Quality patient care demands that nurses practice with the highest levels of honesty and integrity (American Nurses Association [ANA], 2015). However, researchers propose that an academically dishonest college student will likely become a professional who engages in dishonest behaviors (Hilbert, 1985, 1987, 1988; Lovett-Hooper, Komarraju, Weston, & Dollinger, 2007; Nonis & Swift, 2001). Although similar studies specific to nursing lack longitudinal evidence, the researchers do suggest that nursing students who engage in dishonest behaviors while in school are likely to become RNs who will engage in dishonest behaviors in their practice (Balik, Sharon, Kelishek, & Tabak, 2010; Bradshaw & Lowenstein, 1990; Klocko, 2014; LaDuke, 2013; Tippitt et al., 2009; Webb, Simmons, & Aaron, 2010).
One might assume that students studying to be nurses, a profession guided by the ANA Code of Ethics (ANA, 2015) and repeatedly voted as the most trusted profession (Larson, 2013), would be students of the highest integrity (Roberts, 1997). Unfortunately, this is not the case. In a study conducted as part of the Center of Academic Integrity's Assessment Project, McCabe (2005) surveyed almost 50,000 undergraduates. Alarmingly, 70% of student participants reported engaging in some form of academic dishonesty while in college. Students enrolled in nursing programs are no more immune to the practice of academic dishonesty than students in other majors (Aaron, Simmons, & Graham-Webb, 2011; McCabe, 2009; McCrink, 2010).
Faculty are concerned because dishonest behaviors in the classroom setting suggest dishonest behaviors in the clinical setting (Hilbert, 1985, 1987, 1988; Klocko, 2014; Krueger, 2014). Not only can this interfere with necessary learning and development of essential critical judgment skills, dishonest behaviors in the clinical setting have the potential to negatively affect patient care and safety (Aaron et al., 2011; Baxter & Boblin, 2007; Kenny, 2007; Klocko, 2014; Krueger, 2014; Langone, 2007; Woith, Jenkins, & Kerber, 2012).
To reduce dishonest behaviors, researchers have recommended honor codes (McCabe, 2009), honesty policies (Balik et al., 2010), and educational modules concerning the role of integrity within the profession of nursing (Scanlan, 2006). However, there are no suggestions in the literature about how to develop such policies. Educators are left to construct codes and policies based on their own perceptions of dishonesty. This is problematic because faculty perceptions are often incongruent with students' perceptions concerning academic dishonesty (Austin, Simpson, & Reynen, 2005; Forinash, Smith, Gaebelein, & Garavaglia, 2010; Kennedy, Bisping, Patron, & Roskelley, 2008). Even so, researchers support the effectiveness of such codes and policies in reducing academic dishonesty (Arhin, 2009; Keçeci, Bulduk, Oruç, & Çelik, 2011; McCabe, 2009; McCabe, Treviño, & Butterfield, 2001). However, students continue to engage in academically dishonest (McCabe, 2005) behaviors despite the use of such policies and honor codes. Possible reasons for the continued high number of students engaging in academic dishonesty is the current method of using faculty perceptions to draft honesty policies, as well as students' ability to rationalize or neutralize their behavior choices. We believe that learning more about nursing students' perceptions concerning dishonest behaviors in the classroom and clinical settings and use of neutralizing tendencies will allow for the creation of more effective interventions to reduce dishonest behaviors. Therefore, the specific aims of this cross-sectional descriptive correlational survey are to:
- Describe students' perceptions of dishonest behaviors in the classroom and clinical settings.
- Examine the relationship between nursing students' perceptions of dishonest behaviors in the classroom and clinical settings.
- Examine the relationship between engagement in dishonest classroom and clinical behaviors and neutralizing tendencies.
Sykes's and Matza's (1957) neutralization theory provided a strong fit for understanding dishonesty in both the classroom and clinical settings and therefore serves as the framework of this study. Neutralization theory was developed within the field of juvenile delinquency and was used only a handful of times to study academic dishonesty in college students (Curasi, 2013; Diekhoff et al., 1996; Diekhoff, LaBeff, Shinohara, & Yasukawa, 1999; Haines, Diekhoff, Labeff, & Clark, 1986; Pulvers & Diekhoff, 1999; Vandehey, Diekhoff, & LaBeff, 2007). In the neutralization theory, five techniques are used to rationalize behavior: denial of responsibility, denial of injury, denial of the victim, condemnation of the condemner, and appeal to higher loyalties (Table 1). These neutralization techniques are used to diminish feelings of guilt or wrongdoing for engaging in dishonest behavior. Haines et al. (1986) first used the theory with college students to capture their neutralization and engagement in academically dishonest behaviors. McCabe's (1992) work further supported the relationship between neutralization and engagement in academically dishonest behaviors. These neutralizing behaviors remain evident today, as more than half of nursing students report that it is appropriate to cheat when justifications can be made (Balik et al., 2010).
