Elsevier

Nurse Education Today

Volume 37, February 2016, Pages 15-20
Nurse Education Today

Including sustainability issues in nurse education: A comparative study of first year student nurses' attitudes in four European countries

https://doi.org/10.1016/j.nedt.2015.11.005Get rights and content

Highlights

  • The paper draws attention to sustainability and climate change as a global challenge in nursing and healthcare.

  • The paper compares student nurses attitudes towards climate change and sustainability across four European Countries.

  • SANS_2 is a reliable instrument to assess nursing students’ sustainability awareness.

  • There are significant differences in sustainability awareness of students of different European countries.

Summary

Introduction

Education in sustainable development is a goal recognised by a large number of countries and a vital concept in healthcare. It is therefore important that nurse education incorporates elements of sustainable development into nursing education curricula. However, there is limited research on student nurses' attitudes towards sustainability and no comparison of attitudes towards sustainability and its inclusion in the nursing curriculum across Europe.

Aim

This project aims to assess student nurses' attitudes towards sustainability, its relevance to nursing and its inclusion in the nursing curricula.

  • 1.

    To assess base-line attitudes at the start of nursing and midwifery training;

  • 2.

    To compare sustainability awareness between students participating in training in a number of European universities.

Design

A comparative survey design using the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire.

Settings

Nursing classes of Universities and Nursing Schools in four European countries were investigated using a questionnaire consisting of five sustainability-related items.

Participants

916 nursing students (UK: 450, Germany: 196, Spain: 124, Switzerland: 146).

Data analysis

Standard descriptive and inferential statistical methods were used to establish psychometric quality (Principal Components Analysis, Cronbach's alpha, Pearson correlations) and compare student nurses from the four countries.

Results

The reliability of SANS_2 was good (Cronbach's alpha = .82) and the five items loaded on a single factor which explained 58% of variance. ANOVA of the SANS_2 total score showed significant differences between countries with German nursing students showing more sustainability awareness than students from the UK and Spain.

Conclusions

SANS_2 is a reliable instrument to assess nursing students' sustainability awareness; there are significant differences in sustainability awareness of students of different European countries.

Limitations of the study include non-random sampling, possible method effects and social desirability effects.

Relevance to clinical practice

Sustainability will become increasingly important in clinical practice; greater knowledge about the attitudes of nurses towards sustainability can support the development and testing of sustainability-focused teaching and learning materials.

Introduction

Sustainable development is a concept vital to healthcare: due to its relatively large CO2 emissions, the use of toxic materials and the production of vast amounts of waste, healthcare is ultimately compromising public health and damaging the ability of future generations to meet their needs (Healthcare Without Harm, 2010). In the EU, the health sector creates at least 5% of total CO2 emissions, the equivalent of the region's international aviation and shipping industries combined (KPMG, 2012). Hence, reductions in energy use and improvements in resource efficiency are vital elements of a more sustainable health sector. Recent research commissioned by Health Care Without Harm and Health and Environment Alliance (Healthcare Without Harm, 2010) puts forward a strong case for greater EU leadership in climate change policy that puts peoples' health first. Higher Education has a role to play in developing students of all disciplines with skills that support sustainable development. For example, one of the five priority actions for the Global Action Plan (UNESCO:ESD after, 2014) is to integrate sustainability practices into education and training environments through whole institution approaches.

Section snippets

Background

High CO2 producing sectors across the EU are responding to the need to take a lead on sustainability. For example, the German Government reaffirmed its commitment to reduce Germany's greenhouse gas (GHG) emission by 40% by 2020 and to increase renewable energies to 18% by 2020 and 60% by 2050.

The Spanish Climate Change and Clean Energy Strategy aims to support clean energies, while improving social welfare, economic growth and environment protection; according to official data on the Spanish

Sample

First year student nurses in Universities and Schools of Nursing in 4 European countries (UK, Spain, Switzerland, Germany) participated in this study at the start of their training. Ideally, respondents could be sampled across all European countries and, within countries, by random selection. However, this study design would be too large and expensive in the current framework. Thus, we decided to sample first-year students from cooperating universities across countries participating in the

Psychometric Analysis of SANS_2

Correlational analysis reveals that all five items of SANS_2 show positive and highly significant (p < .001) Pearson correlations. As can be expected, item 5 which relates to personal sustainability-related attitudes shows lower intercorrelations with the other items (Table 1).

A principle components analysis revealed only one component with an Eigenvalue larger than 1 (2.92). This component explains 58.4% of total variance. Thus, both according to the Scree Test and the Eigenvalue criterion, a

Discussion

The main aims of the current paper were to (i) to compare student nurses' attitudes across four European countries and (ii) assess psychometric data of a questionnaire to assess student nurses' attitudes on including sustainability in the curriculum. Based on analyses from a pre-test with 363 nursing students from three European countries, a revised scale (SANS_2) consisting of five items was employed in this study. Psychometric analyses revealed good psychometric characteristics of the scale

Conclusions

These data indicate that there are significant differences in sustainability awareness of students of different European countries. The scale described in this paper is a reliable and valid instrument to assess nursing students' attitudes towards sustainability and should be used in further research. Limitations of the study include possible method effects, confounding of country and training status and non-random sampling.

Relevance to Clinical Practice

Greater knowledge about the attitudes of nurses towards sustainability and including this topic in nursing curricula can support the development and testing of sustainability-focused teaching and learning materials. Education for sustainable development will be central to equipping nurses to practice healthcare in the context of an environment challenges by climate change and increasing scarcity of natural resources.

What Does This Paper Contribute to the Wider Global Clinical Community?

  • The paper draws attention to sustainability and climate change as a global challenge in healthcare and the need to embed these topics into nursing curricula.

  • The paper compares student nurses attitudes towards climate change and sustainability in nursing curricula across four European Countries.

  • The SANS questionnaire has been translated into a number of languages, tested for psychometric properties, and can be used to measure changes in attitudes following educational interventions.

Permissions

The revised version of the SANS (in English, Spanish, German, Dutch and French) is freely available for use from the senior author.

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