in modern nursing , nurses are expected to deliver holistic care , taking into account patients biological , psychosocial , and spiritual needs . however , formal nursing programs in iran follow a biomedical approach that focuses mainly on medical problems.[35 ] these formal education programs focus on the transfer of knowledge and the mastery of techniques related to patient physical care ; however , students also learn informally through hidden curricula of nursing education . direct observation of situations , such as birth , death , loss , and suffering results in emotional learning . additionally , students gain experience through interactions with each other , teachers , and senior professionals , known as peer learning , which studies have found can have life - long effects on students . the limited scope of formal nursing education in iran may result in informal learning experience for nursing students that differs from those of other countries . if nursing education recognizes this informal learning and its achievements may be able to take advantages of these opportunities to improve students competency . informal or indirect learning can occur as a function of observing , retaining , and replicating behaviors during educational experiences . the aim of this qualitative study was to explore the perceived informal learning achievements in undergraduate nursing programs from the iranian student perspective . this study was designed to answer the question : what are undergraduate nursing student perceptions of the informal learning that occurs during nursing studies ? this study was conducted over a 2-year period ( 2009 - 2010 ) using a qualitative content analysis . the participants were 14 nursing students in their fourth year of study at  x  university who were recruited through a purposeful sampling method . they were at their final stage of clinical apprenticeship so had passed major part of their education and could share their achievements of learning experiences , including informal ones . sampling was done according to the maximum variant approach in terms of gender , age , marital status , geographical location ( local or not local ) , student work experience , and level of academic achievement ( e.g. , good , average , or superior ) . each interview began with the open question :  apart from the theoretical and practical knowledge you gained during four years of nursing study , what other changes do you think you have experienced during your study ? answers were explored more deeply with relevant probing statements or questions , such as : please tell me more about that ,   how did that make you feel ? please describe an actual experience you have had that will help me understand what it meant to you .  the interviews lasted an average of 70 min , usually in a single session . each interview was transcribed verbatim , and then converted to rich text format for use in maxqda software , which facilitated data management . data were analyzed through a constant comparison analysis method using strauss and corbin coding techniques to develop the categories . data were analyzed initially by the main author , then the emerging codes were revised independently by 2 other members of the research team . throughout coding and category development , the analysis process and the accuracy of codes and categories were discussed and checked in regular sessions ; discrepancies were resolved through continuing discussion and analysis . lincoln and guba ( 1985 ) criteria were used to address trustworthiness ( p.296 ) . dependability was gained by precise documentation of data , methods , and decisions about the research . credibility was established through participant confirmation of our understanding , prolonged engagements with participants , a peer check , and an external check . throughout the study , data were managed by maxqda and all analysis precisely documented to maintain an audit trail . student participation was voluntary . written information about the purpose of the study and confidentiality management was delivered to all participants and written consent was obtained for the study , including permission for recording the entire interview for transcribing . the 14 participants consisted of 3 male and 11 female nursing students , age 21 - 23 years , in the last semester of their studies . based on students experiences , 5 categories were extracted : personal maturity and emotional growth , social development , closeness to god , alterations in value systems , and ethical and professional commitments [ table 1 ] . although some participants described the process leading to their internal changes as challenging and difficult , almost all of them stated that it facilitated their growth as a whole person . students achievements of informal learning during nursing study this category consisted of 2 subcategories : personal maturity ( consisting of self - awareness and self - discovery , accelerated mental maturity , and more open - mindedness ) and emotional growth ( consisting of greater patience , appreciation , kindness , and compassion , and altruism ) . the participants viewed their 4 years in nursing school as an opportunity for gaining a deeper self - awareness and self - knowledge . they believed that the duties of nursing practice , such as frequent personal interactions and development of relationships , have great influence on deep reflection about humanity as well as their personal beliefs . in contrast , the importance of rigorous assessment throughout nursing studies resulted in regular self - assessment in their daily lives . these helped them obtain more realistic knowledge about their personal strengths , weaknesses , and talents . some participants described this awareness as self - discovery by saying :  i learned about myself based on what they taught us about humans in the program . i understood myself , in the university setting , through the eyes of my friends , who criticized me . another significant change reported by students was an increasing maturity of mind that resulted in more rational behavior . the frequent exposure to life - and - death situations in nursing helped promote maturity . one student said :  my personality developed at this school . at first , i behaved very childishly . there were a series of realities of which i was wholly ignorant ; i acquired them here in the school .  