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The purpose of this project was to develop a repository of NextGen NCLEX case studies that can be accessed by all faculty members in Maryland.

Detailed information about how faculty members can use these case students is in this PowerPoint document .

The case studies are in a Word document and can be modified by faculty members as they determine. 

NOTE: The answers to the questions found in the NextGen NCLEX Test Bank  are only available in these faculty case studies. When students take the Test Bank questions, they will not get feedback on correct answers. Students and faculty should review test results and correct answers together.

The case studies are contained in 4 categories: Family (13 case studies), Fundamentals and Mental Health (14 case studies) and Medical Surgical (20 case studies). In addition the folder labeled minireviews contains PowerPoint sessions with combinations of case studies and standalone items. 

Family  ▾

• Attention Deficit Hyperactivity Disorder - Pediatric
• Ectopic Pregnancy
• Febrile Seizures
• Gestational Diabetes
• Intimate Partner Violence
• Neonatal Jaundice
• Neonatal Respiratory Distress Syndrome
• Pediatric Hypoglycemia
• Pediatric Anaphylaxis
• Pediatric Diarrhea and Dehydration
• Pediatric Intussusception
• Pediatric Sickle Cell
• Postpartum Hemmorhage
• Poststreptococcal Glomerulonephritis Pediatric
• Preeclampsia

Fundamentals and Mental Health  ▾

• Abdominal Surgery Postoperative Care
• Anorexia with Dehydration
• Catheter Related Urinary Tract Infection
• Deep Vein Thrombosis
• Dehydration Alzheimers
• Electroconvulsive Therapy
• Home Safety I
• Home Safety II
• Neuroleptic Maligant Syndrome
• Opioid Overdose
• Post Operative Atelectasis
• Post-traumatic Stress
• Pressure Injury
• Substance Use Withdrawal and Pain Control
• Suicide Prevention
• Tardive Dyskinesia
• Transfusion Reaction
• Urinary Tract infection

Medical Surgical  ▾

• Acute Asthma
• Acute Respiratory Distress
• Breast Cancer
• Chest Pain (MI)
• Compartment Syndrome
• Deep Vein Thrombosis II
• End Stage Renal Disease and Dialysis
• Gastroesphageal Reflux
• Heart Failure
• HIV with Opportunistic Infection
• Ketoacidosis
• Liver Failure
• Prostate Cancer
• Spine Surgery
• Tension Pneumothorax
• Thyroid Storm
• Tuberculosis

Community Based  ▾

Mini Review  ▾

• Comprehensive Review
• Fundamentals
• Maternal Newborn Review
• Medical Surgical Nursing
• Mental Health Review
• Mini Review Faculty Summaries
• Mini Review Training for Website
• Mini Reviews Student Worksheets
• Pediatric Review

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Clinical decision making : case studies in medical-surgical nursing

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Medical-surgical nursing test success : an unfolding case study review

• Karen K. Gittings , Rhonda M. Brogdon , F. Cornelius
• Published 2013
• Medicine, Education

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Core Curriculum for Medical-Surgical Nursing

Core curriculum for medical-surgical nursing (6th edition).

The updated 6 th Edition of the Core Curriculum for Medical-Surgical Nursing  provides the latest information in medical-surgical nursing practice, making it an essential tool to stay current on specific practice areas, trends, and topics. Presented in an easy-to-use topic and outline format, this comprehensive resource provides the foundational body of knowledge for medical-surgical nursing practice and providing patient care. 

New chapters in the 6 th edition include:

• LGBTQIA+ Patients
• Care of Victims of Intimate/Domestic Partner Violence and Human Trafficking
• Care of Patients with Stroke
• Healthy Practice Environment

33 chapters, 700+ pages

Purchase the 6th Edition Core Curriculum for Medical-Surgical Nursing

Previous Version

Core curriculum for medical-surgical nursing (5th edition)  .

Are you preparing for the CMSRN exam? Are you a med-surg nurse interested in providing excellent care? Do you want to stay current on trends and topics in medical-surgical nursing?

This comprehensive resource provides the foundational body of knowledge for medical-surgical nursing practice.  This must-have reference book is written by expert medical-surgical nurses who designed it for new and experienced nurses.

Each chapter ends with a Case Study where you will learn to apply your knowledge to real life patient care.

Presented in an easy-to-use topic and outline format, the Core Curriculum for Medical-Surgical Nursing is your go-to guide for medical-surgical nursing, best practices, and exam preparation.

29 chapters, 600+ pages

Sample Pages | Sample Case Study | Table of Contents

 Buy the Book

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• Nursing Science
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Medical-Surgical Nursing

• October 2021
• Publisher: Wolters Kluwer

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Medical-Surgical Nursing

Medical-Surgical Nursing is a specialized field that focuses on the care of adult patients who are acutely ill with various medical conditions or diseases and those recovering from surgery (perioperative care).

On this page, you’ll find an extensive collection of Medical-Surgical Nursing study guides, designed to support your learning and exam preparation. Our resources include detailed explanations of key concepts, procedures, and patient care strategies, as well as sample test bank questions to test your knowledge and readiness.

Key topics include:

• Nursing care of adult clients
• Management of Various Medical Conditions and Diseases
• Perioperative Care Techniques
• Patient Care Strategies

Enhance your understanding and proficiency in Medical-Surgical Nursing with our expertly curated study materials. Whether you’re a student or a practicing nurse, these resources will help you excel in your field. Explore our Medical-Surgical Nursing guides now and take your knowledge to the next level.

EKG Interpretation & Heart Arrhythmias Cheat Sheet

Use this EKG interpretation cheat sheet that summarizes all heart arrhythmias in an easy-to-understand fashion. Download now!

Perioperative Nursing

Ever wondered what drives the critical decisions behind surgical procedures? In perioperative nursing, understanding the reasons for surgery—curing, diagnosing, preventing, enhancing, repairing, or relieving—empowers nurses to deliver exceptional, tailored patient care.

