What does this research mean for the field?

Egyptian NICU nurses possess moderate climate-change literacy, but systemic constraints hinder their environmental stewardship practices. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To explore the climate-change literacy and environmental stewardship practices of NICU nurses in Egypt.

February 21, 2026Open Access

Climate change literacy and environmental stewardship in neonatal intensive care: a mixed-methods study of nursing practice patterns

Key Points

To explore the climate-change literacy and environmental stewardship practices of NICU nurses in Egypt.
Mixed-methods design with quantitative and qualitative approaches
95 NICU nurses completed the Climate, Health and Nursing Tool (CHANT)
Quantitative data analyzed using SPSS v28
24 nurses underwent qualitative interviews analyzed via reflexive thematic analysis in NVivo 12
Moderate overall literacy score (mean = 3.15) with higher climate awareness (3.45)
Prior environmental training and NICU experience significantly predicted higher literacy scores
Stewardship behaviors varied by hospital type, with general hospitals showing highest energy-efficient equipment use (75.7%)
Nurses cited resource scarcity and unclear policies as barriers to stewardship, while supportive leadership aided practices.

Abstract

Healthcare produces ≈ 4.4% of global greenhouse-gas emissions, and Neonatal Intensive Care Units (NICUs) are among its most resource-intensive services. In Egypt, where material constraints intensify ecological strain, the climate-change literacy and stewardship practices of NICU nurses remain undocumented. To examine climate-change literacy levels, environmental-stewardship practices, and the factors that influence their implementation among NICU nurses in Egypt. Convergent parallel mixed-methods study (January – March 2024). Ninety-five nurses from three NICUs completed the Climate, Health and Nursing Tool (CHANT). Quantitative data were analysed in SPSS v28 (descriptives, χ², Spearman ρ, multiple linear regression). Twenty-four purposively selected nurses were interviewed, and their transcripts were analyzed using reflexive thematic analysis in NVivo 12. Meta-inferences were generated through joint-display integration. Literacy was moderate (mean = 3.15 ± 0.89); climate awareness was higher (3.45 ± 0.82), while professional engagement lagged (2.87 ± 1.03). Prior environmental training (β = 0.35, p < 0.001) and NICU experience (β = 0.31, p < 0.001) predicted higher literacy (R² = 0.64). Stewardship behaviours differed by hospital type; for energy-efficient equipment use, χ² (2) = 8.94, p = 0.011, with the highest prevalence in general hospitals (75.7%). Qualitatively, nurses described stewardship as constrained by resource scarcity, time pressure, and unclear policy, and enabled by visible leadership, practical training, and supportive peer micro-cultures. Egyptian NICU nurses possess the knowledge base to champion sustainability; however, systemic constraints hinder their actions. Embedding mandatory environmental modules, visible managerial endorsement, and enforceable eco-policies is essential to convert literacy into low-carbon neonatal care. The study provides administrators and educators with a data-driven blueprint for greening NICU operations without compromising neonatal outcomes, thereby advancing national climate commitments and Sustainable Development Goal 3. Not applicable.

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