they also attributed this increase in maturity to multiple factors , including interactions with instructors , senior students , and people with various personalities , as well as engagement in difficult situations . one participant said :  this maturity has been partly influenced by interactions with professional instructors and encounters with classmates as well as senior students i improved little by little through experiencing critical situations , seeing the darker side of life , the troubles and pains of other people , all of which i was unaware of in my previous relaxed lifestyle . the other significant experience reported by participants was increasing open - mindedness . with respect to the principles of fundamental nursing classes , they learned to focus on a patient as a human being , regardless of nationality , ethnicity , religious beliefs , or financial or sociocultural status . as a result , students reported that they were able to accept people by adopting a nonjudgmental manner . one student , who was caring for people with various religious beliefs , described her primary concern about encountering clients with different beliefs as a challenging experience and explained how she successfully overcame those conflicts by overlooking religious prejudices . she said :  at first i thought i had treated them differently ; well , one patient was muslim , the other held another belief . however , after a while , i realized that they are ultimately human , and my job was not to judge the belief system of people . then the differences were no longer serious or problematic and i found myself adapting easily by getting closer to them . i am very grateful to be able to communicate well with various religious minorities despite so many differences . some of them said that they learned patience from patients who were suffering from chronic illnesses . when they saw how these patients worked to manage the disease and its disabling consequences , they realized the triviality of their own problems . i had patients who underwent dialysis every day , yet were quite happy , spoke with joy , laughed , and induced others to be in a good mood . in comparison with them , how could i concern myself with minor issues while i was in good health physically and emotionally ? i felt embarrassed when i saw them struggle steadfastly with such pain , illness , and deprivation . other participants believed that the patience resulting from the nature of discipline made them stronger to handle difficulties . one participant stated :  nowadays the problems do not exhaust my spirit . since in nursing practice you see the pains and troubles of other people , a series of problems are no longer considered problems , or perhaps your experiences and abilities have improved . you should be more patient , in order to help those people who need you and have their hope invested in you . they said seeing patients suffer made them realize the importance of the gifts they took for granted , especially the gift of health : now i see patients with their problems and realize the gifts i have in my life , which i did nt appreciate before . they also explained that nursing made them similar to mothers - kind and ready to help and show compassion . now they feel a stronger sense of love and concern for humankind as well as the ability to love and care for others . one of them indicated :  studying in the nursing field gives you the sense of being a mother . they teach us that we must be able to establish good communication , and understand others and support them . one participant stated :  generally , my morale and personality is such that i really like people . it seems that these traits were developed for inner satisfaction and for the affection you can induce in others . the second category derived from the interviews was related to becoming more social and expert in interpersonal relationships . some of the participants , especially those who had limited communication skills before entering the program , acknowledged nursing studies as a turning point that improved their social relationships . they asserted that gaining communication skills with patients in clinical settings as fundamental to improving their interpersonal proficiency by saying :  nursing improved my communication with others . i , who had a habit of building fences around me , was forced out of that closed space . during this period , my communication skills got much stronger , since they are required and necessary skills in nursing .  