Climate Change: An Ecocentric Values Based Caring Approach, International Journal of Human Caring

Full text

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2014, Vol. 18, No. 2
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
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.
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
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International Journal for Human Caring
Climate Change: An Ecocentric Values-Based Caring Approach
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
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 evidence-
based 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
EBP
Earth
Community
Person
Nurse
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Figure 1. Conceptual model of ecocentric values-based caring
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2014, Vol. 18, No. 2
Climate Change: An Ecocentric Values-Based Caring Approach
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 values-
based 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
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International Journal for Human Caring
Climate Change: An Ecocentric Values-Based Caring Approach
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 (http://envirn.org).
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 Earth-
centered 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.
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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 20057 USA. Electronic mail may be sent via Internet to la266@georgetown.edu
IJHC_Journal 18.2_rev2.indd 37 3/21/14 8:33 AM

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