Planetary health in global nursing education: A scoping review of integration strategies across high- and low-income contexts

Abstract

Objectives

To map strategies, competencies, barriers, and pedagogical approaches for integrating planetary health into undergraduate nursing education across high- and low-income contexts.

Design

Scoping review following Arksey and O’Malley and PRISMA-ScR guidelines.

Data sources

Nine electronic and regional databases searched January 2020–December 2025.

Review methods

Three independent reviewers screened 2,158 unique records; two conducted data extraction and thematic coding, with consensus discussions involving a fourth author. Thirteen primary empirical studies met the inclusion criteria. Final inter-rater reliability achieved κ = 0.87.

Results

Cross-curricular infusion predominated (62%), whereas low- and middle-income country (LMIC) programs adopted hybrid models leveraging digital tools and community partnerships. Four core competency domains emerged: ecological literacy, systems thinking, climate-health linkages, and health equity advocacy. LMIC representation improved to 38.5% (5/13). Major barriers included curriculum overload and faculty knowledge gaps; key facilitators were institutional leadership and interdisciplinary collaboration. Climate education also correlated with reduced student psychological distress (β = −0.205).

Conclusions

Context-responsive integration, spiral curricula, and tiered faculty development are essential for scalable planetary health education. Embedding these competencies addresses clinical readiness and student well-being, providing a practical, evidence-based roadmap for global nursing curriculum designers and accreditation bodies.