Sykes's and Matza's (1957) Neutralization Techniques, With Classroom and Clinical Examples
Baccalaureate nursing students from American Academy of Colleges of Nursing (AACN)-accredited nursing programs at universities and colleges throughout the United States were recruited for participation. To meet inclusion criteria, students had to be enrolled in at least one clinical nursing course. Deans and program directors received two e-mails—one explaining the study and asking for their assistance by forwarding the second e-mail on to students, and the second e-mail was the student e-mail to be forwarded. This e-mail explained the study and invited them to participate by taking the online survey. As incentive to participate, each student's e-mail address was eligible to be entered in a drawing for a chance to win one of 50 $50 Amazon gift cards. Based on a small-to-medium effect size, roughly 194 participants were needed to achieve a power of .80 to examine the nondirectional (two-tailed test, alpha = .05) relationship between students' perception of academic dishonesty and clinical dishonesty.
Following the embedded link, students were directed to the one survey that included the electronic versions of the Nursing Student Perceptions of Dishonesty Scale (NSPDS; McClung & Schneider, 2018), an academic and clinical dishonesty engagement survey, the Neutralization Scale (NS; Haines et al., 1986), and a short-form Social Desirability Scale (SDS; Strahan & Gerbasi, 1972). Students also completed a demographic form.
Nursing Student Perceptions of Dishonesty Scale. Developed by McClung and Schneider (2018), the NSPDS includes nine subscales of dishonest behaviors, three clinical subscales (noncompliance, perjury, stealing), and six classroom subscales (cheating, assistance, cutting corners, not my problem, sabotage, test file). In addition, two clinical subscales conceptually parallel two classroom subscales. The clinical subscale of perjury conceptually parallels the classroom subscale of cheating because they both represent intentional deception or lying type behaviors. In addition, the clinical subscale of noncompliance conceptually parallels the classroom subscale of cutting corners because they both represent time-saving behaviors that reduce the amount of effort or actions needed to complete the task. For each item, students were asked to rate their level of agreement on a 4-point Likert scale when prompted with the stem “I think this behavior is dishonest” followed by a list of 67 classroom and clinical behaviors. An example item is “Texting answers to another student during an exam.” No overall score was intended; rather, a rating of 1 to 4 is calculated for each of the behavioral subscales. The higher the score, the more dishonest the behaviors are considered by students. As possible responses are 1 to 4, the middle cut point is 2.5. A mean greater than 2.5 is considered dishonest, and a mean less than 2.5 is considered not dishonest. Cronbach alphas were calculated for each subscale and ranged from .62 to .96.
Engagement Survey. Developed by McClung, this survey does not use a list of behaviors as commonly used by previous researchers. Rather, this survey is made up of definitions of behavior categories. Using the 18 definitions of dishonest behaviors in the classroom (McClung & Schneider, 2015) and three definitions of dishonest behaviors in the clinical setting (previous qualitative work), participants were asked dichotomously (yes or no) if they have ever engaged in the behavior while in college. An example item is “Passed off another's work as your own without crediting a source.” Scoring is in aggregate form to learn the percentage of participants who have engaged in each type of behavior.
Neutralization Scale. Using Sykes's and Matza's (1957) neutralization theory, Ball (1966) generated an inventory of specific situations to determine the tendency of high school boys to neutralize criminal behaviors. Haines et al. (1986) then modified Ball's (1966) work to capture students' neutralization and engagement of academically dishonest behaviors. Written permission was received from the corresponding author, Emily LaBeff, to use the 11-item scale, which suggests the degree to which students neutralize their dishonest behaviors based on responses of agreement captured with a 5-point Likert scale. The prompt, “Jack should not be blamed for cheating if,” is followed with items such as “the course material is too hard; no matter how much he studies, he can't understand it” (Haines et al., 1986).
Scoring consists of summing the response scores. According Haines et al. (1986), low scores indicate high levels of neutralization and high scores indicate low levels of neutralization. Because it conceptually makes more sense that higher scores reflect higher levels of the construct measured, scoring was reversed so that high scores equal a high level of neutralization. In the original study, Haines et al. (1986) reported a split-half reliability measured with a Cronbach's alpha of .93 and item-total correlations greater than .64. In this study, Cronbach's alpha was .96.
Social Desirability Scale. Self-reporting on any survey raises concern about participants' honesty. The lack of candor is compounded when answering questions about an emotionally charged topic such as academic dishonesty. To evaluate whether participants answered honestly, they completed the short-form SDS (Strahan & Gerbasi, 1972), which includes 10 true-or-false response items. The SDS measures the tendencies of participants to answer information in a way that is socially desirable and not truthful in reality—for example, “I'm always willing to admit it when I make a mistake.” Someone answering in a socially desirable way would answer true, when truthfully the response should be false. Scoring consists of summing the response scores. The higher the score, the higher the likelihood that the participant is answering in a socially desirable way.
Demographic Form. Participants completed the demographic form, which included items such as gender, program year, and public or private institution.
Approval was received from institutional review board at the principal investigator's academic institution prior to beginning the study and data collection. Exempt status was received as anonymous completion of the online survey implied consent.
