Abstract
The study compares nursing training in terms of health promotion between Indian and German curricula. Therefore, the scope of the analysis is limited to the health promotion of trainee nurses, and it is explicitly not intended for patients. To address this, the current curricula in nursing training in India and Germany are examined using content analysis. In addition, three interviews with Indian nurses were conducted to complement the curriculum analysis and to validate implementation in the classroom. The results show that the German curriculum covers the topic of trainees’ health promotion more frequently and in greater depth, both quantitatively and qualitatively. The Indian curriculum focuses more on general concepts and emphasises the role of nurses as productive members of society. Furthermore, nutrition is treated in more detail in the curriculum in India than in Germany. The results are both innovative, as no detailed studies exist to date, and of practical importance, as they can be used to target recognition processes and any necessary post-qualification activities in the context of nurse migration from India to Germany.
Keywords: Nurses, India, Germany, Health Promotion, Curriculum
1 Introduction
To address the increasing demand for skilled healthcare professionals in Germany (Heinen et al. 2013), the recruitment of nurses from abroad has intensified in recent years (Reiff et al. 2020), including those from India (Goel 2013; Datta & Basu 2023). Indian nurses are in high demand in the global workforce, as well as in Germany, due to their well-respected training and professional reputation (Walton-Roberts & Irudaya Rajan 2023). The migration of nurses from India to Germany has a long-standing tradition and continuing connection, originating in the 1960s and 1970s through initiatives by Catholic networks and church-affiliated organisations (Wichterich 2024). However, while studies have examined the migration of Indian nurses, including the factors influencing their migration (e.g., Oda et al. 2018), there is a lack of research specifically addressing and comparing the professional training of nurses in India with that in Germany. In view of the extensive Indo-German project activities initiated in recent years, the high number of participants, and the pressing societal need in light of the nursing crisis and workforce shortages in Germany (Wittenborg & Wollnik 2014; von Ungern-Sternberg 2025), a knowledge gap exists in this area.
Therefore, this study aims to compare nursing training in India and Germany, with a particular focus on the integration of health promotion in training programmes. The overarching objective is to explore various approaches to health promotion within nursing education and to identify any potential particularities. The research question can therefore be formulated as follows: How is health promotion incorporated within the curricula of German and Indian nursing training, and in what ways do they differ? The findings can contribute to improving the recognition of Indian nursing qualifications in Germany by providing substantive evidence and, where necessary, identifying gaps that require targeted qualification measures (Biebeler et al. 2016; Wichterich 2024).
A crucial aspect of this study is its focus on health promotion for nursing trainees, rather than for patients. The increasing workload and stress levels faced by nurses worldwide make this specific emphasis highly relevant (Fiabane et al. 2013; Magnavita 2014). Research has shown that nurses are particularly susceptible to occupational stress due to the demands of their profession (Wesselborg & Bauknecht 2025). Physical complaints, psychological exhaustion and high dropout rates have been identified as potential consequences. Given that nurses experience significant physical and mental strain, health promotion plays a crucial role in their professional development (Babapour et al. 2022). Within the fields of nursing training, the structural and curricular framework conditions established serve as the fundamental basis for a conducive approach to professional challenges. The knowledge and competencies held by nurses in regard to health promotion are of crucial relevance, given their capacity to exert a beneficial influence on nurses’ perceptions and practices (Melariri et al. 2022).
To compare the integration of health promotion in nursing training in India and Germany, the respective curricula were analysed. Curriculum studies facilitate the analysis of content-related, structural, and normative aspects, as demonstrated by Dukpa and Pattanaik (2025) in their research on vocational training curricula in India’s construction sector and by Chinengundu (2025) on the South African construction technology curriculum. In the present study, health promotion and related specific aspects served as the comparison parameter between Indian and German curricula, also referred to as tertium comparationis (Pilz 2012). The application of a clearly defined, country-independent criterion of comparison facilitates the systematic examination of similarities and differences between countries. In addition to the curriculum analysis, interviews were conducted with Indian nurses to validate the content and practical implementation of the Indian curriculum. The interviews were conducted exclusively in India because, unlike the German context (Jakobs & Vogler 2020; Wochnik et al. 2022; Großmann et al. 2023; Olden et al. 2023), no empirical findings exist regarding the detailed implementation of the nursing curriculum in the classroom. Therefore, the interviews aimed to bridge the gap between the curriculum’s formal content and its actual relevance in training practice in the Indian context. This validation is necessary for India, as there is a general lack of detailed information on how curricula are implemented in vocational and professional training (Zenner et al. 2017; Schneider et al. 2023). Moreover, insights from Indian nurses provided essential guidance for accurately interpreting the Indian curriculum, which may be unfamiliar to German researchers.
