Dorothy Serwaa BoakyepersName, Atswei Adzo KwashiepersName, Samuel AdjorlolopersName, Kwadwo Ameyaw KorsahpersName (2024date). “Nursing Education for Sustainable Development: A Concept Analysis..” Nursing Opentitle·j.
Object of study — nursing education for sustainable developmentterm·dom
Research question — what attributes, antecedents, consequences and exemplars represent nursing education for sustainable developmentterm·dom
Contribution — a nursing-focused definition and framework of sustainabilityterm·key education for undergraduate programmes
phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | sustainability is inconsistently conceptualised and integrated in nursing curricula — “However, there remain gaps regarding the consistent conceptualisation and integration of sustainability in nursing curriculums” | |
| claim-type | existence — “This moves beyond previous single‐dimension conceptualisations focused predominantly on environmental learning, towards a more comprehensive characterisation aligning with transformational sustainability pedagogies in higher education” | |
| method — evidence | — “The purpose of this concept analysis using the Walker and Avant method is to produce a nursing‐focused conceptual definition and framework of sustainability education for undergraduate nursing programmes” | |
| object of study — evidence | — “In this instance, the concept was ‘nursing education for sustainable development’” | |
| research question — evidence | — “The research question is: What are the core attributes, prerequisites, results and exemplars that represent the concept of ‘nursing education for sustainable development’” | |
| contribution — evidence | — “The concept analysis provides an original synthesised perspective advancing coherence and applicability to guide sustainability education in nursing programmes through a translational framework for competency, curriculum design and content delivery approaches” | |
| mechanism | institutional priority Institutions that prioritise sustainability are more likely to build it into nursing curricula. — “Institutional Priorities : Institutions that prioritise sustainability and recognise its importance in healthcare are more likely to integrate sustainable development principles into their nursing curricula” | mechanisms[0] |
| mechanism | student demand Students who press for sustainability content lead schools to adapt their programmes. — “Student Interest and Engagement : When students demonstrate a strong interest in sustainability and advocate for its inclusion in the curriculum, nursing schools are more likely to respond and adapt their educational programmes accordingly” | mechanisms[1] |
| builds-on | Walker and Avant, concept analysis framework — “We followed the guidelines outlined in the Walker and Avant framework in the conduct and reporting of this paper” | claim_relations[0] |
| builds-on | Hsieh and Shannon 2005, directed qualitative content analysis — “For concept attribute extraction, a directed qualitative content analysis methodology as described by Hsieh and Shannon ( 2005 ) was utilised” | claim_relations[1] |
| sense | sustainability in nursing (environmental lens) - defined chiefly through environmental health and climate change — “Thompson and Schwartz Barcott ( 2017 ) focus strongly on environmental health, defining sustainability for nurses primarily through an ‘environmental lens’ with emphasis on climate change impacts” | senses[0] |
| sense | sustainability in nursing (four pillars) - economics, environment, society and culture, and governance, blended — “Meanwhile, Brundiers et al. ( 2021 ) conceptualise four pillars of sustainability in nursing: economics, environment, society/culture and governance, arguing for a blended integration across these areas” | senses[1] |
| sense | sustainability in nursing (social justice) - framed by faculty as justice and advocacy, by students as stewardship — “Richardson et al. ( 2016 ) found notions of social justice and advocacy were salient themes among nursing faculty, whereas environmental stewardship resonated more among nursing students” | senses[2] |
| relation | SDGs —same-as→ sustainable development goals — The 2015 sustainable development goals (SDGs) codified an agenda to collectively advance people, the planet, prosperity, peace and partnership through cross‐sector collaboration — “The 2015 sustainable development goals (SDGs) codified an agenda to collectively advance people, the planet, prosperity, peace and partnership through cross‐sector collaboration” | concept_edges[0] |
| weight | SDGs —same-as→ sustainable development goals — 0.9 — “The 2015 sustainable development goals (SDGs) codified an agenda to collectively advance people, the planet, prosperity, peace and partnership through cross‐sector collaboration” | concept_edges[0] |
| relation | SANRA —same-as→ scale for the assessment of narrative reviews — Narrative reviews and discussion papers were appraised with the scale for the assessment of narrative reviews (SANRA) — “Narrative reviews and discussion papers were appraised with the scale for the assessment of narrative reviews (SANRA)” | concept_edges[1] |
| weight | SANRA —same-as→ scale for the assessment of narrative reviews — 0.9 — “Narrative reviews and discussion papers were appraised with the scale for the assessment of narrative reviews (SANRA)” | concept_edges[1] |
| relation | environmental health literacy —contrasted-with→ sustainability competencies — As Richardson et al. ( 2016 ) argue, ambiguity persists around constructs like environmental health literacy versus wider interpretations of sustainability competencies expected of nurses — “As Richardson et al. ( 2016 ) argue, ambiguity persists around constructs like environmental health literacy versus wider interpretations of sustainability competencies expected of nurses” | concept_edges[2] |
| weight | environmental health literacy —contrasted-with→ sustainability competencies — 0.5 — “As Richardson et al. ( 2016 ) argue, ambiguity persists around constructs like environmental health literacy versus wider interpretations of sustainability competencies expected of nurses” | concept_edges[2] |
