Planetary Health and Planetary Nursing Awareness Scale: Scale Development Study

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Medical waste, consisting of plastic materials likely to be toxic or radioactive, poses a greater burden on the planet than other kinds of waste such as office supplies. It is clear that nurses, who play a key role in protecting and promoting health, also play a key role in environmental sustainability, and in protecting and promoting planetary health. The purpose in this study is to develop a scale aimed at determining nurses' awareness of planetary health and planetary nursing. Methods : In this study having a methodological research design, data were collected from 359 nurses currently working via an online form between March 31, 2025 and May 14, 2025. The SPSS (Statistical Package for the Social Sciences) for Windows version 25.0 and AMOS (Analysis of Moment Structures) version 21 were used in the analysis. For the categorical variables, number (N) and percentage (%) values were calculated for the descriptive statistics. After the expert opinion was obtained, the Content Validity Index (CVI) and Content Validity Ratios (CVR) were calculated, and a pilot study was conducted with 40 nurses. In the reliability analyses, the test-retest and split-half techniques were used, and the Cronbach's alpha coefficient, item-total correlation and item discrimination index were calculated. Construct validity of the scale was established via a two-stage factor analysis. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted. Results : The result of the test-retest reliability was r = 0.798 (p < 0.01). KMO and Bartlett's Test of Sphericity values for EFA ​​were 0.961 and 6861.981, respectively (p < 0.001). The total Cronbach's alpha coefficient of the scale was 0.951. The model fit index results determined after the CFA were as follows: RMSEA (Root Mean Square Error of Approximation) = 0.073, SRMR (Standardized Root Mean Squared Residual = 0.034, CFI (comparative fit index) = 0.955, IFI (Incremental Fit Index) = 0.955, TLI (Tucker–Lewis index) = 0.947, NFI (Normed Fit Index) = 0.934, GFI (Goodness of Fit Index) = 0.903 and AGFI (Adjusted Goodness of Fit Index) = 0.875. The explained ratio of the total variance of the scale was calculated as 57.969. According to the EFA and CFA results, 11 items with low factor loadings were removed and the scale took its 16-item final form. Conclusions : The Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS) is a valid and reliable measurement tool, and it is believed to be useful tool for nurses who play a key role in the delivery of sustainable health services. Environmental Sustainability Planetary Nursing Planetary Health Scale Development Sustainable Consumption Figures Figure 1 Figure 2 Introduction Humanity's relationship with the natural environment has changed over the centuries. Humans who initially lived in harmony with nature later began to destroy it by consuming and depleting natural resources recklessly. Primitive societies lived as part of nature, and consumed only what they needed. However, with advancements in technology, urbanization, and a growing global population, the ecosystem's balance began to deteriorate. Today, at the point we are in, environmental problems have reached global dimensions [ 1 ]. The human-environment interaction consists of three stages. The first stage called the Unconscious Existence Stage lasted until the 19th century. At this tage, people were unconscious and unaware of how the environment and events in it would affect them. The second stage marked the beginning of pre-consciousness. This stage, during which ethical values were discussed, lasted from the second half of the 19th century until the 1970s. It is called the Consciousness Stage . The third stage, which started in the 1970s and has continued until today, is called the stage of formation of conscience . At this stage, not the anthropocentric ethical approach that assumes that only humans have value [ 2 ], but the ecocentric ethical approach, which includes all living beings, was adopted. According to this approach, all living beings are important, and every living being is indispensable for the ecosystem. The survival of each living being depends on the existence of another living being) (the food chain) [ 3 ]. According to the ecocentric ethical approach, not only living things in nature but also inanimate objects that enable the continuity of life/living have an intrinsic value [ 4 ]. Within this context, the consumption of limited world resources is among the most debated issues today; thus, the concept of continuous and balanced development , in other words, sustainable development , comes to the fore. Sustainable development is a type of development that ensures the needs of the present generation to be met without compromising the ability of future generations to meet their needs [ 2 ]. The concept of sustainable development started to emerge in the 1970s as a new expression of the balance desired to be established between economy, society, and the environment. Although the concept was initially translated into Turkish as "continuous and balanced development," the phrase "sustainable development" has become the more commonly used term [ 5 ]. The United Nations (UN) convened the Environment and Development Conference, known as the Earth Summit, in Rio in 1992. After this conference, the concept of sustainable development has shaped global economic growth and development thinking. Since then, experts dealing with environmental problems have begun to accept the idea that the current generation assumes responsibility towards future generations as a fundamental principle. Thus, discussions regarding the current generation’s responsibilities towards future generations have begun [ 2 ]. The current generation’s ethical responsibility towards future generations arises from the possibility of their existence. Every individual currently existing in the world is responsible for future generations for their actions, because every individual takes certain actions to live. These actions constitute the steps of the process that ensures the formation of future generations. For instance, when a farmer plants tomatoes in the field, they not only sustain their own life but also provide food for society, thus contributing to the formation of future generations. A nurse, through each individual they heal, contributes not only to the survival of that person but also, though indirectly, to the existence of future generations. Thanks to such behaviors, the continued existence of humans is inevitable, except in extraordinary situations such as epidemics, wars, or natural disasters [ 6 ]. Within this context, it has been thought that global development policies should be redesigned within the framework of sustainability in order to leave a healthy and livable planet to future generations. To achieve this purpose, 17 Sustainable Development Goals were determined at the 2030 Sustainable Development Summit held at the UN Headquarters in New York between September 25, 2015 and September 27, 2015, aimed at providing solutions to the environmental problems facing humanity. These goals cover a wide range of issues such as eradicating poverty, providing quality education, promoting equality between people, ensuring access to clean water and safe food, ensuring sustainable consumption, and combating climate change. These goals were adopted by 193 countries [ 7 ]. Goal 3, one of the Sustainable Development Goals, aims to ensure that individuals at all ages lead healthy lives and achieve a high level of well-being. The analysis of the sub-objectives defined within the scope of this goal has revealed that issues such as health promotion, disease prevention, and equal access to health services directly coincide with the fundamental duties and responsibilities of nursing. Nurses play a key role in the implementation of these goals in the field. Another objective of Goal 3 draws attention to the negative effects of air, water, and soil pollution on human health. This objective emphasizes that environmental factors are critically important not only for ecological life but also for human health. Therefore, it is becoming increasingly important that healthcare services be addressed with a holistic approach that not only focuses on people but also encompasses planetary health. Such perspective necessitates the development of health policies which do not ignore the effect of planetary health on human health and include environmental sustainability. Planetary health was first defined in 2015 as follows: “achieving the highest possible levels of health, well-being, and equality worldwide by caring for natural resources of the Earth with its limited safe environment which shapes the future of humanity from political, economic and social aspects.” In short, planetary health is defined as “the health of humans and, consequently, the state of the ecosystem” [ 8 ]. Within this context, the concept of “planetary nursing” based on the mutual interaction between planetary health and human health has come to the forefront in the literature in recent years. Planetary nursing is a holistic approach that advocates that nursing practices should focus on the protection of both human and planetary health, and environmental sustainability of the Earth [ 9 , 10 ]. It is estimated that approximately 15% of medical waste generated in healthcare settings is hazardous, because this waste is likely to be infectious, toxic, or radioactive. Furthermore, a large portion of medical waste is made of plastics, whose decomposition in nature takes a long time. If medical waste is not properly treated, it poses serious risks to both human and environmental health. From this perspective, it can be said that medical waste places a greater burden on the ecosystem than do other types of waste. Therefore, it is considered necessary that policies and procedures that enable the reuse of non-hazardous materials and/or recycling of these materials should be developed and implemented. Another recommendation is that its environmental effect should be minimized by regulating purchasing strategies and consumption patterns [ 11 ]. Given the medical waste generated during the provision of healthcare services, it is easier to understand the mutual interaction between planetary health and human health. The increase in treatment and care processes due to the increase in disease rates directly increases the amount of medical waste, resulting in increases in the environmental burden, which negatively affects planetary health. On the other hand, the deterioration of planetary health threatens human health through air, water and soil pollution; therefore, planetary health becomes an indispensable element for human health, and human health becomes an indispensable element for planetary health. Not only the use of necessary materials during healthcare services, but also appropriate use of these materials without waste is of great importance. Excessive or improper use of medical supplies poses a significant problem for planetary health. For instance, in procedures where there is no risk of infection (e.g., measuring the blood pressure of a non-infected patient), the use of gloves is unnecessary; washing hands after each procedure is sufficient. Similarly, discarding unused disposable materials after a procedure is cancelled leads to the waste of resources and excess medical waste. It is crucial that nurses directly involved in treatment and care processes should act consciously and responsibly in this regard. The present study was aimed developing a scale to assess awareness of Planetary Health and Planetary Nursing. Methodology Study Design This methodological descriptive study was conducted and reported in accordance with the STROBE checklist. Place and Time of the Study The study was conducted in Çankırı State Hospital between March 31, 2025 and May 14, 2025. Participants As indicated in the literature, in scale studies, the sample size should be five -fold or ideally ten-fold the number of the items in the scale [ 12 ]. However, it is also emphasized that a sample size less than 200 may be inadequate to reveal the psychometric structure, and that a sample size of 300, and ideally 500, is generally needed for a test to yield valid and reliable results [ 13 ]. Therefore, 359 nurses who met the inclusion criteria and who had at least 6 years of active nursing experience and were currently working as nurses in a healthcare facility were included in the sample. Healthcare professionals who were not nurses were not included in the study. Data Collection Data were collected using the Personal Information Form and the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS). The researchers visited the units in the aforementioned hospital, sent online form links to nurses who met the inclusion criteria and volunteered to participate in the study, and asked them to answer the questions on the data collection forms. The simple random sampling method was used to select nurses to be included in the study. Data collection took 5 to 8 minutes. Before the study was conducted, the PH-PNAS was pilot tested. No changes were made to the PH-PNAS after the pilot study. Data Collection Forms Personal Information Form The Personal Information Form developed by the researchers consists of 10 items questioning the participants’ characteristics such as age, sex, marital status, education level, city of residence, length of residence in the same city, and socioeconomic level. The participants were also asked whether they had any children and whether they had a bachelor's degree in a field other than nursing [ 14 , 15 ]. Development of the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS) The PH-PNAS was developed to assess nurses' awareness of planetary health and planetary nursing. Responses given to the items in the PH-PNAS are rated on a five-point Likert-type scale ranging from 1 to 5 (1: Strongly Disagree, 2: Disagree 3: Undecided, 4: Agree, 5: Strongly Agree). To develop the PH-PNAS, the researchers reviewed the literature [ 6 , 7 , 8 , 9 , 10 , 15 , 16 , 17 , 18 , 19 , 20 ] and created a pool of 58 items. The senior quantitative analyst reduced the number of items in the scale pool from 58 to 27. After statistical analysis, in the final version of the PH-PNAS, the number of the items was reduced to 16 and the single-dimensional structure was considered as the best structure. No items in the PH-PNAS are reverse scored. The minimum and maximum possible scores that can be obtained from the PH-PNAS are 16 and 80, respectively. There is no cut-off point. The higher the score is, the higher the respondent’s level of awareness is. Validity of the Scale Content To assess the content validity of the PH-PNAS, opinions were obtained from 11 experts. Of them, 5 were specialized in nursing, 3 in health sustainability, 2 in environmental sustainability, and 1 in statistics (senior quantitative analyst). The Davis Method was used to obtain expert opinions [ 21 ]. They rated each item in the PH-PNAS as follows: 1-Very suitable, 2-Suitable but needs modification, 3-Item should be modified, 4-Not suitable. The content validity ratio of the items was ≥ 0.80. Therefore, no changes were made to the scale items after the expert opinions were obtained (Table 1 ). Table 1 Content Validity Ratios for the Item Pool Item (I) CVR Item (I) CVR Item (I) CVR I1 1.00 I10 1.00 I19 1.00 I2 0.91 I11 1.00 I20 1.00 I3 1.00 I12 1.00 I21 0.82 I4 1.00 I13 0.91 I22 0.91 I5 1.00 I14 1.00 I23 1.00 I6 0.91 I15 1.00 I24 1.00 I7 1.00 I16 0.91 I25 8.82 I8 1.00 I17 1.00 I26 1.00 I9 1.00 I18 1.00 I27 0.91 Pilot Study Before data collection was started, a pilot study was conducted with 40 nurses who were not included in the study sample to assess the comprehensibility of the items in the PH-PNAS. The results of the pilot study demonstrated that all the items were clear enough to understand. Because the items were not changed and these 40 nurses would not be included in the main sample, a test-retest analysis was also performed with them. Pre-test data for the pilot study were collected between January 27, 2025 and January 29, 2025. Fifteen days after the pretest, they were asked to answer the same questions again, and the second set of data was collected between February 11, 2025 and January 12, 2025 (Table 2 , Table 3 ). Table 2 Results of the pilot study (n = 40) ITEMS IN THE POOL Item-total score correlation values Alpha value when the item is deleted 1. Reducing ecological footprint is the responsibility of every individual. 0.522 0.976 2. Attention should be paid to the use of medical supplies to protect world resources. 0.788 0.975 3. Ecosystems are closely related to public health. 0.877 0.974 4. To protect the planetary health), it is essential that healthcare should be provided equally and fairly. 0.835 0.974 5. Protection and improvement of health are important for the planetary health). 0.814 0.974 6. The world's resources are only for humans. -0.008 0.981 7. Prevention of infectious diseases positively affects planetary health. 0.845 0.974 8. Good planetary health is important for future generations. 0.873 0.974 9. Humans are a part of nature. 0.889 0.974 10. Transporting hospital staff to and from the hospital on a shuttle bus is an environmentally friendly practice. 0.508 0.977 11. The appropriate use of medical supplies is important for the protection of the planetary health. 0.899 0.974 12. Features of a building are related to the planetary health 0.776 0.975 13. Access to natural resources affects human health. 0.839 0.974 14. Complying with medical waste guidelines is important for the planetary health. 0.901 0.974 15. Planetary health is directly related to the health of living beings. 0.853 0.974 16. Preventive health services have a positive effect on the planetary health. 0.867 0.974 17. Climate change affects human health. 0.833 0.974 18. Nurses should be trained on planetary health. 0.809 0.975 19. Nurses should be trained on environmental sustainability. 0.858 0.974 20. Nurses play a significant role in planetary health. 0.800 0.975 21. Planetary health is closely related to the health of present-day humans and future generations. 0.841 0.974 22. Providing natural lighting with sunlight in hospitals is essential for the planetary health. 0.745 0.975 23. Type of the diet affects the planetary health. 0.860 0.974 24. Consuming local foods is important for the planetary health. 0.764 0.975 25. The use of medical supplies is related to planetary health. 0.841 0.974 26. There is a relationship between sustainability and health. 0.882 0.974 27. Protecting and improving human health is important for the planetary health. 0.842 0.974 Cronbach's Alpha = 0.976 In the preliminary study conducted with 40 nurses who were not included in the sample, it was determined that the item-total correlation values ​​for all the items were quite high, and that the internal consistency coefficient of the PH-PNAS was 0.976. Table 3 Test-retest analysis (n = 40) Mean SD Min. Max. Median Correlation (r) z test p value PH-PNAS pre-test 18.45 8.93 14.00 68.00 16.50 0.798** -1.275 0.202 PH-PNAS post-test 19.05 12.00 14.00 69.00 15.00 Spearman correlation analysis was performed. The Wilcoxon signed-rank test was performed to assess the difference between measurement times. **p < 0.01 While the mean score and the median value obtained at the pretest were 18.45 ± 8.93 and 16.50, respectively, they were 19.05 ± 12.00 and 15.00, respectively at the posttest, indicating that the values obtained at the posttest given 15 days after the pretest were not statistically significant different (p > 0.05). Furthermore, the correlation (r) between the two measurements (0.798) (**p < 0.01) was strong, indicating that responses given by the participants were consistent over the time elapsed. Ethical Considerations Before the study was conducted, ethical approval was obtained from the Çankırı Karatekin University Ethics Committee (decision date: March 19, 2024; decision number: 12), institutional permission from the management of Çankırı State Hospital (decision date: July 2, 2024; document number: E-64943697-799-247570303), and verbal consent from the participants. The study was carried out in accordance with the ethical standards established in the Declaration of Helsinki. Data Analysis The data obtained in the study were analyzed using the SPSS (Statistical Package for the Social Sciences) for Windows, version 25.0 and AMOS (Analysis of Moment Structures), version 21. Basic descriptive statistical methods (number, percentage, arithmetic mean, standard deviation) were used in the analysis of the data. These methods are aimed at determining the demographic characteristics of the participants and the general trends of responses given to the scale items [ 22 ]. In reliability analyses, the test-retest technique, split-half correlations, and Cronbach's alpha coefficient were used. The construct validity of the PH-PNAS was performed based on two-stage factor analysis. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed, and the item discrimination index was calculated. All the results were at a 95% confidence interval. P values less than 0.05 were considered statistically significant. Results Of the participating nurses, 42.1% were in the age group of 31–40 years, 86.4% were women, 63.8% were married, 57.7% had children, 57.7% had a bachelor's degree, 20.6% had studied in a field other than nursing, 59.1% had lived in the same city for more than 10 years, and 79.1% described their socio-economic level as moderate (Table 4 ). Table 4 Distribution of the Demographic Characteristics of the Participating Nurses Demographic Characteristics n % Age (years) ≤ 30 31–40 ≥ 41 129 151 79 35.9 42.1 22.0 Sex Men Women 49 310 13.6 86.4 Marital status Single Married 130 229 36.2 63.8 Do you have any children? Yes No 207 152 57.7 42.3 Education Doctorate degree Bachelor's degree High school Associate degree Master's degree 33 207 19 14 86 9.2 57.7 5.3 3.9 24.0 Did you study in another field? Yes No 74 285 20.6 79.4 How many years have you been living in this city? (years) 0–1 > 1–5 > 10 > 5–10 10 66 212 71 2.8 18.4 59.1 19.8 How do you perceive your socioeconomic level? Good Not good Medium 58 17 284 16.2 4.7 79.1 TOTAL 359 100.0 Content Validity In the assessment of the content validity conducted based on the opinions of 11 aforementioned experts, the validity ratio at the item level was 0.80 or higher. No changes were made to the items in the PH-PNAS after expert opinions were obtained. Exploratory Factor Analysis (EFA) An Exploratory Factor Analysis (EFA) was conducted to assess the construct validity of the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS). Initial factor structure analysis of the PH-PNAS revealed a highly dispersed factor structure. However, despite this dispersed structure, due to the high eigenvalues, the number of factors was limited to one. Therefore, after the items with low factor loadings and insufficient explanation were excluded, the exploratory factor analysis was performed. The final stage of the exploratory factor analysis revealed that the scale had a single-factor and holistic structure. Whether the data were suitable for factor analysis was determined using the Kaiser-Meyer-Olkin (KMO) test and the Bartlett’s Test of Sphericity. The KMO value (0.961), and the result of Bartlett’s Test of Sphericity [Χ² (253) = 6861.981; p < 0.001] were statistically significant and confirmed that the correlation between the variables was suitable for factor analysis. The result of the Exploratory Factor Analysis (EFA) performed using the Principal Component Analysis (PCA) method demonstrated that factor loadings of all the items were above 0.40. The total explained variance ratio of the PH-PNAS was calculated as 57.969 (Table 5 ). Table 5 Results of the Exploratory Factor Analysis of the PH-PNAS (n = 359) Factor loadings Item27 0.847 Item16 0.845 Item15 0.831 Item8 0.826 Item14 0.826 Item21 0.820 Item17 0.815 Item26 0.800 Item11 0.777 Item19 0.775 Item4 0.767 Item22 0.759 Item13 0.753 Item23 0.742 Item9 0.737 Item5 0.729 Item3 0.725 Item7 0.719 Item2 0.710 Item18 0.701 Item20 0.668 Item12 0.646 Item1 0.585 Eigenvalue 13.270 Variance Explained 57.696 KMO = 0.961 Χ 2 (253) 6861.981; Bartlett’s Test of Sphericity (p) = 0.000 The scree plot in Fig. 1 shows the eigenvalue distribution of the factor analysis of the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS). As can be seen on the scree plot, while the eigenvalue of the first factor was high, eigenvalues of the other factors were low, which indicates that the optimal number of the