CLINICAL TEACHING OF NURSING FUNDAMENTALS IN THE COMMUNITY ENSINO CLÍNICO DE FUNDAMENTOS DE ENFERMAGEM NA COMUNIDADE ENSEÑANZA CLÍNICA DE FUNDAMENTOS DE ENFERMERÍA EN LA COMUNIDAD

Objective: to describe the methodology and strategies of the educational plan of the clinical teaching of Nursing Fundamentals in the community that, through the study of health determinants with elderly people, has the goal of training the skills and abilities of undergraduate students in Nursing. Method: this is a qualitative, descriptive, experience-type study developed with Nursing students. The results are presented in figures. Results: the students were led to develop the competencies defined by the different capacities and criteria experienced by the students, in this clinical teaching, during the suggested learning experiences, as well as others that were implemented. Conclusion: the Nursing student was allowed to integrate nursing activities shared between teams and subteams, to build their own knowledge and to add technical and scientific quality to their training. It has become the study of health determinants with older people key to the training of students' undergraduate nursing course. Through this experience, it is possible to offer, based on the perspective of the European continent, a new dimension of learning in the clinical teaching of the Nursing Degree to other continents. Descriptors: Clinical Teaching; Fundamentals of Nursing; Community; Skills; Student; Elderly. RESUMO Objetivo: descrever a metodologia e as estratégias do plano educacional do ensino clínico de Fundamentos de Enfermagem na comunidade que, por meio do estudo de determinantes de saúde com pessoas idosas, tem como meta a formação de competências e capacidades dos estudantes do curso de Licenciatura em Enfermagem. Método: trata-se de um estudo qualitativo, descritivo, do tipo relato de experiência, desenvolvido com estudantes de Enfermagem. Apresentam-se os resultados em forma de figuras. Resultados: conduziu-se os estudantes a desenvolver as competências definidas pelas diferentes capacidades e critérios vivenciados pelos estudantes, neste ensino clínico, durante as experiências de aprendizagem sugeridas, assim como outras que foram implementadas. Conclusão: permitiu-se, ao estudante de Enfermagem, pela integração de atividades de Enfermagem compartilhadas entre equipes e subequipes, construir seu próprio conhecimento e acrescentar qualidade técnica e científica à sua formação. Tornou-se o estudo de determinantes de saúde com pessoas idosas fundamental para a formação de competências dos estudantes do curso de Licenciatura em Enfermagem. Pode-se disponibilizar, por esta experiência, com propostas baseadas no olhar do continente europeu, uma nova dimensão de aprendizagem no ensino clínico da Licenciatura de Enfermagem para outros continentes. Descritores: Ensino Clínico; Fundamentos de Enfermagem; Comunidade; Competências; Estudante; Idoso. RESUMEN Objetivo: describir la metodología y las estrategias del plan educativo de la enseñanza clínica de Fundamentos de Enfermería en la comunidad que, a través del estudio de determinantes de salud con personas mayores, tiene como meta la formación de competencias y capacidades de los estudiantes del curso de Licenciatura en Enfermería. Método: se trata de un estudio cualitativo, descriptivo, del tipo relato de experiencia, desarrollado con estudiantes de Enfermería. Se presentan los resultados en forma de figuras. Resultados: se llevó a los estudiantes a desarrollar las competencias definidas por las diferentes capacidades y criterios vivenciados por los estudiantes, en esta enseñanza clínica, durante las experiencias de aprendizaje sugeridas, así como otras que se implementaron. Conclusión: se permitió al estudiante de Enfermería, por la integración de actividades de Enfermería compartidas entre equipos y subequipos, construir su propio conocimiento y añadir calidad técnica y científica a su formación. Se ha convertido el estudio de determinantes de salud con personas de edad avanzada para la formación de competencias de los estudiantes del curso de Licenciatura en Enfermería. Se puede disponer, por esta experiencia, con propuestas basadas en la mirada del continente europeo, una nueva dimensión de aprendizaje en la enseñanza clínica de la Licenciatura de Enfermería para otros continentes. Descritores: Enseñanza Primaria; Fundamentos de Enfermeíra; Comunidad; Habilidades: Estudiante; Ancianos. PhD, Federal University of São João Del Rei / UFSJ. Divinópolis (MG), Brazil. E-mail: gylcepanitz@ufsj.edu.br ORCID iD: https://orcid.org/0000.00011--6624-1235; PhD, Nursing School of Coimbra / ESEnFC. Coimbra, Portugal. E-mail: mchaves@esenfc.pt ORCID iD: https://orcid.org/0000-0002-8018-9581; E-mail: apostolo@esenfc.pt ORCID iD: https://orcid.org/0000-0002-3050-4264 CASE REPORT ARTICLE Cruz GECP, Chaves MCRF, Apóstolo JLA. Clinical teaching of nursing fundamentals...

