A Measurement of the Environmental Literacy of Nursing Students for a Sustainable Environment

Abstract

Environmentally literate citizenship is a lifelong learning process that aims to develop citizens who possess the knowledge, skills, and commitment to make responsible decisions that will affect the quality of the environment. The purpose of the present study was to evaluate the environmental literacy levels of nursing students in terms of a sustainable environment by considering the dimensions of environmental literacy. This study was also aimed at understanding the correlation between the dimensions of environmental literacy and revealing the factors affecting the dimensions of environmental literacy. This research was designed as a descriptive study using a survey model. A total of 278 nursing students participated in this research. It was revealed that the students obtained a high score for the use and concern dimensions of environmental literacy, and their attitudes towards the environment were moderate; however, the nursing students had the lowest scores for the environmental knowledge component, which indicates that they need support in improving their environmental knowledge. There were also statistically significant differences in the dimensions of environmental literacy based on gender and whether the students had taken environment-related courses. All the dimensions of environmental literacy were found to be positively correlated with each other, ranging from low to moderate correlations.

1. Introduction

The concept of environmental literacy was first used by Charles E. Roth in 1968 [1]. Environmental literacy was defined as an individual’s level of environmental knowledge and awareness [2]. Roth (1992) expanded his first definition of environmental literacy and reported that environmental literacy should also include observable behaviors [3]. At this point, Roth emphasized the necessity of developing skills in problem solving, planning, and cooperation, in addition to the knowledge, behavior, and sensitivity necessary for literacy, as well as the importance of education about the environment [4]. According to Orr (1990), an environmentally literate individual knows the effect of science, technology, culture, and agricultural activities on the functioning of natural systems and takes sound environmental decisions that will allow for the sustainability of the environment [5].

It is stated that an environmentally literate individual should be an individual who can use environmental behavior, beliefs, opinions, and attitudes in the detection and prevention of environmental problems, as well as having a wide environmental knowledge [6]. An environmentally literate individual is conscious, sensitive, and morally mature and will not contribute to the deterioration of his/her environment [7]. Environmentally literate citizenship is a lifelong learning process that aims to develop citizens who have the knowledge, skills, and commitment to make responsible decisions that will affect the quality of the environment [6].

Environmental education and the development of environmental values in higher education institutions are some of the topics that have been discussed intensively [8,9,10,11]. University students are expected to take an active role in social and professional life after graduation because one of their important roles is to carry the knowledge, skills, attitudes, and values they gained during their university education to their professional and personal lives and environments. Therefore, one of the goals of the university is to enable all students to become environmentally literate regardless of their field. The first step to achieve this goal is to find the current environmental literacy levels of university students. The development of this phenomenon is an important step for future generations to live on a healthier and more sustainable planet [12]. Higher Education for Sustainable Development has been encouraged by UNESCO through different programs [13], with the current program being Agenda 2030 [14].

Studies have been carried out to determine the level of environmental literacy in various universities around the world. A total of 19,890 students participated in the study conducted by Kaplowitz and Levine at Michigan State University in the 2001–2002 academic year. The results of this study stated that the environmental literacy level of university students was higher than that of other American citizens, but their environmental knowledge was lower [9]. In a study carried out at the University of Georgia, the practice of an “environmental literacy requirement” at the university was evaluated [15]. The Environmental Literacy Project carried out in Canada produced material for all teachers, based on the fact that environmental issues are an interdisciplinary subject and students need to be environmentally literate regardless of their field of study [8]. In a study conducted by Kibert (2000) [16], it was revealed that the environmental literacy levels of university students were low. The results of these studies demonstrated that the environmental knowledge level of university students was low. Through the results of the research carried out at different levels of formal education in Turkey, it was found that students’ environmental knowledge levels were low [17,18].

Researchers emphasized that research should be carried out with the aim of determining environmental literacy, and in this way, the effectiveness of environmental and sustainable development education in universities should be determined [19]. Universities are leaders in the development of forms of education to design solutions to problems associated with sustainable development [20]. A researcher (2002) reported that nursing students receive insufficient training to understand the links between the environment, sustainability, and health [21]. Therefore, pedagogical strategies are required to break the current education gap and include environmental sustainability in nursing degree programs. Nurse training in environmental sustainability should include competences at different levels. At the individual level, it would allow for a better understanding of the rationale and scope of the problem, as well as allowing individuals to act accordingly in the professional field and with the relevant personnel. At the social level, nursing has a key role in the promotion of environmental health. It is stated that nurses must have communication skills and abilities to provide environmental health education and counselling. Based on the scientific evidence, the knowledge, skills, attitudes, competences, and behaviors in relation to environmental sustainability necessary for nurses has been identified [20]. Incorporating formal education within the nursing curricula, regarding the health impact of environmental sustainability, is key to raising social awareness and developing evidenced actions to mitigate environmental problems [22]. It has been reported that environmentally literate nursing students have the knowledge, tools, and sensitivity to address environmental problems encountered professionally [23].

The concept of sustainable environmental literacy is fundamental to health systems, and it is necessary for nurses to know the terms of sustainability and the environment and their relationship to human health and well-being [24,25]. The nursing group is a change agent with the capacity to improve health and control the use of health resources; therefore, knowledge and skills related to sustainability in the nursing profession and the effects of environmental issues will make it possible to change attitudes and forms of action in their daily work, which will improve people’s health [20,26].

It can be seen from the results of the studies above that although there are many studies on environmental literacy in various universities around the world, this research was conducted because there are very few studies on the environment in the field of nursing.

In light of this information, to determine the environmental literacy levels of nursing students studying at a faculty of nursing in terms of a sustainable environment, we considered the four main dimensions of environmental literacy (knowledge, attitude, use, and concern); conducted an investigation in to whether environmental literacy levels changed depending on selected variables (gender and having taken environment-related courses) and determined the correlations among the dimensions of environmental literacy (EL) that constitutes the main research question of this study.

2. Literature Review

Environmental Problems

The environment plays an important role in supporting life on earth. However, there are some problems that harm living conditions and the world’s ecosystems. These problems concern not only the environment, but all living things on earth. The main sources of these problems are pollution, global warming, greenhouse gases, and other environmental problems. People’s daily activities are constantly degrading the quality of the environment, resulting in the loss of survival conditions day by day. There are many problems that harm the environment [27].

One of the main causes of environmental problems is air, water, and soil pollution. It is known that the number of industries has been increasing rapidly in recent years and the discharge of waste produced from these industries into bodies of water, soil, and air causes significant damage to the environment. Much of this waste contains harmful and toxic substances that spread very easily due to the movement of bodies of water bodies and wind. Another factor causing environmental pollution are greenhouse gases. These gases cause an increase in the temperature of the soil surface. They are produced by factories and vehicles containing toxic chemicals that harm life and the environment and cause direct air pollution [28].