factors based on the scree plot is one [ 23 , 29 ]. Confirmatory Factor Analysis (CFA) The analysis of the results of the CFA regarding the single-factor structure of the 16-item Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS) revealed that the χ²/SD ratio which was 4.336 before the modification decreased to 2.890 after the modification. This value which is less than 3 indicates that the single-factor structure had an excellent fit. The goodness-of-fit indices for the model were RMSEA = 0.073, SRMR = 0.034, CFI = 0.955, IFI = 0.955, TLI = 0.947, NFI = 0.934, GFI = 0.903, and AGFI = 0.875. These results confirm the single-factor structure of the scale, and support its construct validity statistically. The improvements in fit obtained after the modifications strengthened the validity of the model compared to its original form (Table 6 , Fig. 2 ). Table 6 Results of the Confirmatory Factor Analysis of the Planetary Health and Planetary Nursing Awareness Scale (16 items, six factors) (n = 359) Index Before the modification After the modification \(\:{X}^{2}\) /SD 4.336 2.890 RMSEA 0.097 0.073 SRMR 0.041 0.034 CFI 0.919 0.955 GFI 0.854 0.903 AGFI 0.809 0.870 IFI 0.919 0.955 TLI 0.906 0.947 RFI 0.882 0.921 NFI 0.897 0.934 Chi-square / Degrees of Freedom ( \(\:{X}^{2}\) /SD) Table 7 Factor Loadings According to the Confirmatory Factor Analysis (First Level) Items Standardized factor loading Unstandardized factor loading S.E. C.R. p Item1 0.557 1.000 Item3 0.722 0.961 0.092 10.432 *** Item4 0.752 1.095 0.102 10.692 *** Item5 0.715 1.088 0.105 10.367 *** Item7 0.717 1.029 0.099 10.386 *** Item8 0.854 0.945 0.082 11.479 *** Item9 0.744 0.787 0.074 10.617 *** Item11 0.770 0.922 0.085 10.838 *** Item13 0.735 1.022 0.097 10.548 *** Item14 0.846 0.962 0.084 11.419 *** Item15 0.844 1.078 0.094 11.404 *** Item16 0.804 1.134 0.102 11.110 *** Item17 0.824 0.996 0.088 11.262 *** Item18 0.635 0.979 0.102 9.601 *** Item21 0.800 1.028 0.093 11.076 *** Item22 0.710 1.056 0.102 10.324 *** S.E. standard error; CR: test value indicating the significance of the items, Table 7 shows that all the CR values ​​were significant, and that factor loadings of all the items which ranged from 0.557 to 0.854 were above 0.30. Table 8 Item analysis of the Planetary Health and Planetary Nursing Awareness Scale (n = 359) Items Groups Mean SS r The alpha value when the item is deleted t (**Lower-Upper 27) p value (**Lower-Upper 27) Item1 Upper 5.00 0.00 0.553 0.953 11.499 0.000* Lower 3.69 1.12 Item3 Upper 5.00 0.00 0.715 0.948 9.808 0.000* Lower 4.03 0.97 Item4 Upper 5.00 0.00 0.753 0.947 10.139 0.000* Lower 3.91 1.06 Item5 Upper 5.00 0.00 0.714 0.948 10.666 0.000* Lower 3.87 1.05 Item7 Upper 5.00 0.00 0.697 0.948 12.405 0.000* Lower 3.85 0.92 Item8 Upper 5.00 0.00 0.825 0.946 6.796 0.000* Lower 4.34 0.96 Item9 Upper 5.00 0.00 0.723 0.948 5.142 0.000* Lower 4.51 0.95 Item11 Upper 5.00 0.00 0.742 0.947 9.633 0.000* Lower 4.13 0.89 Item13 Upper 5.00 0.00 0.701 0.948 11.051 0.000* Lower 3.92 0.96 Item14 Upper 5.00 0.00 0.814 0.946 8.976 0.000* Lower 4.19 0.89 Item15 Upper 5.00 0.00 0.816 0.946 10.359 0.000* Lower 4.01 0.94 Item16 Upper 5.00 0.00 0.795 0.946 12.352 0.000* Lower 3.80 0.95 Item17 Upper 5.00 0.00 0.797 0.946 7.821 0.000* Lower 4.23 0.97 Item18 Upper 5.00 0.00 0.639 0.950 12.827 0.000* Lower 3.75 0.96 Item21 Upper 5.00 0.00 0.785 0.946 10.484 0.000* Lower 4.01 .93 Item22 Upper 5.00 0.00 0.686 0.949 11.512 0.000* Lower 3.84 1.00 n1 = n2 = 97 (lower-upper group) Total sample size 359 r = Item Total Score Correlation, t: (Lower 27% - Upper 27%) ** Significant values ​​for p < 0.05. In Table 8 , the results of the independent samples t-test indicating the discrimination power of all the items and the item-total correlation were presented. The analysis of the item-total test correlation values ​​of the participants' answers to the questions in the PH-PNAS revealed that none of the items had a correlation coefficient below 0.30. Since the PH-PNAS has one dimension, the item-total score correlation values ​​were calculated for the entire scale, and the item analysis was performed for the entire scale. Since the item-total score correlation coefficients of the items ranged between 0.553 and 0.825, they were considered statistically significant. To determine the discrimination power of the items in the PH-PNAS, the raw scores obtained from it were ranked from highest to lowest, and the mean scores of the groups in the lower 27% and upper 27% were compared using the independent samples t-test. The results of the comparison demonstrated that there was a statistically significant difference between the mean scores of the lower and upper group items. Reliability Analysis The Cronbach's alpha value of the overall PH-PNAS was calculated as 0.951. The data were split in half using odd or even rows. According to the results, the correlation coefficient between the two halves was calculated as 0.925; the Spearman-Brown coefficient as 0.961; and the Guttman coefficient as 0.961 (Table 9 ). Table 9 Split-Half Method Cronbach's Alpha Part 1 = Item1, Item4, Item7, Item9, Item13, Item15, Item17, Item21 0.899 Part 2 = Item3, Item5, Item8, Item11, Item14, Item16, Item18, Item22 0.909 Correlation between two halves 0.925 Spearman-Brown coefficient 0.961 Guttman Split-Half coefficient 0961 The reliability of the measurement model was also tested by analyzing the Average Variance Extracted (AVE) and composite reliability (CR) values ​​for each factor separately. The AVE value was determined as 0.574, and the CR value was determined as 0.949. There was no response bias for the PH-PNAS (Hotelling's T² = 216.228; p = 0.000). Discussion Nursing is a profession that cares for the environment, advocates policies and programs aimed at sustaining and restoring the natural world, understands the effect of climate change on environmental and public health, and considers all of these as a core competency of nursing education [ 24 , 25 ]. Nurses should also lead the advancement of planetary health science, as they have the understanding that human health and dignity are intertwined with the vitality of the natural world [ 15 ]. In a literature review, it was revealed that there is gap regarding measurement tools used to assess nurses' awareness of planetary health or planetary nursing. Thus, it was decided to develop a scale in the present study. In the present study, one of the researchers is a health academician who has a doctorate degree in bioethics and environmental ethics, a field she has worked in for about 10 years and has been working in the field of environmental sustainability.The other researcher is also an academician who has a doctorate degree in internal medicine nursing with approximately 10 years of experience. Both academicians are experienced in nursing practice. The present study was aimed at addressing this gap in the field. To test the validity of the scale, content and construct validity studies were performed. Expert opinions were consulted to test the content validity of the PH-PNAS. The Davis Method was used to collect expert opinions [ 21 ]. The accepted criterion value for the Content Validity Index is 0.80 [ 26 ], and a minimum content validity ratio of 0.80 is required for each item. In the present study, the content validity ratio for all the items was 0.80 and above. Therefore, no changes were made to the scale items. These results indicate that there is consensus among the experts, that the statements in the PH-PNAS are appropriate to Turkish culture, that they represent the area to be measured, and that content validity has been achieved. According to the results of the pilot study, all the items were understandable by the respondents, and thus, no items were modified. Since none of the items was modified and the respondents would not be included in the main sample, a test-retest reliability analysis was also performed on the respondents who took the pilot test. In the test-retest reliability method, the same test is administered to the same individuals under the same conditions at different time intervals to demonstrate whether the features of the test measured change over time. The time elapsed between two measurements is important. A period of approximately two weeks between the first and second measurements is generally considered appropriate. A high positive correlation (r > 0.80) between the two measurements is desirable. However, it should be emphasized that only the direction and strength of the relationship between the two measurements are not sufficient to determine the test-retest reliability coefficient. What is truly important is the high degree of agreement between the measurements obtained at two different times. When measuring the same characteristic twice on the same sample, a certain level of correlation between the two measurements is expected, but the agreement between the scores obtained from two different measurements may be low [ 27 ]. Therefore, it is recommended to use the intra-class correlation coefficient (ICC) to determine the relationship between two measurements, as well as the level of consistency or agreement [ 28 ]. In the present study, before the ICC calculation, the test-retest reliability coefficient and the correlation coefficient between the two measurements (Pearson correlation coefficient) were calculated for comparison. The internal consistency coefficient was 0.976. In the first measurement, the mean score was 18.45 ± 8.93; the median value was 16.50. In the last measurement, they were 19.05 ± 12.00 and 15.00, respectively. The difference between the repeated measurements taken 15 days apart was not statistically significant (p > 0.05). In addition, the correlation (r) between the measurements (0.798) indicated a strong relationship with (p < 0.01). The answers given by the participants were consistent throughout the time elapsed. To determine the structural validity of the PH-PNAS, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted [ 29 ]. Factor analysis is one of the statistical techniques frequently used to transform a large number of related variables into a small number of independent factors. In the present study, the KMO value was calculated as 0.961, indicating that the data had an “excellent” level of suitability for factor analysis, i.e., the sample size was adequate and suitable for analysis [ 30 ]. Furthermore, the results of Bartlett’s Test of Sphericity were statistically significant, confirming that there was a suitable level of correlation between the variables for factor analysis. Based on the EFA and CFA results, 11 items were removed from the 27-item PH-PNAS (Fig. 1 ). The Turkish version of the PH-PNAS consists of 16 items. According to the EFA results, the factor loadings of this PH-PNAS ranged from 0.557 to 0.854, and all factor loadings were greater than 0.500. Factor loadings of all the items were above 0.40. Tabachnick and Fidell [ 31 ] stated the threshold value for factor loading should be 0.32. According to the analysis results, the factor loadings of all the items were adequate, which indicated that the items of the PH-PNAS strongly represented the factor and that the PH-PNAS had structural validity [ 30 , 32 ]. The total explained variance ratio of the PH-PNAS was calculated as 57.969. This ratio is well above the threshold value of 50 recommended for structural validity [ 31 ] and indicates that the PH-PNAS successfully represents the concept it measures. Furthermore, considering the view that the eigenvalue should be above 1 [ 30 , 32 ]. these results confirm that the single-factor structure of the scale is strong and significant. The results of the CFA regarding the single-factor structure of the 16-item PH-PNAS indicate that the model fits the data at a significant level. The χ²/SD ratio which was 4.336 before modification decreased to 2.890 after modification. Because it is below 3, it indicates an excellent fit. The RMSEA (0.073), one of the goodness-of-fit indices, indicates an acceptable fit, while the SRMR (0.034) indicates an excellent fit [ 33 ]. Furthermore, the CFI (0.955), IFI (0.955), TLI (0.947), NFI (0.934), and GFI (0.903) values ​​are above 0.90, and the AGFI (0.875) value is within acceptable fit limits [ 34 , 35 ]. These results confirm the PH-PNAS’s single-factor structure and statistically support its construct validity. The improvements in fit obtained