encouraging and developing communication with patients required students to exploit strategies , such as developing cultural and ideological common ground , respecting others interests and wishes , and adapting themselves to others . gradually they noticed they were applying these advanced communication skills in their personal life . now , i can look at the subject from his / her point of view . i take the initiative and try to begin from a point that is welcomed by the other party . another factor that contributed to students social development was existing in a social environment larger than that of high school , which involved interaction with a heterogeneous population from various towns , ethnic groups , and cultures , which was regarded as expanding  the friends circle  by participants : i do nt limit myself to making friends with people of my own type ; i always search for new thoughts and new ideas with their own experiences . nonlocal participants , who resided in the student dormitory during their studies , explained the significant influence of living in the dormitory on their social growth and development as : when you become a college student and live in the dormitory with other students coming from different places and cultures with various upbringings , you are obliged to encounter them , and automatically learn how to adapt yourself and in fact be flexible . since all participants were muslim , a belief in god was one fundamental characteristic . however , most of them stated that they experienced a different type of connection with god during their nursing studies . some of them attributed this new belief to gaining a deeper knowledge about the intricacies of the human body and about human beings in general during the nursing program : i understood the complexities of this perfect system ( the human body ) , how accurately it has been designed , and how many problems are caused by a small deviation . we were told that the patients do nt respond to any treatment , but they did and i saw with my own eyes the effect of the prayers that the person accompanying the patient offered from the depths of the heart , and how it worked . i touched god s power and presence .  others stated they felt closer to god through nursing practice because they were satisfying god s wishes by caring for the most vulnerable . this optimism significantly improved the quality of their prayers and replaced traditional ceremonies with enthusiastic worship and inner dialog with god . this type of close connection with god led to a pleasant feeling of dependency , which made them calmer when confronting difficulties :  now i feel that god is looking at me , for my interest in caring for his people . i tell myself since i serve god s people sincerely ; certainly he would also pay attention to me ... i have noticed that whenever i have troubles , they are resolved at once . i sense some resolution and interpret it as god s promise that , if you help someone , god will help you in return . participants believed that confrontation with the light as well as the dark side of life in nursing expanded their world view through a change in focus from living a superficial life to a life more concerned with serious and substantive matters beyond their calendar age . one participant explained :  in nursing , you see the beginning of life  and the termination of it . you are faced with certain facts that make other issues trivial and insignificant in life while they are still important for your peers . these challenging confrontations acted as awakening experiences , allowing students to obtain a new perspective about life and death that stimulated changes in their value systems . as a result they described these alterations as achieving a deeper and more realistic point of view of life :  now my objectives for the future have changed in principle . whenever i see patients who have only a few days to live , i no longer waste my time . before , i had a child - like view of life as a bowl of cherries with no worries , but now i know that life has its own hardships , which are considered a part of life . moreover , most of them asserted that they feel they were chosen by god for this profession and they appreciated it as an opportunity for growth and transcendence . i sensed that i was invited by god to take a right path that changed my destiny forever . i began taking steps on a road that i was supposed to begin with and i interpreted this as special attention to me on god s part ... i believe that we were summoned by god . nurses were invited for their kind heart , for their sympathy , and for their ability to provide relaxation to patients . if you knew this from the beginning and you appreciated being invited , any experience along the way would become important and valuable to you . most participants admitted that they feel a strong commitment to their work and try to be conscientious in the care of their patients . they believed that this inner commitment had a stronger influence than any rules or external controls . some of them attributed this inner commitment to their increased closeness to god and consequent sense of being observed constantly by god . they were delighted by this connection and attention so they tried to sustain this perceived attention by working ethically and conscientiously . even though i can work unsterile and the patient may not know it , i notice what i do and god does , too . however , your ethical commitment forces you to work better . to me , respecting the patient s rights is more important than anything else . i always tell myself to imagine that the patient is one of your dear siblings . i always try to hold that thought and work according to such feelings to do my best .  in addition , participants attributed this commitment to other reasons , such as respecting patient s rights and dignity to enjoy humanistic and proper care as a human being , responding their inner desire to do their best as a nurse , and trying to improve nursing image in society . one participant related her sense of ethical and professional commitment to satisfaction of her inner philanthropic desire :  to me , it does not matter whether someone see or appreciate my efforts or ethically working . doing my best firstly as a human , secondly as a nurse satisfies me , so it is enough to follow my inner voice and desire to work as well as i can to help a needy patient to make him / her condition better . this study was designed to answer the question : what are undergraduate nursing student perceptions of the informal learning that occurs during nursing studies ? this study was conducted