Abstract
Introduction: at a global level, one of the fundamental challenges for nursing education is to guarantee that students progressively develop practical skills and abilities that are solid and highly relevant. These skills are essential to develop confident and secure performance in clinical environments. Objective: to assess the mode of professional action of nursing students from the practices in the services Development: the student during his initial training in his performance, faces a series of professional problems of various kinds, with a variety of causal and intervening factors; Therefore, being competent demands that the future graduate assume the actions that make up a competent professional mode of action, far from any rigidity, with creativity, innovation and with the knowledge, skills, methods, values and experiences to design solutions, alternatives and their own intervention strategies. Conclusions: both the facilitators and the limitations were assessed in a comprehensive and committed manner, capable of ensuring that the practices in the services fulfill their fundamental mission, forging nurses who are not only technically skilled, but also ethical, compassionate, reflective and owners of their professional mode of action that dignify the profession and care for the person with excellence.
Keywords
Professional mode of action, practices in services, nursing students
INTRODUCTION
Nursing education has undergone significant changes in recent years, driven by the need to train professionals who are better equipped and adapted to constantly evolving healthcare environments. These innovations aim not only to improve the quality of education but also to prepare students to face the challenges of an increasingly complex healthcare system (1).
Globally, one of the fundamental challenges for nursing education is ensuring that students progressively develop practical skills and competencies that are robust and highly relevant. These skills are essential for performing with confidence and assurance in clinical settings (2).
Nursing is a profession distinguished by the professional’s role in this health sector, which essentially manifests in four fundamental dimensions: nursing care for the individual, family, and community; health; and the environment. (3)
Learning occurs through social interaction; teaching takes place within a real-world setting in meaningful situations that allow students to construct their own knowledge and give meaning to their care practices. To achieve this, the process must begin with practical skills integrated with theoretical knowledge (3).
The authors assume that students’ practical training constitutes an initiation into professional life; therefore, the role of the instructor is very important, as they occupy a central position in the methodological work because of their regulatory function, which takes precedence over the direction of the educational teaching process.
Torres proposed that the teacher’s role is to be a moderator and facilitator of the teaching and learning process rather than one who solely and exclusively transmits knowledge. During the process of constructing, analyzing, and presenting the practical case, the teacher assumes a dual role as both an observer and an authority, intervening when necessary, reorienting activities, clarifying knowledge, and providing feedback (4).
In nursing practice, the student must be able to integrate knowledge, technical, ethical, and communication skills with a scientific foundation to provide holistic and humanized care.
The individual, the family, and the community, as professional content, represent the part of objective reality upon which the actions of the nursing student in training are directed and which is modified through the application of their mode of practice.
Various authors have investigated the formation and structuring of professional modes of action from different perspectives.
Addine noted in his study that the professional mode of action manifests itself through the way the subject acts upon the object of the profession and, at the same time, reveals the level of skills, abilities, and other ways in which the subject expresses their professional and personal development (4).
This definition highlights the practical nature of professional modes of practice by integrating skills and abilities.
Similarly, Horruintiner agreed, “Professional practice: The knowledge, skills, and character of that professional are expressed in their actions and involve the integration of the knowledge, skills, and values that ensure that performance” (5).
We share Miranda Lena’s view that the mode of action is linked to the way in which the professional acts upon the object of their work, expressed in the form of professional methods or functions. In this context, a function is understood as the manifestation of the internal properties or characteristics of the profession and its structure, as reflected in the modes of action. Although each function has its own specificities, on the basis of the object of the profession, they are subordinate to one another during their operation and in their relations with the environment. It follows that professional functions manifest themselves through their modes of professional action and constitute a unit of action, in close relation and interdependence.
Remedio defines a teacher’s mode of action as “the system of actions for communication and pedagogical activity that shapes the teacher’s performance in a specific context of action, revealing the level of development of their knowledge, skills, abilities, and creative potential, and serving as a means for self-improvement” (7)
Sariego defines preventive professional nursing practice as a process characterized by a pattern of mental approaches established by the accumulation of prior experiences, which are determined by the knowledge of being, knowing, doing, knowing-how, and knowing-how-to-transform, which, grounded in the Nursing Care Process as a method of practice, enable a set of actions aimed at preventing the emergence of health risks for the patient, family, and community, or, failing that, reducing their effects (8).