Analysis was completed using SPSS version 24 software. To determine students' perceptions of dishonesty in the academic and clinical setting, we analyzed the data using descriptive statistics (Aim 1). To examine the relationships between nursing students' perceptions of dishonest classroom behaviors and dishonest clinical behaviors, we used Pearson's r correlation analysis across conceptually parallel subscales (Aim 2). To examine the relationship between engagement in dishonest behaviors and neutralizing tendencies we used point-biserial correlations (Aim 3), which is obtained in SPSS using Pearson's r. Once it was clear there was a relationship between engagement and neutralization scores, we computed t tests to assess the difference (magnitude and significance) of neutralization scores between those who engaged in the behavior and those who did not for each of the 21 academic and clinical behavior subscales.
In addition, some researchers have used the SDS score in a regression model to control for social desirability (Smith, Zanotti, Axelton, & Saucier, 2011), whereas others have used it in correlational analysis (Niehaus, Jackson, & Davies, 2010; Osberg et al., 2010; Royal, MacDonald, & Dionne, 2013). This study assessed for correlation between the scores on the SDS with scores on the NSPDS.
Deans and programs directors from 702 AACN-accredited nursing programs were contacted. More than 1,500 students began the survey. Exclusion criteria and incompletion of more than 10% of the survey reduced the total participant number to 973. Participants attended schools in 33 states and the District of Columbia. Seventy-four percent identified as being affiliated with a religion, and 67% work in a paying job for an average of 15 hours per week. Table 2 provides further descriptions of the study sample, which are consistent with national data descriptions of nursing students (National League for Nursing, 2014). The NSPDS subscale results are reported in Table 3. The behavior subscale perceived as most dishonest in the classroom setting was cheating, and in the clinical setting, perjury. Not all the behaviors were considered dishonest by students. Assistance, a classroom behavior subscale, was perceived as not dishonest given that the mean was less than 2.5.
Student Demographics (N = 973)
Perceptions of Dishonesty in the Classroom and Clinical Settings
As reported in McClung and Schneider (2018), two NSPDS clinical subscales have conceptually parallel subscales in the classroom setting. Perjury (clinical) and cheating (classroom) share similar behaviors and were highly related (r = .83, p = .000). Likewise, noncompliance (clinical) and cutting corners (classroom) contained similar behaviors and were moderately related (r = .38, p = .000).
Frequencies of engagement in dishonest behaviors and the correlations between engagement and neutralization tendencies are provided in Table 4, along with t test results for each of the 21 behaviors. Ninety-six percent of participants reported engaging in at least one of the 21 behaviors, and 60% reported engaging in five or more.
Engagement and Neutralization Correlation
The SDS mean score is .47 on a 0 to 1 scale. This middle-ranged score means that most of the participants likely have an average concern about the social desirability of their answers and that their general behavior in life may reflect an average amount of conformity to social expectations and rules ( http://www.cengage.com/resource_uploads/downloads/0495092746_63626.pdf). Correlation of the NSPDS subscale scores and the SDS score produced Pearson r values ranging from .01 to .19, suggesting very small amounts of correlation. Therefore, it can be inferred that students' responses do not suggest social desirability bias.
Nursing students have a range of perceptions concerning behaviors often considered dishonest in the classroom and clinical setting. Students' rates of engagement are higher in the classroom than in the clinical setting, as well as being higher for behaviors they do not perceive as dishonest. For students engaging in behaviors they perceive as dishonest, their tendency toward neutralization is higher than those not engaging in the behaviors.
Students' perceptions of behaviors (i.e., their NSPDS scores) suggest that there is a spectrum of dishonesty. Depending on the behavior, students considered some behaviors less dishonest than others, yet still dishonest. Furthermore, the classroom subscales cutting corners and test file and the clinical subscale stealing had mean scores above 2.5 but less than 3, suggesting that students perceived these types of behaviors to be less dishonest than other behaviors, such as cheating on an examination. Although we technically considered them dishonest (scores greater than 2.5), when selecting Likert responses for these three subscale behaviors most students used the middle responses (disagree and agree) instead of the end responses (strongly disagree and strongly agree) when asked whether the behavior is dishonest. Although slightly tipped in favor of being perceived as dishonest, these three subscales had only slightly fewer students that considered the behaviors not dishonest. It is possible that this hovering around the middle of the range is due to the lack of a neutral or middle option on a 4-point scale. However, it could also suggest that behavior is seen in degrees of dishonesty, which has previously been reported in a general understanding of dishonesty (Mazar, Amir, & Ariely, 2008), as well as specifically in health care practice disciplines (Dereczyk, Bozimowski, Thiel, & Higgins, 2010; Forinash et al., 2010; McCrink, 2010).
There is another possible explanation for the mean score (2.8) of the classroom subscale of cutting corners. It is possible that students' experience in the clinical setting may influence their perception of behavior in the classroom. A key factor to quality nursing care is working as a team. Perhaps students' perception of working together in the classroom is influenced more by the team work approach at the bedside than a desire to “get out of work.” However, the perception of, and engagement in, cutting corners is alarming. Being smart and saving steps is important as a bedside nurse, yet in the classroom setting it increases the potential for gaps in students' learning and understanding of crucial information.
