Mapping the discourse of environmental sustainability in intensive care nursing: a lexicometric exploration of professional meaning-making

Abstract

Introduction: Intensive Care Units (ICUs) are among the most resource-intensive hospital environments, contributing substantially to healthcare’s environmental footprint. While sustainable practices are increasingly recognized as essential, little is known about how critical care nurses linguistically frame and make sense of sustainability within their professional culture and daily work. Aim: To explore how critical care nurses construct and articulate meanings of environmental sustainability in their professional discourse. Methods: Semi-structured interviews were conducted with 29 critical care nurses across diverse hospital settings. Narratives were analyzed using Automatic Analysis of Textual Data (IRaMuTeQ) with similarity analysis to map term relationships and uncover semantic clusters. Statistical associations (χ2 ≥ 3.84; p < 0.05) guided identification of lexical hubs and thematic subnetworks. Computational findings were integrated with qualitative interpretation to ensure contextual depth and rigor. Results: The central lexical hub, sustainability, connected clusters reflecting reflective engagement, collaborative responsibility, organizational structures, and systemic gaps. Secondary hubs included environment (ecological impact and cost considerations), practice (behavioral integration), patient (embedded in bedside care), and waste (material handling, energy use, lifecycle awareness). Nurses framed sustainability as both a professional duty and systemic challenge, mediated by organizational support, personal commitment, and environmental constraints. Conclusions: ICU nurses’ discourse reveals sustainability as a multidimensional construct bridging ethics, operational practice, and systemic limitations. Lexicometric mapping provides a structured view of how sustainability is embedded in professional narratives, offering insights to inform targeted educational and organizational strategies. Implications for clinical practice: Integrating sustainability into professional identity enhances patient care and environmental responsibility. These findings deepen understanding of which dimensions of environmental sustainability can be meaningfully enacted through professional culture and organizational alignment, rather than through the direct imposition of fixed behavioural routines.