| relation | societal and global context —causes→ nursing education for sustainable development — Societal and Global Context : The societal and global context, including the recognition of environmental challenges, climate change, and the United Nations SDGs, can influence the occurrence and development of nursing education for sustainable development — “Societal and Global Context : The societal and global context, including the recognition of environmental challenges, climate change, and the United Nations SDGs, can influence the occurrence and development of nursing education for sustainable development” | concept_edges[3] |
| weight | societal and global context —causes→ nursing education for sustainable development — 0.5 — “Societal and Global Context : The societal and global context, including the recognition of environmental challenges, climate change, and the United Nations SDGs, can influence the occurrence and development of nursing education for sustainable development” | concept_edges[3] |
| replication | not-applicable | |
| limitation | Primary research was scarce; only four included articles reported original research. — “Primary sources were scarce, with only four articles conducting original research” | limitations[0] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | Core attributes: linked human and ecological health, sustainability-focused curricula, competencies, social justice. — “Core concept attributes are interconnectedness of human/ecological health, sustainability‐focused curriculums, competency cultivation and social justice orientations” | content_tags.findings[0] |
| finding | Antecedents include seeing ecological determinants of health and committed faculty. — “Antecedents include recognising ecological determinants of health and committed nursing faculty” | content_tags.findings[1] |
| quantity | 52,867; 93; 19 — — “Our database searches and Google Scholar exploration yielded 52,867 records. Following an assessment of their eligibility, we pinpointed 93 studies for full‐text screening, of which 19 aligned with the inclusion criteria” | content_tags.quantities[0] |
| key-terms | nursing education for sustainable development, sustainability, sustainable development goals, systems thinking, nursing curricula, concept analysis |
| concept | nursing education for sustainable development — The process of preparing nursing students to understand the interconnectedness of human and environmental health and to address sustainability issues in healthcare, with a focus on enacting systems thinking, social justice orientation and environmentally responsible practices throughout their nursing careers — “The process of preparing nursing students to understand the interconnectedness of human and environmental health and to address sustainability issues in healthcare, with a focus on enacting systems thinking, social justice orientation and environmentally responsible practices throughout their nursing careers” | concepts[0] |
| concept | sustainable development goals — not defined in this paper's own words; the United Nations' 2015 agenda of seventeen goals — “The 2015 sustainable development goals (SDGs) codified an agenda to collectively advance people, the planet, prosperity, peace and partnership through cross‐sector collaboration” | concepts[1] |
| concept | SDGs — sustainable development goals — “The 2015 sustainable development goals (SDGs) codified an agenda to collectively advance people, the planet, prosperity, peace and partnership through cross‐sector collaboration” | concepts[2] |
| concept | environmental awareness — the importance of understanding environmental issues and their impact on health — “Environmental Awareness: Nurse education for sustainable development emphasises the importance of understanding environmental issues and their impact on health” | concepts[3] |
| concept | systems thinking — the ability to think critically and systemically, understanding the complex relationships between healthcare, the environment and society — “Systems Thinking: Nurses should develop the ability to think critically and systemically, understanding the complex relationships between healthcare, the environment and society” | concepts[4] |
| concept | holistic perspective — not defined in this paper's own words; attention to how nature, society and economy bear on health together — “Holistic Perspective: Nurses need to adopt a holistic perspective that considers the interconnectedness of ecological, social and economic systems” | concepts[5] |
| concept | environmental health literacy — not defined in this paper's own words; a narrow, environment-only reading of what nurses must know — “As Richardson et al. ( 2016 ) argue, ambiguity persists around constructs like environmental health literacy versus wider interpretations of sustainability competencies expected of nurses” | concepts[6] |
| concept | sustainability competencies — not defined in this paper's own words; the wider set of abilities nurses need to act for sustainability — “As Richardson et al. ( 2016 ) argue, ambiguity persists around constructs like environmental health literacy versus wider interpretations of sustainability competencies expected of nurses” | concepts[7] |
| concept | societal and global context — not defined in this paper's own words; the wider recognition of environmental threats and global goals — “Societal and Global Context : The societal and global context, including the recognition of environmental challenges, climate change, and the United Nations SDGs, can influence the occurrence and development of nursing education for sustainable development” | concepts[8] |
| concept | Walker and Avant — a widely recognised framework used in nursing and other healthcare disciplines to explore and clarify the meanings of complex concepts — “The Walker and Avant ( 2011 ) model of concept analysis is a widely recognised framework used in nursing and other healthcare disciplines to explore and clarify the meanings of complex concepts” | concepts[9] |
| concept | scale for the assessment of narrative reviews — not defined in this paper's own words; a checklist for rating the quality of narrative reviews — “Narrative reviews and discussion papers were appraised with the scale for the assessment of narrative reviews (SANRA)” | concepts[10] |
| concept | SANRA — scale for the assessment of narrative reviews — “Narrative reviews and discussion papers were appraised with the scale for the assessment of narrative reviews (SANRA)” | concepts[11] |
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Nursing Education for Sustainable Developmentterm·dom: A Concept Analysisterm·key.