Appendicitis

Appendicitis (also known epityphlitis) is the inflammation of the appendix which is a small finger-like appendage attached to the cecum.

Urinary Tract Infection

Urinary tract infections (UTIs) are caused by pathogenic microorganisms in the urinary tract.

Urolithiasis (Renal Calculi)

Urolithiasis refers to stones (calculi) in the urinary tract. Stones are formed in the urinary tract when the urinary concentration of substances such as calcium oxalate, calcium phosphate, and uric acid increases.

Status Asthmaticus

Status asthmaticus is severe and persistent asthma that does not respond to conventional therapy; attacks can occur with little or no warning and can progress rapidly to asphyxiation.

Sickle Cell Anemia

Sickle cell anemia is a severe hemolytic anemia that results from inheritance of the sickle hemoglobin gene.

Sepsis and Septic Shock

Sepsis is a systemic response to infection. Septic shock is associated with sepsis.

Respiratory Acidosis

Respiratory Acidosis is an acid-base imbalance characterized by increased partial pressure of arterial carbon dioxide and decreased blood pH.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease of unknown origin. Here’s the nursing care management for patients with rheumatoid arthritis.

Study Guide for Medical-Surgical Nursing

• 10th Edition
• Authors: Donna D. Ignatavicius, Linda A. LaCharity, M. Linda Workman
• Language: English

Get a thorough review of medical-surgical nursing Concepts and Exemplars while developing your clinical judgment skills! Corresponding to Medical-Surgical Nursing: Concepts for I… Read more

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Get a thorough review of medical-surgical nursing Concepts and Exemplars while developing your clinical judgment skills! Corresponding to Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care, 10th Edition, from Ignatavicius, Workman, Rebar, and Heimgartner , this Study Guide is thoroughly revised with a fresh emphasis on the Concepts and Exemplars featured in the textbook. It adds application-level NCLEX® Exam-style questions and exercises, new NCLEX alternate item questions, and a completely new collection of Case Studies to prepare you for the Next Generation NCLEX Examination. With this practical study guide, you will prepare for NCLEX success and build the clinical reasoning skills you need for safe, effective nursing practice.

