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1. Introduction
The concept of practice or praxis has been forged from different perspectives and thinkers who have determined the bases for its construction and understanding (Masi, 2008), so, praxis leads to the work or conduct of people where social, political, psychological, economic, historical, cultural, institutional and, of course, moral and ethical configurations are involved. Nursing professionals and students materialize their praxis with individuals, families and communities (Switzerland, International Council of Nurses ICN, 2021); however, the literature related to community nursing care identifies that it is emphasized in the home visit (Jarrín, Pouladi & Madigan, 2019:Watson, Horseman, Fawcett, Hockley & Rhynas, 2019), disease prevention controls (Panamerican Health Organization, 2018) and in education to individuals (Devido, Doswell, Braxter, Terry & Charron, 2019); which gives secondary importance to direct work with communities as a group and reflects a vacuum in the face of knowledge.
The community is not conceived as a substance, nor a subject, but implies presence; it is what it means to be in common, which necessarily involves the other in communication from the seemingly separate singular beings that, in the end, would no longer be separated, but linked through communication (García, 2017). Community nursing in the context of PHC has as its main role, among others, the application of scientific knowledge and techniques aimed at the promotion, restoration and conservation of community health (Alonso, 2013). Thus, it is necessary to promote, through the curricula, students, and teachers towards the development of community care, the above with the aim of promoting a continuous and integral practice in favor of the promotion of health education, which responds to the socio-political and cultural conditions of the territories (ACOFAEN, 2014 De Arco & Suárez, 2018; Seah, Rong-Tan, Eriksson, Wang & Ramazanu, 2022).
In line with the above, in Colombia, the Comprehensive Health Care Policy supports that several professions, including nursing, have lost capacity for the coordination of community programs and interventions, given the trend towards hospital-centric training profiles (Ministerio de Salud y Protección Social, 2016). For students, community practices are recognized as a complex experience, they show the importance of approaching the reality of the health context and they highlight the disciplinary educational role and participation (Santos, Torres, Capcha, Garcia, Infante, Erdmann, 2019), while highlighting the emphasis of inter-institutional work in the framework of Primary Health Care (PHC) (Aguirre, Cerón, Pulcini & Bryant, 2019).
Recent studies indicate that developments on innovation and research in the community nursing curriculum have been marginal (Valls, Calderón, March & Oltra, 2018; García, Sosa, Travé & Simôes, 2019) and indicate that research is required on aspects related to community academic practices (Panamerican Health Organization, 2018). Several authors have investigated the challenges and threats in nursing training, insisting on the need to incorporate curricular content in community nursing that contributes to increasing the quality, rigor, and sustainability of interventions. However, the emphasis on traditional public health is notable (Valls et al., 2018). Similar findings suggest including the perspectives of disciplines other than nursing; however, they continue to be connected from positivist health (Bel & Maiola, 2020; Martínez, Díaz, Martínez, Chao, Dandicourt,Vera, Elers, 2020). This shows a gap 1n knowledge that accounts for other theoretical and methodological approaches based on the contribution of the social and human sciences for the analysis and reflection of community practices (Seah et al., 2022).
The objective of the article is to determine the categories that are extracted from the scientific literature on community praxis in nursing programs.
The methodology section of the article employs a narrative review to scrutinize scientific studies on community practices in nursing programs, with a particular focus on their role in Primary Health Care (PHC). This methodological approach aims to identify key categories emerging from the literature on community praxis in nursing education. The results section presents three main categories: the complexity and simplicity of community nursing practices, the inherent contradictions between theoretical texts and practical contexts, and the critical role of relational action and creation in community nursing education. These categories reflect the actual complexities and challenges observed in community nursing practices. The discussion emphasizes the socio-cultural and interdisciplinary aspects of community nursing practices, highlighting the significant contributions of both teachers' and students' knowledge and experiences in diverse healthcare situations. In conclusion, the authors stress the importance for nursing students and teachers to recognize the value of community learning environments, underscoring the necessity of integrating theoretical and practical aspects of nursing education. This integration is crucial for fostering epistemologically coherent, ethical, and politically aware community nursing practices. Overall, the paper underscores the dynamic, multifaceted nature of community nursing and advocates for a more integrated and holistic approach to nursing education within the primary health care context.