The next chapter provides a brief conceptual and empirical introduction to health promotion, followed by an overview of nursing training in India and Germany. The methodology is outlined in Chapter Four, followed by the results of the curriculum analysis and the interviews. Finally, the results are discussed, and a concluding section presents potential future research directions.
2 The concept of health promotion
Health promotion has evolved into a central concept in healthcare and health sciences over the past decades. The term “health promotion” extends beyond the mere prevention of diseases and encompasses measures aimed at actively strengthening and maintaining individual and community health. The WHO (1986) describes health promotion as “the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment”. Individuals should be empowered to make informed decisions about their health. This requires the dissemination of knowledge and skills, as well as access to health resources. Furthermore, a health-promoting society relies on the active participation of those affected. Individuals and communities must be included in decision-making processes to ensure that measures are tailored to their needs. Additionally, environments must be created that facilitate healthy choices (WHO 1986).
Health-promoting behaviour encompasses physical activity, health responsibility, interpersonal relations, nutrition, spiritual growth, and stress management (Walker et al. 1987). Thus, health promotion can be categorised into physical and psychological/mental dimensions. The physical dimension encompasses measures aimed at maintaining physical health, including regular physical activity and a balanced diet. In the workplace, preventing occupational diseases and promoting a body-conscious work style are particularly relevant. The psychological dimension of health promotion focuses on mental well-being. This includes strategies for stress management, resilience enhancement, burnout prevention, and fostering a positive self-concept. Given the rising prevalence of mental health disorders in professional settings, particularly in high-stress occupations such as nursing, this dimension is gaining increasing importance (Wesselborg & Bauknecht 2025). As demonstrated in the literature reviews by Schaller et al. (2022) and Proper and van Oostrom (2019), the majority of studies focusing on health promotion primarily seek to enhance the mental well-being of nurses, with a particular emphasis on stress reduction (Stanulewicz et al. 2020). However, it is crucial to recognise the inherent interconnectedness between physical and psychological dimensions. Psychological stress has been shown to have a detrimental effect on physical health, and conversely, physical health concerns can adversely impact mental well-being. Otto et al. (2019) reveal that nurses surveyed experience chronic stress and physical strain, highlighting the necessity for ergonomic and strength training, as well as stress management strategies. Additionally, there is a requirement for holistic nursing interventions, such as educational classes, massage therapy and employee wellness programmes (McElligott et al. 2009). In this context, Mojtahedzadeh et al. (2022) emphasise in their study that health promotion measures already exist, such as exercise programmes, subsidies for fitness studios and back training. Nevertheless, the responding nursing staff complained that they often lack the energy to take advantage of these programmes after work and that programmes should be held during working hours instead.
In addition to the existing literature on the measures employed by institutions and employers to promote the physical and mental health of nurses, there is also research focusing on nurses, particularly nursing trainees, and their behaviour regarding health promotion. For instance, both Mak et al. (2018) and Alzahrani et al. (2019) found that nursing students exhibited a high level of engagement in interpersonal relationships and spiritual growth, but a low level of physical activity. The significant factors, such as health responsibility, spiritual growth, stress management and physical activity as predictors of health promotion, underscore the necessity for curriculum adjustments. Consequently, Mooney et al. (2011) and Alpar et al. (2008) underline that health promotion should be a constant and integral part of training, as it facilitates the development of a more profound understanding among trainees, complemented by practical experience. This notion is further substantiated by Whitehead’s (2007) literature review. As a result, the present study is dedicated to the curricular integration of health promotion in nursing training programmes in India and Germany.
