Empowerment Program about Health Risks of Global Warming and Sustainability Practices among Nurses Providing Maternal and Child Health Services

Empowerment Program about Health Risks of Global Warming and Sustainability Practices among Nurses Providing Maternal and Child Health Services | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Empowerment Program about Health Risks of Global Warming and Sustainability Practices among Nurses Providing Maternal and Child Health Services Eman Mahmoud Seif El –Nasr, Marwa Mamdouh Shaban, Rania Abd Elmohsen Abo El Nour, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5876096/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Global warming poses a severe and escalating threat to human health worldwide, affecting both direct and indirect aspects of human well-being. This study aimed to evaluate the effect of empowerment program about health risks of global warming and sustainability practices among nurses providing maternal and child health services. Methods Employing a quasi-experimental design, a purposive sample of 100 nurses working in maternal and child health services in Tanta City. The research was approved by the ethical committee of the faculty of nursing with IRB number: RHDIRB555-11-2024. The study was conducted across all (6) healthcare facilities providing maternal and child health services in Tanta City. Data was collected using adapted tools including the Self- Nurses Knowledge Interview Questionnaire, and the Environmental sustainability practices questionnaire. Demographic characteristics were analyzed, and pre- and post-intervention scores were compared using paired t-tests were statistical methods. Results There was a statistically significant correlation between knowledge levels regarding global warming and environment sustainability practices among the studied nurses before, immediate post and after three months of empowerment program. Conclusion The study’s findings conclude that implementation of the empowerment program improves nurses’ knowledge regarding global warming and sustainability practices among nurses. The findings suggest a continuous in-service training program for nurses regarding global warming as well as other sustainable development goals and their impact on health, to promote sustainable development. Empowerment Global warming Sustainability practices Figures Figure 1 Figure 2 Figure 3 Background Global warming is recognized as one of the major public health issues of the 21st century, significantly affecting human health and healthcare systems globally [ 1 ]. Nurses, as primary healthcare providers, are essential in tackling the health consequences of global warming and in fostering sustainable healthcare practices. Nonetheless, studies reveal that many nurses do not possess a thorough understanding of the relationship between climate change and health outcomes, nor do they effectively implement sustainable practices in their healthcare environments [ 2 ]. The health effects of global warming are becoming more apparent, showing up in several ways such as extreme weather events, changes in disease patterns, food scarcity, and poor air quality [ 3 ]. Paradoxically, healthcare facilities are major contributors to greenhouse gas emissions, responsible for around 4.4% of global net emissions. This highlights the urgent need to equip nurses with the knowledge and resources necessary to effectively tackle climate-related health issues and to adopt environmentally sustainable practices in their workplaces [ 4 ]. Global warming presents significant and extensive risks to human health, operating through both direct and indirect channels. Increasing temperatures notably heighten the incidence of heat-related illnesses and fatalities, especially among at-risk groups such as the elderly, children, and individuals with pre-existing health issues. The health consequences include cardiovascular diseases, respiratory issues, kidney problems, and mental health disorders. Additionally, global warming aids in the spread of infectious diseases by changing the habitats of disease vectors and pathogens. Extreme weather events associated with climate change led to injuries, fatalities, displacement, and damage to essential healthcare facilities. Deteriorating air quality contributes to rising respiratory and cardiovascular problems, while challenges in food and water security can lead to malnutrition and waterborne diseases [ 1 ]. Global warming denotes the prolonged increase in the Earth's surface temperature, a pattern that has been evident since the pre-industrial period (1850–1900) and is mainly fueled by human activities. The World Health Organization identifies this phenomenon as the most critical health risk of the 21st century. The leading cause of global warming is the escalation of greenhouse gases, such as carbon dioxide, methane, and nitrous oxide in the atmosphere, primarily resulting from fossil fuel combustion. The healthcare sector significantly contributes to this issue, responsible for 8% of carbon emissions in the United States. The impact of the medical field is substantial, accounting for 10% of overall smog and 9% of respiratory diseases associated with particulate matter. This creates a concerning cycle where healthcare operations intensify environmental issues, which in turn exacerbate health challenges among the population [ 5 ]. The greenhouse effect significantly impacts the roles of nurses and healthcare workers in their professional duties. The rise in global temperatures and the occurrence of extreme weather events attributed to this effect result in more cases of heat-related illnesses, respiratory issues, and vector-borne diseases among patients. Nurses need to modify their care protocols to address the increasing instances of heat exhaustion and heatstroke, especially in vulnerable populations like the elderly and those with chronic illnesses. Furthermore, nurses encounter difficult working conditions as healthcare facilities grapple with higher cooling expenses and potential power outages during severe weather. They must also be ready to face new health threats, such as the spread of infectious diseases to different regions and deteriorating air quality affecting respiratory health. Additionally, the greenhouse effect raises occupational health concerns for nurses, who must remain effective while working in potentially overheated environments and managing larger patient volumes during extreme weather [ 5 ]. By the years 2030 to 2050, global warming is projected to lead to around 250,000 extra deaths each year due to malnutrition, malaria, diarrhea, and heat stress. These effects are particularly severe for vulnerable populations in developing countries, which frequently lack the necessary resources and healthcare infrastructure to adapt. Rising temperatures also pose risks to occupational health, as more than 70% of the global workforce is exposed to climate-related health hazards. Additionally, mental health repercussions are becoming more apparent, ranging from acute stress due to extreme weather events to chronic anxiety [ 6 ]. A thorough review by the American Nurses Association [ 7 ] emphasizes that global warming has played a role in the emergence and spread of new pathogens, leading to greater exposure to infectious diseases for nurses. Furthermore, deteriorating air quality due to heightened pollution and wildfires has been associated with increased respiratory issues among healthcare workers. The Intergovernmental Panel on Climate Change (IPCC) [ 3 ] has noted that the link between environmental health and human well-being is becoming clearer, with studies showing that climate change contributes to the rise in respiratory diseases, vector-borne illnesses, heat-related conditions, and mental health challenges. In Egypt, equipping nurses with knowledge about sustainable practices and climate change could enhance the cost-effectiveness of healthcare delivery while minimizing environmental impact. Research has shown that although global warming influences healthcare delivery in Egypt, there is a lack of studies focusing on sustainable healthcare practices specifically for maternal and child health services [ 8 ]. The health impacts of climate change impose a significant economic strain on Egypt, with annual costs amounting to $ 4.8 billion due to medical expenses and lost workforce productivity. By empowering nurses to adopt environmentally sustainable practices, Egypt could potentially lower these costs by 25% while improving maternal and child health outcomes. This highlights the urgent necessity of integrating climate-aware strategies into healthcare delivery systems [ 9 ]. From a public health standpoint, climate-sensitive diseases impact around 35% of maternal and child health cases. Well-educated and empowered nurses can significantly contribute to early detection and prevention, potentially reducing these cases by 40% through enhanced awareness and intervention strategies. Moreover, this study would add to the expanding global research on climate change and healthcare. It also aligns with Egypt's commitment to the United Nations Sustainable Development Goals (SDGs), especially SDG 3 (Good Health and Well-being) and SDG 13 (Climate Action) [ 10 ]. This study aims to evaluate the effect of empowerment program about health risks of global warming and sustainability practices among nurses providing maternal and child health services. Operational definition The empowerment program refers to strengthening nurses' knowledge regarding global warming health risks and implementation of environmental sustainability practices in Maternal and Child Health Services Methods Research Hypothesis: H1. Mean knowledge score of nurses after implementation of the empowerment program will be higher than before. H2. Mean practice scores (immediate and 3 months) of nurses after implementation of the empowerment program will be higher than before. Study Design : A Quasi-experimental design one group pretest-posttest design will be utilized to fulfill the aim of the study. Quasi experimental research design involves the manipulation of independent variables to observe the effect on dependent variable but does not have randomly assigned groups. By using one group pre-posttest design, single case is observed at two time points. One before the intervention and one after intervention. Changes in the outcome of interest are presumed to be the result of the intervention. No control or comparison group is employed [ 11 ]. Setting : The study was conducted across all healthcare facilities providing maternal and child health services in Tanta City, which comprised six centers in total: four maternal and child health centers and two medical health centers. The facilities included Maternal and Child Health Centers include El-Shrouk First District Center, El-Shrouk Second District Center, Kohafa Center, and Azigzy Center. Medical Centers include Mohamed Mashally Center and Siger Medical Center. Sample : A purposive sample of 100 nurses working in previously specified settings in Tanta City. From a total nursing workforce of 134, the researchers determined the sample size using the Raosoft statistical software. The calculation incorporated a 95% confidence level and 5% margin of error. The study maintained a statistical power of 0.90, which reduced the risk of Type II errors and ensured a 90% chance of identifying significant statistical effects when present. The study included nurses who voluntarily consented to participate and excluding those with previous training in global warming health impacts and sustainability practices. A total of 100 out of 134 nurses who fulfil the previous criteria participated and distributed across various maternal and child healthcare facilities in Tanta City. The participants were distributed across six centers: El-Shrouk First District Center (10 nurses), El-Shrouk Second District Center (14 nurses), Kohafa Center (16 nurses), Azigzy Center (10 nurses), Mohamed Mashally Center (30 nurses), and Siger Medical Center (20 nurses). Tools for data collection Data were collected by utilizing the following two tools Tool (I): Nurses Knowledge Interview Questionnaire Regarding Global Warming and sustainability practices : It was crafted by the investigators after an examination of pertinent recent literature [ 12 , 13 ] composed of two parts: First part included sociodemographic and work characteristics of nurses such as age, sex, marital status, residence, educational qualification, place of work, years of experience, training programs attainment, knowledge regarding global warming and environmental sustainability practices, and its source of information. Second part A knowledge assessment tool was developed by investigators to assess nurses' knowledge of global warming and sustainability practices before and after empowerment program. The questionnaire contained 37 questions divided into; health risks assessment (5 questions), greenhouse gas effects (7 questions), global warming (14 questions), sustainability practices (6 questions) and prevention strategies (5 questions). Scoring system : Each correct answer was given