after the modifications strengthened the model's validity compared to its original form. Factor loadings above 0.30 indicate that the items are suitable for the structure. In the present study, factor loadings of all the items were above 0.30. CR statistics indicate whether the items are statistically significant. In the present study, all the CR values ​​were significant, and factor loadings of all the items were above 0.30. If the factor loading of an item is above 0.30, it can be concluded that the item is suitable for the structure [ 36 ]. In the present study, the item factor loadings ranged from 0.557 to 0.854. The minimum required value for a sufficient item-total test correlation should be 0.30 [ 37 ]. Items with correlations below 0.30 should not be included in the analysis. The analysis of the item-total test correlation values ​​of the participants' answers to the questions in the PH-PNAS demonstrated that there were no items whose correlations were below 0.30. Since the PH-PNAS had one dimension, item-total score correlation values ​​were calculated for the entire PH-PNAS, and item analysis was performed for the entire PH-PNAS. The item total score correlation coefficients of the items ranged between 0.553 and 0.825, indicating that they were statistically significant. To determine the discriminative power of the items in the PH-PNAS, the raw scores obtained from the PH-PNAS were ranked from highest to lowest, and the mean scores of the groups in the lower 27% and upper 27% were compared using the independent samples t-test. The results of the comparison revealed a statistically significant difference between the mean scores of the lower and upper group items. Based on this, it can be said that the PH-PNAS is discriminative in terms of measuring the desired quality. In other words, the results of the 27% upper and lower item analysis for the measurement instrument demonstrated that all the items had discriminatory power. Reliability analysis is conducted to test whether the statements included in a scale are consistent with each other. In reliability analysis, a Cronbach's Alpha (α) coefficient value ranging between 0.00 and 0.40 indicates that the scale is not reliable; a value between 0.40 and 0.60 indicates that the scale has low reliability; a value between 0.60 and 0.80 indicates that the scale is quite reliable; and a value between 0.80 and 1.00 indicates that the scale is highly reliable [ 25 ]. In the present study, the Cronbach's alpha value was calculated as 0.951, suggesting that the PH-PNAS is highly reliable. The split-half method is used when a test can be divided into two halves to obtain a single score. The method relies on the scores obtained from both halves of the sample being similar, if the measurement instrument is reliable. The split-half method can be performed by separating items according to their odd and even numbers, or in a random order [ 38 ]. The correlation between the two halves indicates whether the instrument is reliable. A correlation coefficient above 0.70, i.e., close to 1, indicates that the instrument is reliable [ 26 ]. In the present study, the data was split in half using odd-even sequences, and the results (correlation coefficient = 0.925; Spearman Brown coefficient = 0.961; Guttman coefficient = 0.961) indicated that the instrument was reliable. The reliability of the measurement model was also tested with the Average Variance Extracted (AVE) and composite reliability (CR) values ​​of each factor separately. The CR value of the factors in the measurement model should be higher than 0.70, and the AVE value should be higher than 0.50 [ 39 ]. In the present study, the AVE value was 0.574 and the CR value was 0.949, indicating that the measurement model is reliable. The response bias of the PH-PNAS was analyzed using the Hotelling's T² analysis method to assess whether the responses given to the items were homogeneous. The results of this test demonstrated that the participants answered the items according to their own opinions, indicating that there was no response bias (Hotelling's T² = 216.228; p = 0.000). Strengths and Limitations of the Study When the results of the present study are evaluated, some limitations should be taken into account, particularly regarding the characteristics of the study sample. Since the results were obtained from the nurses working in a single secondary care center in a small province, they cannot be generalized to all nurses. It is recommended that the validity and reliability studies of the PH-PNAS should also be tested with nurses working in primary and tertiary care facilities. The PH-PNAS is the first scale developed in this field. Widespread use of the PH-PNAS by adapting it to different languages ​​and cultures will make a significant contribution to the literature. The PH-PNAS can also be adapted for other healthcare professionals besides nurses. Conclusion The analyses conducted to test the construct validity and reliability of the PH-PNAS revealed that it provided valid and reliable measurements. The analyses of the item discrimination, item-total correlation, exploratory factor analysis, internal consistency reliability analysis, interdimensional correlations, and confirmatory factor analysis for validity and reliability analyses demonstrated that the values obtained ​​were at an adequate level, indicating that the Turkish version of the PH-PNAS is a valid and reliable measurement tool. The results also demonstrate that the Turkish version of the PH-PNAS consists of a single dimension and 16 items. Its Cronbach's alpha coefficient is high. The use of the PH-PNAS is important for determining nurses' awareness levels regarding environmental sustainability, planetary health, and planetary nursing, and for supporting interventions aimed at addressing knowledge gaps and increasing awareness levels in this field. Abbreviations PH-PNAS Planetary Health and Planetary Nursing Awareness Scale Declarations Ethics approval and consent to participate In accordance with the ethical principles of the Declaration of Helsinki, confidentiality and anonymity were guaranteed in this study. All participants provided informed consent before starting the questionnaire. Ethical approval was obtained from the Çankırı Karatekin University Ethics Committee for the study (decision date: March 19, 2024; decision number: 12), institutional permission from the management of Çankırı State Hospital (decision date: July 2, 2024; document number: E-64943697-799-247570303). Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding The authors received no financial support for the research, authorship, and/or publication of this article. 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2","display":"","copyAsset":false,"role":"figure","size":108913,"visible":true,"origin":"","legend":"\u003cp\u003eFirst-level Multifactorial Model Confirmatory Factor Analysis (standardized) of the Planetary Health and Planetary Nursing Awareness Scale\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8457797/v1/1b00511c610e475463efea0e.png"},{"id":100949285,"identity":"efef4434-ce7a-49f3-a3d7-be4a085c4736","added_by":"auto","created_at":"2026-01-23 06:57:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1468510,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8457797/v1/c4274146-15ba-4807-aaf8-b8e145298f7f.pdf"},{"id":99793616,"identity":"98f88e7c-d3c8-4cde-9425-6a70d48b57d7","added_by":"auto","created_at":"2026-01-08 13:31:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16340,"visible":true,"origin":"","legend":"","description":"","filename":"suppfile30.12.2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-8457797/v1/c16eac33fc4016ad20a37092.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePlanetary Health and Planetary Nursing Awareness Scale: Scale Development Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHumanity's relationship with the natural environment has changed over the centuries. Humans who initially lived in harmony with nature later began to destroy it by consuming and depleting natural resources recklessly. Primitive societies lived as part of nature, and consumed only what they needed. However, with advancements in technology, urbanization, and a growing global population, the ecosystem's balance began to deteriorate. Today, at the point we are in, environmental problems have reached global dimensions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The human-environment interaction consists of three stages. The first stage called the \u003cem\u003eUnconscious Existence Stage\u003c/em\u003e lasted until the 19th century. At this tage, people were unconscious and unaware of how the environment and events in it would affect them. The second stage marked the beginning of pre-consciousness. This stage, during which ethical values were discussed, lasted from the second half of the 19th century until the 1970s. It is called the \u003cem\u003eConsciousness Stage\u003c/em\u003e. The third stage, which started in the 1970s and has continued until today, is called the \u003cem\u003estage of formation of conscience\u003c/em\u003e. At this stage, not the anthropocentric ethical approach that assumes that only humans have value [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], but the ecocentric ethical approach, which includes all living beings, was adopted. According to this approach, all living beings are important, and every living being is indispensable for the ecosystem. The survival of each living being depends on the existence of another living being) (the food chain) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to the ecocentric ethical approach, not only living things in nature but also inanimate objects that enable the continuity of life/living have an intrinsic value [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Within this context, the consumption of limited world resources is among the most debated issues today; thus, the concept of \u003cem\u003econtinuous and balanced development\u003c/em\u003e, in other words, \u003cem\u003esustainable development\u003c/em\u003e, comes to the fore. \u003cem\u003eSustainable development\u003c/em\u003e is a type of development that ensures the needs of the present generation to be met without compromising the ability of future generations to meet their needs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The concept of sustainable development started to emerge in the 1970s as a new expression of the balance desired to be established between economy, society, and the environment. Although the concept was initially translated into Turkish as \"continuous and balanced development,\" the phrase \"sustainable development\" has become the more commonly used term [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The United Nations (UN) convened the Environment and Development Conference, known as the Earth Summit, in Rio in 1992. After this conference, the concept of sustainable development has shaped global economic growth and development thinking. Since then, experts dealing with environmental problems have begun to accept the idea that the current generation assumes responsibility towards future generations as a fundamental principle. Thus, discussions regarding the current generation\u0026rsquo;s responsibilities towards future generations have begun [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The current generation\u0026rsquo;s ethical responsibility towards future generations arises from the possibility of their existence. Every individual currently existing in the world is responsible for future generations for their actions, because every individual takes certain actions to live. These actions constitute the steps of the process that ensures the formation of future generations. For instance, when a farmer plants tomatoes in the field, they not only sustain their own life but also provide food for society, thus contributing to the formation of future generations. A nurse, through each individual they heal, contributes not only to the survival of that person but also, though indirectly, to the existence of future generations. Thanks to such behaviors, the continued existence of humans is inevitable, except in extraordinary situations such as epidemics, wars, or natural disasters [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Within this