• Complete review of textbook content builds students’ clinical nursing judgment skills and enhances their ability to make safe and effective clinical decisions.
• UNIQUE! Focus on interprofessional collaboration provides tips for coordinating care with other health professionals, and includes application of IPEC’s Core Competencies for Interprofessional Collaborative Practice.
• Answer Key follows each chapter and adds new in-depth rationales for improved self-study and remediation.
• UNIQUE! Unparalleled emphasis on NCLEX ® Exam-style questions includes multiple-choice and multiple-select formats, familiarizing students with all NCLEX question formats to better prepare them for the NCLEX Examination.
• UNIQUE! Emphasis on the textbook’s Concepts and Exemplar disorders focuses students on key medical-surgical nursing concepts and how they are exemplified in common disorders.
• Cover image
• Table of Contents
• Unit I: Concepts for Medical-Surgical Nursing
• Chapter 1 Overview of Professional Nursing Concepts for Medical-Surgical Nursing
•     Chapter 1 Answer Key
• Chapter 2 Clinical Judgment and Systems Thinking
•     Chapter 2 Answer Key
• Chapter 3 Overview of Health Concepts for Medical-Surgical Nursing
•     Chapter 3 Answer Key
• Chapter 4 Common Health Problems of Older Adults
•     Chapter 4 Answer Key
• Chapter 5 Assessment and Concepts of Care for Patients with Pain
•     Chapter 5 Answer Key
• Chapter 6 Concepts of Genetics and Genomics
•     Chapter 6 Answer Key
• Chapter 7 Concepts of Rehabilitation for Chronic and Disabling Health Problems
•     Chapter 7 Answer Key
• Chapter 8 Concepts of Care for Patients at End of Life
•     Chapter 8 Answer Key
• Chapter 9 Concepts of Care for Perioperative Patients
•     Chapter 9 Answer Key
• Unit II: Concepts of Emergency Care and Disaster Preparedness
• Chapter 10 Concepts of Emergency and Trauma Nursing
•     Chapter 10 Answer Key
• Chapter 11 Concepts of Care for Patients with Common Environmental Emergencies
•     Chapter 11 Answer Key
• Chapter 12 Concepts of Disaster Preparedness
•     Chapter 12 Answer Key
• Unit III: Interprofessional Collaboration for Patients with Problems of Fluid, Electrolyte, and Acid-Base Balance
• Chapter 13 Concepts of Fluid and Electrolyte Balance
•     Chapter 13 Answer Key
• Chapter 14 Concepts of Acid-Base Balance
•     Chapter 14 Answer Key
• Chapter 15 Concepts of Infusion Therapy
•     Chapter 15 Answer Key
• Unit IV: Interprofessional Collaboration for Patients with Problems of Immunity
• Chapter 16 Concepts of Inflammation and Immunity
•     Chapter 16 Answer Key
• Chapter 17 Concepts of Care for Patients with HIV Disease
•     Chapter 17 Answer Key
• Chapter 18 Concepts of Care for Patients with Hypersensitivity (Allergy) and Autoimmunity
•     Chapter 18 Answer Key
• Chapter 19 Concepts of Cancer Development
•     Chapter 19 Answer Key
• Chapter 20 Concepts of Care for Patients with Cancer
•     Chapter 20 Answer Key
• Chapter 21 Concepts of Care for Patients with Infection
•     Chapter 21 Answer Key
• Unit V: Interprofessional Collaboration for Patients with Problems of the Skin, Hair, and Nails
• Chapter 22 Assessment of Skin, Hair, and Nails
•     Chapter 22 Answer Key
• Chapter 23 Concepts of Care of Patients with Skin Problems
•     Chapter 23 Answer Key
• Unit VI: Interprofessional Collaboration for Patients with Problems of the Respiratory System
• Chapter 24 Assessment of the Respiratory System
•     Chapter 24 Answer Key
• Chapter 25 Concepts of Care for Patients Requiring Oxygen Therapy or Tracheostomy
•     Chapter 25 Answer Key
• Chapter 26 Concepts of Care for Patients with Noninfectious Upper Respiratory Problems
•     Chapter 26 Answer Key
• Chapter 27 Concepts of Care for Patients with Noninfectious Lower Respiratory Problems
•     Chapter 27 Answer Key
• Chapter 28 Concepts of Care for Patients with Infectious Respiratory Problems
•     Chapter 28 Answer Key
• Chapter 29 Critical Care of Patients with Respiratory Emergencies
•     Chapter 29 Answer Key
• Unit VII: Interprofessional Collaboration for Patients with Problems of the Cardiovascular System
• Chapter 30 Assessment of the Cardiovascular System
•     Chapter 30 Answer Key
• Chapter 31 Concepts of Care for Patients with Dysrhythmias
•     Chapter 31 Answer Key
• Chapter 32 Concepts of Care for Patients with Cardiac Problems
•     Chapter 32 Answer Key
• Chapter 33 Concepts of Care for Patients with Vascular Problems
•     Chapter 33 Answer Key
• Chapter 34 Critical Care of Patients with Shock
•     Chapter 34 Answer Key
• Chapter 35 Critical Care of Patients with Acute Coronary Syndromes
•     Chapter 35 Answer Key
• Unit VIII: Interprofessional Collaboration for Patients with Problems of the Hematologic System
• Chapter 36 Assessment of the Hematologic System
•     Chapter 36 Answer Key
• Chapter 37 Concepts of Care for Patients with Hematologic Problems
•     Chapter 37 Answer Key
• Unit IX: Interprofessional Collaboration for Patients with Problems of the Nervous System
• Chapter 38 Assessment of the Nervous System
•     Chapter 38 Answer Key
• Chapter 39 Concepts of Care for Patients with Problems of the Central Nervous System: The Brain
•     Chapter 39 Answer Key
• Chapter 40 Care of Patients with Problems of the Central Nervous System: The Spinal Cord
•     Chapter 40 Answer Key
• Chapter 41 Critical Care of Patients with Neurologic Emergencies
•     Chapter 41 Answer Key
• Unit X: Interprofessional Collaboration for Patients with Problems of the Sensory System
• Chapter 42 Assessment and Concepts of Care for Patients with Eye and Vision Problems
•     Chapter 42 Answer Key
• Chapter 43 Assessment and Concepts of Care for Patients with Ear and Hearing Problems
•     Chapter 43 Answer Key
• Unit XI: Interprofessional Collaboration for Patients with Problems of the Musculoskeletal System
• Chapter 44 Assessment of the Musculoskeletal System
•     Chapter 44 Answer Key
• Chapter 45 Concepts of Care for Patients with Musculoskeletal Problems
•     Chapter 45 Answer Key
• Chapter 46 Concepts of Care for Patients with Arthritis and Total Joint Arthroplasty
•     Chapter 46 Answer Key
• Chapter 47 Concepts of Care for Patients with Musculoskeletal Trauma
•     Chapter 47 Answer Key
• Unit XII: Interprofessional Collaboration for Patients with Problems of the Gastrointestinal System
• Chapter 48 Assessment of the Gastrointestinal System
•     Chapter 48 Answer Key
• Chapter 49 Concepts of Care for Patients with Oral Cavity and Esophageal Problems
•     Chapter 49 Answer Key
• Chapter 50 Concepts of Care for Patients with Stomach Disorders
•     Chapter 50 Answer Key
• Chapter 51 Concepts of Care for Patients with Noninflammatory Intestinal Disorders
•     Chapter 51 Answer Key
• Chapter 52 Concepts of Care for Patients with Inflammatory Intestinal Disorders
•     Chapter 52 Answer Key
• Chapter 53 Concepts of Care for Patients with Liver Problems
•     Chapter 53 Answer Key
• Chapter 54 Concepts of Care for Clients with Problems of the Biliary System and Pancreas
•     Chapter 54 Answer Key
• Chapter 55 Concepts of Care for Patients with Malnutrition: Undernutrition and Obesity
•     Chapter 55 Answer Key
• Unit XIII: Interprofessional Collaboration for Patients with Problems of the Endocrine System
• Chapter 56 Assessment of the Endocrine System
•     Chapter 56 Answer Key
• Chapter 57 Concepts of Care for Patients with Pituitary and Adrenal Gland Problems
•     Chapter 57 Answer Key
• Chapter 58 Concepts of Care for Patients with Problems of the Thyroid and Parathyroid Glands
•     Chapter 58 Answer Key
• Chapter 59 Concepts of Care for Patients with Diabetes Mellitus
•     Chapter 59 Answer Key
• Unit XIV: Interprofessional Collaboration for Patients with Problems of the Renal/Urinary System
• Chapter 60 Assessment of the Renal/Urinary System
•     Chapter 60 Answer Key
• Chapter 61 Concepts of Care for Patients with Urinary Problems
•     Chapter 61 Answer Key
• Chapter 62 Concepts of Care for Patients with Kidney Disorders
•     Chapter 62 Answer Key
• Chapter 63 Concepts of Care for Patients with Acute Kidney Injury and Chronic Kidney Disease
•     Chapter 63 Answer Key
• Unit XV: Interprofessional Collaboration for Patients with Problems of the Reproductive System
• Chapter 64 Assessment of the Reproductive System
•     Chapter 64 Answer Key
• Chapter 65 Concepts of Care for Patients with Breast Disorders
•     Chapter 65 Answer Key
• Chapter 66 Concepts of Care for Patients with Gynecologic Problems
•     Chapter 66 Answer Key
• Chapter 67 Concepts of Care for Patients with Male Reproductive Problems
•     Chapter 67 Answer Key
• Chapter 68 Concepts of Care for Transgender Patients
•     Chapter 68 Answer Key
• Chapter 69 Concepts of Care for Patients with Sexually Transmitted Infections
•     Chapter 69 Answer Key
• Next Generation NCLEX® Examination Unfolding Case Studies
•     NGN Unfolding Case Study #1: Musculoskeletal Trauma (Concepts of Mobility and Perfusion)
•     NGN Unfolding Case Study #2: Venous Thromboembolism (Concepts of Clotting and Perfusion)
•     NGN Unfolding Case Study #3: Chronic Obstructive Pulmonary Disease (Concepts of Gas Exchange and Infection)
•     NGN Unfolding Case Study #4: Spinal Cord Injury (Concepts of Mobility and Perfusion)
•     NGN Unfolding Case Study #5: Chronic Kidney Disease (Concepts of Elimination and Infection)
•     NGN Unfolding Case Study #6: Traumatic Brain Injury (Concepts of Cognition and Perfusion)
•     NGN Unfolding Case Study #7: ST Elevation Myocardial Infarction (STEMI) (Concept of Perfusion)
•     NGN Unfolding Case Study #8: Diabetes Mellitus Type 2 (Concepts of Metabolism and Fluid and Electrolyte Balance)
•     NGN Unfolding Case Study #9: Peptic Ulcer Disease (Concepts of Infection and Fluid and Electrolyte Balance)
•     NGN Unfolding Case Study #10: Bowel Obstruction (Concepts of Elimination and Fluid and Electrolyte Balance)
• Answers and Rationales for Next Generation NCLEX® Examination Unfolding Case Studies
• Language : English
• Edition : 10
• Published :
• Imprint : Elsevier