a score of 1, while incorrect answers received a score of 0. The total knowledge score was 37 grades, which categorized as the following: low (< 60.0%), equal to 60% to < 75% was moderate and high was ≥ 75.0% of the total score. Tool (II): Environmental sustainability practices questionnaire : was developed by the investigators drawn the research of [ 14 , 15 ]. It was used to assess the nurse's recognition of environmental sustainability practices, across seven dimensions encompassing 26 items as follows; energy saving (6 items); carbon emission reduction (4 items); waste reduction (2 items); water recycling (2 items); economic sustainable practices (3 items); saving nurses (3items) and energy consumption nurses (6items). Scoring system Respondents answered items with a three points Likert scale ranging from one to three as follows (Agree = 3, neutral = 2, disagree = 1). The nurse item scores were aggregated to yield a total percentage. The total was divided by the number of items, and the calculation of the mean and standard deviation was done. The scoring criteria were established such that a high perception was defined as ≥ 70%, while a low perception was indicated by < 70%. Validity and Reliability To validate the data collection instruments, five experts from the community health nursing departments at Tanta and Cairo Universities conducted a thorough evaluation. They assessed the tools for relevance, clarity, and comprehensiveness, achieving a Content Validity Index (CVI) of 0.95, demonstrating strong expert consensus. The tools' reliability was evaluated using Cronbach's alpha, which measures internal consistency. Tool I, containing 27 items, showed high reliability with a coefficient of 0.913. Tool II, comprising 26 items, demonstrated excellent reliability with coefficients of 0.987 and 0.929. These robust statistical measures confirm that both instruments were dependable and consistent in measuring their intended constructs. Ethical Approval The current study obtained ethical approval from the Research Ethics Committee of the Faculty of Nursing at Tanta University, with the assigned code 2024-11-555. Before administering the questionnaire, the investigators emphasized the voluntary nature of participation and provided comprehensive information on the purpose and objectives of the study. Informed consent was obtained from the participants. Nurses who agreed to take part were assured that all data collected during the study would be kept confidential, and they were informed of their ability to withdraw from the study at any point. The questionnaires were completed anonymously, and all gathered information was handled with the utmost discretion, being used exclusively for research-related purposes. Procedure: This study was conducted in Tanta, a city in the Gharbia Governorate of Lower Egypt, approximately 94 km northeast of Cairo. Data collection took place for six months, beginning in August 2024 and ending in January 2025. This period encompassed the pretest, implementation of the empowerment program sessions, and post-test. The investigators introduced themselves to the nurses and explained the aim of the study. Data collection was carried out through group interviews with approximately 30 minutes for each session. Phases of Application of the Program: there were four phases I. Assessment phase: The researcher provided a detailed explanation of the study's objectives and introduced the components of the research tools to the nurses under investigation. Subsequently, the investigators distributed a questionnaire to these nurses to evaluate their knowledge of global warming and environmental sustainability practices. The empowerment program was meticulously crafted and tailored to meet the specific needs of the studied sample. II. Planning phase: The investigators designed a structured educational intervention consisting of four sessions for the participating nurses. They developed clear learning objectives and program content focused on global warming and sustainable development, drawing from current literature. The teaching strategy incorporated multimedia presentations, including PowerPoint slides enriched with videos and images, to deliver the empowerment program effectively. The planning phase encompassed comprehensive preparation of educational materials, careful consideration of teaching venues, and selection of appropriate instructional methodologies to address the identified knowledge gaps and practical needs of the nursing staff. III: Implementation phase: Permission was obtained from all centers that provide maternal and child health services after explaining the work nature and objectives of the study. The investigators divided the study sample into four equal groups, each consisting of 25 nurses. There were four sessions with about 30 minutes for each session. After analyzing the relevant literature and considering the actual needs of the nurses’, a condensed booklet was organized and disseminated to nurses in Arabic language. This resource encompassed both theoretical and applied aspects of global warming and sustainable development. Applying an empowerment program utilized diverse educational strategies, such as lectures, brainstorming sessions, and small-group discussions. The use of a range of teaching aids, such as figures, PowerPoint, handouts, flipcharts, and animated movies. Empowerment Program regarding global warming and sustainability practices included these sessions: The first session began with the investigators introducing themselves, extending their gratitude to the nurses for participating in the study, and outlining the goals, numbers of sessions and expectations of these training sessions. The first session's topics included an introduction to greenhouse effect: definition, ozone layer functions, common greenhouse gases, economic sectors and human activities that increase the greenhouse gases emissions. At the end of the session, encourage participants to ask questions and engage in a group discussion. The second session : gave summary about what was taught in the previous session and give introduction about global warming in the form of (definition, facts of occurrence, causes and impacts on the environment). The Third session: gave summary about what was taught in the previous session, health risks of the global warming and gave introduction to environmental sustainability covering definition, importance, principles and barriers of sustainability practices. Fourth Session: marked the practical component of the empowerment program. This session focused on implementation of global warming actions, green management and sustainability practices. These actions covered areas of energy saving, carbon emission reduction, waste reduction, water recycling, saving nurses, economically practices and energy Consumption actions Also, asking participants about their past experiences and answered any concerns they had about global warming and sustainability development. Subsequently, the post-test was conducted, and the investigators expressed gratitude to each participant for their involvement in the study. IV-Evaluation phase: The effect of the empowerment program regarding global warming and sustainability practices on nurse' knowledge and practice were re- evaluated by using the pre-mentioned tools following the implementation of the program (immediately post and 3 months of the application of the program. Statistical Analysis: The collected data were meticulously organized and categorized, with the results presented in tabular format for clarity. Data analysis was carried out on a compatible personal computer using SPSS; version 23. For quantitative data, mean and standard deviation were calculated. For qualitative data, which describes a categorical set of data by frequency, percentage or proportion of each category, comparison between two groups and more was done using Chi-square test (c 2 ). The one-way ANOVA test was utilized to compare mean scores of three groups. Multiple regression is used to predict the value of one dependent variable based on multiple independent variables. The correlation coefficient was employed as a numerical indicator of statistical relationships between various variables, results were considered significant if p <0.05 and highly significant if p <0.01. Furthermore, the developed research tools were subjected to reliability testing using Cronbach's alpha test, to ensure their consistency and accuracy in measuring the intended constructs. Results Table 1: Demographic and professional work characteristics of study participants Demographic and professional work characteristics No % Age: 20< 30 44 44 30< 40 16 16 40< 50 28 28 50-60 12 12 Mean & SD: 35.730 ± 11.21 Sex Male 29 29 Female 71 71 Marital Status: Single 8 8 Married 81 81 Divorced 9 9 Widow 2 2 Residence Rural 63 63 Urban 37 37 Years of Experience 1<5 27 27 5<10 19 19 10<15 13 13 15<20 27 27 20 & more 14 14 Mean & SD: 14.540± 9.47 - Having information about global warming and environmental Sustainability practices Yes 25 25 No 75 75 - If Yes, Mention Sources of information regarding global warming and environmental sustainability practices * Social media & internet 20 80 TV & Radio 19 76 Family & Friends 12 48 Doctors & other medical staff 9 36 *More than one answer is allowed Table (1): Illustrated that, the age of nurses spanned from 20 to 59 years, with a mean age and standard deviation of 35.730 ± 11.21. Furthermore, slightly less than half (44%) of the participants were under 30 years of age, in contrast to 12% who were below 60 years of age. Most of the nurses surveyed (81%) were married and slightly less than two-thirds (63%) were residing in rural regions. The mean years of experience, along with the standard deviation, were reported as 14.540 ± 9.47. Concerning having information regarding global warming and environmental sustainability, this table elicit that three quarters (75%) of the studied participants lacked this information while, only one quarter (25%) possessed information. The most prevalent sources were social media and the internet, cited by 80% of respondents, closely followed by television and radio, which accounted for 76% of information sources. Figure 1: shows educational levels within the nursing profession, data revealed that graduates from technical nursing institutes constituted the most significant educational category, accounting for 47%, while postgraduates represented the smallest portion at 6%. Figure 2: represents that 30% of the nurses were employed at the Mohamed Mashally Center on Said Street, whereas 20% were affiliated with the medical center in Siger. Additionally, 16% worked at the Maternal and Child Center in Kohafa, with the lowest percentages (10%) observed for those employed at the Maternal and Child Center in El Shrouk (the first district) and the Maternal and Child Center in Azigzy. Figure (3): shows that, 88% of the nursing profession under the study don’t have training programs regarding global warming and environmental sustrainbility practices, in the contrast, there was only 12% of them had training programs. Table (2): Mean Scores of Levels of knowledge among the studied nurses regarding global warming (before, immediate post and after three months of empowerment program (n=100) Levels of knowledge regarding the global warming Before Immediately post 3 months posttest F P N % N % N % 1- knowledge about greenhouse gas effects, global warming & sustainability practices Low 75 75 5 5.0 4 4 89.35 0.0001** Moderate 17 17 9 9. 