Operating room nurses, often seen as the backbone of surgical care, are tasked with ensuring patient safety and facilitating surgical procedures. However, when it comes to maritime disasters, their responsibilities can extend beyond traditional roles. The research team conducted a qualitative study involving interviews and focus groups with seasoned nurses working in these high-stakes scenarios. The findings underscore that the competencies expected from these professionals often reside beneath the surface, much like an iceberg. While technical skills are visible, many critical competencies, such as decision-making under pressure, emotional resilience, teamwork, and communication, are less apparent but equally essential.

The Iceberg Model serves as an apt metaphor to convey the dichotomy between visible and hidden competencies. The visible part of the iceberg, which is above the waterline, represents the technical skills and knowledge that can be easily observed and measured. This includes proficiency in surgical instruments, adherence to sterilization protocols, and knowledge of pharmacology. Conversely, the submerged portion, which constitutes the bulk of the iceberg, symbolizes the soft skills that are often undervalued in healthcare settings. These include the ability to manage stress, maintain emotional stability, demonstrate empathy, and function effectively within a team—all of which are crucial during maritime emergencies.

One of the critical revelations of the study is the recognition that traditional medical training often fails to adequately prepare nurses for the multifaceted challenges posed by maritime disasters. The unpredictable nature of such events often requires adaptability and quick thinking that are not typically part of conventional nursing curricula. This gap in training highlights the urgent need for specialized programs that focus on disaster preparedness, risk assessment, and emergency response in maritime contexts. The research suggests that educators and policymakers must reassess nursing education models to integrate these competencies into the curricula, ensuring future nurses are better equipped for disaster scenarios.

The qualitative study took a unique approach by not only gathering data from operating room nurses but also engaging with other stakeholders involved in maritime disaster response. This interdisciplinary perspective informed a more holistic understanding of the operational dynamics and interdependencies present in emergency medical teams. By involving various actors, including surgeons, paramedics, and logistical coordinators, the researchers aimed to create a comprehensive competency framework that reflects the complex nature of disaster response. This collaborative approach ensures that the resulting findings are relevant and actionable for a wide range of healthcare professionals.

Additionally, the study’s focus on emotional intelligence and interpersonal skills emerged as a significant theme. In high-stress environments like maritime disasters, the ability to communicate effectively with team members and patients can have a direct impact on operational success and patient outcomes. Nurses must often act as liaisons between different healthcare providers and must possess the skills necessary to facilitate communication across diverse professional backgrounds. Developing these competencies can enhance team cohesion and ultimately improve the quality of care provided in emergency settings.

The implications of this research extend well beyond the specific context of maritime disasters. The essential competencies identified by the study resonate with the broader field of healthcare, where the ability to function in high-stress situations is increasingly critical. As healthcare systems worldwide face mounting pressures from pandemics, natural disasters, and increasing patient loads, understanding how to cultivate these hidden competencies within nursing roles is of paramount importance. The findings advocate for a paradigm shift in how nursing competencies are defined and assessed, promoting a more comprehensive approach to healthcare education and practice.

Moving forward, the research team envisions the development of competency-based training modules that would not only target the technical skills required for operating room procedures but also integrate soft skills essential for emergency response. This dual-focus training could serve to better prepare nurses for the realities they will face on the frontline of healthcare, particularly in disaster scenarios. As the research highlights, there is no one-size-fits-all solution, and training must be adaptable to the specific demands encountered in various emergency contexts.

Moreover, the study calls for increased collaboration between academic institutions, healthcare organizations, and emergency management agencies. Such partnerships can foster a more integrated approach to disaster preparedness training, ensuring that nurses are well-prepared to handle the complexities of maritime or any other disasters. By pooling resources and expertise, these collaborations can support the development of evidence-based training programs that align with the competencies identified in this research, ultimately benefiting the nurses and the patients they serve.

In conclusion, the study by Peng and colleagues sheds light on the often-overlooked competencies vital for effective nursing practice in maritime disaster responses. By employing the Iceberg Model, the researchers have successfully illustrated the need for a comprehensive understanding of both visible and hidden skills. As the healthcare landscape continues to evolve in response to global challenges, it becomes increasingly crucial to equip nurses with the competencies necessary to thrive in demanding environments. This research is a salient reminder that in emergency medical response, the success of operations is often driven not just by what is seen but also by the deep-seated skills that lie beneath the surface.

