Abstract
Background:
Occupational health nursing plays a fundamental role in addressing the health of the working population; however, training in this area differs around the world in terms of levels, duration, content, and requirements, and the current situation in Latin American countries is unknown. The objective of this study was to analyze undergraduate nursing education in occupational health from an international perspective considering Chile, Colombia, Brazil, and Mexico.
Methods:
We conducted a multicenter, descriptive study, based on bibliographic methodology, whose sample was documentary, consulting government databases in Chile, Colombia, Brazil, and Mexico.
Findings:
Heterogeneity was identified within the training in the countries analyzed, with a small number of courses in the course structures; in most cases, the courses were taught in the last years of training and predominantly as elective courses.
Conclusions:
The authors recommend that training centers develop programs associated with occupational nursing, which is considered an imperative to strengthen public health in developing countries and an ethical and equitable response to the working population.
Background
Currently in the world, there are more than three billion working people (International Labour Organization [ILO], 2022), many of whom are exposed to occupational hazards, such as long working hours, air pollution, and ergonomic risks, and claiming the lives of millions of workers every year (Organización Mundial de la Salud [OMS], 2021). Occupational health nursing can play a key role in prevention of occupational disease and injury (World Health Organization [WHO], 2001).
Occupational nursing delivers specific clinical and emergency services, as well as benefits associated with specialized skills, such as providing effective incident investigation, prevention, recognition, treatment, and directing the rehabilitation of workers’ illnesses and injuries (American Association of Occupational Health Nurses [AAOHN], 2020).
In this context, occupational health nursing education is an area of much importance to public health. However, education in this area differs around the world in terms of types of programs, duration, content, and requirements (Gok Metin & Naci Tildiz, 2023). At the undergraduate level, studies have shown that occupational nursing content has been covered in public health courses, demonstrating the need to develop standardized education programs (Yoshikawa et al., 2019).
Currently, the status of undergraduate nursing education in occupational health in Latin American countries is unknown. To solve this information deficit, this article responds to the objective of analyzing undergraduate nursing education in occupational health from an international perspective, considering Chile, Colombia, Brazil, and Mexico.
Methodology
We conducted a multicenter, descriptive study, using bibliographic methodology, based on a documentary sample, and consulting the government databases of Chile, Colombia, Brazil, and Mexico. It required the use of registered and substantiated sources collected by the researchers. In addition, it was a secondary and cross-sectional study.
The course structures of the programs that teach the nursing profession were analyzed in two stages: (a) Identification of the number of universities that teach nursing. (b) Analysis of the course structures, identifying the number of courses associated with occupational nursing, occupational health, or occupational safety training.
Results
Chilean Reality
In Chile, the Ministry of Education reports in the second semester of the year 2022, the existence of 144 institutions of higher education (IES) that have official recognition by the state, of which 41 train nursing professionals (Ministerio de Educación de Chile, 2022), whose training has a duration of 10 semesters (5 years).
After a thorough analysis of the course structures of the 41 institutions, only 17% (seven institutions) explicitly present courses related to occupational health; the universities and the courses taught will be named below:
Universidad de Chile “Enfermería en salud ocupacional (Occupational Health Nursing)”; Universidad de la Serena “Aspectos legales y laborales (Legal and Labor Aspects)” and “Enfermería en salud ocupacional (Occupational Health Nursing)”; Universidad de O’Higgins “Enfermería ocupacional (Occupational Nursing)”; Universidad Central de Chile “Enfermería en salud ocupacional (Occupational Health Nursing)”; Universidad Mayor “Derecho laboral (Labor Law)”; Universidad SEK “Enfermería en salud ocupacional (Occupational Health Nursing)”; Universidad de las Américas “Salud Ocupacional y Ambiental (Occupational and Environmental Health).” These courses are taught in the last years of training, most of them in the fourth year, except for the Universidad Central de Chile, which teaches them in the third year.
Colombian Reality
In Colombia, 150 universities were analyzed, of which 56 offer undergraduate nursing courses, with a duration of eight, nine, or 10 semesters, that is, 4 to 5 years (Asociación Colombiana de Facultades y Escuelas de Enfermería [ACOFAEN], 2021), 24 of the study program include courses related to occupational nursing, which are presented below:
Universidad de Antioquia “Cuidado a la salud de los trabajadores (health care for workers)”; Universidad de Cundinamarca “Cuidado de enfermería al adulto en situación quirúrgica, urgencias y trabajador (nursing care for adults in surgery, emergencies, and workers)”; Universidad de Ciencias Aplicadas y Ambientales “Cuidado de enfermería en salud ocupacional (nursing care in occupational health)”; Universidad de Caldas “Cuidado de la salud del trabajador (health care for workers)”; Universidad Manuela Beltrán “Legislación y Salud Ocupacional (Legislation and Occupational Health)”; Universidad Nacional de Colombia- Sede Bogotá “Enfermería en Salud a los Trabajadores (Nursing in Workers’ Health)”; Universidad El Bosque “Enfermería V: Adulto Trabajador, Anciano (Nursing V: Adult Worker, Elderly).” In the case of the universities Fundación Universitaria del Área Andina- Sede Pereira, Universidad del Sinú (UNISINU), Universidad Libre- Seccional Bogotá, Universidad Libre- Seccional Cali, Corporación Universitaria Remington, Universidad de Córdoba, Universidad del Magdalena, Universidad Popular del Cesar, Universidad del Tolima, Fundación Universitaria de San Gil- Sede Yopal and Corporación Universitaria Rafael Nuñez- Sede Barranquilla agreed in naming the subject “Salud Ocupacional (Occupational Health).”
