1. Intro to problem (Need to create a culture, not a course). In order to be a safe, effective nurse, student nurses must have an understanding and working knowledge of integrity as it relates to both academic and professional roles. ““Ethical behavior and practice are essential to providing safe patient care and are key components of nursing education” (Morgan & Hart, p. 241, 2013). Often, policies are created and standards are set without giving students the information and tools to utilize and implement integrity into their training (Morgan & Hart, 2013; McGee, 2013; Craig, Federici, & Buehler, 2010).
Across all nursing tracks, students have a genuine lack of knowledge regarding what is inappropriate behavior related to academic integrity. This lack of knowledge can lead to unethical practices beyond the student role (Laduke,2013). The development of an interactive course that addresses integrity related to both academic and professional roles should facilitate a culture of integrity which engages all stakeholders. II. Review of literature Research interest surrounding academic integrity is growing.
Several integrity-related themes have emerged. These include the development of academic integrity as it pertains to teaching and learning; the correlation of academic integrity to professional integrity; and the development of a culture of integrity. In regards to teaching and learning, Morgan and Hart (2013) investigated the impact of an academic integrity intervention deployed in an online RN to BSN nursing program.
In this randomized, controlled study, the nursing program’s tandard integrity education was compared to an 8-week course that included intense faculty led academic integrity discussions. Results showed no differences related to self-reported cheating or perceptions of seriousness of cheating between control and comparison groups. Results also showed that the comparison group had “significantly higher perceptions of faculty and student support for Al policies”, “higher levels of understanding for Al policies by faculty”, and “perceived Al policies to be more effective” than the control group (Morgan and Hart, 2013, p. 242).
East and Donnelly (2012) emphasized that a systemic process fostering a culture of academic integrity resulted in greater understanding and expression of this behavior by faculty, staff, and students. Simply having academic integrity policies in place and accessible to faculty and students did not guarantee they would be promoted and utilized. In addition, the authors found that student perception of academic integrity centered on fear of plagiarism and its punitive consequences. Students had a limited knowledge of all the areas encompassed within academic integrity (East & Donnelly, 2012).
To promote a culture of integrity, East and Donnely (2012) developed a project that “aimed to demystify the rules of academic integrity and to reform the entrenched departmental attitudes in regard to the referencing styles nominated for students to use”(p. 3).. The project included educational resources on the university library site related to the university’s values, a module for staff and faculty on managing academic integrity breaches, two student modules focused on proper referencing, and a link to an academic integrity site. Participation was mandatory.
Upon completion of the education, students were surveyed on their perception of the impact of the modules. Students reported a positive educational benefit. Further work is planned to develop a systemic approach to teaching academic integrity at the program level as well as offering students an opportunity to practice their skills (East and Donnelly, 2012). In her 2013 study, Laduke found that cheating rates in schools of nursing were reported from 70% to 90%. In one study, 94% of students surveyed had witnessed cheating. Additionally, integrity issues in school were more likely to lead to integrity issues at work.
These findings led to a “Nursing Educator’s Call to Duty” (p. 405). The authors urged nursing educators to give students all the tools and training necessary to strengthen moral decision making. Nursing educators also have a duty to hold students accountable – even if it means dismissal. Additional academic integrity studies uncovered common themes related to crea a culture of integrity. First, academic integrity knowledge must be improved at all stakeholder levels (Macfarlane, Zhang, & Pun, 2014; East & Donnelly, 2012; Boykins & Gilmore, 2012).
Next, the culture should be developed from an empowering rather than punitive framework, by teaching students how to protect their academic and professional integrity instead of emphasizing consequences. (East & Donnelly, 2012; Western Interstate Commission for Higher Education, 2009). Finally, universities must ensure that integrity is embedded into the program culture through consistent learning and accountability (Morgan & Hart, 2013; McGee, 2013; Craig, Federici, & Buehler, 2010).
III. Background A small private faith-based mid-western university was the focus of this process improvement strategy. Academic integrity policies at this institution mirrored standard policies on many universities. The student code of conduct defines integrity expectations based on Franciscan values and then further defines academically dishonest behaviors. Annually, students are instructed to review the student code of conduct and are given information on where to access it on the university website.