Abstract Sustainabilityterm·key represents an increasingly vital yet inconsistently implemented topic in nursing education. Formal concept analysisterm·key can promote unified conceptualisation to inform sustainabilityterm·key integration in nursing curriculums.
Analyse the concept of ‘nursing education for sustainable developmentterm·dom’ using the Walker and Avantterm·mth framework to clarify meaning and application in nursing programmes.
The literature was systematically searched for attributes, antecedents and consequences used to formulate a concept definition, and compared to existing conceptualisations.
Core concept attributes are interconnectedness of human/ecological health, sustainabilityterm·key‐focused curriculums, competency cultivation and social justice orientations. Antecedents include recognising ecological determinants of health and committed nursing faculty. Consequences encompass the preparation of sustainabilityterm·key‐competent nurses and elevated nursing contributions to sustainable health systems.
The concept analysisterm·key provides an original synthesised perspective advancing coherence and applicability to guide sustainabilityterm·key education in nursing programmes through a translational framework for competency, curriculum design and content delivery approaches.
We followed the guidelines outlined in the Walker and Avantterm·mth framework in the conduct and reporting of this paper.
No patient and public contribution.
Introduction Sustainabilityterm·key has become an increasingly crucial issue across industries, including healthcare and nursing education (Goodman 2011 ; Sendall, Fleming, and Lidstone 2011 ). Educating future generations of nurses on sustainabilityterm·key supports environmentally responsible policies and practices in healthcare for the long term (Joseph et al. 2021 ). However, there remain gaps regarding the consistent conceptualisation and integration of sustainabilityterm·key in nursing curriculums (Lawlis et al. 2014 ). To advance a shared understanding in this emerging field, formal concept analysisterm·key methodology can be highly useful for constructing conceptual clarity (Walker and Avantterm·mth 2005 ). The Walker and Avantterm·mth approach to concept analysisterm·key is one of the most established methods that involves identifying essential attributes, antecedents, consequences and prototypes to develop a sdefinitive conceptualisation of the concept (Rodgers, Jacelon, and Knafl 2018 ).
The purpose of this concept analysisterm·key using the Walker and Avantterm·mth method is to produce a nursing‐focused conceptual definition and framework of sustainabilityterm·key education for undergraduate nursing programmes. The research question is: What are the core attributes, prerequisites, results and exemplars that represent the concept of ‘nursing education for sustainable developmentterm·dom’? By rigorously analysing this concept, the resulting theoretical understanding can help inform nursing curriculum development, advance consistency in nursing sustainability competenciesterm·dom, and ultimately guide the integration of sustainabilityterm·key content in nursing schools towards sustainable healthcare systems.
Background Integrating sustainabilityterm·key principles into nursing education aligns with longstanding international policies emphasising nursing's role in primary health care and addressing social determinants of health. The 1978 Alma‐Ata Declaration first highlighted nursing's crucial responsibilities in mitigating economic and social conditions impacting community well‐being. It laid the groundwork for an expanded population health focus beyond just clinical treatment (WHO 1978 ). The 1986 Ottawa Charter for Health Promotion (WHO 2024 ) similarly urged preparing health professionals like nurses to confront the interconnected economic, social and environmental factors allowing poor health to persist—foreshadowing today's need for sustainability competenciesterm·dom.
Over subsequent decades, landmark policies continued positioning nurses to holistically promote equitable communities resilient to modern challenges. The 2015 sustainable development goalsterm·dom (SDGsterm·dom) codified an agenda to collectively advance people, the planet, prosperity, peace and partnership through cross‐sector collaboration (Upvall and Luzincourt 2019 ). Achieving the SDGsterm·dom necessitates developing a health workforce, including sustainabilityterm·key‐oriented nurses, capable of cultivating sustainable, just communities able to withstand threats like climate change, conflicts and globalisation (McKinnon and Fitzpatrick 2017 ; Rosa et al. 2019 ; Rosa and Coach 2017 ).
Nursing has been identified as a pivotal profession to the United Nations agenda towards the achievement of the SDGsterm·dom with a demonstrable alignment between health and the seventeen (17) goals (International Council of Nurses 2017 ; World Health Organization 2016 ). Therefore, nursing education plays a crucial role in promoting sustainable development (Benton and Ferguson 2016 ). Integrating sustainabilityterm·key content across both the theoretical foundations and applied practice experiences in nursing education programmes is vital. Educators can cultivate sustainable change agents capable of meaningfully contributing nursing's unique perspectives and skillsets towards SDGterm·dom targets across ecological, economic and social domains. This bidirectional integration prepares future nurses as sustainabilityterm·key leaders improving health and well‐being for current and future generations (Lilienfeld et al. 2018 ; WHO 2020 ; Fields et al. 2021 ).