over a 2-year period ( 2009 - 2010 ) using a qualitative content analysis . the participants were 14 nursing students in their fourth year of study at  x  university who were recruited through a purposeful sampling method . they were at their final stage of clinical apprenticeship so had passed major part of their education and could share their achievements of learning experiences , including informal ones . sampling was done according to the maximum variant approach in terms of gender , age , marital status , geographical location ( local or not local ) , student work experience , and level of academic achievement ( e.g. , good , average , or superior ) . each interview began with the open question :  apart from the theoretical and practical knowledge you gained during four years of nursing study , what other changes do you think you have experienced during your study ? answers were explored more deeply with relevant probing statements or questions , such as : please tell me more about that ,   how did that make you feel ? please describe an actual experience you have had that will help me understand what it meant to you . each interview was transcribed verbatim , and then converted to rich text format for use in maxqda software , which facilitated data management . data were analyzed through a constant comparison analysis method using strauss and corbin coding techniques to develop the categories . data were analyzed initially by the main author , then the emerging codes were revised independently by 2 other members of the research team . throughout coding and category development , the analysis process and the accuracy of codes and categories were discussed and checked in regular sessions ; discrepancies were resolved through continuing discussion and analysis . lincoln and guba ( 1985 ) criteria were used to address trustworthiness ( p.296 ) . dependability was gained by precise documentation of data , methods , and decisions about the research . credibility was established through participant confirmation of our understanding , prolonged engagements with participants , a peer check , and an external check . throughout the study , data were managed by maxqda and all analysis precisely documented to maintain an audit trail . student participation was voluntary . written information about the purpose of the study and confidentiality management was delivered to all participants and written consent was obtained for the study , including permission for recording the entire interview for transcribing . the 14 participants consisted of 3 male and 11 female nursing students , age 21 - 23 years , in the last semester of their studies . based on students experiences , 5 categories were extracted : personal maturity and emotional growth , social development , closeness to god , alterations in value systems , and ethical and professional commitments [ table 1 ] . although some participants described the process leading to their internal changes as challenging and difficult , almost all of them stated that it facilitated their growth as a whole person . this category consisted of 2 subcategories : personal maturity ( consisting of self - awareness and self - discovery , accelerated mental maturity , and more open - mindedness ) and emotional growth ( consisting of greater patience , appreciation , kindness , and compassion , and altruism ) . the participants viewed their 4 years in nursing school as an opportunity for gaining a deeper self - awareness and self - knowledge . they believed that the duties of nursing practice , such as frequent personal interactions and development of relationships , have great influence on deep reflection about humanity as well as their personal beliefs . in contrast , the importance of rigorous assessment throughout nursing studies resulted in regular self - assessment in their daily lives . these helped them obtain more realistic knowledge about their personal strengths , weaknesses , and talents . some participants described this awareness as self - discovery by saying :  i learned about myself based on what they taught us about humans in the program . i understood myself , in the university setting , through the eyes of my friends , who criticized me . another significant change reported by students was an increasing maturity of mind that resulted in more rational behavior . the frequent exposure to life - and - death situations in nursing helped promote maturity . one student said :  my personality developed at this school . at first , i behaved very childishly . there were a series of realities of which i was wholly ignorant ; i acquired them here in the school . they also attributed this increase in maturity to multiple factors , including interactions with instructors , senior students , and people with various personalities , as well as engagement in difficult situations . one participant said :  this maturity has been partly influenced by interactions with professional instructors and encounters with classmates as well as senior students i improved little by little through experiencing critical situations , seeing the darker side of life , the troubles and pains of other people , all of which i was unaware of in my previous relaxed lifestyle . the other significant experience reported by participants was increasing open - mindedness . with respect to the principles of fundamental nursing classes , they learned to focus on a patient as a human being , regardless of nationality , ethnicity , religious beliefs , or financial or sociocultural status . as a result , students reported that they were able to accept people by adopting a nonjudgmental manner . one student , who was caring for people with various religious beliefs , described her primary concern about encountering clients with different beliefs as a challenging experience and explained how she