Adjunct Nursing Faculty Perceptions of and Reactions to Unethical or Dishonest Nursing Student Behaviors in the Classroo...

MISSING IMAGE

Material Information

Title:
Adjunct Nursing Faculty Perceptions of and Reactions to Unethical or Dishonest Nursing Student Behaviors in the Classroom and Clinical Areas
Physical Description:
1 online resource (180 p.)
Language:
english
Creator:
Marshall, Deborah J
Publisher:
University of Florida
Place of Publication:
Gainesville, Fla.
Publication Date:

Thesis/Dissertation Information

Degree:
Doctorate ( Ed.D.)
Degree Grantor:
University of Florida
Degree Disciplines:
Curriculum and Instruction, Teaching and Learning
Committee Chair:
Black, Erik Wade
Committee Members:
Kumar, Swapna
Terzian, Sevan G
Krueger, Charlene Ann

Subjects

Subjects / Keywords:
adjunct -- dishonesty -- ethics -- faculty -- nursing -- training
Teaching and Learning -- Dissertations, Academic -- UF
Genre:
Curriculum and Instruction thesis, Ed.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract:
Registered Nurses are expected to behave professionally and ethically by the society who trusts that they are competent to provide care. Nursing education programs must therefore include ethical development in their academic curricula. Yet a troubling finding is that nursing faculty members disagree on what constitutes unethical and dishonest nursing student behaviors. In an effort to mitigate student cheating, a top-down approach was designed to measure the impact of a training session on adjunct nursing faculty perceptions on identifying and dealing with dishonest and unethical behaviors. The brief three hour training session was rooted in Michaelsen’s Team-Based Learning strategy, and was found to be positively significant related to improving understanding in a convenience sample of adjunct nursing faculty at a large, southern community college. Implications of these important findings for teaching and learning in adjunct groups, faculty groups, as well as groups outside nursing and academia are discussed, and recommendations for future study are offered.
General Note:
In the series University of Florida Digital Collections.
General Note:
Includes vita.
Bibliography:
Includes bibliographical references.
Source of Description:
Description based on online resource; title from PDF title page.
Source of Description:
This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility:
by Deborah J Marshall.
Thesis:
Thesis (Ed.D.)--University of Florida, 2013.
Local:
Adviser: Black, Erik Wade.
Electronic Access:
RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2014-02-28

Record Information

Source Institution:
UFRGP
Rights Management:
Applicable rights reserved.
Classification:
lcc - LD1780 2013
System ID:
UFE0045686:00001


This item is only available as the following downloads:


Full Text

PAGE 1

1 ADJUNCT NURSING FACULTY PERCEPTIONS OF AND REACTIONS TO UNETHICAL OR DISHONEST NURSING STUDENT BEHAVIORS IN THE CLASSROOM AND CLINICAL AREAS By DEBORAH JEAN MARSHALL A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION UNIVERSITY OF FLORIDA 2013

PAGE 2

2 2013 Deborah Jean Marshall

PAGE 3

3 To my m om and d ad

PAGE 4

4 ACKNOWLEDGMENTS Along my academic journey, I have been assisted and supported by many people, to whom I owe my deepest thanks. First of all, I would like to thank my parents Glenn and Jean Haller who have always supported and encouraged me in the pursuit of a higher ed ucation My parents created an environment that challenged my thinking and provided me with the foundation to believe that I could achieve whatever I decided to pursue. Without their parental enthusiasm and guidance since childhood, I would not have developed my passion for education or my fervor to educate others. Dr. Erik Black has not only been my committee chairperson, but he has been a tireless, patient mentor who has guided my learning over several years. Through his dedication as an ou tstanding educator, he has inspired my thinking to continually improve my perspective my communication and my teaching practice, and has always done so in a supportive, collaborative manner. Dr. Swapna Kumar has also channeled m y growth throughout this e ducational journey as an instructor and mentor. She has provided feedback that has allowed me to process and assimilate new knowledge, and incorporate innovative and progressive teaching techniques into my teaching practice. Her professionalism is a role model for all busy educators who wish to influence students in the classroom s and colleagues in the con ference centers. I am also grateful to my committee members; Dr Sevan Terzian and Dr. Charlene Kru e ger who helped me focus my study and communicate my under standing during the development, application and evaluation stages of the writing process. Their perspectives were invaluable to my interpretations and helped contribute to my success

PAGE 5

5 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ ........... 4 LIST OF TABLES ................................ ................................ ................................ ...................... 9 LIST OF FIGURES ................................ ................................ ................................ .................. 10 CHAPTER 1 INTRODUCTION ................................ ................................ ................................ ............. 14 Perceptions of Unethical Behavior ................................ ................................ ..................... 14 Unethical Student Behavior ................................ ................................ ................................ 15 Nursing Education and Professionalism ................................ ................................ .............. 17 Significance ................................ ................................ ................................ ....................... 20 Purpose of the Study ................................ ................................ ................................ .......... 22 Theory ................................ ................................ ................................ ............................... 25 Contextual Components of the Study ................................ ................................ ................. 25 Summary ................................ ................................ ................................ ............................ 26 2 REVIEW OF LITERATURE ................................ ................................ ............................. 28 Overview ................................ ................................ ................................ ........................... 28 Unethical and Ethical Student Behaviors ................................ ................................ ............ 29 Defining the Terms ................................ ................................ ................................ ...... 30 Unethical, Dishonest Characteristics and Complications Studies ................................ 32 The Value of Developing Ethical Student Be havior ................................ ..................... 33 Nursing Faculty Role in Developing Ethical Nursing Student Behavior ....................... 34 A History of Unethical and Dishonest Student Behavior ................................ ..................... 34 Unethical Student Behavior Studies ................................ ................................ ............. 35 Who, Why and How ................................ ................................ ................................ .... 36 Who is an unethical or dishonest student? ................................ ............................. 36 Why and how are students unethical or dishonest? ................................ ............... 37 ................................ ........................ 38 Situational or Contextual Factors ................................ ................................ ................. 39 Nursing Education and Nursing Student Behavior ................................ .............................. 41 The Evolution of the Profession of Nursing and Professional Nursing Education ......... 41 A History of Nursing Ethics ................................ ................................ ........................ 45 Academic Dishonesty in Nursing ................................ ................................ ................ 47 Faculty and their Responses ................................ ................................ ............................... 49 Adjunct Faculty ................................ ................................ ................................ ........... 49 Faculty Turning a Blind Eye ................................ ................................ ........................ 52 Faculty Reaction Studies: Overworked and Under Supported ................................ ...... 53 Faculty Lacks Agreement on what Constitutes Unethical Student Behavior ................. 54 Purpose of the Study ................................ ................................ ................................ .......... 54

PAGE 6

6 Team Based Learning ................................ ................................ ................................ ........ 55 Social C ognitive Theory ................................ ................................ ................................ ..... 58 Summary ................................ ................................ ................................ ............................ 60 3 METHODOLOGY ................................ ................................ ................................ ............. 62 Overview ................................ ................................ ................................ ........................... 62 Research Design ................................ ................................ ................................ ................. 65 Population and Sample Participants ................................ ................................ .................... 65 Instrumentation ................................ ................................ ................................ .................. 66 The Team Based Learning Method ................................ ................................ ............. 66 Course design ................................ ................................ ................................ ....... 67 Readiness assurance activities ................................ ................................ .............. 68 The P ower P oint lesson ................................ ................................ ......................... 69 Team selection ................................ ................................ ................................ ..... 70 Team application activities ................................ ................................ ................... 70 Evaluation ................................ ................................ ................................ ............ 72 The IRAT and GRAT Instrument Used ................................ ................................ ....... 72 Application Exercises ................................ ................................ ................................ .. 76 Final Surveys ................................ ................................ ................................ .............. 77 Data Analysis ................................ ................................ ................................ ..................... 77 Limitations ................................ ................................ ................................ ......................... 80 Summary ................................ ................................ ................................ ............................ 81 4 RESULTS ................................ ................................ ................................ .......................... 82 Overview ................................ ................................ ................................ ........................... 82 Demographic Explanation of the Sample ................................ ................................ ............ 82 Descriptive Analysis ................................ ................................ ................................ .......... 83 Instrument ................................ ................................ ................................ ................... 83 Instrument Results ................................ ................................ ................................ ....... 84 Inferential Analysis of Research Questions ................................ ................................ ......... 85 Research Question #1: Identification ................................ ................................ .................. 86 Classroom Identification ................................ ................................ ............................. 86 Clinical Identification ................................ ................................ ................................ .. 87 Omnibus Identification ................................ ................................ ................................ 88 Research Question #2: Preparedness ................................ ................................ .................. 89 Classroom Preparedness ................................ ................................ .............................. 89 Clinical Preparedness ................................ ................................ ................................ .. 90 Omnibus Preparedness ................................ ................................ ................................ 91 Research Question #3: Willingness ................................ ................................ .................... 92 Classroom Willingness ................................ ................................ ................................ 93 Clinical Willingness ................................ ................................ ................................ .... 94 Omnibus Willingness ................................ ................................ ................................ .. 95 Summary of Findings ................................ ................................ ................................ ......... 96

PAGE 7

7 5 CONCLUSIONS ................................ ................................ ................................ .............. 110 Overview ................................ ................................ ................................ ......................... 110 Research Question 1 Discussion ................................ ................................ ....................... 111 Research Question 2 Discussion ................................ ................................ ....................... 114 Research Question 3 Discussion ................................ ................................ ....................... 117 Implications for Nursing Practice ................................ ................................ ..................... 120 Team Based Learning in Professional Development and Continuing Education ......... 121 Improving Nursing Adjunct Faculty Perceptions of Managing Student Cheating ....... 123 Adjunct Faculty Teams ................................ ................................ .............................. 125 ................................ ................................ ................................ ..... 126 Limitations ................................ ................................ ................................ ....................... 127 Teaching Experie nces ................................ ................................ ................................ 127 Classroom Experiences ................................ ................................ ............................. 128 Convenience Sample ................................ ................................ ................................ 128 Researcher Influence ................................ ................................ ................................ 129 Recommendations for Further Research ................................ ................................ ........... 130 Continuing Education and Professional Development ................................ ................ 130 Levels 3 and 4 Analyses ................................ ................................ ............................ 131 Concluding Remarks ................................ ................................ ................................ ........ 131 APPENDIX A. INFORMED CONSENT ................................ ................................ ................................ ... 134 B. IRAT ................................ ................................ ................................ ................................ 135 C. COPYRIGHT PERMISSION ................................ ................................ ............................ 138 D. THREE CASE STUDY SCENARIOS ................................ ................................ ............... 139 E. PRE INTERVENTION INDIVIDUAL IRAT RESULTS ................................ .................. 142 F. GRAT RESULTS ................................ ................................ ................................ .............. 144 G. POST INTEVENTION FINAL IRAT RESULTS ................................ ............................. 146 H. THREE MONTH FOLLOW UP IRAT RESULTS ................................ ............................ 148 I. PRE INTERVENTION IRAT, GRAT, POST INTERVENTION FINAL IRAT, AND FOLLOW UP IRAT MEANS STANDARD DEVIATIONS, AND VARIANCES ........... 150 J. UNIVERSITY OF FLORIDA INSTITUTIONAL REVIEW BOARD PERMISSION ........ 155 K. PALM BEACH STATE COLLEGE RESEARCH STUDY APPROVAL .......................... 157

PAGE 8

8 LIST OF REFERENCES ................................ ................................ ................................ ........ 158 BIOGRAPHICAL SKETCH ................................ ................................ ................................ ... 179

PAGE 9

9 LIST OF TABLES Table page 4 1 Demographic Information for IRAT Participants ................................ ........................... 97 4 2 ................................ .............. 98 4 3 Survey Mean Scores in the Classroom and Clinical ................................ ....................... 98 4 4 Classroom Identification of Unethical or Dishonest Behavior ................................ ........ 99 4 5 Clinical Identification of Unethical or Dishonest Behavior ................................ ............ 99 4 6 Omnibus Identification o f Unethical or Dishonest Behavior ................................ ........... 99 4 7 Classroom Preparedness to Deal with Unethical or Dishonest Behavior ......................... 99 4 8 Clinical Preparedness to Deal with Unethical or Dishonest Behavior ............................. 99 4 9 Omnibus Preparedness to Deal with Unethical or Dishonest Behavior ........................... 99 4 10 Classroom Willingness to Deal with Unethical or Dishonest Behavior ......................... 100 4 11 Clinica l Willingness to Deal with Unethical or Dishonest Behavior ............................. 100 4 12 Omnibus Willingness to Deal with Unethical or Dishonest Behavior ........................... 100

