Sociology in Undergraduate Nursing Education in Greece: A Curricular Analysis

Abstract

Sociology provides essential insights into the social and cultural determinants of health and is critical to holistic nursing education. However, its integration into Greek undergraduate nursing curricula remains underexplored. This study employed a qualitative content analysis of the curricula from the eight public university nursing departments in Greece to examine the inclusion of sociology-related courses. Findings show that seven out of eight curricula (87.5%) include dedicated sociology courses, indicating a strong incorporation of sociological content. Compared to medical curricula in Greece, where sociology is largely absent, nursing education demonstrates greater engagement with sociological frameworks. The results support the need for curriculum harmonization across institutions and more robust interdisciplinary collaboration and interprofessional care. Standardizing the inclusion of sociology in healthcare education can strengthen interprofessional collaboration between doctors and nurses to address health inequities and improve patient-centered care.

1. Introduction

This study pursues two main objectives: first, to investigate the incorporation of sociological content within the undergraduate nursing curricula of Greek public universities; and second, to compare these findings with those of a recent national survey on Greek medical education, which confirmed the marginal curricular position of sociology in the training of future medical doctors.

1.1. Sociology in Nursing Studies

Sociological knowledge equips healthcare professionals with the analytical tools necessary to interpret the broader social, cultural, and structural determinants that influence health outcomes [1,2]. The significance of sociology within healthcare education is widely acknowledged in the international literature; its importance lies in equipping future professionals with the ability to understand how social structures, cultural norms and systemic inequalities shape health outcomes. By providing this critical lens, sociology enhances culturally competent care, fosters equity-oriented practice and prepares students to engage effectively in interprofessional collaboration [3,4].

Social justice, a cardinal component of sociology of health, has also been widely recognized as a cornerstone of nursing practice, reflecting the profession’s responsibility to deliver equitable care across diverse populations. Yet, as a recent review demonstrates, nursing organizations and curricula differ significantly in how they conceptualize and implement social justice, often relying on general theoretical frameworks rather than embedding concrete pedagogical strategies [5,6].

The curricular integration of sociology of health in nursing studies remains inconsistent and uneven across contexts. For instance, in the United Kingdom, the integration of sociology into nursing education has experienced significant fluctuations over the past century. A historical review of the literature from 1919 to 2019 offers a critical examination of the shifting status of sociology within UK nurse training. Initially absent from early vocational models dominated by biomedical and moral instruction, sociology entered the curriculum more visibly during the transition to university-based nurse education, particularly following the Project 2000 reforms. During this period, sociology was leveraged to cultivate reflective practitioners who could engage with issues such as inequality, culture and institutional power. However, a subsequent decline in emphasis on sociological content, as economic pressures and the marketization of higher education redirected attention toward skills-based, ‘job-ready’ training [7].

In Scandinavia, nursing education has undergone significant reforms, aligned with the Bologna Process highlighting a systemic commitment to harmonization across Denmark, Finland, Norway, and Sweden. Social sciences form an established component of nursing curricula, ranging from 6 ECTS in Finland to 30 ECTS in Norway, reflect a systemic commitment to interdisciplinary knowledge, although sociology is not always delineated as a discrete course [8]. A comparative review of Iranian and Scandinavian nursing curricula highlights the strong alignment of Swedish nursing education with European standards, emphasizing the integration of social science perspectives alongside clinical training [9].

In addition, a recent international review highlights that despite widespread rhetorical support for social justice in nursing education, explicit and systematic curricular inclusion remains fragmented and inconsistent across contexts [5]. The authors found that while many nursing programs acknowledge the relevance of social justice—particularly in relation to health equity, structural inequality, and marginalized populations—there remains a widespread lack of explicit, structured content addressing these issues within curricula. Sociology, with its emphasis on the social determinants of health, power relations and systemic analysis, is identified as a key avenue through which nursing students can develop the critical thinking skills necessary to understand and challenge health disparities. However, the inclusion of such content is often fragmented or embedded within broader themes like ethics or community health, limiting its pedagogical impact [5].