successfully overcame those conflicts by overlooking religious prejudices . she said :  at first i thought i had treated them differently ; well , one patient was muslim , the other held another belief . however , after a while , i realized that they are ultimately human , and my job was not to judge the belief system of people . then the differences were no longer serious or problematic and i found myself adapting easily by getting closer to them . i am very grateful to be able to communicate well with various religious minorities despite so many differences . almost all of the participants indicated that increasing patience was their most significant change . some of them said that they learned patience from patients who were suffering from chronic illnesses . when they saw how these patients worked to manage the disease and its disabling consequences , they realized the triviality of their own problems . i had patients who underwent dialysis every day , yet were quite happy , spoke with joy , laughed , and induced others to be in a good mood . in comparison with them , how could i concern myself with minor issues while i was in good health physically and emotionally ? i felt embarrassed when i saw them struggle steadfastly with such pain , illness , and deprivation . other participants believed that the patience resulting from the nature of discipline made them stronger to handle difficulties . since in nursing practice you see the pains and troubles of other people , a series of problems are no longer considered problems , or perhaps your experiences and abilities have improved . you should be more patient , in order to help those people who need you and have their hope invested in you . they said seeing patients suffer made them realize the importance of the gifts they took for granted , especially the gift of health : now i see patients with their problems and realize the gifts i have in my life , which i did nt appreciate before . they also explained that nursing made them similar to mothers - kind and ready to help and show compassion . now they feel a stronger sense of love and concern for humankind as well as the ability to love and care for others . one of them indicated :  studying in the nursing field gives you the sense of being a mother . they teach us that we must be able to establish good communication , and understand others and support them . one participant stated :  generally , my morale and personality is such that i really like people . it seems that these traits were developed for inner satisfaction and for the affection you can induce in others . the second category derived from the interviews was related to becoming more social and expert in interpersonal relationships . some of the participants , especially those who had limited communication skills before entering the program , acknowledged nursing studies as a turning point that improved their social relationships . they asserted that gaining communication skills with patients in clinical settings as fundamental to improving their interpersonal proficiency by saying :  nursing improved my communication with others . i , who had a habit of building fences around me , was forced out of that closed space . during this period , my communication skills got much stronger , since they are required and necessary skills in nursing .  encouraging and developing communication with patients required students to exploit strategies , such as developing cultural and ideological common ground , respecting others interests and wishes , and adapting themselves to others . gradually they noticed they were applying these advanced communication skills in their personal life . now , i can look at the subject from his / her point of view . i take the initiative and try to begin from a point that is welcomed by the other party . i moved away from a partial and limited understanding of others and i feel that i am growing in regards to social relations in general . another factor that contributed to students social development was existing in a social environment larger than that of high school , which involved interaction with a heterogeneous population from various towns , ethnic groups , and cultures , which was regarded as expanding  the friends circle  by participants :  i tried to experience all group types . i do nt limit myself to making friends with people of my own type ; i always search for new thoughts and new ideas with their own experiences . nonlocal participants , who resided in the student dormitory during their studies , explained the significant influence of living in the dormitory on their social growth and development as : when you become a college student and live in the dormitory with other students coming from different places and cultures with various upbringings , you are obliged to encounter them , and automatically learn how to adapt yourself and in fact be flexible . since all participants were muslim , a belief in god was one fundamental characteristic . however , most of them stated that they experienced a different type of connection with god during their nursing studies . some of them attributed this new belief to gaining a deeper knowledge about the intricacies of the human body and about human beings in general during the nursing program : i understood the complexities of this perfect system ( the human body ) , how accurately it has been designed , and how many problems are caused by a small deviation . we were told that the patients do nt respond to any treatment , but they did and i saw with my own eyes the effect of the prayers that the person accompanying the patient offered from the depths of the heart , and how it worked . i touched god s power and presence .  