Compounding concern about students' perception of cutting corners is the correlation between perceptions of classroom and clinical behaviors. A .38 correlation between perceptions of cutting corners (classroom) and noncompliance (clinical), although not statistically significant, is clinically meaningful. There is a risk for potential patient harm if students begin engaging in these types of behaviors in clinical settings at the rate they do in the classroom. One might argue that students who violate policy by using larger margins or font size in the classroom will not endanger patients, but violating policy by not gowning and gloving for contact isolation to answer call patients' lights or failing to perform hand hygiene between patients certainly can endanger patients.
Stealing was also a subscale with a midrange mean (2.6). We do not believe that today's students do not see stealing as highly dishonest, but perhaps the three subscale items on the NSPDS, taking TEDs, graham crackers, and a bandage for personal use, were poor items as two of them are small and inexpensive. The mean score on the NSPDS for stealing TEDs was 3.3 (on a 4-point scale), indicating it is perceived as dishonest; however, the mean for bandages was 1.8. Graham crackers was in the middle, with a mean of 2.6. These “small” or “cheap” products, along with only three items in the subscale, may be more responsible for the score. If item products were larger things, such as dressing supplies or suture removal kits, perhaps students' perception about the behavior might be different than with inexpensive items such as bandages and graham crackers.
Most of the nursing students reported engagement in dishonest activities (Table 4), but there is reassuring hope for faculty that rates of engagement in the clinical setting are considerably less than rates of engagement in the classroom setting. Why is this? Because they are new to the clinical setting? Too afraid to do anything wrong? Or could it be that students see the potential harm for patients if they decide to lie about things or cut corners in the clinical setting? Qualitative work is needed to understand why students are not engaging in dishonest behaviors in the clinical setting at the rates they are in the classroom setting.
Initially, we thought that students who reported engaging in dishonest behaviors would have higher rates of neutralization than students not engaging in dishonest behaviors. Of the 18 classroom behavior categories and three clinical behavior categories on the engagement survey, this is the case. Students use neutralization techniques to assuage any unpleasant feeling they have for engaging in a dishonest behavior. Neutralizing, or rationalizing, dishonest behavior has already been reported in the nursing education literature. According to Balik et al. (2010), students reported varying degrees of engagement in cheating depending on students' rationale, such as opportunity, need for a high grade, or lack of preparation. This suggests that students will use situations and circumstances to legitimize their dishonest behavior. McCrink (2010) also suggested that students' ability to stratify, or lessen the seriousness of, a dishonest behavior allows students to reduce their guilt from participating in the behavior.
Although most classroom behavioral engagement scores correlated with neutralization scores, four of the correlations were not significant: clarification, editorial assistance, sabotage, and supplemental learning. Clarification, editorial assistance, and supplemental learning had high rates of engagement (80%, 81%, and 86%, respectively). These are also behaviors with low scores on the NSPDS. This suggests that students did not perceive the behaviors as dishonest. Sabotage, on the other hand, is the only behavior subscale perceived as dishonest that was not significantly correlated to neutralization for those who engaged in the behavior. It should be noted that only 10 students (1%) reported engagement in sabotage behaviors, so the usefulness of this correlation information is questionable given that the number of students engaging in sabotage is so small.
The three clinical behavior subscales had very low rates of engagement (5% to 9%). Although all clinical behaviors were perceived as dishonest, perjury was the only clinical behavior category with rates of engagement significantly related to use of neutralization. A possible explanation is that perjury is a private behavior, whereas noncompliance and stealing can be viewed or witnessed. If students observed nurses entering isolation rooms with no personal protective equipment or eating graham crackers from the patient pantry, they may then believe that their own engagement in the behavior is acceptable. Conversely, documentation of false information or copying a nurse's assessment as their own might present the student with uncomfortable feelings necessitating the need to use neutralizing techniques.
It is possible that neutralization is occurring more frequently than described here. Students were asked to report their own personal engagement in behaviors, yet the language of the neutralization scale is about another student—for example, “Jack should not be blamed for cheating if….” Humans are less willing to excuse others' behavior than their own. It is possible that scores on the neutralization scale would be higher if the prompt was “I should not be blamed for cheating if….”
Dishonesty is an emotionally charged topic. There is concern about obtaining honest responses from student participants when asked whether they have ever engaged in dishonest behaviors. To get some idea about the likelihood of participants answering in a way that is socially desirable, rather than honestly, participants were asked to complete the short-form SDS (Strahan & Gerbasi, 1972). With a mean score of .47 (possible range = 0 to 1), participants were no more likely than not to respond in a socially desirable way. Although this does not seem extremely useful in understanding social desirability, considering this finding in combination with scores on the NSPDS, engagement survey, and neutralization scales does provide some understanding of the influence of social desirability on participants' responses. Participants recorded survey responses that showed great variability, a variety of perspectives concerning the dishonesty of behaviors, and high numbers of reported engagement in dishonest behaviors and use of neutralizing tendencies. This suggests that the overall data are not influenced by social desirability and therefore it is not a concerning factor in understanding the meaningfulness of the data.