In the United States, several scholars have critically examined the integration of sociology into nursing education, yielding nuanced insights into its pedagogical role. A potent critique is delivered, calling for consistency in how sociological content is structured throughout curricula, rather than its ad hoc adoption, in order to fully harness students’ understanding of social determinants and systems-level influences [10]. Earlier, Balsamo and Martin advocated for a curriculum that not only incorporates sociological theory but also aligns its methodological underpinnings with clinical practice, underscoring the discipline’s potential to cultivate socially aware practitioners [11]. Nonetheless, a cautionary counterpoint that is offered is that sociology’s multi-paradigmatic nature may dilute its relevance to action-oriented nursing unless firmly embedded within professional competencies [12]. Building on these debates, this contested terrain has been revisited, suggesting that sociology’s contested place in curricula is indicative of broader questions around knowledge legitimation in nursing [13]. Together, these U.S. studies highlight both the promise and pitfalls of sociological education in nursing—underscoring the need for intentional, theory-driven curricular design that supports critical thinking and social awareness.

1.2. Harmonization of Medical and Nursing Curricula

The imperative of interprofessional education (IPE) emphasizes that aligning medical and nursing education is both a pedagogical and a practical necessity [14]. Interprofessional education is essential for preparing health professionals to work effectively in teams and to deliver safe and high-quality care. In practice, however, many students have little exposure to structured IPE during their studies. International examples, such as joint nursing and medical school initiatives using shared simulations, show how aligning curricula around common foundations can build social competence [15].

Aligning medical and nursing curricula, particularly in areas such as sociology, may enhance mutual understanding of the social dimension of health and reduce hierarchical divides. While differences in student motivation and learning strategies may affect the outcomes of IPE, a more harmonized curriculum provides common ground for shared learning experiences. Thus, curricular convergence, which is also emphasized in the Bologna Process and wider European Higher Education Area reforms, can not only support the logistical integration of IPE activities but also cultivate the collaborative competencies essential for multidisciplinary teamwork in real-world clinical settings [16].

According to the Bologna Process, nursing education in Europe is expected to cultivate a range of competencies: (a) theoretical–analytical competence, involving observation, analysis, reflection, and systematization; (b) practical competence, referring to the application of knowledge in systematic problem-solving; (c) learning competence, or the capacity to acquire and apply new knowledge in novel contexts; (d) social competence, which emphasizes the ability to establish and maintain effective interpersonal relationships; and (e) professional–ethical competence, ensuring that graduates are able to justify their practice in accordance with ethical principles and regulatory frameworks [17]. The Bologna framework also calls for harmonization of curricula across European countries that enhances interprofessional collaboration. Within this context, the present study focused on the dimension of social competence, as it is closely linked to the integration of sociological perspectives in nursing education. It follows that the curriculum of a Bachelor’s degree in nursing consists of two interconnected components: theoretical instruction and clinical education. The theoretical component is designed to provide students with scientific, ethical, moral, and professional knowledge, enabling them to ground their actions in practice on a well-founded rationale. Within this framework, emphasis is placed on Nursing Care, the Fundamental Sciences, and the Social Sciences [18].

A comparative, yet relatively outdated, analysis of nursing education reforms across twenty Western European countries identified recurrent challenges in aligning nursing curricula with higher education standards, particularly regarding faculty adjustment, graduate competencies, and curricular adequacy [19]. Despite shared reform agendas driven by the Bologna Process, substantial national variation persists—for example, in France, where structural integration has been slower, compared to Scandinavia’s stronger alignment [8]. These contrasts highlight the novelty of the Greek case, where sociology is more formally present in nursing curricula but remains inconsistently embedded and insufficiently harmonized with broader European directives.

To our knowledge, this study constitutes the first systematic inquiry of its kind within the national educational landscape, providing new insights into how sociology is positioned in Greek nursing education and how this compares with broader European developments.

2. Materials and Methods

A qualitative, descriptive research design was employed to examine the inclusion of sociology—either as a discrete subject or through the integration of sociological concepts—within all undergraduate nursing programs in Greece.

With respect to selection criteria, public higher education in nursing in Greece comprises eight (8) university departments, all of which were included in this study, thereby representing the entirety of the national public nursing education system. As private higher education has not yet been fully institutionalized in Greece, it was not considered.