2. Method
2.1. Type of Study
A narrative review was conducted, incorporating studies by Etherington, Wu, Cheng-Boivin, Larrigan, and Boet (2019) and Franco Giraldo (2022), to analyze scientific research pertaining to community practices within nursing programs from the perspective of Primary Health Care (PHC).
A protocol was formulated for the bibliographic review, encompassing the planning, selection, extraction, and execution phases, as outlined by Grijalva, Cornejo, Gómez, Real, and Fernández (2019) This review aimed to address the following research question:What categories emerge from the scientific literature concerning community praxis in nursing programs within the context of Primary Health Care (PHC)?
2.2. Article Search and Selection Protocol
About planning, the thesauri were defined in DeCs (Descriptors in Health Sciences) and MeSH (Medical Subject Headings): community health nursing, community health nurses, public health,community health,primary care nursing, nursing education, nursing teaching, curriculum and education. Also, in English: Community Health Nursing, Nurses community health, Primary Care Nursing, Education nursing, Curriculum, Education (boolean connectors "AND", "OR"). The constructs were based on the theoretical model of Alma Ata and on the epistemological, conceptual, pedagogical, curricular and didactic guidelines of the Comprehensive Health Care Routes (RIAS), as well as on the guidelines of the Comprehensive Health Care Policy (PAIS) of Colombia (Ministerio de Salud y Protección Social, 2016; Pan American Health Organization, 1978; Ministerio de Salud y Protección Social, 2018 - 2018).
During the selection phase, a bibliographic search of information sources was conducted, utilizing scientific articles published between the years 2011-2022 as the selection criteria. The intention was to establish a broader temporal context of scientific evidence related to the subject of investigation, without geographic restrictions.
The proposed timeframe between 2011 and 2022 provides a critical period for determining community practices in nursing at an international level, in line with the principles of the 2005 Social Determinants of Health. This period marked a milestone in addressing not only disease care but also understanding and addressing the underlying factors that impact health more broadly, providing a solid foundation for the analysis and continuous improvement of public health interventions at the local level.
The search was conducted in Spanish, English, and Portuguese, the languages that have experienced the greatest development in community nursing research. Publications in scientific journals of original articles and reflections found in databases such as the Virtual Health Library (VHL), PubMed were utilized as well as Google Scholar.
Initially, document extraction was related to database search equations, leading to the identification of 1,690 articles. Subsequently, five filters (Figure 1) were applied, and an extraction matrix was constructed, including the following items: title, authors, journal, abstract, year of publication, country, language, and database. This matrix facilitated subsequent stages of manuscript selection, including inclusion and exclusion.
The next filter was a selection process with detailed and rigorous criteria that were applied to the documents that remained; the exclusion was based on: duplicate work, analysis of the title, the summary and of the results. Finally, it was taken into account that the selected articles were indexed and approved in the Colombian Scienti Publindex System for the year 2022, in addition, articles that could not be obtained in full text, literature books, theoretical reviews and editorials were excluded.
The final filter pertained to the evaluation of article quality and subsequent selection. Each article underwent a critical reading process utilizing two tools, namely the Critical Reading Skills Program (CASPe) and the STROBE statement (Santamaría, 2017; Cuschier, 2019). Criteria, such as the validity of the research question, objectives, methodology, and the consistency of the method with the objectives, were considered. Additionally, aspects including the population selection strategy and data collection techniques in congruence with the question and method were assessed. Rigor in data analysis, drawing conclusions, addressing conflict of interest, and evaluating external validity and applicability of results were crucial criteria. Any discrepancies in the selection process were resolved through consensus.