Donna D. Ignatavicius

Linda a. lacharity, m. linda workman.

• Open access
• Published: 02 September 2024

Ecological care in nursing practice: a Walker and Avant concept analysis

• Golshan Moghbeli 1 ,
• Amin Soheili 2 ,
• Mansour Ghafourifard 1 , 3 ,
• Shahla Shahbazi 1 &
• Hanieh Aziz Karkan 1  

BMC Nursing volume  23 , Article number:  614 ( 2024 ) Cite this article

Metrics details

Today, the human population faces an increasing array of emerging environmental challenges. Despite its importance, nurses often neglect ecological issues, which can compromise patient health. While the ecological nursing perspective has the potential to lead to innovative care approaches that benefit patients, the nursing profession, and the environment, the concept of ecological care lacks a clear definition and its dimensions remain unclear. This study aimed to analyze and clarify the concept of ‘ecological care’ in the nursing discipline.

Walker and Avant’s analysis method was used to identify descriptions, antecedents, consequences, and empirical referents of the concept of ‘ecological care’ in nursing. We searched the databases (PubMed, Scopus, PsycINFO, CINAHL, ERIC, SID, and IranDoc) using the keywords “ecological,” “nurse,” and “nursing” using Boolean operators “AND” and “OR” in the title and abstract fields both in English and Persian to identify relevant literature on ecological care in nursing.

Ecological care, as a multidimensional concept, encompasses ecological thinking, ecological attitude, ecological awareness, ecological sensitivity, and ecological literacy. This entails the optimal utilization of environmental factors to provide patients with high-quality care and preserve ecological sustainability through environmentally friendly behaviors.

Conclusions

The findings highlight the need to elucidate, endorse, and solidify ecological thinking in all aspects of nursing care including nursing management, education, and research, which can lead to improved care quality, patient safety, and sustainability. Within this framework, nursing educators could play an essential role in integrating ecological care into nursing education. The study emphasizes the need to integrate ecological thinking into all aspects of nursing.

Peer Review reports

Ecology, the study of interactions between living organisms and their environments, encompasses physical and social surroundings that impact all living beings. From a human science perspective, ecology emphasizes these interconnected relationships, fostering a deeper understanding of nursing and caring practices [ 1 ]. Currently, environmental concerns are considered significant threats to public health. However, healthcare professionals often lack sufficient awareness of the importance of ecological issues [ 2 ].

As the largest group of healthcare professionals, nurses play a crucial role in decisions regarding product use, energy consumption, and chemical selection in healthcare settings. However, they face a significant challenge: balancing environmental concerns and ecological principles with their professional duties [ 3 ]. Although nurses can advocate reducing exposure to harmful chemicals and adopting less toxic products, their work environments often require high energy consumption and generate substantial medical waste [ 4 ]. This medical waste encompasses both hazardous (infectious, pathological, chemical, pharmaceutical, cytotoxic, and radioactive) and non-hazardous or general waste, posing potential risks to patients, communities, and broader ecological health [ 5 ]. Multiple studies have highlighted the critical role of ecological considerations within healthcare in the overall health of ecosystems [ 6 , 7 , 8 , 9 ]. Consequently, ecological issues have become a high priority for nurses, demanding attention and action [ 10 ].

The importance of environment, ecosystems, and ecology in nursing practice has been recognized by pioneers like Florence Nightingale as the founder of modern nursing (published in 1992, originally written in 1959) [ 11 ] and subsequently by Fawcett (1984) [ 12 ]. This vision is further reflected in the International Council of Nurses (ICN) Code of Ethics, which states that “nurses contribute to the population’s health and work to achieve the sustainable development goals.” By adopting sustainable practices, nurses can significantly reduce their environmental footprint and contribute to achieving the UN 2030 Agenda for Sustainable Development [ 9 ]. Recognizing this crucial role, nursing organizations such as the American Nurses Association actively promote nurses’ participation in environmental protection initiatives [ 13 ].

The concept of ecological care in nursing, as a multidimensional concept, encompasses several aspects. Lausten (2006) proposed a nursing ecological theory to broaden nurses’ perspectives by incorporating concepts of global ecosystems, communities, and interrelationships from the ecological sciences. This theory recognizes that human interactions with the environment extend beyond the personal sphere and encompass professional activities. Consequently, nurses can integrate ecological principles into their practice, fostering new directions in care that benefit patients, healthcare professionals, and the environment [ 14 ]. Dahlberg et al. (2016) conducted an empirical study to explore how a phenomenological life-world theory could expand the concept of holistic care into “ecological care.” They argued that the traditional approach to holistic care has neglected environmental and ecological dimensions. Their findings suggested that ecological care goes beyond fighting illnesses. It emphasizes understanding patients within the context of their world, a world that they both influence and are influenced by. This approach helps patients reintegrate into their rhythm of existence [ 1 ].

