INTRODUCTION

Nursing in its training curriculum executes an educational practice towards health care, based on strategies and pedagogical actions that tend to restore or improve the health conditions of the population; therefore, care must be focused on a pedagogical practice to consolidate a university education based on humanism and social justice, hence, pedagogical practices constitute a process that unfolds in the classroom, laboratory or field of action, where the teacher-student relationship focuses on the construction and application of knowledge involving shared learning ¹.

In this sense, nursing care involves and shares the human experience through a transpersonal relationship of respect ^1,2, trust and dialogue between teachers and students; dimensions of care that are learned over time and that it is important to practice and model it in the training of the nursing profession; since the teacher becomes the role model for the student and may imitate certain behaviors. Derived from this, the professors recognize, to teach Nursing care, it is necessary to do it with practical examples and anecdotes, so that they can discuss and understand what the books or scientific evidence explain what is done in practice ³.

Regarding the didactic strategies in the teaching of care, teachers must consider essential aspects such as motivational problems towards learning and towards the profession that students may have, the environment in which they live, the school and the clinical area, which will allow establishing a link and identity as future nursing professional ⁴.

In addition, the innovation of learning strategies for the integration of theory and practice in nursing constitutes the current challenge in the discipline, so critical thinking and theoretical orientation are tools that facilitate the consolidation of disciplinary identity and decision-making. Decision making. Decisions are consistent with the value system of their discipline ⁵.

In this way, the educational environment demands from teachers a broad disciplinary and pedagogical domain; Diversity in teaching should be considered, which allows students to have confidence, hope, courage, patience, continuity, and constancy, as well as disciplinary knowledge, which together guarantee the training of active and proactive human resources in health care in any environment.

To carry out this study, it was based on a diagnosis obtained through a previous investigation, where difficulties and challenges were identified in the practice of the pedagogical practices of undergraduate clinical practice teachers in Nursing, related to pedagogical and didactic planning, the use of teaching strategies. And techniques and the achievement of curricular objectives. This marks academic and professional challenges, although the discipline frames the actions of the nursing profession, humanism and interpersonal relationships must also be reinforced in the teaching process, to achieve a comprehensive training of future nursing professionals.

Faced with this scenario, the questions arise: How are nursing students being taught caré And What proposals can be obtained to improve the teaching of caré To respond to these approaches, the researchers of this study planned and carried out a training course for teachers of clinical practice in nursing, on the "Teaching of care", to raise awareness about their pedagogical practices and carry out their strategies improvement or enhancement. Solutions to the real context of teaching practice.

Therefore, the objective of this study was to participate in a participatory way in the training of teachers in the teaching of care, through the awareness and interpretation of their pedagogical practices that transcend the academic performance of the students of the Nursing Degree.

METHODOLOGY

This research has a qualitative-interpretative approach, for which the Action-Research method is used in the educational area of ​​nursing since it integrally links the participation of the community (researchers and teachers) to raise awareness and improve its teaching Praxis ⁶.

The development of this research considers as a scenario a university nursing institution in the State of Mexico. Authorities' permission was requested to be able to work with clinical practice teachers who teach undergraduate learning units. It is worth mentioning that the research is derived from a macro-project entitled “Pedagogical practices for an innovative teaching model of nursing care - Brazil and Mexico”, approved by the Ethics Commission of the Academic Body.

The stages that continued this research are based on the Susman and Evered Action Research Model ⁷.

Diagnosis

Derived from the results of the macro project, it was concluded that the teachers of the Faculty of Nursing define pedagogical practices as the processes that explain how to maintain a stronger interaction with the student and that this, in the end, is reflected in more meaningful learning, which is why they place the student as an active and responsible agent in the learning sequence. Although this concept is consistent with the definition of pedagogical practices, certain difficulties and challenges were identified when talking about their practice, since teachers mention that many times the relationship with students is difficult due to factors such as pedagogical planning and didactics, the use of teaching strategies and techniques, the achievement of curricular objectives and communication, as evidenced by the following arguments:

"[...] I think we have a certain fear, because ... Well, they will learn what we teach them, so if we don't know, we can't teach [...] I also had to learn to organize myself to express myself in front of the group [...] All this at some point is difficult for us, but then we gradually [...] acquire more of the way we organize ourselves so that it is also easier for them and for us” E2.

"At first it was difficult for me to teach the students how to achieve the objectives of the program, I knew that I had to document, update and move, learn and implement teaching techniques" E3.