The evaluators independently identified the design of the studies and assessed compliance with each criterion. The analysis and interpretation process utilized ATLAS.ti version 8 software. In this process, emerging codes were identified based on the observation parameters proposed by Ryan and Bernard (2003). The codes were then consistently compared in a back-and-forth spiral, considering the researchers' reflexivity and identifying existing tensions between the studies and the interpretative moment (Corbin & Strauss, 1990). Trends were derived and grouped to allow for the emergence of subcategories and definitive categories.
Declaration on Ethical Aspects
Regarding ethical considerations, this review of secondary databases of open access does not imply risks for people and the environment. It should be noted that it is part of a macro-project with ethical endorsement from the Faculty of Health Sciences of the public university managing it.
3. Results
For the purposes of this article, the results are presented broken down into three emerging categories that account for the realities of community nursing practices expressed in the documents reviewed and analyzed (Table 1).
The complexity and simplicity of community nursing practices
The category that is developed corresponds to the concept of complexity and simplicity as a characteristic of the practice. For some students and teachers, community practices are perceived as something easy to carry out. At times, the activities of the practice become routine, leading to monotony, passivity, downtime, and demotivation. This provokes feelings of irrelevance in students regarding the contributions of nursing work. As extracted from one of the research results, "It was a good course; we thought it is a break for the next clinical course which is difficult" [5:10]; (Ildarabadi, et al, 2018, p. 459).
When reflecting on the topics that are pillars of community practice, among which are public health, epidemiology, public policies, among others, it is evident that students perceive an overload of information, which brings with it difficulties to apply the knowledge obtained. Reflection of this situation described includes, among other considerations, a) in theory, community issues are specified, and in practice, individual work predominates, b) in some cases the family environment is involved, with serious limitations related to the community field, the improvement of social and health services and, especially, the political component of health.
Another characteristic that configures the academic practice of nursing as a praxis located between the complex and the simple, is the priority on the part of the teacher to develop disciplinary knowledge in addition to the fulfillment of their role as an educator. Knowing and/or living the context by the teacher is placed in the research as a basic task; however, the achievement of community action places the practice in a complex situation, while community actions are directed to leaders, while the participation of other members of the community is limited, which constitutes a challenge in the development of community practice.
The teacher, serving as a guide for the students, is recommended to possess social skills that impact community actions while also being a source of inspiration for the students. This is to enable the teacher to forge their own knowledge by creating a structured learning environment that demonstrates the broad possibilities of professional practice. As stated, "[...] that teachers should have dual specialty, i.e., they must be specialists in a particular field of knowledge (community) and in teaching" [1:28]; (Falcón, Alvarez, Caso, et al, 2019, p. 844-845).
Commonly, field insertion and constant reflection during community practices are generators of knowledge, skills and ethical values. These practices foster the development of the capacity to implement actions that seek solutions to community situations, those that favor leadership and teamwork, both for students, teachers and care recipients themselves. These actors undergo changes and intellectual maturation as a result of the experience, which demonstrates the involvement and appropriation of the practice. These conditions are expressed in narratives such as the following " The results demonstrate that the curricular proposal of the study scenario has characteristics that favor the learning mediated through experience and reflexivity, mobilizing the development of competencies for health promotion " [2:54]; (Netto & Silva, 2018, p. 7-8).
3.1. Contradictions between text and context in community nursing practices
This category demonstrates the tension between text and context. Firstly, the meaning of the text will be taken into account, expressed as a network of meanings recognized as devices of a specific culture. In this context, when referring to culture, it pertains to community nursing practice, wherein social actors, including nurses, students, and teachers, converge. The produced texts articulate meanings and senses that can be explained and understood by users of the same language and, eventually, by others who can and want to learn to decipher and interpret them.
The text is a device, a virtual space, in principle open and not closed to interaction, embodied in oral and/or written language, as well as in the iconic forms of media cultures such as the new communities that have been built around virtuality. The above, without ignoring the importance of giving the context to the visual and stories of people "With regard to students' focus on the patient or on the context, presenting images, stories, and patient cases that contrast with stereotypical views commonly held in the media and society is helpful. " [15:39]; (Van Lersel, Latour, Van Rijn, De Vos, Kirschner & Scholte, 2018, p. 61).
