Elucidating the Hidden Curriculum in Professional Ethics Education in Nursing: A Grounded Theory Study

Abstract

Curriculum is one of the most crucial instruments for achieving educational objectives. The hidden curriculum refers to the emotional climate and unwritten conditions that exert the greatest influence on the values and emotions of learners in medical sciences, particularly in nursing. This qualitative study aimed to elucidate the hidden curriculum in professional ethics education in nursing, employing a grounded theory approach. Purposive sampling was initiated and subsequently continued through theoretical sampling. Data were collected using in-depth semi-structured interviews with 14 participants (students, nurses, and faculty members), along with observations and field notes, until theoretical saturation was achieved. Data analysis was performed using the Corbin and Strauss (2008) method. Data analysis revealed that the participants’ main concern was “ineffective management of interactions resulting from deficiencies in nurses’ communication and individual skills”. The core strategies adopted to address this concern included “faculty members’ professional competence in serving as role models for learners”, “introducing exemplary nurses and promoting professional role modeling”, and “the necessity of enhancing professional competencies for patient care”. The outcomes of these strategies were “ improved nurses’ satisfaction with care based on professional ethics”, “creating opportunities to enhance professional behaviors in clinical practice”, and “the development of patient needs-based care”. The study identified “enhancement of nursing care through adherence to professional ethics” as the main category. These findings can inform the development and enhancement of the hidden curriculum in professional ethics education in nursing. Accordingly, attention to individual and environmental factors, as well as the role of faculty members in teaching professional ethics, can provide a foundation for designing targeted interventions aimed at improving clinical interactions and narrowing the theory-practice gap in clinical settings.