Nurses’ Perspectives on Climate Change and Sustainability in Healthcare: A Systematic Review and Qualitative Meta-Synthesis

Abstract

Context: Climate change poses significant challenges to global health and healthcare systems, with nurses playing a pivotal role in addressing its impacts and promoting sustainability. Despite the increasing body of qualitative research on nurses’ perspectives, no comprehensive synthesis currently exists to integrate these findings. Objectives: The present study aims to explore nurses’ perceptions, roles, and barriers regarding climate change and sustainable healthcare practices. A qualitative meta-synthesis was conducted to uncover deeper patterns and inform nursing practice and policy. This systematic review and qualitative meta-synthesis aims to explore nurses’ perceptions, roles, and barriers regarding climate change and sustainable healthcare practices to inform nursing practice and policy. Methods: A systematic review and qualitative meta-synthesis was conducted, searching PubMed, Scopus, Web of Science, CINAHL, and PsycINFO for peer-reviewed qualitative studies (2015 - 2025). Eligibility was determined using the SPIDER framework: Sample (registered nurses, nursing students, educators); phenomenon of interest (perceptions, attitudes, experiences of climate change and sustainability); design (qualitative or mixed-methods with substantial qualitative data); evaluation (roles, barriers, facilitators); and research type (peer-reviewed, original studies). Thematic synthesis, following Thomas and Harden (2008), was used to analyze data, with NVivo 12 facilitating coding. Quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist by two reviewers; no studies were excluded based on quality, but results informed interpretation of findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines ensured reporting transparency. Results: Finally, eighteen studies were included after screening 304 records. Four overarching themes emerged: Nurses’ perceptions of climate change and sustainability, impacts on health and healthcare delivery, barriers to sustainable practices, and strategies for action. Nurses viewed sustainability as an ethical imperative but faced a personal-professional divide. Climate change was linked to respiratory and mental health issues, with disruptions in care delivery. Barriers included organizational constraints, lack of education, and workload pressures. Strategies emphasized individual actions, policy reforms, and interdisciplinary collaboration. Conclusions: Nurses are pivotal in addressing climate change within healthcare, yet systemic barriers hinder their engagement in sustainable practices. This meta-synthesis highlights the need for education, policy integration, and interdisciplinary efforts to empower nurses. By aligning personal values with professional roles, nurses can lead sustainability initiatives, mitigating climate impacts and enhancing health equity. Future research should explore quantitative measures and evaluate interventions across diverse healthcare systems to scale effective strategies.