Climate change Clinical impacts and solutions

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

Published: 19 February 2026

Background

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.

Aim

To examine climate-change literacy levels, environmental-stewardship practices, and the factors that influence their implementation among NICU nurses in Egypt.

Design

Convergent parallel mixed-methods study (January – March 2024).

Methods

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.

Results

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.

Conclusion

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.