Integrating the fundamental of care framework in the undergraduate nursing curriculum: A randomized, controlled, and multicentric study

Background: Fundamentals of Care (FoC) are often perceived as “invisible” and of lesser clinical relevance, especially among nursing students. Evidence on how to integrate the FoC Framework into undergraduate education and assess its impact remains scarce. Aim: To assess the effectiveness of integrating the FoC Framework into a three-year undergraduate nursing curriculum on students’ clinical reasoning, technical and relational competencies and patient-reported experiences of care. Design: Multicentric randomized study following first-year students through their third year. Methods: The experimental group followed an FoC-informed integrated curriculum; the control group the standard one. Assessments included the Triple Jump test and Objective Structured Clinical Examination. Additional data were collected on patient perception and students’ learning approaches. Results: A total of 234 students were enrolled across four universities, with 150 progressing to year two and 79 to year three. The intervention group consistently achieved higher Triple Jump scores in the second and third years (p < .05) and higher Objective Structured Clinical Examination scores across all three years, both pre- and post-placement (p < .05). Relational skills scores were also higher in the third year. No significant differences were found in patient-reported experiences of care or in students’ learning approaches. Conclusions: Integration of the FoC Framework into the curriculum enhanced clinical reasoning and improved early technical and relational performance, although these gains were not reflected patient-reported outcomes. Future studies should consider involving the broader healthcare team to support a more effective and sustained transfer of FoC principles into clinical practice.