PAGE 10

10 LIST OF FIGURES Figure page 2 1 Conceptual Model for Team Based Learning. A dapted from Team Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning, p. 124, by L. Michaelsen, D. Parmelee, K. McMahon, R. Levine, D. Billings (Eds.). Copyright 2008 by Stylus Publishing. Reprinted with p ermission (see Appendix C ). ................................ ................................ ................................ .......... 56 4 1 Differences in Identification of Classroom Dishonest or Unethical Behaviors Pre Intervention and Post Intervention ................................ ................................ ............... 101 4 2 Differences in Classroom Identification of Dishonest or Unethical Behaviors Pre Intervention, Post I ntervention and Three Month Follow Up ................................ ....... 101 4 3 Differences in Identification of Classroom and Clinical Dishonest or Unethical Behav iors Pre Intervention and Post Intervention ................................ ........................ 102 4 4 Differences in Classroom and Clinical Identification of Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up ................ 102 4 5 Differences in Classroom, Clinical, and Omnibus Identification of Dishonest or Unethical Behaviors Pre Intervention and Post Intervention ................................ ........ 103 4 6 Differences in Classroom, Clinical and Omnibus Identification of Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 103 4 7 Differences in Classroom Preparedness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention ................................ ........................ 104 4 8 Differences in Classroom Preparedness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up ................ 104 4 9 Differences in Classroom and Clinical Preparedness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention ................................ ........ 105 4 10 Differences in Classroom and Clinical Preparedness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 105 4 11 Differences in Classroom, Clinical, and Omnibus Preparedness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention .................... 106 4 12 Differences in Classroom, Clinical and Omnibus Preparedness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up ................................ ................................ ................................ ........ 106

PAGE 11

11 4 13 Differences in Classroom Willingness to Take Action on Dishonest or Unethic al Behaviors Pre Intervention and Post Intervention ................................ ........................ 107 4 14 Differences in Classroom Willingness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up ................ 107 4 15 Differences in Classroom and Clinical W illingness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention ................................ ........ 108 4 16 Differences in Clas sroom and Clinical Willingness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 108 4 17 Differences in Classroom, Clinical, and Omnibus Willingness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention .................... 109 4 18 Differences in Classroom, Clinical and Omnibus Willingness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up ................................ ................................ ................................ ............................... 109

PAGE 12

12 LIST OF ABBREVIATIONS ANA American Nurses Association GRAT Group Readiness Assessment Tool IRAT Individual Readiness Assessment Tool NLN National League for Nursing RN Registered Nurse TBL Team Based Learning

PAGE 13

13 Abstract of Dissertation Presented to the Graduate School of the University of Florida i n Partial Fulfillment of the Requirements for the Degree of Doctor of Education ADJUNCT NURSING FACULTY PERCEPTIONS OF AND REACTIONS TO UNETH ICAL OR DISHONEST NURSING STUDENT BEHAVIORS IN THE CLASSROOM AND CLINICAL AREAS By Deborah Jean Marshall August 2013 Chair: Erik Black Major: Curriculum and Instruction Registered Nurses are expected to behave professionally and ethically by the society who trusts that they are competent to provide care. Nursing education programs must therefore include ethical development in their academic curricula. Yet a troubling finding is that nursing faculty members disagree on what constitutes unethical and dis honest nursing student behaviors. In an effort to mitigate student cheating a top down approach was designed to measure the impact of a specifically designed, brief training session on adjunct nursing faculty perceptions on identifying and dealing with d ishonest and unethical behaviors. The three hour training session Based Learning strategy, and was found to be positively significant related to improving understanding in a convenience sample of adjunct nursing faculty at a large southern community college Implications of these important findings for teaching and learning in adjunct nursing groups, as well as other adjunct groups outside nursing are discussed and recommendations for future study are offered.

PAGE 14

14 CHAPTER 1 I NTRODUCTION Nursing students who cheat in school are likely to also cheat in the profession as Registered Nurses (Langone, 2007; Lewenson, Truglio Londrigan, & Singleton, 2005; Stern & Havlicek, 1986; Wilk & Bowllan, 2011). If a student has cheated in nursing school and not learned requisite information to care for a human being safely, then that nurse can potentially become an uns afe and even dangerous practicing Registered Nurse, causing suffering, harm or even death to the patient. Faculty must therefore identify and deal with nursing student cheating, since it would be absolutely intolerable to allow an unprepared cheater to en ter into the profession of nursing and potentially harm patients. Perceptions of Unethical Behavior This dissertation on the study of adjunct nursing faculty perceptions toward unethical nursing student behaviors begins with an introduction, followed by a literature review, methodology, results, and concludes with a discussion that includes implications The study, conducted at a large southeastern United States state college nursing program, evaluated the impact of a faculty development session on: identi fication of unethical or dishonest nursing student behaviors; evaluation of the differences between individual faculty members and faculty group perceptions and the relationships between pre intervention and post intervention including a three month follow u p on faculty conceptualizations of unethical student behavior identification ; and assessment of the awareness for professional expectation and follow through. It was predicted that a brief development session would result in an i ncreas ed understan ding as to what constitutes unethical nursing student behavior and what faculty actions are to be performed when an unethical nursing student behavior is discovered, and improve individual

PAGE 15

15 perceptions that faculty are willing to take action when dishonest or unethical nursing s tudent behavior is discovered. In the introduction, the definitions and the historical background on nursing education and professionalism in nursing are discussed Chapter 1 provides a context for the significance of this study as w ell as the purpose and theoretical framework. The introduction ends in a brief description of the method of inquiry and a summary. The second chapter, the literature review, is a synthesis of published research and theory that underlies this study. The third chapter analysis. C hapter 4 lists the results where findings associated with the data collection are detailed. Finally, C hapter 5 concludes with a discussion of the implications and significance of the findings, limitations associated with the study, and recommendations for future research. Unethical Student Behavior Not all bad behavior by nursing students is unethical behavior. Unethical behavior is a broad term that encompasses academic dishonesty and cheating behaviors, as these terms tend to interrelate in the literature (Correa, 2011; Gaberson, 1997). Clark and Springer (2007) identify incivility in nursing education as a broad range of behaviors includ ing disapproving groaning noises, cheating on exams and even verbal abuse and physical contact. Daniel, Adams and Smith (1994) discuss fabrication and falsification of data cademic misconduct, which can be observed in both the classroom and the clinical areas. Cheating behavior, when performed in the student context for this study is academically dishonest behavior. Several of the terms can overlap, so this study will defin e these terms as follows:

PAGE 16

16 Unethical behaviors will be defined in the nursing student and nursing faculty context as a breach in conduct or behavior that is contrary to the standardized expectations and demands of the profession of nursing. Cheating and academic dishonesty, when defined in a student context is obtaining or receiving information that was not done within the learning objectives of the intended work and/or circumventing an intended process in order to gain a perceived advantage. Academic misconduct is another form of cheating or academic dishonesty, but is more structured and planned than academic dishonesty, and can rise to a higher level of teacher and school response. Ethical behaviors will be defined in the context of nursing as hon est conduct or behavior that meets and can exceed the standardized expectations and demands of the profession of nursing, where the community places trust, and nurses work to maintain a positive professional reputation through their attitudes and actions. Professionalism is defined as the practice of individuals who have specific knowledge, training and experience that allows them to become licensed and provides unique and lawful services to a population that has come to expect those services to be delive red in a trustworthy, ethical manner. Academic integrity is a dedication to act on five basic values: honesty, trust, fairness, respect, and responsibility, even when faced with challenges and adversity (The Center for Academic Integrity, 1999) and is mo re than simply the opposite of academic dishonesty or academic misconduct.

PAGE 17

17 For this study, unethical student behavior will include academic dishonesty and cheating behavior. Neither unethical behavior, academic dishonesty nor cheating behaviors are consis tent with the standard expectations for ethical, professional behavior in the nursing profession. Unethical student behavior is not a new subject, and studies conducted over the last several decades have reported that academic dishonesty, a form of unethi cal student behavior, is on the rise (Callahan, 2004; Hughes & McCabe, 2006a; Daniel et al., 1994; McCabe, 1999; McCabe & Trevio, 1996). Other studies have examined the numerous characteristics of academically dishonest students, including personality an d intelligence characteristics, demographics, and courses taken. Each of these factors were found to be related to dishonest behaviors (Anderman & Murdock, 2007; Burris, McGoldrick, & Schuhmann, 2007; Davis, Drinan, & Gallant, 2009; Gewertz, 2007; Hilbert, 1988; Kerkvliet & Sigmund, 1999; McCabe, 1999; Pino & Smith, 2003; Trenholm, 2007; Whitley, 2001). Unethical student behaviors are defined differently by both students and faculty (Higbee & Thomas, 2002; PeSymaco & Marcelo, 2003; Solomon & De Natale, 20 00; Stern & Havlicek, 1986; Wajda Johnson, Handal, Brawer, & Fabricatore, 2001). Faculty members, who must guide students in learning how to behave ethically (Glen, 1999) are not in agreement about defining cheating, academic dishonesty, or unethical stud ent behaviors (Barrett & Cox, 2005; Birch, Elliott, & Trankel, 1999; Bradshaw & Lowenstein, 1990; Hughes & McCabe, 2006a; Pickard, 2006; Pincus & Schmelkin, 2003; Price, Dake, & Islam, 2001), which makes faculty response to unethical behaviors inconsistent and assessment of unethical behaviors challenging. Nursing Education and Professionalism and (Dock & Stewart, 1931; Judd, Sitzman, & Davis, 2010; Palmer, 1985). Nightingale established hospital

PAGE 18

18 training centers rather than standardized university training programs (Baly, 1986; Holliday & Parker, 1997; Palmer, 1985; Zilm, 1993). Nursing stude nts not only received training in hospitals as apprentices, but also provided the majority of the client care. This free labor was justified as a function of training before the nursing programs eventually moved out of the hospitals and into the classroom s, and outside the direct supervision of physicians who ran the hospitals (Baumgart & Kirkwood, 1990; Hanson, 1991; Krampitz, 1983; Palmer, 1985; Ruby, 1999). The impact of wars and other social and educational issues have influenced the evolution of nursi ng training programs in hospitals, community colleges and upper level colleges since the The American Nurses Association (ANA), founded in 1909 (Judd et al ., 2010; Smith, requiring nurses to be competent in the practice of nursing (American Nurses Association Professional Role Competence, 2008), yet the ANA has not been able to reach a consensus of its members regarding the minimum degree needed for entry into the practice of nursing today (Donley & Flaherty, 2008; Fairman & Okoye, 2011; Gosnell, 2002; Joel, 2002; Kidder & Cornelius, 2006; Mahaffey, 2002; Smith, 200 9). Individuals completing a Diploma Registered Nurse program typically study for two to three years and complete most of the same coursework as the two year Associate Degree nurse but include a heavy concentration in clinical experiences and direct client care in the same hospital where they receive their training (Donley & Flaherty, 2008; Smith, 2009). Individuals with a n Associate Degree in Nursing, who train primarily in community college settings which leads to entry into professional practice ( Smith, 2009) were initially intended to ease the increased demand for nurses needed during and after World War II (Mahaffey, 2002; Petry, 1943; Smith, 2009). These two year degree nursing programs were

