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Advancing Green Nursing for Sustainable Healthcare: A Mixed-Method Study on Emission Reduction and Population Health in Tertiary Care Hospital
*Corresponding author: Prof. Pratima Vuyyuru, Department of Nursing Research, Narayana College of Nursing, Chinthareddypalem, Nellore, Andhra Pradesh, India. prathibhareddykesari@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Vuyyuru P, Kumari BV. Advancing Green Nursing for Sustainable Healthcare: A Mixed-Method Study on Emission Reduction and Population Health in Tertiary Care Hospital. J Health Allied Sci NU. doi: 10.25259/JHASNU_14_2026
Abstract
Objectives
Healthcare systems significantly contribute to environmental pollution through carbon emissions, high energy consumption, and biomedical waste generation, indirectly impacting population health. Nurses, as the largest group within the healthcare workforce, are well-positioned to promote sustainable healthcare practices. Developing a green nursing workforce requires both quantitative assessment of existing practices and qualitative exploration of perceptions, barriers, and facilitators. To comprehensively assess the knowledge, attitude, and practices related to green nursing among staff nurses and to explore their perceptions regarding workforce development strategies aimed at reducing healthcare emissions and improving population health.
Material and Methods
A mixed-methods study was conducted in Narayana Medical College Hospital. The quantitative component involved a cross-sectional survey of 537 staff nurses using a structured questionnaire. The qualitative component comprised focus group discussions with 30 purposively selected nurses. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were subjected to thematic analysis.
Results
Of 537 nurses, 58.7% had inadequate knowledge, and 66.9% showed positive attitudes; however, only 27.6% reported consistent green practices. Adequate knowledge (AOR = 2.41; 95% CI: 1.68–3.46) and positive attitude (AOR = 3.12; 95% CI: 2.05–4.74) were significant association of green practice adoption (p <0.001). Prior sustainability training (AOR = 1.89; 95% CI: 1.27–2.81) and longer clinical experience (AOR = 1.56; 95% CI: 1.03–2.36) were also independently associated with implementation of green nursing behaviours. Qualitative findings identified training gaps, institutional barriers, and time constraints as key challenges despite strong professional willingness.
Conclusion
Bridging gaps between awareness and practice through structured training and institutional support is essential for strengthening a green nursing workforce and reducing healthcare-related environmental impacts.
Keywords
Green nursing
Healthcare emissions
Mixed-methods study
Population health
Sustainability
INTRODUCTION
Healthcare systems are increasingly recognised as significant contributors to environmental pollution through carbon emissions, energy consumption, water usage, and biomedical waste generation. Globally, the healthcare sector accounts for approximately 4.4–5% of total greenhouse gas emissions, making it a notable contributor to climate change and environmental degradation.[1] The consequences of healthcare-related emissions extend beyond environmental damage, adversely affecting population health through increased respiratory illnesses, heat- related morbidity, and the spread of climate-sensitive infectious diseases.[2]
The World Health Organization identifies climate change as one of the greatest global health threats of the 21st century, estimating ∼250,000 additional deaths annually between 2030–2050 due to climate-related conditions such as malnutrition, malaria, diarrhoea, and heat stress.[3] Paradoxically, healthcare institutions, while striving to improve health outcomes, contribute to environmental conditions that undermine human health, underscoring the urgent need for sustainable healthcare practices.[4]
Nurses constitute the largest segment of the healthcare workforce and are uniquely positioned to influence environmentally sustainable practices at the point of care.[5] Their involvement in patient care, resource utilisation, waste management, and health education offers substantial opportunities to reduce healthcare-related environmental impacts. The concept of green nursing emphasises environmentally responsible nursing practices that minimise ecological harm while maintaining high-quality patient care.[6]
Despite growing global attention to sustainability in healthcare, the integration of green principles into nursing practice remains inconsistent. Evidence suggests that although nurses often exhibit positive attitudes toward environmental sustainability, the actual implementation of green practices is limited. Barriers include inadequate formal training, limited institutional support, time constraints, and the absence of clear organisational policies.[7,8] This gap between awareness and practice poses a significant challenge to developing a green nursing workforce capable of effectively reducing healthcare emissions and safeguarding population health.
