Academic Policies and Practices to Deter Cheating in Nursing Education

Abstract

AIM The aim of this systematic literature review was to assess the evidence available to facilitate nursing faculty in policy development and implementation of strategies to deter cheating.

BACKGROUND No previous comprehensive summary of successful faculty practices was found in the literature on which to base academic practice.

METHODS A search of six databases was undertaken using the combination of terms: nursing and policy, nursing and student misconduct, nursing and cheating, and nursing and integrity. More than 28,000 publications were reviewed for English language, US higher education system, and health care programs. Excluded articles described bioethical and research misconduct, admission policy, or workforce issues.

RESULTS Forty-three articles met criteria; a matrix table lists specific faculty action plans and deterrent strategies by category of misconduct for each publication.

CONCLUSION Clearly defined behaviors, processes, and consequences should be delineated by school policies to guide implementation of specific cheating deterrent strategies.

KEY WORDS

Academic Dishonesty - Honor Code - Nursing Education - Plagiarism - Student Misconduct

Cheating in colleges and universities is prevalent, with 21 percent to 90 percent of college students from all majors reporting cheating (Aaron, Simmons, & Graham Webb, 2011; Gaberson, 1997; Harper, 2006; Hart & Morgan, 2010; Hayes, Hurtt, & Bee, 2006; McCabe, 2009; McCrink, 2010; Roberson, 2009; Tippitt et al., 2009; Tomasi, Figiel, & Widener, 2009; Wilk & Bowllan, 2011; Woith, Jenkins, & Kerber, 2012). No matter the prevalence of cheating, the educator's professional duty remains the same: to identify the deviant behavior, to resolve unethical issues, and to develop policies and processes that prevent or correct unacceptable behaviors. Unfortunately, faculty often learns misconduct deterrent strategies by trial and error.

Academic policies have provided structure for the development of honor codes, implementation of practices to maintain student integrity, and support for academic and legal processes and consequences (Calhoun & Wood, 2010; McCabe, 2009). Institutions publish honor codes in school catalogs and program handbooks (Faucher & Caves, 2009; Schmidt, 2006; Wilk & Bowllan, 2011), and honor code ethical behavior is discussed in faculty and student orientation programs (DiBartolo & Walsh, 2010; Lewenson, Truglio-Londrigan, & Singleton, 2005; Randall, Hoppes, & Bender, 2008). Some schools revisit the honor code prior to each testing experience (Arhin, 2009; Faucher & Caves, 2009; Langone, 2007).

While faculty are committed to maintaining nursing education's integrity, no comprehensive, evidence-based summary of successful faculty practices was found in the literature to assist faculty in confronting academic misconduct. The purpose of this systematic review was to assess the evidence available to facilitate the development of policy and the implementation of strategies to deter cheating.

METHOD

Six databases (CINAHL Plus, PubMed, PsychINFO, ERIC, OVID Medline, and Scopus) were searched for the years between 1996 and January 2013. Search terms included: nursing, policy, student misconduct, cheating, and integrity. A global search using all terms in all databases simultaneously found two articles using the Boolean connector and. When the Boolean connector was replaced with or, oversampling occurred, with more than 798,800 publications retrieved in PubMed alone. Therefore, a separate search of each database was conducted for each set of terms: nursing and policy, nursing and student misconduct, nursing and cheating, and nursing and integrity; 28,510 articles were identified. Titles and abstracts were reviewed for the inclusion criteria of English language, United States educational system, higher education, and health care discipline. Publications were excluded if they described bioethical issues and research misconduct, admission policy, workforce issues, or leadership delegation policy.

After duplicate publications were removed, 43 articles were retained for full review and are displayed in the matrix Table. The academic programs represented in this review are primarily nursing and education, with 25 and 7 publications respectively, followed by two reports each from radiology, pharmacy, and physical therapy. One article each was found for clinical allied health, laboratory science, dental hygiene, psychology, and physician assistant programs.