Al-Shamaly (2021) highlights “ecological awareness,” which emphasizes creating a safe and comfortable patient environment through noise, light, color, and temperature control [ 15 ]. Sattler (2013) adds another dimension, suggesting that nurses can act as catalysts for transforming hospitals into environmentally sustainable spaces. This can be achieved through practices such as adopting environmentally friendly purchasing policies (e.g., waste management strategies, reduced chemical use, and proper disposal of hazardous materials such as batteries), promoting healthy food options, and favoring mercury-free products [ 16 ].

Although ecological factors could influence the quality of care, patient safety, individual and community health, resource preservation, and sustainable practices [ 16 , 17 , 18 , 19 ], nurses’ awareness of ecological care and its dimensions remains limited [ 2 ]. Moreover, there is no universally accepted definition of ecological care as a complex concept [ 20 ]. Therefore, this study aimed to analyze and clarify the concept of ‘ecological care’ within the nursing discipline.

Walker and Avant’s concept analysis method was used as a rigorous and systematic approach to identify descriptions, antecedents, consequences, and empirical referents of the concept of ‘ecological care’ in nursing. Ecological care is a widely applicable concept that extends beyond the confines of nursing care. Therefore, the literature review encompasses all the various applications of ecological care, including both implicit and explicit aspects. The stages of the concept analysis method are as follows: (A) selecting a concept, (B) determining the aims or purposes of the analysis, (C) identifying all uses of the concept that you can discover, (D) determining the defining attributes, (E) identifying a model case, (F) identifying borderline, related, contrary, invented, and illegitimate cases, (G) identifying antecedents and consequences, and (H) defining empirical referents [ 21 ].

Literature search

A systematic literature review was conducted using multiple health databases, including PubMed, Scopus, PsycINFO, CINAHL, ERIC, SID, and IranDoc. The concepts “ecological,” “nurse” and “nursing” were searched using Boolean operators “AND” and “OR” in the title and abstract fields of each database. No temporal limits were applied and articles published in either English or Persian until July 2023 were retrieved.

Initially, 1083 records were identified by searching the titles and abstracts of these databases. Subsequently, 16 additional records were manually included, resulting in a total of 1099 records. Duplicate records were removed, leading to an initial selection of 1068 records. The titles and abstracts of these records were screened, and the eligibility criteria were applied to the full text of the selected records. Eventually, 36 records met the criteria and underwent a comprehensive review of concept analysis (Fig.  1 ). A detailed overview of the included studies, including publication year, title, country, and key findings, can be found in Appendix A.

Flow diagram of the study (data search and selection process)

Concept selection

The importance of a specific concept is influenced by a variety of factors both within and outside its field over time. Consequently, concepts lacking clear definitions warrant further analysis [ 21 ]. Considering the interconnectedness of ecosystems and human health, as well as the imperative to maintain environmental sustainability, particularly within healthcare, the concept of ecology has gained prominence in nursing and other health professions. Nightingale’s emphasis on the environment underscores this importance. Given the increasing significance of ecological care in healthcare and the lack of a clear, unified definition, this concept was selected for analysis to elucidate its dimensions and characteristics.

Determining the aims of the analysis

The concept of “ecological care” has been insufficiently analyzed within the healthcare context, resulting in a lack of a clear definition. This study aims to refine the meaning of ecological care in nursing by identifying its descriptions, antecedents, consequences, and empirical referents.

Identifying the use of the concept

To explore the concept of ecological care, it is crucial to understand the distinct meanings of each word from a variety of sources such as dictionaries, thesauruses, websites, and scholarly literature.

According to the Merriam-Webster dictionary, the term ‘ecological’ is an adjective related to the science of ecology. This refers to the environment of living things or the relationships between living things and their environments [ 22 ].

According to the Merriam-Webster dictionary, the term ‘care’ functions both as a noun, representing responsibility for or attention to health, well-being, safety, or solicitude, and as a verb, meaning to feel interest or concern and to provide care [ 23 ].

Ecological care in nursing literature

The concept of ecological care, originating from the theory of biological ecology, aims to offer solutions that effectively minimize the adverse impacts of nursing care on the ecosystem [ 14 ]. Ecological care can be classified into two types: individuals and professionals. The individual approach focuses on raising public awareness, shaping attitudes and behaviors, and promoting responsible actions regarding energy consumption, the production of toxic substances (such as greenhouse gases), chemical usage, and healthy and organic diet adoption. Conversely, the professional approach emphasizes the importance of sensitivity, awareness, attitude, behavior, and responsible actions among individuals when carrying out their professional responsibilities [ 9 , 24 ].

Clinical environments require ecological care, which can be achieved through two distinct approaches: environmental and organizational care. Environmental care involves maintaining equipment and machines, ensuring workplace safety, minimizing risks, managing noise levels, optimizing lighting conditions, regulating temperature, and employing creative designs to create a comfortable and relaxing environment. It also involves facilitating visits from family members and pets and improving patients’ sleep quality. Additionally, the use of digital technology helps ensure a healthy and safe treatment environment for patients in the Intensive Care Units (ICU). On the other hand, organizational care focuses on time and resource management. This includes strategies such as reducing paper and ink consumption by utilizing electronic records, which aids in efficient time management. Organizational care aims to streamline nurses’ tasks and improve overall work efficiency by minimizing their workload and improving access to patient information. Finally, waste management practices play a crucial role in maintaining an environmentally conscious approach in healthcare settings [ 15 ].

Determining the defining attributes

Ecological thinking.