The authors agree with the premise that the current demands of the educational process necessitate distinguishing the undergraduate training stage as a platform for “professional-oriented learning” to lay the foundation for future performance.
The entire preceding analysis allows us to define modes of action as the set of algorithmic actions aimed at solving professional problems in an innovative and creative manner, where students gradually acquire, during their initial training, the knowledge, skills, and values inherent to professional practice. This enhances the mastery of methods for their professional practice, fostering efficient performance in relation to the demands of the socially constructed model of professional performance.
In the educational context, we can speak of modes of professional practice among students in training when they possess full mastery of the logic of science and the logic of the practice settings in which they will operate and are capable of integrating the knowledge, skills, and values that characterize healthcare professionals in solving the problems present in their field of work from the outset of their training process, thereby creating their professional identity. (9)
The authors consider that the professional practice of nursing consists of the actions of nursing staff directed toward the patient, family, and community, involving responsible intervention in the development of skills and the integration of knowledge through the application of the scientific method, which is based on fundamental and ethical principles, with a humanistic approach, in accordance with sociocultural demands.
General objective.
To evaluate the professional practices of nursing students on the basis of their clinical placements.
METHODS
A descriptive phenomenological study involving a search on Google Scholar, PubMed, SciELO Regional, SciELO Public Health, and SciELO Cuba was conducted. The search strategy utilized the following terms: modes of professional practice, clinical practice, and professional practice in nursing.
A literature review was conducted of 23 articles related to the research topic, including review articles, original articles, and theses submitted for academic degrees, to reflect on the content of documents published nationally and internationally between 2001 and 2023.
After the references consulted were analyzed, a selection was made in accordance with the proposed objective; of these, twelve were from the past five years, and eleven were older than five years because of the relevance of their content to the research.
The documents were evaluated in full, for a total of 23 works referenced in the documentation presented.
DEVELOPMENT
During their initial training and in their professional practice, students face a series of professional problems of various types, with a variety of causal and intervening factors; therefore, being competent requires that future graduates adopt actions that constitute a competent professional approach, free from rigidity, with creativity, innovation, and knowledge, skills, methods, values, and experiences to design solutions, alternatives, and their own intervention strategies (10).
Research requires drawing on previous studies related to the work to be carried out to complement and ground the process upon which the selected research will be based.
Below are some studies identified with the construct under study.
Title | Authors | Main findings/Results |
|---|---|---|
Professional Practice through the Nursing Care Process at the "Julián Grimau García" University Polyclinic, Santiago de Cuba. | Lores Guerra E (2011) (10) | An evaluation of professional practice through the Nursing Care Process revealed that healthcare providers were dissatisfied with the insufficient preparation they had received regarding the process, the lack of training, and the outcomes of their work related to the program. It was concluded that the quality of care provided through the Nursing Care Process was inadequate. |
Professional practices and their role in medical education | Salas Perea R S (2014) (11) | The characteristics and components of the modes of practice, as well as their basic structure within the professional model, were described in close connection with the other didactic categories; this will serve as a guide for the development of competencies throughout the training process; it allows us to verify how these designed modes of practice align with the actual work performance of physicians in the National Health System Health. |
Professional Modes of Practice: A Necessity and Challenge in the Training Process for the Dentistry Program | Guerra Pando J.A. et al. (2016)(12) | The full scope of professional modes of practice is not yet fully understood. This complex educational category encapsulates society’s expectations regarding professional quality and depends on a versatile, comprehensive, proactive, and context-specific teaching process |
Validation of the assessment model for the professional practice of nursing graduates. | Collazo Lemus E de la C (2020) (13) | The experts consulted evaluate all the indicators that determine the quality of healthcare as quite adequate, which allowed for the collection of highly competent opinions that enabled the theoretical validation of the evaluation model for the professional practice of nursing graduates. |
Training in the professional practice of registered nurses | Collazo L E C, Ávila SM, Alonso AO 2020(14) | The analysis conducted regarding the need to develop a professional practice model for nursing in accordance with the social context allowed for the establishment of a approach consistent with the social context and the theoretical frameworks underpinning the topic. |
The professional practice of medical students in initial training. | Mora Reyes K M (2020) (15) | The medical student in their initial training, based on the growing need for the educational process to unfold, from the early years of the program, within a coherent theory–practice relationship—a key role in expanding the shared space between faculty and medical specialists, students, and the public. The main theoretical findings are embodied in a methodology that provides levels of training for the medical MAP |
Assessment of the current state of the professional pedagogical practice of clinical nursing educators. | Collazo Lemus E C et al. (2022) (16) | Assessment of the current state of the professional pedagogical practice of nursing faculty. We identified weaknesses and areas of potential be considered to improve the professional pedagogical practice of clinical nursing educators. |
Source: Author’s own work.