Secondly, the context, linked to the setting of the community in which nursing practices are carried out, is considered not only from the idea of territory as something physical or geographical. On the contrary, in the community (context), linkage and relational forms are sought that are instituted in various possible environments. These spaces are where nursing workers, students, and teachers relate to each other. As expressed, "We were comfortable in interaction with the community. "All members of the community and stakeholders were very supportive and cooperative" [7:20]; (Mohammad, et al, 2019, p. 1255).
Students find that the theoretical learnings resulting from the texts, what they have learned at university, sometimes contradict each other, with the context of the social, cultural, political or economic reality of the communities, because what the communities have experienced finds its correlation in the practices and experiences of everyday life, whether personal, professional or social, and this is often not documented or written "In this context, it is worth mentioning that nurses approach the user from a biopsychosocial perspective, incorporating the family and its territorial context. " [1:34]; (Muñoz, Illesca, Gallego, et al, 2021, p. 264).
In this way, the contradictions between the texts that have been interpreted and given meanings by students, teachers, and nursing professionals regarding the context reveal existing ignorance about them. This includes difficulties in their location and positioning, both spatial and geographical. Likewise, there is a lack of information regarding the social determinants of health and access to services, among others. "Education requires this topic social determinants of health (SDH) included in...school curricula [...] advocating for healthy public policy" [2:46-10:17]; Mangold, Bartell, Doobay-Persaud et al., 2019, p. 1355;Valaitis, Schofield, Akhtar-Danesh N, et al, 2014, p. 1).
3.2. Relational action and creation for community nursing education
Nursing education encompasses a broad spectrum of dimensions that gathers elements to revolutionize the way it is done in the community setting. On the one hand, the educational action alludes to the common practice of nursing students that must make sense according to the contexts and actors; on the other hand, it speaks of the creation or creative capacity as a generator of common good for society and with it the transcendental role of teachers, students and the community; in addition, the challenges in the pedagogical skills of the modern world with its constant technological changes are taken into account.
As previously evidenced, in educational action it is essential to be aware of the context, to analyze the territory - almost always inequitable - and specific groups - with their generational differences. Thus, students and teachers must be prepared to interact, strengthen the bond with community members, plan accompaniment and encourage them in their empowerment regarding decision-making aspects about their health): "Thus, the community orientation of primary care not only contemplates health determinants with an intersectoral perspective, but rather promotes participatory processes that have proven effective in promoting health and reducing inequities" [2:29]; (Valls, et al, 2018, p. 82), which can generate a window of opportunity in the light of social justice.
In the action it is important to educate in community for the promotion of health and, consequently, the improvement of the quality of life of people. In this regard, challenges are presented that are evident by the inaccuracies and confusion in the actions developed by health personnel focused on morbid processes; with an approach to lifestyles whose focus ignores social determinants; an education focused on the individual and not on families and the predominance in practice with institutionalized structured groups such as schools, groups of older adults, among others, deprotecting education with the territorial or community approach itself.
This was expressed by some students "Health promotion as a new way of thinking and doing health enables the confrontation of multiple problems affecting human populations and their environment. However, the preparation of professionals must be expanded in order to act in health promotion with effective actions, and this process involves the development of competencies " [2:6]; (Netto & Silva, 2018, p. 2).
In the development of creative capacity, it is necessary to have teachers from the area who have experience in public health, community health and social skills. In their role, it is necessary to strengthen the development of skills, provide support in knowledge and skills, as well as promoting their immersion in learning spaces that allow the stimulation of creative and cognitive potential. Therefore, the most favorable contexts for reflective practice in community nursing education are those that include integration teaching-service-community-integration between teachers and students "[.] so that it can generate an integral change and produce an innovative teaching, has a transformation in thinking, doing and developing the teaching, in function of the evolutions that occur in the society" [2:55]; (Medrano, 2021, p. 148).
From the role of students, a fundamental aspect is to achieve trust, this generates security and originality to unleash creative products, with their own and unique details that make a difference in the didactic area. When emotions are linked in the community process, the student finds their own style and rhythm, begin to feel a connection with the team and the community to whom they provide care "When they feel (students) accepted, their perception of the experience changes significantly " [1:46]; (Falcón, Alvarez, Caso, et al, 2019, p. 846).