context, it has been thought that global development policies should be redesigned within the framework of sustainability in order to leave a healthy and livable planet to future generations. To achieve this purpose, 17 Sustainable Development Goals were determined at the 2030 Sustainable Development Summit held at the UN Headquarters in New York between September 25, 2015 and September 27, 2015, aimed at providing solutions to the environmental problems facing humanity. These goals cover a wide range of issues such as eradicating poverty, providing quality education, promoting equality between people, ensuring access to clean water and safe food, ensuring sustainable consumption, and combating climate change. These goals were adopted by 193 countries [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Goal 3, one of the Sustainable Development Goals, aims to ensure that individuals at all ages lead healthy lives and achieve a high level of well-being. The analysis of the sub-objectives defined within the scope of this goal has revealed that issues such as health promotion, disease prevention, and equal access to health services directly coincide with the fundamental duties and responsibilities of nursing. Nurses play a key role in the implementation of these goals in the field. Another objective of Goal 3 draws attention to the negative effects of air, water, and soil pollution on human health. This objective emphasizes that environmental factors are critically important not only for ecological life but also for human health. Therefore, it is becoming increasingly important that healthcare services be addressed with a holistic approach that not only focuses on people but also encompasses planetary health. Such perspective necessitates the development of health policies which do not ignore the effect of planetary health on human health and include environmental sustainability.\u003c/p\u003e \u003cp\u003ePlanetary health was first defined in 2015 as follows: \u0026ldquo;achieving the highest possible levels of health, well-being, and equality worldwide by caring for natural resources of the Earth with its limited safe environment which shapes the future of humanity from political, economic and social aspects.\u0026rdquo; In short, planetary health is defined as \u0026ldquo;the health of humans and, consequently, the state of the ecosystem\u0026rdquo; [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Within this context, the concept of \u0026ldquo;planetary nursing\u0026rdquo; based on the mutual interaction between planetary health and human health has come to the forefront in the literature in recent years. Planetary nursing is a holistic approach that advocates that nursing practices should focus on the protection of both human and planetary health, and environmental sustainability of the Earth [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is estimated that approximately 15% of medical waste generated in healthcare settings is hazardous, because this waste is likely to be infectious, toxic, or radioactive. Furthermore, a large portion of medical waste is made of plastics, whose decomposition in nature takes a long time. If medical waste is not properly treated, it poses serious risks to both human and environmental health. From this perspective, it can be said that medical waste places a greater burden on the ecosystem than do other types of waste. Therefore, it is considered necessary that policies and procedures that enable the reuse of non-hazardous materials and/or recycling of these materials should be developed and implemented. Another recommendation is that its environmental effect should be minimized by regulating purchasing strategies and consumption patterns [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the medical waste generated during the provision of healthcare services, it is easier to understand the mutual interaction between planetary health and human health. The increase in treatment and care processes due to the increase in disease rates directly increases the amount of medical waste, resulting in increases in the environmental burden, which negatively affects planetary health. On the other hand, the deterioration of planetary health threatens human health through air, water and soil pollution; therefore, planetary health becomes an indispensable element for human health, and human health becomes an indispensable element for planetary health.\u003c/p\u003e \u003cp\u003eNot only the use of necessary materials during healthcare services, but also appropriate use of these materials without waste is of great importance. Excessive or improper use of medical supplies poses a significant problem for planetary health. For instance, in procedures where there is no risk of infection (e.g., measuring the blood pressure of a non-infected patient), the use of gloves is unnecessary; washing hands after each procedure is sufficient. Similarly, discarding unused disposable materials after a procedure is cancelled leads to the waste of resources and excess medical waste. It is crucial that nurses directly involved in treatment and care processes should act consciously and responsibly in this regard. The present study was aimed developing a scale to assess awareness of Planetary Health and Planetary Nursing.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e \u003cstrong\u003eStudy Design\u003c/strong\u003e \u003cp\u003eThis methodological descriptive study was conducted and reported in accordance with the STROBE checklist.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePlace and Time of the Study\u003c/strong\u003e \u003cp\u003eThe study was conducted in \u0026Ccedil;ankırı State Hospital between March 31, 2025 and May 14, 2025.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eAs indicated in the literature, in scale studies, the sample size should be five -fold or ideally ten-fold the number of the items in the scale [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, it is also emphasized that a sample size less than 200 may be inadequate to reveal the psychometric structure, and that a sample size of 300, and ideally 500, is generally needed for a test to yield valid and reliable results [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, 359 nurses who met the inclusion criteria and who had at least 6 years of active nursing experience and were currently working as nurses in a healthcare facility were included in the sample. Healthcare professionals who were not nurses were not included in the study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData Collection\u003c/b\u003e Data were collected using the Personal Information Form and the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS). The researchers visited the units in the aforementioned hospital, sent online form links to nurses who met the inclusion criteria and volunteered to participate in the study, and asked them to answer the questions on the data collection forms. The simple random sampling method was used to select nurses to be included in the study. Data collection took 5 to 8 minutes. Before the study was conducted, the PH-PNAS was pilot tested. No changes were made to the PH-PNAS after the pilot study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Forms\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePersonal Information Form\u003c/h2\u003e \u003cp\u003eThe Personal Information Form developed by the researchers consists of 10 items questioning the participants\u0026rsquo; characteristics such as age, sex, marital status, education level, city of residence, length of residence in the same city, and socioeconomic level. The participants were also asked whether they had any children and whether they had a bachelor's degree in a field other than nursing [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDevelopment of the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS)\u003c/h3\u003e\n\u003cp\u003eThe PH-PNAS was developed to assess nurses' awareness of planetary health and planetary nursing. Responses given to the items in the PH-PNAS are rated on a five-point Likert-type scale ranging from 1 to 5 (1: Strongly Disagree, 2: Disagree 3: Undecided, 4: Agree, 5: Strongly Agree). To develop the PH-PNAS, the researchers reviewed the literature [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and created a pool of 58 items. The senior quantitative analyst reduced the number of items in the scale pool from 58 to 27. After statistical analysis, in the final version of the PH-PNAS, the number of the items was reduced to 16 and the single-dimensional structure was considered as the best structure. No items in the PH-PNAS are reverse scored. The minimum and maximum possible scores that can be obtained from the PH-PNAS are 16 and 80, respectively. There is no cut-off point. The higher the score is, the higher the respondent\u0026rsquo;s level of awareness is.\u003c/p\u003e\n\u003ch3\u003eValidity of the Scale Content\u003c/h3\u003e\n\u003cp\u003eTo assess the content validity of the PH-PNAS, opinions were obtained from 11 experts. Of them, 5 were specialized in nursing, 3 in health sustainability, 2 in environmental sustainability, and 1 in statistics (senior quantitative analyst). The Davis Method was used to obtain expert opinions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. They rated each item in the PH-PNAS as follows: 1-Very suitable, 2-Suitable but needs modification, 3-Item should be modified, 4-Not suitable. The content validity ratio of the items was \u0026ge;\u0026thinsp;0.80. Therefore, no changes were made to the scale items after the expert opinions were obtained (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContent Validity Ratios for the Item Pool\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem (I)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem (I)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eItem (I)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" 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\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePilot Study\u003c/h2\u003e \u003cp\u003eBefore data collection was started, a pilot study was conducted with 40 nurses who were not included in the study sample to assess the comprehensibility of the items in the PH-PNAS. The results of the pilot study demonstrated that all the items were clear enough to understand. Because the items were not changed and these 40 nurses would not be included in the main sample, a test-retest analysis was also performed with them. Pre-test data for the pilot study were collected between January 27, 2025 and January 29, 2025. Fifteen days after the pretest, they were asked to answer the same questions again, and the second set of data was collected between February 11, 2025 and January 12, 2025 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the pilot study (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eITEMS IN THE POOL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem-total score correlation values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlpha value when the item is deleted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Reducing ecological footprint is the responsibility of every individual.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Attention should be paid to the use of medical supplies to protect world resources.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Ecosystems are closely related to public health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. To protect the planetary health), it is essential that healthcare should be provided equally and fairly.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Protection and improvement of health are important for the planetary health).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. The world's resources are only for humans.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Prevention of infectious diseases positively affects planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Good planetary health is important for future generations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Humans are a part of nature.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Transporting hospital staff to and from the hospital on a shuttle bus is an environmentally friendly practice.