Climate Change Awareness: a Randomized Controlled Trial

Background: Climate change awareness among nurse managers is crucial for enhancing healthcare efficiency and mitigating environmental and societal impacts. This study aims to develop and implement an educational program to improve nurse managers' awareness of climate change.

Methods: A randomized controlled trial will be conducted with 108 nurse managers (54 experimental, 54 control) from two major hospitals in Istanbul, Turkey: Kartal Dr. Lütfi Kırdar City Hospital (n=71) and Göztepe Prof. Dr. Süleyman Yalçın City Hospital (n=58). Sample size was determined using G\*Power 3.1.9.7, referencing the study by Alvarez-Nieto et al. (2022), assuming an effect size of 0.79, a significance level of α=0.05, and 95% power. The required sample size was calculated as 90, increased by 20% to account for potential attrition, resulting in 108 participants.

Participants will be recruited through full enumeration sampling due to the limited number of nurse managers. Data will be collected via face-to-face administration of a Demographic Information Form (12 items) and the Climate Change Awareness Scale (Ataklı \& Kuran, 2022), which consists of 52 items rated on a 5-point Likert scale, with a reliability coefficient (α) of 0.92.

Intervention: Following institutional approval from the Provincial Health Directorate, education nurses will disseminate information about the study via digital communication platforms. Nurse managers will be enrolled in separate digital groups for experimental and control conditions. Pre-test data will be collected face-to-face before the intervention. The educational program will be delivered to the experimental group, while the control group will receive no intervention. Post-test data collection will occur four weeks after the intervention.

Statistical Analysis: Nominal and ordinal data will be presented as frequencies and percentages, while scale scores will be reported as means and standard deviations or medians and ranges. Normality of data distribution will be assessed using the Kolmogorov-Smirnov test. Independent Samples T-Test and One-Way ANOVA will be used for normally distributed variables, while Mann-Whitney U and Kruskal-Wallis tests will be used for non-normally distributed data. Analyses will be conducted using SPSS 26 with a significance level set at p\<0.05.

Expected Outcomes: The study will evaluate the effectiveness of the educational program in enhancing climate change awareness among nurse managers. Findings will contribute to the development of targeted training programs to integrate environmental awareness into nursing leadership.

Ethical Considerations: Ethical approval and institutional permissions will be obtained prior to study commencement.