In the world of nursing, where the stakes are high and the environments are unpredictable, continuous reflection and adaptation of training programs are essential. As this groundbreaking study illustrates, the future of nursing in emergency contexts depends on our ability to recognize and nurture the full spectrum of competencies required for success. It is time for the nursing community to embrace this challenge, fostering a culture of resilience, adaptability, and collaboration that would ultimately lead to better outcomes for all in times of crisis.

Subject of Research: Core competencies of operating room nurses in maritime disaster emergency medical teams.

Article Title: Exploring the core competencies of operating room nurses in the maritime disaster emergency medical teams based on the Iceberg Model: a qualitative study.

Article References:
Peng, Y., Yan, L., Guo, C. et al. Exploring the core competencies of operating room nurses in the maritime disaster emergency medical teams based on the Iceberg Model: a qualitative study. BMC Nurs 24, 1482 (2025). https://doi.org/10.1186/s12912-025-03969-y

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12912-025-03969-y

Keywords: Core competencies, operating room nurses, maritime disasters, emergency medical teams, Iceberg Model, qualitative study, nursing education, disaster preparedness.

The System for Change Award, one of the three accolades received, distinguishes health systems that have exhibited substantial leadership and commitment to embedding sustainability deeply within their organizational culture and daily operations. Out of nearly 400 hospital systems nationwide, Mount Sinai stands as one of a select group of 15 honored for this milestone. This award is not simply a badge of recognition but a reflection of the systemic transformation occurring at Mount Sinai, where sustainability principles are ingrained at all levels, from administrative practices to clinical protocols.

In parallel, several of Mount Sinai’s campuses were recognized with the Emerald Award, reserved for hospitals showcasing exceptional, advanced sustainability programs paired with tangible environmental performance outcomes. This accolade was conferred upon The Mount Sinai Hospital, Mount Sinai West, and Mount Sinai Brooklyn for their exemplary initiatives. These hospitals have implemented cutting-edge strategies that not only reduce their carbon footprint but also create healthier, more sustainable environments for patients, staff, and the surrounding communities.

The Partner for Change Award further highlights specific campuses within the Mount Sinai network exhibiting superior performance in environmental sustainability. Mount Sinai Morningside, Mount Sinai Queens, and the New York Eye and Ear Infirmary each received this honor for their commitment to continuous improvement in sustainability metrics. These distinctions collectively portray a health system-wide culture of innovation and responsibility toward ecological impact reduction.

Mount Sinai Green initiatives encompass a broad array of environmental priorities. Central to these efforts are waste reduction programs designed to minimize landfill contributions through comprehensive recycling and repurposing protocols. Simultaneously, energy efficiency programs leverage data-driven technologies to optimize resource use, including the integration of waste heat recovery systems in data centers—a pioneering step in reducing overall energy consumption and greenhouse gas emissions. These technical implementations showcase Mount Sinai’s investment in scalable, innovative solutions that marry operational efficiency with environmental goals.

The synergy between Mount Sinai’s sustainability agenda and its scientific research is notable. Scientists at the Icahn School of Medicine at Mount Sinai are actively investigating the intricate relationships between environmental exposures and human health outcomes. This research informs clinical and organizational practices that prioritize environmental determinants of disease, underscoring the interconnectedness of planetary health and patient care. By aligning sustainability with cutting-edge biomedical research, Mount Sinai sets a model for evidence-based environmental stewardship in healthcare.

Leadership voices at Mount Sinai emphasize that environmental responsibility transcends regulatory compliance—it is intrinsic to delivering high-quality patient care. The Medical Director of Sustainability, Dr. Muoi A. Trinh, articulates a vision where safer and healthier environments promote healing while reducing risks associated with environmental hazards. This philosophy guides new sustainability initiatives aimed at enhancing indoor air quality, reducing harmful emissions, and implementing greener procurement policies.

