{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:01:33Z","timestamp":1790060493548,"version":"4.0.1"},"reference-count":58,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intensive care units (ICUs) are among the most resource\u2010intensive areas within health care and generate more waste and greenhouse gas emissions. Critical care nurses (CCNs) are well positioned to influence environmentally sustainable practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess CCNs' attitudes and climate\u2013health engagement related to healthcare sustainability, to explore perceived challenges and identify other factors affecting sustainable practice in critical care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A quantitative descriptive cross\u2010sectional 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\u20102), Climate, Health and Nursing Tool (CHANT) and a self\u2010developed 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20102 score\u2009=\u200923.87\u2009\u00b1\u20098.69). Concern about the health impacts of climate change ranked highest among CHANT domains (76.0%), while sustainability\u2010related 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\u2010health engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>The study highlights sustainability attitudes, climate\u2013health engagement, perceived challenges and persistent behavioural gaps, while identifying the central roles of education, leadership, and organisational support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70627","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T01:05:39Z","timestamp":1786583139000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Critical Care Nurses' Attitudes, Engagement, Challenges and Other Factors Influencing Healthcare Sustainability and Climate Change"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2416-2843","authenticated-orcid":false,"given":"Amal Ismael","family":"Abdelhafez","sequence":"first","affiliation":[{"name":"Critical Care and Emergency Nursing Department Faculty of Nursing, Assiut University  Asyut Egypt"},{"name":"Nursing Department Fatima College of Health Sciences  Abu Dhabi UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa Wael Mostafa","family":"Mohamed","sequence":"additional","affiliation":[{"name":"The Cambridge High School  Abu Dhabi UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2559-416X","authenticated-orcid":false,"given":"Ahmed Mansour","family":"Alrajeh","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy College of Applied Medical Sciences, King Faisal University  Alhasa Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9151-1882","authenticated-orcid":false,"given":"Annie","family":"Rosita","sequence":"additional","affiliation":[{"name":"Nursing Department Fatima College of Health Sciences  Abu Dhabi UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0062-0325","authenticated-orcid":false,"given":"Nathira","family":"Al Hmaimat","sequence":"additional","affiliation":[{"name":"Nursing Department Fatima College of Health Sciences  Abu Dhabi UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"World Health Organization (WHO) \u201cClimate Change. 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