The development of creative capacity within the community is achieved through the participation of members and the recognition of social actors in educational processes. They are no longer seen only as passive recipients and beneficiaries but as active subjects who participate critically in the construction of alternatives oriented toward the well-being of people and their groups. One of the verbatim excerpts from the research says, "Initially, I felt hesitation in interaction, but soon I received encouragement from all stakeholders. As we were working, I felt the need of the community, and we received much cooperation from high officials of the community" [7:19]; (Mohammad, et al, 2019, p. 1255). This illustrates that community work is of a procedural nature, requiring patience, cooperation, and the dynamization of actors.
Creative capacity or creation requires responding to challenges in pedagogical skills, which implies taking advantage of technologies put at the service of community learning. The evidence from the studies shows as examples: virtual simulations, face-to-face simulation mediated by interactive support, the development of avatars with scripts for the encounter with students around certain parameters and the preparation of educational material in a self-taught way, tools of creativity that allow the adoption of the contents required by each population.
4. Discussion
Thus, for some authors (Martínez et al., 2020; Torres, 2020 Godoy, Illesca, Seguel & Salas, 2019; Martínez, Díaz, Chao & Martínez, 2015; Atehortúa, Castaño & Restrepo, 2019), the practices are conceived as the result of a socio-cultural and interdisciplinary product, which the contribution of the knowledge and experiences lived by teachers and students, provide attention to the different circumstances of people.
Studies conducted in Chile and Mexico (Félix, Garay & Santos, 2017; Muñoz, Illesca, Gallego, Cabezas, Hernández & Godoy, 2021) argue that spaces are required for practice in real contexts, given that this lack is notorious at the lower levels of the curricula. Likewise, it is taken into account that individual or teamwork during the exercise of community nursing is built in practice, which has the connotations of being located in the space for learning. Thus, these spaces for practice are proposed with the aim that the actors integrate the appropriate texts and knowledge when providing nursing care to people, families, groups, and communities (Félix et al., 2017).
At the community level, including the Colombian case, nursing staff, students and teachers act within the context of the local, sectional, and national policies of each country (De Arco & Suárez, 2018; Congress of The Republic of Colombia, 1993; Ministry of Health and Social Protection, 2012); for this reason, research reveals that it is from regulations that consensus and conflicts are generated in the face of health paradigms and their own work or practice. Although it is a guide for interventions, the mandatory nature of health standards can constitute a limitation for nursing in the development of actions aimed at meeting the needs expressed by the population. The above in terms of health promotion and health education specifically. Thus, these activities are vertical, standardized and fragmented.
Both the work of the nursing professional and academic practices are oriented towards the fulfillment of productivity goals as required by current national health regulations. This regulation shifted attention from the area where people live daily (concretization of the practice) to the institutional area with an emphasis on disease prevention and basic individual treatment. These measures increased the detriment of health promotion and the community approach (De Arco & Suárez, 2018; Mondragón, Bernal & Corpus, 2021).
On the other hand, the evidence shows that there are countries that lack a scientific and effective teaching system to prepare nurses at the community level (Cai, 2020; Calma, Halcomb & Stephens, 2019; Chan, Cheng, Fong, Fung, Ki, Li,Wong, Wong & Tsoi, 2019), while others have important theoretical and research developments that allow for a reflective analysis of the topic. This phenomenon occurs in other disciplines such as psychology (Rivera, Velázquez, Custodio, Hildenbrand & Wakeham, 2019;Villagra, 2018).
The practice of community nursing often overlooks the theoretical disciplinary component that enables the student to evolve towards reflective thinking, transcending the technical thinking carried out with assiduity. The results of the study by Félix et al. state that "the development of nursing theory and practice in a simultaneous and systematized way is important, as a fundamental axis for the development of professional skills and abilities" (2017, p.12).