[...] my two difficulties: First, the content that is very broadly comparable to time and the other is that, with very large groups, it is difficult for me to evaluate skills [...] The truth is that I try to do it [use active methodologies], but it is quite long, and, to a certain extent, it is much more work for the teacher, [...] E4.

"Since each student learns in a different way, I think the most difficult thing is having different learning methods and getting to know the students as they learn because I can only have one method, but it would not be effective for one, everyone has... Different learning abilities E5.

"In nursing, we lack that pedagogical training and strategy ... We have the knowledge, we know it, but we lack a lot to be able to share it with the students in a more successful way" ... E6.

Consequently, under the reflection of the experiences and daily experiences product of the teaching practice of nursing, the researchers made the decision to actively intervene in the improvement of these situations by taking a course whose purpose would be to raise awareness and improve their pedagogical practices in the teaching care.

1. Action planning

The intervention-action of the researchers towards the practice teachers, a course-workshop was carried out with two calls, one for the morning shift and the other for the afternoon shift. We worked with 30 undergraduate nursing professors selected at the convenience of the researchers, who met the criteria of Minimum 3 years of experience in teaching, the teaching of clinical or community practical subjects in the undergraduate program in nursing, and enrollment to the courses offered.

The course was scheduled for a week, five hours a day, 25 hours in total. The topics addressed in this intervention were: epistemology of care, humanized care, reflective and critical thinking, educational model of the degree, teaching, and pedagogical practices in nursing, which were taught by full-time teachers and researchers from the educational institution.

It is worth mentioning that for the development of the course sessions, the theoretical approach proposed by Maguerez was used in its five stages: 1) Observation of reality, 2) Key points, 3) Theorization, 4) Solution hypothesis, 5) Application to reality.

2. Carrying out the action

During each session of the course, the experiences, opinions, and perspectives of the participants were documented through audios, with prior consent. For this stage, reflection and criticism of the teachers attending the course were encouraged, with the aim that the characteristics, problems, and possible solutions regarding their teaching and pedagogical practices were identified as a group. Content analysis was used to classify and interpret the testimonies of each participant and open categorization was used, which resulted in four categories and subcategories:

To preserve the identity of the participants, their statements were identified with codes formed by the letter "P" (participant) followed by the corresponding number assigned to them during the meetings.

3. Evaluation

The evaluation of the course was developed through a qualitative assessment, in which comments and final conclusions were obtained from the participating teachers.

4. Definition of new knowledge

As a result of the investigative action, changes were observed in the attitudes and disposition of teachers to improve their teaching practice, acquiring individual and collective commitments for quality nursing teaching.

RESULTS

The results shown below represent the last three stages of the Susman and Evered Action Research Model: taking the action, evaluating, and defining new knowledge.

Carrying out the Action

In this stage, the experiences and opinions of the teachers were documented in the face of the reality felt and lived in their teaching practice daily, among this accumulation of reflections, the a) Meaning of the teaching of care can be identified, which they consider being a construction of a human relationship, with the use of strategies to strengthen the student's competences: I teach to transcend in life, for personal and social well-being. P-2

To strengthen knowledge, skills, and attitudes for everyday life -people training-. P-8 Increase self-knowledge. P-9

Improve the learning strategies and knowledge of the person from the experiences that the teacher had as a student. P-10

Also, among the speeches, ideas, and conceptions around the application of care were identified, where the teaching of care begins with the self-care that teachers infuse in each of the students, as seen in the following story:

Make students aware of providing human or humanistic care. As a teacher, I care about their physiological needs or the needs that he has, then he is going to worry about the needs of his patient; because he knows that it is an action that must be taken as a nursing professional, unlike, as some teachers say: you cannot eat, you have to get up at 5 in the morning to have breakfast, that is, you cannot come to have breakfast here do not? Then he says: not then if she doesn't let me have breakfast because I must let other people have breakfast and she becomes like the example again. P-17

As the intervention sessions passed, the teachers self-reflect and can express the way in which the teachings obtain a greater impact when they start from the example, for this reason, their experiences are described in the b) Pedagogical practices based on the example (hidden curriculum):

... also with our example, that is, if I can, you can also, and it is being made like a chain, if my teacher can, I can also, and that word is very big, very strong, with a great meaning already time is very simple; Because they are things, maybe they are not easy but they are simple, that we have the ability to do and teach the student, that little by little with those actions in which we are training them, what we are learning, well we can do great jobs, in the end, Yes, of the day is to believe that we are capable, obviously it is to put the chain on them so that the fire of their knowledge is lit. P-9