Due to environmental pollution, the climate is changing rapidly, and events such as smog and acid rain are becoming increasingly common. However, the number of natural disasters is increasing day by day and floods, droughts, landslides, and many other natural disasters occur frequently. Therefore, some measures should be taken to combat environmental problems. Moreover, these measures are essential to not only protect the environment, but also to save the planet’s life and ecosystem. One of the ways to minimize these environmental threats is through afforestation. This not only helps maintain the balance of the ecosystem, but also helps restore the natural cycles that work with it. It also helps with everything from maintaining the monsoon cycle, to reducing the amount of carbon in the air. On the other hand, reduction, reuse, and recycling principles known as the 3R principle (reduce, reuse, and recycle) help prevent environmental problems [29].

3. Purposes of the Study

The purpose of the present research was to evaluate the environmental literacy levels of nursing students studying at the faculty of nursing in terms of a sustainable environment by considering the four main dimensions of environmental literacy (environmental knowledge, environmental attitude, environmental use, and environmental concern). In the present study we aimed to understand the correlation among the four components of environmental literacy and investigate whether the environmental literacy levels change depending on selected variables (gender and having taken environment-related courses). Responses to the following questions were sought within the scope of this purpose:

1.

What is the level of the four dimensions of environmental literacy among nursing students studying at the Faculty of Nursing? (Environmental knowledge, environmental attitudes, environmental uses, and concern toward environmental problems.)

2.

Is there any correlation among the four dimensions of EL of nursing students studying at the Faculty of Nursing?

(a)

Is there any correlation between the nursing students’ EL regarding the dimensions of knowledge and attitude?

(b)

Is there any correlation between the nursing students’ EL regarding the dimensions of knowledge and use?

(c)

Is there any correlation between their EL regarding the dimensions of knowledge and concern?

(d)

Is there any correlation between their EL regarding the dimensions of attitude and use?

(e)

Is there any correlation between their EL regarding the dimensions of attitude and concern?

(f)

Is there any correlation between their EL regarding the dimensions of use and concern?

3.

Do the level of environmental literacy for four dimensions scores differ?

(a)

Based on their gender?

(b)

Based on their environment-related courses taken?

4. Materials and Methods

4.1. Model of Study

This research is a descriptive study using a survey model [30,31]. Survey research is a method that aims to collect data to identify certain characteristics of a group [32,33].

4.2. Population and Sample

The population of the research consisted of nursing students studying at the Faculty of Nursing at the University of Akdeniz in Antalya, Turkey in the fall term of the 2021–2022 academic year (1st Grade = 238, 2nd Grade = 232, 3rd Grade = 245, 4th Grade: 285; total = 1000 nursing students). The reason for the selection of nursing students was that environment-related courses are not taken in nursing faculties.

The sample of the study consists of a total of 278 students who were able to represent a universal, based on a 5% deviation for the 95% confidence interval [32,34]. The ratio of each class to the total in terms of the number of students was determined and a sample was taken from each class at this rate. The simple random sampling method was used to determine the sample for this research [32]. Before the questionnaire forms were distributed, the students were informed about the aim of the research, the implementation period of the questionnaire, and the questionnaire form, then, they were asked to fill in the questionnaire forms on a voluntary basis.

The implementation of the research method was performed by the researcher between 13 October and 13 November 2021. The process of filling out of questionnaire forms was carried out using a face-to-face interview technique. A total of 278 completed questionnaire forms were returned (response rate = 100%) and analyzed.

4.3. Data Collection Tool

An environmental literacy questionnaire and a personal information form were employed to determine the environmental literacy levels of the nursing students. The personal information form used in the current research was developed to reveal the socio-demographic characteristics of the nursing students. It covers two categories: gender and taking environment-related courses.

The environmental literacy questionnaire (ELQ) was derived from part of the Michigan State University’s project and was originally used by Kaplowitz and Levine (2005) [9]. This questionnaire was translated and adapted into the Turkish language and applied by Tuncer et al. (2009). They determined the Cronbach’s alpha (internal consistency) coefficient for the knowledge, attitude, uses, and concern item sets to be 0.88, 0.64, 0.80, and 0.88, respectively [35]. Later, the environmental literacy questionnaire was revised and used by Kahyaoğlu (2011) [36].

In this study, the environmental literacy questionnaire revised by Kahyaoğlu (2011) was used. This questionnaire (ELQ) consists of four components; knowledge (11 items), attitude (12 items), uses (19 items), and concern (9 items). Kahyaoğlu (2011) determined the Cronbach’s alpha values for the four components of the survey as follows: knowledge, 0.88; attitude, 0.88; use, 0.70; and concern, 0.90 [36].

In the present study, the Cronbach’s alpha coefficient was determined for each component to examine the reliability of the measurements, which was found to be 0.702 for the component of knowledge, 0.706 for the component of attitude, 0.833 for the component of use, and 0.933 for the component of concern. Nunally stated that the coefficient for the reliability measurement needs to be ≥0.70 [37].

In the knowledge component of the environmental literacy questionnaire, we used multiple-choice questions. Each of the response choice sets was designed to have one correct response.

The attitude dimension of the questionnaire was presented to participants who answered using a five-point Likert-type scale ranging from 1 “strongly disagree” to 5 “strongly agree” (1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree, 5 = strongly agree).

The environmental use items measured participants’ intentions to take part in pro-environmental behaviors [35]. The use dimension of the questionnaire was presented to participants who answered using a five-point Likert-type scale ranging from 1 “strongly disagree” to 5 “strongly agree”.

The concern dimension used a five-point Likert-type scale ranging from “very concerned” to “not concerned”. Therefore, the maximum score for the “concern” component was 45, and the minimum score was 9 [9]. A higher score indicates a higher concern toward environmental problems.

4.4. Analysis of the Data

The data analysis was conducted using the “Statistical Package for Social Sciences 21.0” (SPSS Inc., Chicago, IL, USA). Descriptive statistics such as frequencies and percentages were measured for the dimensions of environmental literacy, and for the items regarding demographic information. Moreover, the means, medians, minimum and maximum scores, and standard deviations were also evaluated for the components of environmental literacy. Shapiro–Wilk and Kolmogorov–Smirnov Tests were used on the data in order to find out whether they were normally distributed. The groups were not normally distributed since the significance values of the Kolmogorov–Smirnov and Shapiro–Wilk tests were both less than 0.05 (p < 0.05) [38,39]. To check whether the distribution of scores was normal, we looked at the values of skewness and kurtosis. In a normal distribution, the values of the skewness and kurtosis should be 0 [40]. In this study, the skewness test value was −7.04, while the kurtosis test value was +2.19. Because the groups were not distributed normally, the non-parametric Kruskal Wallis H test and the Mann Whitney U test were performed to compare groups, and correlation analysis (Spearman’s rho correlation) was also performed [38].

Thus, non-parametric Mann Whitney U tests were used to compare the two groups and the Kruskal Wallis H test was used to compare three groups to determine whether the environmental literacy of nursing students for a sustainable environment significantly differed statistically depending on their gender and whether they had taken an environmental education/environmental issues course during their nursing students’ education. Spearman’s rho correlation is a non-parametric measure of rank correlation (statistical dependence of ranking between the two variables). It measures the strength and direction of the association between two ranked variables. Huck (2011) stated The Spearman coefficient can take a value between +1 and −1 [41].

