A Dissertation on Sustainability Competence: Directions for Nursing

Abstract

Human health and wellbeing are rooted in the environment, and thus are threatened by environmental degradation. The healthcare industry, as the largest sector of the economy by volume and workforce, is a significant contributor to environmental degradation. Sustainable solutions mitigate environmental degradation and protect future generations. Sustainability – defined as the optimization of inclusive human health and wellbeing – is well aligned with the goals of nursing. As members of the most trusted and largest healthcare profession, nurses have a unique opportunity to be change agents by promoting sustainable solutions in practice, research, advocacy, and education. However, sustainability problem-solving is complex and requires advanced critical competence. Sustainability competence is the complex of knowledge, skills, and attitudes that enables sustainability problem-solving. This dissertation explores sustainability competence in nursing education through three specific aims: 1) to describe sustainability competence among a sample of undergraduate and graduate nursing students; 2) to examine whether sustainability competence increases with additional years of nursing education; and 3) to evaluate a sustainability learning intervention (SLI) for its effectiveness at improving sustainability competence among undergraduate students. To address Aims 1 and 2, a baseline survey was electronically distributed to University of Michigan School of Nursing (UMSN) students (n=1,008) using validated measures of sustainability competence from the Sustainability Cultural Indicators Program (SCIP) questionnaire. Sample descriptive statistics of sustainability competence and its components were calculated. Student-level multiple regression analyses investigated associations between years of nursing education and sustainability competence. To address Aim 3, a two-arm randomized pilot of the SLI – a four-hour (two hours of pre-learning, two hours in-class) multimedia case study focused on a local water quality issue from Gala (learngala.com) – compared to a standard curriculum control was conducted in the Fall 2018 UMSN Community Health Nursing course. Five clinical sections (n=38 students) integrated the SLI into standard curriculum and four received a standard curriculum alone (n=30 students). Pre-intervention data was abstracted from the baseline survey. An identical post-intervention survey was distributed in December 2018. Baseline-adjusted difference in differences models estimated intervention effects on sustainability competence. The baseline sample included 380 nursing students. Mean sustainability competence was 4.3, SD=1.0, on a scale from 1 (low) to 10 (high). Component scores ranged from 3.9, SD=1.4 (knowledge), to 4.5, SD=0.8 (skills), to 4.4, SD=1.8 (attitudes). Association of sustainability competence with years of nursing education was not significant (β=-0.05, p=0.237). Among the competence components, knowledge was non-significantly associated (β=-0.05, p=0.360); skill was significantly negatively associated (β=-0.07, p=0.046); and attitude was non-significantly associated with years of nursing education (β=-0.03, p=0.685). The SLI evaluation sample included 35 students among intervention (n=26) and control (n=9) groups. The change in total sustainability competence between the SLI and control groups was not significant (β=0.84, p=0.066). Among the competence components, a significant increase in knowledge (β=1.76, p=0.017), no significant difference in skills (β=0.49, p=0.186), and no significant difference in attitudes (β=0.27, p=0.670) were observed. This dissertation research documents a moderate baseline level of sustainability competence among nursing students, indicating room for improvement. However, results suggest that current nursing curricula may not be effective in developing sustainability competence in students. The SLI improved sustainability competence with medium-to-large effect sizes, indicating potential significance in higher-powered studies. Integrating SLIs into nursing curricula may be an effective and feasible way of increasing sustainability competence among nursing students.