Introduction: the strategy is a pedagogical approach to the teaching process that is implemented in the subjects and disciplines of the curriculum. They are aimed at integrating knowledge by addressing complex problems and objects that lead to the training of professionals with a broad and relevant profile. Objective: analyze the ways to apply different curricular strategies in the undergraduate degree in Nursing. Development: the contemporary University is called to achieve a graduate whose training is increasingly comprehensive, with new perspectives from various factors and social contexts. In the Nursing degree, the implementation and impact of curricular strategies in the comprehensive training of students stands out. Twelve key strategies are identified, which try to incorporate a new aspect to the vision of the characteristics of the training process. It is essential that the teacher encourages participation, reflection, debate, and interpersonal relationships among students, in such a way as to favor the formation of criteria specific to the future graduate. Conclusions: curricular strategies, from the methodological work of each of the groups of teachers, have to integrate all the elements that make it up to articulate them and seek the learning of significant content and the apprehension of human values for the comprehensive training of future nursing graduates. Its application in practice requires the development of methodological work of interdisciplinary coordination, which allows strengthening the teaching-methodological process.

The strategy, line or curricular axis is defined by Horruitiner, (1) as a pedagogical approach to the teaching process that is carried out with the purpose of achieving general objectives related to certain knowledge, skills and modes of professional action that are key in their training and that cannot be achieved with due depth from the perspective of a single discipline or academic subject. To achieve this, it requires the participation of more than one curricular unit of the degree. (2) 

Curricular strategies in medical sciences are pedagogical approaches that are implemented in the subjects and disciplines of the curriculum. Its objective is to train comprehensive professionals with solid scientific knowledge and principles. (3) In Cuba, higher education is premised on achieving the formation of the personality of young people in values ​​that characterize their professional performance. To achieve this, three essential dimensions included in the educational teaching process are identified: educational, instructive and developmental. 

The curricular strategies aim to develop knowledge, skills and modes of professional action that lead to the training of professionals with a broad and relevant profile that can respond to the health needs of the population. They seek to perfect professional modes of action and health services, training professionals with a high scientific and cultural preparation, with a system of well-consolidated human values.  (4)

In the Cuban Universities of Medical Sciences, curricular strategies are aimed at integrating knowledge by addressing complex problems and objects in a multilateral and integrated manner, teamwork is encouraged, achieving the suppression of barriers by linking methods, practices and knowledge. These seek to establish clear expectations with a sense of direction that supports students in their progress toward their goals. (4)

The implementation of curricular strategies is enriched with valuable contributions from international and national authors who, in different contexts, refer to how to organize them and put them into pedagogical practice in Higher Education. At an international level, those studies that conceive the curricular strategy as a transversal axis that integrates a system of coherent actions and ensure compliance with the stated objectives stand out. (5) 

In the national context, those jobs that favor the use of an interdisciplinary or transdisciplinary approach through concrete actions staggered by years throughout the career stand out. The transformation of the student's personality until the professional personality matures means that the graduate must be able to achieve comprehensive professional performance. (6)

The achievement of this performance is the expression that the graduate has achieved a solid scientific and technical preparation, a humanistic training and the development of his philosophical thinking. All of the above must be supported by an ethical platform, the development of which is the fundamental content of the main strategy. (7) 

There are well-established psychopedagogical criteria, there are practical experiences of their application in the world and in Cuba, many of them highly positive, and at the same time with negative aspects of their application that constitute the sources and bases for their improvement. The strategies are basically aimed at ensuring that graduates are able to project economic and health thinking with an environmentalist approach with adequate professional action and performance. (8) 

In recent years, in Cuban Higher Education, a group of curricular strategies has been conceived that, due to their general training content, constitute invariants for the different careers. In the Medical Sciences there is a history of applying these strategies and currently they have been taken up in a curricular context that has varied in various ways. (9)

In this way, the current design of the study plan has included various curricular strategies of interdisciplinary coordination. They are aimed at establishing a system of influences that serves the development of the comprehensive professional personality of students and future nurses. The authors intend to analyze the ways to apply different curricular strategies in the Bachelor's degree in Nursing.