Derived from these reflections, teachers also consider that establishing a relationship and accompaniment during clinical practices generates a teacher-student interaction, which allows strengthening the sense of belonging to the nursing profession, as shown by the following comments:

I believe that the student's identification with the career is rooted, it is a very important situation if from the beginning he is not aware of social responsibility and the impact that his career has, he does not identify with it, now the impact that it must be a nurse or a degree in nursing... To return from the University entails having values, having the commitment, and social responsibility, all this situation entails that the student feels identified with their university. P-12

Lately, to get to know the students in some way, I made an identification card, who they are, what they do in their free time if they like nursing, why did they study nursing and, I have realized that there really are students who are theirs last option or they are studying nursing, because that is how the family wanted it, so during the development of the practice, perhaps, support and motivation are qualities to be a nurse and make them like it, that they see the essence of what it is Being a nurse, however, sometimes they also face staff who are really the same, for example, emotionally speaking, the truth is that we have nurses in hospitals who are like this, that is, they became nurses because it was your last choice ... P-4

You also know many problems or many situations, for example, they are here supporting their career, sometimes they do not have money for the passage, I have seen that in that way it also impacts, that is, there are many situations, but if it is to listen to them and motivate them to discover those qualifications or abilities that they have, that's good, for my part personally he also learned from the students. P-6

In addition to this reflection, teachers consider that undoubtedly the promotion of security and self-confidence is a strength that helps students to face adverse situations, which prepare them for their professional life.

I support them, I give them security, I always tell them -you can-. Well, as a teacher, I provide security and motivation to the student, so that he continues studying, he has the knowledge, disposition, and initiative, so there is the same institution takes advantage of it. P-10

More than anything, convince them to have that confidence in them because in the first semester they are given anatomy, many subjects that would be part of their training, but they are never told that they must believe they are nurses, from the first moment they enter here to the Faculty and they say I am a student of the Faculty of Nursing, but they say it as head down, as well as that they do not believe it; And the way they speak to them, they call them a student or a young person, so if they need to believe it, I see that they are not told by the nurse. P-11

… We are all teaching differently, I think we should teach ourselves, we are colleagues; I tell the student I am going to teach you, if it can be done with the help of the nurse, to do a procedure. It gives him certain security and confidence, if I leave in the teaching plan the student forms a barrier. P-1

In this sense, when analyzing their experiences as teachers, they consider that empowerment should be working with students, since they have identified the link between professional identity and being nursed professionals, as a way in which students can develop all its capabilities:

But in the end, we are nurses, to have that professional identity what do you have to do ... You must be professional, that if there are still missing or some such as certain attitudes ... Then we are going to strengthen the identity, and I also see that the student must learn an objective that is to take care of him, how you are going to take care of him, to be there and tell him I am helping you, I tell my students we are going to teach you as a nurse… to be as a professional. P-17

Probably what we teachers demand is to tell them that they have to believe it, because in other careers they are already the chemist, dentist, dentist, in all subjects they are told like this, if not simply tell them, hey, if you are sure you want to study, then you start to believe that you are a nurse, you lack a lot of knowledge, yes of course, but start to believe that you are going to do it and you are going to be the best, ask a sixth-grade student and put him together with other students. What do you study? because they are still not able to say with pride Nursing, they lack that. P-11

In addition, they consider that empowerment allows them to fall apart in different nursing contexts, especially in those that require autonomy, leadership, and decision-making, as well as require relationships with multidisciplinary groups, where students must position themselves as experts before health care.

In the field of public health, being in the community is very different, because the student there is everything, the student there is the one who knows, the one who attends, the one who gives everything, and the people around him empower him. More, because they say how is it possible that you know so much, how it is possible that you are a nurse you know all that, -I thought that they only channeled, -I only thought that they injected and channeled-; and there the paradigm changes, but within the hospital, the student has many agents that damage his self-esteem as a professional P-13

... Certain students who had in the occupational health practice, request to be involved with other characters that have nothing to do with health, for example, engineers, even the president of the company, then that gives the other opportunity to be able to relate to other individuals or professionals who are not from the health area and then since he is the only one who has the possibility of expressing that power in his area, he has to empower himself and say, I have to promote health with them and then they see that do have the commitment and that they are an authority Figure there, that they have a voice and vote. P-12

These testimonies are evidence of the reflection exercise that do the teachers about their pedagogical practices, in consequence of the topics addressed in the course. In the last sessions and the product of self-analysis of their pedagogical practices, teachers have reached the c) Identification of needs to improve pedagogical practices, in this category, the teachers identified that the didactic planning that guides some learning units presents certain weaknesses, which they describe:

