Climate change is intensifying extreme heat exposure globally, posing severe occupational health risks to outdoor agricultural workers whose labor remains critical to agricultural production and global food security (El Khayat et al., 2022). Emerging agronursing perspectives, aligned with broader planetary health frameworks in nursing, increasingly recognize climate-related occupational hazards as interconnected threats to human well-being, agricultural worker health, and the sustainability of food-production systems (Vandenberg et al., 2025; Kurniyawan et al., 2026). Macroeconomic simulations demonstrate that heat stress-induced declines in labor capacity could reduce national gross domestic product by up to 20 percent under severe warming scenarios (Houessou et al., 2025). High-resolution spatial modeling corroborates that occupational heat stress thresholds are frequently exceeded during key harvest months, placing millions of farmworkers at high risk (Parajuli et al., 2026).

Agricultural workers face disproportionate physiological, psychological, and socioeconomic burdens due to prolonged exposure to extreme temperatures and inadequate workplace protections (Iglesias-Rios et al., 2023). Occupational heat exposure induces substantial thermoregulatory strain, dehydration, electrolyte depletion, and acute organ injury, particularly kidney injury, across diverse agricultural environments worldwide (Abasilim et al., 2024). Field studies demonstrate that heat-induced urinary acidification significantly amplifies inflammatory responses, driving acute declines in renal function among outdoor laborers (Yang et al., 2026). Sweat loss is the primary driver of sodium and potassium depletion, leading to marked interindividual variability in thermophysiological responses among temporary agricultural workers (Cemeli et al., 2026). The prevalence of severe heat-related symptoms increases significantly with each incremental increase in wet-bulb globe temperature among sugarcane harvesters (Van Tongeren et al., 2026). Farmworkers also exhibit an elevated burden of anxiety and depression compared to national benchmarks (Castellano et al., 2026).

Current agronursing and occupational health interventions primarily focus on individual-level behavioral adaptations and basic hydration strategies to mitigate heat strain (Roca et al., 2025). Subsistence farmers use self-pacing, extended work hours, and task shifting to limit physiological strain, yet women exhibit higher physiological strain indices due to concurrent household responsibilities (Eggert et al., 2025). Shifting work hours to avoid peak heat emerges as the most effective farm-level adaptation strategy, potentially reducing modeled productivity losses by up to 40 percent during critical harvest months (Ferro et al., 2025). Community-based agronurses often deliver culturally competent education on hydration and on recognizing early symptoms of heat-related illness using indigenous knowledge-based approaches (Nyambe et al., 2025).

Existing literature predominantly examines isolated physiological or macroeconomic outcomes, lacking a comprehensive synthesis of the cascading effects of heat stress across multiple domains within the agronursing framework (Nath et al., 2026). Chronic heat stress substantially lowers life satisfaction among migrant farmworkers, primarily driven by negative physical, cognitive, and emotional health outcomes (Chabba & Bhat, 2025). Extreme heat and concurrent public health crises significantly reduce the average number of hours worked by migrant farmworkers, driven by financial vulnerabilities compelling labor market participation under hazardous conditions (Sánchez-Vargas et al., 2025). The integration of wearable technology provides actionable data for identifying high-risk work shifts, yet comprehensive models linking micro-level physiological strain to macro-level agricultural outcomes remain underdeveloped (Barteit et al., 2025).

This systematic review introduces a novel agronursing perspective by integrating multidimensional health, environmental, and socioeconomic data to evaluate the holistic impact of occupational heat stress on farming populations. The synthesis transcends traditional occupational health boundaries by connecting acute physiological injuries with profound psychological distress and macroeconomic labor disruptions. Agronursing frameworks must adopt this holistic paradigm to address the interconnected physical, emotional, and financial vulnerabilities exacerbated by global warming (Dasgupta et al., 2024; Tang & Ho, 2025). The review uniquely categorizes diverse methodological approaches, ranging from high-resolution regional weather modeling to longitudinal wearable-sensor tracking, thereby providing a comprehensive evidence base for targeted clinical interventions.

The primary objective of this systematic review is to critically appraise and synthesize recent empirical evidence regarding the multifaceted impacts of heat stress on agricultural workers to inform evidence-based agronursing interventions. The analysis evaluates the incidence, risk factors, and occupational impacts of heat stroke and other severe heat-related illnesses among farming populations worldwide (Tran et al., 2026). Examining the efficacy of current behavioral adaptations and environmental monitoring strategies helps identify critical areas where agronursing practice can mitigate thermal risks (Amoadu et al., 2023). The findings will guide the development of targeted occupational health strategies and gender-responsive policies (Nemer et al., 2026).