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. The appropriate use of medical supplies is important for the protection of the planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Features of a building are related to the planetary health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Access to natural resources affects human health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Complying with medical waste guidelines is important for the planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Planetary health is directly related to the health of living beings.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Preventive health services have a positive effect on the planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Climate change affects human health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Nurses should be trained on planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. Nurses should be trained on environmental sustainability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. Nurses play a significant role in planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Planetary health is closely related to the health of present-day humans and future generations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. Providing natural lighting with sunlight in hospitals is essential for the planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. Type of the diet affects the planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. Consuming local foods is important for the planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. The use of medical supplies is related to planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26. There is a relationship between sustainability and health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27. Protecting and improving human health is important for the planetary health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eCronbach's Alpha\u0026thinsp;=\u0026thinsp;0.976\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the preliminary study conducted with 40 nurses who were not included in the sample, it was determined that the item-total correlation values ​​for all the items were quite high, and that the internal consistency coefficient of the PH-PNAS was 0.976.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTest-retest analysis (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMax.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCorrelation (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ez test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH-PNAS pre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.798**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-1.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH-PNAS post-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSpearman correlation analysis was performed. The Wilcoxon signed-rank test was performed to assess the difference between measurement times. **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003cp\u003eWhile the mean score and the median value obtained at the pretest were 18.45\u0026thinsp;\u0026plusmn;\u0026thinsp;8.93 and 16.50, respectively, they were 19.05\u0026thinsp;\u0026plusmn;\u0026thinsp;12.00 and 15.00, respectively at the posttest, indicating that the values obtained at the posttest given 15 days after the pretest were not statistically significant different (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Furthermore, the correlation (r) between the two measurements (0.798) (**p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) was strong, indicating that responses given by the participants were consistent over the time elapsed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e Before the study was conducted, ethical approval was obtained from the \u0026Ccedil;ankırı Karatekin University Ethics Committee (decision date: March 19, 2024; decision number: 12), institutional permission from the management of \u0026Ccedil;ankırı State Hospital (decision date: July 2, 2024; document number: E-64943697-799-247570303), and verbal consent from the participants. The study was carried out in accordance with the ethical standards established in the Declaration of Helsinki.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data obtained in the study were analyzed using the SPSS (Statistical Package for the Social Sciences) for Windows, version 25.0 and AMOS (Analysis of Moment Structures), version 21. Basic descriptive statistical methods (number, percentage, arithmetic mean, standard deviation) were used in the analysis of the data. These methods are aimed at determining the demographic characteristics of the participants and the general trends of responses given to the scale items [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In reliability analyses, the test-retest technique, split-half correlations, and Cronbach's alpha coefficient were used. The construct validity of the PH-PNAS was performed based on two-stage factor analysis. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed, and the item discrimination index was calculated. All the results were at a 95% confidence interval. P values less than 0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the participating nurses, 42.1% were in the age group of 31\u0026ndash;40 years, 86.4% were women, 63.8% were married, 57.7% had children, 57.7% had a bachelor's degree, 20.6% had studied in a field other than nursing, 59.1% had lived in the same city for more than 10 years, and 79.1% described their socio-economic level as moderate (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the Demographic Characteristics of the Participating Nurses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDemographic Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003cp\u003e\u0026ge;\u0026thinsp;41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003cp\u003e151\u003c/p\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.9\u003c/p\u003e \u003cp\u003e42.1\u003c/p\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003cp\u003e310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003cp\u003e86.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003cp\u003e63.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you have any children?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctorate degree\u003c/p\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003cp\u003eMaster's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003cp\u003e207\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003cp\u003e57.7\u003c/p\u003e \u003cp\u003e5.3\u003c/p\u003e \u003cp\u003e3.9\u003c/p\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid you study in another field?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003cp\u003e79.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow many years have you been living in this city? (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u0026ndash;5\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e66\u003c/p\u003e \u003cp\u003e212\u003c/p\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003cp\u003e18.4\u003c/p\u003e \u003cp\u003e59.1\u003c/p\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow do you perceive your socioeconomic level?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003eNot good\u003c/p\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003cp\u003e79.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity\u003c/h2\u003e \u003cp\u003eIn the assessment of the content validity conducted based on the opinions of 11 aforementioned experts, the validity ratio at the item level was 0.80 or higher. No changes were made to the items in the PH-PNAS after expert opinions were obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eExploratory Factor Analysis (EFA)\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eAn Exploratory Factor Analysis (EFA) was conducted to assess the construct validity of the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS). Initial factor structure analysis of the PH-PNAS revealed a highly dispersed factor structure. However, despite this dispersed structure, due to the high eigenvalues, the number of factors was limited to one. Therefore, after the items with low factor loadings and insufficient explanation were excluded, the exploratory factor analysis was performed. The final stage of the exploratory factor analysis revealed that the scale had a single-factor and holistic structure. Whether the data were suitable for factor analysis was determined using the Kaiser-Meyer-Olkin (KMO) test and the Bartlett\u0026rsquo;s Test of Sphericity. The KMO value (0.961), and the result of Bartlett\u0026rsquo;s Test of Sphericity [Χ\u0026sup2; (253)\u0026thinsp;=\u0026thinsp;6861.981; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001] were statistically significant and confirmed that the correlation between the variables was suitable for factor analysis. The result of the Exploratory Factor Analysis (EFA) performed using the Principal Component Analysis (PCA) method demonstrated that factor loadings of all the items were above 0.40. The total explained variance ratio of the PH-PNAS was calculated as 57.969 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the Exploratory Factor Analysis of the PH-PNAS (n\u0026thinsp;=\u0026thinsp;359)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor loadings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEigenvalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariance Explained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.696\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cb\u003eKMO\u0026thinsp;=\u0026thinsp;0.961 Χ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e(253) 6861.981; Bartlett\u0026rsquo;s Test of Sphericity (p)\u0026thinsp;=\u0026thinsp;0.000\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe scree plot in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the eigenvalue distribution of the factor analysis of the Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS). As can be seen on the scree plot, while the eigenvalue of the first factor was high, eigenvalues of the other factors were low, which indicates that the optimal number of the factors based on the scree plot is one [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eConfirmatory Factor Analysis (CFA)\u003c/h2\u003e \u003cp\u003eThe analysis of the results of the CFA regarding the single-factor structure of the 16-item Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS) revealed that the χ\u0026sup2;/SD ratio which was 4.336 before the modification decreased to 2.890 after the modification. This value which is less than 3 indicates that the single-factor structure had an excellent fit. The goodness-of-fit indices for the model were RMSEA\u0026thinsp;=\u0026thinsp;0.073, SRMR\u0026thinsp;=\u0026thinsp;0.034, CFI\u0026thinsp;=\u0026thinsp;0.955, IFI\u0026thinsp;=\u0026thinsp;0.955, TLI\u0026thinsp;=\u0026thinsp;0.947, NFI\u0026thinsp;=\u0026thinsp;0.934, GFI\u0026thinsp;=\u0026thinsp;0.903, and AGFI\u0026thinsp;=\u0026thinsp;0.875. These results confirm the single-factor structure of the scale, and support its construct validity statistically. The improvements in fit obtained after the modifications strengthened the validity of the model compared to its original form (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the Confirmatory Factor Analysis of the Planetary Health and Planetary Nursing Awareness Scale (16 items, six factors) (n\u0026thinsp;=\u0026thinsp;359)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the modification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter the modification\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{X}^{2}\\)\u003c/span\u003e\u003c/span\u003e/SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.890\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.870\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.934\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eChi-square / Degrees of Freedom (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{X}^{2}\\)\u003c/span\u003e\u003c/span\u003e/SD)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor Loadings According to the Confirmatory Factor Analysis (First Level)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStandardized factor loading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnstandardized factor loading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC.R.