3 Nursing training in India and Germany
3.1 India
The Indian education system is one of the largest in the world, reflecting the country’s social, cultural, and economic realities. A distinctive feature of the Indian education system is its strong emphasis on academic education, even in fields that are typically taught in a more vocational or practice-oriented manner in other countries (Wessels & Pilz 2018; Pilz & Regel 2021; Schneider & Pilz 2024).
The Indian Nursing Council recognises three distinct foundational nursing education programmes: Auxiliary Nursing & Midwifery (ANM), General Nursing & Midwifery (GNM) and the Bachelor of Science in Nursing (B.Sc. Nursing). The ANM programme lasts two years and provides fundamental nursing and midwifery skills. The GNM programme is a three-year diploma course that offers comprehensive training in general nursing and midwifery. The B.Sc. nursing programme is a four-year academic degree that imparts in-depth theoretical and practical knowledge in nursing (Indian Nursing Council 2024).
This study focuses on the GNM programme, as it constitutes the primary training pathway for the majority of nursing professionals in India, despite only a marginal numerical difference compared to Bachelor’s degree graduates. In 2021, 104,980 students were enrolled in the GNM programme, while 99,527 students were admitted to the B.Sc. Nursing programme (Ghosh 2022). Compared to the Bachelor’s programme, GNM training is characterised by a stronger practical orientation, making it more comparable to practice-based nursing training models in countries such as Germany (Indian Nursing Council 2024). The overarching goal of the GNM programme is to train nursing professionals who can work effectively and competently across all healthcare settings. Furthermore, the programme aims to support their personal and professional development, enabling them to contribute to disease prevention, health promotion, rehabilitation, and continuous professional education (Indian Nursing Council 2015).
3.2 Germany
In Germany, multiple training pathways result in a qualification as a nurse. Following the implementation of the Nursing Professions Act (“Pflegeberufegesetz”) in 2020, the nursing training system underwent substantial modifications, primarily characterised by the standardisation of training programmes and the transition to a generalist approach (Federal Ministry of Health 2024). A fundamental distinction can be drawn between generalist nursing training and the academic path, which is pursued through nursing science or nursing education degree programmes (Schuppann et al. 2022).
Since 2020, generalist nursing training has superseded the former distinct training courses in healthcare, including geriatric nursing and paediatric nursing. The training programme to become a nurse is a three-year course that culminates in the state-recognised qualification of nursing specialist. This qualification confers the ability to work in all areas of care, including hospitals, nursing homes for the elderly and outpatient services. Within the generalist training programme, trainees have the option to specialise in geriatric nursing, healthcare or paediatric nursing during their third year (Federal Ministry of Health 2024).
The academic path provides a range of career opportunities and is typically completed within a period of three to four years. Admissions criteria encompass the requirements for admission to universities of applied sciences or the general higher education entrance qualification, with the degree being designated as Bachelor of Science Nursing (Federal Ministry of Health 2024).
The present study focuses on the generalist training programme leading to the qualification of nursing specialist. This pathway represents the most frequently used entry route into professional nursing, with 61,458 trainees commencing their vocational training to become nursing specialists in Germany in 2021. In comparison, there are 1,091 students enrolled on comparable degree programmes (Meng et al. 2022).
4 Methods
The study examines the extent to which health promotion is integrated into nursing training in India and Germany. Therefore, the study employs a most-different research design, as India and Germany exhibit major differences in terms of culture, economy, and educational systems (Pilz 2012). Despite these differences, the clearly defined tertium comparationis, namely health promotion, allows for a systematic analysis of commonalities and differences without being confined to a national perspective (Pilz 2012). Consequently, the study employs an exploratory approach, as analysing curricula is necessary to determine the extent to which health promotion is embedded in nursing training programmes.
To analyse the curricula, this study employs the methodology of qualitative content analysis, which enables an empirical and intersubjectively verifiable examination that can be adapted to meet research objectives (Kuckartz 2014). The curricular documents examined include those widely used in nursing training in each country. For India, the study examines the “Syllabus and Regulations – Diploma in General Nursing & Midwifery” issued by the Indian Nursing Council (2015). To ensure that this document accurately represents the standard curriculum for nursing training in India, Indian nursing professionals were consulted regarding whether they had been trained according to this curriculum. For Germany, the study refers to the “Rahmenausbildungspläne der Fachkommission nach § 53 PflBG” (Curriculum of the expert commission according to § 53 PflBG) published by the Federal Institute for Vocational Education and Training (BIBB 2023).