According to Balgopal and Wallace (2009), ecological thinking is a combination of ecological understanding and ecological awareness [ 25 ]. Understanding ecology involves understanding concepts such as biotic, abiotic, and biological interactions. This serves as the initial stage of ecological thinking, which is further developed by comprehending the impact of human activities on the ecosystem [ 26 ]. Ecological understanding can be conceptualized as a continuum, with one end representing the capacity to identify problems and propose ecological decisions, considering their potential consequences. On the other end of the continuum is a lack of understanding, where the ability to explain the impact of human actions on the ecosystem is insufficient [ 25 ].

Ecological thinking causes a transformation in people’s presuppositions and attitudes towards the surrounding world, enabling them to recognize that we are interconnected and evolving alongside nature. Embracing an ecological perspective requires acknowledging ourselves as integral components of nature rather than being superior to it. This encompassing concept embodies various underlying principles such as ecology, wholeness, interdependence, diversity, partnership, energy flows, flexibility, cycles, and sustainability [ 17 , 27 ]. Hes and de Plessis (2014) refer to this set of principles as the ‘ecological worldview.’ Shifting towards an ecological perspective entail altering our perspective on the world and ourselves. The fundamental essence of this transformation involves moving away from egocentric and anthropocentric thinking, which emphasizes separateness, and instead adopting a holistic perception that aims to counterbalance environmental damage. Enhancing ecological thinking can be achieved through the instruction of ecological concepts and behaviors [ 28 ].

Ecological attitude

Ecological attitude is a complex construct that encompasses various key components such as emotions, perceptions, personal norms, values, and relationships with the environment. The emotional dimension of ecological attitude plays a pivotal role in preparing individuals to address environmental issues and cultivate ecological behaviors in all aspects of life [ 29 , 30 , 31 ], as it determines the extent to which individuals will act in environmentally responsible ways [ 32 ].

Predicting a specific behavior entails possessing a specific attitude towards that behavior, as attitudes alone do not guarantee behavior, but predict or influence it [ 2 , 33 ]. Ecological behavior can be defined as the actions taken by a nurse to protect the environment, and it varies depending on the individual’s context and circumstances. Achieving the goal of ecological behavior can be challenging in certain situations, but it is crucial to promote sustainable living and preserve the planet’s natural resources [ 31 ].

Ecological awareness

Ecological awareness refers to knowledge, attitudes, and behaviors related to the environment. Its focus is on increasing responsibility toward achieving ecological sustainability [ 34 ]. One of its important characteristics is the perception of natural objects from a subject’s perspective [ 35 ]. As a theoretical and practical science, ecological awareness includes two stages: awareness of environmental changes, and feelings of concern about environmental problems and trying to solve them. People with ecological awareness try to be actively responsible for their interactions with the environment and exhibit positive behaviors towards the surrounding environment [ 9 , 20 ].

Ecological awareness is also a level of cognitive thinking that enables nurses to focus on protecting the environment while providing nursing care. This concept requires nurses to pay attention to the potential of nature and the surrounding environment that promotes, maintains, and restores human health [ 9 , 14 ]. This raises important questions about whether nurses are aware of the positive effects of recycling medical equipment and materials, or the harmful effects of greenhouse gases (CO2, NO, etc.) caused by fossil fuels and smoke from medical waste incinerators. It also highlights how much nurses are aware of the impact of their care activities on ecosystem damage and public health [ 9 , 19 , 36 ]. The role of nurses with ecological awareness is crucial in raising awareness among colleagues, managers, patients, and students [ 8 , 37 , 38 , 39 ].

Ecological sensitivity

Ecological sensitivity refers to the inclination to actively address environmental threats and the extent to which healthcare providers demonstrate awareness of hazardous and protective circumstances [ 40 ]. Individuals with varying psychological traits, such as extroversion or introversion, exhibit distinct levels of sensitivity to environmental health [ 41 ].

Ecological sensitivity is a multidimensional concept that contributes significantly to sustainable development. This serves as an emotional foundation for cultivating an ecological worldview and establishing personal norms for pro-environmental actions. This dynamic framework takes shape within families during childhood and is strengthened throughout professional life. Therefore, an essential initial step in enhancing ecological sensitivity among healthcare providers is to impart ecological education and raise awareness levels [ 42 , 43 , 44 ]. The development of ecological sensitivity is influenced by various factors, including families, educational institutions, mass media, and non-governmental organizations [ 45 , 46 , 47 ]. In general, nurses who actively engage in staying informed about ecological news and trends, participate in ecological protection activities and events, and demonstrate awareness of ecologically detrimental behaviors, both in themselves and their colleagues exhibit higher levels of ecological sensitivity [ 42 , 43 ].

Ecological literacy

Ecological literacy is a crucial concept that includes three core components: cognitive, emotional, and behavioral. According to UNESCO, there are five key characteristics of ecological literacy: awareness and sensitivity to the environment; comprehension of environmental issues; having values and sentiments towards environmental concerns; possessing skills, desire, and commitment; and actively engaging in identifying and resolving ecological problems. Generally, ecological literacy can be defined as the integration of environmental sensitivity, knowledge, skills, attitudes, values, responsibilities, and active engagement, which enables nurses to make informed and responsible decisions to promote environmental sustainability [ 48 , 49 ].

Model and additional cases

A model case serves as a paradigmatic illustration of the application of a concept encompassing all its defining elements. In addition to the model case, two other types of cases are presented: (A) the borderline case, which shares most of the essential characteristics of the concept but exhibits some differences; and (B) the contrary case, which presents an apparent example that contrasts with the concept, highlighting what it is not [ 21 ].

A 65-year-old woman was admitted to the neurology ward with a diagnosis of transient ischemic attack during the night shift. The attending nurse approached the patient’s bedside and introduced herself and the inpatient department. During the evaluation, the nurse observed the patients’ uneasiness, homesickness, and concerns regarding sleep disturbance due to changes in sleeping arrangements. She addressed the situation by repositioning the patient’s bed next to the window, aiming to provide a more comfortable environment and alleviate feelings of homesickness. Careful attention was paid to ensure that the bed and equipment were securely locked. During medication administration, the nurse utilized a tablet for dosage calculations, opting for a paperless approach to reduce waste. Proper disposal procedures were followed after medication administration, with empty vials discarded in the chemical waste bin, and needles placed in a safety box. During the initiation of infusion, the nurse noticed loose screws on the electronic infusion device and promptly sought assistance from a colleague to rectify the issue. Toward the end of her tasks, the nurse dimmed unnecessary lights in the ward and adjusted the alarm range of the device to an audible level for more comfort. Immediately before leaving the ward, the nurse noticed a leaking water tap and promptly contacted the facility manager to initiate immediate remedial action.

