BLOG: OBSERVATION OF EBP

Outlook and Perspective

Upholding the reputation of nurses:

Academic integrity

Each year as the national Gallup poll publishes its results on perceived ethics of professionals, the popu- lar press sings praise to nursing. For the American public, nurses are seen as having the highest ethical standards of all the professions from medical doctors to lawyers to chaplains. Consequently, nurses are believed to be the most trusted professionals of our working world. There can be little doubt that uphold- ing values and standards of academic integrity is foun- dational if nurses are to sustain this trust. Conversely, academic misconduct threatens the national trust for nursing and, if not prevented or eliminated, can trans- late to misconduct in health care settings as our stu- dents move on to become licensed clinicians Academic integrity is a core component of profes-

sionalism and an aspect of professional identity that is first learned in prelicensure nursing education (Crigger and Godfrey, 2014) and continues throughout one’s career. The frequency of student cheating is difficult to quantify or trend over time, in large part because most data arise from studies that use self-report methodolo- gies. Nevertheless, recent publications capture emerg- ing issues that may reshape our traditional views of academic misconduct. Today’s students cite the high pressure to succeed, an

intensely competitive culture, and anxiety around the postgraduation jobmarket as factors that push high-per- formers to cheat, plagiarize, or commit other dishonesty (Henning et al., 2014). One recent study indicates that high-performing students may be an underreported group who are the most likely to engage in academic misconduct (Ottaway, Murrant, Ritchie, 2017). Age influ- ences the likelihood of engaging in academic miscon- duct; for example, plagiarism has a higher likelihood in younger, less academically experienced students (Birks, Smithson, Antne, Zhao, Burkhot, 2018). All of these observations are relevant to nursing, a discipline that draws many young and high-performing students into its university-based schools. Scholars have sought for years to understand the reasons why students choose to cheat or act dishonestly, but the literature suggests these reasons are diverse. There are also many nuances and contextual factors involved in the motivations behind academic dishonesty, and possible distinctions between pre-meditated versus spontaneous cheating, intentional versus nonintentional dishonesty. Regardless of reasons or intent, there is evidence

that those who act dishonestly as students may well carry over this behavior into their lives as working

clinicians. In a study of over 300 nursing students, there was a strong positive relationship between fre- quency of cheating in classroom settings and ethical misconduct in a clinical setting (Krueger, 2014). These observations provide high motivation for nursing edu- cators and leaders to find new and more effective ways to combat academic dishonesty in classroom and clinical settings. Here we share examples of approaches from three nursing schools participating in the Big Ten Academic Alliance Deans of Nursing Interest Group with the goal of stimulating discussion by academic leaders across the profession. At the University of Nebraska Medical Center (UNMC)

College of Nursing, our shared values undergird all that we do. Academic integrity begins with the values espoused by UNMC and our clinical partner, Nebraska Medicine. These values are known by the acronym, “ITEACH”, which stands for innovation, teamwork, excellence, accountability, courage, and healing. Accountability particularly espouses academic integ- rity. Regular reinforcement of the values contributes to development of professional identity (Crigger & Godfrey, 2014). Incoming students are introduced to these values during orientation to the programs. The values are described in white coat ceremonies for undergraduate students. Undergraduate students sign a pledge at their white coat ceremonies in which they commit to developing a professional identity founded on integrity, honesty, and ethical behavior. Profession- alism and relevant professional codes are learned and reinforced with new roles in all levels of academic programs. Faculty are expected to be role models of academic

integrity, including research and clinical integrity. Stu- dents are expected to uphold clear standards of aca- demic, research, and clinical integrity. We emphasize that integrity is fundamental for protecting patient safety, supporting trust of nurses’ clinical practice and veracity of research findings, and upholding profes- sional trust in teammembers. In 2016, the Purdue University School of Nursing

implemented a four-year undergraduate expansion project that increased freshman enrollment from 100 to 200 students annually. With this significant increase in enrollment, and recognizing the impact this growth would have on the ecosystem of the School, a team of faculty and students adopted a continuous quality improvement framework to develop strategies that would continue to support a culture of ethics, honor,