We really need to see the program on the subject, both theoretical and practical, to gather the elements and resources necessary to achieve the competencies and, perhaps we must start in the formal part and improve the real part of the practice ... P-3

In the development of the practice, it is sought that the students acquire skills, but, the theoretical classes sometimes contribute little and, what had already been planned, does not apply because the students have deficiencies, so those plans sometimes cannot be applied to a hundred, For example, clinical fields are sometimes reduced, so students spend 5 to 6 days in an area and there they cannot achieve skills, sometimes what is planned is not applicable to reality P-8.

Continuing with this self-reflective exercise, some teachers agreed to have weaknesses in the application of teaching techniques:

I think that I lack techniques, that is, I do it empirically, I would like to have that fundamental part of how I can strengthen student learning. P-1

I think that teaching strategies or techniques sometimes fail us, but it takes courage to recognize that as teachers there are faults in teaching, that the ways of doing it are not always the best ... P-11

… What is the strategy that we are going to do to work the procedural part and the attitudinal part? So maybe problem-based learning ... I'm not going to tell the students the concepts because they can download that from the Internet, they will copy it and they won't read it, what I'm going to do in my teaching, is that each content is focused on reality, where the student has to apply ... knowledge, combination, analysis, synthesis, and evaluation and in that way, perhaps we could get to the other side and have already crossed the ditch, we are so on the other side P-15.

In addition to these experiences felt by teachers, they recognize that in their teaching practice they face the lack of links between theory-practice, as described below:

I believe that in our teaching practice, in the classroom or clinical setting, be it community or hospital, what should we teach the student? In other words, we are going to emphasize the cognitive part of the declarative part and, perhaps where we have left off if we see it through Bloom's taxonomy, pure knowledge, pure knowledge, and the student who recites everything to us, is OK, but we haven't moved on to the next step, which is understanding, so we are staying in that declarative part. P-14

The need arises to sit down with colleagues to integrate theory and practice and that they both do the same program as if the practice program were going to theory and as if the theory we're going to practice, if right now we cannot, We cannot demand that today they give me theory and the next semester practice because at least we can sit down so that the two can communicate or talk, but really, maybe time doesn't give us and maybe we can only change in unit one, but that this is enough, that it gives us time to be able to change the four units or the five units, but that we take that part so that we can check how much yes, how much we can promote this type of participatory learning for them. P-4

Undoubtedly, the teachers' experiences allow us to describe the concerns and concerns felt during their daily practice, and from a critical point of view, it seems that they present doubts about the practice of the necessary teaching processes in practical settings; The compiled arguments regarding their feedback from the applied course are presented below.

Evaluation

At this stage, teachers mainly express their gratitude to the experts who taught the course, to the authorities of the institution for worrying about their experiences and uncertainties regarding their teaching practice:

I thank you for having that interest in us because, not in back steps, they really did not take us like that here you have to work this and who knows how to do it and that is the interest that the faculty must keep us trained and updated for the student and that's how you also get hold of that, right? Because if not, I have no idea how to transmit it, how am I going to teach it to my student? Because there are demands, but there is not that part of training and I do thank you, Doctor, who has always had this concern about us being trained and these courses at Inter I already missed them P-2

These leaves comments in evidence of the felt need of teachers for academic-professional accompaniment and guidance, as well as continuous training to improve and update their pedagogical practices.

Definition of new knowledge

This is the last stage of action research, and it is where the learning results of the intervention are described, so it is important to note that the group reflection exercise on their performance in the teaching exercise allowed teachers to make commitments with them. Themselves, as well as strengthening work teams to achieve better learning results with students, as described below:

… Enriching ourselves with all our opinions, with our experiences… It was a course too rich and clear as everything, right? Maybe we lacked the time, or we lacked to be more dynamic, but he considered that it was a good course and above all the learning that I had from our teamwork as a union, as fellow practitioners were very good, thank you. P-5

... I want to tell you that I see the great difference between last year and this ... Well, now I'm going to lead a group... I felt supported by some of the colleagues who told me: don't worry, look, you're not going to cost work, you must do this, you must do the other. Today I feel extremely happy and very motivated, precisely because I see that you are committed, because you are at the forefront, because you are familiar faces because you are instilling all this confidence in us because you are talking to us about the empowerment that we need outside because I see all the circumstances and I realize that all my colleagues go through the same problems that we do because this coexistence strengthens us as professionals P-7