Two main research questions frame this empirical work:

• To what extent is sociology—understood as a key component of social competence within the Bologna Process—incorporated into undergraduate nursing curricula in Greece?
• To what extent are the nursing and medical curricula of Greek universities harmonized with respect to the social competence dimension?

A comprehensive content analysis was performed across n = 8 nursing departments of an equivalent number of public universities. The research methodology was guided by a structured, transparent protocol adapted from previous curriculum studies and aligned with the objectives of this analysis.

Data were collected during May–June 2025 from the official websites and academic catalogs of the eight public nursing departments in Greece:

• National and Kapodistrian University of Athens
• University of West Attica
• University of Thessaly
• University of Ioannina
• International Hellenic University
• University of Patras
• University of the Peloponnese
• Hellenic Mediterranean University

The most recent available undergraduate study guides (academic year 2024–2025) were retrieved and examined. Each curriculum was reviewed to identify courses titled “Health Sociology”, “Sociology of Health”, or equivalent.

A structured, four-phase search protocol was developed to ensure comprehensive identification of sociological content across the nursing curricula:

Phase One involved identifying courses explicitly titled “Sociology”, “Sociology of Health”.

Phase Two would be initiated if Phase One yielded no results; at this stage, course titles and descriptions were examined for related terminology, including “social medicine”, “social theory”, and “social determinants of health”.

Phase Three entailed a detailed review of ostensibly unrelated courses to detect embedded sociological themes or frameworks.

Phase Four would be applied when no relevant content was identified in the previous phases, at which point the complete absence of sociology-related instruction was recorded.

To ensure methodological rigor, two researchers independently conducted the analysis, applying the same four-phase protocol. Inter-rater reliability was established through independent coding and subsequent comparison of findings. Discrepancies were discussed and resolved by consensus, thereby enhancing the consistency and credibility of the results.

This study relied on manual content analysis without the support of qualitative software such as NVivo. Although systematic procedures and inter-rater reliability checks were applied to strengthen consistency, future research may benefit from computer-assisted qualitative data analysis to allow more detailed theme classification and comparison.

3. Results

Our findings indicate that 87.75% (7: 8) of the eight reviewed undergraduate nursing curricula include standalone courses dedicated to sociology. This suggests a broad recognition of the importance of sociological perspectives within nursing education in Greece. These courses typically appear early in the curriculum and cover foundational topics such as the social patterning of health, experience of illness, social determinants of health, health knowledge and practice health care organization and health policy. The presence of such courses reflects a growing institutional acknowledgment of the need to prepare nurses for socially complex healthcare environments, although the depth and consistency of sociological content vary across institutions.

Table 1. Integration of sociology course in undergraduate nursing curricula.

University	Course	Type & ECTS	Semester
National and Kapodistrian University of Athens (NKUA)	Sociology of Health	N/C, 2	2nd
University of West Attica (UNIWA)	Sociology of Health & Disease	C, 2	2nd
University of Thessaly	Sociology of Health	N/C, 2	3rd
University of Ioannina	Sociology of Health	N/C, 3	5th
International Hellenic University (IHU)	Sociology of Health	C, 3	3rd
University of Patras	Sociology of Health	C, 4	1st
University of Peloponnese	Sociology of Health	C, 4	4th
Hellenic Mediterranean University	None	N/A	N/A

N/A—not applicable.

presents a detailed overview of the integration of sociology as a standalone course within the curricula of the eight nursing departments at Greece’s public universities. It outlines the course title, its classification as either compulsory (C) or non-compulsory (N/C), the number of credits awarded (ECTS), and the academic semester in which the course is offered. In cases in which the course is not offered, non-applicable (N/A) applies to the details of the course (i.e., type of curriculum, credits, academic semester).

4. Discussion

The findings of this empirical investigation may be distilled into two principal observations. First, the incorporation of sociology of health within undergraduate nursing curricula is documented in the majority of the relevant curricula examined across Greek public universities. Second, our findings stand in marked contrast to the current state of Greek medical education, where sociology remains largerly absent from undergraduate curricula.

