REVIEW AND COMMENT

The ethics of nursing care for environmental crises

Lydia Vieira Freitas¹; Emanuella Silva Joventino¹; Lorena Barbosa Ximenes¹; Neiva Francenely Cunha Vieira¹; Rui Verlaine Oliveira Moreira¹

¹Federal University of Ceará

ABSTRACT
The environment, understood in both its global and household dimensions, affects the health of living beings directly and, especially, human beings. Environmental and climatic disasters show that this fact has become increasingly common in everyday life. This study aimed to discuss further the thematic of ethics of care for the environment, aiming to talk about humanity’s responsibility of for it. This is a reflective study on the ethics of nursing care towards the environment. It was observed that nursing can work to guide and sensitize people about the care which the environment requests. Both nursing and people need to resort to the ethics of care because it is necessary to reflect on the performance of each which can be considered morally right or wrong. Therefore, the ethical care for the environment means to use its resources, in an organized way, so that the environment can compose itself and continue to maintain self-sufficiency. Otherwise, human beings will continue to endanger the environment and, consequently, their own survival.
Keywords: Environment; Ethics; Nursing.

INTRODUCTION

The environment influences directly and indirectly living beings’ survival and quality of life of. It is noteworthy that this environment refers to both a macro scale, considered, therefore, to be the planet and the universe as a whole, and, in its micro size, i.e., the places frequented by each individual. These are their workplace; their school; their places of leisure; their home; their own room; and, finally, any context in which the individual is inserted.

The absence of a healthy environment can cause damage to living beings who can become targeted; for example, the transmission of diseases undermining their health. Consequently, this denotes the importance of maintaining the environment to be beneficial to survival and well-being. Consequently, is the implicit idea of taking care of the environment to provide a healthier place for people?

It is observed that, in its micro dimension, people can perform more effectively and care (but not enough) for the environment. With respect to the macro scale, it lacks the responsibility on the need for preservation and sensitivity which carelessness can influence directly on health.

This care cannot be done, carelessly; it should be responsible, respectful and ethical. Only by doing so, could the people be offered a better environment for their survival.
Therefore, the ethical principles are essential in caring for the environment. The term ethics refers directly to responsibility, respect and morality; these features being considered by the individual who practices it. Therefore, the behavior is acceptable morally in an ethical action, whilst the actions, which infringe morals accepted by society, are called unethical and, generally, should be reflected and faced by society. These concepts apply not only to actions between humans or those reflected between them but, also, in the relationship between man and environment in an attempt to make this interaction more harmonious and, therefore, more ethical. It is noteworthy that, as a professional practice, ethical reflections a permanent learning process which requires the participation of all involved individuals⁽¹⁾. This applies, also, to the practice of caring for the environment.

Consequently, this article seeks to discuss further the issue of ethics of care of the environment in order, characterized as a reflective article, to talk about humanity’s responsibility to the environment. The subject is discoursed in three areas: environment and health care; nursing and caring; and ethics in environmental care as a possible solution.

ENVIRONMENT AND HEALTH CARE

The concept of health has abandoned the idea that health is merely the absence of disease, increasing the need, therefore, to understand what constitutes a concept which encompasses a complete physical, mental and social dynamic condition⁽²⁾. In order to maintain a healthy condition, care is needed ranging from self-care to environmental conditions such as housing and transportation, among others, so that health is a result of the balance between self-care and intersectoral actions in society⁽³⁾.

However, that said, welfare does not include all the needs of the individual who lives in a perpetual state of "seeking to be well" himself, with people around him and the environment in which it operates. This causes the promotion of health to be a continuing need for all subjects⁽⁴⁾.

Health Promotion identifies itself as a healthier lifestyle. Actions which include quality food; housing and education; and the interaction between people and the environment in which they live, promote a healthy environment for the development of human beings aiming at good health⁽⁵⁾. This involves setting up guidance in various fields such as politics, health care and education, in order to contribute to the transformation of health⁽⁶⁾.

In this context, we emphasize that health promotion is linked directly to the social determinants so that, as can be seen in the scheme proposed by Dahlgren and Whitehead (Figure 1)^(7,8), you cannot think about health without considering socioeconomic, cultural and environmental conditions.

