The hidden and the informal curricula in nursing education: a possible way to stop the crisis of caring

INTRODUCTION: The hidden and the informal curricula are two dimensions of learning that transmit moral, social and cultural values. The hidden curriculum stands at the level of the organizational culture of the institution, whereas the informal curriculum is transmitted through the behaviors and relationships established by the actors involved in the learning process. These dimensions of learning, even if not formally declared, have a greater impact than the formal curriculum in the internalization of professional values in nursing education. As nursing literature highlights a loss of professional values, particularly the caring value, researchers agree that it is essential to start with education to address the so-called crisis of caring. Therefore, the aim of this thesis is to explore the hidden and informal curricula of nursing undergraduate education to offer an overview of current knowledge related to these dimensions of learning. METHODS: Nursing literature about the hidden curriculum was mapped through a scoping study in accordance with the framework outlined by Arksey and O’Malley. The content of nursing research papers was analyzed using Hafferty’s framework as reference: Hafferty suggested studying the hidden curriculum by paying attention to four domains (policy development, resource allocation, institutional slang, and evaluation). The content of each nursing article read was assigned to one or more of Hafferty’s four domains. The informal curriculum was studied through the behavior of clinical instructors, as observed by students. Clinical instructors’ behavior was chosen as students have reported this to be more influential than lectures on their professional growth; and students’ point of view was chosen because it is the most direct way to find out the consequences of the learning process, desirable or otherwise. Hence, a qualitative study was performed to describe the nursing profession as perceived by students who observed their clinical instructors' behaviors during the clinical experience. In-depth interviews of nursing students were conducted until data saturation was attained. Sixteen interviews were analyzed using inductive content analysis methodology. FINDINGS: The scoping study included 18 articles, 13 of which were published during the last 5 years. A total of 12 were research articles, 10 of which used qualitative methodology. Regarding the areas of analysis, all four areas could be identified within nursing education literature. The most widely explored area proved to be institutional policies, mentioned by 15 articles, predominantly to highlight the negative effect of the hidden curriculum. Some relational aspects, attributed to the hidden curriculum within nursing literature, belong to the informal curriculum. The qualitative study enabled a description to be drawn up of the nursing profession, as perceived by students, according to five themes as follows: the helping relationship, technical role, professional growth, working group, and contradictions and conflicts. Several examples of unprofessional behaviors on the part of the clinical instructors were reported by the respondents. The nursing profession, as perceived by nursing students, does not always reflect their expectations and their ideas of professionalism. To stem the crisis of caring, educators should work at the level of the hidden and informal curricula using appropriate learning methodologies and instruments to measure caring behaviors. CONCLUSIONS: Overall, the loss of the ability to care is a critical issue that emerges from this thesis, supporting the idea that nursing education plays a fundamental role in the transmission of this value, particularly at the level of the hidden and informal curricula. In spite of this, these two dimensions of learning still seem to be overlooked by educators. Future research should be focused on addressing the hidden and/or informal curriculum to enhance the transmission of caring and the internalization of this value by the students.