4.1. Integration of Sociology into Nursing Undergraduate Studies

In greater detail, the inclusion of sociology in 87.5% of the nursing programs analyzed reflects a clear institutional recognition of the discipline’s relevance to contemporary nursing education. This finding further suggests that one of the central imperatives of the Bologna Process—namely, the development of social competence—has been achieved to a considerable extent within Greek nursing education. These courses, typically embedded early in the curriculum, address crucial themes such as the social determinants of health, health disparities, and cultural competence. Their placement suggests a pedagogical intention to ground nursing students in holistic frameworks from the outset of their professional training [1,2].

The literature remains scarce and inconclusive regarding the integration of the sociology of health within nursing curricula. In the UK, sociology has shown a cyclical presence, gaining prominence during periods of curricular reform but receding under economic and policy pressures [7]. In Ireland, tensions between policy-driven calls for holistic, critical training and the operational realities of preregistration programs have similarly limited the role of sociology [20]. Also it is worth noting that in cases that sociology courses are integrated, as in the UK, their pedagogical framing often constrains their transformative potential, with content presented descriptively rather than critically [21]. A more recent review highlights that while social justice is widely recognized as a professional imperative, its systematic incorporation into nursing education—often facilitated through sociological content—remains inconsistent [5]. Broader European analyses of nursing education reforms also reveal uneven curricular integration across countries, despite the harmonizing aims of the Bologna Process [8,19]. This lack of clarity underscores the importance of systematically examining the Greek case, both to document the current state of sociology in nursing education and to situate it within wider European debates on curricular convergence and interprofessional competence.

However, even when sociology is included in nursing curricula, its pedagogical framing often limits its transformative potential. For instance, it was shown that content was frequently presented from a structural–functional perspective, emphasizing descriptive knowledge rather than fostering critical engagement with issues such as power, inequality, or social justice [20]. This suggests that the presence of sociology in curricula does not automatically ensure meaningful integration; instead, the way it is taught determines whether it equips future nurses with the critical competencies required by the Bologna Process and interprofessional education. The detailed content of the curricula was beyond the scope of this study; however, as suggested below, further research in this area would substantially enrich our understanding.

4.2. Convergence of Medical and Nursing Curricula

Our findings can be compared with those of a recent survey of Greek medical schools, which reported a near-total absence of sociology as a discrete subject: none of the seven medical undergraduate curricula examined included a standalone sociology course, whereas only three offered social medicine and six incorporated limited sociological elements within broader modules [22]. By contrast, seven out of eight of Greek nursing programs include sociology as a dedicated course, demonstrating a more systematic acknowledgment of its relevance to professional formation. This disparity underscores a striking curricular asymmetry between medicine and nursing education in Greek public universities. It appears that nursing education acknowledges sociology as integral to developing social competence, but medical education continues to privilege a predominantly biomedical orientation, leaving social dimensions of health largely marginal. The result is a fragmented educational landscape in which future nurses and physicians are socialized into divergent epistemological frameworks, potentially hindering interprofessional collaboration. Addressing this imbalance through a more consistent integration of sociology across both fields would align with the harmonizing goals of the Bologna Process and strengthen the foundations for interprofessional education in Greece.

Interprofessional education (IPE) is increasingly recognized as a cornerstone for improving patient safety and healthcare quality. A recent systematic review demonstrates that IPE interventions consistently enhance interprofessional attitudes, skills, knowledge, and behaviors among nursing and medical students and professionals. Importantly, studies also reported downstream effects on organizational culture—such as improved teamwork climates—and on patient outcomes, including reductions in falls and hospital-acquired pressure ulcers. These findings suggest that embedding IPE within both medical and nursing curricula does not simply prepare graduates for collaboration in theory, but has also tangible benefits for safety and care delivery in practice [23,24].

From a more theoretical perspective, IPE may be conceptualized not merely as an instructional innovation but as a social practice embedded within fields of power. Drawing on Bourdieu’s concepts of habitus, capital, and field, Bonello and colleagues show that professional identities and hierarchies are reproduced through IPE encounters, shaping how collaboration is enacted and legitimized. This analysis suggests that unless the structural dynamics of professional power are critically interrogated, IPE risks reinforcing existing divisions rather than transforming them. Accordingly, the systematic incorporation of sociological perspectives into nursing and medical curricula offers a means of equipping students with the analytical resources necessary to recognize and contest these dynamics, thereby advancing the emancipatory potential of IPE [25].

