Abstract
Climate change is among the greatest of threats to human health. Paradoxically the health system is a contributor to planetary degradation through emissions and waste. Climate change and sustainability are important issues for the nursing profession. We explored the impact of an education module with embedded sustainability principles in the context of clinical simulation. This mixed methods study used pre- and post-intervention waste audits and student surveys to explore attitudes, knowledge and practices relating to climate change and sustainability. The intervention, a digital clinical simulation education module, included three themes: 1) professional conduct, 2) work health and safety, 3) resource stewardship and sustainability. Quantitative data were analysed through descriptive statistics and comparison of pre- and post-intervention means and proportions. Qualitative data were analysed thematically to identify facilitators and barriers. We examined two weeks of simulation for the same cohort of 170 students preparing for clinical practice assessment. We found no significant difference in waste per student following the intervention. Most items targeted for re-use were actively diverted to the recycling station with proportional increases following the intervention. A total of 44 (30.3 %) and 80 (53.3 %) students completed the surveys and most agreed that climate change and sustainability are important issues for nurses. Students' perceived application of sustainability during clinical simulation increased following the intervention (mean 4.8 to 5.4, p ≤0.01). Perceived application of sustainability in clinical practice, and of the principles 'reduce' and 're-use' also increased. Barriers to sustainable practice included cognitive overload, knowledge deficit, time pressure, and desire for authentic practice. Clinical simulation generates substantial volumes of waste. Student nurses are motivated and capable of applying sustainability principles during simulation, however, often experience barriers. Embedding sustainability principles in simulation curriculum demonstrated positive impacts and ongoing efforts are needed to address barriers and increase opportunities for sustainable practice.
Notes
Open Access Details:
This is an open access article originally published under the terms of a Creative Commons License, which permits the Sigma Repository to post a copy in its collections. The license is attached to this item record; please click on the license for further details.
Original Article Citation:
Wang, B., Sheehy, L., Frotjold, A., Power, T., & Saravanos, G. (2025). Sustainability in undergraduate nursing clinical simulation: A mixed methods study exploring attitudes, knowledge and practices. Nurse education today, 153, 106805. https://doi.org/10.1016/j.nedt.2025.106805
No changes have been made to this article.
Sigma Membership
Non-member
Lead Author Affiliation
University of Sydney, Camperdown, NSW, Australia
Type
Article
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Planetary Health, Climate Change, Sustainable Healthcare, Clinical Simulation
Recommended Citation
Wang, Bangyun; Sheehy, Louise; Frotjold, Astrid; Power, Tamara; and Saravanos, Gemma, "Sustainability in Undergraduate Nursing Clinical Simulation: A Mixed Methods Study Exploring Attitudes, Knowledge and Practices" (2026). Individual Articles. 49.
https://www.sigmarepository.org/individual_articles/49
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Publisher
Elsevier
Version
Publisher's Version
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
External Review: Previously Published Material
Acquisition
Indexed Previously Published Material (Per Creative Commons License)
Date of Issue
2026-01-15
Full Text of Presentation
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