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BACKGROUND: Healthcare systems are adapting to environmental challenges and digital transformations. Practical nurses' perceptions and engagement are key to advancing sustainability in everyday care in a digital setting. Hence, it is essential to explore whether practical nurses within telehomecare settings are prepared for the adoption of sustainable practices and the implications of their perceptions of sustainability within nursing practice for nursing leadership.

AIM: To explore how practical nurses perceive and engage with sustainability within telehomecare.

DESIGN: This study had a qualitative exploratory design.

METHODS: Ten practical nurses working in telehomecare were interviewed between February and April 2024 in Finland. The interviews were individual and semistructured. Data were analyzed through reflexive thematic analysis.

RESULTS: The main themes identified in this study, Emerging Eco-Consciousness in Telehomecare and Constrained Eco-Engagement in Telehomecare, encapsulate the tension between emerging environmental awareness and the limitations of telehomecare settings. The participants demonstrated limited awareness of and engagement with sustainability in their professional roles. Moreover, they regarded the concept of sustainability as ambiguous and had a fragmented understanding of what it entails in the context of healthcare. Their capacity to actively engage in sustainable practices was shaped by challenges related to assuming responsibility, the need to balance professional values with the potential negative outcomes of sustainable digital practices, and limited opportunities for involvement in key organizational decision-making processes.

CONCLUSION: This study highlights a need to cultivate greater consciousness among healthcare professionals and leaders of the critical role of sustainability in healthcare delivery. The results highlight the importance of integrating targeted education and training on environmental issues and sustainable practices to foster climate-health literacy and deepen engagement and of equipping leaders to champion green transitions. Enhancing knowledge and competence in sustainability can, in combination with an ethical, green, transformational leadership style, support organizational shifts toward more environmentally sustainable healthcare systems.

AIM(S): To explore how practical nurses perceive telehomecare in relation to sustainability.

DESIGN: This study had a qualitative exploratory design.

METHODS: Ten practical nurses working with telehomecare were interviewed in February-April 2024. The interviews were individual, semi-structured and were analysed through Braun and Clarke's reflexive thematic analysis.

RESULTS: The overarching theme of this study was 'Telehomecare: A catalyst for a multifaceted transformation towards sustainable practices in homecare nursing', with three main themes and seven subthemes. The three main themes were 'Reshaped delivery of care', 'Reformed work environment' and 'Reallocated resources'. The findings reveal that nurses have multifaceted perspectives on telehomecare in relation to sustainability, recognising both its positive and negative impacts on healthcare organisations, nurses and clients while also acknowledging that more sustainable practices demand significant changes in the healthcare environment.

CONCLUSION: Telehomecare has significant impacts on multiple dimensions of sustainability within healthcare and notable drawbacks. These findings emphasise the critical need for comprehensive education and training in sustainable digital work practices to enhance healthcare professionals' awareness of environmental impacts. This underscores the importance of transformative leadership that drives organisational change towards sustainable healthcare practices and implements effective sustainability policies.

IMPACT: The findings present some aspects of telehomecare that contribute to a lesser environmental impact from a nursing care perspective, encouraging healthcare leaders to make conscious and effective strategic decisions towards more sustainable healthcare. The findings strengthen nurses, leaders and policymakers' knowledge and awareness of sustainable nursing activities in the digital milieu, highlighting the urgent need for transformation of healthcare practices to decrease the environmental impact.

REPORTING METHOD: The study followed the consolidated criteria for reporting qualitative studies (COREQ).

PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.

Aims and objectives: This discussion paper proposes four new nursing leadership roles to address planetary health challenges.

Background: Nurses are essential in reducing healthcare's greenhouse emissions. The Planetary Health Education Framework (PHEF) supports integrating planetary health concepts into sustainable healthcare practice. Nurse educators with planetary health expertise should teach the PHEF, while nurse climate advocates promote it to health professionals, with nurse-led planetary health researchers undertaking climate-change research and Planetary Health Nurse Practitioners practicing sustainable healthcare.

Design: Discussion paper.

Data sources: A PICO framework was used to identify relevant articles: In nursing (P) should new roles be introduced (I) compared to no new roles (C) to understand climate change impacts on both nursing and planetary health (O).

Discussion: Barriers to sustainable healthcare include denial, group-think, and ignorance. National and International organisation enablers highlight the importance of climate change in nurse education. The Australian College of Nursing recommends government funding for nurse-led planetary health research.

Conclusion: Educators should focus on curricula development, nurse climate advocates on education and policy, researchers on supporting planetary health research, and PHNPs on climate justice, environmental protection, and emissions reduction.

Klimatförändringar utgör ett allvarligt hot mot människors hälsa och kräver att hälso- och sjukvården tar en aktiv roll i klimatanpassningen. Denna kunskapsöversikt visar att sjukvårdens anpassning måste utgå från dess kärnuppdrag: att skydda människors liv och välbefinnande. 

Ökad frekvens av extremväder, luftföroreningar och infektionssjukdomar skapar nya utmaningar för vården. Trots detta saknas en tydlig strategi för hur sjukvården ska hantera dessa förändringar. Kunskapsöversikten visar att det behövs en samordnad nationell plan där resurser avsätts för att både förebygga och hantera klimatrelaterade hälsorisker. Idag ser vi en obalans där klimatanpassning ofta prioriteras bort i en redan pressad vårdsektor. Detta leder till att ansvaret faller på enskilda regioner och vårdinrättningar, vilket skapar ojämlikheter och ineffektivitet. 