In addition to teamwork, teachers consider it essential to continue with continuous training:

As we share them here in the group, in the various teams that we make up during the course, and as the days went by, I realized that there are things in which we agree, in opinions, in techniques, and in what we do well, just what is lacking is to strengthen, continue training us and I consider that this is a good opportunity to get to know each other, to share, to understand the point of view of the partner, so that perhaps he understands us and strengthens us with what they know, well the topics that You gave us the truth is that they are very good! In other words, they enrich us a lot. P-5

Finally, teachers recognize the opportunities for improvement that they can have in their pedagogical practices:

I believed that there were situations that were only experienced in my practice, that perhaps as a teacher, only I perceived certain things about my students, but in this course, I realized that no, that there are generalized situations, just as there are students who have many There are students who we must support ... But, enriching ourselves with all our opinions, with our experiences... It was a too-rich course... And above all the learning that I had from our teamwork as a union, as fellow practitioners were very good, Thank you. P-5

... It was really an honor... I have learned a lot ... One leaf with the same commitment and with humanism... So, for me always the magic word is and will be to transcend, transcend for and with the students .... Someone told me, do you have children? No, I don't have children, I have many children, many little plants, little seeds in which something of me was inserted and right now they are germinating, they are being my colleagues ... P-4

... I am leaving with high expectations; I must keep learning and I must keep documenting myself to be able to solve situations that arise in practice and my goal is also to leave that little seed ... I have realized that yes, that is, I have left a grain there, even if it is a grain of mustard as he says, and I have seen my students get ahead. So, I am happy and especially with that challenge because I know that I still have many things to learn, thank you… P-8.

DISCUSSION

It should be mentioned that this study contemplated the reflection and professional commitment of Nursing teachers in teaching care to students, in turn, sharing divergent and convergent points of view that unite in a common objective: to train human beings who they take care of people. This coincides with the proposal of far-reaching educational projects for the formation of responsible and committed subjects in creative interventions with reality, highlighting that this entails a great challenge. Pedagogical practices are a shared construction of new ethical and political commitments for health products, for teaching and learning, for scientific research ⁸.

In the same way, difficulties or situations that complicate the teaching of care were found, derived from the student-teacher interrelation and from the different learning environments in Nursing practice; Regarding this, Barbel, refers that the conception of historical-critical education has a greater purpose of preparing the student or human being to become aware of their world and to act intentionally to transform it ⁹, this transformation being the form of transcending from teachers to students.

In the training of nursing professionals, between 40 to 50% of the credits are clinical practice and the recommended teaching methodologies that reinforce the experience are problem-based learning (PBL), evidence-based practice (EBP) case study, clinical simulation, authorization, and clinical supervision¹⁰. As well as experiential laboratories and socio-drama ¹¹. This is related to the way in which the professors provide the teaching of care to the students of the faculty.

The pedagogical practices constitute a process that unfolds in the context of the classroom, laboratory, or field of practice, in which a certain teacher-student relationship is revealed focused on the construction and application of knowledge, they involve a network of interpersonal and transpersonal relations with shared learning ¹¹, it is in this same sense that the Faculty teachers define as indispensable components of their pedagogical practices, the relationship, and accompaniment to the students, which favors the empowerment, security, and confidence of their students.

The need for continuous training is also highlighted, as a way of exchanging experiences; results that coincide with those found by Tejada and collaborators, who recognize the need for training in information technologies, pedagogy, and didactics that use the innovation and application of various teaching methodologies, which constitute the necessary tools to achieve the profile of the university teacher and meet the graduation profile ³.

Although the challenges to be faced to improve the pedagogical practices of undergraduate nursing teachers are still diverse, it was observed that through the course on teaching care, the ethical vision and humanism demanded by our profession was promoted and rescued and, therefore, hence, the education of future Nursing professionals.

CONCLUSION

The purpose or objective of the pedagogical practices of the teachers of the faculty is to: Transcend, reduce fears in the student, achieve and develop professional and human skills and increase knowledge.

Pedagogical practices must be taught by example, or what we know as the hidden curriculum.

The relationship and accompaniment to the students, the empowerment, the security, and self-confidence, are pedagogical practices that should prevail in the teaching of the care of future Nursing Graduates.

Among the participating teachers, pedagogical and didactic needs were observed to favor teaching, as well as a lack of a link between theory and practice.

It is necessary to strengthen work teams and continuous training in the teaching of care, distinguishing that there are opportunities for improvement in the development of pedagogical practices.