It is understood that clinical teaching in the course of Nursing Degree cannot be defined only as a stage of application of theoretical knowledge, since this experience leads to critical reflection for the improvement of skills in real situations of enormous importance in the construction of professional identity of the student in the development of competences for the integral formation of the professional nurse. 1 It is intended to enable, through this knowledge, a competent action based on a series of clinical practices and shared activities of knowledge, inserted in a teaching-context network, with a professional community, to the future nurse, thus allowing the collective construction of the learning. 2 It is the learning to learn, therefore, as a structuring axis of the teaching-learning process, allowing the professional to maintain, throughout the life, a attitude of permanent learning in face of the challenges imposed by the health. 3 It is known that building a competency profile for Nursing is one of the tasks that are done in the initial Nursing training. 1 Nursing is a discipline and a profession focused on the interpersonal relationship of nurses with a person, family or community. 4 It is believed that the role of the nurse is to help the sick or healthy individual in performing activities that contribute to health, recovery, or a serene death and to do so in a way that helps individuals become independent as fast as possible. 5 The nurse interacts with a human being in a health-disease situation, which is, in part, integrated into the sociocultural context, experiencing some type of transition or is anticipating a transition. 5 The interactions between the nurse and the people around a purpose, the Nursing process, are organized, allowing nurses to use therapeutic actions to improve, bring or facilitate health. 6 In this sense, the aim is to provide students with the opportunity to develop skills and abilities to carry out the Nursing care process, to understand individuals and groups in their natural life contexts and the influence of the determinants of health, the clinical teaching of Nursing Fundamentals in the community of the Coimbra College of Nursing (ESEnfC), developing itself also with the elderly community, being considered a privileged time of strong relevance, meanings and contributions.
There is a change in demographic and epidemiological profiles in Portugal, marked by an aging population and a significant increase in people with chronic diseases and multiple pathologies. It explains, therefore, the number of deaths that has been increasing, with more than 110 thousand in 2016, and this evidence points to challenges to society, the economy and the National Health System in the country (NHS). 7 With these conceptions, the average age of the 10.3 million Portuguese residents is observed. Life expectancy exceeds 80 years of age, as 21% of the population in 2017 were 65 years of age or more and more than one million people, aged 75 or over, with more women than men. 7 Health education with older people is a multifaceted field that constitutes a space for evidence-based training and delivery of knowledge. Thus, it is possible to instrument the Nursing student in the way each community understands healthy living, one of the priorities for the reality of the demographic and epidemiological profile of Portugal, consolidated in the educational plan of the Nursing Fundamentals clinical teaching of the ESEnfC.
• To describe the methodology and strategies of the educational plan of the clinical teaching of Nursing Fundamentals in the community that, through the study of determinants of health with elderly people, has as a goal the training of competences and abilities of the undergraduate students in Nursing. This is a qualitative, descriptive study of the type of experience, about the methodology and strategies of the educational plan of the Nursing Fundamentals clinical teaching in the community, with elderly people, developed with students of the 2nd year of ESEnfC, in the year in 2017-2018, in the city of Coimbra-PT.
This educational plan, reformulated four years ago, is supported by the theory that the client of nursing care is understood as a human being in a developmental (throughout the life cycle), situational transition (changes in life situation and location), health-disease and organizational status, transition described by Afaf Meleis, and in Virginia Henderson's theoretical conception where people desire and seek independence in meeting 14 Fundamental Human Needs (FHN). 5 With the objective of providing support in the training of competences and abilities of the students, by ESEnfC teachers, a guide guiding the clinical teaching of Nursing Fundamentals in the community [2017][2018]. It is described in this guide, available to the student for consultation, all the conceptual framework of the educational plan, which bases the general and specific activities, assisting in the way to systematize the operational aspects in a simple and objective way throughout clinical teaching.
It was identified, in this dynamic, considering the interaction with the community, the students by the badge and the coat of the ESEnfC, directing them to ask permission of the elderly to photograph, besides preserving the anonymity, placing black bars on the eyes or attenuating the image, to elaborate the works and reports and to share the developed activities.
It was requested to sign the consent form to the elderly to photograph and respond to the data collection instruments; however, because it is an experience report, this study was not submitted to the Research Ethics Committee in the ethical precepts of secrecy and anonymity of the participants were guaranteed.