In the school of nursing (SON), the student nurse handbook includes policies specific to academic integrity. Historically, nursing faculty placed individualized integrity tatements within courses. At present, a standardized integrity statement approved by all nursing faculty has been placed in nursing courses. Development of an academic integrity course was inspired by the recognition that current processes did not engage stakeholders. Handbook policies and statements did not fully provide the education needed to promote academic and professional integrity.
Faculty noted that academic integrity issues occurred within the school of nursing across all tracks and levels. Students demonstrated a lack of understanding of integrity principles outside of plagiarism. Additionally, faculty knowledge and comfort levels led to inconsistent accountability.
IV. Course Development and Implementation Course development considerations included the need to address both academic and professional components of integrity. Academic content areas were pulled from the university’s student code of conduct, values, and the SON student handbook.
Additionally, the course focused on university and SON expectations and responsibilities of the student while on campus and at clinical sites. Content related to professional nursing expectations was also included. The ANA Code of Ethics provided the framework from which to draw standards of professional practice and ethical performance (American Nurses Association, 2015)). The type of learning management system (LMS) utilized was supported and in place at the university. This customizable LMS allowed for adaptable features that promote engagement and encourage interactive learning.
The university provided technical support for the development of courses within this LMS. The course was modeled after existing nursing courses to ensure comfort, ease of use, and familiarity with navigation. User engagement was promoted through interactive modules, videos, storyboard presentations, reflective assignments and quizzes. Goal for time of course completion was set at 1 hour.
Learning objectives included: (a) understand university and SON academic integrity expectations, (b) relate the university and SON academic integrity expectations to the university values, (c) nderstand professional nursing standards related to integrity, (d) understand the relevance of integrity to the academic community and the nursing profession, (e) utilize university and American Nurses Association integrity sources to recognize and correct common integrity errors, and (f) commit to academic and professional integrity. Course completion was set at an annual occurrence.. Achievement of learning would be measured by pre- and post-test results comparison, with a required achievement of 90% on the post-test.
Once the course was developed by a core group of faculty and staff, it was introduced to and piloted by the full nursing faculty and staff. Requested feedback focused on length of time for completion, ease of navigation, and participant learning. Faculty and staff were encouraged to provide feedback outside of these topics, if they desired. Of the 38 faculty and staff invited, 31 accepted the course invitation, and 20 participated. Of those faculty and staff who participated, 9 provided feedback related to length of time for course completion, promotion of university values, ease of navigation, and quiz flow.
In reviewing self-reported length of time for completion, variations were noted from fifteen minutes to 1. 5 hours with an average completion time of 41 minutes. No changes were made to shorten the course. Course adjustments were implemented based on the non-time related concerns. First, content was revised to better correspond with university values. Second, presentations were changed to open in a new window to promote ease of navigation. Finally, quiz answer format was adjusted to improve clarity in “select all that apply” style options. The integrity course was approved by full nursing faculty with the following process recommendations.
In order foster integrity competence, course completion was included with current annual requirements such as blood-borne pathogen training, fire safety awareness, math competency, and hospital specific web-based training. Successful course completion will be monitored by a dedicated faculty or staff member and notification will be provided to students who do not meet achievement requirements. Students would be required to remediate the course before repeating the post-test.
V. Plan for Outcomes Measurement Future plans for outcomes measurement include evaluating student learning by analyzing pre- and post-test scores. Additionally, students will be given an opportunity to provide feedback about the course. The overarching goal is to determine if the interactive integrity course improved academic and professional integrity behaviors by measuring annual integrity incidences within the SON. Through the transition from a policyfocused environment to fostering a culture of integrity, the hope is students will apply ethical decision making in the nursing profession..
VI. Additional research needs Along with future plans to measure the impact of integrity education on annual breaches, additional research areas should be explored. Faculty patterns in teaching and learning integrity principles along with student accountability should be explored. Further research is needed to evaluate the growth of online nursing education and the impact to academic integrity, as well as the impact of a positive versus punitive focus for teaching integrity (Morgan and Hart, 2013). Ultimately, confirmation of the correlation between academic dishonesty and unprofessional nursing practice would be of interest to academic and professional stakeholders. (Laduke, 2013).
