Nurses’ perceptions, attitudes, and perspectives in relation to climate change and sustainable healthcare practices: A systematic review

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Climate change threatens human existence and is caused by increasing carbon emissions. Healthcare systems generate about 5% of global net CO2 emissions, further contributing to the crisis. Green healthcare practices could be implemented and nurses, as the largest workforce group, could potentially drive these practices. This review explored nurses’ awareness, perceptions, attitudes and perspectives towards sustainable nursing and healthcare practices concerning climate change.

The Joanna Briggs Institute [JBI] methodology for conducting mixed methods systematic reviews was applied and results were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines. CINAHL, PsycINFO, SCOPUS, and PUBMED databases were searched. JBI and Mixed Method Appraisal Tool [MMAT] critical appraisal tools were used for the data appraisal. Data synthesis and integration followed the JBI convergent integrated approach and thematic analysis was performed.

Eighteen papers were included that represented nine different countries across five continents. One study was found in Africa, no studies in South America, and three in Asia. Five key themes were identified: i) knowledge and awareness of climate change, ii) link between nursing and climate change, iii) environmental sustainability, iv) barriers to environmentally responsible healthcare, and v) routes to environmentally sustainable nursing practices.

The review indicates the need to raise awareness regarding climate change and sustainable practices among nurses. It is vital policy makers, and healthcare leaders ensure criteria relating to environmental sustainability and carbon reduction are included in decisions about procurement and service delivery. Nurses’ engagement could drive forward a net-zero agenda.
Original languageEnglish
Article number100290
Number of pages7
JournalThe Journal Of Climate change and Health
Early online date2 Dec 2023
Publication statusPublished - 1 Mar 2024

Bibliographical note

/© 2023 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (


This PhD is funded by the Research Centre for Healthcare and Communities, Coventry University, UK.


  • Nursing
  • Climate change
  • Environmental sustainability
  • Environmental responsible healthcare
  • Net-zero healthcare
  • Sustainable healthcare


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