PAGE 19

19 conceptualized to produce large numbers of nurses who allowing the upper level college trained four year b accalaureate nurses (Petry, 1943; Smith, 2009) to deliver and manage client care. All three programs; the two year, three year, and four year degree nursing program s produce graduates who are qualified to take the same licensing examination to become a r egistered n urse. Many hospitals however have not differentiated the roles between the three degrees while employing Registered Nurses. These varied levels of traini ng, delegation of client care responsibilities, and entry into practice continue to be debated among nursing members today (Gosnell, 2002; Joel, 2002: Mahaffey, 2002; Smith, 2009). Designation as a profession is recognized when groups distinguish themse lves from disciplines and occupations by building their knowledge and practice on technical and scientific knowledge; competence that is evaluated by peers (Krampetz, 1983; Schriner & Harris, 1984); a community orientation and a code of ethics (Martinez, D esiderio, & Papakonstantinou, 2010; Starr, 1982); and moving the group practice forward with specializations within the field (Joel, 2002; Marriner Tomey, 1990). The American Nurses Association (ANA) and National League for Nursing Accrediting Commission (NLNAC) leads the profession of Registered Nursing by establishing and supporting evidence based practice through the American Nurses Association Professional Standards (2012); competence through the American Nurses Association Professional Role Competence (2008) and the National L eague of Nursing Accreditation C ommission Mission Statement and Goals (2012) and the accreditation of nursing programs (DeSilets, 1998). The ANA supports nurses in their ethical obligation to provide fair and just nursing care t hrough the American Nurses Association Code of Ethics Standard 7 (2010) with Interpretation and Application statements (Fowler, 2010; Viens, 1989). It also oversees nursing specialties through its American Nurses Association; American Nurses Credentialin g Center

PAGE 20

20 (2012), American Nurses Association Continuing Professional Development (2012), the Accreditation Commission Purpose Statement, 2012) and its support for advanced nu rsing degrees (Marriner Tomey, 1990). The National Council of State Boards of Nursing (NCSBN) provides the individual states a common place to interact about public health, safety and welfare, including the national licensing examination that students take to become registered in their state (National League of Nursing Accreditation Commission Mission Statement and Goals, 2012). Following the completion of a degree, continuing education is required to renew a r egistered n urse l icense in most states (Case D i Leonardi & Biel, 2012), and is supported by the ANA (American Nurses Association Continuing Professional Development, 2012) and by the National Council of State Boards of Nursing (National Council of State Boards of Nur sing Learning Extension, 2012). Sig nificance pain of permanent change, there is a need for the kind of human service we call nursing. Diers, Between Science and Humanity The American Nurses Association (ANA) has steadily focused on the ethical practice of nursing in the context of a continually dynamic and changing field. The ANA states that the ethical development of nursing students is a cornerstone in ethical nursing pr actice (Ludwick & Silva, 1999) and American Nurses Association Code of Ethics for Nurses, Standard 7, (2010, p. to the American Nurses Association Code of E thics for Nurses (Fowler, 2010) describes nursing as a profession that embodies the values, moral ideals, and moral requirements of the group.

PAGE 21

21 Globally, the World Health Organization (2005, p. 3) identifies ethical client care as a core workforce competen cy. Since registered nurses are expected to demonstrate ethical behavior, it is concerning that students who are preparing to become nurses have been discovered to behave unethically, given that unethical and cheating behaviors of both non nursing and nu rsing students have subsequently been found to carry on into professional careers (Bradshaw & Lowenstein, 1990; Daniel et al., 1994; Davis et al., 2009; Elmore, 2009; Fass, 1986; Fontana, 2009; Gray & Smith, 1999; Hilbert, 1985; Langone, 2007; Lewenson et al., 2005; Truglio Londrigan, & Singleton, 2005; Nonis & Swift, 2001; Petress, 2003; Stern & Havlicek, 1986; Wilk & Bowllan, 2011). In a review of both nursing student and non nursing student ethical studies, it is reported the high stress demands of colle ge that produces unethical behaviors are a strong predictor of unethical behavior later in high stress professions (Lovett Hooper, Komarraju, Weston, & Dollinger, 2007; Lucas & Freidrich, 2005; Martin, Rao & Sloan, 2009). The public, who trust that nurses are honest (Gallup Poll; Honesty/Ethics in Professions 201 2 ) and ethical (Kelly, 1998; McCrink, 2010), believe that college diplomas represent a level of accomplishment for students who have earned a degree (Davis et al., 2009). They develop disrespect and distrust for those professionals who are caught cheating. McCabe, Trevio, and Butterfield (2001a) emphasized that degrees and credentials signify to the public that a certain level of competence has been demonstrated, and that those who receive unear ned credentials can (Sparks, 2011). Nurses have historically ranked as the most trusted profession ( Gallup Poll; Honesty/Ethics in Professions, 201 2 ), and episodes of cheating by nursing students or nursing faculties undermine the public trust in nurses (Randolph, 2007). The effects of cheating in

PAGE 22

22 nursing school can have ramifications for students, faculty student relations, clients, the nursing prog ram, and the profession of nursing. The effects of nursing school cheating can result in severe consequences for clients when students do not learn prerequisite information, which needs to be taught and measured carefully in the classroom and clinical area s. For example: if a student nurse had difficulty in independently calculating an accurate medication dosage and relied on a peer to complete the calculations, the instructor must identify this dishonest behavior and provide more instruction and guidance and ensure student competency Faculty do es not identify and follow up on episodes of dishonest behavior due to numerous reasons including a sense of: lack of administrative support (McCabe & Katz, 2009); follow up is too much work (Parameswaran & Devi, 2006); a desire to help students who are otherwise struggling (Lewenson et al., 2005); or Belzer, Keith Spiegel, & Wrangham, 2001). Not taking action to deal with dishonest behavior allows students to continue cheating without guidance and intervention. Dishonest students are likely to continue to behave dishonestly as a registered nurse (Gaberson, 1997). Students who cannot independently calculate medication dosages accurately, and resort to cheating in scho ol, will potentially be causing client harm as registered nurses. Purpose of the Study A fundamental assumption for this study wa s that before students can be trained or guided by faculty on learning how to behave ethically as a student, and carry this beh avior into the profession of nursing, the faculty must uniformly agree on what ethical behavior actually consists of, understand how unethical student behavior impacts learning and competence, consistently deal with acts of unethical student behavior accor ding to college policy, and implement strategies that will enhance ethical behavior. The purpose of this study wa s to

PAGE 23

23 evaluate the impact of a brief faculty development session on: faculty perceptions of how prepared faculty we re in identifying and dealin g with dishonest and unethical nursing student behaviors, and faculty perceptions of taking action when dishonest or unethical nursing student behaviors are discovered, and faculty willingness to take action when dishonest or unethical nursing student beha viors are discovered. The hypotheses being tested we re as follows: Hypothesis #1: The null hypothesis states that the mean score for identification of dishonest or unethical nursing student behavior by adjunct nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis states that the mean score for identification of dishonest or unethical nursing student behavior by adjunct nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT. Hypothesis #2: The null hypothesis states that the mean score for the preparedness in dealing with dishonest or unethical nursing student behav ior by adjunct nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis states that the mean score for the preparedness in dealing with dishone st or unethical nursing student behavior by adjunct nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT. Hypothesis #3: The null hypothesis states that the mean score for the willingness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesi s states that the mean score for the willingness in

PAGE 24

24 dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRA T. A convenience sample of adjunct nursing faculty from an Associate in Science in Nursing program at a large south eastern community college in Florida was social learning theory (1977) frames the design of the contextual factors of the faculty development group intervention on unethical behavior where individuals learn from members of a group. The study intended to investigat e faculty perceptions of unethical or dishonest nursing student behaviors It also intended to analyze the relationships between pre and post intervention faculty conceptualizations of unethical student behaviors, measured again three months after the lea rning intervention and enhance the development of an environment of awareness for professional expectation and follow through. It wa s predicted that the faculty development session w ould result in a positive correlation of those who participate d in the f aculty development session and improvement in their understanding and agreement o n what constitutes unethical nursing student behavior, and also what nursing faculty actions we re to be performed when an unethical nursing student behavior is discovered and an increase in their willingness to perform those actions Quantitative data w as obtained at the beginning of the session identifying individual perceptions of the identification of dishonest or unethical nursing student behaviors and perceptions of prep aredness and willingness to deal with unethical or dishonest nursing student behaviors The same questions were used in a s econd survey to enable the participants to analyze similarities and differences between individual adjunct faculty member and adjunc t

PAGE 25

25 faculty group perceptions and come to an improved agreement on how to deal with examples of unethical or dishonest nursing student behaviors A third survey was used to obtain individual participants perceptions of identification, preparedness and willingness levels after the team and group work, and was studied for differences between pre intervention and post intervention faculty perceptions. A fourth survey was used at the end of the semester to measure faculty perceptions of unethical nursing student behaviors, and changes are described and discussed. This last evaluation w as expected to enlighten the study by analyzing any significant change over time It revealed the degree to which changes o ccurred between the learning session at the beginning of the semester until the follow up survey at the end of the semester. Recommendations for future application and study using the team based group learning system are discussed in Chapter 5. Theory Soc ial learning theories emphasize interpersonal relationships that involve learners to observe, imitate, and model the behaviors of others, thereby internally processing (learning) the actions and relationships (Wenger, 2009), and yet even though something h as been processed (learned) in this manner, behavior can go unchanged. T he foundation for this inquiry wa s rooted efficacy, modeling and perceived collective efficacy, which i s particularly appropriate for training and learning in groups (Sweet & Michaelsen, 2007). Contextual Components of the Study Structured cooperative learning in groups ha s long been found to be an effective method of training students to work collaborative ly (Slavin, 1996), and collaboration, or working and learning interdependently on a team, is a practice that can be taught in nursing school using team based learning (Yang, Woomer, & Matthews, 2012). This study assess ed the effectiveness

PAGE 26

26 of a novel facul ty development experience for adjunct nursing faculty at Palm Beach State College Typically, adjunct nursing faculty members are practitioners who work part time or less than 30 hours per week as defined by the institution and must have a minimum of a ( National League of Nursing Accreditation Commission, Accreditation Manual, 2013). Using a Team Based Learning (TBL) approach (Michaelson, Watson, Cragin & Fink, 1982 ; Parmalee & Michaelsen, 2010; Sibley & Parmalee, 2008), the brief intervention, hosted during a three hour afternoon session, attempt ed to promote a collaborative and constructivist interactive discussion, where faculty were able to voice their varied opi nions about academic honesty and work ed toward improving outcomes that could be appli e d in their teaching practices. Team based learning has been found to be particularly effective in medical education and has been used to discuss ethically oriented topics (Chung, Rhee, Baik, & Oh Sun, 2009), and promoting engagement and high levels of satisfaction among participants (Baldwin, Bedell & e t al. 2003; Sisk, 2011; Thompson et al. 2007) Team based learning has also been recently found to be an effective teaching tool in nursing education (Andersen, Strumpel, Fensom, & Andrews, 2011; Clark, Nguyen, Bray, & Levine, 2008; Feingold Cobb, Givens, Arnold, Joslin, & Keller, 2008 ; Holleman, P oot, Mintjes de Groot, & van Achterberg, 2009; Timmermans, Van Linge, Van Petegem, Van Rompaey, & Denekens, 2012). Summary Students behaving dishonestly or unethically in their academic endeavors have been studied for decades. The fact that student nurses behave unethically in school, which may then foreshadow unethical behavior as a registered nurse, is of concern to all who might use the services of a registered nurse. With faculty in disagreement about how to identify and deal with

PAGE 27

27 unethical nursing st udent behavior, the trend for nursing students to continue to behave unethically is facilitated. Professional development is considered to be an effective manner in which to improve faculty management of unethi cal student behaviors (Andersen et al., 2011 ; Clark et al., 2008; Feingold et al., 2008; Holleman et al., 2009; Timmermans et al., 2012 ). The training session for adjunct nursing faculty wa s projected to improve understanding about the ethical behaviors that are expected to be demonstrated in the profession of nursing, which when applied to the training and guidance of nursing students, would result in a more competent professional nursing workforce. The literature and research on unethical behaviors, nursing education, professionalism and ethics will be synthesized in Chapter 2, along with an explanation of the theory that grounds this study.