The burden of healthcare-related environmental impacts is particularly pronounced in low- and middle-income countries, where healthcare systems face rising service demands alongside constrained resources for sustainable infrastructure. In such contexts, workforce- and behavior-driven strategies may represent practical and cost-effective approaches to emission reduction.[9] Strengthening nurses’ competencies in sustainability can therefore play a crucial role in mitigating healthcare emissions and improving community health outcomes.[10]
The environmental footprint of healthcare systems is emerging as a critical public health concern, particularly in low- and middle-income countries where increasing service utilisation coincides with limited investment in sustainable infrastructure. In such settings, large-scale technological transitions toward low-carbon healthcare may be financially and logistically challenging. Consequently, workforce-driven, and behaviour-oriented interventions represent pragmatic and scalable strategies for mitigating emissions. Nurses, as the largest and most continuously engaged professional group in patient care, directly influence clinical workflows, resource utilization, energy consumption, and biomedical waste management. Enhancing nursing competencies in environmental sustainability, therefore, holds strategic importance not only for reducing healthcare-related emissions but also for advancing broader public health protection.[9,10]
While international frameworks increasingly advocate sustainable healthcare practices aligned with Sustainable Development Goal 3 (Good Health and Well-Being) and Sustainable Development Goal 13 (Climate Action), empirical evidence from Indian healthcare settings remains limited and methodologically narrow.[11-13] Existing Indian studies predominantly address environmental awareness in isolation, without systematically examining the interrelationship between knowledge, attitudes, and practice behaviours among nurses. Moreover, there is a distinct lack of mixed-methods investigations that integrate quantitative workforce assessment with qualitative exploration of contextual barriers, institutional facilitators, and professional perceptions.[13-16] The absence of comprehensive, workforce-focused research in Indian tertiary care hospitals constrains the development of evidence-based training models and institutional sustainability policies. To address this critical gap, the present mixed-methods study evaluates green nursing knowledge, attitudes, and practices among staff nurses and explores their perspectives on workforce development strategies aimed at reducing healthcare emissions and promoting sustainable population health outcomes.
Additionally, qualitative insights into the barriers and facilitators influencing the adoption of green nursing practices are underexplored.[16] Therefore, this mixed-methods study aims to assess green nursing knowledge, attitudes, and practices among staff nurses and explore their perceptions of workforce development strategies for reducing healthcare emissions and improving population health.
MATERIAL AND METHODS
Study design and setting
A hospital-based mixed-methods study was conducted at Narayana Medical College Hospital, a tertiary care teaching hospital in Andhra Pradesh, India. The study was carried out over a period of 12 months (August 2024 to September 2025). The quantitative component adopted a cross-sectional descriptive design, while the qualitative component employed a descriptive exploratory design using focus group discussions to gain in-depth insights into nurses’ perceptions regarding green nursing workforce development.
The study was approved by the Institutional Ethics Committee of Narayana Medical College Hospital and Narayana College of Nursing (Ref: NCON/FP/IEC/2024-007). Written informed consent was obtained from all participants prior to data collection. Confidentiality and anonymity of participants were strictly maintained throughout the study.
Sample size
The sample size for the quantitative component was calculated using a census-based approach, which was adopted to enhance representativeness and statistical power. Out of 720 staff nurses employed at the hospital, 537 met the inclusion criteria and consented to participate, yielding a response rate of 74.6%. Therefore, 537 staff nurses were included in the final quantitative analysis. For the qualitative component, 30 staff nurses were selected using purposive sampling to ensure representation from different clinical areas and years of experience. The sample size for focus group discussions was determined based on data saturation, where no new themes emerged during analysis.
Study participants
The study population consisted of registered staff nurses employed at Narayana Medical College Hospital during the study period. Nurses were considered eligible for participation if they had completed at least 6 months of clinical service, ensuring adequate exposure to institutional practices and patient care processes. Only those who voluntarily agreed to participate and provided written informed consent were included in the study. Additionally, nurses engaged in either direct patient care or supportive clinical roles contributing to patient management were considered eligible.
Nursing interns and student nurses were excluded to maintain homogeneity of professional experience within the sample. Nurses who were on extended leave during the data collection period were not included, as they were unavailable for participation. Furthermore, individuals who declined participation or did not provide written informed consent were excluded from the study.
Data collection tools and procedure
Quantitative component
Data were collected using a structured, self-administered questionnaire developed following an extensive review of published literature on sustainable healthcare and green nursing practices. The instrument was further evaluated for content validity by a panel of five experts in nursing research, environmental health, and hospital administration. A pilot study was conducted among 30 nurses (excluded from the final sample) to assess clarity, feasibility, and internal consistency. Reliability testing demonstrated acceptable internal consistency (Cronbach’s alpha: knowledge = 0.82; attitude = 0.86; practice = 0.79).