others stated they felt closer to god through nursing practice because they were satisfying god s wishes by caring for the most vulnerable . this optimism significantly improved the quality of their prayers and replaced traditional ceremonies with enthusiastic worship and inner dialog with god . this type of close connection with god led to a pleasant feeling of dependency , which made them calmer when confronting difficulties :  now i feel that god is looking at me , for my interest in caring for his people . i tell myself since i serve god s people sincerely ; certainly he would also pay attention to me ... i have noticed that whenever i have troubles , they are resolved at once . i sense some resolution and interpret it as god s promise that , if you help someone , god will help you in return . participants believed that confrontation with the light as well as the dark side of life in nursing expanded their world view through a change in focus from living a superficial life to a life more concerned with serious and substantive matters beyond their calendar age . one participant explained :  in nursing , you see the beginning of life  and the termination of it . you are faced with certain facts that make other issues trivial and insignificant in life while they are still important for your peers . these challenging confrontations acted as awakening experiences , allowing students to obtain a new perspective about life and death that stimulated changes in their value systems . as a result they described these alterations as achieving a deeper and more realistic point of view of life :  now my objectives for the future have changed in principle . whenever i see patients who have only a few days to live , i no longer waste my time . before , i had a child - like view of life as a bowl of cherries with no worries , but now i know that life has its own hardships , which are considered a part of life . moreover , most of them asserted that they feel they were chosen by god for this profession and they appreciated it as an opportunity for growth and transcendence . i sensed that i was invited by god to take a right path that changed my destiny forever . i began taking steps on a road that i was supposed to begin with and i interpreted this as special attention to me on god s part ... i believe that we were summoned by god . nurses were invited for their kind heart , for their sympathy , and for their ability to provide relaxation to patients . if you knew this from the beginning and you appreciated being invited , any experience along the way would become important and valuable to you . most participants admitted that they feel a strong commitment to their work and try to be conscientious in the care of their patients . they believed that this inner commitment had a stronger influence than any rules or external controls . some of them attributed this inner commitment to their increased closeness to god and consequent sense of being observed constantly by god . they were delighted by this connection and attention so they tried to sustain this perceived attention by working ethically and conscientiously . even though i can work unsterile and the patient may not know it , i notice what i do and god does , too . however , your ethical commitment forces you to work better . to me , respecting the patient s rights is more important than anything else . i always tell myself to imagine that the patient is one of your dear siblings . i always try to hold that thought and work according to such feelings to do my best .  in addition , participants attributed this commitment to other reasons , such as respecting patient s rights and dignity to enjoy humanistic and proper care as a human being , responding their inner desire to do their best as a nurse , and trying to improve nursing image in society . one participant related her sense of ethical and professional commitment to satisfaction of her inner philanthropic desire :  to me , it does not matter whether someone see or appreciate my efforts or ethically working . doing my best firstly as a human , secondly as a nurse satisfies me , so it is enough to follow my inner voice and desire to work as well as i can to help a needy patient to make him / her condition better . since students who felt more personal growth were more eager to participate in the study , it is possible that other students experiences have been ignored unintentionally by the researchers . according to the results of this study , the undergraduate nursing students achieved knowledge and insights that were not provided by the formal , biomedical - centered , nursing program . these included the following : personal maturity and emotional development , social development , greater closeness to god , an alteration in value systems , and ethical and professional commitment . these are nontechnical professional competencies that are important to the goals of the nursing curriculum . although these are not included in a specific lesson , they are beyond theoretical knowledge and the technical skills and could be considered as the soul of nursing education . the results indicate that nursing students develop important qualities through a  hidden curriculum  that help fulfill the mission of nursing education in creating ethical , spiritual , legal , and professional values . in this study , one of the most important categories was personal growth , which included self - awareness , self - knowledge , and self - discovery due to frequent interactions with patients and other people and reflection on the experiences of these relationships . the meaning of this category was compatible with that of a previous study , indicating a self - awareness theme related to experiences of being and presence . participants in the previous study also experienced nurse - patient interactions that resulted in self - awareness . the participants who increased self - awareness did so through reflection , and found meaning in being a nurse . chiu