This model shows that human well-being is linked to a number of factors which affect it: agricultural and food production; education; work environment; unemployment; water and sewerage; social services; and health and habitation. However, for well-being, other factors can be added such as, among others: service quality healthcare; public safety; and leisure.

It should be noted, also, that, for the well-being condition, quoted in Dahlgren and Whitehead model, the environment was highlighted in three different areas: work environment; water and sewerage; and habitation. This shows the emphasis which these authors placed on the environment as a strong influence of human health and, hence, their welfare. Namely, the maintenance of a healthy environment becomes a facilitator's condition a person’s or a community’s health, and should be valued as such.
In this theme, we emphasize the need for reflection since, often, only the environment is enhanced by people as a social determinant of health condition, when it is broken and impaired often due to one or more factors associated clearly with the lack of care of the environment.

Consequently, to achieve a condition of wellness, it is essential that a favorable environment exists for the individual's health; this ranges from basic sanitation to the quality of the air which we breathe.

However, despite these concepts and concern for the environment which more recently, the media conveyed especially,  for some years, they were already the subject of discussion. Florence Nightingale (1820-1910) was an example of this; the precursor of Nursing as a profession and scientific care which, since the Crimean War (1854-1857), emphasized, that the inappropriate environment, in which the wounded lived, would hamper or delay their cure. This idea makes us reflect on the importance of life in a healthy environment, endowed with minimum conditions for the maintenance of health, both for recovery and for the prevention of disease. Nevertheless, over the years, it was observed that humanity ignored its role of being co-responsible for the environmental conditions; exploring disorderly actions; and causing damage leading to climate and environmental disasters of global proportions.

The media has not hesitated to show the consequences of large and small proportions of human aggression against Earth. Therefore, we see, in near real time, environmental complications such as, amongst others, global warming; floods; greenhouse gases; tornadoes; tsunamis; desert areas; ozone layer damage; melting of glaciers; earthquakes; endangered animals;  and soil, water and air pollution. Given this reality, the question is: Are i so many demonstrations not a way of the environment calling for help? Is it not time to rethink the care or lack of care which humanity has paid to the environment?

Even if all these environmental tragedies influence directly people’s daily lives by causing the loss of family and friends and undermining the health of those, who survive these disasters, and sinking entire countries’ economies, humanity seems to refuse to open its eyes and take action which seeks to minimize such consequences.

In this regard, we emphasize the importance of the role of the social movements; civil society organizations; and health professionals to raise awareness about their responsibilities in caring for the planet. In health, we highlight the nurse’s role. Being a professional whose scientific training is focused on the care others, the nurse has, also, responsibilities to the environment, in which people live by targeting urgently the ethics of care to the environment.

Consequently, the nurse should include, in his/her guidelines, the care related to the environment. This includes, amongst other actions, habitation and community care to prevent the dumping of sewerage or garbage in the open or in the water of rivers and lakes; the health care of animals; and care to avoid motor vehicles or factories polluting the air.

In cases of environmental disasters, the minimum conditions for maintenance of an environment, conducive to health, are violated during and after them. A natural disaster causes immediately million deaths in its area. However, its impact on health is not limited to that because the physical and social injury and, above all, the psychological injury persist for centuries. As an example, the Haiti earthquake of 2010, consisted of a catastrophic earthquake which had its epicenter approximately 25 kilometers from the Haitian capital, affected about three million people and led to the deaths of 100 to 200 thousand people. In this episode, the sewage system was damaged and the country experienced an epidemic of cholera and other waterborne diseases.

Such consequences demonstrate the effects of these disasters and, also, for those who survive these episodes.

As regards Brazil, recently, torrential rains in the mountainous region of Rio de Janeiro caused mudslides which resulted in over 1.000 dead and thousands were made homeless; they had no food or drinking water in quantities sufficient for survival.

These episodes show how the environment was and continues to be violated, and the effects of the accumulation of this degradation on human lives for many years. However, this situation can be considered to be a cliché since it can never be over-emphasized that the direct influence of human aggression against the environment causes severe imbalances which return as humanity disasters as a consequence of their own actions. Lately, this imbalance has been so severe that it may be realized that disasters are becoming more frequent and stronger.