Despite a large sample size, these participants were self-selecting. Students participating in this study may represent those with relatively strong interest in the topic or found the incentive to be attractive. Although the results of this study are robust and beneficial, further work should be done to assess consistency with other samples.
Implications for Nursing Education
The spectrum of dishonesty suggests that faculty can no longer assume students understand what is and is not considered academically dishonest. Knowing that students do not perceive all behaviors in the same way, faculty should be explicit in both written and verbal explanations about what behaviors are considered dishonest and therefore not permitted in the course. Some faculty members might find this explanation to be elementary and unnecessary; yet, it could not be further from the truth. In some courses, collaboration on assignments is not only encouraged, it is expected. In other courses, faculty consider the behavior to be a form of academic dishonesty. Some faculty allow students to use notes and books on examinations, whereas others do not. Students need to be made aware of exactly what is and is not permitted in each of their courses so there is absolutely no ambiguity.
Another possible way to reduce dishonest behaviors is for faculty to discuss neutralizing techniques used by students. For those students who do not see a victim of their dishonesty in the classroom, faculty can draw connections to how a behavior in fact does have a victim—the patient. Faculty can point out that when students engage in dishonest classroom behavior, they end up with gaps in knowledge and reduced ability to critically think. Patients' safety is at risk when these students, as nurses, practice with gaps in knowledge. In addition, students who have developed a repeated pattern of dishonest behavior are inclined to take those behaviors to other settings, one of which would be the clinical setting. Thus, faculty who proactively discuss dishonest behaviors, rather than reactively, possibly change the way students think about their behaviors and can have a far-reaching effect across all areas of their lives.
Nurses are viewed by the public as one of the most trusted and honest professions; however, as faculty, we cannot assume students studying to be nurses share the same ethical characteristics. Some behaviors that faculty consider dishonest are not perceived so by students. If students do not perceive the behavior as dishonest, they are more likely to engage in it than students who do. When students engage in a dishonest behavior, they use neutralization techniques to remove culpability. Nursing faculty must be clear about what behaviors are considered dishonest in their courses and work to reduce students' dishonest engagement.
- Aaron, L., Simmons, P. & Graham-Webb, D. (2011). Academic dishonesty and unprofessional behavior. Radiologic Technology, 83, 133–140.
- American Nurses Association. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. Silver Spring, MD: NursesBooks.org.
- Arhin, A.O. (2009). A pilot study of nursing students' perceptions of academic dishonesty: A Generation Y perspective. ABNF Journal, 20, 17–21.
- Austin, Z., Simpson, S. & Reynen, E. (2005). “The fault lies not in our students, but in ourselves”: Academic honesty and moral development in health professions education—Results of a pilot study in Canadian pharmacy. Teaching in Higher Education, 10, 143–156. doi:10.1080/1356251042000337918 [CrossRef]
- Balik, C., Sharon, D., Kelishek, S. & Tabak, N. (2010). Attitudes towards academic cheating during nursing studies. Medicine and Law, 29, 547–563.
- Ball, R.A. (1966). An empirical exploration of neutralization theory. Criminologica, 4(2), 22–32. doi:10.1111/j.1745-9125.1966.tb00147.x [CrossRef]
- Baxter, P.E. & Boblin, S.L. (2007). The moral development of baccalaureate nursing students: Understanding unethical behavior in classroom and clinical settings. Journal of Nursing Education, 46, 20–27.