Sustainabilityterm·key has garnered increasing attention in nursing curriculums and education in recent years (Thompson and Schwartz Barcott 2017 ). A study by Sendall, Fleming, and Lidstone ( 2011 ) traces the increasing focus on sustainabilityterm·key within nursing, highlighting conceptualisations that recognise the connections between environmental health, human health and nursing advocacy. However, analyses suggest there remains a lack of consensus around sustainability competenciesterm·dom and policy in nursing education (Lawlis et al. 2014 ; Mitchell 2011 ).
Existing literature reveals variable conceptualisations of sustainabilityterm·key in nursing education contexts. Thompson and Schwartz Barcott ( 2017 ) focus strongly on environmental health, defining sustainabilityterm·key for nurses primarily through an ‘environmental lens’ with emphasis on climate change impacts. Meanwhile, Brundiers et al. ( 2021 ) conceptualise four pillars of sustainabilityterm·key in nursing: economics, environment, society/culture and governance, arguing for a blended integration across these areas.
Recent qualitative studies provide additional perspectives into how nursing educators and nursing students conceptualise these issues about curricular priorities (Anåker et al. 2021 ; Kitt‐Lewis et al. 2020 ; Richardson et al. 2014 ). Richardson et al. ( 2016 ) found notions of social justice and advocacy were salient themes among nursing faculty, whereas environmental stewardship resonated more among nursing students. Still, other conceptualisations align sustainabilityterm·key in nursing curriculaterm·key closely with wider organisational and policy dimensions in healthcare settings (Roden and Lewis 2021 ; Fields et al. 2021 ).
Synthesising these works highlights gaps and inconsistencies in conceptualising nursing education for sustainabilityterm·key. As Richardson et al. ( 2016 ) argue, ambiguity persists around constructs like environmental health literacyterm·dom versus wider interpretations of sustainability competenciesterm·dom expected of nurses. This demonstrates the need to advance conceptual clarity through structured concept analysisterm·key geared for application in nursing sustainabilityterm·key education contexts specifically (Rodgers, Jacelon, and Knafl 2018 ; Walker and Avantterm·mth 2005 ).
Methods The Walker and Avantterm·mth ( 2011 ) model of concept analysisterm·key is a widely recognised framework used in nursing and other healthcare disciplines to explore and clarify the meanings of complex concepts. Developed by Kay C. Avant and Lorraine O. Walker, this model provides a systematic and structured approach to concept analysisterm·key, allowing researchers and practitioners to explore complex concepts in a rigorous and comprehensive manner. Per Walker and Avantterm·mth ( 2011 ), this inductive process derives concept meaning through an iterative cycle of scholarly literature review and analytical scrutiny of cases and related examples. Using this well‐established method provides a systematic foundation for conceptual clarity and real‐world applicability. It also helps in promoting clarity and consistency in understanding concepts, enhancing communication and supporting evidence‐based practice in healthcare and other disciplines. The model has eight steps used to highlight the aspects and attributes of a concept. These eight steps are elaborated in Table 1 .
Walker and Avantterm·mth model of concept analysisterm·key: analysis steps.
Literature was systematically searched in PubMed and CINAHL databases in November 2023 using the key terms “nurs* education,” “sustainab* development goal*,” “sustainabilityterm·key principle*” “sustainable development” “curricul*,” “competen*”. Additional highly relevant sources were snowball sampled from references and relevant journal websites. Rigorous Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methods were applied during screening and review (Moher et al. 2009 ; Page et al. 2021 ). The studies for this concept analysisterm·key were selected based on predetermined criteria for inclusion and exclusion. The inclusion criteria were primary research studies (all designs) that explore, describe or measure concepts/attributes related to sustainabilityterm·key education in nursing programmes, systematic reviews, meta‐analyses and other reviews synthesising evidence on sustainabilityterm·key integration in nursing curriculaterm·key, theoretical/conceptual papers and frameworks focused on defining or modelling sustainability competenciesterm·dom for nurses, sources from all geographical regions and publications in English language. Studies/papers focused solely on environmental health nursing without broader sustainabilityterm·key framing, sources about generic ‘environmental education’ without explicit nursing context and opinion pieces, commentaries or editorials without theoretical/empirical analysis were excluded. Our database searches and Google Scholar exploration yielded 52,867 records. Following an assessment of their eligibility, we pinpointed 93 studies for full‐text screening, of which 19 aligned with the inclusion criteria. Details of the screening process is outlined in Figure 1 .
PRISMA flow diagram.
