Educational processes in primary health care: nurses’ role and approaches to advanced practice

Abstract

Health education is a central dimension of nursing work in primary health care (PHC), expressed in individual and collective actions with users, families, and teams. In Brazil, nurses play a strategic role in coordinating educational processes, but many initiatives remain fragmented, poorly evaluated, and weakly grounded in theory and scientific evidence. This integrative review aimed to analyze educational processes conducted by nurses in PHC and their proximity to advanced‑level practice. Searches were performed in LILACS, SciELO, MEDLINE/PubMed, and CINAHL (2013–2026) using controlled descriptors and free terms related to primary care, nursing, health education, in‑service education, preceptorship, advanced practice, and evidence‑based practice, in Portuguese, English, and Spanish. Empirical studies and institutional documents addressing nurse‑led educational actions in PHC were included. Twenty‑seven documents met the inclusion criteria. Thematic analysis yielded three main axes: patient‑ and family‑focused health education; in‑service education and preceptorship; and the interaction between educational activities, clinical autonomy, Evidence‑Based Practice (EBP), and ethics. A large number of educational actions was identified; however, they showed low degrees of systematization, limited outcome assessment, and incipient integration of scientific evidence. Nurses in PHC show clear potential to perform advanced‑level educational roles, but consolidating this profile requires institutional support, specific pedagogical training, and strengthening of a culture of research and evidence use in daily practice.