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eS.E. standard error; CR: test value indicating the significance of the items,\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e shows that all the CR values ​​were significant, and that factor loadings of all the items which ranged from 0.557 to 0.854 were above 0.30.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItem analysis of the Planetary Health and Planetary Nursing Awareness Scale (n\u0026thinsp;=\u0026thinsp;359)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe alpha value when the item is deleted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u003c/p\u003e \u003cp\u003e(**Lower-Upper 27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003cp\u003e(**Lower-Upper 27)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9.633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12.352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003en1\u0026thinsp;=\u0026thinsp;n2\u0026thinsp;=\u0026thinsp;97 (lower-upper group)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eTotal sample size 359\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;Item Total Score Correlation, t: (Lower 27% - Upper 27%) ** Significant values ​​for p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, the results of the independent samples t-test indicating the discrimination power of all the items and the item-total correlation were presented. The analysis of the item-total test correlation values ​​of the participants' answers to the questions in the PH-PNAS revealed that none of the items had a correlation coefficient below 0.30. Since the PH-PNAS has one dimension, the item-total score correlation values ​​were calculated for the entire scale, and the item analysis was performed for the entire scale. Since the item-total score correlation coefficients of the items ranged between 0.553 and 0.825, they were considered statistically significant. To determine the discrimination power of the items in the PH-PNAS, the raw scores obtained from it were ranked from highest to lowest, and the mean scores of the groups in the lower 27% and upper 27% were compared using the independent samples t-test. The results of the comparison demonstrated that there was a statistically significant difference between the mean scores of the lower and upper group items.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eReliability Analysis\u003c/h2\u003e \u003cp\u003eThe Cronbach's alpha value of the overall PH-PNAS was calculated as 0.951. The data were split in half using odd or even rows. According to the results, the correlation coefficient between the two halves was calculated as 0.925; the Spearman-Brown coefficient as 0.961; and the Guttman coefficient as 0.961 (Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSplit-Half Method\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCronbach's Alpha\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePart 1\u0026thinsp;=\u0026thinsp;Item1, Item4, Item7, Item9, Item13, Item15, Item17, Item21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePart 2\u0026thinsp;=\u0026thinsp;Item3, Item5, Item8, Item11, Item14, Item16, Item18, Item22\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCorrelation between two halves\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSpearman-Brown coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGuttman Split-Half coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe reliability of the measurement model was also tested by analyzing the Average Variance Extracted (AVE) and composite reliability (CR) values ​​for each factor separately. The AVE value was determined as 0.574, and the CR value was determined as 0.949. There was no response bias for the PH-PNAS (Hotelling's T\u0026sup2; = 216.228; p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eNursing is a profession that cares for the environment, advocates policies and programs aimed at sustaining and restoring the natural world, understands the effect of climate change on environmental and public health, and considers all of these as a core competency of nursing education [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Nurses should also lead the advancement of planetary health science, as they have the understanding that human health and dignity are intertwined with the vitality of the natural world [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a literature review, it was revealed that there is gap regarding measurement tools used to assess nurses' awareness of planetary health or planetary nursing. Thus, it was decided to develop a scale in the present study. In the present study, one of the researchers is a health academician who has a doctorate degree in bioethics and environmental ethics, a field she has worked in for about 10 years and has been working in the field of environmental sustainability.The other researcher is also an academician who has a doctorate degree in internal medicine nursing with approximately 10 years of experience. Both academicians are experienced in nursing practice. The present study was aimed at addressing this gap in the field.\u003c/p\u003e \u003cp\u003eTo test the validity of the scale, content and construct validity studies were performed. Expert opinions were consulted to test the content validity of the PH-PNAS. The Davis Method was used to collect expert opinions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The accepted criterion value for the Content Validity Index is 0.80 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and a minimum content validity ratio of 0.80 is required for each item. In the present study, the content validity ratio for all the items was 0.80 and above. Therefore, no changes were made to the scale items. These results indicate that there is consensus among the experts, that the statements in the PH-PNAS are appropriate to Turkish culture, that they represent the area to be measured, and that content validity has been achieved.\u003c/p\u003e \u003cp\u003eAccording to the results of the pilot study, all the items were understandable by the respondents, and thus, no items were modified. Since none of the items was modified and the respondents would not be included in the main sample, a test-retest reliability analysis was also performed on the respondents who took the pilot test. In the test-retest reliability method, the same test is administered to the same individuals under the same conditions at different time intervals to demonstrate whether the features of the test measured change over time. The time elapsed between two measurements is important. A period of approximately two weeks between the first and second measurements is generally considered appropriate. A high positive correlation (r\u0026thinsp;\u0026gt;\u0026thinsp;0.80) between the two measurements is desirable. However, it should be emphasized that only the direction and strength of the relationship between the two measurements are not sufficient to determine the test-retest reliability coefficient. What is truly important is the high degree of agreement between the measurements obtained at two different times. When measuring the same characteristic twice on the same sample, a certain level of correlation between the two measurements is expected, but the agreement between the scores obtained from two different measurements may be low [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, it is recommended to use the intra-class correlation coefficient (ICC) to determine the relationship between two measurements, as well as the level of consistency or agreement [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In the present study, before the ICC calculation, the test-retest reliability coefficient and the correlation coefficient between the two measurements (Pearson correlation coefficient) were calculated for comparison. The internal consistency coefficient was 0.976. In the first measurement, the mean score was 18.45\u0026thinsp;\u0026plusmn;\u0026thinsp;8.93; the median value was 16.50. In the last measurement, they were 19.05\u0026thinsp;\u0026plusmn;\u0026thinsp;12.00 and 15.00, respectively. The difference between the repeated measurements taken 15 days apart was not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In addition, the correlation (r) between the measurements (0.798) indicated a strong relationship with (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The answers given by the participants were consistent throughout the time elapsed.\u003c/p\u003e \u003cp\u003eTo determine the structural validity of the PH-PNAS, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Factor analysis is one of the statistical techniques frequently used to transform a large number of related variables into a small number of independent factors. In the present study, the KMO value was calculated as 0.961, indicating that the data had an \u0026ldquo;excellent\u0026rdquo; level of suitability for factor analysis, i.e., the sample size was adequate and suitable for analysis [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, the results of Bartlett\u0026rsquo;s Test of Sphericity were statistically significant, confirming that there was a suitable level of correlation between the variables for factor analysis. Based on the EFA and CFA results, 11 items were removed from the 27-item PH-PNAS (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The Turkish version of the PH-PNAS consists of 16 items. According to the EFA results, the factor loadings of this PH-PNAS ranged from 0.557 to 0.854, and all factor loadings were greater than 0.500. Factor loadings of all the items were above 0.40. Tabachnick and Fidell [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] stated the threshold value for factor loading should be 0.32. According to the analysis results, the factor loadings of all the items were adequate, which indicated that the items of the PH-PNAS strongly represented the factor and that the PH-PNAS had structural validity [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The total explained variance ratio of the PH-PNAS was calculated as 57.969. This ratio is well above the threshold value of 50 recommended for structural validity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and indicates that the PH-PNAS successfully represents the concept it measures. Furthermore, considering the view that the eigenvalue should be above 1 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. these results confirm that the single-factor structure of the scale is strong and significant.\u003c/p\u003e \u003cp\u003eThe results of the CFA regarding the single-factor structure of the 16-item PH-PNAS indicate that the model fits the data at a significant level. The χ\u0026sup2;/SD ratio which was 4.336 before modification decreased to 2.890 after modification. Because it is below 3, it indicates an excellent fit. The RMSEA (0.073), one of the goodness-of-fit indices, indicates an acceptable fit, while the SRMR (0.034) indicates an excellent fit [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Furthermore, the CFI (0.955), IFI (0.955), TLI (0.947), NFI (0.934), and GFI (0.903) values ​​are above 0.90, and the AGFI (0.875) value is within acceptable fit limits [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These results confirm the PH-PNAS\u0026rsquo;s single-factor structure and statistically support its construct validity. The improvements in fit obtained after the modifications strengthened the model's validity compared to its original form.\u003c/p\u003e \u003cp\u003eFactor loadings above 0.30 indicate that the items are suitable for the structure. In the present study, factor loadings of all the items were above 0.30. CR statistics indicate whether the items are statistically significant. In the present study, all the CR values ​​were significant, and factor loadings of all the items were above 0.30. If the factor loading of an item is above 0.30, it can be concluded that the item is suitable for the structure [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In the present study, the item factor loadings ranged from 0.557 to 0.854.