A university academic integrity policy served as the organizing framework for this systematic review. The honor code addresses academic honesty by classifying unethical behaviors into four categories: a) acquiring information and providing information; b) plagiarism and dual submission; c) acquisition of examination and answers to examinations, conspiracy; and d) fabrication, misrepresentation, alterations of documents, and forgery (Prairie View A&M University, n.d., pp. 127-130). Specific faculty action plans and academic misconduct deterrent strategies were formulated for each reviewed publication. Action plans and misconduct deterrent strategies were organized by the four honor code categories and serve as exemplars of interventions presented in the publications.

The academic strategies in the following summary are not referenced. Consult the table for details about the recommendations in each of the 43 articles reviewed.

STRATEGIES

Policymaking

Academic integrity policy, honor code, code of conduct, and an honor statement to address cheating require ownership by administrators, faculty, and students. Administrators and faculty should ensure that policies clearly define expected and deviant behaviors to ensure that all stakeholders have the same understanding. Faculty and students should jointly participate in the policy's development and enforcement and receive initial orientation and regular reinforcement of the policy.

Policies should be easily accessible to students in handbooks, syllabi, and college websites. In addition, administrators and faculty have the responsibility to consistently implement the policy. Operationalizing the procedural statement provides faculty with explicit guidelines to follow when a student is suspected of academic misconduct. Delineating the consequences for a specific action prevents variation in disciplinary practices. Students who cheat or witness cheating and see a lack of disciplinary action (Hard, Conway, & Moran, 2006; Schmidt, 2006) or low detection (Owunwanne, Rustagi, & Dada, 2010) and no consequences for the misconduct assume that the behavior is acceptable. A well-communicated policy of zero tolerance for misconduct with uniform policy enforcement sends a strong message to the contrary.

When a student has been found guilty of misconduct, faculty may experience a personal feeling of disappointment toward the student, making it difficult to maintain the same positive student-faculty relationship during the remainder of the program (Fontana, 2009; Gaberson, 1997). Also, the liability related to the misconduct accusation can lead to professional feelings of failure, retributions of verbal abuse or physical assault, unfair end-of-course student evaluation, or risk to tenure (Bailey, 2001; Fontana). Hence, faculty who discover a student cheating ought to recuse themselves from the disciplinary judgment process to help maintain a productive student-faculty relationship (Calhoun & Wood, 2010; Fontana).

Acquiring Information and Providing Information

When presented with academic misconduct scenarios, 54 percent of students commonly admitted to participating in at least one cheating behavior in their present professional program (Graham Webb, Simmons, & Aaron, 2010/2011). Arhin (2009) asked students to identify cheating behaviors; 93 percent correctly identified overt cheating during an exam (e.g., writing notes on body parts, leaving the testing room to look at notes), yet only 27 percent of students identified providing course work to underclassmen as cheating. In another self-reported survey (McCabe, 2009), only 24 percent of students recognized that receiving help from others on an independent assignment was cheating.

Hard et al. (2006) found that 27 percent of students admitted to planning to cheat from another student's paper; 29 percent denied planning to cheat but did so anyway; 30 percent planned to cheat using unauthorized devices or material to do so; and 36 percent collaborated with other students to be able to copy from their exams. Acquiring or distributing an exam improperly was reported by 8 percent of the students in the Hard et al. study.

It is clear that up to a third of students cheat in a premeditated manner and often in collaboration with another student. Therefore, faculty should be aware that students pass exams on to others, acquire textbook test banks, and purchase what they believe to be copies of standardized end-ofprogram NCLEX exams.

Two reasons given by students for academic dishonesty were first, a lack of knowledge regarding the behavior (Tippitt et al., 2009) and second, rationalizing that everyone cheats, so they could also (Schmidt, 2006). Well-defined and distributed policy addresses the first issue; engaging students through interactive learning addresses the second (McCurry & Martins, 2010). Assigning projects with a purpose connected to the lecture topic encourages students to apply new knowledge and skills. In particular, students aged 18 to 24 (Millennials) find attaining knowledge for knowledge's sake to be less rewarding than searching and manipulating information to solve problems (Mangold, 2007). Higher cognitive order exam items (e.g., application or higher level) challenge students' critical thinking skills (Harper, 2006; Mohr, Ingram, Fell, & Mabey, 2011; Mujtaba & Kennedy, 2005).

