Critical Care Nurses' Attitudes, Engagement, Challenges and Other Factors Influencing Healthcare Sustainability and...

Intensive care units (ICUs) are among the most resource-intensive areas within health care and generate more waste and greenhouse gas emissions. Critical care nurses (CCNs) are well positioned to influence environmentally sustainable practices.

To assess CCNs' attitudes and climate-health engagement related to healthcare sustainability, to explore perceived challenges and identify other factors affecting sustainable practice in critical care settings.

A quantitative descriptive cross-sectional study was conducted using convenience sampling of CCNs working in adult ICUs, emergency departments and cardiac care units in the Eastern Region of Saudi Arabia. Data were collected using the Sustainability Attitudes in Nursing Survey (SANS-2), Climate, Health and Nursing Tool (CHANT) and a self-developed checklist to assess perceived challenges to practising healthcare sustainability, which were distributed electronically. Descriptive and inferential statistics, correlation analysis and multivariate linear regression were performed.

A total of 216 CCNs participated, yielding a response rate of 90%; the respondents demonstrated generally positive attitudes towards sustainability and climate change (mean SANS-2 score = 23.87 ± 8.69). Concern about the health impacts of climate change ranked highest among CHANT domains (76.0%), while sustainability-related behaviours at work were lowest (49.1%). Awareness, concern and motivation were positively associated with sustainability behaviours, whereas attitudes showed weak associations with behaviour. Key challenges included lack of organisational support (45.8%), staff shortages and workload (41.2%) and inadequate policies or infrastructure (36.1%). Leadership role and lack of previous training independently predicted higher attitude scores, whereas prior education predicted greater climate-health engagement.

Although CCNs express strong concern and positive attitudes towards sustainability, organisational and workload constraints limit translation into practice. Strengthening leadership engagement, targeted education and institutional support is essential to embed sustainable practices in critical care.

The study highlights sustainability attitudes, climate-health engagement, perceived challenges and persistent behavioural gaps, while identifying the central roles of education, leadership, and organisational support.