17 17 High 8 8 86 86 79 79 2- knowledge regarding health risks of warming on human health Low 50 50 3 3.0 8 8 69.97 0.0001** Moderate 28 28 7 7.0 8 8 High 22 22 90 90.0 84 84 3- knowledge regarding preventive and control measures of global warming and environmental sustainability practices Low 52 52 4 4 13 13 45.43 0.0001** Moderate 22 22 5 5 9 9 High 26 26 91 91 78 78 Table (2): reveals that 75 % of the studied nurses exhibited low level of knowledge compared to 8 % had high level prior program, although there were 5% and 4% seen directly after the intervention and at the three-month evaluation had low level of knowledge compared to 86 % and 79% respectively of them had high level. Concerning knowledge regarding health risks of global warming on human health, 50% of the studied nurses had low level of knowledge compared to 22 % had high level of knowledge prior program. Immediately post and three months of follow up, there were low level of knowledge (3% and 8% respectively) compared to (90% and 84% respectively) at the same intervals. As regards to knowledge regarding Preventive and control measures of global warming and environmental sustainability practices, there was 52% of the participants had had low level of knowledge compared to 26 % of them had high level of knowledge, in contrast to the results of the immediately post and three months of fellow up periods, which there were only 4% and 13 % respectively had low level of knowledge compared to 91% and 78 % respectively had high level of knowledge at both points. There was statistically significant difference between score of knowledge prior to program until 3 months after the program implementation (p= 0.0001). Table (3): Mean scores differences of the studied nurses' sustainability practices before, immediate post and after three months of empowerment program (n=100). Environmental sustainability practices items Before Immediately Post 3 months post (Fellow up test) F P value Energy saving 8.56 ±1.68 16.44± 3.26 15.46±2.47 80.266 0.0001 ** Carbon Emission Reduction 7.30±1.77 11.34±2.34 10.27± 1.67 74.429 0.0001** Waste reduction 3.1± 0.849 5.44± 0.923 5.18± 0.821 46.583 0.0001** Water recycling 3.21± 0.936 5.64± 0.789 5.40± 0.772 49.018 0.0001** Saving nurses 4.49± 1.68 8.05± 2.31 7.89± 1.551 73.391 0.0001** Economically practice 4.59± 1.751 8.12±1.78 7.32± 1.205 79.673 0.0001** Energy Consumption Nurses 9.43± 1.590 15.20±3.56 14.94± 2.645 87.347 0.0001** Total 40.71± 8.366 70.26±7.50 66.46± 6.360 136.38 0.0001** ** Highly significant (p<0.01) * significant (p<0.05) F. Repeated measures Table (3): reveals that, there were a highly statistically significant difference ( P<0.0001) in the mean items of environmental sustainability practices and the total mean of nurses’ environmentally sustainable practices throughout the three phases of the study. The notable mean improvement along with standard deviation was observed in energy-saving practices, as they scored 8.560 ±1.68 prior to the program and then increased to 16.44± 3.26 and 15.460±2.47, respectively, immediately post and 3 months after program application. The total mean of environmental sustainability practices was 40.710± 8.366 before program and it improved to 70.26±7.50 immediately post of the program and remained at 66.460 ± 6.360 during the three-month follow-up period. Table 4 : Multivariate linear regression model explaining factors affecting on nurses sustainability practices (n = 100) S.E. is the standard error, and a P value less than 0.05 is significant Table (4): From the results of the regression analysis model, it was illustrated that age, sex, marital status, residence, education and having knowledge weren’t significantly predictors of total sustainability practice scores before empowerment program. Immediately after implementation of the program and 3 month Posttest, 27.3% and 25.7 % respectively of the variance in sustainability practices among nurses were explained by sex only, as (β = -7.982, p = 0.000) and (β = -7.011, p = 0.000) respectively. Table (5): Correlation matrix between the total mean of the study group regarding improvement in Total Environmental Sustainability practice and nurses’ Knowledge regarding the global warming (n=100) Time Total Environmental Sustainability Practice Scores Nurses’ knowledge regarding the global warming r P Before 0.656 0.004** Immediately Post Nurses’ knowledge regarding the global warming 0.305 0.002** 3 Months posttest Nurses’ knowledge regarding the global warming 0.764 0.003** Table 5 represents that, there were a statistically significant positive correlation between the nurses' knowledge and environmental sustainability before, immediately following program and three months of fellow up (p= 0.004, 0.002 and 0.003 respectively). Discussion The current study aimed to investigate the effectiveness of empowerment program about health risks of global warming and sustainability practices among nurses providing maternal and child health services. The socio-demographic characteristics of nurses in the current study indicated that less than half of the participants were aged between twenty and thirty years, with around three-quarters being female and approximately two-thirds residing in rural areas. These findings are consistent with Ebrahim, Ali, & Ahmed, [16] who reported that more than half of both the study and control groups were females aged 17 and that 66.1% lived in rural regions. This trend may be linked to a relative increase in the number of girls compared to boys, as noted in population census data. In terms of work characteristics, about half of the participants in the current study had education from nursing technical institutes, while roughly one-third had less than five years of experience, and over a quarter had between fifteen and twenty years of experience. These results contrast with those of Isangula et al., [17] who found that 75% of nurses had university degrees and more than five years of experience in maternal and child health centers. Regarding nurses' sources of information on global warming and environmental sustainability, the current study found that three-quarters of the participants had no knowledge of these topics. Among those who did have information, 80% obtained it from social media and the internet. These results align with findings from Reddy [18] who reported that participants accessed climate change information primarily through the internet (72%), television (68%), and newspapers (59%). Similarly, Tuna et al [19] discovered that students mainly relied on television and the internet for climate change information. However, this contrasts with the findings of Ali, Mohamed, & Hafez [20] who revealed that over two-thirds (69.9%) of students had prior knowledge about climate change, with the majority (66.8%) acquiring it through their university education. Regarding the knowledge levels of the studied nurses about global warming before, immediately after, and three months following the empowerment program, the current study indicated that most nurses had a low understanding of the fundamentals of global warming and environmental sustainability practices. Half of them also had limited knowledge about the health risks and preventive measures associated with global warming. Furthermore, three-quarters lacked knowledge on these topics, and most had not previously attended training workshops, which explains their low knowledge levels before the program. The study found a significant improvement in nurses' knowledge on various subtopics after the empowerment program sessions and three months later. This outcome is consistent with research by Maiz, Rashed, & Shetaway [21] which demonstrated a significant difference in nurses' knowledge before and after the instructional guidelines on climate change were implemented. Similarly, Álvarez-Nieto et al [22] reported that over 95% of their sample exhibited excellent or highly satisfactory knowledge after completing a training program that utilized scenario-based learning and augmented reality focused on sustainability, climate change, and health. Concerning the differences in mean scores before, immediately after, and three months following the empowerment program, the current study found significant statistical differences in all subitem scores related to environmental sustainability practices among nurses. Additionally, there was a highly significant difference in the total scores for environmental sustainability practices. These results may be attributed to the positive impact of the empowerment training program on sustainability practices, as nurses demonstrated improvements in their methods. Such activities highlight the importance of adopting a holistic approach to sustainability within healthcare settings. The findings of this study align with previous research by Luque-Alcaraz [23] who suggested that incorporating environmental sustainability education into nursing programs can better prepare future nurses to tackle the challenges posed by climate change and foster sustainable health outcomes. Regarding the association between nurses' sociodemographic characteristics and total sustainability practices (before, immediately after, and three months post-tests), the study revealed that sex was a significant positive predictor for variance in total sustainability practice scores immediately after and three months post-test (p=0.000). The investigator believes this may be attributed to the larger sample size of female nurses compared to males. Gender differences in sustainable consumption behaviors, along with stereotypes and variances in social norms and identities, can influence how these gender differences manifest in environmentally relevant actions. This finding is consistent with the research by Mohammed, El-Mouty, & Ameen [24] who found a highly statistically significant association between gender and the total score of practices. Conversely, it contrasts with the results of Mohammed, Fahmy, & Megahed [25] who reported no statistically significant differences in total practice levels based on gender. The current study reveals a statistically significant positive relationship between knowledge about global warming and environmental sustainability practices. This outcome may be attributed to the program's structure, including its activities and events, which primarily emphasized training nurses in essential skills, expanding their knowledge, and providing tools to address health challenges linked to climate change while promoting sustainable healthcare practices. These results underscore the vital role of educational programs in preparing future medical professionals to tackle sustainability and climate change issues effectively. These findings align with previous studies by Aly et al. and Zhang et al. [26 & 27], which reported a positive association between knowledge levels and practical application. Additionally, research conducted by Abdel Nabi, Shafik, and Saad [28] identified a highly significant positive correlation between total knowledge and reported practices concerning climate change. Future research could investigate the generalizability of these findings across various nursing specialties and healthcare settings. Conclusion The study’s findings conclude that implementation of the empowerment program improves nurses’ knowledge regarding global warming and sustainability practices among nurses. There was a statistically significant correlation between knowledge levels regarding global warming and environment sustainability practices among the studied nurses (before, immediate post and after three months of empowerment program). Limitation of the study: The sample was drawn from a single geographic region in Egypt, which may limit the generalizability of the findings to other settings or countries with different healthcare systems. Also, reliance on self-reported measures could introduce bias, although efforts were made to minimize this through selecting diversity maternal and child health centers and using structured tools. Recommendations: Based on the findings of this study, the following recommendations were suggested: Continuous in-service training program for nurses regarding global warming as well as other sustainable development goals and their impact on health, to promote sustainable development. Incorporating global warming and sustainability practices topics into the nursing curriculum and the policies of different nursing workplaces. Social media can be utilized and community organizations mobilized to disseminate correct and relevant information on global warming and sustainable developments goals 2030 Conducting the study again with a larger sample size in a different setting to confirm and generalize the findings. Future research should be established to investigate how rural areas, academic year, gender, and clinical practice influence nurses' knowledge of global warming and its health implications. Expanding the research to include multiple geographic regions and diverse healthcare settings would also enhance the generalizability of the findings. Declarations Ethical Approval: The Tanta University Faculty of Nursing's ethical and research committee granted formal approval IRB number: 555-11-2024, Informed consent to participate was obtained from all of the participants in the study Consent for publication: Not applicable Availability of data and materials: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding: No funding support was received for this study. Acknowledgement: Appreciation is given to all nurses that contributed to the study. Author contribution EMS, MMS, RAE, SMM, NIMand SI contributed to the study conception and design, and Material preparation. All authors read and approved of the final manuscript. Competing interests The authors declare that they have no competing interests. Clinical trial number : Not applicable References World Health Organization (WHO). (2023). Climate Change and Health: Key Facts and Strategic Framework for Action. Geneva: World Health Organization. Leffers, J., McDermott-Levy, R., Smith, C. M., & Sattler, B. (2021). Nursing Education's Response to Climate Change: A Review of the Literature. Nursing Education Perspectives, 42(4), 207-214. Intergovernmental Panel on Climate Change (IPCC). (2022). Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Anderko, L., Schenk, E., Huffling, K., Chalupka, S. (2021). "Climate Change, Health, and Nursing: A Call to Action." 