PAGE 28

28 CHAPTER 2 REVIEW OF LITERATURE Overview This chapter will synthesize the published research that underlies the study of unethical and dishonest student behaviors. It will begin with the terms and examples used in the study, and continue with a description of unethical and dishonest student beha vior studies. Included in nurturing ethical nursing student behavior. The next section will outline the history of unethical and dishonest student behavio r s tudies including international student perceptions and situational or contextual factors effecting unethical behaviors. Continuing in this section is a deeper o n the history of nursing education the development of nursing professionalism and ethics and academic dishonesty in nursing Faculty perceptions and reactions to unethical student behavior, and faculty turning a blind eye on (ignoring) unethical student behavior, and the impact of administrative support will be reviewed in this section. Finally, C hapter 2 will conclude in an overview of the application of the TBL tools developed by Michaelson, Watson, Cragin and Fink (1982) for group learning, and Alber The purpose of this study is to evaluate the impact of a faculty development session on: adjunct nursing faculty identification of unethical nursing student behavior, and perception of how prepare d adjunct nursing faculty are in dealing with dishonest and unethical nursing student behaviors, and adjunct nursing faculty perceptions of taking action when dishonest or unethical nursing student behaviors are discovered. A convenience sample of adjunct nursing faculty from an A ssociate in Science in n ursing program at a large south eastern community college in Florida w as

PAGE 29

29 contextual factors of the faculty development g roup session on unethical behavior where individuals learn from members of a group. The study evaluate d the differences between individual adjunct nursing faculty members and the adjunct faculty group identification of and perceptions of unethical nursing student behaviors, and the relationships between pre intervention post intervention, and follow up data on faculty conceptualizations of unethical student behaviors, and the development of an environment of awareness for professional expec tation and follo w through. It wa s predicted that a three hour faculty development session w ould result in a positive correlation of those who participate in the faculty development session (Tsui & Gao, 2006) in improving their understanding and agreement on what constitu te d unethical nursing student behavior, and also what nursing faculty actions are to be performed when an unethical nursing studen t behavior is discovered. It wa s anticipated that this positive outcome would be achieved due to the individual collaboration that was predicted to be developed during the team collaboration, re awakening the spirit of caring about honest and ethical practice that initially attract s individuals to become nurses earlier in their professional careers ( Day, Field, Campbell, & Reutt er, 2005 ; Eley, Eley, Bertello and Rogers Clark, 2012). Unethical and Ethical Student Behaviors The following section gives examples of definitions of the terms used in this study; discuss es some unethical and dishonest characteristics that have been studi ed; and identif ies some of the complicating factors that have confounded the study of unethical behaviors and academic dishonesty. In addition, the value of developing academic honesty as a foundation for professional honesty will be discussed. Finally, f will conclude this section.

PAGE 30

30 Defining the Terms Cheating behavior, when performed in the context of the nursing profession is unethical, but not all unethical behaviors qualify as cheating (Gaberson, 1997). Cheating behavior, when performed in the student context is the act of being academically dishonest, or may rise to the level of academic misconduct (Clark & Springer, 2007; Correa, 2011; Daniel et al., 1994; Gaberson, 1997). The terms can overlap, so th is study will define these terms as follows: Cheating and academic dishonesty, when defined in a student context is obtaining or receiving information that was not done within the learning objectives of the intended work and/or circumventing an intended pr ocess in order to gain a perceived advantage. It can be planned or spontaneous and based on the context of the moment. For example: telling a lie is considered cheating if a student tells a teacher he was ill and unable to take an exam when he was not il l, and only sought to gain extra time to study more or discuss the exam with someone who had already taken the exam Academic dishonesty will be used synonymously with cheating for this study. Academic misconduct is another form of cheating or academic di shonesty, but is more structured and planned than academic dishonesty, and can rise to a higher level of teacher and school response. For example: changing the grade on a transcript in order to secure admission to a school or employment at a job. Unethical behaviors will be defined in the nursing student and faculty context as a breach in conduct or behavior that is contrary to the standardized expectations and demands of the profession of nursing. For example: a statement would be unethical if a nurse tol d a client that a particular doctor was really the only one who was very good at a surgery the client was about have, or that the client was not able to have any more pain medication so the client had to continue to suffer longer. Plagiarism is also

PAGE 31

31 consi proper recognition. Plagiarism is a breach of the standardized rules that students must adhere to while attempting to produce papers for assignments. Ethical behaviors will be de fined in the nursing student and faculty context as honest conduct or behavior that meets and can exceed the standardized expectations and demands of the profession nursing, where the community places trust, and nurses work to maintain the reputation throu gh their professional attitudes and actions. Immoral behavior is still a breach in conduct or behavior, but not a break in the professional standard. Immoral behavior is more of a judgment of others in a cultural or community context For example: a lie would be considered immoral if a husband told his wife he had did not come home on time because he had to stay late at work to finish an important business assignment when he really was meeting his mistress. Professionalism is defined in this study in the context of the nursing profession as follows: the practice within a specified group of individuals who have gained specific knowledge from education, training and experience that allows them to enter into (become licensed) and practice (perform their duti es) to provide unique and lawful services to a population that has come to expect those services to be delivered in a trustworthy, ethical manner. Academic integrity in the nursing student and faculty context is a dedication to act on five basic values: ho nesty, trust, fairness, respect, and responsibility, even when faced with challenges and adversity (The Center for Academic Integrity, 1999) and is more than simply the opposite of academic dishonesty or academic misconduct.

PAGE 32

32 It is imperative to help studen ts develop academic integrity while they are within the academic setting in order to enable these behaviors to translate into the professions and the communities in which they will be practicing and living. Students, faculty, and administrators all play a vital role in ensuring that ethical behavior has been applied in the curriculum. Unethical Dishonest Characteristics and Complications Studies Academic dishonesty, cheating, and unethical behaviors are not new subjects in academe (Crown & Spiller, 1998; Faulkender et al., 1994; Gaberson, 1997; Gardner, Roper, Gonzalez, & Simpson, 1988; Martin et al., 2009; McCabe & Trevio, 1993; Nuss, 1984; Stern & Havlicek, 1986). Studies conducted over the last several decades have reported that up to 88% of high scho ol and college students have participated in some form of academic dishonesty during their education (Faulkender et al., 1994; Feinberg, 2009; Firmin, Burger, & Blosser, 2007; Gewertz, 2007; Mastin, Peszka, & Lilly, 2009; McCabe & Katz, 2009; Miller, Shopt augh, & Parkerson, 2008; Stern & Havlicek, 1986; Vilchez & Thirunarayanan, 2011), and that academic dishonesty is on the rise (Callahan, 2004 ; Daniel et al., 1994 ; Hughes & McCabe, 2006b; McCabe, 1999). These studies have examined characteristics of acade mically dishonest students including; personality types (Davis et al., 2009); gender (Davis et al., 2009; Whitley, 2001); IQ and GPA (Hilbert, 1988; Kerkvliet & Sigmund, 1999); age (Anderman & Murdock, 2007); hard science versus liberal science students (M cCabe, 1999; Trenholm, 2007); nursing versus non nursing students (Brown, 2002; Clark & Springer, 2007; Gaberson, 1997; Glen, 1999; Hilbert, 1985; McCabe, 2009; McCabe & Katz, 2009); online versus face to face students (Gaberson, 1997; Harmon & Lambrinos, 2008; Hart & Morgan, 2010; McCabe, 1999 ; McCabe, 2009; Sparks, Spiegel, Tabachnick, Whitley, & Washburn, 1998; Petress, 2003; Roig, 2001; Sims,1995; Staats, Hupp, Wallace, & Gresley, 2009; Tellings, 2006; Throckmorton Belzer et al., 2001). All of

PAGE 33

33 these factors were found to be related to academic dishonesty; however the results and nature of the relationship varied significantly across each of the studies. Complica ting the study of academically dishonest student behaviors, or cheating, is how those behaviors are defined differently by both students and faculty (Higbee & Thomas, 2002; PeSymaco & Marcelo, 2003; Solomon & De Natale, 2000; Stern & Havlicek, 1986; Wajda Johnson et al., 2001). Carter and Punyanunt Carter (2006) studied student opinion about faculty response to student cheating behavior and found that students also disagreed on what was an appropriate response to confirmed acts of cheating. S pecifical ly, f aculty members are not in agreement amongst each other about how collaboration between students in the college setting is interpreted ( Barrett & Cox, 2005 ; Kohn, 2007 ) Some faculty encourages collaboration between students while others may label student collaboration as dishonest (Barrett & Cox, 2005; Cole & McCabe, 1996; Graham, Monday, PeSymaco and Marcelo (2003) each found varied levels of faculty agreement about whether turning in the same paper twice in two different courses, or talking to another student who has already taken an exam, is academically dishonest. This lack of agreement between faculty members about what constitutes academic dishonesty contribute s to student miscommunication about what is considered academically dishonest behavior in both face to face and online classes (PeSymaco & Marcelo, 2003). The Value of Developing Ethical Student Behavior The value of developing ethical student behavior is at the foundation for ethical professional behavior. Academic integrity is an integral part of education (Beckett, Gilbertson, & Greenwood, 2007), and an essential component of developing an ethical approach to becoming an ethical professional. Since stu dent cheating in the classroom may be indicative of

PAGE 34

34 cheating later in a profession or career (Bouville, 2010; Bradshaw & Lowenstein, 1990; Daniel et al., 1994; Gray & Smith, 1999; Martin et al., 2009; Nonis & Swift, 2001) students who are able to be dishon est through school can graduate without the moral, ethical and social skill sets that will be required in the professions in which they are trying gain entrance (Gaberson, 1997; Lewenson et al., 2005; Parameswaran & Devi, 2006; Sparks, 2011; Stern & Havlic ek, 1986; Sternberg, 2011) and in the leadership roles that they will assume within their society (Resick et al., 2011). Faculty must therefore include ethical development into the academic curriculum (Cartwright, Davson Galle & Holden, 1992). Nursing Faculty Role in Developing Ethical Nursing Student Behavior The n (Ludwick & Silva, 1999) and to prepare them to contribute to health care quality and safety (National League of Nursing; The Four Core Values, 2011) as professional nurses. Ethical students do not actually learn requisite lessons due to academically dishonest beha viors, they not only circumvent the traditional assessments in school, they also may not have internalized the necessary skills to conduct themselves as professional and ethical nurses after graduation (Bouville, 2010; Randolph, 2007; Stern & Havlicek, 198 6). Unethical nurses can harm the clients they care for, the profession of nursing, the schools from which th ey graduate and themselves. Ethical nurses are more likely to properly care for clients as expected, and be a credit to the profession, their sch ools and themselves (White, 20 0 1). A History of Unethical and Dishonest Student Behavior The following section will describe the background of some unethical student behavior studies, the personal characteristics of who is dishonest, including why and how students are dishonest, and a discussion of unethical and dishonest student behaviors and perceptions that

PAGE 35

35 have been reported in the literature. Next, some differences between North American and behavior will be explored. Finally, this section will conclude with the situational or contextual factors that influence academically dishonest or unethical student behaviors. Unethical Student Behavior Studies Academic dishonesty has been studied in the literature for almost a century (Brown & Emmett, 2001; Correa, 2011; Crown & Spiller, 1998; Spiller & Crown, 1995). Research into these unethical student behaviors stems from a society and faculty concern that students who cheat their way through school could graduate without the skills required to be ethical and competent professionals (Kasprzak & Nixon, 2004; McCabe et al., 2001a). Many of the studies studies are significant because correlations between student cheating and professional cheating have been established in several professions including business (Elmore, 2009; Martin et al., 2009; Nonis & Swift, 2001; Parameswaran & Devi, 2006; Petress, 2003), medicine (Papadakis et al., 2005), and nursing (Baxter & Boblin, 2007; Langone, 2007; Lewenson et al., 2005; Semple, Kenkre, & Achilles, 2004; Solomon & DeNatale, 2000; St ern & Havlicek, 1986). The majority of the studies report using a self report methodology (Black, Greaser, & Dawson, 2008; Brown, D., 2002; Hart & Morgan, 2010; Higbee & Thomas, 2002; Hilbert, 1985 1988; McCabe, Trevio, & Butterfield, 1999; Stuber McEw en, Wiseley, Hoggatt, 2009); however other forms of inquiry are also reported, including Randomized Response (Grijalva, Nowell, & Kerkvliet, 2006; Kerkvliet & Sigmund, 1999; Ostapczuk, Moshagen, Zhao, & Musch, 2009; Scheers & Dayton, 1987), qualitative int erview (McCabe, 1999), Multidimensional Scaling (MDS) or pairing of dishonest behaviors (Pincus & Schmelkin, 2003), and actual

