Contextual Variability in Nurses' Discourses on Environmental Sustainability Across Intensive Care Settings: An Exploratory Lexical Analysis

Background: Intensive care units (ICUs) are among the most resource-intensive hospital settings, generating substantial greenhouse gas emissions and waste. While ICU nurses play a central role in advancing sustainability, how clinical context shapes their understanding and enactment of sustainable practices remains unclear. Aim: To explore how nurses frame and integrate environmental sustainability across different intensive care settings. Study design: A qualitative exploratory design was adopted using semi-structured interviews with ICU nurses from Trauma, General, Cardiac and General Surgery ICUs in Italy. Textual data were analysed through Automatic Analysis of Textual Data within the framework of Exploratory Multidimensional Data Analysis. Correspondence analysis identified lexical associations and latent semantic dimensions differentiating sustainability discourses across settings. Findings: A total of 29 ICU nurses participated in the study. Discourses varied markedly by clinical context. Trauma ICUs emphasised cultural awareness and collective responsibility. General ICUs reflected institutional coordination and procedural integration. Cardiac ICUs described systemic barriers and operational strain, while Surgical ICUs highlighted pragmatic alignment with infection prevention. Two latent dimensions, cultural promotion versus institutional coordination and integration versus operational strain, captured how sustainability transitions from value-driven awareness to structured policy practice. Conclusions: Environmental sustainability in intensive care is not a universal construct, but a negotiated, context-dependent practice shaped by cultural, organisational and material factors. Relevance to clinical practice: Promoting sustainability in critical care requires setting-specific strategies that align ecological principles with clinical priorities. Nursing education and leadership should foster both bottom-up engagement and top-down institutional support to embed sustainability into the culture and operations of intensive care.