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Egyptian Journal of Nursing & Health Sciences; 3(1): 2682-2563. World Bank Report. (2023) The Global Climate. Crisis Poses Serious Risks to Human Health and Wellbeing. Available from: eliefweb.int/report/world/globalclimate-crisis-poses-serious-risks-humanhealth Ibrahim A, Fahmy H, Mahmoud S. (2018). Knowledge and Attitude Regarding Global Warming Phenomenon among Assiut University Students. Assiut Scientific Nursing Journal.; 6(14): 3-13. Christopher J. Miller, Shawna N. Smith, Marianne P. (2020). Experimental and quasi experimental designs in implementation research, Volume 283, 112452. Woodhall S., Landeg O. and Kovats S. (2021). Public health and climate change: How are local authorities preparing for the health impacts of our changing climate? J Public Health (Oxf.), 43(2):425-432. [Doi:10.1093/PubMed/fdz098]. AL- Mailam M., Arkesh, J. and Hamzawy A. (2023). Climate Change in Egypt: Opportunities and Obstacles. IEJNSR. Vol. 4 (2), 2024 315 available at: https://carnegieendowment.org/2023/10/26/climat e-change-in-egypt-opportunities-and-obstaclespub-90854 Ghazy, H., & Fathy, D. (2023). Effect of Awareness Program Regarding Climate Change on Knowledge, Attitudes and Practices of University Students. International Egyptian Journal of Nursing Sciences and Research , 3 (2), 186-203. Wanda, M. and Lindsey, V. (2019). Climate Change and Health: It's Time for Nurses to Act.' June 2019.; Canadian Association of Physicians for the Environment (CAPE). 'Climate Change Toolkit for Health Professionals: Factsheet: Global Health Impacts of Climate Change. Canadian Federation of Nurses Unions (CFNU). Available at https://nursesunions. ca/wp-content /uploads /2019/0 5/CFNU climatechange-web.pdf. Ebrahim, E., Ali, S., & Ahmed, F. (2024). Effect of Youth Empowerment Program About Climate Change. African journal of biological science, Volume 6, Issue 2, Page 2157 to 10 doi: 10.48047/AFJBS.6.2.2024.2156-2169 Isangula, K., Mwasha, L., Pallangyo, E., & Ndirangu-Mugo, E. (2023). The role of nurse-client relationships in maternal and child healthcare: a qualitative study in rural Tanzania. Front. Health Serv. 3:1058840. Available at: http://doi:10.3389/frhs.2023.1058840 Reddy GP., Rajamouli J., Arora KD., Jothula KY., Amaravadi S., & Boda A., (2022). Knowledge, perceptions and practices of medical students towards climate change and global warming: A cross-sectional study. Journal of family medicine and primary care . 11(6):2557-2564. DOI: 10.4103/jfmpc.jfmpc_1782_21. Tuna, I., Tuna, T., Molu, B., & Keskin, Y. (2022). Determination of nursing students’ awareness of the health effects of climate change. Int J CaringSci, 15:1149 Ali, W., Mohamed, H., & Hafez, D. (2023). Empowering Nursing Students to Face Climate Changes and Its Effects on Health. Egyptian Journal of Nursing & Health Sciences, Vol.4, No.2, 49-64. Maiz, A., Rashed, N., & Shetaway, G.(2024). Effect of instructional Guidelines regarding Climate Change on Nurses' knowledge and its Relation to Environmental Sustainability Practice. Egyptian Journal of Health Care, ( EJHC) Vol. 15:2, 534-547. Álvarez-Nieto C., Álvarez-García C., Parra-Anguita L., Sanz-Martos S. and López-Medina I. (2022). Effectiveness of scenario-based learning and augmented reality for nursing students’ attitudes and awareness toward climate change and sustainability. BMC Nurs., 21, 245. A vailable at: https://doi.org/10.1186/s12912-022-01023-9. Luque-Alcaraz, O., Aparicio-Martínez, P., Gomera, A., & Vaquero-Abellán, M. (2024). The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis. BMC Nursing, 23:229, p3-12. https://doi.org/10.1186/s12912-024-01895-z Mohammed, E., El-Mouty, S., & Ameen, N. (2022). Nursing Students Knowledge, Attitude, And Practice Regarding Health Effect of Climate Change. Mansoura Nursing Journal, 9(2), 589-601. Mohammed, E., Fahmy, L., & Megahed, F. (2024). Effect of Educational Program Regarding Climate Change on Nursing Students' Awareness, Attitude and Practices in Suez Canal University. International Egyptian Journal of Nursing Sciences and Research, 4(2), 297-316 23. Aly, S., Ragab, S., Ahmed, H., Elmowafi, H., Ayed, M., Elsayed, N., & Maiz, M. (2024). Effect of Awareness Program regarding Climate Changes and Sustainability Development on Nursing Internship Students' Knowledge. Egyptian Journal of Health Care, Vol. 15. No. 3, 348- 361 Zhang, J., Tong, Z., Ji, Z., Gong, Y., & Sun, Y. (2022). Effects of Climate Change Knowledge on Adolescents’ Attitudes and Willingness to Participate in Carbon Neutrality Education. International Journal of Environmental Research and Public Health , 19 (17), 10655. Abdel Nabi, E., Shafik, S., & Saad, A. (2023). Assessment of Nursing Students’ Awareness regarding Climate Change. Helwan International Journal for Nursing Research and Practice, 2(1), 69-82. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5876096","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":409555501,"identity":"dfeda502-aac2-48f3-b424-a9c29c0bc5f5","order_by":0,"name":"Eman Mahmoud Seif El –Nasr","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"Eman","middleName":"Mahmoud Seif El","lastName":"–Nasr","suffix":""},{"id":409555502,"identity":"18846003-a6bb-4623-aa1e-224212c3553e","order_by":1,"name":"Marwa Mamdouh Shaban","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYHCDBAZmhgowy4AULWdI1sLYRoQW3fazzyR+MGyT121PPiZdOM8usYG9eZsEQ0UtTi1mZ9LNJHsYbhtuO/MsTXrmtuTEBp5jZRIMZ47j1nIgje0GD8Ntxm03csykebcdSGyQyDGTYGw7hlvL+WdsN/8w3LaHaJkD1CL/BqjlHx4tN9LYbgNtSYRoaQDZwgPU0lCDR8sz9t8yBreTgX5JtuY5lmzcxpNWbJFw7AAeh6UxG76puG277Xjywds8NXay/eyHN974UFOHUwsEIEcEG4hIYDhMQAsWQMiWUTAKRsEoGEEAAEYrVZ+6KBkFAAAAAElFTkSuQmCC","orcid":"","institution":"Lecturer at Community Health Nursing- Faculty of Nursing- Cairo University","correspondingAuthor":true,"prefix":"","firstName":"Marwa","middleName":"Mamdouh","lastName":"Shaban","suffix":""},{"id":409555503,"identity":"8731505f-8d5c-45e5-9871-066548796625","order_by":2,"name":"Rania Abd Elmohsen Abo El Nour","email":"","orcid":"","institution":"Beni-Suef Health Technical Institute, Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Rania","middleName":"Abd Elmohsen Abo El","lastName":"Nour","suffix":""},{"id":409555504,"identity":"1f489d70-3c1e-4750-aa89-f52b0333a1af","order_by":3,"name":"Sayeda Mohamed Mohamed","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"Sayeda","middleName":"Mohamed","lastName":"Mohamed","suffix":""},{"id":409555505,"identity":"9b1372cd-9656-4911-9aab-e52f4e094c57","order_by":4,"name":"Nagwa Ibrahim Mabrouk Baraka","email":"","orcid":"","institution":"Tanta University","correspondingAuthor":false,"prefix":"","firstName":"Nagwa","middleName":"Ibrahim Mabrouk","lastName":"Baraka","suffix":""},{"id":409555507,"identity":"29b211b8-c9cd-4264-928a-68922724b3dc","order_by":5,"name":"Samia Ibrahim Mabrouk baraka","email":"","orcid":"","institution":"Tanta University","correspondingAuthor":false,"prefix":"","firstName":"Samia","middleName":"Ibrahim Mabrouk","lastName":"baraka","suffix":""}],"badges":[],"createdAt":"2025-01-21 22:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5876096/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5876096/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75315014,"identity":"5410bd64-c15b-4f2a-8007-dfa40b85e111","added_by":"auto","created_at":"2025-02-03 09:34:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":152647,"visible":true,"origin":"","legend":"\u003cp\u003eEducational levels within the nursing profession (n=100)\u003c/p\u003e\n\u003cp\u003eshows educational levels within the nursing profession, data revealed that graduates from technical nursing institutes constituted the most significant educational category, accounting for 47%, while postgraduates represented the smallest portion at 6%.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5876096/v1/a6018a9ad15fb70a2ffba972.png"},{"id":75315015,"identity":"d261e278-e87a-450d-9ce0-04f076d31e34","added_by":"auto","created_at":"2025-02-03 09:34:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":186498,"visible":true,"origin":"","legend":"\u003cp\u003eWorkplace of the nursing profession (n=100)\u003c/p\u003e\n\u003cp\u003erepresents that 30% of the nurses were employed at the Mohamed Mashally Center on Said Street, whereas 20% were affiliated with the medical center in Siger. Additionally, 16% worked at the Maternal and Child Center in Kohafa, with the lowest percentages (10%) observed for those employed at the Maternal and Child Center in El Shrouk (the first district) and the Maternal and Child Center in Azigzy.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5876096/v1/dda5656096dea011f0630aa1.png"},{"id":75316508,"identity":"c7bf93b3-4468-4202-a55f-0b9bfa3a72c7","added_by":"auto","created_at":"2025-02-03 09:42:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":188518,"visible":true,"origin":"","legend":"\u003cp\u003ePrevious Training programs about global warming and environmental sustainability practices among nursing profession (n=100)\u003c/p\u003e\n\u003cp\u003eshows that, 88% of the nursing profession under the study don’t have training programs regarding global warming and environmental sustrainbility practices, in the contrast, there was only 12% of them had training programs.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5876096/v1/b6ab2b16f9a3df6ee115c94e.png"},{"id":99796208,"identity":"aac50acd-39a8-431e-8832-80d02f6070da","added_by":"auto","created_at":"2026-01-08 13:40:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1910131,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5876096/v1/93c83ec5-1070-4d85-b781-f235f3cd451e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Empowerment Program about Health Risks of Global Warming and Sustainability Practices among Nurses Providing Maternal and Child Health Services","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobal warming is recognized as one of the major public health issues of the 21st century, significantly affecting human health and healthcare systems globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nurses, as primary healthcare providers, are essential in tackling the health consequences of global warming and in fostering sustainable healthcare practices. Nonetheless, studies reveal that many nurses do not possess a thorough understanding of the relationship between climate change and health outcomes, nor do they effectively implement sustainable practices in their healthcare environments [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe health effects of global warming are becoming more apparent, showing up in several ways such as extreme weather events, changes in disease patterns, food scarcity, and poor air quality [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Paradoxically, healthcare facilities are major contributors to greenhouse gas emissions, responsible for around 4.4% of global net emissions. This highlights the urgent need to equip nurses with the knowledge and resources necessary to effectively tackle climate-related health issues and to adopt environmentally sustainable practices in their workplaces [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobal warming presents significant and extensive risks to human health, operating through both direct and indirect channels. Increasing temperatures notably heighten the incidence of heat-related illnesses and fatalities, especially among at-risk groups such as the elderly, children, and individuals with pre-existing health issues. The health consequences include cardiovascular diseases, respiratory issues, kidney problems, and mental health disorders. Additionally, global warming aids in the spread of infectious diseases by changing the habitats of disease vectors and pathogens. Extreme weather events associated with climate change led to injuries, fatalities, displacement, and damage to essential healthcare facilities. Deteriorating air quality contributes to rising respiratory and cardiovascular problems, while challenges in food and water security can lead to malnutrition and waterborne diseases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobal warming denotes the prolonged increase in the Earth's surface temperature, a pattern that has been evident since the pre-industrial period (1850–1900) and is mainly fueled by human activities. The World Health Organization identifies this phenomenon as the most critical health risk of the 21st century. The leading cause of global warming is the escalation of greenhouse gases, such as carbon dioxide, methane, and nitrous oxide in the atmosphere, primarily resulting from fossil fuel combustion. The healthcare sector significantly contributes to this issue, responsible for 8% of carbon emissions in the United States. The impact of the medical field is substantial, accounting for 10% of overall smog and 9% of respiratory diseases associated with particulate matter. This creates a concerning cycle where healthcare operations intensify environmental issues, which in turn exacerbate health challenges among the population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe greenhouse effect significantly impacts the roles of nurses and healthcare workers in their professional duties. The rise in global temperatures and the occurrence of extreme weather events attributed to this effect result in more cases of heat-related illnesses, respiratory issues, and vector-borne diseases among patients. Nurses need to modify their care protocols to address the increasing instances of heat exhaustion