Similarly, Universidad Pontificia Bolivariana (UPB) “Salud Pública con énfasis en Salud Ocupacional (Public Health with emphasis on Occupational Health),” Universidad Pedagógica y Tecnológica de Colombia “Salud- Trabajo (Occupational Health),” Universidad CES “Salud y Trabajo (Health and Work).” Likewise, Escuela Colombiana de Carreras Industriales (ECCI) and Universidad Católica de Manizales “Seguridad y Salud en el Trabajo (Safety and Health at Work)” and Universidad del Norte “Seguridad y Salud en el Trabajo y un énfasis de profundización en SST (Safety and Health at Work and an emphasis on OSH).”
The aforementioned courses are located between the fourth and eighth semesters and most of them are compulsory.
Brazilian Reality
In Brazil, nursing schools are linked to Higher-Educational Institutions (HEI) and/or public (state-funded) and/or private universities. The 2017 Higher Education Census evidenced the existence of 109 Federal Universities (UF)/Federal Institutes, with 1,500,000 students; 124 state (736,000) and 63 municipal (98,000) (FIA Business School, 2019). The Higher Education Census in 2019 showed 2,608 HEIs with 8,604,526 enrolled and the majority (6,524,108) from the private network (Gobierno de Brasil, 2022).
No recent information has been identified on the number of IES nursing schools/faculties and the existence of disciplines on occupational health-occupational nursing or similar. An internet survey was performed in the universities or federal institutes from 26 to 28 of December 2022 with data from the sites about the nursing course and 87 institutions were accessed (79.81%/109). In the North (Acre, Pará, Tocantins, Amazonas, Roraima, Amapá, and Rondônia), Northeast (Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraíba, Sergipe, Pernambuco, Alagoas, and Bahia), Center (Mato Grosso, Mato Grosso do Sul, Distrito Federal, and Goiás), Southeast (São Paulo, Rio de Janeiro, Minas Gerais, and Espirito Santo), and South (Paraná, Santa Catarina, and Rio Grande do Sul).
Finally, 42 courses were identified in the 87 universities or federal institutes that participated in the survey, most of them with a theoretical load of 45 hours, optional, which the undergraduate student can take if interested.
Mexican Reality
In Mexico, 197 universities were analyzed during the second semester (Mextudia, 2022), of which 64 offer a bachelor’s degree in nursing, with a 10-semester (5-year) program, and 28 of the study programs include courses related to occupational health, which are presented below:
Instituto Politécnico Nacional, Universidad de Guadalajara, Universidad Autónoma de Puebla, Universidad Iberoamericana, Universidad de Guanajuato, Universidad Autónoma de Ciudad Juárez and Universidad Autónoma de Coahuila coincide in calling the course “Enfermería Laboral (Occupational Nursing)”; Universidad Autónoma Metropolitana, Universidad Autónoma de Baja California, Universidad Panamericana and Universidad de Sonora call it “Enfermería en Salud Ocupacional (Occupational Health Nursing)”; as well as Universidad Autónoma del Estado de México, which also offers Enfermería en Salud Ocupacional (Occupational Health Nursing Practice).
Universidad Veracruzana has the subject “Atención a la Salud Laboral (Occupational Health Care)”; Universidad Michoacana de San Nicolás de Hidalgo “Higiene y Seguridad en el Trabajo (Occupational Hygiene and Safety)”; Universidad Autónoma del Estado de Hidalgo “Salud Laboral (Occupational Health)”; Universidad Autónoma de Querétaro “Salud y Seguridad en el Trabajo (Occupational Health and Safety)”; Universidad Juárez Autónoma de Tabasco “Cuidado en Salud Ocupacional (Occupational Health Care)”; Universidad Valle de México “Enfermería Laboral y Ocupacional (Labor and Occupational Nursing)”; Universidad Autónoma del Estado de Morelos “Salud en el Trabajo (Occupational Health)”; Universidad Autónoma de Tlaxcala “Enfermería Ocupacional (Occupational Nursing)”; Universidad Autónoma de Aguascalientes “Enfermería Comunitaria y Salud Laboral (Community Nursing and Occupational Health)”; Universidad del Valle de Puebla “Seguridad y Salud en el Trabajo (Occupational Safety and Health)”; Universidad Autónoma del Carmen “Enfermería en Salud en el Trabajo (Occupational Health Nursing)”; Universidad del Noreste “Salud Laboral (Occupational Health)”; Universidad Kino “Enfermería Escolar, Laboral y Ocupacional (School, Labor and Occupational Nursing)”; Universidad España, Universidad ETAC and Universidad de Estudios Avanzados “Enfermería en Salud Laboral (Occupational Health Nursing).”