4.5. Research Ethics

In order to carry out the research, “institutional permission” was required from the Faculty of Nursing of the University of Akdeniz. We obtained “permission” from the Clinical Research Ethics Committee of the Faculty of Medicine of the University of Akdeniz, and both written and verbal consent were obtained from the nursing students who participated in the research via “volunteer informed consent forms” on the basis of voluntariness. Permission was obtained from the author via e-mail for the environmental literacy scale, which was used in the collection of research data.

5. Results

As shown in

Table 1. Descriptive characteristics of the sample.

Variable	Group	n	%
Sex	Male	106	38.3
	Female	171	61.7
	Total	277	100.0
Taking an environmental education/environmental issues course during nursing students’ education	Yes	35	12.6
	No	243	87.4
	Total	278	100.0

, 61.7% of the respondents in this research were female, while 38.30% were male. It can be seen that 87.4% of the nursing students who participated in the research did not take environment-related courses during their education, while 12.6% of the students took environment-related courses during their education.

In

Table 2. Environmental knowledge levels of the nursing students.

Number of Questions Responded Correctly	Point Percentage Range	Percent of Participants per Point	Grade	Adequacy of Points
10 or more	90–100%	0.4	A	Adequate
9	89–80%	1.4	B	Adequate
8	79–70%	5.4	C	Adequate
7	69–60%	12.9	D	Inadequate
6 or fewer	59% or less	79.9	F	Inadequate

, it can be observed that only 7.2% of the nursing students had an acceptable level of environmental knowledge according to NEETF/Roper’s classification. Another remarkable point is that 92.8% of the nursing students participating in this study did not obtain adequate scores in the knowledge component of the survey.

The aggregate number of right answers for each nursing student was scored as either acceptable or unacceptable regarding the respondents’ overall level of environmental knowledge, as has been carried out in previous studies [9,42]. According to NEETF/Roper’s calculated letter grades (e.g., A, B, C, and F) based on the percentage of participants’ right responses, aggregate scores of greater than 70% were considered as passing or acceptable levels of environmental knowledge [42].

In

Table 3. Nursing students’ answers to the environmental knowledge items concerning environmental matters.

Item Number	Item Topic	Correct n	Response %
4	Biodiversity	261	75.0
5	Motor vehicles are the most important source of carbon monoxide	41	11.8
6	Electricity generation in Turkey—hydro power plants	75	21.6
7	The main cause of river and sea pollution in Turkey is untreated domestic, industrial, and agricultural wastewater	208	59.8
8	Trees as a renewable resource	202	58.0
9	The protective effect of the ozone layer	104	29.9
10	Garbage in Turkey	119	34.2
11	The official institution in Turkey that makes decisions to protect the environment is the Ministry of Environment, Urbanism, and Climate Change	161	46.3
12	Batteries as hazardous waste	165	47.4
13	Extinction of animal species	170	48.9
14	A method for storing nuclear waste	73	21.0

, it can be seen that the majority (74.5%) of the nursing students answered correctly to the question about biodiversity in the environmental knowledge items. Moreover, more than half (58.6%) of the participants answered correctly to the question related to major sources of river and sea pollution and trees as a renewable resource (56.5%). Furthermore, less than half of the participants responded correctly to the questions concerning the extinction of animal species (48.2%), batteries as hazardous household waste (46.8%), and the question concerning the Ministry of Environment, Urbanism, and Climate Change being the official institution in Turkey that makes decisions to conserve the environment (46.03%). An overwhelming majority of respondents gave incorrect responses for items 5 (89.6%), 6 (79.1%), and 14 (79.1%). The environmental knowledge items with the least correct responses (20.9%) were concerned about methods for storing nuclear waste and electricity generation in Turkey. Nursing students’ responses indicate that their level of environmental knowledge was low, given that the participants did not provide correct responses to all the questions.

In

Table 4. Nursing students’ answers to the environmental attitude items regarding environmental matters.

ItemNo.	Items	Strongly Disagree	Disagree	Undecided	Agree	Strongly Agree	Means	SD
		%	%	%	%	%
15	We are approaching the limit of the number of humans that the earth can support.	19.4	9.4	22.7	18.7	29.9	3.30	1.47
16	The balance of nature is very delicate and easily disturbed.	12.2	15.5	16.2	19.4	36.7	3.53	1.43
17	People have the right to modify the natural environment according to their needs.	40.6	20.1	18.0	12.2	9.0	2.29	1.34
18	The main purpose of mankind is to dominate nature.	39.6	13.3	21.2	13.7	12.2	2.46	1.43
19	When humans use natural resources, it often produces disastrous consequences.	6.8	12.9	25.2	25.2	29.9	3.58	1.23
20	Plants and animals exist for the benefit of humans.	11.2	11.2	25.2	24.5	28.1	3.47	1.31
21	To maintain a healthy economy, we will need to develop a steady state economy in which industrial growth is controlled.	4.0	7.6	24.8	24.5	39.2	3.87	1.13
22	Mankind must live in harmony with nature in order to survive.	4.0	7.2	15.1	18.3	55.4	4.14	1.16
23	Earth has limited space and resources like a spaceship.	7.2	11.2	30.2	22.3	29.1	3.55	1.22
24	Humans need not conform to nature, because they can arrange nature according to their own needs.	37.8	17.6	21.6	9.4	13.7	2.44	1.42
25	There are limits to growth beyond which our industrialized society cannot expand.	4.3	7.9	21.2	23.7	42.8	3.93	1.16
26	Mankind is seriously destroying nature.	5.8	2.9	15.5	18.0	57.9	4.19	1.15

, the “agree” and “strongly agree” options in this section were assessed together. An overwhelming majority of the respondents (75.9%, M = 4.19, SD1.15) agreed that mankind is seriously destroying nature, and 73.7% believe that humanity must live in harmony with nature in order to survive (M = 4.14, SD 1.16); a total of 66.5% of the nursing students agreed that there are growth limits beyond which industrialized society cannot expand (M = 3.93, SD 1.16); a total of 63.7% of the students agreed that we must develop a steady-state economy in which industrial growth is controlled in order to maintain a healthy economy (M = 3.87, SD 1.13). A total of 56.1% of the participants believe that the balance of nature is very delicate and easily disturbed, while 27.7% disagreed that they had an opinion about the matter (M = 3.53, SD 1.43). A total of 55.1% supported the notion that when people use natural resources, it often produces disastrous consequences, while 25.2% were undecided about the matter (M = 3.58, SD 1.23); while 48.6% of the nursing students agree that we are approaching the limit of the number of humans that the earth can support, 22.7% of them are undecided about the matter (M = 3.30, SD 1.47). Taking the expressions of negative opinions into account, 60.7% of the nursing students did not endorse the idea that human beings have the right to change the natural environment according to their needs (M = 2.29, SD 1.34). Moreover, 52.9% disagreed with the statement that the main purpose of man is to dominate nature (M = 2.46, SD 1.43); 55.4% of the respondents disagreed that people need not conform to nature, because they can arrange nature according to their own needs, i.e., that “people were meant to rule over the rest of nature” and about 22.4% disagreed that plants and animals exist for the benefit of humans (M = 3.47, SD 1.31) (Table 4).