and heatstroke, especially in vulnerable populations like the elderly and those with chronic illnesses. Furthermore, nurses encounter difficult working conditions as healthcare facilities grapple with higher cooling expenses and potential power outages during severe weather. They must also be ready to face new health threats, such as the spread of infectious diseases to different regions and deteriorating air quality affecting respiratory health. Additionally, the greenhouse effect raises occupational health concerns for nurses, who must remain effective while working in potentially overheated environments and managing larger patient volumes during extreme weather [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy the years 2030 to 2050, global warming is projected to lead to around 250,000 extra deaths each year due to malnutrition, malaria, diarrhea, and heat stress. These effects are particularly severe for vulnerable populations in developing countries, which frequently lack the necessary resources and healthcare infrastructure to adapt. Rising temperatures also pose risks to occupational health, as more than 70% of the global workforce is exposed to climate-related health hazards. Additionally, mental health repercussions are becoming more apparent, ranging from acute stress due to extreme weather events to chronic anxiety [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA thorough review by the American Nurses Association [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] emphasizes that global warming has played a role in the emergence and spread of new pathogens, leading to greater exposure to infectious diseases for nurses. Furthermore, deteriorating air quality due to heightened pollution and wildfires has been associated with increased respiratory issues among healthcare workers. The Intergovernmental Panel on Climate Change (IPCC) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] has noted that the link between environmental health and human well-being is becoming clearer, with studies showing that climate change contributes to the rise in respiratory diseases, vector-borne illnesses, heat-related conditions, and mental health challenges.\u003c/p\u003e \u003cp\u003eIn Egypt, equipping nurses with knowledge about sustainable practices and climate change could enhance the cost-effectiveness of healthcare delivery while minimizing environmental impact. Research has shown that although global warming influences healthcare delivery in Egypt, there is a lack of studies focusing on sustainable healthcare practices specifically for maternal and child health services [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe health impacts of climate change impose a significant economic strain on Egypt, with annual costs amounting to \u003cspan\u003e$\u003c/span\u003e4.8\u0026nbsp;billion due to medical expenses and lost workforce productivity. By empowering nurses to adopt environmentally sustainable practices, Egypt could potentially lower these costs by 25% while improving maternal and child health outcomes. This highlights the urgent necessity of integrating climate-aware strategies into healthcare delivery systems [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom a public health standpoint, climate-sensitive diseases impact around 35% of maternal and child health cases. Well-educated and empowered nurses can significantly contribute to early detection and prevention, potentially reducing these cases by 40% through enhanced awareness and intervention strategies. Moreover, this study would add to the expanding global research on climate change and healthcare. It also aligns with Egypt's commitment to the United Nations Sustainable Development Goals (SDGs), especially SDG 3 (Good Health and Well-being) and SDG 13 (Climate Action) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eThis study\u003c/b\u003e aims to evaluate the effect of empowerment program about health risks of global warming and sustainability practices among nurses providing maternal and child health services.\u003c/p\u003e\n\u003ch3\u003eOperational definition\u003c/h3\u003e\n\u003cp\u003eThe empowerment program refers to strengthening nurses' knowledge regarding global warming health risks and implementation of environmental sustainability practices in Maternal and Child Health Services\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003ch2\u003eResearch Hypothesis:\u003c/h2\u003e\u003cp\u003e \u003cb\u003eH1.\u003c/b\u003e Mean knowledge score of nurses after implementation of the empowerment program will be higher than before.\u003c/p\u003e\u003cp\u003e \u003cb\u003eH2.\u003c/b\u003e Mean practice scores (immediate and 3 months) of nurses after implementation of the empowerment program will be higher than before.\u003c/p\u003e\u003cp\u003e \u003cb\u003eStudy Design\u003c/b\u003e: A Quasi-experimental design one group pretest-posttest design will be utilized to fulfill the aim of the study. Quasi experimental research design involves the manipulation of independent variables to observe the effect on dependent variable but does not have randomly assigned groups. By using one group pre-posttest design, single case is observed at two time points. One before the intervention and one after intervention. Changes in the outcome of interest are presumed to be the result of the intervention. No control or comparison group is employed [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003cb\u003eSetting\u003c/b\u003e: The study was conducted across all healthcare facilities providing maternal and child health services in Tanta City, which comprised six centers in total: four maternal and child health centers and two medical health centers. The facilities included \u003cb\u003eMaternal and Child Health Centers\u003c/b\u003e include El-Shrouk First District Center, El-Shrouk Second District Center, Kohafa Center, and Azigzy Center. \u003cb\u003eMedical Centers\u003c/b\u003e include Mohamed Mashally Center and Siger Medical Center.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample\u003c/b\u003e: A purposive sample of 100 nurses working in previously specified settings in Tanta City. From a total nursing workforce of 134, the researchers determined the sample size using the Raosoft statistical software. The calculation incorporated a 95% confidence level and 5% margin of error. The study maintained a statistical power of 0.90, which reduced the risk of Type II errors and ensured a 90% chance of identifying significant statistical effects when present. The study included nurses who voluntarily consented to participate and excluding those with previous training in global warming health impacts and sustainability practices. A total of 100 out of 134 nurses who fulfil the previous criteria participated and distributed across various maternal and child healthcare facilities in Tanta City. The participants were distributed across six centers: El-Shrouk First District Center (10 nurses), El-Shrouk Second District Center (14 nurses), Kohafa Center (16 nurses), Azigzy Center (10 nurses), Mohamed Mashally Center (30 nurses), and Siger Medical Center (20 nurses).\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eTools for data collection\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eData were collected by utilizing the following two tools\u003c/p\u003e\u003cp\u003e \u003cb\u003eTool (I): Nurses Knowledge Interview Questionnaire Regarding Global Warming and sustainability practices\u003c/b\u003e: It was crafted by the investigators after an examination of pertinent recent literature [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] composed of two parts:\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eFirst part\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eincluded sociodemographic and work characteristics of nurses such as age, sex, marital status, residence, educational qualification, place of work, years of experience, training programs attainment, knowledge regarding global warming and environmental sustainability practices, and its source of information.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eSecond part\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eA knowledge assessment tool was developed by investigators to assess nurses' knowledge of global warming and sustainability practices before and after empowerment program. The questionnaire contained 37 questions divided into; health risks assessment (5 questions), greenhouse gas effects (7 questions), global warming (14 questions), sustainability practices (6 questions) and prevention strategies (5 questions).\u003c/p\u003e\u003cp\u003e \u003cb\u003eScoring system\u003c/b\u003e: Each correct answer was given a score of 1, while incorrect answers received a score of 0. The total knowledge score was 37 grades, which categorized as the following: low (\u0026lt; 60.0%), equal to 60% to \u0026lt; 75% was moderate and high was ≥ 75.0% of the total score.\u003c/p\u003e\u003cp\u003e \u003cb\u003eTool (II): Environmental sustainability practices questionnaire\u003c/b\u003e: was developed by the investigators drawn the research of [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It was used to assess the nurse's recognition of environmental sustainability practices, across seven dimensions encompassing 26 items as follows; energy saving (6 items); carbon emission reduction (4 items); waste reduction (2 items); water recycling (2 items); economic sustainable practices (3 items); saving nurses (3items) and energy consumption nurses (6items).\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eScoring system\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eRespondents answered items with a three points Likert scale ranging from one to three as follows (Agree = 3, neutral = 2, disagree = 1). The nurse item scores were aggregated to yield a total percentage. The total was divided by the number of items, and the calculation of the mean and standard deviation was done. The scoring criteria were established such that a high perception was defined as ≥ 70%, while a low perception was indicated by \u0026lt; 70%.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eValidity and Reliability\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eTo validate the data collection instruments, five experts from the community health nursing departments at Tanta and Cairo Universities conducted a thorough evaluation. They assessed the tools for relevance, clarity, and comprehensiveness, achieving a Content Validity Index (CVI) of 0.95, demonstrating strong expert consensus. The tools' reliability was evaluated using Cronbach's alpha, which measures internal consistency. Tool I, containing 27 items, showed high reliability with a coefficient of 0.913. Tool II, comprising 26 items, demonstrated excellent reliability with coefficients of 0.987 and 0.929. These robust statistical measures confirm that both instruments were dependable and consistent in measuring their intended constructs.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study obtained ethical approval from the Research Ethics Committee of the Faculty of Nursing at Tanta University, with the assigned code 2024-11-555. Before administering the questionnaire, the investigators emphasized the voluntary nature of participation and provided comprehensive information on the purpose and objectives of the study. Informed consent was obtained from the participants. Nurses who agreed to take part were assured that all data collected during the study would be kept confidential, and they were informed of their ability to withdraw from the study at any point. The questionnaires were completed anonymously, and all gathered information was handled with the utmost discretion, being used exclusively for research-related purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure:\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was conducted in Tanta, a city in the Gharbia Governorate of Lower Egypt, approximately 94 km northeast of Cairo. Data collection took place for six months, beginning in August 2024 and ending in January 2025. This period encompassed the pretest, implementation of the empowerment program sessions, and post-test. The investigators introduced themselves to the nurses and explained the aim of the study. Data collection was carried out through group interviews with approximately 30 minutes for each session.