Environmental Sustainability-Related Knowledge, Behaviors, and Perceived Barriers Among Italian Intensive Care Unit...

Background/Objectives: Healthcare systems are increasingly recognized as contributors to climate change, and intensive care units represent particularly resource-intensive clinical environments. Nurses play a central role in shaping daily care practices that may influence the environmental footprint of critical care. However, limited quantitative evidence is available on intensive care nurses' knowledge, behaviors, and perceived barriers regarding environmental sustainability. This study aimed to assess knowledge, sustainability-related behaviors, and perceived barriers among Italian intensive care unit nurses using the preliminary version of the Knowledge, Attitudes, and Behaviors Questionnaire on Environmental Sustainability in Intensive Care Units (KABQES-ICU). Despite the instrument's name, attitudes were not operationalized as a separate scored domain in the preliminary version used in this study and were therefore not analyzed as an independent construct. Methods: A cross-sectional online survey using self-selected convenience sampling was conducted between November 2024 and July 2025. Participants were Italian registered nurses or nurse coordinators working in intensive care settings with at least one year of critical care experience. The survey was distributed through the official website of the Italian National Association of Critical Care Nurses. Descriptive statistics, correlation analyses, and group comparisons were performed on a final analytical sample of 278 participants. Results: Participants reported high levels of climate change knowledge, while sustainability-related behaviors were moderate, particularly in workplace settings. Perceived workload, time pressure, and organizational barriers were moderate to high, reflecting substantial perceived obstacles to the implementation of sustainable practices in everyday intensive care. Relatively small proportions of participants reported awareness of specific organizational sustainability initiatives, particularly carbon-emissions reporting, structured emission-reduction plans, staff training, and sustainable procurement strategies. Knowledge was positively but weakly associated with home- and work-based sustainability behaviors, with these associations showing small effect sizes. Sustainability-related scores were only weakly associated with sociodemographic and professional characteristics. Conclusions: Italian intensive care nurses reported high climate change knowledge scores alongside only moderate levels of workplace sustainability behaviors. The modest unadjusted associations indicate that climate change knowledge was only weakly related to reported workplace sustainability behaviors. These exploratory findings should not be interpreted as evidence of independent predictors or of the relative contribution of individual and organizational factors.