Abstract:

Introduction:
Andalusia (Spain) is currently implementing a plan for the renewal of Primary Health Care. Therefore, we believe it is appropriate to reinforce the knowledge and skills of nursing students with respect to the nursing process in the family and community environment. The aim of this study is to evaluate and assess the learning of nursing students' competencies with respect to nursing care plans in family and community contexts.

Methodology:
A quasi-experimental study was carried out on first-year students of the Faculty of Nursing and Physiotherapy and second-year students of the Faculty of Nursing of the University of Cadiz (Spain) during the academic year 2018/2019. Different auxiliary material to the activity was elaborated. In addition, two clinical cases were prepared, but with different characteristics to deal with a greater number of situations in which the critical judgment of the students is fundamental (patient with dependency problems in the first case, dependent patient and their caregiver in the second case).
A pre-test questionnaire was distributed to all participating students along with specific questions on nursing process. Subsequently, they were then divided into teams of 2-3 people to resolve the clinical cases, with the possibility of exposing and discussing their impressions on the chosen nursing diagnoses. Finally, the students completed a post-test questionnaire at the end of the session.

Results:
It should be noted, in the pre-test questionnaire in the second-year students, that the majority response in 4 of the 15 questions did not correspond to the correct ones, and therefore, there were areas of knowledge in nursing methodology that could be reinforced. In the case of the first-year students, there was a higher percentage of error, especially in a question centered on the family and community context.
In one of the clinical cases, the second-year students highlighted as a nursing diagnosis the "Risk of suffocation" with 26% (9) in the dependent patient, due to the caregiver's smoking habit. It should be noted that only 5.88% of the groups warned of the data collected in the clinical case about possible risk of physical abuse through thermal burns caused by cigarettes. In the case of the caregiver, there was a large consensus in choosing the diagnosis "Caregiver role strain" as the first choice, with 55% (18).
It is important to mention the following item within the organizational aspects in the results of the post-test questionnaire: "I think that the time dedicated to the clinical case on aspects related to the family and the community is adequate", which obtained an average of 7.21 +- 2.38 points. Although the data is positive, some students pointed out that it was necessary to dedicate more time to this type of activities.

Conclusions:
Through the application of these clinical cases adapted to the family and community context, it is observed that the students value very positively the implementation of this type of activities. In addition, they suggest more time for the realization of these clinical cases. They believe that these exercises will increase their competencies in nursing methodology and improve their future professional performance in primary care.

Keywords:

Primary Health Care, Nursing Process, Clinical Competence.