En viktig del av klimatanpassningen är att integrera klimatfrågor i hälso- och sjukvårdens styrning, utbildning och forskning. Ett ökat fokus på klimat och hälsa i vårdutbildningar behövs, så att framtida vårdpersonal är rustade för de utmaningar som klimatförändringarna innebär. Samtidigt måste forskning finansieras och riktas mot lösningar som möjliggör en mer klimattålig sjukvård, inklusive utveckling av klimatanpassad infrastruktur och sjukvårdssystem. Kunskapsöversikten rekommenderar att:

• Hälsa bör införlivas i all utformning och genomförande av klimatanpassning, med hälso- och sjukvårdspersonal engagerade i varje steg. 
• Den politiska ledningen bör prioritera klimatåtgärder inom landet, regioner och kommuner och över nationsgränserna med fokus på miljörättvisa och främjande av hälsan hos utsatta befolkningar.
• Klimatutbildning bör införlivas i hälso- och sjukvårdens professionsutbildningar för att säkerställa att en grundläggande kunskap byggs upp inom alla sektorer och att kritiskt tänkande utvecklas.
• Forskningsfinansiering bör stimulera klimatsmarta initiativ, inklusive grön och klimattålig infrastruktur och sjukvårdssystem, samt hälsosamma miljöer.

BACKGROUND: As climate change continues to challenge global health, nursing education must evolve to prepare future nurses for the impacts on care delivery and promote sustainable practices within the healthcare system which is itself a contributor to the climate crisis through emissions and waste. In this study we aimed to i) explore undergraduate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nursing education at a Swedish university, and ii) explore differences in awareness and attitudes across student groups in different semesters.

METHODS: In this cross-sectional descriptive research study, nursing students from six groups (semester 1,2,3,4,5,6) of a three-year BSc Nursing programme were asked to complete the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. Descriptive statistics were used to present mean scores for each item, and the Kruskal-Wallis test was used to identify differences in responses between different student groups. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement has been used to report this research.

RESULTS: A total of 211 (32%) students completed the questionnaires. The findings showed that nursing students across the six semesters had relatively good awareness of, and positive attitudes towards, sustainability and climate change (no mean rating below 4 on a scale 1-7). Statistically significant differences between student groups were found in four out of nine items of the SANS_2 questionnaire, with students in their second semester consistently providing the highest ratings (p < 0.05). Notably, the lowest ratings across these four items were provided by students in their last year of the programme.

CONCLUSIONS: This study found that whilst students initially felt equipped to address sustainability issues and climate change in practice, this confidence appears to diminish by the programme's end, raising concerns about the preparedness of the future workforce. This underscores the urgency and importance of continuous reinforcement of sustainability concepts in nursing education, aligning with a spiral curriculum approach which advocates for reiterating themes throughout the curriculum to deepen understanding.

CLINICAL TRIAL NUMBER: Not applicable.

OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).

METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.

RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.

CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

BACKGROUND: Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units.

OBJECTIVE: The aim of this systematic review was to compile the concept of an EE in stroke units.

METHODS: The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included.

RESULTS: This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements.

CONCLUSIONS: To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.

BACKGROUND: It is important to map the clinical competence of newly graduated nurses in Nordic countries. The use of a common Nordic instrument could provide insights into nurses' levels of self-assessed clinical competence and perceptions of their need for professional development.

AIM: To translate and culturally adapt the original Norwegian version of the Professional Nurse Self-Assessment Scale II (PROFFNurse SAS II) into (1) Danish, (2) Finnish and (3) Icelandic versions.

METHOD: The PROFFNurse SAS II was translated and cross-culturally adapted. This translation was inspired by the process used in the Guidelines for Cross-Cultural Adaptation.

RESULT: The translation and cultural adaptation processes employed the required steps and provided specific details. In addition, practical issues encountered during the translation process while translating and adapting instruments that may influence future translations were revealed. This study found that having a professional bilingual/bicultural agency translator was partly problematic in the process of translation and found that it is important to adjust the translations to each country's specific words used in nursing.

CONCLUSION: Translating the PROFFNurse SAS II instrument into all Nordic languages enables us to use the instrument from a Nordic perspective and across various countries. This is important when comparing self-awareness and reflecting on nurses' clinical competencies. Professional development is central to valuing and developing clinical competence and allowing for the discovery of gaps in clinical competence.

Initial harmonization has been found within nursing education in the European Union member states, but with a need for the establishment of further, well-defined standards. The aim of this study was to describe and analyze the main content of nursing education expressed in national guidelines in the Nordic countries, seen as comparisons between the countries and to the European Federation of Nurses Associations (EFN) Competency Framework. A qualitative deductive research method and content analysis were applied to analyze 20 documents, using the EFN Competency Framework as a theoretical framework and analysis matrix. The study was performed in line with the Standards for Reporting Qualitative Research (SRQR) checklist. Variations in structure between the included countries was seen and evident uniformity was lacking. There were differences, e.g. the number of European Credit Transfer and Accumulation System (ECTS) credits needed for a degree that needs to be further explored in relation to the quality of education and the competence of newly qualified nurses. There is a question of whether the EU Framework corresponds to the need for nursing competencies for today and the future. Homogenization of guidelines and structures might facilitate further development and deeper collaboration between the Nordic countries, thereby leading to enhanced patient safety and care quality.