How the hospital context influences nurses’ environmentally responsible practice: A focused ethnography

Abstract

Aim To describe ways in which a hospital context, physically and culturally, influences nurses’ abilities to promote and engage with environmentally responsible practice. Design A focused ethnographic study. Methods Data were collected during May and August, 2019. Nurses (n = 22) working in the emergency room and three medicine units within a large Western Canadian hospital were invited to participate. Semi‐structured interviews were conducted, and observations were collected. Reporting is in accordance with the consolidated criteria for reporting qualitative research. Results Three themes were identified: patient care not environmental care, organizational role and operational efficiency. Overall, participants indicated patient care was their primary priority, and due to their workload, they were unable to simultaneously consider the environmental impact of their work. Participants stated they had difficulties practicing in environmentally responsible ways because they felt unsupported by their hospital organization. Regardless, there was a desire for the organization to support environmentally responsible practices. Conclusion Climate change is a major health concern, and partnership between hospitals and nurses is necessary to ensure environmentally responsible healthcare is delivered. We suggest both a top‐down and bottom‐up approach to help develop hospital contexts that are relevant and environmentally responsible. Impact Nurses have a professional responsibility to address climate change, yet this study identified that nurses found it challenging to practice in environmentally responsible ways within the hospital context. Challenges they faced are related to their workload, their misaligned nursing priorities and, more importantly, because they felt unsupported by their hospital. Findings are important to both the nursing profession as well as other hospital leaders so that a culture of environmentally responsible healthcare can be developed within hospitals.

Association Between Climate Change and Patient Health Outcomes: a Mixed-methods Systematic Review

“…On the other hand, it should be emphasized that nurses are aware that their actions can signi cantly affect waste areas and impact the environment [34]. The main reason for their actions is the lack of support from hospital management [41]. The ndings of this review highlighted that hospitals prioritize patient safety and budget.…”

“…The ndings of this review highlighted that hospitals prioritize patient safety and budget. Nursing students already perceived several obstacles in providing sustainable care to patients within clinical education [35,37,41]. They felt that their lecturers during clinical education did not address awareness of environmental aspects [35] not only because they prioritized the needs of patients in terms of quality and safety, but also due to demands and rush in providing care in the clinical environment, and due to insu cient management support [41].…”

“…Nursing students already perceived several obstacles in providing sustainable care to patients within clinical education [35,37,41]. They felt that their lecturers during clinical education did not address awareness of environmental aspects [35] not only because they prioritized the needs of patients in terms of quality and safety, but also due to demands and rush in providing care in the clinical environment, and due to insu cient management support [41]. On the other hand, rather low nursing competence to support sustainable practice is a result of insu cient education in this area [25,34,36,38].…”

“…When deciding between the needs of the patients and the environmental perspective, the patient is the priority. Nurses must deal with competing priorities and prioritize patient care/safety over the environment [41]. Authors [33]found that although nurses scored high on the awareness scale, awareness alone did not lead to behavior change, because nurses feel overwhelmed.…”

“…These barriers included a lack of con dence due to an imbalance of power and lack of knowledge, resistance to change in practice, lack of time, and lack of facilities [37]. What students may perceive as a lack of environmental awareness on the part of the healthcare staff with whom they work during their clinical placements [35], may be the result of competing priorities in busy clinical settings, prioritizing patient needs and safe care, and lack of organizational support that prevents nurses from acting sustainable [41]. The lack of support was also evident regarding insu cient education about environmental stewardship, as reported by nurses in two studies [25,34].…”