Immediate agronursing action is required to promote comprehensive and systemic occupational health policies that protect vulnerable farming communities from escalating climate-related health risks while strengthening the resilience and sustainability of agricultural systems (Masuda et al., 2024). The integration of health monitoring, behavioral education, hydration, cooling strategies, and workplace improvements is essential for protecting outdoor agricultural workers from occupational heat strain (Roca et al., 2025). Translating empirical evidence into actionable public health strategies requires interdisciplinary collaboration, locally responsive heat-health warning systems, and strengthened occupational heat-protection measures (Chandra N & Lee, 2025). Future research should prioritize longitudinal study designs and objective physiological and molecular biomarkers to clarify the cumulative and long-term health consequences of occupational heat exposure among agricultural workers (Nath et al., 2026).

The systematic literature search was executed across three major electronic databases: Scopus, PubMed, and ProQuest. This comprehensive search strategy initially yielded a substantial pool of 774,082 records, comprising 531 records from Scopus, 50,846 from PubMed, and 722,705 from ProQuest. A primary temporal filtering step was immediately applied to align with the predefined publication timeframe. This step resulted in the removal of 646,363 records published before 2024. Consequently, 127,719 records remained and advanced to the initial title and abstract screening phase.

During the screening phase, a rigorous evaluation of document types was conducted to ensure methodological relevance. A total of 107,266 records were excluded because they did not constitute original research articles, effectively removing duplicates, conference abstracts, case reports, literature reviews lacking primary data, editorials, and expert opinions. This filtration left 20,453 reports sought for full-text retrieval. Access limitations significantly affected the retrieval process, resulting in the exclusion of 14,864 reports due to closed-access restrictions. Ultimately, 5,589 reports were successfully retrieved and advanced to the full-text eligibility assessment.

The full-text assessment involved a detailed evaluation of the remaining reports against the predefined inclusion and exclusion criteria, which mandated English language, active DOIs, and explicit ethical clearance. This rigorous appraisal resulted in the exclusion of 5,577 reports that failed to meet the specific methodological, thematic, or ethical requirements of the review. Following this comprehensive evaluation, a final total of 12 studies were deemed eligible for inclusion in the systematic review. The included studies were evenly distributed across the searched databases, with four studies originating from Scopus, four from PubMed, and four from ProQuest, ensuring a balanced and robust representation of the available high-quality literature.

See Figure 1 presents the PRISMA 2020 study-selection flow from database identification to the 12 studies included in the review.

See Figure 1 shows the database counts, exclusions, retrieval stage, eligibility assessment, and final inclusion.

The synthesized findings reveal that occupational heat stress imposes substantial physiological, psychological, and socioeconomic burdens on agricultural workers globally (Tang & Ho, 2025). Extreme environmental temperatures contribute to thermoregulatory strain, dehydration, heat-related illness, and acute kidney injury among agricultural workers across diverse geographical settings. Agronursing professionals should recognize these multidimensional health threats when developing targeted occupational health strategies for rural farming populations, consistent with broader planetary-health approaches in nursing (Vandenberg et al., 2025). The integration of health monitoring, behavioral education, workplace adaptation, and policy advocacy is therefore essential for strengthening protection against escalating climate-related occupational risks (Tran et al., 2026). Current evidence further indicates that heat and climate-related stressors extend beyond acute physical discomfort, encompassing kidney dysfunction, psychological distress, reduced labor capacity, productivity losses, and wider economic consequences (Dasgupta et al., 2024). Agronursing frameworks should consequently adopt a holistic paradigm addressing the interconnected physical, psychological, socioeconomic, and environmental vulnerabilities intensified by global warming.

Severe physiological strain, particularly acute kidney injury and electrolyte imbalance, represents a critical occupational hazard requiring immediate agronursing assessment. Occupational heat stress drives acute declines in renal function through mechanisms involving elevated core temperatures, renal ischemia, and urinary acidification (Yang et al., 2026). Field studies demonstrate that heat-induced urinary acidification significantly amplifies inflammatory responses, as evidenced by elevated levels of monocyte chemotactic protein-1 and N-acetyl-β-D-glucosaminidase in agricultural workers (Yang et al., 2026). Sweat loss is the primary driver of sodium and potassium depletion, leading to marked interindividual variability in thermophysiological responses among temporary agricultural workers exposed to Mediterranean heat waves (Cemeli et al., 2026). The prevalence of severe heat-related symptoms, including those characteristics of heat stroke, specifically confusion and rapid pulse, increases significantly with every incremental rise in wet bulb globe temperature among sugarcane harvesters (Van Tongeren et al., 2026). Agronursing practitioners must prioritize monitoring renal function, tracking point-of-care biomarkers, and educating on electrolyte replacement to mitigate these life-threatening physiological cascades among outdoor laborers.

The psychological burden of heat exposure, compounded by structural vulnerabilities, significantly degrades the subjective well-being and mental health of farmworkers. Chronic heat stress substantially lowers life satisfaction and feelings of life's worth among migrant farmworkers, primarily driven by negative physical, cognitive, and emotional health outcomes (Chabba & Bhat, 2025). Farmworkers exhibit an elevated burden of anxiety, depression, and climate change psychological distress compared to national benchmarks, with symptom severity directly correlating with the number of heat-related illnesses experienced during single work shifts (Castellano et al., 2026). Restrictive immigration policies further deter healthcare-seeking behaviors and exacerbate psychological distress within these marginalized communities, creating a compounding effect of environmental and systemic stressors (Castellano et al., 2026). Agronursing frameworks must incorporate routine mental health screenings utilizing validated tools to address the invisible psychological toll of climate-driven occupational hazards. Community-based agronurses are uniquely positioned to provide trauma-informed care that acknowledges the intersection of extreme weather and immigration-related anxieties.

