title: Including sustainability issues in nurse education: A comparative study of first year student nurses' attitudes in four European countries.
abstract: BACKGROUND
  Education in sustainable development is a goal recognised by a large number of countries and a vital concept in healthcare. It is therefore important that nurse education incorporates elements of sustainable development into nursing education curricula. However, there is limited research on student nurses' attitudes towards sustainability and no comparison of attitudes towards sustainability and its inclusion in the nursing curriculum across Europe.
  
  
  OBJECTIVE
  This project aims to assess student nurses' attitudes towards sustainability, its relevance to nursing and its inclusion in the nursing curricula. 1. To assess base-line attitudes at the start of nursing and midwifery training; 2. To compare sustainability awareness between students participating in training in a number of European universities.
  
  
  METHODS
  A comparative survey design using the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire.
  
  
  METHODS
  Nursing classes of Universities and Nursing Schools in four European countries were investigated using a questionnaire consisting of five sustainability-related items.
  
  
  METHODS
  916 nursing students (UK: 450, Germany: 196, Spain: 124, Switzerland: 146).
  
  
  METHODS
  Standard descriptive and inferential statistical methods were used to establish psychometric quality (Principal Components Analysis, Cronbach's alpha, Pearson correlations) and compare student nurses from the four countries.
  
  
  RESULTS
  The reliability of SANS_2 was good (Cronbach's alpha=.82) and the five items loaded on a single factor which explained 58% of variance. ANOVA of the SANS_2 total score showed significant differences between countries with German nursing students showing more sustainability awareness than students from the UK and Spain.
  
  
  CONCLUSIONS
  SANS_2 is a reliable instrument to assess nursing students' sustainability awareness; there are significant differences in sustainability awareness of students of different European countries. Limitations of the study include non-random sampling, possible method effects and social desirability effects.
  
  
  CONCLUSIONS
  Sustainability will become increasingly important in clinical practice; greater knowledge about the attitudes of nurses towards sustainability can support the development and testing of sustainability-focused teaching and learning materials.
authors.affiliation: Faculty of Health and Human Sciences, Plymouth University, 8 Portland Villas, Drake Circus, Plymouth PL4 8AA, UK. Electronic address: janet.richardson@plymouth.ac.uk.
authors.forename: Janet
authors.initials: J
authors.lastname: Richardson
authors.affiliation: Faculty of Social Work, Health Care and Nursing Sciences, Hochschule Esslingen - University of Applied Sciences, Flandernstr. 101, 73732 Esslingen, Germany. Electronic address: Thomas.Heidenreich@hs-esslingen.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Heidenreich
authors.affiliation: Department of Nursing, Faculty of Health Sciences Institution, University of Jaén, Edif. B3, Dep. 243, Campus Las Lagunillas, s/n, 23071 Jaén, Spain. Electronic address: calvarez@ujaen.es.
authors.forename: Carmen
authors.initials: C
authors.lastname: Álvarez-Nieto
authors.affiliation: Institute of Psychology, Research Center in Health Psychology (CerPsa), Faculty of Social and Political Sciences, University of Lausanne, Geopolis - 4530 Dorigny, 1015 Lausanne, Switzerland. Electronic address: Fabienne.Fasseur@unil.ch.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Fasseur
authors.affiliation: Faculty of Health and Human Sciences, Plymouth University, 8 Portland Villas, Drake Circus, Plymouth PL4 8AA, UK. Electronic address: jane.grose1@plymouth.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Grose
authors.affiliation: Faculty of Social Work, Health Care and Nursing Sciences, Hochschule Esslingen - University of Applied Sciences, Flandernstr. 101, 73732 Esslingen, Germany. Electronic address: Norma.Huss@hs-esslingen.de.
authors.forename: Norma
authors.initials: N
authors.lastname: Huss
authors.affiliation: Universiteit Maastricht, Minderbroedersberg 4-6, 616, 6200 MD Maastricht, The Netherlands. Electronic address: m.huynen@maastrichtuniversity.nl.
authors.forename: Maud
authors.initials: M
authors.lastname: Huynen
authors.affiliation: Department of Nursing, Faculty of Health Sciences Institution, University of Jaén, Building B3, Dep. 265, Campus "Las Lagunillas", s/n, 23071 Jaen, Spain. Electronic address: imlopez@ujaen.es.
authors.forename: Isabel M
authors.initials: IM
authors.lastname: López-Medina
authors.affiliation: Research Centre for Health Psychology, Faculty of Social and Political Sciences, University of Lausanne, Geopolis - 4530 Dorigny, 1015 Lausanne, Switzerland. Electronic address: Angelick.Schweizer@unil.ch.
authors.forename: Angélick
authors.initials: A
authors.lastname: Schweizer
mesh_terms: D057231:Climate Change; D003247:Conservation of Natural Resources; D003430:Cross-Sectional Studies; D004508:Education, Nursing, Baccalaureate; D005060:Europe; D006801:Humans; D015404:Nursing Methodology Research; D015203:Reproducibility of Results; D066262:Social Norms; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Attitudes; Climate change; Education; Nurse education; Social norms; Sustainability