PAGE 36

36 deception (Gardner et al., 1988; Kerkvliet & Sigmund, 1999; Nowell & Laufer, 1997; Tittle & Rowe, 1974). Standing and Shearson ( 2010) considered the order that items were presented on a questionnaire and demonstrated that item order is a rarely studied example of methodological bias in examining student cheating behaviors. Each of these methods discusses strengths and weaknesses. Who, Why and How Numerous studies have considered the personal characteristics of students who either participate in or report that they participate in dishonest behaviors in order to mitigate dishonest and unethical student behaviors (Burrus et al., 2007; Franklyn Stokes & Newstead, 1995; Hughes & McCabe, 2006b; McCabe & Trevio, 1993; McCabe, Trevio & Butterfield, 1999 ; McCabe, Trevio & Butterfield, 2001b; Newstead, Franklyn Stokes & Armstead, 1996; Trushnell, Byrne & Simpson, 2011). The following sect ion will describe who has been reported to be dishonest or unethical and why and how it is done. Many of these characteristics will overlap. Who is an unethical or dishonest student? At one time psychologists thought that there was a particular persona lity type that lent itself toward dishonest behaviors (Davis et al., 2009) however this has not been empirically demonstrated. Rather, studies have looked at male/female relationships, with men behaving dishonestly slightly more than women (Anderman & Mur dock, 2007; Davis et al., 2009), and women having more negative attitudes about dishonest behaviors (Whitley, 2001). Students with a higher IQ or GPA are dishonest less frequently than lower IQ students (Davis et al., 2009; Hilbert, 1988; Kerkvliet & Sigm und, 1999). Burris et al. (2007) found that pre and post survey results of college students who were given a definition of cheating were more likely to self report cheating behaviors after the

PAGE 37

37 order on a self reported cheating questionnaire study published in 2010. Anderman and Murdock (2007) reported that cheating and age are not correlated in a linear relationship, as cheating increases during K 12, and diminishes through college, graduate school, and professional school, which is charted as a curvilinear effect increasing through elementary and high school, and diminishing through college. The hard sci ence courses that usually use objective tools to measure learning have more dishonest students than liberal science courses that involve essay tests according to Anderman and Murdock (2007), McCabe (1999), and Trenholm (2007). Students with high efficacy are less likely to be academically dishonest, and conversely students with low efficacy are more likely to be dishonest, and under contextual situations like increased stress, have a significantly more positive, acceptable attitude about dishonesty (Anderm an & Murdock, 2007; Gewertz, 2007) and ironically, past cheaters are likely to have expectations of success in the future. Finally, Milliron and Sandoe (2008) find that college cheating is pervasive throughout the Net Generation, and these students have n o distinguishing characteristics since the behavior is widespread across the entire generation. Why and how are students unethical or dishonest? It has been reported by Davis et al. (2009), Sparks (2011), and Raines Ricci, Brown, Eggenberger, Hindel & S chiff, 2011 ) that students frequently behave dishonestly to achieve a better grade than what the student thought could be earned on their own without dishonest behavior, however cheating has been shown to be influenced by many factors (McCabe & Katz, 2009; McCabe et al., 2001a 2001b; Shipley, 2009; Stern & Havlicek, 1986; Sternberg, 2011; Walker & Townley, 2012; Whitley, 2001; Wotring & Bol 2011; Wowra, 2007). Several confounding variables may influence why students, who indicate that they understand wha t academic dishonesty (cheating) is, and that it is unacceptable, still go on to become cheaters.

PAGE 38

38 These complex issues have been frequently studied in an effort to find a cause for academic dishonesty to thereby design a remedy to mitigate dishonest behavi ors or devise curriculum to enhance integrity (academic honesty). McCabe and Trevio (1996) argue that students who have lived in a society that is frequently fraught with reports of ethical misconduct have a disconnect rds of academic dishonesty, seeming to believe that getting the degree in order to pursue a career, no matter how that degree is obtained, is the ultimate educational experience (Sapp, 2002; Xueqin, 2002). All of the reported studies agree that there is n o single reason why students are academically dishonest. Some students simply do not view academically dishonest behaviors as cheating (Gaberson, 1997; McCabe, 1999; Tanner, 2004; Wajda Johnston et al., 2001). Some high school students rationalize their academic dishonesty by blaming others, including society, parents, schools and teachers, while others students hold the belief that cheating is a normal part of everyday life, and everybody does it (Gaberson, 1997; McCabe, 1999; PeSymaco & Marcelo, 2003). being driven by pressures from parents, employers, schools and peers to achieve high grades (Christe, 2003; Davis et al., 2009; Gomez, 2 001; Laird, 2001; Wowra, 2007). Non native students, particularly those who speak English as a second language, may have a culturally different view of plagiarism and academic dishonesty than Western students (Amsberry, 2010; Correa, 201 1; Mundava & Chaudhuri, 2007; Russikoff, Fucaloro, & Salkauskiene, 2003; Sapp, 2002). To successfully earn the qualification to attend undergraduate or graduate studies in the United States is a life changing opportunity for a foreign student. These high achievers, who have competed with their peers throughout their lives to obtain an offer to study in the United States, can misunderstand what Western schools believe is academic

PAGE 39

39 dishonesty. In a study by Marcus (2011), one in 53 international students ha d been charged with academic dishonesty compared to one in 1,122 Canadian students. Being accused of academic dishonesty can result in expulsion from the school and being returned to their home country in disgrace (Marcus, 2011). Western students are enco uraged to critically think, to discuss and challenge, even to question their instructors. Asian students however are taught to memorize material and never question the teacher, even if that teacher is wrong (Badke, 2002). In cultures where individualism is non existent, and collectivism is the social context, students from China, Poland, Russia, and Latvia do not understand how the thoughts and words of one person belong to that in Western schools (Amsberry, 2010; Correa, 2011; Lupton, Chapman, & Weis, 2000; Russikoff, Fucaloro, & Salkauskiene, 2003; Sapp, 2002; Xueqin, 2002). Marcus (2011) reports that Chinese students believe they are honoring the author when using th at person words without citing a reference. Situational or Contextual Factors Some researchers have reported that the more consistently a teacher or a peer will take action when dishonest behavior is discovered and the more severe the penalty, the less likely the student will behave dishonestly (Christe, 2003; Davis et al., 2009; Gomez, 2001; Harmon & Lambrinos, 2008; Laird, 2001; Miller, Shoptaugh, & Wooldridge, 2011; Wowra, 2007). Several studies discuss the lack of faculty involvement, or a feeling that studen ts can get away with dishonest behavior as a significant factor (Christe, 2003; Correa, 2011; Fontana, 2009; McCabe, 1999; Miller et al., 2011; Staats et al., 2009; Ste a rns, 2001). Students have reported feeling compelled to help ano ther student to behave dishonestly to be successful because of a personal friendship, pity, competition, or a perceived lack of It has been frequently reported

PAGE 40

40 by students that it is all student, causing major reluctance in reporting known acts of dishonesty by friends and peers, thereby allowing students to be openly dishonest without negative consequences (Cole & McCa be, 1996; Kerkvliet & Sigmund, 1999; McCabe, 1999; McCabe et al., 2001b; Wryobeck & Whitley, 1999). Firmin et al. (2007) report that students who witness dishonesty on an exam go through five cognitive stages in order to process the behavior before it can be neutralized, starting with recognition of the observed cheating behavior; shock and disbelief; rationalization; realization and finally resolution. Often, cheating students know that academically dishonest behaviors are wro ng (Snyder, 2004; Stuber McE wan et al., 2009) and may seek to neutralize the cognitive dissonance caused by their cheating behaviors (McCrink, 2010; Stern & Havlicek, 1986). Students who perceive other students behaving dishonestly are more likely to neutralize their attitude, or ju stify the academically dishonest behavior and therefore might not find it as 2010). Wryobeck and Whitley (1999) found that dishonest students are often viewed more harshly than their accomplices by their peers, seeming to make a distinction about a dishonest behavior, and assisting in a dishonest behavior. The more likely the dishonest p erson is a friend, or is seen as a sympathetic person, the less likely peers will be to report the dishonest person, and more likely to abet dishonest behaviors. A lack of an honor code (McCabe & Trevio, 1993; Wajda Johnston et al., 2001) has been reporte d to contribute to increased dishonesty, and involvement in an athletic or a Greek organization has been linked by Wajda Johnston et al. (2001) to an increased tendency for dishonest behavior. McCabe (1999) also found that students in large crowded classr ooms feel that it was easier to be dishonest than when in a smaller, monitored

PAGE 41

41 classroom. Academic dishonesty is therefore less likely to happen when students are more closely monitored in smaller classes. Nursing Education and Nursing Student Behavior Nu rses have been developing formal, structured educational programs to train students peer review and continuing education (Starr, 1982). This training is intende d to prepare student nurses to become qualified registered nurses who will be responsible for the delivery of client care, including not only the planning and delivery of client care, but the documentation of that care on the legal record, the administrati on of narcotic medications, the complete and honest communication with the rest of the health care team, and even contribute to life and death decisions (Wilkinson & Treas, 2011). Unethical nursing student behaviors are a concern to faculty and society since graduates who have not actually mastered required material can then be licensed to practice on the society, but may not be competent to practice on the society (Bailey, 2001; Elmore, 2009; Fass, 1986; Langone, 2007; Petress, 2003). An important impact that dishonest students have on nursing educational programs is the improper holding of a student seat in a nursing program, thereby excluding a qualified student from ent ering the program and becoming a graduate nurse who w ill then become a professional registered n urse. Consequently nursing students who are initially successful due to dishonest behaviors can later fail out of the program, causing student and faculty dis appointment, and a delay in placing a qualified candidate into the program (Gaberson, 1997) and subsequently into the profession The Evolution of the Profession of Nursing and Professional Nursing Education ed a nurse as drunken and dishonest (Judd et al., 2010), Florence Nightingale was able to positively influence and transform that belief into the idea that nursing was a career that good women could participate in for the benefit

PAGE 42

42 of the community (Holliday & Parker, 1997; Palmer, 1985; Zilm; 1993). Nightingale enjoyed national hero status after intervening in the physician dominated world of client care and successfully nurs ing wounded British soldiers in the Crimean War (Holliday & Parker, 1997), decreasi ng the mortality rate by 46% (Wilkinson & Treas, 2011). She used that popularity to not successful in moving the nursing training out of hospitals where stude nts exchanged their free labor for their nursing training (Baly, 1986; Ruby, 1999; Zilm, 1993), but increasingly more women were personally called to care for the sick and injured in more than a voluntary capacity (Holliday & Parker, 1997). The hospitals continued to be dominated by mostly male physicians (Baly, 1986; Palmer, 1985) who depended on female nursing students who were apprenticed to do what the doctors ordered, without an understanding of why the task should be done (Hanson, 1989; Ruby, 1999). Nursing in the United States was influenced by the standard set by Nightingale in England, and the training of nurses continued to be directly tied to hospitals for decades (Hanson, 1989). After the Civil War in the United States citizens moved from the rural farmlands into the cities, adding to the influx of immigrants where the populations exploded. This resulted in overcrowding of the poorest parts of the cities and creating more health problems. Again, nursing developed a way to intervene by creatin g a public health nursing service for indigent inner city dwellers who had no other recourse to receive healthcare (Hanson, 1989). These efforts were again stalled by the mostly male physicians, and hospital administrators and trustees who saw this nursin g movement as a means to deny the hospitals of revenue, so the physicians lobbied to put a stop to the public health nursing movement (Baumgart & Kirkwood, 1990).

PAGE 43

43 Alumnae of (ANA) was founded in 1896 with the intent to license nurses (Egenes & Burgess, 2001). This sparked statewide interests to develop a nurse practice act outlining standards for licensure in each state. Of concern was a lack of consistency about the training for nurses, and the standards used to select candidates for entrance into training (Palmer, 1985 ; Ruby, 1999 ) Some schools required physical strength as a prerequisite to enter school; some had no requirements, including no academic requirements. This resulted in the formation of the American Society of Superintendents of Training Schools of Nursing, the eague for Nursing (NLN) (Egenes & Burgess, 2001). Universities began to offer more scientific didactic education, but these programs lacked a leader who could outline a consistent recommendation for even the entrance into a nursing program, and certainly there was no agreement on what the curriculum should include in the nursing program. Programs varied at that time from two to five years in length. So while the nursing leaders disagreed and stalled the progress, other professions painfully birthed their tenets and guidelines and moved c loser to what we today consider a profession (Egenes & Burgess, 2001; Hanson, 1989). ame the American Nurses Association (Judd, et al., 2010). Critical articles against the reform of nursing education moving out of the hospitals and into the universities were published in favor of the educating nurses would be dangerous and encourage nurses to involved with total client care (Hanson, 1989).