The pedagogical value of sociology in nursing education can be meaningfully situated within Mezirow’s Transformative Learning Theory [26]. This framework emphasizes the role of critical reflection and perspective transformation in adult learning, particularly when learners are confronted with experiences or knowledge that challenges their prior assumptions. In the context of nursing, sociology introduces students to concepts such as structural inequality, social determinants of health and cultural marginalization—content that encourages learners to reassess their understanding of patient care and professional responsibility. Sociology may cultivate reflective practitioners who could engage with issues such as inequality, culture, and institutional power—perspectives that directly intersect with nursing ethics, particularly in relation to dignity, justice, and equitable care provision [27]. However, as this study shows, inconsistent curricular inclusion across institutions may limit students’ opportunities to experience this type of transformative learning. Embedding sociological content more systematically could strengthen further nursing education by fostering critical, equity-oriented practitioners prepared for interdisciplinary collaboration and complex care environments.

5. Conclusions, Limitations, and Recommendations

This study offers the first systematic curricular analysis of sociology’s presence in undergraduate nursing education in Greece and reveals encouraging trends: most programs include dedicated sociology courses, signaling a shift toward holistic, socially conscious nursing education. However, the variation in course type, credit weight, and semester placement suggests inconsistencies in how institutions prioritize sociological knowledge.

These findings have both local and international relevance. Within Greece, the stark contrast between medical and nursing curricula points to a missed opportunity for curricular harmonization that could support interprofessional education. Internationally, these results align with the broader literature identifying sociology’s unstable position in nursing education and the challenges of embedding it meaningfully within skill-driven curricula.

To reinforce both nursing education and interprofessional collaboration, three key actions are recommended:

• Standardize the inclusion of sociology as a compulsory component in all undergraduate nursing curricula.
• Promote curricular alignment between nursing and medical education to enable interdisciplinary learning.
• Invest in faculty development to ensure educators can effectively connect sociological theory to clinical practice.

As health systems increasingly demand care that is not only clinically effective but also socially responsive, the structured inclusion of sociology appears not optional, but essential. Preparing future nurses to engage critically with the social dimensions of health is a prerequisite for achieving equity, collaboration, and patient-centered care in 21st-century healthcare delivery.

This study has several limitations that warrant consideration. First, the analysis was limited to public university nursing departments in Greece. Curricula from private institutions or related fields such as midwifery and public health nursing were not included and may exhibit different patterns of sociological integration. The exclusive focus on public tertiary education reflects the fact that private higher education in Greece is not yet institutionally established. Second, the study relied on publicly available academic catalogs and course descriptions, which may not fully represent the depth, delivery, or pedagogical emphasis of sociological content in actual classroom settings. Sociological themes embedded within broader interdisciplinary modules may have gone unrecognized due to generic course titles or limited detail. Third, curricular documents alone do not capture how sociology is taught, nor do they reflect students’ or instructors’ perceptions, levels of engagement, or educational outcomes. Our study did not capture the perspectives of students or faculty. Lastly, the qualitative, descriptive nature of the research limits the ability to draw causal conclusions or generalize findings beyond the sampled programs. Future studies employing interviews, ethnographic observation, and cross-national comparisons could provide deeper insight into the operationalization of sociology in nursing education and its impact on professional formation.

Future research should extend this line of inquiry by undertaking comparative analyses of nursing and medical curricula, with closer attention to the substantive content and the discourses through which sociology is framed and legitimized. In addition, qualitative studies capturing the perspectives of nursing students and faculty on the sociology of health would provide deeper insights into how this knowledge is understood, experienced, and applied in professional formation. At the policy and practice level, curriculum designers and accreditation bodies should consider strategies for systematically embedding sociology into health professions education. Doing so would not only support the development of social competence, as envisioned by the Bologna Process, but also create a stronger foundation for interprofessional collaboration in the Greek healthcare context.