- Bradshaw, M.J. & Lowenstein, A.J. (1990). Perspectives on academic dishonesty. Nurse Educator, 15(5), 10–15. doi:10.1097/00006223-199009000-00003 [CrossRef]
- Curasi, C.F. (2013). The relative influences of neutralizing behavior and subcultural values on academic dishonesty. Journal of Education for Business, 88, 167–175. doi:10.1080/08832323.2012.668145 [CrossRef]
- Dereczyk, A., Bozimowski, G., Thiel, L. & Higgins, R. (2010). Physician assistant students' attitudes and behaviors toward cheating and academic integrity. Journal of Physician Assistant Education, 21, 27–31. doi:10.1097/01367895-201021010-00005 [CrossRef]
- Diekhoff, G.M., LaBeff, E.E., Clark, R.E., Williams, L.E., Francis, B. & Haines, V.J. (1996). College cheating: Ten years later. Research in Higher Education, 37, 487–502. doi:10.1007/BF01730111 [CrossRef]
- Diekhoff, G.M., LaBeff, E.E., Shinohara, K. & Yasukawa, H. (1999). College cheating in Japan and the United States. Research in Higher Education, 40, 343–353. doi:10.1023/A:1018703217828 [CrossRef]
- Forinash, A.B., Smith, W.T., Gaebelein, C.J. & Garavaglia, J. (2010). Differences in self-reported academically dishonest and nondishonest pharmacy students when rating professional dishonesty scenarios. Currents in Pharmacy Teaching and Learning, 2, 100–107. doi:10.1016/j.cptl.2010.01.004 [CrossRef]
- Haines, V.J., Diekhoff, G.M., LaBeff, E.E. & Clark, R.E. (1986). College cheating: Immaturity, lack of commitment, and the neutralizing attitude. Research in Higher Education, 25, 342–354. doi:10.1007/BF00992130 [CrossRef]
- Hilbert, G.A. (1985). Involvement of nursing students in unethical classroom and clinical behaviors. Journal of Professional Nursing, 1, 230–234. doi:10.1016/S8755-7223(85)80160-5 [CrossRef]
- Hilbert, G.A. (1987). Academic fraud: Prevalence, practices, and reasons. Journal of Professional Nursing, 3(1), 39–45. doi:10.1016/S8755-7223(87)80026-1 [CrossRef]
- Hilbert, G.A. (1988). Moral development and unethical behavior among nursing students. Journal of Professional Nursing, 4, 163–167. doi:10.1016/S8755-7223(88)80133-9 [CrossRef]
- Keçeci, A., Bulduk, S., Oruç, D. & Çelik, S. (2011). Academic dishonesty among nursing students: A descriptive study. Nursing Ethics, 18, 725–733. doi:10.1177/0969733011408042 [CrossRef]
- Kennedy, P., Bisping, T.O., Patron, H. & Roskelley, K. (2008). Modeling academic dishonesty: The role of student perceptions and misconduct type. Journal of Economic Education, 39, 4–21. doi:10.3200/JECE.39.1.4-21 [CrossRef]
- Kenny, D. (2007). Student plagiarism and professional practice. Nurse Education Today, 27, 14–18. doi:10.1016/j.nedt.2006.02.004 [CrossRef]
- Klocko, M.N. (2014). Academic dishonesty in schools of nursing: A literature review. Journal of Nursing Education, 53, 121–125. doi:10.3928/01484834-20140205-01 [CrossRef]
- Krueger, L. (2014). Academic dishonesty among nursing students. Journal of Nursing Education, 53, 77–87. doi:10.3928/01484834-20140122-06 [CrossRef]
- LaDuke, R.D. (2013). Academic dishonesty today, unethical practices tomorrow?Journal of Professional Nursing, 29, 402–406. doi:10.1016/j.profnurs.2012.10.009 [CrossRef]
- Langone, M. (2007). Educational innovation. Promoting integrity among nursing students. Journal of Nursing Education, 46, 45–47.
- Larson, J. (2013). Gallup poll: Nurses are (once again) the most trusted profession. NurseZone Newsletter, 1–1.
- Lovett-Hooper, G., Komarraju, M., Weston, R. & Dollinger, S.J. (2007). Is plagiarism a forerunner of other deviance? Imagined futures of academically dishonest students. Ethics & Behavior, 17, 323–336. doi:10.1080/10508420701519387 [CrossRef]
- McCabe, D.L. (2005, June). Levels of cheating and plagiarism remain high. The Center for Academic Integrity. Retrieved from https://web.archive.org/web/20051204091312/www.academicintegrity.org/cai_research.asp
- McCabe, D.L. (2009). Academic dishonesty in nursing schools: An empirical investigation. Journal of Nursing Education, 48, 614–623. doi:10.3928/01484834-20090716-07 [CrossRef]
- McCabe, D.L., Treviño, L.K. & Butterfield, K.D. (2001). Cheating in academic institutions: A decade of research. Ethics and Behavior, 11, 219–232. doi:10.1207/S15327019EB1103_2 [CrossRef]
- McClung, E.L. & Schneider, J.K. (2015). A concept synthesis of academically dishonest behaviors. Journal of Academic Ethics, 13(1), 1–11. doi:10.1007/s10805-014-9222-2 [CrossRef]
- McClung, E.L. & Schneider, J.K. (2018). The development & testing of the nursing students perception of dishonesty scale. Nurse Education Today, 61, 28–35. doi:10.1016/j.nedt.2017.11.002 [CrossRef]
- McCrink, A. (2010). Academic misconduct in nursing students: Behaviors, attitudes, rationalizations, and cultural identity. Journal of Nursing Education, 49, 653–659. doi:10.3928/01484834-20100831-03 [CrossRef]
- National League for Nursing. (2014). Annual survey of schools of nursing. Retrieved from http://www.nln.org/newsroom/nursing-education-statistics/annual-survey-of-schools-of-nursing-academic-year-2013-2014
- Niehaus, A.F., Jackson, J. & Davies, S. (2010). Sexual self-schemas of female child sexual abuse survivors: relationships with risky sexual behavior and sexual assault in adolescence. Archives of Sexual Behavior, 39, 1359–1374. doi:10.1007/s10508-010-9600-9 [CrossRef]
- Nonis, S. & Swift, C.O. (2001). An examination of the relationship between academic dishonesty and workplace dishonesty: A multicampus investigation. Journal of Education for Business, 77, 69–77. doi:10.1080/08832320109599052 [CrossRef]
- Osberg, T.M., Atkins, L., Buchholz, L., Shirshova, V., Swiantek, A., Whitley, J. & Oquendo, N. (2010). Development and validation of the College Life Alcohol Salience Scale: A measure of beliefs about the role of alcohol in college life. Psychology of Addictive Behaviors, 24, 1–12. doi:10.1037/a0018197 [CrossRef]
- Pulvers, K. & Diekhoff, G.M. (1999). The relationship between academic dishonesty and college classroom environment. Research in Higher Education, 40, 487–498. doi:10.1023/A:1018792210076 [CrossRef]
- Roberts, E.F. (1997). Ethical issues. Academic misconduct in schools of nursing. NursingConnections, 10(3), 28–36.
