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Background <p>Healthcare produces ≈ 4.4% of global greenhouse-gas emissions, and Neonatal Intensive Care Units (NICUs) are among its most resource-intensive services. In Egypt, where material constraints intensify ecological strain, the climate-change literacy and stewardship practices of NICU nurses remain undocumented.</p> Aim <p>To examine climate-change literacy levels, environmental-stewardship practices, and the factors that influence their implementation among NICU nurses in Egypt.</p> Design <p>Convergent parallel mixed-methods study (January – March 2024).</p> Methods <p>Ninety-five nurses from three NICUs completed the Climate, Health and Nursing Tool (CHANT). Quantitative data were analysed in SPSS v28 (descriptives, χ², Spearman ρ, multiple linear regression). Twenty-four purposively selected nurses were interviewed, and their transcripts were analyzed using reflexive thematic analysis in NVivo 12. Meta-inferences were generated through joint-display integration.</p> Results <p>Literacy was moderate (mean = 3.15 ± 0.89); climate awareness was higher (3.45 ± 0.82), while professional engagement lagged (2.87 ± 1.03). Prior environmental training (β = 0.35, <i>p</i> &lt; 0.001) and NICU experience (β = 0.31, <i>p</i> &lt; 0.001) predicted higher literacy (R² = 0.64). Stewardship behaviours differed by hospital type; for energy-efficient equipment use, χ² (2) = 8.94, <i>p</i> = 0.011, with the highest prevalence in general hospitals (75.7%). Qualitatively, nurses described stewardship as constrained by resource scarcity, time pressure, and unclear policy, and enabled by visible leadership, practical training, and supportive peer micro-cultures.</p> Conclusion <p>Egyptian NICU nurses possess the knowledge base to champion sustainability; however, systemic constraints hinder their actions. Embedding mandatory environmental modules, visible managerial endorsement, and enforceable eco-policies is essential to convert literacy into low-carbon neonatal care.</p> Implications for practice <p>The study provides administrators and educators with a data-driven blueprint for greening NICU operations without compromising neonatal outcomes, thereby advancing national climate commitments and Sustainable Development Goal 3.</p> Clinical trial number <p>Not applicable.</p>

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Climate change literacy and environmental stewardship in neonatal intensive care: a mixed-methods study of nursing practice patterns

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月19日

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  • Osama Mohamed Elsayed Ramadan,
  • Afrah Madyan Alshammari,
  • Abeer Nuwayfi Alruwaili,
  • Nadia Bassuoni Elsharkawy,
  • Ali Alhaiti,
  • Nermen Abdelftah Mohamed

摘要

Background

Healthcare produces ≈ 4.4% of global greenhouse-gas emissions, and Neonatal Intensive Care Units (NICUs) are among its most resource-intensive services. In Egypt, where material constraints intensify ecological strain, the climate-change literacy and stewardship practices of NICU nurses remain undocumented.

Aim

To examine climate-change literacy levels, environmental-stewardship practices, and the factors that influence their implementation among NICU nurses in Egypt.

Design

Convergent parallel mixed-methods study (January – March 2024).

Methods

Ninety-five nurses from three NICUs completed the Climate, Health and Nursing Tool (CHANT). Quantitative data were analysed in SPSS v28 (descriptives, χ², Spearman ρ, multiple linear regression). Twenty-four purposively selected nurses were interviewed, and their transcripts were analyzed using reflexive thematic analysis in NVivo 12. Meta-inferences were generated through joint-display integration.

Results

Literacy was moderate (mean = 3.15 ± 0.89); climate awareness was higher (3.45 ± 0.82), while professional engagement lagged (2.87 ± 1.03). Prior environmental training (β = 0.35, p < 0.001) and NICU experience (β = 0.31, p < 0.001) predicted higher literacy (R² = 0.64). Stewardship behaviours differed by hospital type; for energy-efficient equipment use, χ² (2) = 8.94, p = 0.011, with the highest prevalence in general hospitals (75.7%). Qualitatively, nurses described stewardship as constrained by resource scarcity, time pressure, and unclear policy, and enabled by visible leadership, practical training, and supportive peer micro-cultures.

Conclusion

Egyptian NICU nurses possess the knowledge base to champion sustainability; however, systemic constraints hinder their actions. Embedding mandatory environmental modules, visible managerial endorsement, and enforceable eco-policies is essential to convert literacy into low-carbon neonatal care.

Implications for practice

The study provides administrators and educators with a data-driven blueprint for greening NICU operations without compromising neonatal outcomes, thereby advancing national climate commitments and Sustainable Development Goal 3.

Clinical trial number

Not applicable.