Promoting Sustainability Healthcare Practices: A Quasi-experimental Study on Nursing Education in Governmental Hospitals
DOI:
https://doi.org/10.31674/mjn.2025.v16i04.021Abstract
Background: Climate change, driven mainly by human activities such as fossil fuel combustion, poses severe risks to global health and stability. As healthcare practices contribute to environmental degradation, there is a growing emphasis on sustainable healthcare. As crucial healthcare providers, nurses play a vital role in adopting sustainable practices, yet they often need more education on these topics. This study addresses this gap by evaluating an educational programme to enhance nurses' knowledge and attitudes toward sustainable practices in healthcare settings. Objectives: The study aimed to assess the effectiveness of an educational intervention in improving nurses' knowledge and attitudes toward sustainable healthcare practices, thereby promoting a more environmentally conscious approach to healthcare. Methods: A quasi-experimental one-group pre-test/post-test design was implemented with 30 nurses from Mosul's governmental hospitals. Data were collected through a structured questionnaire administered before and after the educational program, which consisted of eight sessions covering topics from energy conservation to sustainable procurement practices. Reliability was confirmed with a Cronbach’s alpha of 0.82. Statistical analyses included paired t-tests to compare pre- and post-intervention scores for knowledge and attitudes. Results: The intervention significantly improved participants' knowledge and attitudes toward sustainability. Average knowledge scores increased from 50 (SD = 8.2) pre-intervention to 75 (SD = 5.6) post-intervention, while attitude scores rose from 60 (SD = 7.3) to 82 (SD = 6.1). These findings suggest that structured educational programmes effectively elevate understanding and positive perceptions regarding sustainable healthcare practices. Conclusion: The educational programme enhanced nurses' knowledge and attitudes toward sustainability, indicating that similar interventions could benefit healthcare sectors. Integrating sustainability education into nursing curricula is essential for equipping nurses with the skills to address healthcare's environmental impacts.
Keywords:
Attitudes, Climate Change, Environment, Knowledge, Nursing Education, Sustainability TrainingDownloads
References
Agbedahin, A. V. (2019). Sustainable development, education for sustainable development and the 2030 agenda for sustainable development: Emergence, efficacy, eminence, and future. Sustainable development, 27(4), 669-680. https://doi.org/10.1002/sd.193 1
Álvarez-Nieto, C., Richardson, J., Parra-Anguita, G., Linares-Abad, M., Huss, N., Grande-Gascón, M. L., . . . López-Medina, I. M. (2018). Developing digital educational materials for nursing and sustainability: The results of an observational study. Nurse Education Today, 60, 139-146. https://doi.org/10.1016/j.nedt.2017.10.008
Bein, T. (2025). [Sustainability-national and international initiatives in intensive care and emergency medicine]. Med Klin Intensivmed Notfmed, 120(1), 15-21. https://doi.org/10.1007/s00063-024-01199-9
Cohen, E. L., & Head, K. J. (2014). Identifying knowledge–attitude–practice gaps in parental acceptance of adolescent vaccinations in Appalachian Kentucky: Implications for communication interventions. Journal of Communication in Healthcare, 7(4), 295-302. https://doi.org/10.1179/1753807614Y.0000000069
Cosenz, F., Noto, G., Cavadi, G., Bivona, E., & Scirè, G. (2024). Pursuing sustainable performance in healthcare organizations: a sustainable business model perspective. Journal of Health Organization and Management, 38(5), 741-759. https://doi.org/10.1108/jhom-12-2023-0369
Cruz, J. P., Felicilda-Reynaldo, R. F. D., Alshammari, F., Alquwez, N., Alicante, J. G., Obaid, K. B., . . . Silang, J. (2018). Factors influencing arab nursing students' attitudes toward climate change and environmental sustainability and their inclusion in nursing curricula. Journal of Nursing Management, 35(6), 598-605. https://doi.org/10.1111/phn.12516
Ennen, K. A. (2001). Shaping the future of practice through political activity: How nurses can influence health care policy. Aaohn Journal, 49(12), 557-571. http://dx.doi.org/10.1177/216507990104901207
Frazer, K., & Davidson, P. M. (2022). Sustainable development goals- A clarion call for leadership in nursing and midwifery. Journal of Nursing Management, 30(8), 3888-3890. https://doi.org/10.1111/jonm.13867
Gaspary, J. F. P., Gerhardt, V. J., de Freitas Michelin, C., Lopes, L. F. D., Rosa, C. B., & Siluk, J. C. M. (2024). Healthcare cannot stop evolving innovation catalyzes the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1438029
Gnjidic, D., Johansson, M., Meng, D. M., Farrell, B., Langford, A., & Reeve, E. (2022). Achieving sustainable healthcare through deprescribing. Cochrane Database of Systematic Reviews, 10(10). https://doi.org/10.1002/14651858.Ed000159
Hamarash, M. Q., Yaas, M. H., Almushhadany, O. I., & Ibrahim, R. H. (2023). Preceptoring of Graduate Nursing Students in Iraq. Advances in Medical Education and Practice, 14, 1025-1034. https://doi.org/10.2147/AMEP.S418824