As expressed in the results of this study, the existence of a broad curricular content that concerns community nursing care, brings consequences related to overload and difficulties of students to understand the topic, even though the literature evidences several individual and collective learning tactics (Félix et al., 2017 Muñoz et al, 2021; Waller & Nestel, 2019; Ogunsiji, Ogbeide, Mukuria, Olugbemiro, Workman & Dune, 2022) and recent curricular proposals (Muñoz et al., 2021; Cai, 2020; Mangold, Bartell, Doobay, Adler & Sheehan, 2019), in some, the community-oriented curriculum is emphasized, to allow students to have greater choice of these topics, in the provision of nursing care (Lersel, De Vos, Rijn, Latour, Kirschner & Scholte op Reimer, 2022).
This highlights the need to develop new strategies where dialogue, reflection and an increase in abstract elements prevail where the student has a leading role with the guidance of the teacher (Santos et al., 2019; Félix et al., 2017, Muñoz et al., 2021; Polo, 2018). Strategies that allow an approach to the context to understand community aspects in line with the constructivist model of learning that occurs in some nursing programs (Nuuyoma & Makhene, 2021; Olsson, Dalmoro, Da Costa, Peduzzi & Toassi, 2022; Fortuna, Dias, Laus, Mishima & Cassiani, 2022).
For some authors, the practical component of community nursing is considered the contextualized complement of theory, where students can learn through their own experiences (Félix et al., 2017; Stagg & Mccarthy, 2020; Davis, 2021 ) and thus strengthen leadership, collaboration, and reflective thinking, while meeting the needs of the community (Santos et al., 2019; Stagg & Mccarthy, 2020). Small group activities are raised as the best option for community care learning (Muñoz et al., 2021; Stagg & Mccarthy, 2020). It should be noted that, at times, research results demonstrate how practice is not aligned with the theoretical, political, and conceptual approaches that involve community care (Muñoz et al., 2021; Cai, 2020), which entails a "rejection" of the students towards theoretical content, considering it unnecessary in practice or far from reality (Félix et al., 2017).
On the other hand, the student's interaction with the teacher and with their other colleagues facilitates learning and the development of skills (Santos et al., 2019; Muñoz et al., 2021; Rivera et al., 2019; Davis, 2021). Research suggests that the teacher should have knowledge in the area (Muñoz et al., 2021), ability to reflect, understanding the context and ability to adapt the demonstration. Thus, the teacher is that engine that guides, illuminates, motivates, sensitizes, and encourages the search, imagination and creativity in students, which allows them to build and deconstruct concepts and to strengthen their role (Félix et al., 2017; Cai, 2020; Rivera et al., 2019).
The implication for the practice, is it can be stated that while several studies demonstrate how community practices from different disciplines of health sciences promote the development of competence in students, they focus on systemic, interpersonal, and instrumental competencies. Community practices focus on strengthening "know-how" (Rivera et al., 2019) which, although it is an important competence, as proposed by Muñoz et al., (2021), the practical component leaves aside other competencies such as reflection, critical analysis, theoretical materialization, creation and innovation typical of professional levels that are also important to be generated in students (Cai, 2020; Rivera et al., 2019) therefore, it is proposed that this be implemented in the training of community nursing.
The literature review also shows a close relationship between community educational action and creative capacity in the framework of Primary Health Care; therefore, it is advisable to generate alternatives to accompany nursing students to acquire learning outcomes, which allow them to be highly competent professionals and committed to social justice. All of the above in favor of improving people's quality of life and overcoming traditional, stiffened and vertical ways of educating (Seah et al., 2022; Obara, Perry, Janzen & Edwards 2022).
Educational action can and should go beyond the transmission of information. As a nodal point, it is essential that nursing professionals know the characteristics of the participating population and of the territory, as well as that they develop skills that allow them to reflect on the importance of what, for what and how of education. This requires the incorporation of innovative approaches that facilitate students to link their practice with broader social contexts through open dialogues and group reflections (photovoice, sociograms, flowcharts, health asset mappings, evaluation matrices) and highlight the use of modern digital material that allow them to analyze, understand, debate, and decide collectively in order to improve lifestyles and social realities (Seah et al., 2022; López, Alberich, Aviñó, Francés, Ruiz & Villasante, 2018; Jordan, Lofton & Richards, 2021).