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhases of Application of the Program:\u0026nbsp;\u003c/strong\u003ethere were four phases\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eI. Assessment phase:\u0026nbsp;\u003c/strong\u003eThe researcher provided a detailed explanation of the study\u0026apos;s objectives and introduced the components of the research tools to the nurses under investigation. Subsequently, the investigators distributed a questionnaire to these nurses to evaluate their knowledge of global warming and environmental sustainability practices. The empowerment program was meticulously crafted and tailored to meet the specific needs of the studied sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eII. Planning phase:\u0026nbsp;\u003c/strong\u003eThe investigators designed a structured educational intervention consisting of four sessions for the participating nurses. They developed clear learning objectives and program content focused on global warming and sustainable development, drawing from current literature. The teaching strategy incorporated multimedia presentations, including PowerPoint slides enriched with videos and images, to deliver the empowerment program effectively. The planning phase encompassed comprehensive preparation of educational materials, careful consideration of teaching venues, and selection of appropriate instructional methodologies to address the identified knowledge gaps and practical needs of the nursing staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIII: Implementation phase:\u0026nbsp;\u003c/strong\u003ePermission was obtained from all centers that provide maternal and child health services after explaining the work nature and objectives of the study. The investigators divided the study sample into four equal groups, each consisting of 25 nurses. There were four sessions with about 30 minutes for each session.\u0026nbsp;After analyzing the relevant literature and considering the actual needs of the nurses\u0026rsquo;, a condensed booklet was organized and disseminated to nurses in Arabic language. This resource encompassed both theoretical and applied aspects of global warming and sustainable development. \u0026nbsp; Applying an empowerment program utilized diverse educational strategies, such as lectures, brainstorming sessions, and small-group discussions. The use of a range of teaching aids, such as figures, PowerPoint, handouts, flipcharts, and animated movies. \u0026nbsp;Empowerment Program regarding global warming and sustainability practices included these sessions:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe first session\u003c/strong\u003e began with the investigators introducing themselves, extending their gratitude to the nurses for participating in the study, and outlining the goals, numbers of sessions and expectations of these training sessions. The first session\u0026apos;s topics included an introduction to greenhouse effect: definition, ozone layer functions, common greenhouse gases, economic sectors and human activities that increase the greenhouse gases emissions. At the end of the session, encourage participants to ask questions and engage in a group discussion. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe second session\u003c/strong\u003e: gave summary about what was taught in the previous session and give introduction about global warming in the form of (definition, facts of occurrence, causes and impacts on the environment).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Third session:\u0026nbsp;\u003c/strong\u003egave summary about what was taught in the previous session, health risks of the global warming and gave introduction to environmental sustainability covering definition, importance, principles and barriers of sustainability practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFourth Session:\u003c/strong\u003e\u0026nbsp; marked the practical component of the empowerment program. This session focused on implementation of global warming actions, green management and sustainability practices. These actions covered areas of energy saving, carbon emission reduction, waste reduction, water recycling, saving nurses, economically practices and energy Consumption actions Also, asking participants about their past experiences and answered any concerns they had about global warming and sustainability development. Subsequently, the post-test was conducted, and the investigators expressed gratitude to each participant for their involvement in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIV-Evaluation phase:\u003c/strong\u003e The effect of the empowerment program regarding global warming and sustainability practices on nurse\u0026apos; knowledge and practice were re- evaluated by using the pre-mentioned tools following the implementation of the program (immediately post and 3 months of the application of the program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u0026nbsp;\u003c/strong\u003eThe collected data were meticulously organized and categorized, with the results presented in tabular format for clarity. Data analysis was carried out on a compatible personal computer using SPSS; version 23. \u0026nbsp;For quantitative data, mean and standard deviation were calculated. For qualitative data, which describes a categorical set of data by frequency, percentage or proportion of each category, comparison between two groups and more was done using Chi-square test (c\u003csup\u003e2\u003c/sup\u003e). \u0026nbsp; The one-way ANOVA test was utilized to compare mean scores of three groups. \u0026nbsp;Multiple regression is used to predict the value of one dependent variable based on multiple independent variables. The correlation coefficient was employed as a numerical indicator of statistical relationships between various variables, results were considered significant if p \u0026lt;0.05 and highly significant if p \u0026lt;0.01. Furthermore, the developed research tools were subjected to reliability testing using Cronbach\u0026apos;s alpha test, to ensure their consistency and accuracy in measuring the intended constructs.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003eTable 1: Demographic\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand professional work\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003echaracteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eDemographic and professional work characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003eAge:\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e20\u0026lt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e30\u0026lt; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e40\u0026lt; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026amp; SD:\u0026nbsp;\u003c/strong\u003e35.730 \u0026plusmn; 11.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSex\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 36.1331%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMarital Status:\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eYears of Experience\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e1\u0026lt;5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e5\u0026lt;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e10\u0026lt;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e15\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003e20 \u0026amp; more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026amp; SD:\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; 14.540\u0026plusmn; 9.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;\"\u003e\n \u003cp\u003e- Having information about global warming and environmental Sustainability practices\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100%;\"\u003e\n \u003cp\u003e- If Yes, Mention Sources of information regarding global warming and environmental sustainability practices *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eSocial media \u0026amp; internet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eTV \u0026amp; Radio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eFamily \u0026amp; Friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63.8669%;\"\u003e\n \u003cp\u003eDoctors \u0026amp; other medical staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.0666%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*More than one answer is allowed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eTable (1): Illustrated that, the age of nurses spanned from 20 to 59 years, with a mean age and standard deviation of 35.730 \u0026plusmn; 11.21. Furthermore, slightly less than half (44%) of the participants were under 30 years of age, in contrast to 12% who were below 60 years of age. Most of the nurses surveyed (81%) were married and slightly less than two-thirds (63%) were residing in rural regions. The mean years of experience, along with the standard deviation, were reported as 14.540 \u0026plusmn; 9.47. Concerning having information regarding global warming and environmental sustainability, this table elicit that three quarters (75%) of the studied participants lacked this information while, only one quarter (25%) possessed information. The most prevalent sources were social media and the internet, cited by 80% of respondents, closely followed by television and radio, which accounted for 76% of information sources.\u003c/p\u003e\n\u003cp\u003eFigure 1: shows educational levels within the nursing profession, data revealed that graduates from technical nursing institutes constituted the most significant educational category, accounting for 47%, while postgraduates represented the smallest portion at 6%.\u003c/p\u003e\n\u003cp\u003eFigure 2: represents that 30% of the nurses were employed at the Mohamed Mashally Center on Said Street, whereas 20% were affiliated with the medical center in Siger. Additionally, 16% worked at the Maternal and Child Center in Kohafa, with the lowest percentages (10%) observed for those employed at the Maternal and Child Center in El Shrouk (the first district) and the Maternal and Child Center in Azigzy.\u003c/p\u003e\n\u003cp\u003eFigure (3): shows that, 88% of the nursing profession under the study don\u0026rsquo;t have training programs regarding global warming and environmental sustrainbility practices, in the contrast, there was only 12% of them had training programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2):\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMean Scores of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eLevels of knowledge among the studied nurses regarding global warming (before, immediate post and after three months of empowerment program (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eLevels of knowledge regarding the global warming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eImmediately post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3 months posttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e1- knowledge about greenhouse gas effects, global warming \u0026amp; sustainability practices\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e89.35\u003c/p\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e9.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 49px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e2- knowledge regarding health risks of warming on human health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e69.97\u003c/p\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e90.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e3- knowledge regarding preventive and control measures of global warming and environmental sustainability practices\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e45.43\u003c/p\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 51px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 51px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable (2): reveals that 75 % of the studied nurses exhibited low level of knowledge compared to 8 % had high level prior program, although there were 5% and 4% seen directly after the intervention and at the three-month evaluation had low level of knowledge compared to 86 % and 79% respectively of them had high level. Concerning knowledge regarding health risks of global warming on human health, 50% of the studied nurses had low level of knowledge compared to 22 % had high level of knowledge prior program. Immediately post and three months of follow up, there were low level of knowledge (3% and 8% respectively) compared to (90% and 84% respectively) at the same intervals. \u0026nbsp;As regards to knowledge regarding Preventive and control measures of global warming and environmental sustainability practices, there was 52% of the participants had had low level of knowledge compared to 26 % of them had high level of knowledge, in contrast to the results of the immediately post and three months of fellow up periods, which there were only 4% and 13 % respectively had low level of knowledge compared to 91% and 78 % respectively had high level of knowledge at both points. \u0026nbsp;There was statistically significant difference between score of knowledge prior to program until 3 months after the program implementation (p= 0.0001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3): Mean scores differences of the studied nurses\u0026apos; sustainability practices before, immediate post and after three months of empowerment program (n=100).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"674\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eEnvironmental sustainability practices items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eImmediately Post\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3 months post (Fellow up test)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eEnergy saving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8.56 \u0026plusmn;1.68\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e16.44\u0026plusmn; 3.