Nurses' Role in Addressing Environmental Factors Associated with Multiple Sclerosis: A Scoping Review

Abstract

Context: Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system, for which the risk and clinical course are substantially influenced by modifiable environmental factors, including heat exposure, smoking, diet, physical inactivity, poor sleep, and psychosocial stress. Nurses are well positioned to assess and manage these factors; however, evidence describing their specific contributions remains fragmented and has not been comprehensively mapped. This review aimed to identify and map the available evidence on the role of nurses in addressing environmental factors associated with MS and to describe documented interventions, strategies, responsibilities, and associated outcomes. Evidence Acquisition: A scoping review was conducted using the Arksey and O'Malley framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The review question and eligibility criteria were developed using the population, concept, and context (PCC) framework. The population comprised adults aged 18 years or older with MS and healthcare professionals, including nurses, who care for people with MS. The concept encompassed modifiable external and contextual factors influencing MS risk, clinical course, and symptom management, including the thermal environment, lifestyle behaviors, sleep environment, psychosocial stress, nutritional environment, and therapeutic care environment. The context included inpatient, outpatient, rehabilitation, community, and home-based settings, as well as remote platforms. Six electronic databases were systematically searched from inception to August 2026: MEDLINE via PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Web of Science, PsycINFO, and the Cochrane Library. Searches were supplemented with gray literature sources. Eligible studies were published in English from January 2000 to August 2026 and involved adults with MS or healthcare professionals caring for them. The search was conducted on August 15, 2026. Two reviewers independently screened records. One reviewer extracted data, and a second reviewer verified all extracted data. Findings were synthesized thematically. Results: A total of 28 studies were included. Nursing engagement with environmental factors was characterized by six themes: 1) thermal environment management and cooling interventions (6 studies); 2) lifestyle modification and modifiable risk factor control, including smoking cessation and physical activity promotion (10 studies); 3) fatigue management using energy conservation and behavioral strategies (9 studies); 4) sleep environment and psychosocial stress regulation (8 studies); 5) the nutritional environment and bowel health (7 studies); and 6) the therapeutic environment, encompassing nurse-patient relationships, education, and self-management support (11 studies). Across the included studies, nurse-led and remotely delivered interventions were associated with improvements in fatigue, sleep quality, physical activity, self-efficacy, quality of life, and resilience. However, small sample sizes, short follow-up periods, and heterogeneous outcome measures limited conclusions regarding effectiveness. Structural barriers, including time constraints, limited resources, transport difficulties, and limited digital literacy, constrained implementation. Conclusions: Nurses have a broad and potentially important role in addressing modifiable environmental factors in MS, with the strongest evidence supporting symptom management and self-management outcomes. Integrating structured environmental assessments and individualized, nurse-led strategies into routine MS care may strengthen person-centered care and support patient autonomy and quality of life. Further high-quality research is needed to establish long-term clinical effectiveness.