PAGE 44

44 War again played a part in the progress of nursing becoming a profession. Leaders and politicians in both World War I and World War II were able to influence the development of nursing toward the goal of professionalism requiring a plan to graduate thousands more nurses to care for anticipated soldier injuries (Orsolini Hain & Waters, 2009). Private foundations and the Federal G overnment offered money and support, and nursing students found that classes were being given in both the hospital and the university setting to build a foundation of knowledge. This resulted in a two year tech nical (terminal) nursing degree that was intended to replace the longer three year hospital programs. These nurses were intended to serve as team members under the leadership of a registered professional baccalaureate qualified nurse. The reality for the competent Associate Degree Nurse evolved quickly into filling leadership positions, and no practical distinction was made by the Institute of Medicine (Fairman & Okoye, 2011) or hospitals in hiring or staffing the wards with 2, 3, or 4 year degree nurses (Orsolini Hain & Waters, 2009). In the past 40 50 years, the evolution of the profession of nursing regarding the education, training and licensing of its nursing graduates has been debated, and is still not agreed upon between nursing leadership and advoc ates of each program ( American Nurses Association Position Statement, 2012 ; Donley & Flaherty, 2008; Gosnell, 2002; Joel, 2002; Mahaffey, 2002; Petry, 1943; Smith, 2009). The core nursing curricula are similar for all three programs, and hospitals have be en slow to acknowledge differences in qualifications, therefore states and the national professional nursing organizations have unsuccessfully struggled to influence the minimal entrance into professional practice at the suggested baccalaureate level. The ANA through the American Nurses Credentialing Center for Accreditation (2013) and the NLN through the National League for Nursing Accreditation Commission Purpose Statement

PAGE 45

45 (2012) have published criterion benchmarks and standards in which nursing teaching programs must adhere in order to continue offering their programs. These regulatory boards are nationally recognized, but each state has a professional licensing board that also r egulates how a student can become a nurse, what the scope of practice is and how that nurse must perform in order to maintain the state r egistered n urse license, including lifelong learning known as continuing education (DeSilets, 1998; Stein, 1998). A His tory of Nursing Ethics Historically, nursing students and practicing r egistered n urses have been found to have a Day et al. 2005 ; Eley et al., 2012). Being traditionally a female dominated profession, Noddings feminist approa ch compared the responsibility of the delivery of nursing care to strangers as similar to a mother caring for her child and described this as ethical caring (McAlpine, 1996). Although ethics has been abundantly discussed in the literature (Baxter & Boblin 2007; Faulkender et al., 1994; Feinberg, 2009; McAlpine, 1996) and encouraged to be included in academic curricula (Bond, Mandleco, & Warnick, 2004; Din & Grgl, 2002), ethics in nursing is an evolving concept (Fowler, 2010; Turner & Rufo, 1992) that is foundational for professional identity. The first code of ethics in nursing was introduced in 1893 by Lystra Gretter as a pledge for students to make at graduation, and was named in honor of Florence Nightingale (Fowler, 2010). The recitation of the Ni ghtingale pledge is a tradition that is still practiced in nursing graduation classes today. The code evolved to reflect the changes in society and the role of women specifically. The first iterations of the nursing code of ethics of 1903 stated that whi le ethical standards were to be promoted, those standards included not only caring for the sick, but also listed Christian morality, obedience, submission to the rules, social etiquette and loyalty to the physician (Viens, 1989). The code of ethics in the mid 1920s evolved by listing involvement in

PAGE 46

46 the nursing organization and continued education as prerequisite for the profession, yet continued to list the proper ethical behaviors of a nurse to include being obedient, trustworthy, loyal and adept in socia l etiquette. By mid century, World War II had influenced nursing to abandon its blind loyalty to the physician and proper social etiquette, and include the concepts of disease prevention and health promotion as being as important as caring for the sick an d injured. autonomy (Davis, 1991), society, and the nursing prof ession (Viens, 1989). Today, the 2001 Code of Ethics for Nurses with Interpretive Statements described by the ANA (Fowler, 2010) warns that the statements are not directives about how to address specific events or changes, but rather a means by which a r egistered nurse can approach a category of concerns (Fowler, 2010, p xvii). This format intentionally avoids mandating specifics about how much each category must be weighted or considered, allowing the code of ethics to be consistent, yet flexible enoug h to respond to change (Fowler, 2010). The major principles of nursing ethics that are included in the training of nursing students today (Turner & Rufo, 1992; Wilkinson & Treas, 2011) include the following: for his or her own health. Nurses therefore cannot paternalistically make all decisions for a client. Autonomy is accomplished by educating the client and obtaining informed consent. Beneficence: the concept of doing good for the client. Nurses pra ctice beneficence when they consider the impact of treatments versus the harm that they can cause. Nonmaleficence: the prevention of harm by the stopping of something that is detrimental to the client. Prevention of a fall for a client who is at risk is an example of nonmaleficence.

PAGE 47

47 Justice: the proper use of resources in the care of a client. Allocation of resources for client care, when those resources are not endless, is the ethical dilemma that nurses must consider when caring for clients with limited funds or insurance. Using under qualified staff to deliver client care is another example of an ethical problem. Veracity: the concept of being honest and telling the truth. A dilemma can occur when the nurse must decide how much of the truth s hould be shared with the client. This concept can also include the act of whistleblowing on peers, colleagues or institutions. Fidelity: the principle of keeping all the other ethical principles balanced. It involves being trustworthy and dependable; to do what is supposed to be done for the good of the client. It requires the nurse to keep the needs of the client above the need of self. The ethical problems that nurses encounter in practicing nursing each day have evolv ed over the past century, as ou tlined by the Nursing Code of Ethics (Fowler, 2010). The Code of Ethics is a scrutinized guideline that helps registered nurses to practice ethically, and registered nurse educators to model and direct the behavior that will help nursing students to pract ice ethically This study will focus on the nursing faculty improving their agreement on what cheating is, and their understanding of what to do for unethical or dishonest nursing student behaviors by reporting an improved perception of the ethical concep t s of veracity, or being truthful; and fidelity, or being trustworthy and dependable. Academic Dishonesty in Nursing Research indicates that associate degree and baccalaureate nursing students cheat at the same rate as non nursing students (Bailey, 2001; Brown, 2002). Hilbert (1985) examined unethical classroom behaviors, including copying without referencing, turning in someone with unethical clinical behaviors, including the recording of medications and treatments as being

PAGE 48

48 done when they were not done, not reporting a client incident, and coming to the clinical area Go involvement in various acts of academic dishonesty. Specific clinical dishones t behaviors discussed included falsifying client records (Baxter & Boblin, 2007; Langone, 2007) non reporting of medication errors (Gaberson, 1997), and the documentation of treatments that were never performed (Bailey, 2001; Wilk & Bowllan, 2011). The in creased use of technology by nurses contributed to an increase in what Harper (2006 p. 672 the workplace where computers are used to document client care. must respond with the appropriate disciplinary reactions, and tactics to avoid future dishonest actions. Gaberson studied the impact that student academic dishonesty has on clients who can then be harmed; the faculty student rel ationship which should be based on trust and respect which can be destroyed; the peers who resent dishonest students progressing without investing r egistered n urse who is not able to make appropriate ethical judgments because these skills have not been acculturated as a nursing student. Each of these student concerns could impact future professional practice, and several strategies were offered to enable academ ic honesty in nursing students, including: development of moral character and moral decision making skills, role modeling, and developing and enforcin g an academic integrity policy. McCabe (2009) postulates that the pervasive use of the internet today suggests that academic cheating must be empirically studied in all disciplines to determine the extent to which

PAGE 49

49 cheating is actually taking place. c ethics research lead to a study of nursing ethics. He found that nursing students cheat less than non nursing students tting information from someone who has already taken a reported cheating at 58% compared to undergraduate non nursing students at 72%. Nursing graduate students reported cheating at 47% compared to non nursing graduate students who reported cheating at 48%. Faculty and their Response s During episodes of student cheating, faculty members respond with many different reactions, some of which may be consistent with official academic poli cies and some of which may not (Pincus & Schmelkin, 2003; Price et al., 2001; Simon et al., 2003; Sims, 1995). Inconsistent application of academic policy can undermine the college, the program, the students and the instructor. Some faculty reactions hav e even been reported to directly increase student academic dishonesty (Kohn, 2007; Levy & Rakovski, 2006; McCabe & Pavela, 2004; Semple, et al., 2004) including student perceptions of a lack of faculty involvement in classroom proceedings, being given a bo ring or unreasonable assignment, or being administered an identical assignment or exam that has been given for several previous semesters. Adjunct Faculty The definition of the part time adjunct faculty role is not universally defined (Creech, 2008). The Bureau of Labor Statistics (2012 2013) classifies part time employees as working less than 35 hours per week, but this number can vary, depending on the definition and needs of an institution (Green, 2007). One half (McLaughlin, 2005) to two thirds (Walli n, 2004) of the faculty at community colleges consist of part time faculty. This majority ratio has been

PAGE 50

50 increasing in the last few decades (Charlier & Williams, 2011; Creech, 2008; Dedman & Pearch, 2004; Gaillard Kenny, 2006), and is projected to continu e to grow as more students enroll in face to face, online, and blended college courses (The Bureau of Labor Statistics, 2012 2013). Part time or adjunct faculty (Caprio, Dubowsky Warasila, Cheatwood, & Costa, 1998) enter s into the teaching arena for many r easons. Practitioners and instructors who teach part time can supplement their income without the constraints of a full time commitment, adjusting their workloads when changes are desired (Green, 2007). Some part time employees find satisfaction in givin g back to the community and to the development of future practitioners (Dedman & Pearch, 2004; McLaughlin, 2005) whereas some professionals enjoy the limited teaching responsibilities that help to keep them active and intellectually stimulated after retire ment from their professional careers. Some adjuncts view a part time position as a pathway to a full time tenured teaching position (McLaughlin, 2005), and others use the part time teaching job as a way to ease away from their children, and to relate with other adults (Green, 2007). Some adjunct faculty are willing to work on weekends and in the evenings after their full time job, and these hours are attractive for the non traditional students who must also hold down a job during the day (Caprio et al, 19 98; Gaillard Kenny, 2006). Adjunct faculty has played a major role in staffing the teaching positions at academic institutions across the nation, particularly in the community colleges. Studies have been conducted recently to analyze the impact of this gr owing teaching group at all levels of teaching institutions to assess the full time tenured faculty to adjunct faculty ratios, but there exists confusion about roles, hours scheduled versus hours worked, and adjunct contributions to teaching, service, and research (Creech, 2008). Administrators value adjuncts for their scheduling flexibility and filling last minute gaps in staffing without the commitment of using

PAGE 51

51 contracted faculty when the student census or budgetary cuts drop the enrollment census (Capri o et al., 1998). Adjunct faculty educators are less expensive than full time tenured educators (Caprio et al., 1998; Creech, 2008; Dedman & Pearch, 2004; McLaughlin, 2005; Wallin, 2004), and adjuncts frequently bring current professional expertise to the classroom since many of them are also specialists in their field of practice (Bedford, 2009; Caprio et al., 1998; McLaughlin, 2005) There is a registered nurse shortage of over one half million qualified nurses projected to occur by the year 2020 (Bureau of Labor Statistics, 2012 2013), yet 75,587 qualified nursing students were turned away from nursing schools in 2011 (Rosseter, 2012). Full time nursing faculty could not realistically conduct both the classroom and clinical components of nursing training exclusively without sharply increasing their numbers ; therefore a team effort of full time and part time faculty in the nursing curriculum has evolved. Nursing adjunct faculty is valued for their clinical expertise by full time faculty where the adjunct faculty teaches the bul k of the clinical assignments. One contributing factor to not enrolling qualified student candidates into nursing school is the shortage of nursing faculty (Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of t he Problem and Strategies for Expanding the Supply, 2005; Rosetter, 2012), and contributing to this shortage is the median age of the nursing workforce, which is about 46 years old (Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Supply, 2005). Hinshaw (2001) refers to this as the replacements. Using the adjunct nursing faculty in the clinical s etting is a means in which more qualified students can be enrolled to become nurses, replenishing the retiring supply of aging