 The description of clinical teaching methodology and strategies
The clinical teaching of Nursing Fundamentals was developed in the community, with learning experiences with elderly people, over ten weeks, with 360 students from the fourth semester of the second year, comprising 405 hours distributed in 350 hours of clinical teaching from Monday to Thursday and 55 hours of autonomous student work.
Five nursing teams were selected to receive the students organized in sub-teams, linked to a geographic area belonging to the following parishes of Coimbra: Eiras and São Paulo de Frades; São Martinho do Bispo and Ribeira de Frades; Santa Clara and Castelo de Viegas; Santo Antônio dos Olivais; Sé Nova, Santa Cruz, Almedina and São Bartolomeu.
During the ten weeks, two groups of 180 students were divided into 17 subteams, with ten students and one teacher to follow the activities of clinical teaching during the academic periods from February 12 to April 27, 2018, for group 1, and from April 30 to July 13, 2018, for group 2.
In the first two weeks, by sub-teams, recognition of the respective geographic areas, guided by the maps available in the Geographic Information System (GIS) of the Coimbra Municipal Council, was carried out. The map of social services was available online, as well as websites of the different social teams, with interviews with the heads of the teams and institutions to prepare the planning of the activities.
It is reported, however, that for the best use in clinical teaching, the sub-teams attended workshops of expressivity of communication carried out in ESEnfC. They are practical workshops that positively contribute to student communication to identify and express feelings and ideas, as well as adjusting behavior in social and cultural contexts, creativity and how they interpret their daily actions, as well as supporting development of skills and abilities and in the construction of each student's personal and professional identity.
The themes of communication with the blind, deaf and dumb, interpersonal communication, communication through music and dance, body and voice and augmentative and alternative communication (AAC), taught by masters, doctors and postdoctors in Psychology, Anthropology, Drama, Languages, Romantic and Modern Linguistics. 8 It is described that, simultaneously with the participation in the workshops, the students selected the areas to be studied together with the teacher, and also visited the sectors of health, economic, water and solid waste treatment, industries, social and interviews with opinion formers, community leaders, teachers, technicians from local authorities and health professionals, to collect information, complementing the data with photographs.
The students also carried out a bibliographic summary, based on scientific evidence, as well as a correlation with the national health indicators, identifying the activities of nurses to propose interventions on education, rights, health services and community mobilization.
From the perspective of integrated health care, the students were instructed on the importance of identifying the network of equipment to support the person who may need hospitalization, resources after returning to the community and also resources emergency and assured by the Health Center Groupings (HCG) in articulation with other resources of the community.
All activities and information were evaluated by the teacher, discussing them during the sixth week of clinical teaching, in each team, and sharing among the teams of other geographical areas and subteams in the classroom, in the seventh and eighth weeks of clinical teaching.

• The study of the health determinants of a community
The study was carried out between the third and sixth week of clinical education, with the application of the data collection script of the study of health determinants of a community, according to figure 1, which is a structured guide from the model of progress of planning and evaluation of the health program PRECEDE-PROCEED. 9 Geo-demographic framework  It is pointed out that this model deals with intervention in health promotion, which classifies the factors that determine the predisposing, facilitating and reinforcing lifestyles because it demonstrates value all the set of factors that influence the practice of preventive behaviors.
Components for the focus of the student's clinical judgment and for the application of the necessary skills to consolidate the intended competences were produced from the collected data.

The skills and abilities developed by the student
During the clinical teaching of Nursing Fundamentals in the community, students' competences were constructed in articulation with the domains of defined abilities and criteria, as well as involving different elements such as personal skills, disciplinary contents, affective, social resources and contextual, among others. Based on this reasoning, the different capacities and criteria experienced by ESEnfC students in this clinical teaching were followed during the As a result, through the study of the health determinants of a community, students were provided with the identification of the basic health requirements and resources that ensure the quality of life and well-being of the elderly, identify situations of increased vulnerability or with specific health problems.
As a result, through the study of the health determinants of a community, students were provided with the identification of the basic health requirements and resources that ensure the quality of life and well-being of the elderly, identify situations of increased vulnerability or with specific health problems. 5,10 Students who are encouraged to reflect take the initiative and take responsibility in a real context of nursing and develop skills, that is, the ability to mobilize different skills to deal with situations inherent in professional practice. When students combine attributescognitive domain (knowledge), skillspsychomotor domain (know-how) and attitudes -affective domain (knowing how to be and live), it is possible to acquire a broad vision of their field of work. 11 It is perceived, therefore, since the competences generate results, that these are closely linked to the professional profile of a nurse [11][12] and, in this line of thought, a careful and organized impression of all the knowledge, skills and attitudes present in the formation Nursing students are necessary and indispensable. 13 The clinical teaching of ESEnfC's Nursing Foundations is not only an individual but a collective aspect of the teaching and learning process, where students can, in their first experience in the field of practice with the community, experience a critical and reflexive analysis of the experiences of this learning that he developed and which were more meaningful for him, allowing him to acquire the desired skills and competences.
It is believed that reporting the methodology and strategies of the educational plan of clinical teaching of Nursing fundamentals in the community with elderly people, added that the integration of shared Nursing activities of the teams and subequipes allowed the Nursing student as a first experience in the clinical teaching, build their own knowledge, and add technical and scientific quality to their training.
The study of the determinants of selfreported health by elderly people, the practice of communication and updating of strategies adapted to the most different publics, contributing to the development of autonomy, responsibility and creativity, but also, fundamentally, to the training of students of the undergraduate course in Nursing at ESEnfC.
It is emphasized that it is the intention of the clinical teaching and the objective of this article to present a multiple view of health care in an initial phase of student training, differentiated from the hospital context, often focused on the diagnosis and treatment of diseases, on the contrary, stimulate, mainly, a complementary look, highlighting the social and health resources that the community provides to the population in a paradigm of the diverse legacies of the individual influences of health determinants.
It is considered that the experience of these students, based on evidence, in the context of the European continent, can socialize a new dimension of learning in the clinical teaching of Nursing Degree.