Building the Climate-Responsive Environmental Theory of Nursing (CRETN): A Q Methodology Study of Nurses’ Perspectives on Climate-Driven Care Challenges
Description
This study, conducted by Dr. Fernan N. Torreno and Frincess Flores, examined the impact of climate change on nursing practice and introduced the Climate-Responsive Environmental Theory of Nursing (CRETN) to guide the profession in an era of environmental instability. Nurses, who represent the majority of the global health workforce, are at the frontline of climate-related crises such as heatwaves, floods, hurricanes, and wildfire smoke, yet traditional frameworks like Florence Nightingale’s Environmental Theory no longer fully capture these challenges. To address this gap, the research used a mixed-methods design integrating Q methodology, qualitative interviews, and systematic review with meta-analysis. In the Q study, 100 nurses sorted 45 climate-related statements across a forced distribution grid, producing four distinct perspectives: burnout and resilience, absenteeism and safety, missed care and system fragility, and medication errors under heat stress. These factors together explained 84% of variance, reflecting robust thematic patterns. Follow-up interviews with 18 nurses enriched the interpretation with personal accounts of stress, coping, and patient care under climate pressures. A systematic review of 38 studies published between 2000 and 2025 confirmed these findings, with pooled meta-analysis results showing significant associations between heatwaves and burnout (OR 1.45), wildfire smoke and absenteeism (OR 1.30), floods and hurricanes and missed care (OR 1.55), and extreme heat and medication errors (OR 1.25). From these insights, Dr. Torreno and Flores extended Nightingale’s model into CRETN, which integrates environmental stressors, nurse outcomes, patient outcomes, and system-level moderators such as staffing and infrastructure. The study concludes that nursing education must incorporate climate literacy, practice should prioritize occupational safety, and policies must strengthen climate-resilient health systems. CRETN thus provides a contemporary framework for advancing nursing knowledge, practice, and advocacy in the face of climate change.