Planetary Health Education in Nursing – Comprehensive Study Notes

Background and Historical Context

• ‘Planetary health’ emerged from Indigenous knowledge and environmental/holistic movements of the $1970{\text{s}}$–$1990{\text{s}}$.
• Term underscores the disruptive decoupling between human health and Earth’s natural systems.
• Planetary Health Alliance (PHA) definition: “solutions-oriented, trans-disciplinary field and social movement focused on analyzing and addressing the impacts of destabilized natural systems on human health and all life on Earth.”
• Anthropocene: new geological epoch—human activities drive climate change (Crutzen $2006$; Lewis & Maslin $2015$).
• Lancet Countdown $2024$: escalating life-threatening weather events (flooding, wildfires, droughts, heatwaves) → infectious diseases, food insecurity, forced migration, mental/physical harm.
• Nurses constitute the largest global health workforce; hold unique positions for advocacy, policy influence, family/community engagement, and direct care (Neal-Boylan et al. $2019$; Rogers $2021$).
• International Council of Nurses (ICN) $2018$ & $2024$: urgent calls to embed climate and sustainability into nursing education/practice.

Aim of the Scoping Review

• Research Question: “How has planetary health education been implemented and contextualized in nursing education?”

Methodology

Design & Frameworks

• Scoping review guided by Arksey & O’Malley $5$-stage framework.
• Followed PRISMA-ScR checklist and Joanna Briggs Institute (JBI) recommendations.
• Additional guidance from Peters et al. ($2015$; $2020a$; $2020b$).

Search Strategy

• Time of systematic search: $13$–$21$ Nov $2024$ (preliminary searches Oct $2024$).
• Databases: Academic Search Elite, CINAHL, Education Source, MEDLINE, ERIC (all via EBSCO) + ScienceDirect.
• Framework: PCC (Population – nursing education; Concept – planetary health; Context – learning strategies).
• Boolean logic sample (Education Source): combined $S<em>7 \text{ OR } S</em>8 \text{ OR } S<em>9$ then $S</em>{11}=S<em>7 \text{ AND } S</em>8 \text{ AND } S_9$ → $271$ peer-reviewed hits.

Study Selection Process

• Total records identified $2590$.
• Duplicates removed $957$ (EndNote) + $5$ (Rayyan) → $962$.
• Titles/abstracts screened $1628$.
• Full-text assessed $83$.
• Excluded $50$ (wrong population $7$, context $17$, concept $2$, publication type $20$, language $4$).
• Final inclusion $33$ studies.
• Screening used Rayyan blind mode; conflicts resolved by consensus.
• Quality appraisal not conducted (scoping reviews map breadth irrespective of quality).

Data Charting & Analysis

• Manual iterative extraction: author, year, aim, methodology, participants, educational focus, learning design, key findings.
• Descriptive analytical approach → $6$ themes agreed upon by full team.

Characteristics of Included Studies

Publication Trends & Geography

• $20$ studies $2001$–$2021$; surge $2022$–$2024$ with $13$ more.
• Country distribution: USA $18$, Spain $4$, UK $4$, Australia $2$, Canada $1$, Egypt $1$; cross-country designs $2$.

Methodological Designs

• Case study $20$ (incl. $6$ with surveys).
• Cohort $3$; quasi-experimental $3$; cross-sectional $2$; time-series $1$; quantitative pre/post $1$; mixed-methods $1$; qualitative focus groups $1$; document analysis $1$.

Education Levels & Focus Areas

• Undergraduate-only $19$; graduate-only $6$; mixed undergrad/grad $6$.
• Topical foci: climate change $9$; community & environmental health $6$; vulnerable populations $3$; waste management $2$; pesticide poisoning $2$; gardening/ecology $1$; SDGs $1$; humanitarian emergencies $1$; global/planetary dimensions $1$; energy use $1$; sustainable management $1$; healthcare sustainability $1$; Anthropocene $1$.

Thematic Learning Approaches

Scenario-Based Learning (SBL)

• $11$ studies.
• Used real-world complex problems; rooted in situated learning.
• Foci: climate change & sustainability, waste management, children’s environmental health, pesticide exposure, neighbourhood climate impacts.
• Outcomes: heightened awareness, systems thinking; barriers – low confidence translating to practice.