Finally, the nursing students expressed positive attitudes about the importance of the attitude dimension for environmental literacy. It seems that nursing students have a pro-ecology worldview.

As shown in

Table 5. Nursing students’ answers to the environmental use items regarding environmental matters.

ItemNo.	Items	StronglyDisagree	Disagree	Undecided	Agree	Strongly Agree	Mean	SD
		%	%	%	%	%
27	Special fields should be reserved for endangered species	12.2	5.0	11.2	17.3	54.3	3.96	1.40
28	Water quality laws should be stricter.	6.5	8.6	16.9	22.3	45.7	3.92	1.25
29	Wild animals that supply meat for humans are the species in most need of preservation species to be preserved.	7.9	15.5	35.6	16.5	24.5	3.34	1.23
30	Poisonous snakes and insects should be killed as they pose a threat to humans.	34.5	16.2	25.9	14.0	9.4	2.47	1.34
31	Landowners should be permitted to use their drainage wetlands for agricultural and industrial purposes.	14.0	16.9	31.3	18.7	19.1	3.12	1.29
32	It is important that everyone recognizes environmental problems.	7.9	6.1	20.1	22.7	43.2	3.87	1.26
33	People should be permitted to use their lands as they wish.	24.1	20.1	28.1	11.2	16.5	2.76	1.37
34	I think I have responsibility to solve environmental problems.	2.9	10.4	19.8	25.5	41.4	3.92	1.13
35	The government should regulate the use of private areas for wildlife conservation.	6.1	8.3	21.6	27.3	36.7	3.80	1.20
36	Humans should be held accountable for any harm they cause to the environment.	3.6	12.6	19.1	26.6	38.1	3.83	1.17
37	All plants and animals play a significant role in nature.	5.8	8.3	16.9	18.7	50.4	4.00	1.24
38	Technological changes have both beneficial and harmful impacts on the environment.	3.6	9.0	18.0	27.0	42.4	3.96	1.14
39	Legislation should be prepared and implemented to make recycling obligatory.	6.8	7.9	17.6	22.7	45.0	3.91	1.25
40	Laws on air pollution are strict enough.	24.1	21.6	29.9	15.1	9.4	2.64	1.26
41	Science and technology play a significant role in resolving environmental problems.	7.2	7.6	19.8	33.1	32.4	3.76	1.19
42	Cultural modifications are very significant in resolving environmental problems.	5.8	13.7	30.6	28.8	21.2	3.46	1.14
43	Changes in humans’ values will play a role in solving environmental problems.	6.1	7.6	20.9	37.1	28.4	3.74	1.13
44	Public participation has an important place in solving environmental problems.	3.2	7.6	17.3	29.1	42.8	4.01	1.09
45	Changes in living habits will play an important role in solving environmental problems.	4.3	5.0	14.4	30.9	45.3	4.08	1.09

, this dimension measured nursing students’ intentions to participate in environmental use. The “agree and strongly agree” and “strongly disagree and disagree” options in this section were evaluated together. The nursing students were asked to answer questions evaluating the use dimension of EL.

A overwhelming majority of the nursing students agreed on the items related to the effect of changes in living habits (such as consumption) in solving environmental problems (76.2%, M = 4.08, SD 1.09); the effect of public participation in solving environmental problems (71.9%, M = 4.01, SD 1.09); the requirement of establishing special fields for endangered species (71.6%, M = 3.96, SD 1.40); the harmful and beneficial impacts of technological changes for the environment (69.4%, M = 3.96, SD 1.14); the notion that all plants and animals play a significant role in nature (69.1%,M = 4.00, SD 1.24); the notion that the requirements of the laws for water quality should be stricter (68%, M = 3.92, SD 1.25); the requirement of legislation to make recycling mandatory (67.7%, M = 3.91, SD 1.25); awareness of responsibilities in resolving environmental problems (66.9%, M = 3.87, SD 1.26); the importance of being aware of environmental problems (65.9%, M = 3.87, SD 1.26); the role of science and technology in resolving environmental problems (65.5%, M = 3.76, SD 1.19); the role of changing human values in resolving environmental problems (65.5%, M = 3.74, SD 1.13); the significance of feeling accountable for any harm humans cause to the environment (64.7%, M = 3.83, SD 1.17); and the government’s role in arranging the use of private areas for the conservation of wildlife (64.0%, M = 3.34, SD 1.23) (Table 5).

As shown in Table 5, when negative items were examined, it seemed that most of the respondents showed a conscious and considerate approach to nature. A total of 50.7% of the nursing students disagreed and strongly disagreed that poisonous snakes and insects should be killed as they pose a threat to people (M = 2.47, SD 1.34), while 25.9% were undecided in their view about the issue. Moreover, less than half of the nursing students (45.7%, M = 2.64, SD 1.26) disagreed or strongly disagreed that the laws on air pollution are strict enough, while 29.9% of the respondents were undecided for this item. A total of 41.9% of the nursing students agreed and strongly agreed that wild animals that provide meat for humans are the most important species to be protected, while 35.6% were undecided for this item (M = 3.34, SD 1.23).

Therefore, it can be inferred as a result that, in the present study, the nursing students tend to use natural resources in an accountable and preventive manner. They believe in the significance of personal accountability as well as governmental measures. As a result, it can be said that nursing students have an eco-centric worldview.

As shown in

Table 6. Nursing students’ answers to the environmental concern items regarding environmental matters.

Item No.	Items	Not Concerned	A Little Concerned	Have No Opinion	Somewhat Concerned	Very Concerned	Mean	SD
		%	%	%	%	%
46	Smoke pollution	10.1	5.0	14.0	24.1	46.8	3.92	1.31
47	Noise pollution	4.7	16.2	21.2	17.3	40.6	3.73	1.27
48	Automobile emissions	3.6	7.2	21.2	23.7	44.2	3.98	1.13
49	Industrial pollution	2.9	6.1	15.5	16.9	58.6	4.22	1.10
50	Hazardous waste	2.9	6.8	11.9	16.9	61.5	4.27	1.09
51	Poor-quality drinking water	5.0	4.0	12.9	17.3	60.8	4.25	1.14
52	Indoor air pollution	2.9	9.0	12.9	24.5	50.7	4.11	1.12
53	Depletion of the ozone layer	3.6	1.8	14.7	14.7	65.1	4.36	1.03
54	Global warming	1.4	4.3	9.7	14.4	70.1	4.47	0.94

, environmental concerns of the participants were evaluated with nine items. Depletion of the ozone layer (65.5%, M = 4.36, SD 1.03), global warming (70.1%, M = 4.47 SD 0.94), poor quality drinking water (61.5%, M = 4.25 SD 1.14), hazardous waste (60.8%, M = 4.27, SD 1.09), industrial pollution (58.6%, M = 4.22, SD 1.10), smoke pollution (46.8%, M = 3.92, SD 1.31), automobile emissions (44.2%, M = 3.98, SD 1.13), and noise pollution (40.6%, M = 3.73, SD 1.27) were problems that nursing students were very concerned about. Accordingly, it can be inferred that the environmental problems that most concerned the nursing students were global warming and the depletion of the ozone layer. Noise pollution, on the other hand, was the least concerning item. It is possible that the water shortage experienced in Turkey in the recent years has caused these problems to appear at the top of the list.

