if resources become unavailable; 30 reported greater awareness of the management of waste in healthcare. Comments on the questionnaire indicated a high level of engagement and interest in the subject. Conclusion: The problem of climate change and resource scarcity can too easily be seen as a distant or intractable problem. However one way to make this topic real for students is through the use of clinically relevant scenarios in skill sessions.

© 2013 Elsevier Ltd. All rights reserved.

Introduction

It has been suggested that climate change presents the biggest single threat to health in the 21st Century (HM Government). Healthcare ser- vices need to plan for the health consequences, and employ mitigation measures to ensure sustainability, service delivery and business conti- nuity. The impacts of climate change on health and healthcare are well documented (Nichols et al., 2009), other challenges relate to the depletion of scarce or carbon intensive materials. We need to develop healthcare professionals who will be able to deal with the mitigation and adaptation challenges that climate change and the possible deple- tion of fossil fuel and scarce materials present. We take sustainabilityto mean more than merely lasting or surviving; it means designing

Corresponding author. Tel.: +44 1752 586535. E-mail addresses: janet.richardson@plymouth.ac.uk (J. Richardson), jane.grose1@plymouth.ac.uk (J. Grose), M.Doman@plymouth.ac.uk (M. Doman), J.A.Kelsey@plymouth.ac.UK (J. Kelsey).

1 Tel.: +44 1752 586510.

2 Tel.: +44 1752 587462.

3 Tel.: +44 1752 586525.

0260-6917/$ see front matter © 2013 Elsevier Ltd. All rights reserved.

and delivering health care that uses resources in ways that don't prejudice future health and wellbeing(Naylor and Appleby, 2012). There is limited literature on nursing and climate change (or sus- tainability); nursing students are poorly prepared to understand the connections between resources, climate change, sustainability and health (Goodman and East, in press; Barna et al., 2012; Goodman, 2011; Goodman and Richardson, 2009). Sustainability can be embedded in the healthcare curriculum through a range of learning opportunities; for example in the context of public health and health inequalities, poverty, food security and infectious diseases (Richardson and Wade, 2010). It has been argued that each learning programme should have sustainability literacy for its nursing students nested within a broader context of links between health and the natural environment, including inequalities in health and opportunities for chronic disease prevention (Barna et al., 2012). Arguably, as climate change and fossil fuel depen- dency pose serious threats to future healthcare we have an obligation to prepare our students for the consequences, to ensure that they are able to deal with the associated healthcare planning and resource issues. Nurse educators have a responsibility to embed this learning using practical (vocational) examples; a nurse who cannot make the links

2 Contemporary Issues between clinical waste, resource use, carbon reduction and health inequalities will not

2

Contemporary Issues

between clinical waste, resource use, carbon reduction and health inequalities will not be able to devise solutions for future healthcare challenges. One way to introduce sustainability to student nurses is through scenarios that have practical application to clinical practice. The use of scenarios is integral to Problem Based Learning in clinical education and promotes communication, team working and problem solving (Wood, 2003). In healthcare, contemporary education approaches emphasise the need for active learning (Endacott et al., 2003). Scenario based learning is founded on situated learning theory, encourages opportunities for active learning, is based on valuing contextual knowl- edge, and provides a strategy for bringing students closer to the realities of their profession (Errington, 2011). Nurses have impact on how resources in healthcare are used and disposed of; through scenarios in clinical skills sessions, practical connections can be made between the sustainable use and potential scarcity of resources, and climate change. This paper describes the delivery and evaluation of a sustainability clinical skills session using an evidence-informed scenario. The scenario was based on healthcare waste management research (Nichols et al., 2013; Grose et al., 2012), and an evaluation designed to identify items used in healthcare that are important for patient care and are potentially at risk in terms of future supply (WRAP, 2013; Grose and Richardson, in press). Grose and Richardson highlighted the vulnerability of plastic items due to their reliance on crude oil supplies and potential for recycling.

Aim

The aims of this paper are to describe how an evidence-informed sustainability and healthscenario introducing two sustainability issues (resource depletion and waste management) was introduced into a nursing clinical skills day, and to report the evaluation of the session.

Methodology

A practical hands-on skill session was delivered as part of a scheduled clinical skills day. The session was observed by one of the facilitators and interactions recorded and this was followed by a brief questionnaire completed by participants.

Participants

Thirty nursing students studying the child eldof the undergradu- ate nursing programme at Plymouth University who were half-way through their second year of training. Students were participating in clinical skill days in January 2013. These students had not previously been involved in skill sessions that focused on sustainability.

Teaching Methods

The sustainability and health skill scenario session formed one of the four skill stations during a clinical skill day. Learning outcomes were specied and students engaged in discussion, fact-nding and practical work. The scenarios and supporting literature were made available prior to the session. See skills session content in Box 1.

Evaluation

Notes were taken by one of the skill facilitators during the session and a brief questionnaire designed to capture awareness and feedback was given to students at the end of the session.

Box 1 Description of skills session.