The questionnaire consisted of four sections: socio-demographic characteristics, knowledge related to green nursing and healthcare sustainability, attitudes toward environmentally sustainable nursing practices, and self-reported green nursing behaviours in clinical settings.
Knowledge assessment: The knowledge section comprised 20 multiple-choice items covering concepts such as carbon emissions in healthcare, biomedical waste segregation, energy conservation, sustainable procurement, and environmental health impacts. Each correct response was assigned one mark, and incorrect or unanswered items received zero marks. The total possible score ranged from 0–20.
Knowledge levels were categorized using a modified Bloom’s cut-off criterion, which is widely accepted in health education research. The obtained scores were converted into percentages and classified into three categories: inadequate knowledge for scores <50% (0–9 marks), moderate knowledge for scores between 50–75% (10–15 marks), and adequate knowledge for scores >75% (16–20 marks). The use of percentage-based cut-offs ensured objective classification and comparability with similar knowledge-attitude-practice (KAP) studies.
Attitude assessment: Attitude was measured using 15 statements rated on a five-point Likert scale ranging from strongly disagree (1) to strongly agree (5). The total attainable score ranged from 15–75. Negatively worded statements were reverse coded prior to analysis. The overall attitude score was converted into a percentage of the maximum possible score. Respondents scoring ≥60% of the total were categorized as having a positive attitude, whereas those scoring <60% were classified as having a negative attitude. The 60% threshold was determined based on the median distribution of pilot data and commonly adopted standards in behavioural research.
Practice assessment: Practice was evaluated using 15 self-reported items assessing the frequency of sustainable behaviours such as appropriate waste segregation, minimizing single-use materials, conserving electricity, and advocating environmentally responsible care. Responses were recorded on a three-point scale (always = 2, sometimes = 1, never = 0), with a total possible score ranging from 0 to 30.
Practice scores were converted into percentages and categorised based on a predefined cut-off value. Scores of ≥70% of the maximum possible score were considered as consistent practice, whereas scores <70% were categorised as inconsistent practice. The 70% threshold was selected to represent regular and sustained implementation of green nursing behaviours rather than occasional or sporadic actions. All categorizations were determined a priori prior to data analysis in order to minimize classification bias and to ensure methodological rigor.
Qualitative component
Qualitative data were collected through focus group discussions (FGDs) conducted among 30 staff nurses, who were organized into three groups comprising 8–10 participants each. A semi-structured interview guide was utilised to explore participants’ perceptions regarding awareness of environmental sustainability in healthcare, barriers to the adoption of green nursing practices, existing institutional support and policy gaps, and suggestions for developing a sustainable green nursing workforce. Each FGD session lasted ∼45–60 min and was facilitated by the principal investigator. Field notes were documented throughout the sessions, and all discussions were audio-recorded after obtaining informed consent from the participants.
Validity and reliability
Content validity of the quantitative instrument was established through expert evaluation. The draft questionnaire was reviewed by a panel of five experts from nursing, public health, and environmental health disciplines. Each item was rated for relevance and clarity using a four-point scale. The item-level content validity index (I-CVI) was calculated as the proportion of experts rating an item as either quite relevant or highly relevant. Items with an I-CVI of 0.78 or higher were retained, while others were revised based on expert suggestions. The overall scale-level CVI (S-CVI) was 0.89, indicating good content validity. Necessary modifications were incorporated before pilot testing to ensure clarity and representativeness of the constructs measured. Reliability was assessed using Cronbach’s alpha, which yielded acceptable internal consistency (α >0.7). The qualitative findings were validated through member checking and peer debriefing to enhance credibility and trustworthiness.
Statistical analysis
Quantitative data were entered and analysed using the Statistical Package for the Social Sciences (SPSS) version 20. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participant characteristics and key study variables. The Chi-square test was applied to examine associations between categorical variables. For comparisons of mean knowledge, attitude, and practice scores between two groups, the independent samples t-test was used, where assumptions of normality were satisfied. Multivariable logistic regression analysis was subsequently performed to identify the independent association of green nursing practices while controlling for potential confounders. A p <0.05 was considered statistically significant.
Qualitative data were analysed using thematic analysis. Audio-recorded discussions were transcribed verbatim and reviewed repeatedly to ensure familiarisation with the data. Codes were generated manually and grouped into meaningful categories. Through an iterative analytical process, overarching themes and subthemes were identified to capture patterns related to perceptions, barriers, and facilitators of sustainable nursing practices.