It is evident that the studies share a common denominator: the pathways to achieving better professional practices that align with the professional model, all with the aim of producing and refining competent professionals with a professional identity who are committed to their work.
A practical course in professional technical nursing services is conceived as the central pillar of training for technical nurses entering at the ninth-grade level, in which skills are developed that enable the training of competent nurses to perform the actions and techniques described in the professional model, whose practice meets society’s demands regarding the health services provided, with the ability to adapt to scientific and technical changes in the profession through comprehensive general education (17).
This course has been organized in coordination with Fundamentals of Nursing; therefore, the sequence of units for practical activities corresponds to the order in which they are studied in this course. This allows for coordination between theory and practice so that students can better organize their learning of basic nursing procedures that complement the profession’s scope of study and apply them in related nursing care (17).
Students understand how practice plays an important role in the educational process, enabling flexible, independent, and creative action on their part, on the basis of their own goals, interests, and the environmental conditions present in various teaching settings; the concrete problems of social practice, which arise in complex and unique situations, can make all theoretical knowledge meaningful and useful to the student.
The clinical practice program describes the skills students must acquire, such as complying with the technical, organizational, and hygiene-epidemiological standards established for the services; performing nursing actions aimed at meeting the affected or altered basic needs through comprehensive care for the individual; and applying scientific, aseptic and antiseptic, ethical, and bioethical principles (17).
The authors assume that clinical practice constitutes the experiential core where technical nursing students construct and consolidate their professional practices, integrating skills, knowledge, ethical values, and competencies related to the professional model.
During initial training, students exhibit professional behaviors that are not exactly characterized by competence and that define their performance.
On the basis of their experience teaching clinical practice in healthcare settings, the authors consider it very important to identify which factors promote or hinder this development, viewing this as essential for training competent and compassionate nurses.
Factors that promote the development of professional practice among nursing students during clinical placements.
The faculty has extensive experience in practical teaching and holds advanced degrees.
The course instructor’s reinforcement of the students’ vocational commitment encourages them to understand the subject matter of the profession and, through their example, fosters the development of professional identity.
The scheduled clinical hours facilitate the practice of skills.
Peer support occurs as students rotate in groups.
Students participate in medical and nursing rounds.
They rotate through the hospital’s various departments, including the emergency department (on-call staff), inpatient wards, and the central sterilization unit, which facilitates the acquisition of skills.
Factors that limit the development of nursing students’ professional practice during clinical rotations in hospital departments.
Students show little interest in their studies, which translates to a lack of commitment to nursing.
Lack of integration of theoretical knowledge into practice.
Poor communication with patients and the healthcare team.
Lack of independence and creativity in performing tasks specific to the profession.
Deficiencies in the development of professional skills and a lack of ability to organize, plan, and deliver care.
Insufficient in-depth understanding of the material covered.
Students do not demonstrate the ability to objectively assess, recognize, and document health problems, which hinders the provision of comprehensive care
Work overload and a lack of time for nursing staff to teach; in some cases, nursing supervisors in the units are fulfilling dual administrative and clinical roles.
Insufficient resources in departments hinder the proper implementation of nursing procedures.
Medication administration schedules do not align with the times when students are attending clinical rotations.
Shortage of faculty members for clinical rotations; a single instructor is responsible for supervising 8 to 9 students assigned to each department, a consequence of the surge in enrollment, which makes it difficult to provide students with adequate and continuous monitoring—including the systematic evaluations required by the course syllabus.
There is a growing shortage of nursing faculty members and clinical instructors.
The aspects outlined above highlight the existing weaknesses that need to be addressed, which have a negative impact, thereby complicating the development of professional practice among nursing students, given that this is a complex and delicate process deeply influenced by the educational environment where many factors, including both human and material resources, come into play.