Borderline case

The head nurse of the pediatric ward conducted a clinical round when she heard the cries of a hospitalized 4-year-old child who was upset due to the absence of her cherished doll. Regrettably, the nurses disregarded the situation and continued down the corridor. Several months later, the nurse was invited to join a committee responsible for making decisions regarding hospital equipment procurement. Drawing from the recent knowledge acquired through a TV program highlighting the hazards of mercury to human health, she recommended the acquisition of mercury-free medical equipment.

Contrary case

A nurse, aged 35, with ten years of experience in surgery, approached the patient who had undergone laparotomy to perform a dressing change. The nurse inadvertently wore a pair of sterile gloves instead of non-sterile gloves while removing the contaminated dressing and disposed of it in the general waste bin. Subsequently, sterile gloves were replaced with a fresh pair, the wound was cleansed using six sterile gauzes, and an additional seven gauzes were applied to dress the surgical site, although a smaller quantity would have sufficed. During the hand washing process, the nurse’s mobile phone rang, and without turning off the water tap, he engaged in a conversation until the patient’s family intervened and turned off the tap. Finally, despite the patient expressing mild pain at the surgical site, the nurse chose to administer a painkiller instead of utilizing non-pharmacological methods to alleviate pain.

Identify antecedents and consequences

Walker and Avant (2011) provided a clear definition of antecedents as events or attributes that precede the occurrence of a concept, whereas consequences refer to events that ensue from the concept’s occurrence [ 21 ]. In this study, it was crucial to identify and examine the associated antecedents and consequences (Fig.  2 ). Therefore, the antecedents and consequences investigated are as follows:

Attributes, antecedents, and consequences of ecological caring in nursing practice

Antecedents

The ecological care provided by nurses can be influenced by both personal characteristics and organizational policies. Personal characteristics include creativity, innovation, responsibility, environmental friendliness [ 41 ], kindness, empathy, and strong communication skills [ 9 ]. Meanwhile, organizational policies encompass the establishment of a supportive organizational culture, provision of training courses [ 14 ], and design of a creative and humanitarian environment within hospitals and healthcare facilities. Moreover, ensuring a safe environment equipped with adequate resources, services, technology, and competent human resources is essential for delivering ecological care in therapeutic settings [ 15 ].

Consequences

Ecological care yields numerous benefits to patients, their families, healthcare providers, healthcare systems, and the environment. Among these benefits, one of the most significant is the provision of high-quality holistic care, which leads to increased patient satisfaction. Additionally, ecological care contributes to patient and staff safety by minimizing hospital infections, conserving energy (electricity, gases, and water), optimizing equipment and time utilization, reducing employee workload, managing hospital procurement costs, and eliminating hospital waste. It also plays a vital role in preventing the entry of pathogens, chemical pollutants, and radioactive substances into the water, soil, and air. Furthermore, ecological care promotes ecological sustainability, safeguards the ecosystem, and helps protect food and agricultural resources by preventing food waste in the hospital setting. These considerations highlight the wide-ranging positive consequences of ecological care [ 14 , 41 ].

Empirical referents

According to Walker and Avant (2011), the final step in concept analysis is to identify the empirical referents of attributes. Empirical referents do not directly serve as instruments for measuring a concept, but they provide illustrations of how defining characteristics or attributes can be recognized or measured. By presenting real-world examples, empirical referents assist in measuring the concept and validating its significance [ 21 ]. Although this study did not identify a specific independent instrument for measuring ecological care in nursing, the following examples demonstrate instruments that measure the defining characteristics or attributes of the concept.

The Nurse’s Environmental Awareness Tool (NEAT) was developed by Schenk et al. in 2015 to measure nurses’ awareness of and behaviors associated with the environmental impact of their practices. The NEAT consists of 48 two-part items in six subscales and three paired subsets as follows: nurse awareness scales, nurse professional ecological behaviors scales, and personal ecological behaviors scales [ 9 ].

The Ecological Risk Perception Scale, developed by Slimak and Dietz in 2006, examines not only the attributes of the risk itself but also the characteristics of individuals perceiving the risk. Consisting of 24 ecological risk items, the scale encompasses four subscales: ecological, chemical, global, and biological [ 50 ].

The Environmental Literacy Questionnaire (ELQ) was derived from part of Michigan State University’s project and was originally used by Kaplowitz and Levine (2005) [ 51 ]. Later, Kahyaoğlu (2011) revised the ELQ. The revised version consisted of four components: knowledge (11 items), attitude (12 items), uses (19 items), and concern (9 items) [ 52 ].

Based on the current analysis, ecological care is a multidimensional integration of thinking, attitudes, awareness, sensitivity, and literacy to deliver high-quality holistic care while maintaining environmental sustainability and promoting energy conservation.

Analysis of the concept of ecological care has significant implications for the nursing profession. Given the limited exploration of ecological care within nursing practice, conducting an analysis can empower nurses to utilize ecological factors in delivering high-quality care and embracing environmentally friendly behaviors. The objective of this study was to present a comprehensive and practical definition of ecological care, thereby establishing a shared platform for not only nurses but also other healthcare professionals to promote pro-environmental behaviors.