As shown in

Table 7. Spearman’s rho correlation.

		Attitude	Use	Concern
Knowledge	r	0.191 **	0.286 **	0.316 **
	p	0.001	0.000	0.000
	N	278	278	278
Attitude	r		0.548 **	0.260 **
	p		0.000	0.000
	N		278	278
Use	r			0.467 **
	p			0.000
	N			278

** p < 0.01.

, Spearman’s rho correlation was analyzed in order to find the relationship between the dimensions of the EL scale investigated in this study.

The environmental attitude dimensions scale had a positive, weak, and significant correlation with environmental knowledge: r (278) = 0.191, p = 0.000. In other words, as the environmental attitude scores increased, the environmental knowledge scores were also found to increase (Table 7).

The environmental use dimension scale had a positive, low, and significant correlation with environmental knowledge: r (278) =.286, p = 0.000 (Table 7). In other words, as the environmental knowledge scores increased, the environmental use scores were also found to increase.

The environmental concern dimension scale had a positive, moderate, and significant correlation with environmental knowledge: r (278) =.316, p = 0.000 (Table 7). In other words, as the environmental knowledge scores increased, the environmental concern scores were also found to increase.

The environmental use dimension scale had a positive, moderate, and significant correlation with environmental attitude: r (278) = 0.548, p = 0.000 (Table 7). In other words, as the environmental attitude scores increased, the environmental use scores were also found to increase.

The environmental concern dimension scale had a positive, low level, and significant correlation with the environmental attitude dimension scale r (278) = 0.260, p = 0.000 (Table 7). In other words, as the environmental concern scores increased, the environmental attitude scores were also found to increase.

The environmental concern dimension scale had a positive, moderately significant correlation with the environmental use dimension scale r (278) = 0.467, p = 0.000 (Table 7). In other words, as the environmental concern scores increased, the environmental use scores were also found to increase.

As shown in

Table 8. The results of the Mann Whitney U test of dimensions of the environmental literacy scale scores based on gender.

Variable	Sex							Mann Whitney U Test			Effect Size
		n	Mean	Median	Min	Max	SD	Mean Rank	U	p	r
Knowledge	Male	106	4.05	3.50	0.00	9.00	2.35	124.38	7513.5	0.016	0.14
	Female	171	4.70	5.00	0.00	10.00	2.07	148.06
	Total	277	4.45	5.00	0.00	10.00	2.20
Attitude	Male	106	38.98	39.00	23.00	56.00	6.39	119.44	6990	0.001	0.19
	Female	171	41.81	42.00	19.00	60.00	6.80	151.12
	Total	277	40.73	41.00	19.00	60.00	6.77
Use	Male	106	64.41	65.00	35.00	89.00	12.04	112.33	6236.5	0.0001	0.26
	Female	171	71.06	73.00	34.00	95.00	10.68	155.53
	Total	277	68.52	71.00	34.00	95.00	11.66
Concern	Male	106	34.93	37.00	9.00	45.00	9.06	117.60	6795	0.0001	0.31
	Female	171	38.77	41.00	10.00	45.00	7.27	152.26
	Total	277	37.30	40.00	9.00	45.00	8.20

, the results of the Mann Whitney U test scores for the dimensions of the environmental literacy scale indicated that there was a significant difference based on gender (knowledge, attitude, use, and concern) (p < 0.05). The present study revealed a higher mean for environmental knowledge, attitude, use and concern levels among female nursing students. The results showed that the female students were more environmentally responsible than the male students.

When the scores of the dimensions of the environmental literacy scale were examined, the mean score attained by the female students (4.70, SD 2.07) in the dimension of knowledge was statistically significantly higher than that of the male students (4.05, SD 2.35). There was a statistically significant difference between the genders in terms of their knowledge dimension scale scores (Mdn = 3.50, U = 7513.5, p < 0.05, r = 0.14). This presents a small effect size for the gender data (it is below the 0.3 criterion for a medium effect size) [40]. The average rank score was higher for the female students (148.06) than for the male students (124.38) (Table 8).

The mean score attained by the female students regarding attitude in the dimension scale score (41.81, SD 6.80) was statistically significantly higher compared to the males (38.98, SD 6.39). There was a statistically significant difference between the genders in terms of their attitude dimension scale scores (Mdn = 41.0, U = 6990, p < 0.05, r = 0.19). This presents a small effect size for the gender data [40]. The average rank score was higher for the female students (151.12) than the male students (119.44) (Table 8).

The females’ use dimension scale score (M = 71.06, SD 10.68) was statistically significantly higher compared to the males (M = 64.41, SD 12.04). There was a statistically significant difference between the genders in terms of their use dimension scale points (Mdn = 71.0, U = 6236.5, p < 0.05, r = 0.26). This presents a small effect size for the gender data [40]. The female students had a higher mean rank score (155.53) than the male students (112.33) (Table 8).

The females’ concern dimension scale score (M = 38.77, SD 7.27) was statistically significantly higher compared to the males’ score (M = 34.93, SD 9.06). There was a statistically significant difference between the genders in terms of their’ concern dimension scale score (Mdn = 40.0, U = 6795, p < 0.05, r = 0.31). This presents a medium effect size for the gender data (it should be between 0.3 and 0.5 for a medium effect size) [40]. The mean rank score was higher in the female students (152.26) than in the male students (117.60) (Table 8).

As shown in

Table 9. The results of the Mann Whitney U test for the environmental literacy scale scores based on the status of taking environment-related courses during their education.

								Mann Whitney U Test			Effect Size
		n	Mean	Median	Min	Max	SD	Mean Rank.	U	p	r
Knowledge Attitude	Yes	35	2.69	2.00	0.00	7.00	1.92	75.96	2028.5	0.0001	0.30
	No	243	4.70	5.00	0.00	10.00	2.12	148.65
	Total	278	4.45	5.00	0.00	10.00	2.20
	Yes	35	37.17	37.00	20.00	56.00	8.06	101.53	2923.5	0.003	0.18
	No	243	41.27	41.00	19.00	60.00	6.43	144.97
	Total	278	40.75	41.00	19.00	60.00	6.78
Use	Yes	35	61.26	56.00	46.00	95.00	13.38	91.47	2571.5	0.0001	0.23
	No	243	69.60	72.00	34.00	95.00	11.03	146.42
	Total	278	68.55	71.00	34.00	95.00	11.66
Concern	Yes	35	30.97	27.00	20.00	45.00	7.99	80.13	2174.5	0.0001	0.28
	No	243	38.24	41.00	9.00	45.00	7.83	148.05
	Total	278	37.32	40.00	9.00	45.00	8.20

, the results of the Man Whitney U test indicated that there was a statistically significant difference between taking an environment-related course in terms of their environmental knowledge dimension scale scores (Mdn = 5.00, U = 2028.5, p < 0.05, r = 0.30). This presents a medium effect size for taking an environment-related course (it should be between Cohen’s criteria 0.3 and 0.5 for a medium effect size) [40]. The knowledge score of the nursing students who did not take an environment-related course (M = 4.70, SD 2.12) was statistically significantly higher than the score of students who took an environment-related course (M = 2.69, SD 1.92). The mean rank score of nursing students who did not take an environment-related course was higher (148.65) than the score of nursing students who had taken an environment-related course (75.96).