the outcome of university courses are not limited to professional development ; they also promoted the personal growth of nurses . being a nurse requires compassion , respect , and humanity . in the present study , participants described nursing as an opportunity to gain empathy and other humanistic feelings . they appreciated the characteristics , such as patience , thankfulness , kindness , compassion , and concern about humankind , that could help them achieve emotional growth . emotional growth means the increasing capacity to recognize one s own emotions and allow them to mature . wilson , stated that nursing students develop emotional competence by critical reflection through classroom sessions and clinical experiences . the participants in the present study also indicated that reflection occurred outside formal sessions in the classroom . because nursing is a profession involving difficult situations , nursing students need preparation to mature enough to successfully handle their professional role , especially during a crisis . studies reveal that nurses younger than 30 years experience greater burnout than their older counterparts . such findings support the idea that emotional issues should be addressed in nursing curricula to nurture a healthier and more competent nursing workforce . the participants in the present study also emphasized improvement in interpersonal and communication skills as a result of their nursing studies . they believed that nursing taught them to put themselves in the patient s place and see through their eyes , which increased the awareness of patients feelings , perceptions , and needs . these critical abilities are referred to as social growth qualities , gained through interactions with professors , classmates , roommates , and patients while out of the classroom . although our participants were muslims , who must maintain a respectful distance from members of the opposite sex that can interfere with some nursing tasks , findings indicated that even the strongly religious female participants did not have problems caring for male patients . another aspect of nursing training that affected students in this study was their relationship with god . from an islamic perspective additionally , nursing is considered a divine profession in iran . in this ideologic context , almost all of the study participants appreciated nursing as a call from god toward transcendence . ravari et al . also reported that the perception of nursing as an opportunity to worship god is a common belief among iranian nurses , which provided their career a transcendental meaning . the study participants reported changes in their value systems , such as finding a deeper meaning beyond the superficial activities of everyday life and more lasting goals and values . university studies provided an awakening experience , and inspired students to re - evaluate and redefine their personal values . since universities are expected to help students achieve a broader perspective , nursing education should help promote student receptivity of human values compatible with their professional mission . indicated that empathizing with patients and caring about their feelings initiates an ethical reflection process in nursing students that may eventually lead to the development of a set of personal values . the last category revealed that , although the participants were just starting their career , they gained a sense of professional and ethical commitment . in a similar study by rahimaghaee et al , participant views about commitment went beyond work commitment to include an inner commitment related to a belief in god s supervision of their lives , including their careers . additionally , le duc and kotzer , found that even novice nurses can hold professional values , indicating that nursing education can initiate a sense of professional commitment in students . according to some nursing theorists , including watson , nursing schools should acknowledge the  hidden learning  that occurs outside the classroom can foster and facilitate development of students as whole human beings , not just professional nurses . according to watson , curriculum development should combine and integrate the cognitive with education about beauty , art , ethics , intuition , esthetics , and spirituality of human - to - human interactions within nursing . the nursing discipline needs to incorporate this type of curriculum to improve nursing student s personal development . during their education , this aspect of nursing was reported by paterson and zedrad ( 2007 ) in their humanistic nursing theory . the findings of this study revealed that nursing education , especially clinical training with its patient - student interactions , provides an excellent opportunity for student personal growth that is less likely in other majors . through their studies , nursing students do not gain expertise in theoretical and technical matters alone , but also fulfill their potential as a whole person . nursing education can prepare students to deliver holistic care only if they consider all aspects of the students as humans . the ability to provide holistic care of patients requires treating each nursing student as a whole person through both formal and informal education . this idea agrees with theories of student development that consider college education as involving the whole person and as a process involving interaction between intellectual development and interpersonal competence . therefore , recognizing and encouraging covert aspects of nursing education as well as overt ones provide more opportunities for student development , not only in cognitive and technical domains but also in affective ones . this can help bring nursing education closer to the ideal of comprehensiveness that enables nurses to care holistically for patients .