Development

The contemporary University is called to achieve a graduate whose training is increasingly comprehensive, with new perspectives from the various factors and social contexts in which this student interacts and seen from his training process due to the imprint demanded by the transformations of the curriculum. (10) In the Nursing degree program, the implementation and impact of curricular strategies in the comprehensive training of students stands out. These strategies are essential to develop professional skills, improve the quality of care and promote patient safety. 

Twelve key strategies are identified, including the development of communication skills, ethical training and knowledge management. Interdisciplinary coordination is essential to guarantee its effectiveness and contribute to a more integrated and quality education in the field of health. (9)

The most effective curricular strategies in the nursing degree include: (9)

Mental Health Nursing: addictions constitute an important health problem in the world and equally in the country. Its content is very diverse, since it ranges from medications to other types of substances that are prohibited or not, but that, in general terms, cause effects on the health and balance of human beings with their natural, family and social environment. Hence the importance for nurses, throughout their training, to incorporate the knowledge, skills and values ​​that allow them, first of all, to adopt healthy lifestyles as a person and, from a professional point of view, to show their competence to provide comprehensive nursing care to people at risk or with addictions.

1. Administration of Nursing Services: the administrative function is one of those defined in the exit profile of nurses in the three levels of training in which the career is structured. Hence the importance of achieving a basic development of the essential management skills of future professionals, which allows the incorporation of concepts of practical use such as quality and continuous quality management, applicable in health services.
2. Elderly curricular strategy: one of the consequences of this population change for the National Health System is the need to adjust the pre- and postgraduate training processes to these characteristics of the population. Health care for the elderly has its specificities. Hence the importance of paying attention to normal aging processes and the care required by healthy or sick people in this age group in all medical science careers.
3. Learning the English language: the accelerated development of science and technology in our time, poses to the integral professional the need to know at least one foreign language to be able to stay outside the various fields of knowledge and establish accurate communication through the use of human language. All of this requires efforts and preparation to transform study programs based on interdisciplinarity.
4. Interpersonal Communication and pedagogical training: the development of communication skills in nurses promotes the establishment of adequate helping relationships, which are consistent with the facilitating attitude of the nursing professional. All of this transforms the therapeutic relationship into an ideal of personal interest and attention to the activity that is being carried out.
5. Health Informatics: the development of computer skills will provide them with mastery of computing and information and communication techniques (ICT), as well as providing them with the means for their development in knowledge management and continuing education. Directed by the discipline, Health Research, coordinated with the main integrating discipline and other subjects of the study plan participate. This strategy responds to a basic function of nurses.
6. Genetics in Nursing: Genetics is the science that studies the elements that govern the development of living beings and their inheritance. One of the factors that contributes to improving the infant mortality rate in Cuba is the prenatal care that pregnant women and their children receive, which includes screening for genetic disorders, associated with genetic counseling and other actions. In this entire process, nurses play a prominent role since they are responsible for an important part of the actions carried out. Hence the importance that in their basic training they acquire the knowledge and skills that allow them to participate in them with quality performance.
7. Nutrition: the comprehensive approach to care is a common characteristic of all health-related professions in Cuba. The transition from a healing paradigm to an integrative social model requires a change in the contents and approaches of the training processes. In the particular case of nursing professionals, the regulation of practice in the country attributes to nurses’ great responsibilities in care, with more emphasis on health promotion and disease prevention actions. The need to structure a curricular strategy on nutrition, as it is an area of ​​knowledge that is not restricted to a single discipline or a certain moment in the career, but rather its mastery must be achieved by the student throughout the training process with a multidisciplinary and interdisciplinary approach.
8. Development of professional personality: ethics in the Nursing professional: the comprehensive approach to educational work in universities was conceived as a work strategy aimed at establishing a system of influences, which serves as a framework for the development of the comprehensive professional personality of students and future university professionals. The system is structured in three aspects or dimensions: curricular, sociopolitical and extension, convergent in their objectives and divergent in the ways and means that each one uses depending on said objectives.

The transformation of the student's personality until the maturation of his or her professional personality means that the graduate must be able to achieve comprehensive professional performance. The "E" study plan creates the conditions so that the student can achieve solid scientific and technical preparation, humanistic training and the development of philosophical thought, as long as the process has the required quality and demands.

