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Global warming and social justice issues are increasing the complexity of global healthcare delivery. Health systems significantly contribute to environmental harm through carbon emissions, medical waste, and resource overuse. Nurses, as the largest group in healthcare, face workplace hazards and environmental challenges, highlighting the need for institutions to promote sustainable practices and workplace safety. The United Nations' Sustainable Development Goals (SDGs) emphasize integrated social, economic, and environmental sustainability, with health and universal health coverage as key themes. The International Council of Nurses (ICN) underscores nurses' vital role in achieving these goals by linking nursing care to public health, sustainability, climate action, and education. Developing sustainability competencies in nursing education requires practical training in environmentally responsible behaviors within healthcare settings, beyond theoretical knowledge.
Global warming and the integration of the concepts of equality and social justice into diseases and care are making healthcare delivery more complex and challenging at a global level today. Health systems contribute significantly to environmental degradation through considerable carbon emissions, medical waste production, and excessive resource use.
Nurses, the largest group within the health system, not only face a high rate of workplace accidents but also encounter a range of challenges such as increased medical waste production and carbon emissions. Therefore, it is important for healthcare institutions to support environmentally friendly behaviors and to ensure workplace safety and sustainable performance by achieving sustainable development .
The Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure all people enjoy peace and prosperity by 2030. The 17 Sustainable Development Goals are integrated and indivisible; they acknowledge that action in one area will affect outcomes in others, and that development must balance social, economic, and environmental sustainability. Health holds a significant place in the 2030 Agenda for Sustainable Development, which sets universal health coverage as a central theme and attaches even greater importance to the interplay of the social, economic, and environmental aspects of sustainable development. The 2017 report by the ICN also highlighted the role of nurses in the SDGs by providing case studies that exemplify the link between individual and public health in nursing care. In subsequent years, ICN reports addressed the relationships between sustainability, climate change, and planetary health, emphasizing the active role of nurses in improving community health and influencing policy. Furthermore, they underscored the importance of integrating the concept of sustainability into nursing practice and education and expressed concerns over students' impact on planetary health.
To adopt a sustainability mindset in nursing education, it is necessary to impart knowledge, attitudes, and skills during training. The literature emphasizes the need to develop competencies through behaviors such as adopting waste reduction, energy conservation, and environmentally friendly practices, especially those that are specific to hospital environments, within the context of sustainable healthcare services. In this context, sustainability competencies should not remain at the theoretical knowledge level only but should also be supported by concrete practices that students can observe and interpret in the hospital environment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Sustainability Training | Experimental | Nursing students who receive a structured sustainability competency training program |
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| Standard Nursing Curriculum | Active Comparator | Nursing students do not receive the sustainability training |
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| No Training | Other | Nursing students do not receive the sustainability training |
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| Clinical Practice | Experimental | Participate in their scheduled clinical hospital rotations and also assessment the clinic throughout sustainability |
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| No Clinical Practice | Other | Nursing students do not participate in their scheduled clinical hospital rotations |
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| Standard Clinical Practice | Active Comparator |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sustainability Training | Behavioral | A [1 week] training program focusing on environmental, social, and economic sustainability competencies in nursing care. |
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| Measure | Description | Time Frame |
|---|---|---|
| The Sustainability Attitudes in Nursing Survey (SANS-2) | The Sustainability Attitudes in Nursing Survey consists of 9 items rated on a 7-point Likert-type scale. Total scores range from 9 to 63, where higher scores indicate a more positive/higher level of sustainability attitude. The average of the item scores is calculated and a higher total score indicates a better attitude towards sustainability in nursing. The Cronbach's alpha coefficient for the original scale was reported as 0.82, while the Turkish version demonstrated a Cronbach's alpha of 0.76. | Baseline (Pre-test) and 4 weeks after the intervention (Post-test). |
| Clinical Sustainability Practice | Assessment of students' sustainable behaviors during clinical rotations. Data will be collected regarding four key areas: waste management (proper segregation and reduction), material management (efficient use of medical supplies), water consumption, and energy conservation (turning off unnecessary equipment/lights). Evaluation will be based on Rubric scale. Higher scores indicate better adherence to sustainable healthcare practices. | Throughout the clinical rotation period (up to 3 weeks) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Emel Gür, Assistant Professor | Contact | +905055738268 | gr.emel.85@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cankiri Karatekin University | Çankırı | 18100 | Turkey (Türkiye) |
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| Label | URL |
|---|---|
| Cankiri Karatekin University Official Website. | View source |
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There are no plans to share individual participant data to protect the privacy and confidentiality of the nursing students involved in the study.
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"A three-arm parallel randomized controlled trial. Group 1 (Intervention): Received sustainability training and participated in clinical practice. Group 2 (Internal Control): Did not receive sustainability training but participated in clinical practice. Group 3 (External Control): Did not receive sustainability training and did not participate in clinical practice."
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This is a single-blind study where the participants (nursing students) are masked to their group assignment. While the researchers are aware of the allocation to either the intervention (sustainability training) or control group to facilitate the education sessions, the students will not be informed of their specific group status during the data collection process to minimize potential bias in self-reported sustainability attitudes and behaviors.
They participate in their scheduled clinical hospital rotations (standard curriculum). |
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| Standard Nursing Curriculum | Other | Nursing students do not receive the sustainability training |
|
| No Training | Other | Nursing students do not receive the sustainability training |
|
| Clinical Practice | Behavioral | Participate in their scheduled clinical hospital rotations and also assessment the clinic throughout sustainability (up to 3 weeks) |
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| Standard Clinical Practice | Other | They participate in their scheduled clinical hospital rotations up to 3 weeks (standard curriculum). |
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| No Clinical Practice | Other | Nursing students do not participate in clinical hospital rotations during the study period |
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