Spontaneous behavioral adaptations to heat stress are frequently inadequate and disproportionately burden female agricultural workers in subsistence farming communities. Subsistence farmers use self-pacing, extended work hours, and task shifting to limit physiological strain, yet women exhibit higher physiological strain indices due to concurrent household responsibilities (Eggert et al., 2025). Shifting work hours to avoid peak heat emerges as the most effective and acceptable farm-level adaptation strategy, potentially reducing modeled productivity losses by up to 40% during critical harvest months (Ferro et al., 2025; Parajuli et al., 2026). Women often lack the autonomy to implement these pacing strategies, forcing them to labor during peak afternoon heat and increasing their vulnerability to severe heat-related morbidity (Eggert et al., 2025). Agronursing interventions must advocate for gender-responsive occupational policies that recognize the dual burdens carried by female farmworkers and promote equitable access to cooling resources. Educational programs designed by agronurses must specifically target the unique thermoregulatory and social challenges faced by women in rural agricultural settings.

Heat-induced declines in labor capacity trigger cascading macroeconomic disruptions and exacerbate household welfare disparities across distinct agro-ecological zones. Extreme heat and concurrent public health crises significantly reduce the average number of hours worked by migrant farmworkers, driven by financial vulnerabilities that compel them to participate in the labor market under hazardous conditions (Sánchez-Vargas et al., 2025). Macroeconomic simulations demonstrate that heat stress-induced labor productivity losses can reduce national gross domestic product by up to 20% under severe warming scenarios, disproportionately devastating rural poor households in arid regions (Houessou et al., 2025). These economic shocks threaten local food security and limit the financial resources available for household health investments, creating a vicious cycle of poverty and illness. Agronursing advocacy must extend beyond individual patient care to support systemic economic protections, agricultural mechanization, and climate-resilient policies that safeguard the financial stability of farming communities. The discipline must collaborate with agricultural economists to quantify the hidden health costs of heat stress and advocate for targeted welfare interventions.

Agronursing practice must evolve to encompass comprehensive, community-based occupational health surveillance and interdisciplinary climate adaptation strategies. The integration of wearable technology and environmental monitoring provides actionable data for identifying critical crop zones and high-risk work shifts, enabling proactive health interventions (Barteit et al., 2025; Parajuli et al., 2026). Community health workers and agronurses are uniquely positioned to deliver culturally competent education on hydration, electrolyte replacement, and recognition of early symptoms of heat-related illness using indigenous knowledge-based approaches (Cemeli et al., 2026; Nyambe et al., 2025). Establishing localized early warning systems and promoting traditional shade structures requires collaborative efforts among healthcare providers, meteorologists, and agricultural leaders to ensure the adoption of wet-bulb globe temperature metrics over simple air temperature readings (Nyambe et al., 2025). The agronursing discipline must champion holistic, worker-centered adaptation policies that safeguard both human health and global food security through evidence-based, multidisciplinary research.

The current body of literature exhibits methodological limitations that necessitate cautious interpretation and guide future agronursing research directions. Many primary studies rely on small convenience samples and cross-sectional designs, limiting statistical power and precluding definitive causal inferences regarding heat exposure and long-term health outcomes (Castellano et al., 2026; Cemeli et al., 2026; Ferro et al., 2025). Self-reported symptom checklists introduce recall bias and may underestimate the true prevalence of severe heat-related illnesses among workers fearing job loss or immigration enforcement (Van Tongeren et al., 2026). Macro-level modeling studies often exclude direct physiological measurements and nighttime urban heat island effects, potentially underestimating the total welfare burden on farming communities (Houessou et al., 2025; Parajuli et al., 2026). Future agronursing research must prioritize longitudinal designs, objective biomarker tracking, and the inclusion of diverse demographic variables to build a robust evidence base for occupational health interventions.

This systematic review synthesizes the multifaceted physiological, psychological, and socioeconomic detriments of occupational heat stress among global agricultural populations. Extreme environmental temperatures drive acute renal injuries, severe electrolyte depletions, and profound mental health burdens that disproportionately affect vulnerable outdoor laborers. Agronursing frameworks must urgently integrate continuous physiological monitoring, routine mental health screenings, and gender-responsive occupational policies to protect this high-risk demographic. Translating these empirical findings into actionable public health strategies requires interdisciplinary collaboration to establish localized early-warning systems and enforce stringent thermal-risk regulations. Future investigations must prioritize longitudinal methods and objective biomarker monitoring to elucidate the long-term cascading effects of climate change on farmers' well-being and global food security.