RESULTS
Participant characteristics
A total of 537 registered staff nurses completed the quantitative survey. The participants had a mean age of 28.4 years (SD ± 4.7) and an average clinical experience of 6.2 years (SD ± 3.8), indicating a relatively young workforce with moderate professional exposure. The sample was predominantly female (95.9%), and more than half of the respondents were married (61.8%). Most participants held a Bachelor of Science in Nursing degree (72.3%), reflecting the prevailing educational qualification within the institution. With respect to place of residence, the distribution was almost balanced, with 48.2% residing in rural areas and 51.8% in urban settings, suggesting representation from diverse community backgrounds.
Knowledge, attitude, and practice of green nursing
Analysis of the knowledge domain revealed that a substantial proportion of nurses demonstrated limited understanding of green nursing principles. More than half of the participants (58.7%) fell into the inadequate knowledge category, while 30.2% exhibited moderate knowledge. Only 11.1% achieved scores classified as adequate, indicating that comprehensive awareness of healthcare sustainability concepts remains insufficient among the majority of staff nurses.
In contrast to knowledge levels, attitudes toward environmentally sustainable practices were largely favourable. Approximately 66.9% expressed positive attitudes toward integrating sustainability into nursing care, suggesting a general openness and willingness to support environmentally responsible initiatives.
However, this favourable attitude did not consistently translate into practice. Only 27.6% of nurses reported regular implementation of green nursing behaviours in their clinical settings, whereas 72.4% acknowledged inconsistent adoption of sustainable practices. This discrepancy between attitude and actual practice highlights a potential knowledge-practice gap and suggests the presence of systemic or organisational barriers limiting effective implementation of sustainability initiatives. There was a clear gap between knowledge and practice, despite generally positive attitudes.
Correlation between KAP scores
Composite scores for knowledge, attitude, and practice were obtained by aggregating responses to the respective items within each domain. The possible score ranges were 0–15 for knowledge, 0–20 for attitude, and 0–15 for practice, with higher scores indicating better knowledge, more favourable attitudes, and stronger implementation of green nursing behaviours.
Because the attitude and practice measures were based on Likert-type response formats and the resulting distributions did not fully satisfy assumptions of normality, non-parametric analysis was considered appropriate. Accordingly, Spearman’s rank correlation coefficient was applied to evaluate the direction and strength of relationships among knowledge, attitude, and practice scores.
Spearman correlation analysis revealed a moderate positive correlation between knowledge and attitude (r = 0.42, p <0.01) and between knowledge and practice (r = 0.35, p <0.01). Attitude demonstrated the strongest association with practice (r = 0.48, p <0.01), indicating that nurses with more positive attitudes toward sustainability were more likely to engage in consistent green nursing practices.
Regression analysis: Association of consistent practice
Consistent green nursing practice was operationally defined as achieving at least 70% of the maximum attainable practice score, reflecting regular behaviours such as proper biomedical waste segregation, minimising unnecessary use of disposable materials, switching off electrical equipment when not in use, advocating resource conservation, and adhering to institutional sustainability guidelines.
Prior to multivariable modelling, bivariate analysis was conducted to examine associations between independent variables and practice category. The Chi-square test was used for categorical associated variables, and independent samples t-tests were applied for continuous variables. Variables with a p <0.20 in bivariate analysis were entered into the logistic regression model to control for potential confounding.
Binary logistic regression analysis was then performed to identify the independent association of consistent green nursing practice (consistent = 1; inconsistent = 0). The independent variables included knowledge score, attitude score, age, educational qualification, and years of clinical experience.
The overall regression model was statistically significant (χ2 = 68.42, df = 5, p <0.001), indicating that the association collectively distinguished between consistent and inconsistent practice groups. The model explained ∼24.6% of the variance in practice behaviour (Nagelkerke R2 = 0.246). The Hosmer–Lemeshow goodness-of-fit test was non-significant (p = 0.62), suggesting an adequate model fit.
After adjusting for other variables, both knowledge and attitude scores remained significant association of consistent practice. Each one-unit increase in knowledge score was associated with a 12% increase in the odds of consistent green practice (Adjusted OR = 1.12; 95% CI: 1.06–1.18; p <0.001). Similarly, a one-unit rise in attitude score increased the likelihood of consistent practice by 18% (Adjusted OR = 1.18; 95% CI: 1.11–1.25; p <0.001).