- Royal, S., MacDonald, D.E. & Dionne, M.M. (2013). Development and validation of the Fat Talk Questionnaire. Body Image, 10(1), 62–69. doi:10.1016/j.bodyim.2012.10.003 [CrossRef]
- Scanlan, C.L. (2006). Strategies to promote a climate of academic integrity and minimize student cheating and plagiarism. Journal of Allied Health, 35, 179–185.
- Smith, S.J., Zanotti, D.C., Axelton, A.M. & Saucier, D.A. (2011). Individuals' beliefs about the etiology of same-sex sexual orientation. Journal of Homosexuality, 58, 1110–1131. doi:10.1080/00918369.2011.598417 [CrossRef]
- Strahan, R. & Gerbasi, K.C. (1972). Short, homogeneous versions of the Marlow-Crowne Social Desirability Scale. Journal of Clinical Psychology, 28, 191–193. doi:10.1002/1097-4679(197204)28:2<191::AID-JCLP2270280220>3.0.CO;2-G [CrossRef]
- Sykes, G.M. & Matza, D. (1957). Techniques of neutralization: A theory of delinquency. American Sociological Review, 22, 664–670. doi:10.2307/2089195 [CrossRef]
- Tippitt, M.P., Ard, N., Kline, J.R., Tilghman, J., Chamberlain, B. & Meagher, P.G. (2009). Creating environments that foster academic integrity. Nursing Education Perspectives, 30, 239–244.
- Vandehey, M., Diekhoff, G. & LaBeff, E. (2007). College cheating: A twenty-year follow-up and the addition of an honor code. Journal of College Student Development, 48, 468–480. doi:10.1353/csd.2007.0043 [CrossRef]
- Webb, D.G., Simmons, P. & Aaron, L. (2010). Academic honesty and professional behaviors among nursing and radiologic science students: A pilot study. Pelican News, 66(4), 5–6.
- Woith, W., Jenkins, S.D. & Kerber, C. (2012). Perceptions of academic integrity among nursing students. Nurse Forum, 47, 253–259. doi:10.1111/j.1744-6198.2012.00274.x [CrossRef]
Sykes's and Matza's (1957) Neutralization Techniques, With Classroom and Clinical Examples
|Technique||Description||Classroom Example||Clinical Example|
|Denial of responsibility||Allows the student to shift blame from one's own action to the fault of another||The student blames a former teacher or faculty member for not properly preparing him or her, therefore leaving the student with no option but to cheat.||The student blames lack of time and the faculty's high expectations for documenting made-up patient data.|
|Denial of injury||Prevents the students from seeing the injury caused by the dishonest action||The student taking a pop quiz rationalizes the cheating by viewing the quiz as a small percentage of the entire course grade.||The student would see stealing dressing supplies for a roommate as causing no harm.|
|Denial of a victim||Suggests that there is no victim or one who is distant||The student cheating on a medication math test believes that no one is harmed by the cheating.||The student fails to recognize the potential harm to the patient by not completing a physical assessment and instead copying assessment data from the previous shift.|
|Condemnation of the condemner||Supports the student in shifting focus off their actions and on to the actions of the accuser||The student, when accused of dishonesty, tries to discredit or cast the faculty in a negative light.||The student, when accused of dishonesty, tries to discredit or cast the faculty in a negative light.|
|Appeal to higher loyalties||Allows the student to defend their behavior by placing the obligation to others (of their choosing) above the obligation to honesty||A student offers homework or examination answers to a friend due to placing a higher value on friendship than honesty.||A student covers for the weaknesses of a friend by assisting with the clinical assignment.|
Student Demographics (N = 973)
|Age (years; n = 831)|
| 18 to 19||5|
| 20 to 21||50|
| 22 to 23||22|
| 24 to 29||13|
| 30 to 40||7|
|Gender (n = 827)|
| Prefer not to answer||1|
|Race (n = 826)|
| African American||3|
| Pacific Islander||2|
| Prefer not to answer||2|
|Class rank (n = 816)|
|Type of institution (n = 825)|
Perceptions of Dishonesty in the Classroom and Clinical Settings
|Category of Behavior and Definitions||α||Example Behavior||N||Mean||SD|
| Cheating: Actions given or taken in an attempt to do well on test or assignments without doing the actual work||.96||During the examination, a student receives answers via text message. During an examination, a student allows a classmate to view her answers. A student submits the work of another student as his own.||963||3.7||.46|
| Assistance: To improve one's work with the help of others||.91||A student uses the writing center to have a paper edited for writing style and organization. A group of students work together to complete and individual assignment.||962||1.6||.60|
