Integrating climate change education in preregistration nursing degree in Indonesia: A case study

With increasing awareness that pollution, climate change and biodiversity loss threaten planetary health, nursing educators globally recognise their unique role in preparing the nursing workforce to engage in climate change mitigation and adaptation and build community climate resilience. While several nursing programs in high-income countries have begun integrating climate-related content, practical models from low- and middle-income settings remain scarce. In Indonesia, where no national standards require such content, this gap is particularly pronounced.

To describe the development, implementation and evaluation of a novel elective subject, "Nursing Perspectives on Climate Change", designed to prepare nursing students to contribute to climate-resilient healthcare through sustainable clinical practices, health education, and community adaptation.

A case study using the Design-Based Research framework.

Universitas Indonesia.

Bachelor-level students from nursing and other disciplines.

The elective was developed for Bachelor of Nursing Program at a Faculty of Nursing, Universitas Indonesia using a six-phase design-based approach: Focus, Formulation, Contextualization, Definition, Implementation, and Evaluation. To evaluate student experience and learning outcomes, educators collected data from two cohorts: those enrolled in semester two of the academic year 2023/2024 and semester one of the academic year 2024/2025. Educators gathered data via university-administered learning evaluation surveys (N = 73) and semi-structured interviews (n = 12). Interview data were analysed thematically. Ethical approval was obtained from Universitas Indonesia no. ET207/UN2.F12.D1.2.1/PPM.00.02/2024.

Students rated the subject highly across both cohorts, with scores of 5.8/6 during the implementation phase (n = 34, response rate 80 %) and 5.75/6 during the evaluation phase (n = 39, response rate 95 %). Three themes were identified from the interview data: 1) paradigm shift on attitudes to climate change; 2) the value of diverse and participatory teaching methods; 3) recognition of the nurse's role in interdisciplinary climate action.

This subject represents one of the first documented, student-informed climate change electives in nursing education in the Asia-Pacific region. It offers a replicable, context-sensitive model for integrating climate competencies into nursing curricula, addressing a critical global implementation gap. The subject equips future nurses with the knowledge and skills to advocate for sustainability, lead climate adaptation in clinical settings, and support climate-resilient healthcare systems.