PAGE 52

52 nurses, and potentially contributing to the preparation of qualified graduates who will be needed in the future. Faculty Turning a Blind Eye Many institutions of learning have academic standards that students are required to put into practice (DeAngelis, 2011; McCabe, et al., 2001a; McCabe & Pavela, 2004; Whitley & Keith Spiegel, 2001). These standards can vary among institutions, but they are published in order to guide both students and faculty in the expectations for conduct. Study results however demonstrate that as many as one third (Correa, 2011) to one half (Milliron & Sandoe, 2008) of faculty do not follow the published pro cedures for episodes of academic dishonesty due to a lack of knowledge about the procedures, an opinion that the procedures are too complicated, or the penalties to students are too harsh, or just a belief that the first time offender can be dealt with in a less formal, one on one manner with the faculty member not following the expected published procedures (Correa, 2011; Fontana, 2009; Wideman, 2011). The significance of this finding is that studies have also shown that faculty who relax the rules of aca demic honesty will be seen as promoting an environment that is safe for dishonest students, causing honest students to either resent th at treatment or become cheaters themselves (Firmin et al., 2007; Hughes & McCabe, 2006b; Ryan, 1998). A contributing fact entry into higher education and a lack of educational preparedness (Findlow, 2012). Findlow asserts that the entry of nursing education into the university has removed nursing from vocat 121), but potentially lacking the faculty preparation necessary to make this transition successfully. Coren (2011) found that 40.3% of faculty preferre d to deal with episodes of student cheating by simply ignoring the behavior and excusing themselves by explaining that

PAGE 53

53 there was a lack of evidence, or the offense was trivial in their opinion, or that they just did not have the time. Coren (2011) also fo und that faculty who were more likely to ignore the dishonest behavior had high stress levels when confronting students, especially if there was a concern that the student would become emotional. Parameswaran and Devi (2006) point out that before students academic standards uniformly. Fear of student retaliation or legal ramifications by students and their lawyers was another concern (Hard, Conway, & Moran, 2006; Keith Spiege l et al., 1998). Lewenson et al. (2005) described an adjunct faculty member who lacked follow through on a blatant episode of cheating. A student who had witnessed the incident, but did not participate, informed a faculty member about an adjunct faculty m adjunct had allowed collaboration on an exam between some students, and explained that she did not think this was cheating because the participating students were at a disadvantage due weak language skills, and she was academic standards and the inequity of follow through is a confounding factor that impacts the amount of cheating that occurs in the classroom and the clinical setting, and the ability of students to behave ethically. Faculty Reaction Studies: Overworked and Under Supported When faculty deny that students cheat, this attitude of denial or simply a lack of awareness on the part of the faculty has resulted in an underestimation of how much ch eating is actually occurring (Hard et al., 2006; Volpe, Davidson, & Bell, 2008; Wajda Johnston et al., 2001). Faculty ignore academic dishonesty in students due to fear of repercussions (Jeffreys & Stier, 1995; Throckmorton Belzer et al., 2001); a feeling (Tellings, 2006 p. 363 ); or a generalized fear of insufficient evidence combined with a lack of administrative support (Keith Speigel et al. 1998; Parameswaran & Devi, 2006; Petress, 2003 ;

PAGE 54

54 Schneider, 1999; Staats et al., 2009 ). Wajda Johnston et al. (2001) found faculty perception of cheating is much lower at 0 10% and Koljactic & Silva (as cited in Hard et al., 2006, p. 1059) also found faculty perception lower. Hard et al. (2006) found a positive correlation be tween faculty beliefs of student dishonesty and the amount of preventative measures that faculty members were likely to initiate or dishonest student behaviors likely to be challenged. McCabe and Pavela (2004) surveyed over 2500 faculty to find that less than two thirds had even published academic integrity expectations in their syllabi, and Roig (2001) and Cole and McCabe (1996) found faculty could not identify what plagiarism wa s, and therefore did not follow up on incidents of student plagiarism. Facult y Lacks Agreement on what Constitutes Unethical Student Behavior Several authors (Higbee & Thomas, 2002; Muldoon, 2011; Pincus & Schmelkin, 2003) have found that faculty disagrees on how to consider student collaboration on assignments that have been direc ted to be individually completed. Some faculty find that collaboration can be a form of social support to assist classmates in the learning process and the development of teamwork skills (Barrett & Cox, 2005), while others believe that collaboration can b e interpreted as cheating under certain circumstances (Misra, McKean, West, & Russo, 2000; Nuss, 1984; Pickard, 2006; Pincus & Schmelkin, 2003; Price et al., 20 01 ). When faculty cannot come to agreement about what constitutes unethical student behavior, i t is unlikely that ethical behavior will be modeled or taught consistently by the faculty. This inconsistency can cause student confusion when trying to be successful in practicing ethically as a student, and eventually as a registered nurse. Purpose of t he Study In a review of the literature on unethical nursing student behavior, its impact on the profession of nursing, both non nursing students and nursing students have been discussed.

PAGE 55

55 Faculty and administrative reactions and support have also been repo rted in an effort to try to learn how to mitigate student cheating (Lewenson et al., 2005). A fund amental premise for this study wa s that before students can be trained or guided by faculty into learning how to behave ethically as a student, and carry this behavior into the profession of nursing, the faculty must uniformly agree on what ethical behavior actually consists of, understan d how unethical student behavior impacts learning and competence, consistently deal with acts of unethical student behavior according to college policy, and implement strategies that will enhance ethical behavior. The purpose of this study wa s to evaluate the impact of a training session in adjunct nursing faculty interpretation and reaction to dishonest or unethical nursing student behaviors, and on adjunct nursing faculty preparation and willingness to follow through on academically dishonest and unethica l nursing student behaviors. It wa s believed that a training class in unethical behavior w ould enhance adjunct nursing faculty perception of unethical student behavior, and help to develop an environment of awareness of professional expectation and follow through for training nursing students in the ethical practice of the profession of nursing. Team Based Learning In an effort to mitigate student unethical and dishonest behaviors, faculty must include ethical and honest behavior training into the nursing curriculum in order for the profession of nursing to enjoy ethical practitioners. A successful method that has been used since the 1970s is Team Based Learning (TBL) strategy for teaching large numbers of multidisciplinary students (see Figure 2 1), tak ing advantage of the collaboration of small working teams (Bastick, 1999; Michaelsen, Knight, & Fink, 2002; Michaelsen, Watson, Cragin, & Fink, 1982; Sibley & Parmelee, 2008). Using small, carefully selected team s can facilitate active lea rning, critical thinking, problem solving and participation, rather than traditionally

PAGE 56

56 lecturing to one large passive group of students (Hadjioannou, 2007; Rider & Brashers, 2006; Sweet & Michaelsen, 2007). Typically, that one large group is seated in an enormous auditorium style lecture hall where a diverse student audience includes age ranges and life experiences from the late teens to the elderly; many may not speak English as a first language as students come from international locations; and many may also be working full or part time increasing their daily commitments and workload. This diversity of students can be a challenge in any classroom, but is used as an advantage in TBL (Michaelsen et al., 200 4 ). Figure 2 1 Conceptual Model for Team Based Learning. Adapted from Team Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning, p. 124, by L. Michaelsen, D. Parmelee, K. McMahon, R. Levine, D. Billings (Eds.). Copyright 2008 by Sty lus Publishing. Reprinted with permission (see Appendix C ).

PAGE 57

57 With vast amounts of materials that are to be learned by the students in a specified timeframe, many capable students who use their established studying skills of reading, listening, note taking memorizing and testing (Michaelsen et al., 1982) struggle to keep up with the course schedule and can become discouraged and sometimes unsuccessful. The use of TBL is a strategy that has been successfully implemented with positive results in medical tra ining (Chung et al., 2009; Haidet & 2010; Thompson et al., 2007), health care policy development (Rider, Brashers, & Costanza, 2008), and nursing programs (Andersen et al., 2011; Cl ark et al., 2008; Feingold et al., 2008; Holleman et al., 2009; Timmermans et al., 201 2 ). Based Learning strategy has four main components: 1. Permanent team assignments; these are assigned by the instructor after gathering some information about the members. Assignments are based on an attempt to diversify the group of 5 to 7 members, engaging participants with various degrees of experience. 2. Readiness Assurance Process; there are 4 levels of readiness starting with the indivi dual student coming to the class having prepared by completing assignments before the team meets to proceed with the next level of application. The individual student will complete and submit a short multiple choice quiz. Then the group will complete the same quiz and collaborate on the answers, using whatever resources are available to answer the questions in the timeframe. Both of these grades are assigned to the individual, so helping the team be successful also helps the individual. The team answers are shared with the entire group, and answers are offered by the faculty. If the team feels that a quiz question answer should be appealed, a structured system is in place to present the appeal for faculty consideration. This effort helps students to bu ild stronger teams that can communicate their concerns in an articulate fashion Finally, the lecturer (expert) will review the process as it unfolds, and spend the end of the allotted time clarifying salient points that had been omitted or brought up as confusing or misunderstood. Once the expert is assured that the students are ready, application activities are introduced to use the information that has been learned. 3. Application Activities; these consist of case studies or real istic data that are pr esented as real problems for processing and determining a final outcome. In nursing, this could be a case study a list of client lab values, or client complaints that requires the team to develop an individualized nursing care plan. Guidelines for the d evelopment of these A. A S

PAGE 58

58 B. The S ame problem must be presented to the entire class in order to make comparisons when the exercise i s completed. C. A S D. A S imultaneous report by the entire group of teams allows all to focus on the present ation of the specific choice without leaving the slower student teams behind. These four steps promote individual deep thinking and engaging, content focused discussions (Parmelee & Michaelsen, 2010). 4. Peer Evaluation; the final component of the TBL str ategy is to have the students evaluate their peer team members with feedback that will be anonymously shared with the individual students. Each of these components ensures that both students and faculty are implementing the strategy for optimal results. S ome students have occasionally complained about the peer review process being concerned about receiving a portion of their course grade from a student peer instead of a teacher, however the vast majority of student and faculty respondents report improved l earning and enthusiasm for the studied subject (Feingold et al., 2008; Parmelee & Michaelsen, 2010). The current study in unethical or dishonest nursing student behaviors in the classroom and clinical areas adapt ed the TBL strategy to determine the effect s of a brief learning session on adjunct nursing faculty perceptions of and reactions to unethical and dishonest nursing student behaviors, which is described in Chapter 3 Social Cognitive Theory There are generalized categories of learning theories that have evolved over several decades, including behaviorist theories, humanist theories, cognitive theories, constructivist theories and social learning theories. The behaviorist approach to learning which was influenced by Thorndike (1913), Pavlov (1927), and Skinner (1974), proposed that learning was an observable change that was caused by an external environmental stimulus, and that the

PAGE 59

59 measure of learning could be seen in the change of the learne 2005). The humanist theories developed by Maslow (1943) and Rogers (1951) consider learning from a human potential for growth perspective (Merriam, Caffarella, & Baumgartner, 2007) where people are inherently good and str ive for higher levels of functioning. The behaviorist approach was questioned by the cognitivists including Piaget and Gagne (1970), who claimed that not all learning could be outwardly seen, and that learning was an internal process, therefore informatio n could be learned without a change in behavior (Merriam, et al., 2007). Constructivist advocates then believed that learning was done when the learner observed and and consequently that learner tried to build coherent, organized knowledge from the processed information (Mayer, 2004 ; Van Der Veer, 1986 ). These schools of thought, when thoroughly reviewed, contain areas where they overlap, but are still effective in explaining how students be used to teach t Social learning theories focus on the learning that is done within a social context, and combine elements from both the behaviorists and cognitivists (Merriam, et al., 2007). Learners in the social g roup learn from one another by observation, imitation, and modeling (Ormrod, 1999). Albert Bandura is considered to be one of the leading theorists on social learning. His Social Learning Theory, which today has been updated to include a focus on self ef ficacy, or labeled the Social Cognitive Theory to address the thinking and processing portion that contributes to human motivation, affect, and action (Merriam, et a