Backes et al. (2011) conducted a study aiming to comprehend the meaning of ecological care from the perspective of students and teachers in the healthcare field at a Public Institution of Higher Education. The study revealed several categories, including (a) ecological care as a result of relationships, interactions, and communication with the global environment (main category); (b) the development of ecological awareness (causal conditions); (c) the connection of ecological care with different systems (context); (d) the perception of human-environment-health interaction (intervention); (e) the need to foster ecological consciousness through new references (strategy); and (f) a sense of motivation to understand ecological care (result). While this study acknowledged ecological awareness and conscience as integral components of ecological care, other attributes of the concept, such as adopting an ecological perspective; ecological literacy; and the impact of values, beliefs, and organizational culture on providing holistic care, were not extensively explained [ 20 ].

The findings of a study conducted by Dahlberg et al. (2016) revealed how ecological care facilitates patients to rediscover their place in a world characterized by interconnectedness. The role of ecological care extends beyond perceiving patients within a web of relationships; it encompasses assisting patients in re-establishing their sense of self and comprehending the world anew. Ecological care entails not only combating illness but also acknowledging patients as individuals influenced by and influencing the world. Such care endeavors to facilitate rhythmic movement and create space for activity and rest, being cared for and actively participating in one’s recovery, withdrawing from the world, and re-engaging with it. This study also highlights the use of the term ecological perspective to enhance the understanding of optimal care for patients. In this study, the novel attributes of the concept of ecological care are introduced. However, the potential impacts of constructive and destructive human activities on ecosystems remain unexplored [ 1 ]. In contrast, we refer to ecological sustainability and energy conservation as significant consequences of ecological care in nursing.

In a focused ethnographic study, Al-Shamaly (2021) explored the culture of multidimensional “caring-for” practice among ICU nurses. The inclusive nature of this culture encompasses caring for oneself, patients and their families, and colleagues (including nurses and other team members) as well as ecological consciousness within the ICU environment and organization. Ecological consciousness involves caring for equipment and machines, ensuring workplace safety, reducing hazards, transitioning towards a paperless unit, maintaining thorough documentation, and demonstrating commitment and concern for the organization’s budget regarding staff and resources [ 15 ]. While this study comprehensively addresses the practical aspects of the concept, it constrains the concept of ecological care solely to ecological consciousness. However, our study revealed that ecological care is a multidimensional, and complex phenomenon that extends beyond ecological consciousness. In another study, religious values were identified as a crucial factor in promoting an ecological care orientation that can be incorporated into daily life through religious education, considering the religious and cultural context of each country. These values are instilled into individuals from childhood to adulthood through various learning activities. Therefore, religious education plays a pivotal role in shaping individuals’ commitment to ecological care [ 53 ]. According to this study, religious values significantly contribute to the development of ecological thinking and the manifestation of ecological behavior.

Moreover, a previous study by Akkuzu (2016) introduced ecological intelligence as a new type of conscience, defined as a combination of environmental awareness and the sensitivity of human beings towards adverse global alterations in nature. This understanding empowers individuals to recognize the perils faced by their communities and comprehend the underlying causes. Furthermore, it equips them with the knowledge necessary to address these perils collectively and devise effective solutions [ 54 ].

Implications for nursing practice

While our analysis primarily focused on the ecological perspective, we contend that a profound understanding of this concept is imperative for establishing cultural and political frameworks within the healthcare system. This study contributes to the limited body of research on nursing by highlighting the essentiality of ecological and holistic thinking in the domains of caregiving, treatment, management, and education. Consequently, it has the potential to yield substantial impacts in ensuring the safety of patients and healthcare providers, enhancing the quality of care, and improving patient and family satisfaction.

Limitations

The conceptual analysis is subject to several limitations. Firstly, the literature search was confined to studies published in English and Persian, potentially limiting the diversity of perspectives from other countries, cultures, and languages. To mitigate this limitation, future studies should conduct a comprehensive search in multiple languages to ensure a more holistic understanding of ecological care in nursing practice. Secondly, the analysis is susceptible to selection bias, extraction bias, and analysis bias. To address these limitations, the study selection process, data extraction, and analysis were independently conducted by two researchers. Despite these limitations, the studies were described accurately and systematically, contributing valuable insights into the concept of ecological care in nursing practice.

The results of the present analysis provide a definition of ecological care in nursing that may guide the profession to new directions of care, striving for the greater good of the patient, the profession of caring, and the environment. It is clear that more research is needed to discover the neglected importance of the environment in holistic care and to identify phenomena related to this concept in practical nursing. The literature review shows that the educational field, as the most effective factor, plays a significant role in the formation of ecological literacy and worldviews and the creation of the perceptions, attitudes, and behaviors of ecological care. In this regard, nursing professors and instructors, as the most important role models, significantly contribute to the development of the identity and character of ecological care for today’s students and future nurses.

Data availability

The data supporting the findings of this study are available upon request from the corresponding author. The data were not publicly available because of privacy or ethical restrictions.

Abbreviations

Carbon dioxide

Nitric oxide

The United Nations Educational, Scientific and Cultural Organization

Nurse’s Environmental Awareness Tool

Environmental Literacy Questionnaire

Intensive Care Unit

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Acknowledgements

This study was extracted from a research project approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 73361). The authors would like to thank all those who spent valuable time participating in this research. We are also immensely grateful to the “anonymous” reviewers for their valuable insights.

The present study was financially supported by Tabriz University of Medical Sciences, Tehran, Iran.

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Golshan Moghbeli, Mansour Ghafourifard, Shahla Shahbazi & Hanieh Aziz Karkan

Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran

Amin Soheili

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Contributions

GM, AS: original concept and study design; GM, HA, ShS: data collection; GM, HA, AS, MGh: data analysis and interpretation; GM, HA, AS, MGh, ShS: manuscript preparation and final critique; GM, MGh: study supervision.

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This study was approved by the ethics committee of Tabriz Tehran University of Medical Sciences (code of ethics: IR.TBZMED.REC.1402.614). All methods were carried out in accordance with relevant guidelines and regulations of Walker and Avant’s concept analysis method and qualitative research.

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Moghbeli, G., Soheili, A., Ghafourifard, M. et al. Ecological care in nursing practice: a Walker and Avant concept analysis. BMC Nurs 23 , 614 (2024). https://doi.org/10.1186/s12912-024-02279-z

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