Among the universities analyzed, 21 study programs were taught in the fourth year and seven study programs were taught in the third year; most of the courses were optional.
Discussion
As described in the results of this article, there are different realities in the countries that were analyzed, in accordance with the global strategic guidelines on nursing and midwifery for 2025 (WHO, 2021); therefore, one of the regulatory priorities is the harmonization of nursing education, revealing a problem that is shared by the different areas of nursing; however, there are general factors that have been described as relevant in the formation of nursing work, which include having a competent, participative faculty, a convincing vision of the desired outcomes, and the application of its contents in professional practice (Ward et al., 2011).
In such a scenario, authors have expressed the need to integrate occupational nursing courses into undergraduate nursing study programs (Topcu & Ardahan, 2019). Likewise, a recent study conducted in Turkey using Delphi methodology (Gok Metin & Naci Tildiz, 2023) has concluded that consideration should be given to expanding the content of occupational nursing in undergraduate education with respect to occupational history taking, basic laboratory testing, interpretation of laboratory results, research methods, and participation in policy and management. Although these results respond to a specific reality, the present authors consider them as an opportunity for Chile, Colombia, Brazil, and Mexico.
Results show heterogeneity in the countries analyzed, a situation that matches with generic information provided in reports that describe the standards for nursing education in the different countries (Pan American Health Organization [PAHO], 2022), where Brazil and Mexico did report them, while Chile and Colombia did not. In addition, regarding the qualification of the quality of the faculties (institutions), Brazil and Colombia did report them, while Mexico only partially and Chile did not report them.
Finally, to facilitate the orientation of the integration of occupational nursing content in undergraduate nursing study program, some models have been described, such as the “Educational Model to Prepare the Baccalaureate Nurse for Occupational Health Nursing” (Talbot, 1983), which consists of six steps: (1) develop a content map of occupational health concepts; (2) utilize grid models for distribution of curriculum–study program–content; (3) help faculty to integrate content; (4) plan for clinical experiences; (5) seek out resources of up-to-date information; and (6) publish your findings. It has also been described that the “Model for Health Education Planning” (MHEP) ensures that the program planning process is adequately accomplished (Moore & Short, 1994).
Practical Implications and Relevance of the Study
The findings of this study highlight the need to update the course structures of undergraduate nursing education, which should consider occupational nursing, as well as to unify its contents and duration. The practical implications of providing future nurses with the necessary knowledge about occupational health not only are framed in the achievement of the physical, mental, social, and spiritual well-being of the working population but also impact the knowledge that future nurses should have about their own health and safety (as a worker), as well as within the work team with whom they will relate in the future, promoting healthy work environments.
As a strength, this study is the first known to provide an analysis of undergraduate nursing education in Chile, Colombia, Brazil, and Mexico; however, more studies are needed in the area, which should consider more Latin American countries, as well as more information on the topics addressed in those institutions that do consider undergraduate nursing education; on the other hand, it would be helpful to know the opinion of expert nurses in the area on the ideal topics that such courses should contain.
Conclusion
This brief article responded to the objective proposed, that is, analyze the undergraduate nursing training in occupational health, identifying heterogeneity in the countries analyzed, with a small number of courses present in the study program (course structures); in most cases, these were taught in the last years of training and with a predominance of elective courses. Training centers are encouraged to develop programs associated with occupational nursing, which is considered an imperative to strengthen public health in developing countries and an ethical and equitable response to the working population.
Footnotes
Acknowledgements
The authors would like to thank the International Network of Nursing in Occupational Health (red internacional de Enfermería en Saud Ocupacional “ENSO”, for its acronym in Spanish), who facilitated the collaboration between countries.
Author Contributions
Miguel Valencia-Contrera, José D. Castro-Bastidas, Maria Lucia do Carmo Cruz Robazzi, and María Quintana-Zavala made a substantial contribution to the concept and design; acquired the data; drafted the article and revised it critically for important intellectual content; and approved the version to be published.
Flerida Rivera-Rojas and Sandra Valenzuela-Suazo made a substantial contribution to the concept and design; analyzed and interpreted the data; drafted the article and revised it critically for important intellectual content; and approved the version to be published.
Conflict of Interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