384 Nur s Out l o o k 6 8 ( 2 0 2 0 ) 3 8 3�3 8 4

and integrity. These strategies included a faculty pro- fessional development program provided by Gen -Z educational experts, academic integrity policy modifi- cation, expanded peer to peer mentoring, and stan- dardized, transparent and consistent communication of academic integrity expectations across the under- graduate program. These strategies reinforced the significance of

integrity in the nursing profession, modeled our com- mitment to promoting an ethical and accountable learning environment, a unified faculty voice, and reinforced the contextual relevance of integrity to safe nursing practice. This approach aligned well with the learning needs of the Gen Z learners with clearly defined expectations, and emphasis on the rel- evance of integrity to their future as professionals. Continuous improvement of academic integrity best practices is critical to assure that our school is responsive and prepared to adapt to meet current and emerging academic integrity challenges. At the University of Michigan School of Nursing, we

have wryly observed that technology and software are part of both the problem and the solution. Academic dishonesty that is accomplished through technology requires both practical and technologic interventions. Although proctoring is one strategy to minimize cheat- ing, even a team of proctors may miss an incident in the face of a determined student. “Smart” classrooms can be equipped with cameras that capture student behavior during the testing. Cameras usually enable the faculty to review the testing environment after the exam and look for indications of cheating such as stu- dents turning their gaze onto the computer of some- one sitting next to them. During computerized testing, students may utilize their computers during testing to electronically leave the specific test site and access answers in various locations through Google or other platforms. This can be prevented by platforms such as Exam Soft and Respondus loaded onto student com- puters and activated during exams. Expanding our code of ethics and professional

behavior has helped to support academic integrity in that it clearly describes dishonest behavior and estab- lishes consequences for violating these criteria. Stu- dents read and sign the honor code expectations as part of their program. While there are no data that sig- natures prevent cheating, the process provides a basis for addressing cheating post-hoc, reminding the stu- dent that they signed a document promising not to cheat. As described above in three mid-western schools of

nursing, a culture of integrity remains the key andmost essential component of the academic environment. Collective values, expectations of honesty, and a deeper understanding of the quantitative and qualitative sig- nificance of dishonesty, all establish a milieu that pub- licly embraces and expects integrity. Our message needs to be clear; in the most publicly

trusted profession, honor is the norm.

R E F E R E N C E S

Birks, M., Smithson, J, Antne, Y. J., Zhao, L., & Burkhot, C. (2018). Exploring the paradox: A cross-sectional study of academic dishonesty among Australian nursing stu- dents. Nurse Education Today, 65, 96–101.

Crigger, N., & Godfrey, N. (2014). From the inside out: A new approach to teaching professional identity forma- tion and professional ethics. Journal of Professional Nurs- ing, 30, 376–382, doi:10.1016/j.profnurs.2014.03.004.

Henning, M. A., Ram, S., Malpas, P., Sisley, R., Thompson, A., & Hawken, S. J. (2014). Reasons for aca- demic honesty and dishonesty with solutions: a study of pharmacy and medical students in New Zealand. Journal of Medical Ethics, 40, 702–709.

Krueger, L. (2014). Academic dishonesty among nursing students. Journal of Nursing Education, 53, 77–87.

Ottaway, K, Murrant, C., & Ritchie, K. (2017). Cheating after the test: Who does it and how often? Advances in Physiology Education, 41, 368–374.

Patricia D Hurn, PhD, RN, FAAN School of Nursing, College of Literature, Sciences and

the Arts, University of Michigan, Ann Arbor, MI

Pamela M. Karagory, DNP, RN School of Nursing, Purdue University, West Lafayette,

IN

Juliann G. Sebastian, PhD, RN, FAAN College of Nursing, University of Nebraska Medical

Center, Omaha, NE

Bonnie M Hagerty, PhD, RN School of Nursing, College of Literature, Sciences and

the Arts, University of Michigan, Ann Arbor, MI Lynnette Leeseberg Stamler, PhD, DLitt, RN, FAAN College of Nursing, University of Nebraska Medical

Center, Omaha, NE

Louise M LaFramboise, PhD, RN College of Nursing, University of Nebraska Medical

Center, Omaha, NE aSchool of Nursing, College of Literature, Sciences and the

Arts, University of Michigan, Ann Arbor, MI bSchool of Nursing, Purdue University, West Lafayette, IN

cCollege of Nursing, University of Nebraska Medical Center, Omaha, NE

*Corresponding author: Patricia D Hurn, School of Nursing, College of Literature, Sciences and the Arts, University of Michigan, 400 North Ingalls, Suite 1320, Ann Arbor, MI

48109. E-mail address: [email protected]

Available online 13 June 2020

0029-6554/$ – see front matter

� 2020 Elsevier Inc. All rights reserved.

https://doi.org/10.1016/j.outlook.2020.05.003