When the environmental literacy attitude dimension was analyzed, a statistically significant difference was determined in terms of taking an environment-related course and the attitude dimension scale scores (Mdn = 41.00, U = 2571.5, SD 6.78, p < 0.05, r = 0.18). This presents a small effect size for taking an environment-related course. For the environmental attitude dimension, the mean score of nursing students’ taking an environment-related course (37.17, SD = 1.92) was statistically significantly lower as compared to the score of the nursing students who did not take an environment-related course (41.27, SD 2.12). It was found that the mean rank score of the nursing students who did not take an environment-related course was higher (144.97) than the score of nursing students who had taken an environment-related course (101.53) (Table 9).

When the environmental literacy dimension scales were analyzed, a statistically significant difference was determined between those who had taken an environment-related course and the environmental use dimension-scale scores (Mdn = 71.00, U = 2571.5, p < 0.05, r = 0.23). This presents a small effect size for taking an environment-related course. The environmental use mean score of students who took an environment-related course (61.26, SD 13.38) was statistically significantly lower than the score of students who did not take an environment-related course (69.60, SD = 11.03). It was found that the mean rank score of the nursing students who did not take an environment-related course was higher (146.42) than the score of the nursing students who had taken an environment-related course (91.47) (Table 9).

When the environmental literacy dimension scales were analyzed, a statistically significant difference was determined between those who had taken an environment-related course and the environmental concern dimension scale scores (Mdn = 40.00, U = 2174.5, p < 0.05, r = 0.28). This presents a small effect size for taking an environment-related course. The environmental concern mean score of the students who took an environment-related course (30.97, SD 7.99) was statistically significantly lower compared to the score of the students who did not take an environment-related course (38.24, SD = 7.83). It was found that the mean rank score of the students who did not take an environment-related course was higher (148.05) than the score of the students who had taken an environment-related course (80.13) (Table 9). The results of the current study indicate that the lack of impact of taking environment-related courses may be caused by the insufficient illustration given by the related item.

6. Discussion

In order to determine the environmental literacy level of nursing students, environmental knowledge, environmental use, attitudes towards environmental problems, and environmental concern tests were utilized. Based on a review of the literature, we found very few studies that aim to directly determine the environmental literacy of nursing students.

Initially, nursing students were asked to respond to questions assessing their knowledge about environmental concepts such as biodiversity and waste. The nursing students’ responses indicated that their level of environmental knowledge was low, given that most of the participants responded incorrectly to most of the questions. In the present study, very few of the nursing students received a “passing” environmental knowledge grade based on the NEETF/Roper Starch grading scale [42]. Most of the nursing students were thus found to have inadequate environmental knowledge. The answers from the nursing students reveal their misconceptions about environmental knowledge. Specifically, nursing students’ misconceptions concern motor vehicles as sources of carbon monoxide, electricity generation, the ozone layer, garbage, and storing nuclear waste. For instance, nearly 1 in 10 nursing students answered correctly to the question related to the contribution of motor vehicles to air pollution and about 1 in 5 to that of electricity generation in Turkey’s-hydro power plants. This result can be explained by the insufficient environmental education of nursing students. Similarly, much research has also highlighted the misconceptions held by participants in relation to specific environmental concepts [43,44,45,46,47,48,49,50,51,52]. Pe’er et al. (2007) stated that students demonstrated an extremely low level of environmental knowledge [53]. A total of 23% of the respondents were determined to have inadequate levels of environmental literacy by Kaplowitz and Levine (2005) [9]. Aydemir (2007) conducted a study in Ankara and found that only a small number of respondents had sufficient knowledge levels about environmental concepts [54]. Buhan (2006) stated that teachers in Istanbul lacked adequate knowledge [55]. Gavrilakis et al. (2007) also stated that the respondents’ environmental knowledge was moderate regarding hydrocarbons, carbon dioxide, and chlorofluorocarbons (27%) or carbon dioxide alone (18%) [44]. Erdoğan (2009) [56] reported that respondents had insufficient environmental knowledge, and he interpreted this as an alarming result. These findings were not considered satisfactory. It can be said that the reason for this is the inadequate environmental education provided during nursing students undergraduate education. One possible explanation for the low level of nursing students’ environmental knowledge in the present study may be due to the absence of courses related to the environment in the current nursing education programs in Turkey. Kapan and Yardımcı Gürel (2022) recommended that students take environmental literacy courses during their university education or make arrangements regarding the quality and content of existing courses. They recommended that a review is conducted to improve nursing education programs by spending more time on environmental education with a comprehensive curriculum [57]. Goldman et al. (2006) highlighted the misconceptions held by participants in relation to specific environmental concepts [58]. Goulgouti et al. (2019) reported that students’ answers were moderate to low in Greece [59].

Although the environmental knowledge of nursing students is low, they were found to express positive attitudes toward the environment. The majority agreed or strongly agreed with the statements. This indicates that nursing students acknowledge the presence of an environmental problem and accept the need to protect the environment. These results matched with the results of other research on positive environmental attitudes [59,60,61,62,63,64,65,66,67]. Goulgouti et al. (2019) found that pre-service teachers’ attitudes towards the environment were positive [59]. On the other hand, Özyürek et al. (2019) [68] discovered that pre-service teachers’ attitudes towards the environment were at a high level. Similarly, Tuncer Teksöz et al. (2014) [66] found that pre-service teachers had positive attitudes toward the environment. Although nursing students’ environmental concerns, usage, and attitudes are at a sufficient level, their lack of environmental knowledge may be due to the inadequacy of the subjects included in the environment-related courses they have taken and the content of these subjects. Moreover, Bodur et al. (2013) [67] reported that the nursing students had positive views about environmental sensitivity. It was stated that this may be related to the fact that the environment, a basic concept in nursing, has been included in nursing curricula.

In the present study, the third dimension of environmental literacy is defined as use, which measures nursing students’ intentions to take part in pro-environmental behavior. The nursing students’ answers show that their level of pro-environmental behavior was high. The majority agreed or strongly agreed with the statements. It was seen that the respondents gave a high rate of positive responses to the items related to awareness of environmental issues, personal responsibilities, and changes in living habits. It can be said that the reason for this is their positive attitude towards the environment and their high level of concern about the topic. These results are congruent with many other studies [55,63,66]. Similarly, Özyürek et al. (2019) also discovered that pre-service teachers’ environmental use levels were high in the sub-dimensions of the environmental literacy scale [68]. However, our study results contrast with those of Goulgouti et al. (2019) who determined that Greek students were willing to do more, but their responses on the behavior dimension did not generally reflect their positive attitudes [59].