The majority of the articles included in this concept analysisterm·key were primarily of secondary sources, such as concept analysisterm·key (1), scoping reviews (2), narrative review (6), discussion papers (4) and integrative review (1). Primary sources were scarce, with only four articles conducting original research (5). The included studies underwent thorough quality appraisal by two independent reviewers using standardised critical appraisal tools. The specific tool utilised depended on the study design. Narrative reviews and discussion papers were appraised with the scale for the assessment of narrative reviewsterm·mth (SANRAterm·mth) (Baethge et al. 2019 ), scoping reviews and integrative reviews were appraised with the Joana Briggs Institute critical appraisal checklist for systematic reviews and research synthesis (JBI 2014 ), Survey studies were appraised with JBI critical appraisal tool for cross‐sectional studies (Moola et al. 2017 ) and mixed‐method studies were appraised with the mixed‐method appraisal tool (Hong et al. 2018 ).
For concept attribute extraction, a directed qualitative content analysis methodology as described by Hsieh and Shannon ( 2005 ) was utilised. A coding schema was developed by two independent coders based on Walker and Avantterm·mth's ( 2005 ) concept analysisterm·key framework. A summary of data extracted for this concept analysisterm·key is provided in Table 2 .
Summary of data extracted.
Exemplar cases were drawn from retained studies assessed as sufficiently describing or demonstrating the concept attributes. These cases provide a real‐world illustration of the conceptual meaning (Walker and Avantterm·mth 2005 ). As recommended by Walker and Avantterm·mth ( 2005 ), contextually diverse cases were intentionally described as explicitly addressing sustainabilityterm·key in nursing education.
Results The Concept In this instance, the concept was ‘nursing education for sustainable developmentterm·dom’.
Aim/Purpose This concept analysisterm·key aimed to explore, describe, explain and clarify the concept, nursing education for sustainable developmentterm·dom as well as explore its attributes, and understand its relationships. We also sought to provide a definition that facilitates the use and understanding of the concept in nursing.
Identify Uses of the Concept To identify the uses of the concept ‘nursing education for sustainable developmentterm·dom’, we explored how this concept is employed in nursing literature, theory, practice and education. Here are some potential uses of the concept: Curriculum Development : According to Clark et al. ( 2020 ), incorporating sustainabilityterm·key concepts in nursing curriculaterm·key prepares future nurses to address the environmental, social and economic determinants of health, contributing to sustainable development.
Competency Development : The International Council of Nurses (ICN) identifies nursing education for sustainable developmentterm·dom as essential for developing competencies related to environmental health, resource management and advocating for sustainable policies (International Council of Nurses 2017 ). This involves equipping nurses with the knowledge, skills and attitudes necessary to promote environmental sustainabilityterm·key, address social determinants of health and advocate for sustainable healthcare systems.
Research and Evidence‐Based Practice : The concept of nurse education for sustainable development can guide research endeavours focused on understanding the impact of sustainable practices on nursing outcomes, patient health and healthcare systems. For instance, Smith et al. ( 2020 ) conducted a scoping review on the implementation of sustainable practices in occupational therapy and found that education for sustainable development was crucial in promoting sustainable behaviours and improving patient outcomes.
Professional Ethics and Responsibility : The American Nurses Association (ANA) highlights nurse education for sustainable development as a means to cultivate nursing professionals' ethical responsibilities towards environmental sustainabilityterm·key and to enhance the quality of healthcare (American Association of Colleges of Nursing 2020 ). This includes promoting environmentally friendly practices, reducing waste and advocating for sustainable policies and practices within healthcare settings.
Policy and Advocacy : The concept can be employed to inform policy development and advocacy efforts aimed at integrating sustainabilityterm·key principles into healthcare systems. Nursing education for sustainable developmentterm·dom equips nurses to be influential advocates for sustainable healthcare policies and practices at local, national and global levels. (Rosa et al. 2019 ).
Conceptual Definition Integrating these components, nursing education for sustainable developmentterm·dom is defined as follows: The process of preparing nursing students to understand the interconnectedness of human and environmental health and to address sustainabilityterm·key issues in healthcare, with a focus on enacting systems thinkingterm·dom, social justice orientation and environmentally responsible practices throughout their nursing careers (Anåker and Elf 2014 ).
This moves beyond previous single‐dimension conceptualisations focused predominantly on environmental learning, towards a more comprehensive characterisation aligning with transformational sustainabilityterm·key pedagogies in higher education (Cotton and Winter 2010 ). It purposefully integrates dimensions of sustainabilityterm·key competency development as well as antecedent factors and project outcomes reflecting wider constructs of sustainabilityterm·key in nursing education contexts (Roden and Lewis 2021 ; Evans, 2019 ). According to the International Council of Nurses ( 2017 ), this concept acknowledges that nurses play a vital role in fostering sustainable healthcare systems and advocating for policies and practices that promote environmental sustainabilityterm·key, social equity and improved health outcomes.
