Exploring the curricular paradox in nursing: a phenomenological study on the experiences of humanized care in clinical training

Abstract

Nursing curricula in Latin America formally declare humanized care as a core competency; however, clinical environments systematically contradict this formal teaching through implicit learning mechanisms that normalize dehumanizing practices. This paradox is particularly relevant in Ecuador’s public health system, where adverse structural conditions coexist with a humanizing curricular mandate. To understand the lived experience of nursing students regarding humanized care during clinical training, at a public university in Ecuador. A hermeneutic phenomenological study was conducted based on Van Manen’s phenomenology of practice. Six focus groups were conducted with 53 nursing students (34 women, 19 men) across six academic levels with active clinical placements. Data analysis followed Van Manen’s hermeneutic method. Rigor was ensured through member checking, investigator triangulation and process auditing, following Lincoln and Guba’s trustworthiness criteria and the COREQ checklist. The analysis revealed two experiential fields: enabling conditions, including students’ personal and communicative skills, humanizing faculty role modeling, and favorable contextual conditions; and restricting conditions, including student insecurities, hidden curriculum contradictions and adverse institutional conditions. Narratives revealed a cross-level pattern: students from early academic levels described moral distress in response to dehumanizing practices, while those from advanced levels tended to describe them with greater naturalness, suggesting progressive normalization. These findings suggest that the clinical environment may function as a hidden curriculum that contradicts the formal teaching of humanized care. They also highlight the need to strengthen faculty role modeling as a systematic curricular policy, incorporate structured reflective spaces within clinical placements, and develop assessment instruments that give relational dimensions of care the same weight as technical competencies.

The authors' abstract, as published at the source. BMC Nursing, 2026 · DOI ↗