Threshold concepts in Primary Health Care nursing education - What they are, why they matter and how to facilitate learning: A reflexive thematic analysis.

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.