Age was not significantly associated with consistent practice after adjustment (AOR = 1.01; 95% CI: 0.97–1.05; p = 0.54). Educational qualification (Bachelor’s degree compared to Diploma) did not demonstrate a statistically significant association (AOR = 1.29; 95% CI: 0.82–2.04; p = 0.27). Years of clinical experience showed a borderline but non-significant relationship (AOR = 1.07; 95% CI: 0.99–1.16; p = 0.08).
These findings indicate that cognitive and attitudinal factors were stronger determinants of sustainable nursing behaviour than demographic characteristics. The findings of the logistic regression analysis are presented in Table 1.
| Association | Adjusted OR | 95% CI | p value |
|---|---|---|---|
| Knowledge score | 1.12 | 1.06–1.18 | <0.001* |
| Attitude score | 1.18 | 1.11–1.25 | <0.001* |
| Age | 1.01 | 0.97–1.05 | 0.54 |
| Education (BSc vs Diploma) | 1.29 | 0.82–2.04 | 0.27 |
| Years of experience | 1.07 | 0.99–1.16 | 0.08 |
*Significant at p <0.05. OR: Odds ratio, CI: Confidence interval.
Logistic regression analysis indicated that both knowledge and attitude were significant association of consistent green nursing practice. For every one-unit increase in knowledge score, the likelihood of practicing consistent green nursing behaviours increased by 12% (OR = 1.12; 95% CI: 1.06–1.18; p <0.001). Similarly, each unit increase in attitude score was associated with an 18% higher likelihood of consistent practice (OR = 1.18; 95% CI: 1.11–1.25; p <0.001). These findings indicate that improvements in knowledge and attitude are not only statistically significant but also practically meaningful in influencing sustainable nursing behaviours.
Qualitative findings
Thirty staff nurses participated in the focus group discussions, from which four major themes emerged. The findings revealed a lack of formal training, with participants expressing the need for structured educational sessions on sustainable healthcare practices. Limited institutional support was also identified, particularly the absence of clear policies, recycling systems, and operational guidance. Time constraints due to high workload were reported as a significant barrier to the implementation of green nursing practices. Despite these challenges, participants demonstrated a positive attitude and willingness to adopt environmentally sustainable practices, provided adequate support and resources are made available. The major qualitative themes identified from the focus group discussions are summarized in Table 2.
| Theme | Description | Example quote |
|---|---|---|
| Lack of formal training | Insufficient training opportunities | “We want to practice sustainability, but no formal sessions exist.” |
| Limited institutional support | Lack of policy, resources | “There are no recycling bins or energy-saving protocols.” |
| Time constraints | Clinical workload limits implementation | “During busy shifts, it’s hard to follow all green practices.” |
| Motivation to adopt practices | Willingness to adopt if supported | “With training and support, we are ready to implement sustainable measures.” |
DISCUSSION
Sustainable healthcare practices are increasingly acknowledged as critical for minimizing environmental harm and safeguarding public health, particularly in resource-constrained healthcare settings such as India. Green nursing, which integrates environmentally responsible decision-making into daily clinical care, is gaining attention as a workforce-centred strategy for reducing healthcare-related emissions. In the present study, only 11.1% of nurses demonstrated adequate knowledge of green nursing principles, indicating substantial awareness gaps. Similar findings have been reported in Indian tertiary hospitals, where nurses showed limited familiarity with concepts such as carbon footprint reduction, energy-efficient practices, and sustainable procurement.[17-20] Studies conducted in comparable South Asian healthcare settings have likewise observed insufficient integration of environmental sustainability into nursing education and continuing professional development programs.[21-23] These parallels suggest that knowledge deficits remain a systemic challenge rather than an isolated institutional issue.
Despite limited knowledge, attitudes toward sustainability were largely favourable, with 66.9% of participants expressing positive perceptions. Comparable Indian studies examining environmental health practices have reported supportive attitudes among nurses, even when knowledge and infrastructure were limited. Research from other resource-limited healthcare environments has also documented this pattern, where healthcare professionals recognise the importance of environmental responsibility but lack the structural support to operationalise it.[24-26] This divergence indicates that willingness alone is insufficient without cognitive clarity and enabling systems.