\u003c/p\u003e \u003cp\u003eThe minimum required value for a sufficient item-total test correlation should be 0.30 [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Items with correlations below 0.30 should not be included in the analysis. The analysis of the item-total test correlation values ​​of the participants' answers to the questions in the PH-PNAS demonstrated that there were no items whose correlations were below 0.30. Since the PH-PNAS had one dimension, item-total score correlation values ​​were calculated for the entire PH-PNAS, and item analysis was performed for the entire PH-PNAS. The item total score correlation coefficients of the items ranged between 0.553 and 0.825, indicating that they were statistically significant. To determine the discriminative power of the items in the PH-PNAS, the raw scores obtained from the PH-PNAS were ranked from highest to lowest, and the mean scores of the groups in the lower 27% and upper 27% were compared using the independent samples t-test. The results of the comparison revealed a statistically significant difference between the mean scores of the lower and upper group items. Based on this, it can be said that the PH-PNAS is discriminative in terms of measuring the desired quality. In other words, the results of the 27% upper and lower item analysis for the measurement instrument demonstrated that all the items had discriminatory power.\u003c/p\u003e \u003cp\u003eReliability analysis is conducted to test whether the statements included in a scale are consistent with each other. In reliability analysis, a Cronbach's Alpha (α) coefficient value ranging between 0.00 and 0.40 indicates that the scale is not reliable; a value between 0.40 and 0.60 indicates that the scale has low reliability; a value between 0.60 and 0.80 indicates that the scale is quite reliable; and a value between 0.80 and 1.00 indicates that the scale is highly reliable [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In the present study, the Cronbach's alpha value was calculated as 0.951, suggesting that the PH-PNAS is highly reliable.\u003c/p\u003e \u003cp\u003eThe split-half method is used when a test can be divided into two halves to obtain a single score. The method relies on the scores obtained from both halves of the sample being similar, if the measurement instrument is reliable. The split-half method can be performed by separating items according to their odd and even numbers, or in a random order [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The correlation between the two halves indicates whether the instrument is reliable. A correlation coefficient above 0.70, i.e., close to 1, indicates that the instrument is reliable [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In the present study, the data was split in half using odd-even sequences, and the results (correlation coefficient\u0026thinsp;=\u0026thinsp;0.925; Spearman Brown coefficient\u0026thinsp;=\u0026thinsp;0.961; Guttman coefficient\u0026thinsp;=\u0026thinsp;0.961) indicated that the instrument was reliable.\u003c/p\u003e \u003cp\u003eThe reliability of the measurement model was also tested with the Average Variance Extracted (AVE) and composite reliability (CR) values ​​of each factor separately. The CR value of the factors in the measurement model should be higher than 0.70, and the AVE value should be higher than 0.50 [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the present study, the AVE value was 0.574 and the CR value was 0.949, indicating that the measurement model is reliable. The response bias of the PH-PNAS was analyzed using the Hotelling's T\u0026sup2; analysis method to assess whether the responses given to the items were homogeneous. The results of this test demonstrated that the participants answered the items according to their own opinions, indicating that there was no response bias (Hotelling's T\u0026sup2; = 216.228; p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations of the Study\u003c/h2\u003e \u003cp\u003eWhen the results of the present study are evaluated, some limitations should be taken into account, particularly regarding the characteristics of the study sample. Since the results were obtained from the nurses working in a single secondary care center in a small province, they cannot be generalized to all nurses. It is recommended that the validity and reliability studies of the PH-PNAS should also be tested with nurses working in primary and tertiary care facilities. The PH-PNAS is the first scale developed in this field. Widespread use of the PH-PNAS by adapting it to different languages ​​and cultures will make a significant contribution to the literature. The PH-PNAS can also be adapted for other healthcare professionals besides nurses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe analyses conducted to test the construct validity and reliability of the PH-PNAS revealed that it provided valid and reliable measurements. The analyses of the item discrimination, item-total correlation, exploratory factor analysis, internal consistency reliability analysis, interdimensional correlations, and confirmatory factor analysis for validity and reliability analyses demonstrated that the values obtained ​​were at an adequate level, indicating that the Turkish version of the PH-PNAS is a valid and reliable measurement tool. The results also demonstrate that the Turkish version of the PH-PNAS consists of a single dimension and 16 items. Its Cronbach's alpha coefficient is high. The use of the PH-PNAS is important for determining nurses' awareness levels regarding environmental sustainability, planetary health, and planetary nursing, and for supporting interventions aimed at addressing knowledge gaps and increasing awareness levels in this field.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePH-PNAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePlanetary Health and Planetary Nursing Awareness Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e In accordance with the ethical principles of the Declaration of Helsinki, confidentiality and anonymity were guaranteed in this study. All participants provided informed consent before starting the questionnaire. Ethical approval was obtained from the \u0026Ccedil;ankırı Karatekin University Ethics Committee for the study (decision date: March 19, 2024; decision number: 12), institutional permission from the management of \u0026Ccedil;ankırı State Hospital (decision date: July 2, 2024; document number: E-64943697-799-247570303).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSGŞ: Conceptualization, Methodology, Investigation, Software, Formal analysis, Writing-original draft preparation, Writing- Reviewing and Editing. GYT: Methodology, Investigation, Software, Formal analysis, Writing-original draft preparation, Writing- Reviewing and Editing.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKeleş R, ve Ertan B. \u0026Ccedil;evre Hukukuna Giriş, 1. Baskı, İmge Kitabevi, Ankara, 2002: 181\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDes Jardins JR, \u0026Ccedil;evre Etiği. \u0026Ccedil;evre Felsefesine Giriş, 1. Baskı, \u0026Ccedil;ev.: Ruşen Keleş, İmge Yayınevi, Ankara, 2006: 46, 158\u0026ndash;160.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoğan M. \u0026Ccedil;evre Etiği ve Biyolojik \u0026Ccedil;eşitlilik 1. 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Ankara: Pegem Akademi; 2015. pp. 166\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 1981;18(1):39\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"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":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Environmental Sustainability, Planetary Nursing, Planetary Health, Scale Development, Sustainable Consumption","lastPublishedDoi":"10.21203/rs.3.rs-8457797/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8457797/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eIntroduction\u003c/b\u003e: Today, increases in human population and longevity, and the rise of chronic diseases lead to an increase in using hospital services. Medical waste, consisting of plastic materials likely to be toxic or radioactive, poses a greater burden on the planet than other kinds of waste such as office supplies. It is clear that nurses, who play a key role in protecting and promoting health, also play a key role in environmental sustainability, and in protecting and promoting planetary health. The purpose in this study is to develop a scale aimed at determining nurses' awareness of planetary health and planetary nursing.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e: In this study having a methodological research design, data were collected from 359 nurses currently working via an online form between March 31, 2025 and May 14, 2025.\u003c/p\u003e \u003cp\u003eThe SPSS (Statistical Package for the Social Sciences) for Windows version 25.0 and AMOS (Analysis of Moment Structures) version 21 were used in the analysis. For the categorical variables, number (N) and percentage (%) values were calculated for the descriptive statistics.\u003c/p\u003e \u003cp\u003eAfter the expert opinion was obtained, the Content Validity Index (CVI) and Content Validity Ratios (CVR) were calculated, and a pilot study was conducted with 40 nurses. In the reliability analyses, the test-retest and split-half techniques were used, and the Cronbach's alpha coefficient, item-total correlation and item discrimination index were calculated. Construct validity of the scale was established via a two-stage factor analysis. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e: The result of the test-retest reliability was r\u0026thinsp;=\u0026thinsp;0.798 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). KMO and Bartlett's Test of Sphericity values for EFA ​​were 0.961 and 6861.981, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The total Cronbach's alpha coefficient of the scale was 0.951. The model fit index results determined after the CFA were as follows: RMSEA (Root Mean Square Error of Approximation)\u0026thinsp;=\u0026thinsp;0.073, SRMR (Standardized Root Mean Squared Residual\u0026thinsp;=\u0026thinsp;0.034, CFI (comparative fit index)\u0026thinsp;=\u0026thinsp;0.955, IFI (Incremental Fit Index)\u0026thinsp;=\u0026thinsp;0.955, TLI (Tucker\u0026ndash;Lewis index)\u0026thinsp;=\u0026thinsp;0.947, NFI (Normed Fit Index)\u0026thinsp;=\u0026thinsp;0.934, GFI (Goodness of Fit Index)\u0026thinsp;=\u0026thinsp;0.903 and AGFI (Adjusted Goodness of Fit Index)\u0026thinsp;=\u0026thinsp;0.875. The explained ratio of the total variance of the scale was calculated as 57.969. According to the EFA and CFA results, 11 items with low factor loadings were removed and the scale took its 16-item final form.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e: The Planetary Health and Planetary Nursing Awareness Scale (PH-PNAS) is a valid and reliable measurement tool, and it is believed to be useful tool for nurses who play a key role in the delivery of sustainable health services.\u003c/p\u003e","manuscriptTitle":"Planetary Health and Planetary Nursing Awareness Scale: Scale Development Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-06 18:16:51","doi":"10.21203/rs.3.rs-8457797/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-09T01:01:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67727628376983730720918744232869675342","date":"2026-01-29T16:37:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333936292157908762065583833630169011633","date":"2026-01-29T04:57:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50870431754157994787840198972194417699","date":"2026-01-29T04:48:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266934992564718670614698764834995733475","date":"2026-01-29T00:31:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T07:57:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T09:28:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-30T10:42:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-30T09:39:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-30T09:31:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea11f06d-93f6-4a94-80b0-ee645361f71f","owner":[],"postedDate":"January 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T08:08:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-06 18:16:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8457797","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8457797","identity":"rs-8457797","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}