Mount Sinai’s executive leadership is also propelling the system forward by committing to ambitious climate targets. Signing the New York State Insurance Fund Climate Action Pledge, the health system is dedicated to halving its emissions by 2030 and achieving net-zero status by 2050. This strategic framework encompasses not only emission reductions but also bolstering campus resilience to climate impacts, a crucial consideration given the increasing frequency of extreme weather events that threaten healthcare infrastructure.

Future efforts will include a refined supplier engagement program, in which carbon emissions embedded in the supply chain will be rigorously tracked and scored. The emphasis on addressing upstream environmental impacts represents a sophisticated understanding that healthcare sustainability must extend beyond direct facility operations to encompass the full lifecycle of medical products and pharmaceuticals. Particularly innovative is Mount Sinai’s intention to promote the use of lower carbon medications, a frontier in sustainable clinical pharmacology.

Technology-driven solutions remain a cornerstone of Mount Sinai’s approach. The innovative application of waste heat recovery systems—capturing and reutilizing thermal energy generated by data center operations—is an example of the hospital’s commitment to integrating advanced engineering solutions for environmental gains. These cutting-edge technologies not only reduce operational costs but also position Mount Sinai as a leader in sustainable healthcare infrastructure design.

Moreover, Mount Sinai Health System actively participates in collaborative networks, such as Practice Greenhealth, which provide platforms for sharing best practices and benchmarking sustainability progress. This membership facilitates ongoing learning and leadership within the healthcare sector’s climate action movement, further amplifying the impact of Mount Sinai’s initiatives on a national scale.

The comprehensive sustainability strategy Mount Sinai pursues resonates beyond environmental benefits; it directly interfaces with equitable health outcomes. By fostering greener, healthier hospital environments and communities, the institution champions a model where ecological and social determinants of health converge, driving improved wellness and resilience for vulnerable populations.

Ultimately, Mount Sinai’s environmental achievements signify an essential evolution in healthcare philosophy—a shift toward embracing ecological responsibility as a foundational element of medical excellence and public health advocacy. As climate change continues to pose unprecedented challenges, Mount Sinai exemplifies how healthcare systems can lead transformative change, not only healing patients but also healing the planet.

Subject of Research: Environmental sustainability and climate action initiatives in healthcare systems

Article Title: Mount Sinai Health System Sets National Benchmark with Triumphant Environmental Excellence Awards

News Publication Date: June 9, 2025

Web References:

• Mount Sinai Facebook
• Mount Sinai Instagram
• Mount Sinai LinkedIn
• Mount Sinai Twitter (X)
• Mount Sinai YouTube

Keywords: Environmental issues, Sustainability, Greenhouse gases, Climate change, Environmental impact assessments, Environmental policy

The carbon impact of anesthetic gases is particularly concerning. While they are effective in providing necessary sedation during surgeries, these gases contribute significantly to global warming. Desflurane, a commonly used inhaled anesthetic, is a prime example, having been documented to be almost 8,000 times more effective than carbon dioxide in terms of its greenhouse gas impact over five years. Each kilogram of desflurane used can result in CO2 equivalent emissions comparable to driving a vehicle for nearly 7,850 kilometers, highlighting the urgent need for alternatives in clinical practices.

Recognizing the severity of the situation, Charité undertook substantial reform in 2018, focusing on educating anesthesiologists about the environmental consequences of their choices. Dr. Susanne Koch, a pivotal figure in this initiative, emphasizes that most practitioners were not aware of the lasting climate effects caused by inhaled anesthetics. Consequently, Charité instituted regular educational programs and continuing professional education activities aimed at elevating awareness of sustainable practices among anesthesiologists.

The response from the anesthesiology departments at Charité was swift and decisive. New guidelines were established to prioritize climate-friendly alternatives, effectively rendering the use of desflurane obsolete as of late 2023. The hospital transitioned towards local anesthesia and intravenous anesthetics like propofol, which have been shown to have a significantly lower environmental impact. These methods not only minimize the carbon emissions associated with anesthesia but also facilitate better outcomes for patients. Studies indicate that propofol-treated patients often exhibit reduced nausea and a calmer awakening compared to those who undergo anesthesia with desflurane.