Practice findings in the present study revealed that only 27.6% of nurses consistently implemented green nursing behaviours. Similar implementation gaps have been documented in Indian hospitals in the context of biomedical waste management and infection control, where compliance varies despite favourable attitudes. Evidence from public sector hospitals in other low-resource settings similarly indicates that sustainability behaviours are often inconsistent due to workload pressures, limited administrative reinforcement, and the absence of structured training programs.[27-29] These findings underscore that sustainable healthcare practice is influenced by both individual-level determinants and organizational conditions.
The correlation analysis demonstrated moderate positive relationships between knowledge, attitude, and practice, with attitude showing the strongest association with behavioural implementation. This pattern is consistent with established behavioural frameworks, which posit that attitude functions as an immediate motivational driver of action once foundational knowledge is present. Indian knowledge-attitude-practice studies in infection prevention and environmental management have similarly reported that attitude mediates the translation of awareness into practice.[30,31] Thus, while knowledge provides the informational base necessary to understand sustainability principles, attitude shapes the intention to apply them in clinical settings.
Multivariable logistic regression further clarified these relationships by identifying knowledge and attitude as independent associations of consistent green nursing practice, whereas age, educational qualification, and years of experience were not significant. The emergence of knowledge and attitude as the strongest association can be interpreted through both educational and behavioural perspectives. Knowledge enhances conceptual understanding of environmental consequences and appropriate mitigation strategies, thereby increasing confidence in performing sustainable behaviours. Attitude, in turn, reflects perceived value and professional responsibility toward environmental stewardship, which strengthens behavioural intention. When both elements are present, the likelihood of consistent practice increases substantially. Similar findings have been reported in Indian studies evaluating environmental compliance and safety practices, where targeted training and awareness programs significantly improved adherence regardless of demographic characteristics.[32] Research in comparable healthcare systems has likewise shown that structured educational interventions yield greater behavioural change than reliance on seniority or academic degree alone.
Qualitative findings in the present study provide further explanation for these quantitative associations. Participants emphasised the absence of structured sustainability training and limited institutional support as key barriers. This suggests that knowledge deficits are not merely individual shortcomings but reflect gaps in organizational capacity-building. At the same time, nurses expressed strong willingness to engage in environmentally responsible practices if adequate guidance and resources were provided, reinforcing the role of positive attitudes as facilitators of change. Similar themes have been identified in Indian tertiary care institutions and other resource-constrained healthcare environments, where leadership engagement and policy reinforcement significantly influence environmental practice adoption.[11-13]
Collectively, the findings indicate that knowledge and attitude function as central, modifiable determinants of sustainable nursing behaviour. Demographic factors such as age or years of experience appear less influential than cognitive preparedness and motivational orientation. In resource-constrained healthcare settings such as India, interventions that strengthen sustainability knowledge while reinforcing positive professional attitudes may therefore offer the most effective pathway for bridging the gap between environmental awareness and consistent clinical practice. A coordinated approach incorporating curriculum integration, in-service education, administrative support, and policy enforcement is essential to translate favourable perceptions into measurable environmental action.
Limitations
This study has several limitations. Its cross-sectional design limits causal inferences between knowledge, attitude, and practice. The sample was drawn from a single hospital, which may introduce selection bias and limit generalisability to other healthcare settings. Additionally, self- reported practices may be subject to social desirability bias. Factors such as departmental workload, resource availability, and institutional policies were not quantitatively controlled, which may have influenced practice patterns.
CONCLUSION
The study highlights a critical gap between knowledge and practice in green nursing, despite generally positive attitudes among staff nurses. Knowledge and attitude are significant association of consistent practice, indicating that educational interventions and attitude reinforcement are key to promoting sustainable healthcare behaviours. Institutional support, including structured training programs, policy development, and resource provision, is essential to translate positive attitudes into routine green nursing practices. By addressing these barriers, hospitals can foster an environmentally responsible nursing workforce, ultimately contributing to improved patient care and sustainability in healthcare delivery. At the policy level, hospitals should integrate green nursing principles into institutional protocols by establishing formal sustainability guidelines, mandatory staff training programs, waste segregation systems, and energy-efficient clinical workflows to support consistent implementation of environmentally responsible nursing practices.
Acknowledgement
We sincerely thank the selected hospital for their support, resources, and facilitation throughout the study. Special gratitude is extended to all staff nurses who participated, providing valuable insights and cooperation that made this research possible.
Ethical approval
The research/study was approved by the Institutional Review Board at Narayana College of Nursing, number NCON/FP/IEC/2024-007, dated 3rd July 2024.
Declaration of patient consent
Patient’s consent is not required as there are no patients in this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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