Identify the Attributes According to Walker and Avantterm·mth ( 2011 ), attributes are the features or qualities that must be present for the concept to be considered nursing education for sustainable developmentterm·dom. The essential characteristics or attributes of this concept discovered in the literature are as follows: Environmental Awarenessterm·dom: Nurse education for sustainable development emphasises the importance of understanding environmental issues and their impact on health. Nurses should be aware of environmental factors that contribute to health problems and be equipped to promote sustainable practices to mitigate these issues (Luque‐Alcaraz et al. 2024 ). Interdisciplinary Approach: This concept recognises the need for collaboration and integration of knowledge from various disciplines. Nurse education for sustainable development encourages interdisciplinary learning, involving fields such as public health, environmental science, ethics and social sciences, to provide a comprehensive understanding of sustainable healthcare (Clark et al. 2020 ; Huss et al. 2020 ). Holistic Perspectiveterm·dom: Nurses need to adopt a holistic perspectiveterm·dom that considers the interconnectedness of ecological, social and economic systems. They should understand how sustainable practices can contribute to improved health outcomes for individuals, communities and the planet as a whole (UNESCO 2017 ; Sherman et al. 2020 ). Ethical Considerations: Nurse education for sustainable development emphasises ethical decision‐making and the promotion of ethical practices in healthcare. This includes addressing issues such as environmental justice, resource allocation, equitable access to healthcare and responsible use of resources (Goodman and East 2013 ). Systems Thinkingterm·dom: Nurses should develop the ability to think critically and systemically, understanding the complex relationships between healthcare, the environment and society (Center for sustainable Future 2008 ). Advocacy and Leadership: Nurses should be equipped with the skills to advocate for sustainable healthcare practices and lead initiatives for change. This includes raising awareness, influencing policies and collaborating with stakeholders to promote sustainable development in healthcare settings (Sensor et al. 2021 ; Smith et al. 2020 ). Lifelong Learning: Nursing education for sustainable developmentterm·dom acknowledges the evolving nature of sustainabilityterm·key challenges. It emphasises the need for nurses to engage in lifelong learning, staying updated on current research, best practices and emerging issues related to sustainabilityterm·key in healthcare (Goodman 2011 ). Practical Application: This concept emphasises the practical application of sustainable practices in nursing education. It encourages hands‐on learning experiences, such as clinical placements in sustainable healthcare settings or participation in sustainabilityterm·key projects, to enhance nurses' skills and understanding of sustainable development (Goodman and East 2013 ; Huss et al. 2020 ).
A Model Case This hypothetical case of a nursing education programme for sustainable development is created by the authors. A group of nursing students from the University of Africa (pseudonym) is enrolled in a community health course dubbed ‘Green Impact for Health’ programme implemented by the nursing school in the University of Africa in collaboration with a local hospital, Serwaa's Memorial Hospital.
In this programme, the nursing students are engaged in a series of workshops and training sessions that promote sustainable healthcare practices. They learn about waste management, energy conservation, water conservation and other eco‐friendly strategies relevant to healthcare settings.
The students are then divided into teams and assigned to the different units in the hospital where they apply their knowledge to identify areas for improvement. They conduct energy audits, assess waste management systems and suggest sustainable alternatives. For example, they may recommend the use of energy‐efficient equipment, recycling programmes, or the implementation of electronic medical records to reduce paper waste.
Throughout the programme, the students collaborate with hospital staff, including nurses, administrators and environmental services, to implement their recommendations. They monitor the impact of their interventions and make adjustments based on feedback and data analysis.
The ‘Green Impact for Health’ programme not only equips nursing students with knowledge and skills related to sustainable healthcare but also empowers them to become agents of change within the healthcare system. It highlights the importance of practical application, interdisciplinary collaboration and leadership in promoting sustainable development in nursing practice.
Borderline Case This borderline case is a fictitious scenario created by the authors.
A nursing school at the University of Africa (Pseudonym) recognises the importance of sustainabilityterm·key in healthcare and establishes a collaboration with a nearby hospital that has embraced sustainable practices. They develop a joint programme where nursing students are assigned to clinical rotations in specific units of the hospital that prioritise sustainabilityterm·key.
During their clinical placements, nursing students observe and actively participate in sustainable healthcare practices. They learn about the hospital's waste management system, energy‐efficient equipment and conservation efforts. They also witness sustainable initiatives like recycling programmes, water conservation strategies and the use of renewable energy sources.
The nursing school integrates sustainabilityterm·key‐focused modules into the core curriculum, ensuring that all nursing students receive dedicated education on sustainable development. These modules cover topics such as environmental health, climate change and health, sustainable resource management and ethical considerations related to sustainabilityterm·key in healthcare.
To further enhance the learning experience, the nursing school invites guest speakers from environmental organisations, public health agencies and sustainabilityterm·key experts to share their knowledge and experiences with the students.
Throughout their education, nursing students engage in research projects and community outreach activities related to sustainable healthcare. They collaborate with faculty members, hospital staff and local communities to raise awareness about sustainable practices, advocate for policy changes and develop innovative solutions to address sustainabilityterm·key challenges.
Although the nursing school has taken significant steps to integrate sustainabilityterm·key into its curriculum and provide practical application opportunities, there is an ongoing effort to expand the scope of sustainabilityterm·key education, foster interdisciplinary collaborations and continuously improve sustainable practices within the nursing school and clinical settings as well as provide continuous training for faculty members.