A central element of content analysis is developing categories either inductively or deductively. This study employs a hybrid approach that incorporates both deductive and inductive elements for the systematic analysis of curricula, allowing for the structured identification of predefined themes while maintaining flexibility to capture emergent content from the material. The combination of deductive and inductive approaches ensures an exploratory yet structured content analysis process (Kuckartz 2014). The deductively formed main categories include, on the one hand, “physical health promotion” and, on the other hand, “psychological/mental health promotion”. The category system with subcategories, which serves as the basis for the content analysis of the curricula, is shown in Table 1.
Table 1: Category system for curricula analysis
| Physical health promotion | ||
| Category | Definition | Example |
| Ergonomics, nutrition and exercise | Reduction of physical strain on trainees and the improvement of their physical health | “Describe the principles of nutrition and dietetics and their relationship to the humanbody in health and disease; Describe the balanced diet in promotion of health” (Indian Nursing Council 2015, 68)“Integrate measures for promoting one’s own health into everyday care activities and work processes and reflect on them using various examples (e.g. back-friendly working, reducing physical strain […])” (BIBB 2023, 31) |
| Workplace safety and prevention of work-related risk factors | Safety of trainees in their everyday work and the minimisation of potential health risks, such as infections | “Practice technique of wearing and removing Personal protective equipment (PPE); Practice Standard safety precautions (Universal precautions)” (Indian Nursing Council 2015, 58)“Take hygiene measures into account in nursing care; integrate basic health promotion and prevention measures into nursing care for self-care” (BIBB 2023, 24) |
| Psychological/mental health promotion | ||
| Category | Definition | Example |
| Stress management and resilience promotion | Immediate stress management with long-term approaches to strengthen personal resilience | “Stress and conflicts, natural sources and types of stress and conflict, frustration – sources and overcoming frustration” (Indian Nursing Council 2015, 42)“Methods for protection against physical and mental stress/stress management/reduction and resilience development, e.g. relaxation exercises, supervision, meditation, etc.” (BIBB 2023, 72) |
| Self-care and self-discovery | Trainees’ awareness of their own health and identity | “Ethics in Nursing-roles and responsibilities of a nurse” (Indian Nursing Council 2015, 46)“Reflection on one’s own specific health behaviour using health behaviour models and derivation of specific consequences for one’s own health-related behaviour and nursing actions” (BIBB 2023, 74) |
To supplement the curricular analysis, semi-structured interviews with Indian nursing professionals were conducted using a guideline-based approach, with the category system developed in the curriculum analysis serving as the foundation for both the interview guide and the interview analysis (Schmidt 2004). Therefore, a mixed-methods design consisting of curriculum analysis and interviews was used for the Indian context. A total of three Indian nurses were interviewed via digital Zoom meetings. The contact with these professionals was facilitated through a collaboration between German researchers and Indian partners. Participation in the interview was entirely voluntary. The nursing staff were assured of the confidentiality and anonymity of their contributions. The ethical guidelines of the University of Cologne were followed. The average duration of the interviews was 25 minutes. As recommended in the literature, technical support was utilised for the transcription and coding process, employing the software MAXQDA (Kuckartz 2014).
5 Results
5.1 Results of the curriculum analysis
An analysis of the German curriculum identified seven text passages that reflect the subcategory of “ergonomics, nutrition, and exercise”. Notably, Germany places greater emphasis on “promoting and maintaining mobility” for nursing trainees (BIBB 2023, 36). Compared to the Indian curriculum, the German curriculum provides a more detailed description of the content to be taught, such as mobility- and development-promoting movement concepts and their effectiveness (BIBB 2023, 36). Specific strategies for personal health maintenance are discussed, including back-friendly work techniques for movement facilitation, patient transfer, and positioning in bed, as well as the adoption of health-promoting postures and training for strength, flexibility, endurance, and coordination (BIBB 2023, 211). These measures are intended to be integrated into daily nursing activities and work routines, encouraging reflective practice. Furthermore, the German curriculum mandates that prospective nurses “recognise their own limitations and competently utilise technical aids to support individuals with impaired mobility” (BIBB 2023, 40). In contrast, the Indian curriculum identifies three relevant content areas that leave room for interpretation, such as: “Implement effective nursing care by integrating scientific principles for maintaining health optimum” (Indian Nursing Council 2015, 53). The topic of a “balanced diet” is addressed more comprehensively in the Indian curriculum, with a dedicated subject on “principles of nutrition and dietetics and its relationship to the human body” (Indian Nursing Council 2015, 68). By comparison, the German curriculum appears to focus on nutrition primarily concerning patient health. Additionally, the Indian curriculum mentions “Physical Education/Yoga”, although this is not an integral part of the core curriculum but rather an extracurricular activity (Indian Nursing Council 2015, 18).