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e15.46\u0026plusmn;2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e80.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001 **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eCarbon Emission Reduction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.30\u0026plusmn;1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11.34\u0026plusmn;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e10.27\u0026plusmn; 1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e74.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eWaste reduction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3.1\u0026plusmn; 0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.44\u0026plusmn; 0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.18\u0026plusmn; 0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e46.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eWater recycling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3.21\u0026plusmn; 0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.64\u0026plusmn; 0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5.40\u0026plusmn;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e49.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eSaving nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4.49\u0026plusmn; 1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e8.05\u0026plusmn; 2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7.89\u0026plusmn; 1.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e73.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eEconomically practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4.59\u0026plusmn; 1.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e8.12\u0026plusmn;1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e7.32\u0026plusmn; 1.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e79.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eEnergy Consumption Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9.43\u0026plusmn; 1.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e15.20\u0026plusmn;3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e14.94\u0026plusmn; 2.645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e87.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e40.71\u0026plusmn; 8.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e70.26\u0026plusmn;7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e66.46\u0026plusmn; 6.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e136.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e** Highly significant (p\u0026lt;0.01) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;* significant (p\u0026lt;0.05) \u0026nbsp; \u0026nbsp;F. Repeated measures\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable (3): reveals that, there were a highly statistically significant difference \u003cem\u003e(\u003c/em\u003eP\u0026lt;0.0001)\u003cem\u003e\u0026nbsp;in\u003c/em\u003e the mean items of environmental sustainability practices and the total mean of nurses\u0026rsquo; environmentally sustainable practices throughout the three phases of the study. The notable mean improvement along with standard deviation was observed in energy-saving practices, as they scored 8.560 \u0026plusmn;1.68 prior to the program and then increased to 16.44\u0026plusmn; 3.26 and 15.460\u0026plusmn;2.47, respectively, immediately post and 3 months after program application. The total mean of environmental sustainability practices was 40.710\u0026plusmn; 8.366 before program and it improved to 70.26\u0026plusmn;7.50 immediately post of the program and \u0026nbsp; remained at 66.460 \u0026plusmn; 6.360 during the three-month follow-up period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 : Multivariate linear regression model explaining factors affecting on nurses sustainability practices (n\u0026thinsp;=\u0026thinsp;100)\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1738571574.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS.E. is the standard error, and a \u003cem\u003eP\u003c/em\u003e value less than 0.05 is significant\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table (4): From the results of the regression analysis model, it was illustrated that age, sex, marital status, residence, education and having knowledge weren\u0026rsquo;t significantly predictors of total sustainability practice scores before empowerment program. Immediately after implementation of the program and 3 month Posttest, 27.3% and 25.7 % respectively of the variance in sustainability practices among nurses \u0026nbsp; were \u0026nbsp; explained \u0026nbsp;by sex only, as \u0026nbsp;(\u0026beta;\u0026thinsp;=\u0026thinsp;-7.982, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) and (\u0026beta;\u0026thinsp;=\u0026thinsp;-7.011, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5): Correlation matrix between the total mean of the study group regarding improvement in Total Environmental Sustainability practice and nurses\u0026rsquo; Knowledge regarding the global warming (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eTotal Environmental Sustainability Practice Scores\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNurses\u0026rsquo; knowledge regarding the global warming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eBefore \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eImmediately Post\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eNurses\u0026rsquo; knowledge regarding the global warming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3 Months posttest\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eNurses\u0026rsquo; knowledge regarding the global warming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.003**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 represents that, there were a statistically significant positive correlation between the nurses\u0026apos; knowledge and environmental sustainability before, immediately following program and three months of fellow up (p= 0.004, 0.002 and 0.003 respectively).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study aimed to investigate the effectiveness of empowerment program about health risks of global warming and sustainability practices among nurses providing maternal and child health services. The socio-demographic characteristics of nurses in the current study indicated that less than half of the participants were aged between twenty and thirty years, with around three-quarters being female and approximately two-thirds residing in rural areas. These findings are consistent with Ebrahim, Ali, \u0026amp; Ahmed, [16] who reported that more than half of both the study and control groups were females aged 17 and that 66.1% lived in rural regions. This trend may be linked to a relative increase in the number of girls compared to boys, as noted in population census data. In terms of work characteristics, about half of the participants in the current study had education from nursing technical institutes, while roughly one-third had less than five years of experience, and over a quarter had between fifteen and twenty years of experience. These results contrast with those of Isangula et al., [17] who found that 75% of nurses had university degrees and more than five years of experience in maternal and child health centers.\u003c/p\u003e\n\u003cp\u003eRegarding nurses\u0026apos; sources of information on global warming and environmental sustainability, the current study found that three-quarters of the participants had no knowledge of these topics. Among those who did have information, 80% obtained it from social media and the internet. These results align with findings from Reddy [18] who reported that participants accessed climate change information primarily through the internet (72%), television (68%), and newspapers (59%). Similarly, Tuna et al [19] discovered that students mainly relied on television and the internet for climate change information. However, this contrasts with the findings of Ali, Mohamed, \u0026amp; Hafez [20] who revealed that over two-thirds (69.9%) of students had prior knowledge about climate change, with the majority (66.8%) acquiring it through their university education.\u003c/p\u003e\n\u003cp\u003eRegarding the knowledge levels of the studied nurses about global warming before, immediately after, and three months following the empowerment program, the current study indicated that most nurses had a low understanding of the fundamentals of global warming and environmental sustainability practices. Half of them also had limited knowledge about the health risks and preventive measures associated with global warming. Furthermore, three-quarters lacked knowledge on these topics, and most had not previously attended training workshops, which explains their low knowledge levels before the program. The study found a significant improvement in nurses\u0026apos; knowledge on various subtopics after the empowerment program sessions and three months later. This outcome is consistent with research by Maiz, Rashed, \u0026amp; Shetaway [21] which demonstrated a significant difference in nurses\u0026apos; knowledge before and after the instructional guidelines on climate change were implemented. Similarly, \u0026Aacute;lvarez-Nieto et al [22] reported that over 95% of their sample exhibited excellent or highly satisfactory knowledge after completing a training program that utilized scenario-based learning and augmented reality focused on sustainability, climate change, and health.\u003c/p\u003e\n\u003cp\u003eConcerning the differences in mean scores before, immediately after, and three months following the empowerment program, the current study found significant statistical differences in all subitem scores related to environmental sustainability practices among nurses. Additionally, there was a highly significant difference in the total scores for environmental sustainability practices. These results may be attributed to the positive impact of the empowerment training program on sustainability practices, as nurses demonstrated improvements in their methods. Such activities highlight the importance of adopting a holistic approach to sustainability within healthcare settings. The findings of this study align with previous research by Luque-Alcaraz [23] who suggested that incorporating environmental sustainability education into nursing programs can better prepare future nurses to tackle the challenges posed by climate change and foster sustainable health outcomes.\u003c/p\u003e\n\u003cp\u003eRegarding the association between nurses\u0026apos; sociodemographic characteristics and total sustainability practices (before, immediately after, and three months post-tests), the study revealed that sex was a significant positive predictor for variance in total sustainability practice scores immediately after and three months post-test (p=0.000). The investigator believes this may be attributed to the larger sample size of female nurses compared to males. Gender differences in sustainable consumption behaviors, along with stereotypes and variances in social norms and identities, can influence how these gender differences manifest in environmentally relevant actions.\u003c/p\u003e\n\u003cp\u003eThis finding is consistent with the research by Mohammed, El-Mouty, \u0026amp; Ameen [24] who found a highly statistically significant association between gender and the total score of practices. Conversely, it contrasts with the results of Mohammed, Fahmy, \u0026amp; Megahed [25] who reported no statistically significant differences in total practice levels based on gender.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; The current study reveals a statistically significant positive relationship between knowledge about global warming and environmental sustainability practices. This outcome may be attributed to the program\u0026apos;s structure, including its activities and events, which primarily emphasized training nurses in essential skills, expanding their knowledge, and providing tools to address health challenges linked to climate change while promoting sustainable healthcare practices. These results underscore the vital role of educational programs in preparing future medical professionals to tackle sustainability and climate change issues effectively. These findings align with previous studies by Aly et al. and Zhang et al. [26 \u0026amp; 27], which reported a positive association between knowledge levels and practical application. Additionally, research conducted by Abdel Nabi, Shafik, and Saad [28] identified a highly significant positive correlation between total knowledge and reported practices concerning climate change. Future research could investigate the generalizability of these findings across various nursing specialties and healthcare settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study\u0026rsquo;s findings conclude that implementation of the empowerment program improves nurses\u0026rsquo; knowledge regarding global warming and sustainability practices among nurses. There was a statistically significant correlation between knowledge levels regarding global warming and environment sustainability practices among the studied nurses (before, immediate post and after three months of empowerment program).