Millennial students are team players who like to work in groups (McCurry & Martins, 2010; Pardue & Morgan, 2008), are technologically savvy, and benefit from formative feedback on assignments (Arhin, 2009). Classroom discussions and debates provide a forum to explain expected behaviors and to relate honesty concepts to patient outcomes and the nursing professional. Faculty should protect school test banks by limiting the students' access to exams for review, thereby reducing their ability to recreate the exam and provide the exam content to other students.

Plagiarism and Dual Submission

Plagiarism is the unethical act of stealing the thoughts of another. The term cyberplagiarism is used when a student acquires information from the Internet without acknowledging the author (Harper, 2006; Tomasi et al., 2009). Defining plagiarism and explaining how it detracts from professionalism is an important deterrent strategy. Students should be aware of the institutional consequences of plagiarism.

Students need to be taught proper citation and referencing techniques. These can be reinforced by using a standardized format (e.g., American Psychological Association) throughout the curriculum. Student involvement in the checking process with anti-plagiarizing software programs will help ensure academic integrity. Faculty should also maintain electronic copies of papers turned in from previous semester students to crosscheck for plagiarism.

Online misconduct monitoring requires sophisticated technological methods. Some of the methods include: using fingerprints to authenticate virtual learners, attaching a camera to the student's computer to record the testing session, and proctoring from a remote location with computer-locking software to prevent Internet access for emailing and messaging (Tomasi et al., 2009). Online writing assignments should have a narrow focus to prevent borrowing or purchasing papers from others. Faculty should require students to make frequent submissions to the instructor for ongoing support and assessment of learning. Allowing students to build on work submitted over time, instead of one final paper submission, will help faculty recognize the student's writing style and identify plagiarism.

Acquisition of Examinations, Answers to Examinations

classroom examinations Most students study and want to succeed. However, some students want to succeed at any cost, and they will cheat. Faculty must make it more difficult for them to cheat successfully. Test security is a primary process to reduce cheating opportunity. Limit the number of faculty who have access to the exam and do not allow student workers to copy exams. Always remember to take the original exam offthe printer and copy machines. Create multiple versions of the exam using numbering and/or colors for each version; scramble the answer choices on the different versions; change the exam questions each semester; and remember to collect all exam copies at the end of the testing session. When blank paper is allowed for calculations, pick up all pages at the end of the exam.

It is best for an instructor, not just a proctor, to be present in the room during an exam as students perceive proctors to be less astute at monitoring for cheating. Instructors or proctors should walk around the room and make eye contact with students, so students are aware of their vigilance. Turning offthe WiFi capabilities of the classroom during an exam will make it more difficult to access the Internet. However, faculty should be aware that newer wireless devices (fourth generation, or "4G") can work without an Internet connection. Hence, a policy addressing the ban of electronic devices during exams is highly recommended.

Placing all personal items at the front of the room avoids student behavior that may be considered dishonest. Assigned seating and empty seats between students separates potential collaborators. Do not allow students to leave the testing room to go to the bathroom without an escort.

online examinations Distance learning is embedded in educational systems. Courses can be completely online or an online and face-to-face hybrid. Assignments in online courses require clear definitions of acceptable behavior for group versus individual projects to avoid any misunderstandings that might allow misconduct. Distance learning may be anonymous, as the instructor may not know the student by face. Frequent communication with the student allows the faculty to be cognizant of the student's writing style in order to be able to determine when someone else is completing assignments.

Online examinations must be secured in the same manner as classroom examinations, with a few additional techniques, for example, allowing only one question on the computer screen at a time and shortening the time each question is on the screen. The campus information technology team can assist in this process. Requiring an online password that is different for each test, and changing log-in codes just prior to testing, are additional cheating prevention techniques.

An open-book test with each student having a different set of questions (but an equivalent exam) supports critical thinking (Conway-Klaassen & Keil, 2010). Written essay questions on exams require the student to apply knowledge (Tomasi et al., 2009). Changing questions each semester to prevent students from passing information on to underclassmen is another useful practice. A test question pool can assist faculty in creating parallel or new exams.