Contrary Case In a contrary case of nursing education for sustainable developmentterm·dom, a nursing school in the University of Africa (Pseudonym) completely neglects the integration of sustainabilityterm·key principles into their curriculum and fails to recognise the importance of sustainable development in nursing practice.
This nursing school follows a traditional curriculum that solely focuses on clinical skills, medical knowledge and patient care without addressing sustainabilityterm·key as a core component. The school does not offer any dedicated courses or modules related to sustainable healthcare practices, environmental health or resource management. The faculty members are not knowledgeable about sustainable development and do not actively promote or advocate for sustainabilityterm·key in healthcare. There is a lack of awareness among the faculty regarding the potential impact of healthcare practices on the environment, society and future generations.
This nursing school does not collaborate with external organisations or healthcare facilities that prioritise sustainabilityterm·key. There are no opportunities for students to gain practical experience or exposure to sustainable healthcare practices during their clinical placements.
In this contrary scenario, nursing education completely disregards the integration of sustainabilityterm·key principles, hindering the preparation of nurses to address the environmental, social and economic challenges in healthcare.
Identify Antecedents and Consequences The occurrence or development of the concept ‘nursing education for sustainable developmentterm·dom’ is influenced by several factors. These factors can vary in their impact and significance across different contexts and educational settings. Some of the key factors include: Institutional Priorities : Institutions that prioritise sustainabilityterm·key and recognise its importance in healthcare are more likely to integrate sustainable development principles into their nursing curriculaterm·key (Goodman 2016 ). Educational Policies and Accreditation Standards : When sustainabilityterm·key is explicitly included as a requirement or expectation in accreditation standards or educational guidelines, nursing programmes are more likely to incorporate sustainable development concepts into their curricula (Byrne et al. 2013 ). Faculty Expertise and Interest : The knowledge, expertise and interest of faculty members play a significant role in shaping the occurrence and development of nurse education for sustainable development (Argento et al. 2020 ). External Partnerships and Collaborations : Collaborations between nursing schools and external organisations, such as healthcare facilities, environmental agencies or sustainabilityterm·key‐focused institutions, can greatly influence the occurrence and development of nurse education for sustainable development (Ubochi et al. 2019 ). Student Interest and Engagement : When students demonstrate a strong interest in sustainabilityterm·key and advocate for its inclusion in the curriculum, nursing schools are more likely to respond and adapt their educational programmes accordingly (Howell 2021 ). Societal and Global Contextterm·dom : The societal and global contextterm·dom, including the recognition of environmental challenges, climate change, and the United Nations SDGsterm·dom, can influence the occurrence and development of nursing education for sustainable developmentterm·dom (The Center of Sustainable Future 2008 ). Resource Availability : The availability of resources, including funding, infrastructure, teaching materials and faculty development opportunities, can impact the occurrence and development of nursing education for sustainable developmentterm·dom (Bvumbwe and Mtshali 2018 ).
The concept of ‘nursing education for sustainable developmentterm·dom’ can lead to various consequences that have a positive impact on healthcare, the environment and society. Some of the key outcomes that emerge as a result of this concept include: increased awareness and understanding (Luque‐Alcaraz et al. 2024 ), integration of sustainable practices into healthcare (Goodman 2016 ), improved health outcomes (Sherman et al. 2020 ), ethical decision‐making in healthcare (Goodman 2011 ) fosters the development of advocacy and leadership skills among nurses (Sensor et al. 2021 ), research and innovation and contribution to SDGsterm·dom (Goodman 2011 ). A summary of the attributes, antecedents and consequences of this concept analysisterm·key is outlined in Table 3 .
Summary: attributes, antecedents and consequences.
Empirical Referents Empirical referents for sustainable development in research or practice, provide several measurable indicators or variables to be considered. These indicators can help evaluate the extent to which nursing education programmes incorporate sustainable development principles and assess the outcomes or impact of such education (Anåker and Elf 2014 ).
The attributes, antecedents and consequences of sustainabilityterm·key development could be assessed through various approaches. For instance, faculty and student learning competencies could be assessed through self‐efficacy scales, self‐reported measures, interviews and pre and posttest. Curriculum integration could be evaluated by assessing the number of dedicated courses and percentage of total curriculum courses. Practical application of sustainabilityterm·key principles and clinical skills could be measured with observation or evaluation of students' application of sustainable healthcare practices during clinical rotations or simulations or an assessment of students' proficiency in implementing eco‐friendly measures, such as waste management or energy conservation, in healthcare settings. Students' attitudes and perceptions towards sustainable development would be better assessed through surveys or questionnaires (Richardson et al. 2016 ). Sustainable Outcomes are better assessed through the evaluation of the environmental impact of nursing practices before and after the implementation of sustainable education.