Iwai, T., Shinji, S., Yamada, T., Uehara, K., Matsuda, A., Yokoyama, Y., . . . Yoshida, H. (2025). Advances in surgery and sustainability: The use of AI Systems and reusable devices in Laparoscopic Colorectal Surgery. Cancers (Basel), 17(5). https://doi.org/10.3390/cancers17050761
Kıyat, P., Palamar, M. (2025). Strategies for sustainability and cost optimization in corneal transplantation: from surgeons’ perspective. Turkish Journal of Ophthalmology, 55(1), 29-35. https://doi.org/10.4274/tjo.galenos.2024.89170
Klein, D., Carazo, M. P., Doelle, M., Bulmer, J., & Higham, A. (2017). The Paris agreement on climate change: Analysis and commentary. Oxford University Press. http://dx.doi.org/10.1017/cyl.2018.14
Lilienfeld, E., Nicholas, P. K., Breakey, S., & Corless, I. B. (2018). Addressing climate change through a nursing lens within the United Nations Sustainable Development Goals framework. Nursing Outlook, 66(5), 482–494. https://doi.org/10.1016/j.outlook.2018.06.010
Mahmood, H. J., Murad, S. H., Abdullah, M. K., & Ibrahim, R. H. (2022). Quality of life in patients with coronary artery disease: A prospective study. Malaysian Journal of Public Health Medicine, 22(3), 259-267. https://doi.org/10.37268/MJPHM/VOL.22/NO.2/ART.1618
Marra, M. (2025). Bridging the gaps in sustainability assessment: A systematic literature review, 2014-2023. Evaluation and Program Planning, 110. https://doi.org/10.1016/j.evalprogplan.2025.102557
Morton, S., Pencheon, D., & Bickler, G. (2019). The sustainable development goals provide an important framework for addressing dangerous climate change and achieving wider public health benefits. Public Health, 174, 65–68. https://doi.org/10.1016/j.puhe.2019.05.018
Morton, S., Pencheon, D., & Squires, N. (2017). Sustainable Development Goals (SDGs) and their implementation: A national global health, development, and equity framework needs a systems approach at every level. British Medical Bulletin, 124(1), 81–90. https://doi.org/10.1093/bmb/ldx031
N. H. S. Confederation (2017). NHS statistics, facts and figures. Retrieved from: https://www.nhsconfed.org/resources/key-statistics-on-the-nhs. Accessed on 20th September, 2024.
Nicholas, P. K., & Breakey, S. (2017). Climate change, justice, and environmental health: implications for the nursing profession. Journal of Nursing Scholarship, 49(6), 606–616. https://doi.org/10.1111/jnu.12326
Nicholas, P. K., Breakey, S., Tagliareni, M. E., Simmonds, K., & Sabo, K. K. (2021). Climate change and population health: incorporating stages of nursing's political development. Nursing Outlook, 69(1), 65–73. https://doi.org/10.1016/j.outlook.2020.08.001
Peng, M. T. (2019). [The Role of Nurses in Achieving Sustainable Development Goals]. Hu Li Za Zhi, 66(2), 93-100. https://doi.org/10.6224/jn.201904_66(2).12
Richardson, J., Grose, J., Doman, M., & Kelsey, J. (2014). Using evidence-informed sustainability scenarios in the nursing curriculum: developing and evaluating teaching methods. Nurse Education Today, 34(4), 490–493. https://doi.org/10.1016/j.nedt.2013.07.007
Rosa, W. E., Dossey, B. M., Koithan, M., Kreitzer, M. J., Manjrekar, P., Meleis, A. I., . . . Watson, J. (2020). Nursing Theory in the Quest for the Sustainable Development Goals. Nursing Science Quarterly, 33(2), 178-182. https://doi.org/10.1177/0894318420903495
Rosa, W. E., Dossey, B. M., Watson, J., Beck, D. M., & Upvall, M. J. (2019). The United Nations Sustainable Development Goals: The ethic and ethos of holistic Nursing. Journal of Holistic Nursing. 37(4), 381-393. https://doi.org/10.1177/0898010119841723
Rosa, W. E., Kurth, A. E., Sullivan-Marx, E., Shamian, J., Shaw, H. K., Wilson, L. L., & Crisp, N. (2019). Nursing and midwifery advocacy to lead the United Nations Sustainable Development Agenda. Nursing Outlook, 67(6), 628–641. https://doi.org/10.1016/j.outlook.2019.06.013
Santiago, C. F., Blekkenhorst, L. C., Hsu, M. P., Mirabito Colafella, K. M., Calkin, A. C., Nicholls, S. J., . . . Chapman, N. (2025). Cardiovascular workforce sustainability sector consultation: recommendations from an Australian Stakeholder Summit. Heart Lung Circulation, 34(1), 95-101. https://doi.org/10.1016/j.hlc.2024.10.012
Tao, X., MacAndrew, M., Dahlke, S., Butler, J. I., Rayner, J., Fetherstonhaugh, D., & Parker, C. (2024). Educational interventions to improve student nurses’ knowledge, attitudes, or willingness to work with older people: a systematic review of quantitative findings. International Journal of Nursing Education Scholarship, 21(1). https://doi.org/10.1515/ijnes-2023-0110
Van Elten, H. J., Howard, S. W., De Loo, I., & Schaepkens, F. (2023). Reflections on Managing the Performance of Value-Based Healthcare: A Scoping Review. International Journal Health Policy Management, 12. https://doi.org/10.34172/ijhpm.2023.7366
Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., . . . Costello, A. (2015). Health and climate change: policy responses to protect public health. Lancet, 386(10006), 1861-1914. https://doi.org/10.1016/s0140-6736(15)60854-6
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