Climate Change at the Bedside: Why NANDA^®-I Nursing Diagnoses Must Evolve 

Climate change is often framed as a distant environmental or political issue. But as the recent episode of The NANDAcast makes clear, its effects are already reshaping daily nursing practice, from increased heat-related admissions to year-round vector-borne diseases like dengue. In this episode of The NANDAcast, guests Dra. Rafaella Moreira and Dra. Vanessa Freire discuss how climate-driven health challenges must be recognized, named, and addressed through standardized nursing diagnoses.

Their message is clear: To care effectively in a changing climate, nurses need a shared language that reflects new risks and emerging patient responses.

From Research to Nursing Practice: Recognizing Climate-Sensitive Health Patterns

Based in Ceará, a semi-arid state in northeast Brazil, Drs. Moreira and Freire began by studying chronic diseases. But over time they observed major shifts in health outcomes related to environmental conditions, patterns that demanded nursing attention.

1. Dengue Is Now a Year-Round Threat

Traditionally linked to rainy seasons, dengue is now appearing even in dry months due to changing precipitation and temperature trends. For nurses, this means:

• • Continuous community education

  • Year-round monitoring of risk for infection

  • Expanded preventive strategies beyond seasonal timing

2. Heat Waves Are Increasing Cardiovascular Emergencies

Their research shows that heat waves significantly raise the risk of:

• • Heart attacks
  • Strokes
  • Decompensation among older adults

This highlights the need for nurses to assess environmental exposure, teach hydration and heat-safety strategies, and adjust diagnoses such as:

• • Ineffective thermoregulation
  • Risk for impaired cardiovascular function

3. Public Health Action Can Offset Climate Risk

An 11-year drought in northeast Brazil surprisingly resulted in a decline in diarrheal hospitalizations; nearly 5% per year. Effective water-supply interventions protected communities despite harsh environmental conditions.

This underscores a hopeful message: Climate impacts can be mitigated when health systems act decisively.

Why Climate Change Must Be Reflected in NANDA-I Diagnoses

In the episode, Drs. Moreira and Freire emphasize that climate change is creating new health problems and exacerbating existing ones. Yet many NANDA-I diagnoses currently do not explicitly identify climate-related influences.

For example:

• Heat exposure contributes to Risk for impaired cardiovascular function, but this relationship is not clearly reflected in current related factors.
• Year-round vector exposure changes the pattern of Risk for infection, demanding updated language and diagnostic cues.
• Emerging responses such as climate anxiety are beginning to appear in clinical settings and require terminology that captures environmental stressors.

By integrating climate-related factors into NANDA-I terminology, nurses gain:

1. Greater Diagnostic Precision

Nurses can more accurately identify why a problem is occurring and tailor interventions accordingly.

2. Standardized Documentation

Climate-related assessments become visible in the patient record, improving communication across healthcare teams.

3. Stronger Evidence-Based Interventions

When the diagnosis reflects environmental realities, the care plan can include targeted strategies such as heat-safety education or vector-control measures.

4. A Foundation for Global Nursing Research

Standardized terminology allows researchers to track climate-related health trends across countries, strengthening nursing knowledge worldwide.

Education, Leadership, and Advocacy: A New Nursing Imperative

The guests stress that all levels of nursing must engage with climate-health issues.

For Clinical Nurses

• Incorporate environmental risk factors into routine assessments.
• Use diagnoses that reflect both biological and environmental etiologies.
• Teach patients how to reduce exposure to heat, poor air quality, unsafe water, and vector risks.

For Nurse Educators

• Integrate climate-health concepts across undergraduate and graduate curricula.
• Use NANDA-I diagnoses to develop students’ climate-aware clinical reasoning.

For Nurse Leaders and Managers

• Provide training that prepares nurses to respond to environmental events.
• Ensure staffing, supplies, and protocols account for predictable climate impacts (heat waves, smoke events, vector seasons).

For the Profession as a Whole

Nursing now includes a role in climate advocacy. By documenting climate-related health effects through standardized diagnoses, nurses generate data that can inform:

• Public health actions
• Policy decisions
• Resource allocation
• System-wide interventions

Standardized language is more than a documentation tool, it is a form of professional influence.

The NANDA-I Climate Change Task Force: Advancing the Taxonomy

The work of the NANDA-I Climate Change Task Force, led by Dra. Moreira with contributions from Dra. Freire and others, aims to:

• Update existing diagnoses with climate-related related factors and defining characteristics
• Identify populations at increased environmental risk
• Support the development of new diagnoses where emerging patterns demand new terminology

Their proposals are currently under review by the Diagnosis Development Group, moving NANDA-I toward a taxonomy that reflects the realities of 21st-century nursing.

Listen to the Full Episode

This conversation offers valuable insights for every nurse, regardless of practice setting or country. You’ll learn how climate research translates into practical nursing interventions, why terminology matters, and how NANDA-I is evolving to meet new health challenges.

Join us on The NANDAcast as we define the profession together, one diagnosis at a time. https://nanda.org/connect-engage/committees-task-forces/educational-clinical-innovation/nandacast/