In this research, the environmental concern level of the respondents was determined to be high. On the other hand, the results of this research showed that although the participants’ concern for environmental problems was generally at the desired level, they differed according to the subjects. Accordingly, it can be inferred that the environmental problems that most concerned the nursing students were global warming and the depletion of the ozone layer. Noise pollution, on the other hand, was the least concerning item. It is possible that the water shortages experienced in Turkey in recent years caused these problems to appear at the top of the list. These findings are also consistent with the results of other research studies on environmental concern [36,65]. Kahyaoğlu (2011) [36] and Tuncer et al. (2009) [35] discovered that pre-service teachers’ concerns about environmental problems were high. They found that the environmental problems that pre-service teachers were most concerned about were poor drinking water quality, indoor air pollution, ozone depletion, global warming, and hazardous wastes. Similarly, Kahyaoğlu (2011) [36] and Özyürek et al. (2019) [68] found that the concern level of the teachers was reported to be very high [33]. Tuncer et al. (2009) [35] reported that such a result seems unexpected in light of Turkey’s circumstances as a developing nation. It is possible that the pre-service teachers do not have complete and/or first-hand knowledge about such issues. They likely do not have much exposure to radon, a natural radioactive gas and a principle indoor pollutant. It is possible that pre-service teachers expressed their concerns about indoor air pollution thinking instead of the high use of tobacco in Turkey.

According to the results of this study, although their environmental knowledge was found to be low, nursing students have a positive profile in terms of their attitudes towards the environment, its uses, and their concern for environmental problems. In particular, they gave highly positive answers to questions such as personal responsibilities and changes in life habits. The nursing students’ positive participation in the items regarding attitude towards the environment showed that they have a pro-ecology view. The nursing students’ responses to the environmental literacy scale attitude dimension questions showed that the students, on average, have a pro-ecology worldview. It can be argued that individuals with this view see themselves as part of nature and tend to take the necessary precautions for the protection of nature. At the same time, these students prefer to solve problems by eliminating the conflicting situations between society and the environment [69]. Similarly, Tikka et al. (2000) who conducted a similar study with a sample from Finland, concluded that environmental knowledge has an increasing effect on the attitudes towards the environment [70].

In this study, all the dimensions of environmental literacy were determined to be positive, and the strongest correlations ranged from low to moderate.

According to the results of this research, a low level but a positive and significant correlation was found between nursing students’ environmental knowledge and environmental attitude as well as between knowledge and environmental use. Similarly, Makki et al. (2003) [71], Kahyaoğlu (2011) [36], and Yavetz et al. (2009) [72] found a positive, low level, and significant relationship between teachers’ environmental knowledge and attitude. Altınöz (2010) [73], Güler (2013) [74], Karatekin (2011) [75], Kibert (2000) [16], Timur (2011) [76], Yavetz et al. (2009) [72], and Goldman et al. (2006) found a positive, low-level, and significant relationship between knowledge and behavior [58]. Tikka et al. (2000) [70] found a significant correlation between respondents’ environmental knowledge and attitude. Similarly, Tuncer et al. (2009) [35] reported a small but significant correlation between pre-service teachers’ environmental knowledge and use. Similarly, Kahyaoğlu [36] obtained a positive, weak, and statistically significant correlation between teachers’ environmental knowledge and use. Erbasan and Erkol (2019) [77], Esa [78], Kaiser et al. (1999) [79], Negev et al. (2008) [80], and Pe’er et al. (2007) [53] found a moderate, positive, and significant relationship between attitude and knowledge. However, our results contradict those of Tuncer et al. (2009) [35], Bar (2003) [81], and DeChano (2006) [82], who did not determine any correlation between the knowledge and attitude components of the EL scale. It is stated that environmental decisions and behaviors are influenced by environmental knowledge and attitudes [71]. Similarly, Tikka et al. (2000) [70], who conducted a similar study with a sample from Finland, concluded that environmental knowledge has an increasing effect on attitude towards the environment. Aksu (2009) [83] reported that the stronger the attitude, the more consistent its relationship with behavior. Tikka et al. (2000) reported that attitudes, the quantity of nature-related activities, and environmental knowledge were related to each other—students who had a favorable attitude toward the environment tended to participate in various nature-related activities [70].

In the present study, a positive, moderate, and significant correlation was found between environmental knowledge and environmental concern. However, Kahyaoğlu [36] obtained the lowest correlation between the knowledge and concern components. Tuncer et al. (2009) [35] stated that pre-service teachers may be more concerned about environmental problems if they have positive attitudes towards the environment and sufficient environmental knowledge. The findings also suggest that individuals’ environmental knowledge and environmental attitudes were positively associated with increased environmental concern and responsibility. Poudel et al. (2005) developed hands-on activities to facilitate environmental learning and claimed that this method enhanced student’s interest, motivation, and ability to think critically about contemporary environmental issues. Such programs may be developed for nursing students’ training to focus on environmental literacy and curriculum development [84].

Our findings show that environmental attitudes were positive and moderate but significantly correlated with the environmental use dimension scale scores. Furthermore, Kahyaoğlu (2011) [36] and Ökeşli (2008) [85] found a strong correlation between the attitude and use dimensions of the EL scale. Moreover, Yavetz et al. (2009) also found the highest correlation between the attitudes and behaviors of the students [72]. It was stated that attitude is one of several variables affecting behavior. Erdogan (2009) [56] discovered a negative correlation between the students’ environmentally responsible behaviors and their environmental attitudes. This may be ascribed to the students’ high level of attitudes and moderate level of behaviors.

In the present study, environmental use was positive, moderate, and significantly correlated with the environmental concern dimension scale score. As the nursing students’ scores on the scale of environmental use increased, their environmental concern scores were also determined to increase. According to the results of this research, the environmental use of nursing students is a factor affecting the environmental concern scale scores. Similar results were obtained in the many studies conducted on this subject [36,83,85].

As the nursing students’ scores for nursing in the scale of environmental knowledge increased, their attitude towards environmental problems, environmental use, and environmental concern scores were also determined to increase. As a result, it can be said that the environmental knowledge of nursing students is a factor affecting their environmental attitude, environmental use, and environmental concern scale scores.

