A holistic approach to healing and health relies on a unified, integrated partnership between the totality of humanness and the physical, spiritual, and natural universe. Holistic nursing practice values the interconnectedness of mind, body, and spirit within a context that includes the natural environment. Nurses often trust nature to guide and influence intentional caring practices that promote healing and well-being. Consider guided imagery and its frequent focus on the natural world, meditation, herbal remedies, relaxation techniques based on deeply breathing oxygen-rich air, green spaces and their restorative influence on mind-body-spirit, and homeopathic remedies and allopathic medications developed from the earth's rich biodiversity. Given the reliance of holistic practitioners on nature's power and bounty, healers should engage in efforts to improve nature's health. Sustainability practices and intentional engagement in education, research, politics, and green practice initiatives are important endeavors that holistic practitioners should actively explore, pursue, and support.
The natural world is under tremendous pressure as a result of many influences, largely man-made, including greenhouse gases. The National Aeronautics and Space Administration (NASA) reports that leading scientific organizations agree that global warming trends over the past century are very likely the result of human activity.1 Cook et al2 investigated the scientific consensus of anthropogenic global warming in peer-reviewed journals and found that 97% or more of actively publishing climate scientists agree that weather-warming trends are very likely due to human activities.
Important contemporary events are having a profound effect on conversations and beginning actions related to global warming and Earth-toxic societal practices. For example, the 2015 United Nations Climate Change Conference, recently held in France, attempted to establish an obligatory and universal agreement on climate change with the intent of reducing greenhouse gas emissions and avoiding catastrophic changes in nature.3 Hundreds of thousands of people across the world marched during this conference period clamoring for environment protections. The World Health Organization concurs with the need for climate change intervention and recognizes climate change as "the greatest threat to global health in the 21st century."4
In addition to the collective international response, moral and religious world leaders are adding to the discussion. The papal encyclical letter Laudata Si' on Care for Our Common Home was also released in 2015.5 Pope Francis comments,
When we speak of the "environment," what we really mean is a relationship existing between nature and the society which lives in it. Nature cannot be regarded as something separate from ourselves or as a mere setting in which we live. We are part of nature, included in it and thus in constant interaction with it.5(p104)
The Dalai Lama has also focused on climate change and has framed the battle against climate change as a "matter of survival of humanity."6 The Pope's and Dalai Lama's perspectives are consistent with the holistic paradigm of complex connections between nature and living beings.
While grand, international efforts are critically important and necessary, the sheer magnitude of needed efforts may seem daunting to a holistic practitioner who is interested in meaningfully contributing to restoring nature. However, both individual and collective efforts are needed to protect and restore the natural resources that holistic practitioners need to promote health, healing, and life. John Holdren, senior advisor to President Barack Obama on science and technology issues, offered 3 choices: mitigation, adaption, and suffering. He also asserted that although society has the ability to choose, the opportunity for mitigation has significantly lessened.7
Nurses and other providers of holistic care may consider reflecting on the following: at a micro level, how might a holistic practitioner affect environmental change? To what sorts of ecology initiatives might an individual nurse or other provider directly contribute in an effort to improve sustainability efforts and intentional engagement with nature? What is the additive value to holistic practice when a practitioner purposefully commits to sustainability and environmental stewardship?
REACH OUT, ENGAGE, AND INFLUENCE
Contribute to formal educational endeavors
Some opportunities for facilitating environmental change are available via educational programs. The American Association of Colleges of Nursing provides guidance for educators interested in better preparing nursing students for practice patterns that prioritize environmental concerns. Its Task Force on Environmental Sustainability developed a guide, Toward an Environmentally Sustainable Academic Enterprise: An AACN Guide for Nursing Education.8 This task force recommends adoption by undergraduate and graduate nursing programs of 4 competencies for environmentally sustainable practices: (1) use health care resources in a judicious and thoughtful way; (2) dispose of health care--associated waste, including pharmaceuticals and biomaterials, in a responsible manner; (3) recognize the importance of minimizing health care's biological, chemical, and physical waste stream; and (4) promote the adoption of institutional policies aimed at promoting environmentally sustainability in schools of nursing and/or clinical settings.8 Holistic practitioners involved in nursing education efforts might consider the adoption of these competencies so that novice and graduate nurses are better prepared to practice using environmentally conscious and friendly interventions. In addition, nurses can and should influence their workplace settings to maximize opportunities for reducing waste and reducing health care systems' carbon and waste environmental footprints.
Engage in climate change efforts
There are many opportunities to directly influence institutional health care system practices. One example of such an option is Health Care Without Harm.9 This international coalition includes hospitals and health care systems, as well as other more broadly based organizations, including labor unions, environmental groups, and religious groups. Health Care Without Harm supports many types of programs, including those addressing medical waste, toxic substances, green building and energy use, climate and health, water, and other key issues related to environmental concerns.9 The coalition's Web-based resources are diverse and plentiful.
The 2015 Lancet Commission on Health and Climate Change exemplifies an opportunity to influence important policy work. This commission was formed to assess the various impacts of climate change and to develop necessary policy responses to ensure the highest realistic health measures for worldwide populations.10 The commission has recognized that the interconnected natural environment means that none will be immune to the effects of climate change, although the poorest and most vulnerable populations will likely experience suffering earliest.10 The report provides expert descriptions, detailed insights, and policy recommendations that may be useful to clinicians as they develop expertise and influence legislative and regulatory processes.
Preach and practice sustainability
Nurses and other providers are obliged to self-educate and enlighten others about sustainable clinical practices. Given the relative newness of sustainable health care practices, it is likely that many practitioners are unfamiliar with sustainable opportunities. A few exemplars serve to demonstrate the breadth and depth of sustainable enterprises focusing on health care systems.
The Centre for Sustainable Healthcare is a charitable organization that explores strategies and metrics to transform models of care in ways that are sustainable and reduce resource utilization.11 The center has a variety of creative, powerful programs including the NHS Forest, a program designed to increase the quality and use of green space on or near health care properties.12 One center effort focus is to create nature walking trails as green gyms to improve community health. Its Innovative Specialties program supports clinicians in efforts to implement evidence-based sustainable practices.13 The possibility of replicating these efforts in other countries may be interesting to holistic clinicians.
The Healthier Hospitals initiative began in 2012 as a similar program to the Institute for Healthcare Improvement's successful 100,000 Lives Campaign.14 This data-driven, 3-year program offered free tools and resources to hospitals of varying sizes interested in implementing sustainable practices. Efforts included reducing chemical usage, improving the quality of food services, reducing energy use and waste, making better purchasing decisions, and using safer chemicals.14 The 2014 Milestone Report documents the significant progress that hospitals can make on a number of indicators that reflect improved sustainability practices.14 Outcomes are impressive and motivating; for example, in 1 year, 38 hospitals collectively reduced their meat utilization by 1359.61 lb equating to a reduction of 21 093 metric tons of carbon dioxide. The report also notes that 391 hospitals decreased their regulated medical waste to approximately 8% of total.14 Certainly, these outcomes measures support the value of sustainability in nursing and health care practice.
There are many opportunities for holistic practice nurses and colleagues to contribute to efforts focused on curtailing climate change and reducing its threat to global health. These few examples offer only a glimpse of available opportunities and awaiting possibilities. The pace of global warming demands an immediate response. Holistic healers are particularly mindful of interconnectedness and the power of incremental, constant change. A holistic approach to the state of the earth's health is key to its survival-and to all planet dwellers.
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