NUR 640 Module 8 Integrity Paper Example

Cheating on Clinical Paperwork: What Nursing Students Report and a Prevention Plan Built on Assessment Design

[Student Name]

Southern New Hampshire University

NUR 640: Assessment and Evaluation in Nursing Education

Module Eight Integrity Paper

[Instructor Name]

[Date]

Cheating on Clinical Paperwork: What Nursing Students Report and a Prevention Plan Built on Assessment Design

In most college courses, cheating harms the integrity of a grade. In nursing, dishonesty in the clinical setting can harm a patient, and habits formed as a student can carry into practice, where falsified documentation is grounds for discipline by a board of nursing. One Lakemont clinical instructor, in this composite program, discovered that a second-semester student had recorded a complete head-to-toe assessment, including lung sounds and skin condition, on a patient she had not examined that day. She had copied the findings from the electronic record to complete a required data sheet before the end of the shift. This paper uses the case to examine dishonesty in clinical nursing education. It argues that prevention depends on assessment design and explicit expectations as much as on detection and sanctions.

What Students Report

McCabe (2009) surveyed undergraduate and graduate nursing students across multiple schools and found that self-reported dishonesty was common in both the classroom and the clinical setting. Clinical behaviors included recording vital signs or assessments that were not performed and discussing patients' care as though it had been completed when it had not. McCabe also found that nursing students' rates of classroom cheating were broadly similar to those of students in other fields, which suggests nursing students are not more honest by nature simply because they chose a caring profession.

Krueger (2014) surveyed baccalaureate nursing students at one institution and found that 65% reported at least one dishonest behavior in the classroom and 54% in the clinical setting. Importantly, students who reported classroom dishonesty were more likely to report clinical dishonesty, a link that supports treating integrity as a single professional habit rather than as separate classroom and clinical rules. Bultas et al. (2017) examined how students think about academic integrity and found that the line between acceptable and unacceptable behavior was not always where faculty assumed it to be. Students may see copying chart data onto a worksheet as efficiency rather than falsification unless they are taught otherwise.

Why the Case Happened

When the instructor met with the student, she said she had been assigned two patients, the data sheet required a complete assessment on each by the end of the shift and she had run out of time while helping her nurse with a rapid response. She believed the chart data was accurate and that copying it was a reasonable shortcut. She did not think of it as falsification. None of this excuses the behavior, but it points to three features of the assignment that made it more likely: a requirement for completeness that valued a finished form over accurate observation, a deadline that ignored the unpredictability of clinical days and no explicit instruction that documenting unobserved findings is falsification.

Prevention Through Assessment Design

The first step is to change the assessment. The data sheet will now ask students to record only what they personally observed, with a column labeled "not assessed today, reason," so that an incomplete but honest sheet is acceptable and a gap can be discussed rather than hidden. Instructors will verify one or two findings on each sheet by asking the student to describe how they obtained them, for example what they heard in the right lower lobe and where they placed the stethoscope. Deadlines will allow submission at the end of the day rather than the end of the shift, with a note if clinical events prevented completion. These changes remove the pressure to fill blanks and make honest reporting the easier path.

Clear Expectations and Professional Formation

The second step is to make expectations explicit. The clinical orientation will include a short session on documentation integrity, using examples such as copying chart data, charting care before it is given and signing off skills that were not observed, and explaining why each is falsification. Students will discuss real board of nursing disciplinary cases involving documentation, with identifying details removed, which connects classroom rules to professional consequences. Because Krueger found classroom and clinical dishonesty linked, the program's integrity policy will be revised so that one statement covers both settings, and faculty will discuss it in the first week of every course rather than only in orientation.

A Fair Response Process

The third step is responding consistently when violations occur. Lakemont faculty had handled cases differently, from a private warning to course failure, which students perceived as unfair. A new process will guide responses. The instructor meets with the student, documents the facts and refers the case to a small integrity panel of faculty from outside the course. The panel considers the severity of the behavior, whether patient care was affected, whether the student acknowledges it and any prior violations. Possible outcomes range from a learning contract with remediation, such as a reflective assignment and supervised practice in assessment, to course failure for serious or repeated falsification. The student may respond in writing and appeal. In this case, because no care decisions were based on the copied findings and the student acknowledged the behavior, the panel required a learning contract and close supervision for the rest of the rotation.

Evaluating the Plan

The program will repeat an anonymous survey of clinical integrity behaviors, based on items from published studies, before the changes and a year after. It will also track the number and type of integrity referrals and the proportion resolved with remediation rather than failure. An increase in referrals in the first year would not necessarily indicate more cheating; clearer expectations and verification may simply reveal behavior that was previously hidden.

Conclusion

The student in this case copied chart data because an assignment rewarded a complete form, time ran out and no one had told her clearly that it was falsification. Research shows such behavior is common and linked across classroom and clinical settings. Redesigning assessments so honest reporting is easier, making expectations explicit, teaching documentation integrity as part of becoming a nurse and responding to violations through a fair and consistent process address the causes as well as the consequences.

References

Bultas, M. W., Schmuke, A. D., Davis, R. L., & Palmer, J. L. (2017). Crossing the "line": College students and academic integrity in nursing. Nurse Education Today, 56, 57-62. https://doi.org/10.1016/j.nedt.2017.06.012

Krueger, L. (2014). Academic dishonesty among nursing students. Journal of Nursing Education, 53(2), 77-87. https://doi.org/10.3928/01484834-20140122-06

McCabe, D. L. (2009). Academic dishonesty in nursing schools: An empirical investigation. Journal of Nursing Education, 48(11), 614-623. https://doi.org/10.3928/01484834-20090716-07