This situation represents a real challenge, since although there has been a shift toward learning models that move away from traditional educational paradigms, it is still necessary to delve deeper into strategies that reflect and promote the construction of disciplinary knowledge consistent with the epistemological nature of nursing (18)
The settings where clinical practice takes place must be supported by a learning ecosystem, featuring the systematic presence of faculty, trained and motivated preceptors, collaborative environments, and the constant integration of theory and practice. To optimize these processes, a shared commitment is required among all those responsible for the educational teaching process, drawing on creativity, inventiveness, innovation, and intervention strategies aimed at enhancing the teaching–learning process and the appropriate planning of available resources.
It is beneficial to have a clear and guiding vision of what one aims to achieve and of the possible paths and alternatives to reach it.
It is considered essential to implement innovations in the educational teaching process in light of increasingly complex clinical scenarios and the care demands they entail. During the systematization phase, several authors agree that the advantages of methodologies and techniques that significantly impact nursing education, such as the use of clinical simulations, the integration of digital technologies, problem-based learning, and interprofessional education, are transforming the way future nurses are trained.
Humanization in teaching is a growing trend in nursing education. This approach focuses on developing soft skills such as empathy, communication, and ethics, which are fundamental to patient care. Educational programs include specific modules to develop these competencies, recognizing that patient-centered care is just as important as technical skills (19).
Clinical simulations have revolutionized nursing education. Through high-fidelity simulators, students can practice complex procedures in a safe environment without risk to patients. These simulations allow students to face real-life situations such as medical emergencies, learn to make quick and accurate decisions, and repeat their experiences as many times as necessary, which enhances learning and builds student confidence (20)
Digital technologies such as online learning platforms, mobile apps, and virtual reality allow students to access educational resources in a flexible and personalized manner. For example, virtual reality enables the exploration of 3D anatomy in simulated clinical scenarios, which enriches their theoretical and practical learning (21).
Problem-based learning is a methodology that places the student at the center of the educational process; rather than passively receiving information, students work on solving real or hypothetical clinical cases, which fosters critical thinking, collaboration, and the application of theoretical knowledge to practical situations. This methodology has proven effective in preparing students for the challenges of clinical settings (22)
Interprofessional education promotes collaboration among students from different health disciplines, such as medicine, physical therapy, and social work, from the earliest stages of their training. Through joint activities, future health professionals learn to work in teams, improve communication, and better understand the roles of each team member in the clinical setting, which is crucial for high-quality patient care (23)
The integration of new methodologies and techniques into education requires a teacher who is effective in their professional practice and capable of fostering superior professional performance in their students and groups; it also demands a professional with the ability to identify, anticipate, and plan for the stimulation, enrichment, and development of learning processes, as well as the use of increasingly effective learning strategies by students.
Professional practice in nursing transcends the mere execution of techniques; it implies a way of being, thinking, and acting inherent to the professional role, characterized by responsibility, critical thinking, empathy, patient advocacy, and teamwork.
Clinical practice in healthcare settings constitutes the living laboratory where professional practice is conceived, tested, and refined under real-world pressure.
CONCLUSIONS
Both the facilitators and the constraints on professional practice were assessed in a comprehensive and committed manner to ensure that clinical placements fulfill their fundamental mission: to shape nurses who are not only technically skilled but also ethical, compassionate, reflective, and masters of their professional practice—nurses who dignify the profession and provide excellent care to the individual.
Future nursing professionals must integrate theoretical and practical skills derived from diverse fields of knowledge to act with responsibility and commitment to the profession’s values, not only to address current healthcare challenges but also to contribute to societal well-being by meeting the needs of the populations they serve.
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Declarations
Funding
“The authors did not receive funding for the conduct of this research.”
Conflict of interest
“The authors declare that there are no conflicts of interest.”
Authorship contributions
1. Conceptualization: Yamilet de la Caridad Hernández López
2. Data curation: Yanet Ortega Dugrot
3. Formal analysis: Yanicela Zapata González
4. Research: Yamilet de la Caridad Hernández López
5. Methodology: Yanet Ortega Dugrot
7. Supervision: Yanet Ortega Dugrot
8. Visualization: Ana Rosa Zulueta Alejo
9. Drafting – original draft: Iskra Marcos Armenteros
10. Writing – revision and editing: Yamilet de la Caridad Hernández López