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The Use, Environmental Knowledge and Climate Change Attitudes of Australian Nurses and Midwives Regarding Nitrous Oxide

Year: 2026

Type: article

Abstract: AIM: The aim of this research was to investigate the clinical use of nitrous oxide among Australian nurses and midwives, assess their pharmacological knowledge of the gas, determine their awareness of its environmental effects and evaluate their broader attitudes toward climate change. BACKGROUND: Balancing clinical efficacy with environmental sustainability is an emerging priority in acute pain management. While nitrous oxide offers rapid, reversible analgesia, its substantial ecological footprint as a greenhouse gas cannot be ignored. Nurses and midwives are well-positioned to drive sustainable analgesic practices, yet their current utilisation and awareness of these environmental impacts require further investigation. DESIGN: A cross-sectional survey of nurses and midwives practising in Australia. METHOD: Australian nurses and midwives who have administered nitrous oxide as part of patient management were invited to complete a 62-item survey. Quantitative data were analysed using descriptive statistics and qualitative responses were thematically analysed. RESULTS: Responses from 446 respondents were analysed. Pharmacological knowledge of nitrous oxide was low (median 28.6%), as was awareness of its environmental impact (median 28.6%). Respondents aged 40 and under had lower awareness of nitrous oxide's impact on climate (28.6% vs. 42.9%). Climate change beliefs and intentions were high (both 80.0%). Awareness of nitrous oxide's environmental impact explained 79% of variance in climate change belief (F = 35.211). CONCLUSION: Administration of nitrous oxide by nurses and midwives in Australia for acute pain management occurs across diverse healthcare settings. However, significant knowledge gaps regarding its pharmacological properties and environmental impact highlight an urgent need for targeted education, clinical guidance and sustainable practice initiatives. Addressing these gaps will empower clinicians to balance patient comfort with environmental stewardship, supporting healthcare delivery that is both high quality and ecologically responsible. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights a critical gap in knowledge regarding both the pharmacology and environmental impact of nitrous oxide among Australian nurses and midwives. While nitrous oxide remains a valued, safe option for acute pain management, addressing its significant ecological footprint requires bridging this knowledge gap through education, clear clinical guidance and sustainable practice initiatives. Effective pain management must balance patient comfort and clinical safety with environmental stewardship to deliver clinically effective, ecologically responsible care. IMPACT: This study investigated the clinical utilisation of nitrous oxide for acute pain management among Australian nurses and midwives, while evaluating their pharmacological knowledge and awareness of its environmental implications. Despite strong climate change commitments, nurses and midwives face a significant knowledge-practice gap regarding nitrous oxide, showing limited understanding of both its pharmacology and its severe environmental impact. REPORTING METHOD: In reporting the results, we have used the Checklist for Reporting of Survey Studies (CROSS). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Source: Journal of Clinical Nursing

DOI: 10.1111/jocn.70639