Learning outcomes By the end of the session the student will be able to: •

Learning outcomes

By the end of the session the student will be able to:

Describe where plastic comes from

Assess the impact of the loss of key items on patient experi- ence and service delivery

Allocate items to the appropriate waste streams.

Materials

Computer Giving sets, IV sets, syringes Yellow and black rubbish bags, sharps bin Tape to make a line on the floor, high/low impact labels File of background information Box of waste materials

sharps bin Tape to make a line on the floor, high/low impact labels File of background

Methods

1) Scenario: students will be given the following scenario (20 min):

Aim The aim of this scenario is to engage you in discussions about risk and sustainable procurement and for dealing with future limited availability of resources that are important for patient care. Background The un-interrupted supply of essential items for patient care is crucial for healthcare organisations. The majority of products central to healthcare are derived from natural resources such as oil and cotton, supplies of which are seeing increased global de- mand with some resources becoming depleted. Initially this will impact on the costs of acquiring them, adding a further burden to NHS expenditure. Also of concern is the possibility that some key resources may become unavailable. The following scenario has been prepared by identifying an item which might present a risk to the delivery of healthcare should its supply be restricted or removed. The scenario describes a situation where the global availability of raw materials, required for critical prod- ucts consumed by the NHS has been affected. The scenario is based on factual information; however the situation described is fictional. Participants are asked to consider how and what strategies could be put in place to mitigate the impact on healthcare provision of restricted or interrupted supply and associated price rises. Participants are encouraged to consider how service provision could be maintained, or even improved, in response to the challenges set out in the scenario. You will be asked to follow the questions and prompts following the scenarios and take notes so you can report back follow- ing your discussions. Scenario It is estimated that globally more than 100 million tonnes of plastic is manufactured each year. The use of plastics in healthcare is widespread. On a typical day in one hospital sev- eral hundred of patients are receiving pill bottles, intravenous lines (IVs) and undergoing surgical procedures which use plas- tic, single use products. Given the fact that many of these items have contact with bodily fluids, none of these compo- nents are usually recycled.

Contemporary Issues 3 The price of plastic increases and your hospital starts to worry about

Contemporary Issues

3

The price of plastic increases and your hospital starts to worry about how many plastic items it can afford.

Why is the cost of plastic increasing (computer work)?

Why might it not be available (computer work)?

What are the implications for practice?

What do you think can be done?

2) Impact of items on patient care The line on the floor is marked with no impact on patient experience or service deliveryat one end and significant impact on patient experience and service deliveryon the other. Students are asked to take an item from a healthcare supplies box and place it on the line where they assess the degree to which the loss of this item would impact on patient experience and service delivery. They must explain to the others the reasons for their decision and some discus- sion amongst the group takes place about the accuracy of the decision. 3) Waste disposal Once all the items have been placed on the line the stu- dents are given a scenario of what has happened to the item (i.e., potential for contamination) and asked to put their item in the waste bag/bin (black, yellow, sharps) they most feel is appropriate. They will explain the rea- sons for their choice. The waste bags will have the cost of their disposal printed on the underside and this will be revealed at the end of the session.

Findings

Makes you think about how your actions have an effect in daily

procedures

Interactive and thought-provoking.

In response to the question Was the scenario realistic?, all students answered yes. Comments included:

Recognised scenario potential within a clinical setting This could really happen in a few years, we need to start to nd alternative methods of production to meet our needs Used things that are frequently used on a ward which was good Makes you think for future practice Everyday items.

With respect to the learning outcomes for the session 19/30 reported being more aware of peak oil; 30/30 were more aware of the risk to patient experience and service delivery if resources become unavailable; 30/30 reported greater awareness of the management of waste in healthcare. Other awareness reported was:

Cost of incineration question everyday routine and need for recycling Was thought provoking Alternative resources awareness of waste Recycling future lack of resources Don't just throw away think!

The evaluation questionnaire also asked What other information would you nd useful/helpful for this workshop?Comments included:

Findings from the Observation

Observations of the group sessions and discussion found that students demonstrated limited knowledge about natural resources (such as oil) used in the production of products utilised in healthcare. Students report- ed overuse of gloves in clinical practice because they are there, but had awareness of the alternative to latex gloves. There was some lack of knowledge regarding the appropriate disposal of clinical waste, though most allocated the correct item to the correct waste stream. Internet searching during the session promoted interesting discussion about possible alternatives to plastics and the increasing demand for oil (and potential political issues that might arise in oil producing countries resulting in interruption to supply). Students discussed the need for the NHS to adapt and nd alternatives, the need for training to raise awareness, and the potential impacts on quality of care.

Findings from the Evaluation Questionnaire

All thirty students completed the evaluation questionnaire.