Within the scope of this study, the effect of gender on the environmental literacy of nursing students was also examined. Female nursing students were more concerned than the male students about environmental problems, and they were also more knowledgeable about environmental issues. The present study indicated a higher mean score for environmental knowledge, attitude, use, and concern level among the female nursing students. The results revealed that the female students felt more responsible for the environment than the male students. Hines (1987) have been found to be more concerned females’ about environmental issues, which is an indicator of a healthy and good quality life [86]. Similar to our results, Kapan and Yardımcı Gürel (2022) found that the environmental literacy levels of female students were higher than those of male students in their study on nursing students [57]. Similarly, Kayalı (2018) found that the environmental literacy levels of female students were higher than those of male students in their study on teacher candidates [87]. Teksöz et al. (2010) found that female students had higher scores in attitudes towards the environment, uses related to the environment, and concern for environmental problems, while male students had higher scores in the environmental knowledge dimension [51]. Altınöz (2010) found that the environmental knowledge level of female students was significantly high in his study on science teacher candidates [73]. Studies indicate that generally female students have higher scores. Kapan and Yardımcı Gürel (2022) reported that this may be due to the nature of women, since women are more sensitive towards and conscious of the environment [57]. As Tikka et al. (2000) stated, while females have a stronger sensitivity towards nature, males are more inclined to dominate nature and benefit from natural resources [70]. In this respect, this result is expected in that gender difference was found to be in favor of females in the dimensions of attitudes towards the environment and uses related to the environment. This difference should not be ignored when providing environmental education in nursing faculties, and appropriate in class activities should be prepared for both male and female students so as to allow them to become environmentally literate at a high level. Because the content of programs for sustainable environmental education must cover the economic and social effects and results of natural resource use as well as the environmental effects, this approach appeals to both females, who have a stronger sensitivity to nature, and to males who are inclined to benefit from natural resources [88].

This study indicated that there was a statistically significant difference between genders in the overall dimension scores of the environmental literacy scale. Similarly, Kapan and Yardımcı Gürel (2022) [57] determined that the mean scale scores of the nursing students were significantly different in terms of gender. Other research studies found a statistical difference between genders in environmental concerns and attitudes toward the environment [77,89]. Kahyaoğlu (2011) and Tuncer Teksoz et al. (2014) stated that men show greater environmental concerns [36,66]. However, females’ attitudes were found to be more eco-centric than those of males. Nonetheless, the results of this study contradict those of many other studies [42,48,58]. Goulgouti, et al. (2019) [59] found that there were no significant differences according to gender; pre-service teachers’ overall understanding of environmental concepts reflect the cognitive, affective, and behavioral dimensions. Similarly, the results of this study contradict those of Kroufek et al. (2015), who determined that the gender variable did not show any statistical difference except in the dimension of behavior [88]. However, surveys indicate that women are more environmentally responsible than men and show greater environmental concern [63,76,89]. For instance, Tuncer Teksoz et al. (2014) found significant differences among men and women regarding environmental concerns and their attitudes toward the environment, with women showing greater environmental concerns and their attitudes being more eco-centric than those of men [66]. The difference created by gender in environmental literacy can be balanced with environmentally sustainable education, which should include content that can eliminate the above-mentioned differences in perception about natural resource use by males and females. In this context, one of the most basic goals should be to ensure that nursing students are environmentally literate. In order to achieve this goal, scientific studies will form an important infrastructure for the goal of a sustainable future.

There was a statistically significant difference between having taken an environment-related course during the nursing students’ education and the overall dimension scores of the environmental literacy scale. Although taking environment-related courses have effects on environmental attitude, use, and concern, this research revealed that taking environment-related courses have no effect on environmental knowledge. Similarly, Owens (2000) studied urban secondary school teachers. It shown that taking pre-service and in-service environmental lessons had a positive effect on environmental behavior but had no effect on environmental knowledge [90]. Furthermore, Alagöz (2009) stated that social studies teacher candidates who took environment-related courses did not have a sufficient level of knowledge about the environment [91]. On the other hand, there are also other studies showing the impact of taking an environment-related course on environmental literacy [36,76,92]. These study results contradict those of Özyürek et al. (2019), who determined no statistically significant difference between all the sub-dimensions of environmental literacy according to the status of teacher candidates taking environment-related courses [68]. Moreover, Erol, in his study aiming to determine the attitudes of primary school teacher candidates towards environmental problems stated that taking environment-related courses did not create a change in their attitudes towards the environment [92]. Although nursing students’ environmental concerns, usage, and attitudes are at a sufficient level, their low environmental knowledge may be due to the insufficient content of the subjects included in the environment-related courses they have taken so far. The fact that the lessons were teacher-centered rather than student-centered may also have caused the nursing students’ environmental knowledge to be insufficiently developed. Studies conducted with pre-service teachers have shown that providing environment-related courses with student-centered teaching methods and techniques positively changes their environmental knowledge and increases their environmental knowledge levels [93,94,95,96]. Lord (1999) stated that in environmental lessons conducted with student-centered activities, the students comprehend the subjects better and their knowledge is more permanent [97]. Jinliang et al. (2004) argued that in order to achieve the purpose of environmental education, experimental methods, discussion, extra-class activities, games, and survey applications should be used [60].

The suggestions based on the findings and results of the present study are as follows: in order to improve the environmental literacy of nursing students, extramural supports and learning opportunities should be developed.

Similar studies to be carried out in other universities in Turkey will lead to the determination of the environmental literacy profile of higher education students. Particularly among nursing students, to create strategies for environmental education in higher education in parallel with the determined profile and to take an important step towards the long term goal of the sustainable use of environmental resources. Additionally, as the nurses of the future, they will play an important role in achieving the goal of a sustainable future. Therefore, it is extremely important to determine the objectives of environmental education in higher education and to provide support for scientific research on this issue.

Environmental education in higher education is very important in a developing country such as Turkey, where natural resource use, consumption, and production movements are intense. The content of such courses should be organized in a way that integrates global and national environmental problems, in accordance with the principle of “think globally, act locally”, and take into account the scope of education for sustainable development. Providing research support in determining the content of the courses and evaluating the application results is important for effective environmental education, environmentally literate university graduates, and sustainable development.

Non-formal education and in-service training can be complementary to the training on the subject for individuals who cannot benefit from the basic programs as required. For this reason, studies should be focused on the preparation of formal and non-formal education programs that will inform individuals about environmental literacy and increase their level of environmental literacy.

7. Limitations of the Study

The present research has two limitations. First, due to the pandemic, the study was limited to undergraduate nursing students in the Faculty of Nursing of Akdeniz University and did not contain students at the other universities. Second, the study sample was unequal in terms of gender; 61.7% of the sample was female, while 38.3% was male.

8. Conclusions

Based on the findings of this study, the results have important implications for nursing education. It can be concluded that the nursing students who participated in this study had a low level of environmental knowledge, which indicates that the students need support in improving their environmental knowledge; however, the students obtained high scores for the attitude, use, and concern dimensions of environmental literacy. Furthermore, there were statistically significant differences in the dimensions of environmental literacy based on gender and whether the students had taken environment-related courses with dimensions of environmental literacy. Moreover, all the dimensions of environmental literacy were determined to be positively correlated and statistically significant with each other ranging from low to moderate correlations.

Furthermore, a longitudinal study with nursing students, starting in the first year of university, could be conducted to analyze how health literacy changes. Longitudinal studies will be important in terms of observing the effects of the courses taken by nursing students during their undergraduate education. In this study, although the environmental knowledge level of the participants was low, their environmental attitude, concern about environmental problems, and environmental use scores were found to be high. In order to investigate the reason for this, future research should also include qualitative analysis.

A suggestion for researchers who will work on this subject in the future is that they should determine the environmental literacy of nursing students at different grade levels and determine the effects of informal learning environments on improving their environmental literacy.