Given the importance of the environment to health care, many professionals and organizations, worldwide, are concerned about the quality of the original size of the environment on the planet in which they live, i.e. more than thinking only of the environment in your house or in your neighborhood. Therefore, although often it has not become a reality in all countries or cities, the environment, in recent decades, is regarded as a target for human care.

NURSING AND CARING

The term caring should be understood as intrinsic to human beings since people cannot exist without being either a care provider or receiver. However, due to the reversal of certain values, there is an urgent need to emphasize this. As Waldow said⁽⁹⁾ :

... human care is a means to live, to be, to express itself. It is an ethical and aesthetic condition to the world. It is a commitment to be in the world and contribute to the general welfare in nature conservation, promoting the potentialities and human dignity and our spirituality; is contributing to the construction of history, knowledge, life.

Human care has existed always. From the beginning, people and animals had, in their nature, the unconditional need of care. However, this type of care arises from in an empirical or instinctive way. Nursing care differs from empirical care because it is a scientific act, with grounding in research and theories.

Nursing care, as scientific act, reveals the ethical aspect of the profession; this is to provide care to the receiver in a respectful and responsible way. A care, which cause intentional harm to the individual rather than healing his/her pain, is irresponsible care and cannot be considered to be ethical care.

The nursing role represents guiding and sensitizing people about the care which the environment demands. Therefore, nurses can avail themselves of educational activities which enable people to compromise with their environment so that they are empowered and autonomous, becoming active agents in promoting a healthy environment and no prejudice⁽¹⁰⁾.

The environment on human care is present in numerous nursing theories, including the following. Virginia Henderson included the need to avoid hazards in the environment and injuries in 14 activities for patient care. Faye G. Abdellah said that the act of creating and maintaining a therapeutic environment was amongst the 21 nursing problems which required interventions. Dorothy Johnson mentioned that the environment was not defined directly but, besides involve internal stressors, was deduced to include all adjacent elements of the human system⁽¹⁰⁾.

Levine added that each individual was an active participant in interactions with the environment and, inevitably, their ability, to interact, was linked to their sensory organs. Moreover, the Neuman Systems Model suggested that, in an open system, the environment was composed of "forces, both internal and external, around the patient, influencing and being influenced by it at any point of time". Therefore, nursing’s main concern is to maintain the patient's system; the detailed investigation of environmental stressors and others; and to aid the maintenance of optimal health⁽¹¹⁾.

Roper, Logan and Tierney’s (2000) nursing model, based on the activities of life, meant that the environment represented physically factors external to the individual and affected all other factors (biological, psychological, socio-cultural, political and economic). The Roy Adaptation Model brings us to the fact that the environment has conditions, circumstances and influences which affect humans’ development and behavior as adaptive systems, and, consequently, people and planet Earth have common patterns and integral relationships; human consciousness creates these transformations in people and in the environment created in⁽¹¹⁾.

Therefore, part of nursing care is performed, or should be, to encourage the preservation of healthy environments and the changes of environments which affect individual health. However, we know the difficulties which permeate this need such as: among others, many professional nursing care assignments, relating to of the most urgent needs of the users’ health, lack political support for environmental preservation.

These and other mishaps arise because nurses are limited in their actions to care for the environment; consequently, on many occasions, the individual or the community are responsible for the health problems. The focus of care focus, in order to solve an individual's health problem and environmental health problem, remains untouched. These facts are clear examples: children with respiratory problems; the elderly with health problems resulting from high temperatures in some countries; high incidence of skin cancer because of the high incidence of ultraviolet rays on the Earth's surface; and manifestation of diseases due to inadequate treatment of water. Even the outbreak of dengue, which, in Brazil, resurfaces, now and then, could be avoided if people took care of the environment.

Given this reality, the question is: Has nursing care of the environment been ethical? Does caring for the people (or would be for human diseases?) without taking care of the environment represent responsible care?

A POSSIBLE SOLUTION: ETHICS ON ENVIRONMENTAL CARE

All previously mentioned aspects, related to environmental care, lead us to a situation of chaos where the people who suffer the most are the people themselves since their health becomes hostage to the environmental consequences of common disorders.

The environmental crises culminate in setbacks to promoting the health of the individuals. Proof of this is the fact that, in cases of natural disaster, even in places where health is promoted properly, human care should deal with the individual’s emergency needs and of a preventive nature. Not that this attitude is wrong; however, it goes against the principles of promoting human health and sets back the welfare of the community.