The financial implications of this shift are equally noteworthy. Charité’s reduced reliance on desflurane has led to significant cost savings, with expenditures for anesthetic agents declining by nearly 50 percent between 2015 and 2023. The annual reduction in carbon emissions from over 7,500 metric tons to just 1,454 metric tons demonstrates not only a commitment to sustainability but also reflects the institution’s strategic financial management. This represents a saving of approximately 6,000 metric tons of CO2 emissions a year—an amount comparable to the annual emissions of around 300 German households.

The real impact of Charité’s transformation stems from the management decisions that underpinned their sustainability initiatives. In research conducted by Dr. Koch and her team, they discovered that the most immediate and transformative changes arose from structural adjustments mandated by hospital leadership. Implementing centralized rules for anesthesiology practices ensured that every professional was aligned with the institution’s sustainability goals, pointing to the critical role of organizational governance in achieving long-term environmental aims.

The approach taken by Charité demonstrates the importance of education within the medical field, particularly as it intersects with environmental consciousness. By holding informational events and sharing knowledge internally and at conferences, Charité has fostered an ongoing dialogue about the implications of anesthetic gases. This exchange of information is proving invaluable in developing best practices that prioritize human health and environmental integrity concurrently.

Moreover, the hospital’s sustainability efforts extend beyond just anesthetic gases; Charité embraces the United Nations Sustainable Development Goals in its broader operational strategies. Initiatives such as replacing conventional lighting with energy-efficient LEDs and adopting sustainable materials for staff uniforms indicate an extensive commitment to reducing its overall carbon footprint. These improvements have resulted in a decrease of CO2 emissions from 126,600 metric tons in 2016 to 104,320 metric tons in 2023, solidifying Charité’s role as a model for sustainability in healthcare.

However, the sustainability journey for healthcare institutions does not conclude with the elimination of harmful gases. Ongoing research and adaptation will be necessary to keep pace with the evolving landscape of medical practices and environmental standards. By continuously monitoring and refining their anesthetic protocols, Charité aims to advance sustainability further, ensuring that their practices set a precedent for others within the healthcare sector.

The outcomes at Charité inspire a wave of enthusiasm among medical professionals who recognize that sustainable practices can be seamlessly integrated into daily operations without compromising patient care. As evidenced by the positive feedback regarding patient experiences under the new anesthetic protocols, educators and practitioners alike can see that sustainable choices in medicine yield tangible benefits.

This progressive viewpoint aligns with the general shift in societal awareness surrounding climate change and emphasizes the necessity for healthcare providers to act as stewards of the environment. In embracing this paradigm shift, institutions can not only fulfill their ethical obligations to care for patients but also champion the health of the planet.

It is essential for medical institutions worldwide to take heed of Charité’s example, embracing education, management, and sustainable anesthetic practices to mitigate their environmental impact. With the healthcare sector being a significant contributor to global greenhouse gas emissions, the responsibility lies with these entities to lead the charge toward sustainable solutions. Charité demonstrates that change is possible when a collective commitment underlines the values of innovation, education, and environmental stewardship.

As the quest for reducing carbon emissions faces ongoing challenges across numerous sectors, healthcare providers have the unique opportunity to adopt strategies that serve both immediate patient needs and longer-term sustainability objectives. By investing in education and embracing systemic changes, institutions can pave the way for future advancements in environmentally conscious medical practice, setting a global benchmark that transcends national boundaries.

This narrative of transformation at Charité resonates widely within the scientific community, inspiring other healthcare organizations to prioritize sustainability as a core value. The healthcare sector can illuminate a pathway toward reducing its carbon footprint and contribute significantly to global efforts in combating climate change, all while providing high-quality patient care and advancing medical science.

Subject of Research: Carbon emissions reduction in anesthesia practices
Article Title: The Power of Education to Reduce the Carbon Footprint of Volatile Anesthetics in Clinical Practice
News Publication Date: (Not provided)
Web References: (Not provided)
References: Schwiethal A et al. The Power of Education to Reduce the Carbon Footprint of Volatile Anesthetics in Clinical Practice. Anesth Analg. 2025 Feb 25. doi: 10.1213/ANE.0000000000007375
Image Credits: © Charité | Artur Krutsch
Keywords: Anesthesia, Carbon emissions, Sustainability, Environmental impact, Desflurane, Propofol, Healthcare, Education, Climate change, CO2 emissions, Anesthesiology, Charité.