Meanwhile, in the development of creative capacity as an innovative principle, it is proposed to bring together aspects and learning activities inspired by alternative pedagogical and didactic proposals that guide students in the acquisition of the social-emotional affective domain. All this is linked to ethical and moral development, which is essential for the practice of a profession with human services (Obara et al., 2022).
Different studies (Obara et al., 2022; Siles, 2019) conclude, for example, that Arts-Based Pedagogy (ABP), improved student participation, group connectivity, social-emotional learning, critical thinking, and new forms of well-being. Likewise, they propose community simulation as a promising didactic strategy to practice therapeutic communication skills, decision-making and respond to the changing needs of families, in an environment that models a complete encounter with subjects and their families (Gunowa, Elliott & Mcbride, 2018; Arnold,Willis & Watts, 2021; O'rae, Ferreira, Hnatyshyn & Krut, 2021).
Meanwhile, several authors (Anguas, Subirón, Antón, Rodríguez, Satústegui & Urcola, 2021; Rourke, 2020) motivated the incorporation of innovative strategies for teaching and learning such as gamification and escape rooms games, which have demonstrated their effectiveness in improving student learning. This is achieved through the application of theoretical content to a case study, exposure to a degree of stress in a safe and controlled environment, the practice and acquisition of skills and attitudes that include communication, teamwork, creative thinking and active learning (Anguas et al., 2021; Villarreal, 2020, Calderón & Betancurth, 2021; Shea, Brophy, Nininger, Abbott & Wilson, 2021).
Other authors propose interdisciplinary teaching strategies as a critical component of evidence-based care delivery and nursing (EBE), an innovative approach that incorporates the acquisition of key professional competencies for decision making and critical thinking (Arnold et al., 2021; Calderon & Betancurth, 2021 ; Shea et al., 2021; Betancurth, Mejía, Sánchez, Orozco & Giraldo, 2021 ; Mikkonen, Kuivila, Sjogren, Korpi, Koskinen, Koskinen, Kouvuka, Koskimäki, Lähteenmäki, Saaranen, Sormunen, Salminen, Mäki, Wallin, Holopainen, Tuomikoski & Kääriäinen, 2022).These learning experiences show that nursing professionals must feel adequately prepared and challenged to give new meaning to their educational practices with different and innovative ways to work in community settings (Rivera & Medina, 2017; Betancurth, Vélez, Sánchez & Jaramillo, 2022).
4. Limitations
The limitations of this study focus on the heterogeneity and complexity of the different practices. This novel work strengthens the link between social actors and community practices. For future research, it is proposed to systematize experiences, and, in turn, joint analyses should allow the establishment of a pedagogical proposal for nursing care in community practices within the context of Primary Health Care (PHC) as support for the communities of the region.
In conducting this study, the limitation of having access only to open-access databases was presented. This meant that some of the literature and data that could have further enriched the analysis were out of reach for researchers due to subscription restrictions or closed access policies. However, it is important to note that various databases were consulted that offer a wealth of valuable and relevant information, including research, case studies, articles, and other documents fundamental to understanding the subject under study to achieve a comprehensive and solid analysis.
5. Conclusions
The study shows that in the practice of community nursing a static paradigm prevails in students and teachers, limited eminently when doing nursing in the individual, that does not allow it to radiate to the communitarian and to the political thing of vital importance for the disciplinary development.
It is imperative that nursing students and teachers understand community learning environments as valuable for integrating theory -text- and practice -context-and, potentially, they can influence the educational process and care of people.
Educational action and creative capacity function relationally with the purpose of educating around epistemological positions with coherence in the community context, which allow reiterating the importance of ethical and political perspectives.
In accordance with the above, advances are required from the community practices of nursing students in the framework of Primary Health Care to address contemporary health needs, in particular health outcomes related to social determinants.
