In response to the persistent problems of “difficult and expensive medical treatment” in China, family doctor contract based services and related policies have become important content in deepening medical reform and promoting graded diagnosis and treatment in recent years. Existing research is mostly based on developed large cities, mainly analyzing the static and dynamic aspects of policy implementation subjectively and objectively, However, there is less attention paid to the problems of collaborative cooperation between grassroots governments and other governance entities in third tier cities with lower levels of development. This study indicates that there are still problems with the management model of family doctors, such as “signing but not signing”, poor funding and referral between superiors and subordinates. It is necessary to further strengthen the vertical and horizontal linkage mechanism, expand the number of family doctors and enhance their professional attractiveness, and strengthen publicity to create a good social environment for the implementation of the family doctor service model, so as to further promote and sustainably develop the system.

This study explores the transformative learning experiences of nursing students during community health practicums, focusing on how these experiences shape their understanding and professional development in healthcare settings. Grounded in Mezirow’s transformative learning framework, this qualitative study employs Interpretative Phenomenological Analysis (IPA) to examine participants’ lived experiences, particularly their emotional and ethical challenges in real-world healthcare environments. Eighteen final-year nursing students, selected for their involvement in community health practicums, participated in semi-structured interviews. The participants, aged 19–21 years (with an average age of 20.68 years), comprised predominantly female students (88.88%). These students were chosen based on their exposure to complex healthcare challenges within the community healthcare context. The study identified four key themes. The first theme, Emotional Dilemmas Requiring Empathy and Professionalism, explores how students faced emotionally intense situations and developed essential emotional regulation skills. This theme highlights their ability to balance empathy with professionalism and navigate family disagreements in care decisions. The second theme, Ethical Dilemmas in Patient Care, addresses the ethical challenges students encountered, including decisions related to patients with limited recovery potential and respecting patients’ autonomy when they declined treatment. Through these experiences, students refined their ethical reasoning and decision-making capabilities. The third theme, Navigating Roles and Responsibilities within Community Healthcare Teams, examines how students clarified their roles within multidisciplinary teams, improving their communication and collaboration skills. This theme emphasizes the growth in confidence and adaptability as students engaged in team-based care. The fourth theme, Resource Allocation Ethics in Community Healthcare, discusses the challenges posed by resource limitations. Students developed critical thinking and adaptability as they navigated ethical dilemmas related to resource constraints, particularly in home visits and access to care. Through these experiences, students critically reassessed their beliefs, refined their ethical decision-making, and developed emotional intelligence and problem-solving strategies. Reflective practices, including journaling, played a key role in bridging theoretical knowledge with experiential insights, further enhancing adaptability and relational understanding. The findings underscore the significance of integrating transformative learning principles into nursing education. Structured experiential and reflective practices foster critical thinking, emotional regulation, and interprofessional collaboration, thereby preparing nursing students to address the challenges of contemporary healthcare with professionalism and ethical integrity.