Regarding the subcategory of “workplace safety and prevention of work-related risk factors”, nine relevant passages were identified in the German curriculum, compared to two in the Indian curriculum. In both countries, hygiene and infection prevention are extensively covered. However, the German curriculum integrates “occupational safety measures” (BIBB 2023, 52), though these are not elaborated further. Similarly, the Indian curriculum addresses this area, including practical training on donning and doffing personal protective equipment, albeit with less prominence in the overall curriculum (Indian Nursing Council 2015, 58). Infection prevention in the Indian curriculum is described in greater detail, covering specific techniques such as “infection control; hand washing techniques; simple hand antisepsis and surgical antisepsis (scrub); prepare isolation unit in lab/ward” (Indian Nursing Council 2015, 57).
Seventeen text passages in the German curriculum address the subcategory of “stress management and resilience promotion”. A closer examination of these passages reveals that German trainees are given substantial attention in this area. For instance, the curriculum explicitly states that trainees should “consciously implement strategies for coping with and managing psychological stressors in complex nursing environments, inform themselves about institutional support services, and utilise them if necessary” (BIBB 2023, 229). This includes processing distressing experiences, particularly those involving emergencies with children and adolescents, as well as interactions with their caregivers and families (BIBB 2023, 89). Additionally, trainees are expected to encounter and reflect on experiences such as “irritation, uncertainty; stress and time pressure; frustration thresholds and tendencies toward violence; rejection, over-involvement; homophobia and (unconscious) heteronormativity; unfounded fears of self-infection (e.g., HIV-positive individuals)” (BIBB 2023, 153). Resilience-building is explicitly incorporated into the German curriculum and embedded in various fields, with mentions of relaxation exercises, supervision, and meditation (BIBB 2023, 53). Students are encouraged not only to experience and process their “own sense of powerlessness, helplessness, and stress/time pressure” but also to reflect on their reactions (BIBB 2023, 46 & 92): “They reflect on internal contradictions between the aspiration to help and the experience of disgust, shame, impatience, rejection, boundary violations, and helplessness” (BIBB 2023, 45). To support this, “initiatives for strengthening health literacy (adherence promotion, self-responsibility, coping, and empowerment)” are provided (BIBB 2023, 112). By contrast, the Indian curriculum contains three general references to stress management and resilience, for example: “Describe the concept of mental health and psychology” (Indian Nursing Council 2015, 41). Alongside the concept of mental health, the curriculum addresses coping with stress, conflict, and frustration. Emphasis is also placed on cultivating a positive attitude among future nurses (Indian Nursing Council 2015, 41f.)
The subcategory of “self-care and self-discovery” comprises 24 passages in the German curriculum and six in the Indian curriculum, representing the most extensive category in both countries and suggesting a relevant focus on this area. In the German curriculum, self-care is explicitly mentioned: “Students practice self-care and contribute to their own health maintenance, access support services, or seek assistance at their respective learning locations” (BIBB 2023, 38). Additionally, trainees “experience, interpret, and process beliefs regarding their own invulnerability; culturally influenced health convictions and self-efficacy expectations; feelings of competence regarding their health; well-being and perceived strength” (BIBB 2023, 52). Reflection on personal health behaviours and deriving consequences are central elements. Furthermore, trainees develop their professional identity and “a professional understanding of nursing” (BIBB 2023, 33), engaging with their professional values and ethical convictions. Additional topics include teamwork, interprofessional collaboration, role conflicts, role uncertainty, and lifelong learning as an essential component of personal and professional development (BIBB 2023, 49). Similarly, the Indian curriculum emphasises the “need for continuing education for professional development” (Indian Nursing Council 2015, 53). However, a notable distinction is that while the German curriculum places strong importance on the individual student, the Indian curriculum highlights the societal role of nurses: “To help nurses in their personal and professional development, so that they are able to make maximum contribution to society as useful and productive individuals, citizens as well as efficient nurses” (Indian Nursing Council 2015, 8). Nursing trainees are encouraged to “break bad habits” and cultivate “good habit”, which are deemed essential for the nursing profession (Indian Nursing Council 2015, 42).
