Guidelines for Undergraduate Nursing Education on Climate-driven Vector-borne Diseases

Guidelines for Undergraduate Nursing Education on Climate-Driven Vector Borne Diseases is a project conducted in 2018 by the Canadian Association of Schools of Nursing (CASN) and funded by the Public Health Agency of Canada to expand the targeting of climate-driven vector-borne diseases (VBDs). The purpose of this project is to build capacity and increase knowledge of nurses entering the workforce through development of nursing faculty curriculum related to climate change and VBDs that is evidence-informed, national, and consensus-based to provide support to individuals, families, communities, and populations affected by, or at risk of being affected by, these diseases.

The project builds on previous work related to nursing education carried out by CASN, including the development of Entry-to-Practice Public Health Nursing Competencies (2014) and an online repository of nursing education strategies for public health.

In addition to the educational guidelines outlined in the project, an open-access e-resource was developed to assist in the integration of entry-level learning into nursing curricula into schools across the country. The e-resource, titled Nursing and Climate Driven Vector-borne Disease is an online learning and teaching tool comprising a series of modules with learning activities, online tools, case studies, self-assessment quizzes, and virtual patient scenarios.

Carried out over 30 months, concluding in March 2021, the e-resource contains 5 modules and 37 learning objectives to support the integration of the health effects of climate change and infectious diseases in schools of nursing across Canada.

Understanding and Assessing Impacts

Shifting weather patterns, changing seasonality, and increases to average temperature have resulted in changes to the conventional patterns of disease vectors. Vector-borne diseases, such as malaria, dengue, West Nile virus, and Lyme disease, are becoming more prevalent in Canada as a direct result of climate change. Warmer temperatures in Canada have resulted in the expansion of vector-borne diseases transmitted by ticks, mosquitos, and other animals. As Canada’s climate continues to warm and increases in spring, summer, and fall season length has contributed to greater distribution of these species and their life cycles.

Lyme disease, carried by black-legged ticks, is the most common tick-borne disease in Canada. Various hosts for black-legged ticks include white-tailed deer, white-footed mouse, and migratory birds. White-footed mice habitat has been expanding northward at a rate of 10 km per year, and migratory bird patterns have been expanding northward at an accelerated pace due to climate change. This, in conjunction with warmer and more temperate fall seasons has resulted in the expansion of black-legged ticks, and the establishment of populations in places previously too cold to sustain them.

Mosquitos carry a host of VBDs, including West Nile virus, dengue, malaria, chikungunya, and Zika. Of primary concern now is the transmission of West Nile, considered the most health-endangering mosquito-borne illness in Canada. Though largely asymptomatic, severe cases of West Nile can be life threatening, and climate models demonstrate a growing geographic range in the spread of West Nile in Canada. Further, the less common vectors of malaria, dengue, chikungunya, and Zika could become more likely as Canada experiences further warming.

Environmental trends related to warmer temperatures in Canada are predicted to increase the risk of acquiring Lyme and West Nile, as well as other mosquito and tick-borne diseases, and represent a public health concern in Canada, especially in at-risk populations such as those over 70, and childbearing persons.

Identifying Actions

The development of guidelines employed an evidence-informed, modified-Delphi approach relying on stakeholder input, guideline revision, and expert panel consultation to build consensus.

CASN established a pan-Canadian advisory committee of experts to establish an environmental scan of the baseline knowledge, skills, and attitudes that entry-level nurses should possess in regards to VBDs and climate change. This included a scoping review and literature review of existing nursing-specific and interprofessional resources, regulatory and/or educational competencies, and other relevant Canadian and international documents. The findings of the literature review were revised, analyzed, synthesized, and developed into a draft document of learning outcomes for nurses.

This draft and the findings of the advisory committee were shared with over 50 stakeholders National Stakeholder Forum comprising multiple sectors including nursing education, nursing regulation, nursing employers, practicing nurses, public health organizations, government, nursing students, and persons with lived experience of VBDs in Canada. This feedback was then reviewed and through a national validation survey by a multi-stakeholder group that included all nursing programs in Canada, CASN’s network, as well as project stakeholders and Forum attendees. Further, the education guidelines underwent both gender-informed and Indigenous reviews to ensure gender-equity, the perspectives of marginalized populations, and the integration of Indigenous perspectives and experiences into the guidelines.

Finally, the Climate Driven Infectious Disease (CDID) Committee, a group of dedicated experts in climate-driven infectious disease and nursing who developed the domains and learning outcomes delineated in this document, reviewed all comments and made revisions to the education guidelines based on the results of the validation survey and the expert reviews. The guidelines were then translated into English and French.

Implementation

The finalized guidelines, available in the Guidelines for Undergraduate Nursing Education on Climate-Driven Vector Borne Diseases report, are also part of an open-access e-resource found at https://vbd.casn.ca/. The guideline consists of five domains:

  • Domain 1: Public Health – Vector-Borne Infectious Diseases
  • Domain 2: Populations Exposed to Potential Risks
  • Domain 3: Prevention (Primary and Secondary)
  • Domain 4: Treatment (Tertiary Prevention)
  • Domain 5: Advocacy

Each domain is accompanied by detailed learning outcomes (37 in total) to help clarify what must be learned in a course or program, offer direction for the selection of learning outcomes, and provide benchmarks for the assessment of the learning. Further, these learning outcomes provide targets for graduates of baccalaureate nursing programs to achieve in the area of climate-driven vector-borne infectious diseases.

The e-resource is targeted at nursing faculty, students, nurses in practice, and other health professionals. It aims to:

  • Support the integration of learning outcomes within CASN’s Guidelines for Undergraduate Nursing Education on Climate-Driven Vector-Borne Disease into entry-level nursing curricula across the country.
  • Provide faculty, students and practicing nurses with information, teaching and learning materials, and tools related to the education guidelines
  • Impart the knowledge and skills to help build nursing capacity to work with populations whose health is, or may be, affected by climate change driven infectious diseases.

Resources

Link to the Full Case Study

Additional Resources:

Further understand how climate information can be applied in decision-making by exploring the Health Module on ClimateData.ca