Sustainability in undergraduate nursing clinical simulation: A mixed methods study exploring attitudes, knowledge and practices

Climate change is among the greatest of threats to human health. Paradoxically the health system is a contributor to planetary degradation through emissions and waste. Climate change and sustainability are important issues for the nursing profession. We explored the impact of an education module with embedded sustainability principles in the context of clinical simulation.

This mixed methods study used pre- and post-intervention waste audits and student surveys to explore attitudes, knowledge and practices relating to climate change and sustainability. The intervention, a digital clinical simulation education module, included three themes: 1) professional conduct, 2) work health and safety, 3) resource stewardship and sustainability. Quantitative data were analysed through descriptive statistics and comparison of pre- and post-intervention means and proportions. Qualitative data were analysed thematically to identify facilitators and barriers.

We examined two weeks of simulation for the same cohort of 170 students preparing for clinical practice assessment. We found no significant difference in waste per student following the intervention. Most items targeted for re-use were actively diverted to the recycling station with proportional increases following the intervention.

A total of 44 (30.3 %) and 80 (53.3 %) students completed the surveys and most agreed that climate change and sustainability are important issues for nurses. Students’ perceived application of sustainability during clinical simulation increased following the intervention (mean 4.8 to 5.4, p ≤0.01). Perceived application of sustainability in clinical practice, and of the principles ‘reduce’ and ‘re-use’ also increased. Barriers to sustainable practice included cognitive overload, knowledge deficit, time pressure, and desire for authentic practice.

Clinical simulation generates substantial volumes of waste. Student nurses are motivated and capable of applying sustainability principles during simulation, however, often experience barriers. Embedding sustainability principles in simulation curriculum demonstrated positive impacts and ongoing efforts are needed to address barriers and increase opportunities for sustainable practice.