Public Health, Medical Geography and Environment: the integrative social approach to the exercise of professions related to human health entails the consideration of the determinants of health, in which the environment plays a very precise role. Therefore, in addition to responding to the needs and development of the culture of environmental care, the training of nursing graduates, framed in the environmental approach, has direct implications for professional competencies. Hence the importance of its adequate curricular projection.

The strategy will allow nurses to act professionally with respect to their environment, environmental and development problems, with an integrative social approach, characterized by the competence to develop actions for the promotion, prevention, recovery and rehabilitation of the health of individuals, families and communities, within the purpose of the nursing profession. 

Human Sexuality: sexuality and human health are closely related, since to enjoy a full, responsible and happy sexuality the individual must be physically, psychologically and socially in balance with the environment that surrounds them, that is, healthy. Furthermore, sexuality is a source of important health problems in whose attention the role played by male and female nurses is relevant, due to the functions they are assigned within the programs aimed at the care of various health problems that in one way or another are related to the way in which people and society assume sexuality.

Mother Tongue: in the educational role of the university, it is responsible for promoting and developing the Cuban variety of Spanish and, in particular, favoring the development of professional verbal behaviors that require mastery of the professional skills of reading, analysis and construction of the academic and scientific discourse on which the teaching-learning processes rest. In the process of curricular improvement, the coordinating Spanish subject of each strategy has been defined.

The curricular strategies declared for the nursing degree program try to incorporate a new aspect to the vision of the characteristics of the training process. They have projected the development of professional modes of action for all the functions of the professional graduate of his time, at the service of the interests and needs of others. 

With everything stated up to this point, it is pertinent to point out that for the implementation of these strategies, the incorporation of computing and its different forms linked to education must be taken into account. It is necessary to use scientific research as a methodological tool for action, planning and execution of interventions that contribute to raising the quality of patient care.

The actions of the curricular strategy in this sense must include ways to ensure that the future graduate is systematically updated and oriented throughout their training in the changing scenario of methodological and statistical computer tools. This will allow them to be successful in finding solutions to real problems in the field of health, with applications and specificities of the scientific method in each training scenario. 

It is essential that the teacher encourages participation, reflection, debate, and interpersonal relationships among students, in such a way as to favor the formation of criteria specific to the future graduate as a health professional.(10) Medical education that does not respond to contemporary cultural and intellectual needs runs the risk of forming citizens with educational deficiencies, which will make their professional development difficult.

The moral education of students based on the internalization of a certain system of values, through a process of conscious, contextualized and argumentative personal construction, has very favorable conditions in the teaching-educational process due to the way in which it integrates the two guiding ideas of Cuban Higher Education: the unity of education and instruction and the link between study and work. (9) The above invites us to reconsider problems of university teaching, related to the role of the teaching staff as facilitator, as expressed by researchers Sánchez, et al. (11)

In relation to the above, studies by Agramonte and Farres, (12) conclude that curricular strategies influence the training of a competent professional, which translates into good, safe and responsible practices in their field of action, although for this there must be methodological action in the teaching staff that favors adequate implementation. The above includes the responsibility that all teachers and other actors in the process have in working for the moral formation of future graduates.

The curricular strategy, as a particular way of developing the teaching-learning process, must be characterized by having an interrelation between the contents and the theoretical and practical methods corresponding to the study plan that is developed, which contributes to the formation of a future professional committed to their work.

This requires new approaches and strategies in the training process of students and professionals, while recognizing the challenges present in the development of the necessary skills for students. It is necessary to strengthen teaching within educational institutions, both among teachers and students, and adapt it to the current labor market with the continuous training of nursing human resources in different health entities.

An action that the authors consider very effective, based on their own experiences, is that interdisciplinary groups are formed in each center to address the development of strategies and that they are articulated in the methodological work with the career group. In this way, the main integrative discipline takes the lead in developing the system of influences that must be consciously and intentionally offered to students.

The curricular strategies, from the methodological work of each of the groups of teachers, have to integrate all the elements that make it up to articulate them and seek the learning of significant content and the apprehension of human values ​​for the comprehensive training of future nursing graduates. Its application in practice requires the development of methodological work of interdisciplinary coordination, which allows strengthening the teaching-methodological process.

Conflicts of interest:

The authors declare that they have no conflicts of interest.