It appears, though, that the environment is in need of care, especially in view of so many climate catastrophes. It should be cared for with the same respect, responsibility and interest which a human being deserves, i.e., with the same ethics in this act of caring. Some people report that environmental care is for their children or grandchildren to consider. However, they should take care of the environment which they live in since thinking of themselves as the environment is a major contributor to their existence and each one is responsible for everything which the environment needs to develop.

Therefore, all humans should take care naturally of other ontological living beings (read the environment as one of these) which are around them. However, since this fact is not yet consistent practice and, before the situation of environmental calamity, there is a need to resort to ethics in its utilitarian aspect to ensure all that which surrounds mankind.

In this sense, ethics concerns human acts, i.e. an intentional act of caring for the environment which exists only through everyone’s responsibility to it. However, for an analysis of the role of people before the universe must resort to moral dealing on either how beneficial or how evil it is being to the environment. Ethics, also, has the meaning of "human habitation", i.e. ethical means everything which helps make the best healthy home environment. The ethics exists as a reference for human beings in society and these are increasingly human and able to see the needs of others: people; animals; or the environment⁽¹²⁾.

With regard to nursing, in a literature review of the ethics employed in nursing research, we selected 135 articles. These enabled the following thematic categories: nursing care, which corresponded to the subcategories bioethics-nursing interface, humanization specific situations; professional wellness relational ethics and palliative care and finitude; dilemmas and events; education; legal issues; research; management; values and beliefs; perspectives and health policies⁽¹³⁾. Before this study, despite having a large number of articles on the subject, none of them addressed the importance of the environment in the context of nursing actions. This was despite the issues being related intrinsically, showing that it ignored the ethical care of the environment.

In recent years, it was noted that humans were concerned with the environment. By reviewing past events, we observed that, from the occurrence of the consequences of the absence of an ethical care about the an intensification of this concern, began to happen and influence human life directly and intensely. Consequently, the question is:  Have humans become more ethical in caring for the environment or care related to themselves? Is this ethic of care by humans a result of awareness of the environment or are they afraid to suffer the most serious natural disasters?

These questions must be considered because they reflect the abuse of human individualism which explored the environment in search of a more comfortable life (accumulation of goods and money against environmental exploitation disordered) and thinking still only about what it can bring to their own lives.
In this respect, the veracity of ethics in caring for the environment should be questioned, especially when it comes to people looking to build an image of environmental advocates and, in fact, seeking only their political and economic interests.

It is noteworthy, also, that the consequences of the lack of ethics in caring for the environment go directly to the health sector.  Therefore nursing is a profession since more and more individuals are needing care because of environmental protests. Worse than seeing these facts is whether this is reversible or, to what extent, it is.
It is hoped, therefore, that there is a stimulus of health professionals, particularly nurses, so that humanity returns to ethical care conditions for the environment in an attempt to contain or, at least, not worsen the damage caused by centuries of inconsequential exploitation.

CONCLUSION

Man is not prohibited from enjoying the environment to meet their needs. God, himself, made the world so that man could master it and dispose of its resources. However, taking advantage does not equate to exploring. The ethical care of the environment is to use its resources in an organized way so that it can recover and continue to be self-sufficient. At present, when human interests are no longer directed to survival and starting to seek profit, arising from environmental exploitation, this care is no longer based on ethics and becomes, to some extent, suicidal, jeopardizing human survival in the long term.

Although humans have exacerbated individualism, they should not see the environment as an enemy of progress. Rather, they should have an individualistic perspective in caring for the environment around them, otherwise it ceases to exist. They need to be less selfish and not think only of their welfare but, also, in being better and, in this sense, seeking to improve their living conditions, i.e. breathing better air, drinking clean water and cultivating the land equally favorably.

Therefore, it is believed that humans could progress much more if they lived in communion with the environment; drawing out only the essentials for their livelihood; using it not so devastatingly and without jeopardizing its existence.  It should be noted, also, that it is virtually impossible to go back and retrieve all the devastated area. However, the aims, discussed about the idea of restraint, would not worsen the already chaotic situation.

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Received: 17/03/2012
Approved: 04/09/2012