The comparative content analysis reveals differences between the German and Indian nursing curricula regarding the emphasis and structure of health promotion for trainees. The findings indicate that Germany allocates more space within the curriculum to health promotion, both quantitatively and qualitatively. While Germany explicitly addresses specific measures and strategies for the physical and psychological health of trainees, the Indian curriculum appears to focus more on the societal function of nurses. This suggests a fundamental cultural distinction: Germany places greater value on individual well-being, whereas India emphasises societal roles and responsibilities.
Overall, Germany includes more content in all categories of health promotion, particularly in the domain of psychological health, where specific strategies for stress management and resilience-building are elaborated. However, the Indian curriculum also exhibits unique features, particularly in the field of nutrition, which holds a higher priority compared to the German curriculum.
5.2 Results of the interviews on India
The interviews conducted highlighted that, in some cases, a discrepancy exists between the content prescribed in the curriculum and the content taught. The respondents’ statements differ regarding the specific areas in which these discrepancies occur. These findings are in line with other study results, also indicating that teachers in India, for various reasons, do not always teach what the curricula prescribe (e.g., Zenner et al. 2017).
In the domain of physical health promotion and the subcategory “ergonomics, nutrition, and exercise”, initial differences become apparent. While two of the three interviewed nurses emphasised that topics such as lifting techniques for back-friendly work were covered, one respondent expressed a critical perspective: “We know how to tend patient. How to carry patient. But not enough. That is not enough. That’s why we have back pain and shoulder pain” (Interview 2). This statement underscores the need for a more comprehensive integration of the topic. This is corroborated by another interview. Although the nurse in this case did not take as explicit a stance as in the aforementioned quote, it was mentioned that posture and related aspects were only briefly addressed in the first year of training (Interview 2). Regarding nutrition, the interviews also reveal differing perspectives. Two of the three respondents confirmed the written curriculum and emphasised that the importance of a healthy and balanced diet was repeatedly conveyed, both to patients and to trainees (Interview 2). However, the remaining respondent stated that this area was not covered in depth: “I am just saying that about the nutritional part only, that is the lacking part” (Interview 1). All interviewed nurses agreed on the absence of physical activities. Only one interview confirmed that such activities were offered sparsely (Interview 1). All respondents expressed a desire for a more extensive integration of physical activity into training.
The content delivered under the subcategory “workplace safety and prevention of work-related risk factors” largely corresponds to the curriculum, according to the interviews. For instance, the use of protective clothing is addressed, and the topic of infection prevention is comprehensively covered (Interviews 2 and 3). One interview also indicated that healthcare facilities provide the necessary protective clothing in accordance with the curriculum (Interview 1).
Within the main category of psychological health promotion, the subcategory “stress management and resilience promotion” emerged as particularly critical in the interviews. The following statement is noteworthy in response to the question of whether stress management was addressed: “Our only technique is facing more stress” (Interview 1). This quote reflects a theme that is evident across all interviews: “We don’t have stress management classes or anything” (Interview 2). “They should have given proper education […] stress wasn’t a basic thing. It was more about, like, you care for the patient” (Interview 3). Consequently, the respondents expressed a desire to integrate stress management into both training and practical work (Interview 2).
In the subcategory “self-care and self-discovery”, the interviewed nurses stated that the implemented content largely aligns with the curriculum. However, in terms of professional identity, it appears that the curriculum places greater emphasis on societal well-being than on the well-being of trainees themselves: “We should have some intention. Good intention in this job. More than good salary and good life” (Interview 1). A certain degree of ‘self-sacrifice’ resonates in this statement. As previously mentioned, a similar interpretation can also be derived from the Indian curriculum.
