Environmental sustainability in cardiovascular intensive care: nursing priorities and system-level barriers

Background Cardiovascular intensive care units are among the most resource-intensive hospital settings due to continuous monitoring, advanced medical devices and high clinical complexity. Although environmental sustainability is increasingly promoted in healthcare, how nurses working in cardiovascular intensive care interpret and integrate sustainable practices within this high-intensity context remains insufficiently explored. Purpose This study aimed to explore nurses’ perspectives on environmental sustainability in cardiovascular intensive care and to identify organisational, operational and contextual factors influencing its implementation in daily clinical practice. Methods A qualitative exploratory study was conducted using semi-structured interviews with nurses working in a cardiovascular intensive care unit. Interview transcripts were analysed using automatic analysis of textual data within an exploratory multidimensional data analysis framework. Correspondence analysis was applied to identify dominant lexical patterns and latent semantic dimensions characterising nurses’ sustainability discourses. Results Environmental sustainability was described as a relevant but difficult-to-operationalise goal in cardiovascular intensive care. Nurses’ discourses were characterised by high operational workload, technological dependency and environmental stressors, including continuous alarms, extensive use of disposable materials and complex device management. While awareness of environmental impact was evident, participants reported limited organisational support, absence of structured sustainability protocols and competing clinical priorities as major barriers. Sustainability was consistently framed as secondary to patient safety and haemodynamic stability, revealing a gap between ecological awareness and practical feasibility. Conclusions In cardiovascular intensive care, environmental sustainability emerges as a system-constrained and context-dependent nursing practice shaped by technological burden, workload intensity and organisational factors. Sustainable practice cannot rely solely on individual awareness but requires system-level strategies that align ecological principles with patient safety, workflow design and technological optimisation. Targeted education and organisational support are essential to embed sustainability within high-complexity cardiovascular critical care.