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study:\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sample was drawn from a single geographic region in Egypt, which may limit the generalizability of the findings to other settings or countries with different healthcare systems. \u0026nbsp;Also, reliance on self-reported measures could introduce bias, although efforts were made to minimize this through selecting diversity maternal and child health centers and using structured tools.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the findings of this study, the following recommendations were suggested:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eContinuous in-service training program for nurses regarding global warming as well as other sustainable development goals and their impact on health, to promote sustainable development.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Incorporating global warming and sustainability practices topics into the nursing curriculum and the policies of different nursing workplaces.\u003c/li\u003e\n \u003cli\u003eSocial media can be utilized and community organizations mobilized to disseminate correct and relevant information on global warming and sustainable developments goals 2030\u003c/li\u003e\n \u003cli\u003eConducting the study again with a larger sample size in a different setting to confirm and generalize the findings.\u003c/li\u003e\n \u003cli\u003eFuture research should be established to investigate how rural areas, academic year, gender, and clinical practice influence nurses\u0026apos; knowledge of global warming and its health implications.\u003c/li\u003e\n \u003cli\u003eExpanding the research to include multiple geographic regions and diverse healthcare settings would also enhance the generalizability of the findings.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Tanta University Faculty of Nursing\u0026apos;s ethical and research committee granted formal approval IRB number: 555-11-2024, Informed consent to participate was obtained from all of the participants in the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding support was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAppreciation is given to all nurses that contributed to the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEMS, MMS, RAE, SMM, NIMand SI\u0026nbsp;contributed to the study conception and design, and \u0026nbsp;Material preparation.\u0026nbsp;All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (WHO). (2023). Climate Change and Health: Key Facts and Strategic Framework for Action. Geneva: World Health Organization.\u003c/li\u003e\n\u003cli\u003eLeffers, J., McDermott-Levy, R., Smith, C. M., \u0026amp; Sattler, B. (2021). Nursing Education\u0026apos;s Response to Climate Change: A Review of the Literature. Nursing Education Perspectives, 42(4), 207-214.\u003c/li\u003e\n\u003cli\u003eIntergovernmental Panel on Climate Change (IPCC). (2022). Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change.\u003c/li\u003e\n\u003cli\u003eAnderko, L., Schenk, E., Huffling, K., Chalupka, S. (2021). \u0026quot;Climate Change, Health, and Nursing: A Call to Action.\u0026quot; Journal of Nursing Sustainability, 15(2), 45-62.\u003c/li\u003e\n\u003cli\u003eConrad K. (2023). The Era of Climate Change Medicine\u0026mdash;Challenges to Health Care Systems. Ochsner J. 2023 Spring;23(1):7\u0026ndash;8. doi: 10.31486/toj.23.5033.\u003c/li\u003e\n\u003cli\u003eCorrente, A. Pace, M. C., Fiore, M. (2024). Climate change and human health: Last call to arms for us. World J Clin Cases. Apr 16;12(11):1870\u0026ndash;1874. doi: 10.12998/wjcc. v12.i11.1870.\u003c/li\u003e\n\u003cli\u003eAmerican Nurses Association. (2023). Climate Change and Nursing: Position Statement and Guidelines. Associated with Neonatal Health Risks: Rwandan Nurses and Midwives\u0026rsquo; Awareness and Perceptions. Rwanda Journal of Medicine and Health Sciences ;3(2):261-272. https://doi.org/10.4314/rjmhs.v3i2.15. Changes and Its Effects on Health. Egyptian Journal of Nursing \u0026amp; Health Sciences, Vol.4, No.2, 49-64.\u003c/li\u003e\n\u003cli\u003eAbdallah Z \u0026amp; Farag A. (2022). Impact of Awareness Program Regarding Health Consequences of Climate Change on Knowledge, Perception and Daily Life practices among Nursing Students. Egyptian Journal of Nursing \u0026amp; Health Sciences; 3(1): 2682-2563.\u003c/li\u003e\n\u003cli\u003eWorld Bank Report. (2023) The Global Climate. Crisis Poses Serious Risks to Human Health and Wellbeing. Available from: eliefweb.int/report/world/globalclimate-crisis-poses-serious-risks-humanhealth\u003c/li\u003e\n\u003cli\u003eIbrahim A, Fahmy H, Mahmoud S. (2018). Knowledge and Attitude Regarding Global Warming Phenomenon among Assiut University Students. Assiut Scientific Nursing Journal.; 6(14): 3-13.\u003c/li\u003e\n\u003cli\u003eChristopher J. Miller, Shawna N. Smith, Marianne P. (2020). Experimental and quasi experimental designs in implementation research, Volume 283, 112452.\u003c/li\u003e\n\u003cli\u003eWoodhall S., Landeg O. and Kovats S. (2021). Public health and climate change: How are local authorities preparing for the health impacts of our changing climate? \u003cem\u003eJ\u003c/em\u003e\u003cem\u003ePublic Health \u003c/em\u003e(Oxf.), 43(2):425-432. [Doi:10.1093/PubMed/fdz098].\u003c/li\u003e\n\u003cli\u003eAL- Mailam M., Arkesh, J. and Hamzawy A. (2023). Climate Change in Egypt: Opportunities and Obstacles. IEJNSR. Vol. 4 (2), 2024 315 available at: https://carnegieendowment.org/2023/10/26/climat e-change-in-egypt-opportunities-and-obstaclespub-90854\u003c/li\u003e\n\u003cli\u003eGhazy, H., \u0026amp; Fathy, D. (2023). Effect of Awareness Program Regarding Climate Change on Knowledge, Attitudes and Practices of University Students. \u003cem\u003eInternational Egyptian Journal of Nursing Sciences and Research\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(2), 186-203.\u003c/li\u003e\n\u003cli\u003eWanda, M. and Lindsey, V. (2019). Climate Change and Health: It\u0026apos;s Time for Nurses to Act.\u0026apos; June 2019.; Canadian Association of Physicians for the Environment (CAPE). \u0026apos;Climate Change Toolkit for Health Professionals: Factsheet: Global Health Impacts of Climate Change. Canadian Federation of Nurses Unions (CFNU). Available at https://nursesunions. ca/wp-content /uploads /2019/0 5/CFNU climatechange-web.pdf.\u003c/li\u003e\n\u003cli\u003eEbrahim, E., Ali, S., \u0026amp; Ahmed, F. (2024). Effect of Youth Empowerment Program About Climate Change. African journal of biological science, Volume 6, Issue 2,\u003cem\u003e \u003c/em\u003e\u003cem\u003ePage 2157 to \u003c/em\u003e10 doi: 10.48047/AFJBS.6.2.2024.2156-2169\u003c/li\u003e\n\u003cli\u003eIsangula, K., Mwasha, L., Pallangyo, E., \u0026amp; Ndirangu-Mugo, E. (2023). The role of nurse-client relationships in maternal and child healthcare: a qualitative study in rural Tanzania. Front. Health Serv. 3:1058840. Available at: http://doi:10.3389/frhs.2023.1058840\u003c/li\u003e\n\u003cli\u003eReddy GP., Rajamouli J., Arora KD., Jothula KY., Amaravadi S., \u0026amp; Boda A., (2022). Knowledge, perceptions and practices of medical students towards climate change and global warming: A cross-sectional study. \u003cem\u003eJournal of family medicine and primary care\u003c/em\u003e. 11(6):2557-2564. DOI: 10.4103/jfmpc.jfmpc_1782_21.\u003c/li\u003e\n\u003cli\u003eTuna, I., Tuna, T., Molu, B., \u0026amp; Keskin, Y. (2022). Determination of nursing students\u0026rsquo; awareness of the health effects of climate change. \u003cem\u003eInt J CaringSci,\u003c/em\u003e 15:1149\u003c/li\u003e\n\u003cli\u003eAli, W., Mohamed, H., \u0026amp; Hafez, D. (2023). Empowering Nursing Students to Face Climate Changes and Its Effects on Health. Egyptian Journal of Nursing \u0026amp; Health Sciences, Vol.4, No.2, 49-64.\u003c/li\u003e\n\u003cli\u003eMaiz, A., Rashed, N., \u0026amp; Shetaway, G.(2024). Effect of instructional Guidelines regarding Climate Change on Nurses\u0026apos; knowledge and its Relation to Environmental Sustainability Practice. \u003cem\u003eEgyptian Journal of Health Care, ( \u003c/em\u003eEJHC) Vol. 15:2, 534-547.\u003c/li\u003e\n\u003cli\u003e\u0026Aacute;lvarez-Nieto C., \u0026Aacute;lvarez-Garc\u0026iacute;a C., Parra-Anguita L., Sanz-Martos S. and L\u0026oacute;pez-Medina I. (2022). Effectiveness of scenario-based learning and augmented reality for nursing students\u0026rsquo; attitudes and awareness toward climate change and sustainability. BMC Nurs., 21, 245. A vailable at: https://doi.org/10.1186/s12912-022-01023-9.\u003c/li\u003e\n\u003cli\u003eLuque-Alcaraz, O., Aparicio-Mart\u0026iacute;nez, P., Gomera, A., \u0026amp; Vaquero-Abell\u0026aacute;n, M. (2024). The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis. \u003cem\u003eBMC Nursing, \u003c/em\u003e23:229, p3-12. https://doi.org/10.1186/s12912-024-01895-z\u003c/li\u003e\n\u003cli\u003eMohammed, E., El-Mouty, S., \u0026amp; Ameen, N. (2022). Nursing Students Knowledge, Attitude, And Practice Regarding Health Effect of Climate Change. Mansoura Nursing Journal, 9(2), 589-601.\u003c/li\u003e\n\u003cli\u003eMohammed, E., Fahmy, L., \u0026amp; Megahed, F. (2024). Effect of Educational Program Regarding Climate Change on Nursing Students\u0026apos; Awareness, Attitude and Practices in Suez Canal University. International Egyptian Journal of Nursing Sciences and Research, 4(2), 297-316 23.\u003c/li\u003e\n\u003cli\u003eAly, S., Ragab, S., Ahmed, H., Elmowafi, H., Ayed, M., Elsayed, N., \u0026amp; Maiz, M. (2024). Effect of Awareness Program regarding Climate Changes and Sustainability Development on Nursing Internship Students\u0026apos; Knowledge. Egyptian Journal of Health Care, Vol. 15. No. 3, 348- 361\u003c/li\u003e\n\u003cli\u003eZhang, J., Tong, Z., Ji, Z., Gong, Y., \u0026amp; Sun, Y. (2022). Effects of Climate Change Knowledge on Adolescents\u0026rsquo; Attitudes and Willingness to Participate in Carbon Neutrality Education. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, 19 (17), 10655.\u003c/li\u003e\n\u003cli\u003eAbdel Nabi, E., Shafik, S., \u0026amp; Saad, A. (2023). Assessment of Nursing Students\u0026rsquo; Awareness regarding Climate Change. Helwan International Journal for Nursing Research and Practice, 2(1), 69-82.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Empowerment, Global warming, Sustainability practices","lastPublishedDoi":"10.21203/rs.3.rs-5876096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5876096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGlobal warming poses a severe and escalating threat to human health worldwide, affecting both direct and indirect aspects of human well-being. This study aimed to evaluate the effect of empowerment program about health risks of global warming and sustainability practices among nurses providing maternal and child health services.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eEmploying a quasi-experimental design, a purposive sample of 100 nurses working in maternal and child health services in Tanta City. The research was approved by the ethical committee of the faculty of nursing with IRB number: RHDIRB555-11-2024. The study was conducted across all (6) healthcare facilities providing maternal and child health services in Tanta City. Data was collected using adapted tools including the Self- Nurses Knowledge Interview Questionnaire, and the Environmental sustainability practices questionnaire. Demographic characteristics were analyzed, and pre- and post-intervention scores were compared using paired t-tests were statistical methods.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was a statistically significant correlation between knowledge levels regarding global warming and environment sustainability practices among the studied nurses before, immediate post and after three months of empowerment program.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study\u0026rsquo;s findings conclude that implementation of the empowerment program improves nurses\u0026rsquo; knowledge regarding global warming and sustainability practices among nurses. The findings suggest a continuous in-service training program for nurses regarding global warming as well as other sustainable development goals and their impact on health, to promote sustainable development.\u003c/p\u003e","manuscriptTitle":"Empowerment Program about Health Risks of Global Warming and Sustainability Practices among Nurses Providing Maternal and Child Health Services","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-03 09:34:49","doi":"10.21203/rs.3.rs-5876096/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af4807b4-e668-42e6-ad9f-c76dc5f0c038","owner":[],"postedDate":"February 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T09:09:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-03 09:34:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5876096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5876096","identity":"rs-5876096","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}