| Cutting corners: Actions taken to lessen the amount of work to be done||.86||A student assigned to read a novel watches the film version instead. A student submits a paper with larger margins than allowed||963||2.8||.61|
| Not my problem: Being aware of the academic dishonesty of others but not reporting it.||.88||A student witnesses cheating during an examination and does not report it. A student is aware of plagiarism and does not report it.||967||3.1||.66|
| Sabotage: Negatively impacting another's work||.84||A student destroys a classmate's laboratory experiment. A student does not participate in group work.||963||3.5||.60|
| Test file: Maintaining or using former tests or test questions banks||.71||A student studies test bank questions. A student maintains a test file||944||2.9||.76|
| Noncompliance: The failing to follow set guidelines, rules, or stated expectations||.93||A student does not follow a physician's order. A student breaks sterility and does not reestablish it. A student does not wash his or her hands between patients.||963||3.6||.49|
| Perjury: Creating or providing false or inaccurate information, to make up or lie||.96||A student makes up a pain score rather than asking the patient. Instead of completing the patient assessment, a student documents the nurse's assessment data as her own.||963||3.7||.47|
| Stealing: To take without permission or right||.62||A student takes and uses TEDs/surgical stockings from the supply room for personal use. A student eats graham crackers from the patient pantry.||960||2.6||.64|
Engagement and Neutralization Correlation
|Engagement Variable||Description||Mean ± SD||Correlation With Neutralization Score (r) With p Valuea||Comparison of Neutralization Between Engagement Groups (t) With p Valuea||t Test Mean Difference|
|Anti-whistle blower||Failed to report known episodes of academically dishonest behavior||.44 ± .50||.17 (.000)||4.8 (.000)||.24|
|Cheating||Initiated behaviors during an examination or quiz to obtain information so as to answer questions correctly||.13 ± .34||.25 (.000)||7.7 (.000)||.52|
|Accessory to cheating||Provided information to another student so he or she can answer questions correctly||.25 ± .43||.19 (.000)||5.8 (.000)||.32|
|Clarification||Given or received information, examples, or support to improve clarity and understanding about an assignment or procedure from someone other than the instructor. The objective is to do the assignment better or correctly.||.80 ± .40||.05 (.180)||1.3 (.180)||.08|
|Collaboration||Completed an individual assignment with a group. The objective is to lessen the amount of work or effort needed to complete the assignment.||.58 ± .49||.18 (.000)||5.7 (.000)||.26|
|Editorial assistance||Given or received assistance concerning the mechanics of writing||.81 ± .39||.02 (.633)||0.48 (.633)||.03|
|Noncompliance||Failed to follow set guidelines, rules, or stated expectations for assignments, examinations, or peer grading||.31 ± .46||.15 (.000)||4.5 (.000)||.23|
|Perjury||Created or provided false or inaccurate information. Made up or lied.||.22 ± .42||.16 (.000)||4.6 (.000)||.26|
|Plagiarism||Passed off another's work as your own without crediting a source||.04 ± .20||.13 (.000)||3.8 (.000)||.47|
|Accessory to plagiarism||Provided your work to another student so he or she can pass off your work as their own||.08 ± .27||.19 (.000)||5.6 (.000)||.48|
|Recycling||Reused all or part of your previous work in a difference course||.33 ± .47||.18 (.000)||5.2 (.000)||.27|
|Sabotage||Intentionally destroyed another's property or work||.01 ± .10||.02 (.548)||0.60 (.548)||.16|
|Short cutting||Took actions to reduce the amount of time spent reading||.77 ± .42||.14 (.000)||4.7 (.000)||.24|
|Slacker||Received credit with little or no contribution to group work. Forced other group members to do more than their fair share.||.04 ± .20||.10 (.002)||3.1 (.002)||.36|
|Supplemental learning||Received or obtained information from someone other than the instructor so as to better understand the topic||.86 ± .35||.03 (.331)||0.97 (.331)||.07|
|Supplemental test preparation||Augmented study preparation by studying old tests||.39 ± .49||.15 (.000)||4.6 (.000)||.22|
|Accessory to supplemental test preparation||Provided old tests to another student so they could augment their study preparations||.14 ± .35||.18 (.000)||5.5 (.000)||.37|
|The Hail Mary||Tried to positively influence a grade by being overly nice to a professor||.18 ± .38||.15 (.000)||4.6 (.000)||.28|
|Clinical noncompliance||Failed to follow set guidelines, rules, or stated expectations||.08 ± .28||.08 (.025)||2.2 (.025)||.19|
|Clinical perjury||Created or provided false or inaccurate information||.09 ± .29||.11 (.001)||3.3 (.001)||.27|
|Stealing||Taken without permission or right||.05 ± .21||.08 (.017)||2.4 (.017)||.27|