Related Experiment Video
Updated: Sep 16, 2026

Using Learning Outcome Measures to assess Doctoral Nursing Education
Published on: June 21, 2010
Threshold concepts in Primary Health Care nursing education - What they are, why they matter and how to facilitate
Debbie Procter1, Kylie McCullough2, Debbie Massey1
1School of Nursing and Midwifery, Edith Cowan University, Australia; Faculty of Health and Human Science, Southern Cross University, Australia.
Aim:
To identify threshold concepts encountered by undergraduate nursing students during Primary Health Care placements, examine influences and supports that help students master these concepts, and explore how addressing them may better prepare students for placement and future workforce.
Background:
Primary Health Care workforce shortages are a growing international concern, emphasising the need to better prepare nursing students for the complexity of Primary Health Care practice. Threshold Concepts provide a lens for examining how students develop new ways of thinking and learning; however, little is known about the threshold concepts encountered during Primary Health Care placements and experiences. Understanding these concepts may strengthen future workforce preparation.
Design:
A qualitative descriptive study.
Participants:
Eight undergraduate nursing students who had completed Primary Health Care placements.
Method:
Semi-structured interviews were conducted in 2026, via an online platform and analysed using reflexive thematic analysis.
Results:
Two threshold concepts underpinning transformative learning during Primary Health Care placements were identified. The first transformed students' understanding of patients by shifting their perspective from illness- and procedure-focused care to understanding the person within the broader personal, social and environmental factors that shape health. The second transformed students' understanding of nursing by integrating previously fragmented knowledge to understand the whole clinical picture. Threshold concept mastery was facilitated through authentic Primary Health Care experiences, supervisor1 guidance and debriefing, with supervisors playing a critical role by making expert thinking explicit.
Conclusion:
These findings provide new insight into how transformative learning occurs during Primary Health Care placements. Identifying threshold concepts and the educational processes that support students to master them offers a theoretical foundation for intentionally designing learning experiences and supervision that better prepare graduates for contemporary nursing practice and the future Primary Health Care workforce.
Related Concept Videos
Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
Patient-centered Care
Concepts of Health and Illness
Critical Thinking II
Theoretical Foundations of Nursing Practice
Theories provide a perspective to assess patients' conditions and organize data and methods. They also assist in analyzing and interpreting information. They represent a...
Critical Thinking I