Use of Scenarios

Twenty eight students reported that it was helpful to have the scenarios prior to the workshop; one said it was ne to have them at the start of the workshop and one reported that they were not aware that they were available. All 30 students answered yesto the question Were the resource materials available in the session useful/helpful?Examples of comments are included below:

Familiar materials used frequently Good to see it visually The computers and journal extracts are helpful at identifying alternatives and the real impact Able to relate theory to practice

How the NHS sources resources What is being done in local Trusts to address this issue, i.e. is cardboard/ packaging being recycled? And information as to what is the anticipated way ahead and predications for future scenarios Information sheet to take away

A sheet describing a quick reference guide on where waste should go

including cost of waste

Specic gures on waste locally and nationally and impact some changes could have Looking at more products we use, improvements that are made after

research

How we can make a difference as students?

The last item on the evaluation questionnaire stated Please provide us with any comments about either the scenario or how the workshop was organised.Thirteen of the 30 students provided a comment:

A good informative session thank you

Really has made me question what to throw away where, and not to use equipment that is not needed. Made me think what I can do to help a problem fast approaching of lack of materials Good to discuss Good to discuss and apply to real life situations Perhaps [might include] audiovisual information e.g. YouTube clips Time-line was really good, easy to see where each item ts in comparison to others Thank you it was helpful Very good Good to know prices of waste disposal, really interactive workshop, interested in our views Interactive and discussions very good/interesting good learning style Liked the lowhigh impact workshop, made me think within relation to

practice

4 Contemporary Issues Good and thought-provoking I really enjoyed this workshop and made me aware

4

Contemporary Issues

Good and thought-provoking I really enjoyed this workshop and made me aware of the part I can play in practice to combat this problem.

As a consequence of running and evaluating this scenario workshop, the question Why is the appropriate segregation of waste important to the NHShas been added to the second year clinical skill assessment (OSCE). Further sessions and assessment have been developed for years one and three students.

Discussion

As educators we have a responsibility to train healthcare practi- tioners who are t for purpose, but also t for futurepractice; climate change and resource scarcity are very real situations that nurses will need to deal with in the future. The NHS has a duty to reduce carbon emissions and embed sustainability into the supply chain (Naylor and Appleby, 2012) and efforts are moving forward to support this (see for example details of specic projects on the NHS Sustainable Develop- ment Unit website: http://www.sdu.nhs.uk/). Whilst there is a growing body of literature available highlighting the health impacts of climate change, less attention is given to the potential impacts on healthcare of resource scarcity. The problem of climate change and resource scarcity can too easily be seen as a distant or intractable problem, leaving us feeling that others (i.e. Government) will sort it out, and any impact we can have is minimal. Kirk (2002) has suggested that nursing students are poorly prepared to understand the connections between climate change, sustainability and health. Although efforts to raise attention about sustainability and nursing are gaining impetus (Goodman and East, in press; Barna et al., 2012; Goodman, 2011; Goodman and Richardson, 2009; Richardson and Wade, 2010), sustain- ability competencies are not currently a requirement within nurse education. Furthermore, nurse educators need to grasp the urgency and up-skill themselves in order that they can teach nurses who will be competent to practice in a changing climate. Sustainability has traditionally been embedded in the nursing curricu- lum in the context of public health (Richardson and Wade, 2010). How- ever one way to make this topic real for students is through the use of scenarios in skills sessions. The scenario used here was developed through our own research into sustainable healthcare procurement, and had previously been used successfully with NHS staff (WRAP, 2013). Col- leagues were keen to use it with students, and as this was a new method of teaching and incorporated new ideas it was important to evaluate the session. It is clear from the student feedback that the session was very well received, stimulated discussion, and provided an innovative learning approach on a topic not generally covered in nursing curricula. The rele- vance to clinical practice was crucial in getting the message across, and this is evident from the comments made by students on the evaluation form. The scenario used in the sustainability skill session presents a snap- shot of much wider challenges and needs to be put into the context of changing global events and geopolitical issues. Other geographical regions

may choose to focus on different items that are at greater risk of scarcity in those regions. It may also be appropriate to test the sustainability skill scenario sessions with students from other health disciplines. There is no doubt that this approach can introduce issues about sus- tainability into nursing curricula in a way that is integral to their clinical skills development and is not an ad-on that could be viewed as tangen- tial to nursing practice. The scenario session reported here, along with a theory session in year 1 and other scenarios in year 3 linked to management and leadership skills, has now been embedded in our undergraduate curriculum. Sessions are linked to learning outcomes, with the potential for further sustainability practice assessments in the future. Opportunities for working with other student groups and inter-disciplinary team working are also being explored. In conclusion, the problem of climate change and resource scarcity can too easily be seen as a distant or intractable problem. One way to make this topic real for students is through the use of clinically relevant scenarios in skill sessions.

References

challenges for nurse education. Nurse Education Today 22 (1), 6071. Naylor, C., Appleby, J., 2012. Sustainable Health and Social Care: Connecting Environmen- tal and Financial Performance. The King's Fund, UK. Nichols, A., Maynard, V., Goodman, B., Richardson, J., 2009. Health, climate change and sustainability: a systematic review and thematic analysis of the literature. Envi- ronmental Health Insights 3, 6388 (http://www.la-press.com/article.php?article_

WRAP, 2013. Raw materials risk in healthcare supply chains. http://www.wrap.org.uk/