In summary, the findings of these few interviews indicate that the objectives and content outlined in the curriculum are not always fully realised in India. In particular, the area of stress management exhibits discrepancies, as it is absent in practice, according to the interviewed nurses.
6 Discussion
The comparative analysis of health promotion in curricula in India and Germany reveals notable discrepancies in the emphasis and organisation of health promotion for trainees. Germany’s approach is characterised by a more systematic, detailed and comprehensive handling of health promotion aspects. The German curriculum demonstrates a congruence with international studies on mental health promotion for trainees (Proper & van Oostrom 2019; Schaller et al. 2022). In terms of the six dimensions of health promotion (Walker et al. 1987), it can be concluded that in Germany, the aspects of health responsibility, interpersonal relationships and stress management are prioritised, while in India, nutrition is a predominant aspect alongside health responsibility.
A potential explanation for these discrepancies can be found in the cultural influences on the curricula in both countries (Ashbee 2021). Existing literature has explored the cultural divergences between Germany and India (e.g., Juhász 2014). A seminal concept in analysing cultural differences is Hofstede’s (2001) model of cultural dimensions, which identifies various dimensions, including individualism and collectivism, that offer insights into the value systems in disparate societies. According to Hofstede’s model, Germany is defined as an individualistic society, while India is classified as a collectivist society. This classification suggests that Germany’s fundamental cultural attitude may lead to a greater emphasis on individual career and health values, while India’s health promotion is more oriented towards patients and society as a whole. It is also noteworthy that, in contrast to Germany, the concept of occupational health and safety in India is generally less pronounced (Dasgupta et al. 2017; Chellappa et al. 2021).
This phenomenon is further compounded by the ongoing high demand for nurses in Germany (The Federal Government 2024), while certain regions of India experience a surplus of skilled workers in the healthcare sector (Khadria & Tokas 2022). This imbalance may also influence the perception of the profession (Nair 2012), potentially diminishing its attractiveness and relevance to health promotion initiatives.
7 Conclusion
The present study analysed health promotion for nursing trainees in Germany and India to ascertain its integration within respective curricula. Specifically, the research question investigated how health promotion is integrated into the curricula of German and Indian nursing training and to what extent these differ. The findings are both innovative, as no detailed studies have been conducted in this area before, and practically relevant, as they can help to guide recognition processes and, if necessary, additional qualification measures in the context of nurse migration to Germany.
In summary, the German curriculum addresses the topic of health promotion for nursing trainees more frequently and in greater depth. In contrast, the Indian curriculum focuses more on general concepts and emphasises the role of nurses as productive and valuable members of society. The area of nutrition is covered in more detail in the Indian curriculum than in the German one. Consequently, both countries can learn from each other and use the respective strengths of their curricula as inspiration for future improvements in health promotion for nursing trainees. For instance, the German curriculum could incorporate aspects of nutrition, while the Indian curriculum could include components on mental health for nursing students. The challenges experienced by nursing staff in India are not unique to this country; such difficulties are prevalent in other regions of the world. In the context of international professional mobility, it is imperative that Indian nursing professionals possess the requisite competencies to effectively manage and mitigate mental distress (Jadhav & Roy 2024).
One limitation of this study that must be acknowledged is the differing availability of sources. In Germany, the various nursing training programmes have been consolidated into a generalist training model under the Nursing Professions Act, making the choice of curriculum to be examined clear. However, for India, a specific curriculum had to be selected for analysis. Based on the outlined reasoning, this study opted for the curriculum of the GNM diploma programme. In India, the number of enrolments in the B.Sc. Nursing and the GNM programme are much closer than the respective figures for nursing vocational training and nursing studies in Germany. Therefore, it may be useful for future research also to analyse the content of the B.Sc. Nursing curriculum in India concerning health promotion. For future studies, expanding the sample size in India and extending the investigation to other learning areas within the profession would be beneficial. Additionally, conducting interviews among German nursing professionals could provide a more detailed comparison between the prescribed curriculum and its practical implementation. A critical analysis is required to ascertain the extent to which learners are genuinely empowered during their training to promote their health in the workplace proactively.
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