Proctors are important to maintain academic integrity of online testing. Some possible methods to assure test security include requiring students to test in person on campus with a proctor; specify a location for testing with a vetted proctor present and use a location other than the testing center, with restricted open test time.

The remote proctor is ideal to maintain online exam integrity. Security features include fingerprints, video and voice recognition, and interference with calculator memory, as well as software to lock the computer desktop. A secure browser will prevent the student from leaving the test window in search of answers from the Internet or another student. A software patch can prevent students from making a copy of the exam.

Fabrication of Information, Misrepresentation, Alterations of Documents, Forgery

Nursing is considered the most trustworthy profession by 85 percent of society, making it difficult to comprehend dishonest behavior from students who aspire to be nurses (Gamble, 2012). However, Bailey (2001) reported student misconduct that included falsifying a CPR card, fabricating information in a public health record, faking a home visit, writing a care plan based on a falsified assessment, and missing a clinical experience but writing it up and turning it in for a grade. Tippitt et al. (2009) discussed fabrication of home visits and false information on patients' charts. Circumventing the process of a patient assessment and falsification of a medical record (Faucher & Caves, 2009; Kolanko et al., 2006), as well as sharing laboratory results with another student who did not do the work, were other cheating behaviors reported (Calhoun & Wood, 2010).

Gaberson (1997) gave an example of academic fraud in which a student asked a staffnurse for assistance with a medication calculation and turned the document in as individual work. Honny's (2010) example of fabricating patient findings instead of performing the task was compounded by billing the insurance company for reimbursement for the fabricated test. Some students have been found to avoid exams or assignment deadlines by claiming to be sick or reporting that a family member had passed away (Faucher & Caves, 2009; Honny). Avoiding tasks and falsely reporting that a task was accomplished are unacceptable clinical performance behaviors (Wilk & Bowllan, 2011). The primary concern is the fear that unethical behavior by a nursing student may carry over into the workplace and deleteriously affect patient outcomes (Graham Webb et al., 2010/2011; Harper, 2006; Honny, 2010; Langone, 2007; Lewenson et al., 2005; Tippitt et al., 2009).

Creating a campus culture of honesty has been shown to deter cheating, especially when students help create this culture by being part of the process of writing the policies that govern behavior. Nursing ethics should be written into academic policies to make students accountable.

Honor codes are effective if the student understands the expectations of the code. Honor codes place culpability on the student and should be clearly written with easy-to-understand steps that inform the student and guide the administrator and faculty. Honor codes, pledges, and statements are well documented as a means of informing students of expected behaviors and placing responsibility for these behaviors on the student. Some programs require students to sign a statement or pledge on each assignment.

CO NCLUSION

To create a culture that views cheating as unacceptable, it is important to develop standards for student behavior with student participation, as well as a just process that is consistently applied to all violators. The plan will be doomed to failure unless the administration makes a commitment to adhere to and enforce these standards. Strong policies should be in place, with clear guidelines for faculty, removing the classroom faculty from the disciplinary process.

Academic integrity policies should be published in handbooks, syllabi, and on websites with clear definitions of terms, identifying misconduct behaviors and consequences of infractions. Orientation is an ideal time to acquaint faculty and students with the policy and process. Test security is a primary method to reduce the opportunity for cheating. Multiple exam versions, scrambling answers, using colored paper, and numbering examinations informs students of security implementations. Proctors should monitor students during examinations, assign seating, and escort students on breaks. Writing test questions at higher cognitive levels supports critical thinking and encourages individual thought. Personal items and all electronic equipment ought to be secured during testing. Clearly communicated and implemented cheating deterrent policies and procedures decrease cheating.

doi: 10.5480/12-1028.1

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ABOUT THE AUTHORS

Karen Stonecypher, PhD, RN, is interin education director, Parkinson's Disease Research Education Clinical Center (PADRECC), Michael E. DeBakey VA Medical Center, Houston, Texas. Pamela Willson, PhD, RN, FNP-BC, CNE, FAANP, is associate professor, Prairie View A&M University, College of Nursing, DNP Program, Houston. For more information, contact Dr. Stonecypher at [email protected].