Discussion This concept analysisterm·key contributes an original synthesised perspective advancing coherence on sustainabilityterm·key education specifically tailored for application in undergraduate nursing curriculums. Compared to previous interpretations, the developed conceptualisation provides a more comprehensive framing—encompassing attributes aligned with wider sustainabilityterm·key constructs beyond predominantly environmental components, while still foregrounding the interrelations of human and ecological health.
These findings carry salient implications for informing policies and competency models guiding the integration of sustainabilityterm·key content in nursing programmes. The antecedent factors highlighted reinforce calls to strengthen systems thinkingterm·dom, transdisciplinary collaboration, and sustainabilityterm·key‐focused educational leadership as imperatives to drive sustainabilityterm·key advances in nursing education (Osingada and Porta 2020 ; Lopez‐Medina et al. 2019 ). The defining attributes provide a comprehensive understanding of the concept of nursing education for sustainable developmentterm·dom, highlighting its ecological, environmental, future‐oriented, global, holistic and maintenance‐focused nature (Anåker and Elf 2014 ; Şimşek and Erkin 2022 ). The concept attributes and definitional components similarly provide a strategic framework to guide curriculum development, mapping of sustainabilityterm·key learning objectives, and content delivery models.
The model case exemplifies the application of nursing education for sustainable developmentterm·dom by integrating the principles of critical pedagogy and the SDGsterm·dom into nursing curriculaterm·key, thereby preparing nursing students to address global concerns and promote sustainabilityterm·key in their practice (Fields et al. 2022 ; Ward et al. 2022 ; Cook et al. 2019 ; Leffers et al. 2017 ). The borderline case depicted in this study highlights the importance of not just introducing sustainable development in nursing education, but also integrating it throughout the curriculum to ensure that nursing students develop a holistic understanding of its principles and their application to various aspects of nursing practice (Şimşek and Erkin 2022 ; Fields et al. 2022 ). In a similar vein, our contrary case highlights the need for a shift in nursing education to prioritise sustainable development principles and equip nursing students with the skills and knowledge necessary to address these global concerns in their practice.
Additionally, the multi‐level consequences suggest potential impact at individual competency, healthcare delivery and broader health system levels—directing attention to opportune areas for sustainabilityterm·key education evaluation research. Specifically, longitudinal and interventional designs tracking sustainabilityterm·key competency progression and associated clinical practice impacts will continue adding clarity (Richardson et al. 2016 ; Walpole et al. 2019 ). Qualitative case studies detailing curriculum innovation processes also can elucidate best practices for sustainabilityterm·key education design in nursing contexts. Collectively, such research can further validate and refine core conceptual components elucidated through this foundational analysis.
The empirical referents of the concept of nursing education for sustainable developmentterm·dom include the integration of sustainabilityterm·key into nursing academic programmes, the description of the academic subject of nursing, and its incorporation into national and international healthcare organisations (Şimşek and Erkin 2022 ). This concept is also recognised as a key aspect for healthcare professionals to take action towards achieving the targets of the SDGsterm·dom, requiring active participation in social affairs to promote a culture of sustainabilityterm·key both professionally and personally.
Key Points Based on this comprehensive concept analysisterm·key, we deduce that nursing education for sustainable developmentterm·dom is fundamentally about: Training future nurses to understand the deep interconnections between human health, community wellbeing, and environmental sustainabilityterm·key. It moves beyond viewing health solely in individual terms to an eco‐social lens. Integrating sustainabilityterm·key principles throughout nursing curriculums and clinical experiences, not siloed in isolated lessons. This enables development of sustainability competenciesterm·dom applicable across diverse practice settings. Cultivating key skillsets like systems thinkingterm·dom and change management to graduate sustainabilityterm·key‐minded nurses prepared to spearhead positive impacts in healthcare. Framing sustainabilityterm·key as an issue of equity and social justice given disproportionate climate and environmental burdens on marginalized groups. Nurses can address these disparities through sustainable, ethical care. Empowering nurses to partner with communities in finding solutions that jointly foster healthy people and healthy environments, embracing nurses' roles as change agents who can bridge environmental and public health advocacy.
Conclusion Overall, this analysis makes a significant research contribution through its advancement of conceptual coherence, specificity and applicability to inform sustainabilityterm·key education in nursing programmes. Finally, the concept evaluation presents a springboard to inform nascent evaluation research on learning processes and clinical practice impacts resulting from nursing sustainabilityterm·key education innovations. Collectively, this can galvanise momentum for nursing schools to deliver graduates capable of embedded sustainabilityterm·key application in their vital role nourishing human and environmental health.
Author Contributions Dorothy Serwaa BoakyepersName , Atswei Adzo KwashiepersName , Samuel AdjorlolopersName and Kwadwo Ameyaw KorsahpersName: conceptualised the study, developed the methods, drafted the original manuscript and contributed equally to the editing and review of the manuscript. All authors have approved the published version of this paper.
Ethics Statement The authors have nothing to report.
Consent The authors have nothing to report.
Conflicts of Interest The authors declare no conflicts of interest.