The exploratory literature review will be conducted in 5 steps, as described by Arksey and O’Malley [25] and refined by Levac et al [26]. These steps are as follows:

As recommended by Levac et al [26], the question we wish to answer through this exploratory review has been clearly articulated and focused. The question under study in this exploratory literature review is, “what are nurses’ perceptions relative to climate change?” This question is justified by the need to advance knowledge about nurses’ perceptions of climate change to better prepare them to tackle these climate issues [16,20,22,23].

We first developed a search strategy with the help of a specialized librarian using an iterative process. Searches were conducted in the following four bibliographic databases targeting biomedical and interdisciplinary topics: MEDLINE (PubMed), CINAHL, Embase, and Web of Science. Two concepts were used to identify keywords for the literature search strategy: climate change (concept 1) and nurses’ perceptions (concept 2). Once identified, the keywords were classified into free-text search terms and controlled vocabulary to define a search strategy specific to each database. The characteristics of free-text and controlled vocabulary searches in the databases used are presented in Table 1.

Table 2 presents the keywords (free-text search terms) and thesauri terms (controlled vocabulary) for each of the four databases for each of the two concepts defined previously.

An example of a preliminary MEDLINE (PubMed) search strategy is shown in Table 3.

For this step, studies identified by the database search were first imported into the bibliographic management software EndNote and then transferred to Covidence (Veritas Health Innovation) to remove duplicates and facilitate the sorting and selection of relevant studies based on previously defined inclusion and exclusion criteria.

Once the duplicates were removed, an initial selection was begun based on the titles and abstracts, by 2 members of the research team (TD and AB) working independently. Studies focused on nurses’ perceptions of climate change will be retained. No date limits will be applied. All studies that address an environmental issue other than climate change, concern health professionals other than nurses, or are published in a language other than English or French will be excluded. Any disagreement regarding inclusion or exclusion will be resolved by consensus and, if necessary, by consultation with a third team member.

Once this initial stage of selection is completed, a second stage of selection will determine which articles will be included in the final analysis, based on their full text. This stage will be carried out by the same 2 researchers performing the initial selection. Studies whose full text is not available, studies that do not provide the authors’ names or publication dates, or those that constitute expert opinions or commentaries will be excluded. Accordingly, only empirical studies will be considered. Once again, any disagreements will be resolved by consensus between the 2 reviewers. A third reviewer will be consulted to establish consensus if the 2 reviewers’ opinions diverge.

The results of the selection process will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram [27], showing the number of studies selected at each stage of selection.

This step consists of extracting the data from the full-text articles selected. For this purpose, a Microsoft Excel table will be developed. It will include the following sections: title, authors, year of publication, geographic area, study objectives, methodology, and key findings.

The data extracted in the previous step will be analyzed by the research team. This analysis may include an informed discussion based on an in-depth examination of the findings and directed toward answering the research question and fulfilling the study’s objective. Quantitative and qualitative data will be analyzed altogether and categorized according to the type of perception to which it refers (eg, perception of nurses’ role toward climate change or perception of their needs regarding climate change).

To supplement the results of the bibliographic database search, we plan to also conduct a search of the grey literature. To this end, we will consult the websites of associations and organizations related to nursing and those focused on the environment. Social media searches or reporting were not considered. We targeted nursing associations and organizations in the province of Québec, those at the federal level in Canada and the United States, and those at the international level. The following associations in Table 4 were identified through the scientific literature [18,28,29] and through a Google search using a combination of keywords related to nursing associations or organizations, climate change, and geographic area of interest (ie, Canada, United States, or international).

Three approaches will be used to search the grey literature. The first approach will consist of searching by navigating the websites of the various associations and consulting their different sections, such as the section on publications; the second approach will involve using the search function of the websites to search for the keywords that were defined for the bibliographic database searches; finally, the third approach will consist of searching on Google by combining the name of the association with the keywords defined for the bibliographic database searches. The data will be extracted into an Excel spreadsheet that will contain the following sections: date of search, site searched, type of search performed (referencing one of the three approaches listed above), number of results found, number of results retained, and comments. For searches conducted by navigating the sites, the sections consulted will be specified, and for keywords searches, the terms or expressions used in searches will be specified.

To our knowledge, this study is the first exploratory review of the literature aiming to identify nurses’ perceptions of climate change. Its relevance comes from the fact that studies have been conducted in recent years that address nurses’ perceptions of climate change [16,17,21-23] but have not been compared and interpreted as a body of literature. The preliminary results of this exploratory literature review suggest that nurses could be preoccupied about climate change to a certain extent [20] but could lack knowledge about climate change, its causes, and its impacts on health [15,20,22]. The perceptions of their role in the fight against climate change as well as concrete ways to include the fight against climate change in their daily work despite constraints seems also unclear [17,22]. The full results of this review of the literature will allow us to cross-reference the different perceptions nurses have of climate change, as described in the various studies, and to develop an overall portrait of these perceptions. These results will allow us to identify ways to fill the possible gap between the importance of the nursing role in addressing the health impacts of climate change and the lack of knowledge and awareness of nurses in this matter. Therefore, this study should also help nursing organizations, educational institutions, and policy makers to better identify the elements that would help prepare these health care workers to face this climate crisis and the subsequent impacts on the health and well-being of the communities and populations they serve. Research could also help better identify promising strategies to empower nurses to fully carry out their advocacy role toward their patients who are the most vulnerable to climate change.

One of the strengths of the search strategy is that it targets diverse interdisciplinary databases in which articles from different fields, such as biomedical sciences and social sciences, are indexed. This will give us a broader view of the scope of the existing literature. In addition, this search is supplemented by a search of the grey literature, which will allow us to find relevant documents that cannot always be found in current bibliographic databases.

One of the limitations of this exploratory review of the literature is that it only includes publications in French and English, which means that all publications in other languages that may be relevant to the topic will not be taken into consideration. Nevertheless, as the vast majority of scientific publications are written in English, our findings should be of interest. Another limitation is that we do not plan to assess the quality of studies. However, this step is optional in the case of a scoping review [25].

The full results will be disseminated through various means, such as international nursing conferences and articles, including an article in a nursing association journal. Authors will also publicize the published articles in their respective professional network. This dissemination strategy hopes to reach nurses and raise awareness toward their role in the fight against climate change and the ways to address its health effects.