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Higher education and its leadership are not yet using their potential impact for a sustainable future. This paper aims to focus on UN developments and the long history of university involvement in sustainability might create more interest and understanding that sustainably oriented universities are actually possible and a much stronger role for higher education is needed when nations are discussing their future.

Literature review with a focus on international treaties and declarations on the UN level and international university networks, literature review of the background and potential of the whole-institution approach and the need/suggestions for further research, also to measure advancement.

History shows a strong engagement of higher education with sustainability from its beginnings. There have been strong calls/offers from within university networks to take a crucial role in moving towards sustainable development that involves more than teaching about sustainability. The international community calls for higher education to be involved in policymaking rather than simply implementation, have been limited and the full potential of higher education institutions using all opportunities such as being living labs for sustainability has not as yet been realized. Currently, calls for engagement are often still limited to training and providing research when scientific evidence is wanted.

Literature review focused on UN level treaties/declarations English- and German-language review national developments limited to samples of members of the Sustainable Development Goal (SDG) 4 subcluster in the Higher Education and Research for Sustainable Development (HESD) Global Cluster by the International Association of Universities (IAU).

Guidance for university leaders and other stakeholders to become aware of and consider a whole-institution approach. Practitioner relevance as countries is encouraged to embed UN recommendations, treaties and declarations. Defining opportunities for further research. Presenting the HESD Cluster by the IAU as a sample for new approaches of higher education to interact with the SDGs.

Strengthening the role of higher education in the pursuit of a better future would focus on science and research as a neutral basis for decision-making and policy development. Sustainability embedded in all streams of university can help universities to be a practical example of the possibilities of sustainability at work.

Composition of authors with UN background and involvement. Focus on UN treaties/declarations and guidance for academics and practitioners in leadership on adopted UN and other international documents. Summarizing the background of the whole-institution approach as a genuine development over time but including limitations and implications for future roles for higher education leadership. IAU SDG 4 Subcluster is unique in its own approach and with its connections to a global network of higher education institutions and UNESCO.

A recent paradigm-shift in patient care advocates for long-term recovery and quality of life in survivors of critical illness. Evidence suggests that occupational therapists in critical care can contribute to recovery in areas such as functional outcomes, length of stay and delirium, although poor role understanding can limit service-utilisation. The purpose of this study is to investigate current and future roles and practices of critical care occupational therapists in the UK.

Occupational therapists with clinical experience in adult critical care were invited to participate in a mixed-methods design using a locally developed online questionnaire and semi-structured interviews, concurrently. Descriptive statistics were generated through SPSS. Qualitative data were analysed using the framework approach.

Twelve occupational therapists participated in the survey element, with five continuing to interview. Occupational therapists described a multifaceted role in critical care where the majority reported practice in upper limb function, seating/positioning, cognition, psychosocial sequelae and discharge planning. Role and internal characteristics impacted on service delivery. It is envisaged that earlier intervention in a greater percentage of patients, a greater evidence-base, raising awareness and adequate staffing will be features for future development.

This study provides new insight into the current role and practices of adult critical care occupational therapists in England and generates insights into their role in addressing physical and non-physical morbidity for this patient cohort. Findings are preliminary in nature; however, future research is warranted to evaluate the effectiveness of interventions.