Simulation-Based Learning (Sim)

• $4$ studies; safe role-play & debrief.
• Modalities: SimCity software; primary-care pesticide poisoning; waste-reduction labs; public-health disaster scenarios.
• Gains: critical thinking, global citizenship values, SDG integration, practical application of public-health principles.

Student-Active Hybrid Approaches

• $7$ studies blending online & face-to-face.
• Strategies: flipped classroom, peer teaching, blogging, online discussions, problem-based mentoring, reflective team projects.
• Addressed gap in faculty expertise; empowered student-led inquiry.

Field Trips & Practice Experience

• $7$ studies.
• Sites: air-pollution districts, poison centers, occupational clinics, hospital ventilation systems, community gardens.
• Students produced blogs, reflections, projects linking SDGs to practice; reported personal & professional growth.

Film-Based Engagement

• $5$ studies.
• Tools: documentaries, true-story movies, video interviews.
• Topics: climate-mental-health nexus, toxicology ethics, political unrest, water safety.
• Arts-based pedagogy amplified marginalized voices; facilitated legal/ethical discourse.

Interdisciplinary Collaboration

• $9$ studies.
• Participants: nursing, allied-health, public-health, engineering, nutrition, PT/OT etc.
• Outputs: joint courses, ambassador trainings, certificate programs.
• Benefits: broader world-view, co-creation of climate solutions, faculty development.

Cross-Cutting Insights & Significance

• Experiential, participatory, socially-oriented pedagogy is central to planetary-health competence.
• Systems thinking, advocacy, and sustainability are critical yet under-confident domains for students.
• Indigenous perspectives scarcely represented—identified curricular gap.
• Western-centric literature dominates; paucity from low-/middle-income nations despite disproportionate vulnerability.
• Nursing educators themselves often lack formal training → need capacity-building.

Ethical, Philosophical & Practical Implications

• Equity & social justice: climate impacts greatest on children, older adults, disabled, economically marginalized, and those in fragile ecosystems—aligns with nursing’s mandate to protect vulnerable groups.
• Planetary-health lens expands patient-centered care toward eco-centric, systems-level responsibility.
• Professional duty: nurses to lead waste reduction, green advocacy, and policy influence within health systems.

Numerical & Statistical Highlights (LaTeX-formatted)

• Total records identified $2590$.
• Duplicates removed $962$.
• Records screened $1628$; full texts assessed $83$; studies included $33$.
• Thematic groups $6$.
• Scenario-based studies $11$; Simulation $4$; Hybrid $7$; Field/Practice $7$; Film $5$; Interdisciplinary $9$.

Identified Gaps & Challenges

• Limited graduate-level, longitudinal, and practice-embedded evaluations.
• Scarcity of research from Africa, Asia (outside Middle East), Latin America.
• Underrepresentation of Indigenous knowledge and local ecological wisdom.
• Students report difficulty applying sustainability knowledge in real clinical contexts; confidence deficits.
• Few studies formally measure competency acquisition or patient/outcome impact.

Recommendations for Nursing Education

• Integrate planetary-health across entire curricula, not isolated modules.
• Use multi-modal active strategies: SBL, Sim, field immersion, arts-based reflection, community projects.
• Embed systems-thinking, advocacy training, and policy literacy.
• Foster interdisciplinary and Indigenous partnerships to contextualize content.
• Provide faculty development programs; leverage toolkits (e.g., Nurses Climate Challenge) for educator readiness.

Recommendations for Future Research

• Conduct longitudinal, mixed-methods studies tracing knowledge–confidence–practice translation.
• Evaluate planetary-health competencies using validated instruments.
• Investigate curricular models in low-/middle-income and climate-vulnerable regions.
• Explore Indigenous-led pedagogies and knowledge integration.
• Assess patient, community, and environmental outcomes of nurse-led planetary-health interventions.

Concluding Takeaways

• Innovative, student-active and interdisciplinary approaches are essential to prepare nurses for the planetary-health era.
• Advocacy, systems thinking, and sustainability must be elevated in nursing education to meet current and future global health threats.
• Broader, inclusive research and curricular efforts required to build resilient, eco-conscious nursing workforces worldwide.