PAGE 60

60 Cognitive Theory can be applied to explain how the use of Team Based Learning (TBL) can be designed to provide professional development to a group of faculty members (Hirsh, 2009). avior and the consequences of those behaviors, those people will be influenced by the expectations of others on the team in TBL (Michaelsen, Parmalee, McMahon, & Levine, 2008). Social Cognitive Theory describes learners observing the behaviors of others in a group, and learning these observed behaviors by paying attention, retaining or remembering, behaviorally rehearsing, and feeling motivated; activities which will ultimately culminate in the learner engaging in and understanding the studied subject (Mi chaelsen, et al., 2008). In the Conceptual Model for TBL Michaelsen et al. (2008, Figure 10.1, p. 124) diagrams TBL with course content, which is accomplished by c oming to the team meeting prepared to contribute by having completed the pre class assignments, and contribute satisfactori ly to the team effort. Careful design by the expert instructor of these two core learner engagement activities enables the team to process at a higher level that is unachievable at an individual level, enhancing the learning potential of all the participa nts in the group (Michaelsen et al., 200 4 ). Summary Unethical student behavior is of concern to faculty, schools, professions and society. student behavior, and h ow these concerning behaviors apply to nursing students has been discussed in this study. Improving ethical student behavior is a curricular goal that can be taught dependably only when faculty can agree on what constitutes unethical behavior, and consist ently

PAGE 61

61 follow up on dishonest behaviors. A learning session on adjunct faculty identification and perceptions of unethical nursing student behavior and adjunct faculty follow through on academically dishonest and unethical nursing student behaviors w as pre sented in this study. It wa s hypothesized that a faculty development group session on unethical behavior w ould enhance adjunct nursing faculty perception of unethical student behavior, assist those faculty in the development of common conceptualizations o f unethical student behaviors, and help adjunct nursing faculty to develop an environment of awareness of professional expectation and follow through while training nursing students in the ethical practice expected in the profession of nursing. This w as a ccomplished by using the Team Based Learning strategies developed by Michaelsen (et al., 1982) which w as delivered to the adjunct nursing faculty at Palm Beach State College in southeast Florida in the spring of 201 3 The methods that w ere used are describ ed in Chapter 3.

PAGE 62

62 CHAPTER 3 METHODOLOGY Overview Nursing students who cheat in school are likely to become r egistered n urses who cheat in the profession of nursing (Langone, 2007; Lewenson, Truglio Londrigan, & Singleton, 2005; Stern & Havlicek, 1986; Wilk & Bowllan, 2011), and this can result in pain, suffering, and even death to patients who are entrusted to their care. It is therefore imperative that nursing faculty identify and deal with nursing student che ating while the student is learning how to practice as a professional r egistered n urse. Nursing educators are challenged to find the most effective teaching techniques to engage nursing students to act honestly and ethically. Research on the effects of ad junct nursing faculty education after a faculty development session on identification, preparation for and willingness to act the research design, the population and sample, instrumentation, data collection methods and procedures, data analysis procedures, and limitations for this study are described. The purpose of this study wa s to evaluate the impact of a faculty development session on: faculty identification o f unethical nursing student behaviors ; perception of how prepared faculty are in dealing with dishonest and unethical nursing student behaviors ; and faculty perceptions of their willingness to take taking action when dishonest or unethical nursing student behaviors are discovered. The questions being studied were as follows: Question #1 : How does a faculty development session impact the adjunct nursing faculty in their identification of dishonest or unethical nursing student behaviors? Question #2 : How doe s a faculty development session impact the preparedness of adjunct nursing faculty in dealing with dishonest or unethical nursing student behaviors?

PAGE 63

63 Question #3 : How does a faculty development session impact the willingness of adjunct nursing faculty in d ealing with dishonest or unethical nursing student behaviors? The hypotheses being tested we re as follows: Hypothesis #1 : The null hypothesis states that the mean score for identification of dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis states that the mean score for identification of dishonest or unethical nursing studen t behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT. Hypothesis #2: The null hypothesis states that the mean score for the preparedness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis states that the mean score for the preparedness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT. Hypothesis #3: The null h ypothesis states that the mean score for the willingness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis states that the mean score for the willingness in dealing with dishonest or unethical nursing student behavior by ad junct nursing faculty on the

PAGE 64

64 follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT A convenience sample (Patton, 1987) of adjunct nursing faculty from an Associate in Science in Nursing program at a large south eastern community college in Florida was used. In of the faculty development group session on unethical behavior where individuals interacted with and learned from members of a group. The venue wa s a state college associate degree nursing program, which favored the professional development of the adjunct nursing faculty by supporting the three hour session, which w as presented during a scheduled pre semester orientation. Participants first attended a mandatory two hour orientation that included information about faculty administrative responsibilities, and then volunteered to attend the learning session where adjunct faculty members were paid their hourly wage to participate. The research question guiding this study wa s: how does a three hour training session impact adjunct nursing faculty identification of dishonest or unethical nursing student behaviors and faculty perception of preparedness and wi llingness to take expected action when dishonest or unethical nursing student behaviors in the classroom and the clinical areas are discovered? The study evaluate d the differences between individual adjunct faculty perceptions of unethical nursin g student behaviors, and the relationships between pre intervention and post intervention conceptualizations of unethical nursing student behaviors. A follow up survey w as administered at the end of the semester to obtain self re ported percept ions of the lesson impact. It wa s predicted that the adjunct nursing faculty development session w ould result in an improved understanding as to what constitute d unethical nursing student behavior, what nursing faculty actions we re to be per formed when an unethical nursing

PAGE 65

65 student behavior wa s discovered, and improve individual perceptions that faculty are willing to take action when dishonest or unethical nursing student behavior wa s discovered. Research Design This study utilized a quantita tive design (Creswell, 2009) approach for this project. Data w as obtained using three separate 25 question surveys during one three hour learning session. A hard copy follow up survey of the 25 questions was administered to available participants three months after the training session, and was used to measure self reports of ch ange of behavior and attitude. Population and Sample Participants The population from which the sample was sel ected consists of part time adjunct nursing faculty members who teach nursing in the clinical facilities and/or the nursing skills laboratory. This population excludes adjunct nursing faculty who may lecture in the classroom. The study invited a convenie nce sample of adjunct nursing faculty in an Associate Degree nursing program in a large community college. The sample for this study consisted of forty one (N=41) adjunct nursing faculty members with zero to 22 years of teaching experience from one Associ ate in Science in Nursing community college Registered Nurse program at Palm Beach State College in Lake Worth, located in southeastern Florida where this researcher works with adjunct faculty in the teaching of nursing students. The nonprobability proces s of convenience sampling was used to identify and include all adjunct nursing faculty volunteer members who attended the biannual semester orientation for adjunct nursing faculty as members of the nursing clinical and skills lab faculty population. The r esearcher obtained Institutional Review Board (IRB) approval from the University of Florida, Gainesville Florida (Appendix J) and Palm Beach State College, Lake Worth, Florida (Appendix K) to conduct the study. The researcher gathered the data to ensure that no participants were harmed or injured. No adjunct skills lab or clinical faculty

PAGE 66

66 members were excluded. These entirely female (100%), part time faculty participants were baccalaureate, masters and doctoral degree nursing faculty who taught in the t wo year degree nursing program in either or both the clinical and skills lab areas in the community college context. Instrumentation The following section will discuss the adjusted Team Based Learning (TBL) application including the Individual Readiness A ssurance Tool (IRAT) the Group Readiness Assurance Tool (GRAT) the final IRAT, and the follow up IRAT instrument, the lesson, and the application activities used to elicit data during the studied TBL training session for nursing adjunct faculty members. TBL is a teaching technique for large groups of students that has been developed and instituted successfully for decades in many teaching institutions and businesses both in the United States and internationally (Bastick, 1999; Haidet & Facile, 2006; McMa hon, 2010; Sibley & Parmalee, 2008; Sweet & Michaelsen, 2007; Thompson et al., 2007), and is beginning to also be studied in nursing (Andersen et al., 2011; Clark et al., 2008; Feingold et al., 2008; Timmermans et al., 201 2 ), and has been successfully impl emented in both full semester reported events and opinions of cheating by nursing students in the nursing clinical and classroom courses is the basis for the 25 su rvey questions used in this study on the individual IRAT, the GRAT, the final IRAT, and the follow up IRAT The Team Based Learning Method The Team Based Learning (TBL) method of instruction was first published in 1982 by Larry Michaelsen (Michaelsen et a l., 1982). Michaelsen developed g roup learning experiences specifically for large numbers of students to enhance learning at the application level by helping students develop into teams which resulted in an improved responsibility for individual learning.

PAGE 67

67 TBL has been successfully utilized in the training of a diversity of numerous groups Instructors apply a series of careful ly constructed steps (Andersen et al., 2011; Bastick, 1999; Chung, et al., 2009; Clark, et al., 2008; Feingold, et al., 2008; Haid et & Fecile, 2006; Michaelsen et al., 1982; Rider, et al., 2006; Rider, et al., 2008; Sibley & Parmalee, 2008; Sweet & Michaelsen, 2007; Timmermans, et al., 201 2 ; Thompson, et al., 2007) to groups as large as 175 or 200 students (Michaelsen et al., 1982). In a review of seventeen studies of TBL that had been applied in nursing, medicine, and business from 2003 to 2011, Sisk (2011) f ound general student satisfaction for improved engagement and higher test scores, and recommend ed further study. The followin g section will describe the sequence of developing a Team Based Learning session, beginning with the design of the se ssion to be developed, and the four components of the TBL design that incorporate individual readiness assurance activities, team selection, team application activities, and final evaluation (McMahon, 2010; Michaelsen, 1982; Michaelsen et al., 2008; Parmelee & Michaelsen, 2010; Sweet & Michaelsen, 2012). Course d esign The training session was designed to be presented in a single three hour seminar during a biannual pre semester orientation for adjunct nursing faculty members, and presented in a large lecture roo m with a computer and audio visual equipment. Groups chose work spaces with either individual movable desks and chairs, or a large fixed desk and movable chairs. The backwards first determining the learning outcomes for the session by asking what the faculty members would be able to do when the session was completed, and the n the course was designed to teach those learning outcomes. The training session was intended to be completed within the three hour timeframe. The learning outcomes included: The faculty will: 1. l ocate the list of student behaviors that warrant disciplinary action.

PAGE 68

68 2. d efine the student behaviors that warrant disciplinary action. 3. i dentify personal perceptions of how to manage unethical stu dent behaviors. 4. r eview personal preparation levels of dealing with unethical student behaviors. 5. d iscuss the steps involved in the student disciplinary process. 6. v alue the need for faculty concurrence in dealing with unethical or dishonest st udent behaviors. The training session was intended to help faculty members learn how to identify, react to, and deal in a consistent manner with unethical and/or dishonest nursing student behavior, and bring a sense of agreement on how to actualize the steps of the discipl inary process. This was intended to be achieved by helping faculty members agree on and value consistency in identifying and acting on known or typical episodes of unethical or dishonest student behavior. Reading assignments were provided to each faculty member prior to the training session via the college email system. The reading assignments were designed to help faculty prepare for participation in the training session prior to attending and to help the faculty member to achieve several of the learnin g outcomes; prepare for the Individual Readiness Assurance activities; activities; and effectively complete the application activities. Readiness a ssurance a cti vities After Informed Consents (Appendix: A) were gathered and anonymity of participants had been assured, the pre intervention Individual Readiness Assurance Tool (IRAT) (Appendix: B) w as given to each participant by the instructor at the beginning of the session. The 25 question instrument used to gather data for the Individual Readiness Assurance Tool (IRAT) and the reported events of cheating by nursing students an d their opinions about behaviors that were or

PAGE 69

69 were not considered cheating in the nursing c linical and classroom courses. The pre instruction IRAT was used to determine demographic information and to determine how faculty members self report ed their perce ptions on 25 dishonest or unethical nursing student behaviors. The Individual Readiness Assurance Tool (IRAT) i s detailed in the Instrumentation section below. The purpose of this activity was to determine individual demographics for team assignments, an d to gather an individual baseline of faculty response data. The IRAT was completed at the beginning of the session, after faculty members had the opportunity to pre read the assignment on their own time. The IRAT was used to help in achieving learning o utcomes 1 through 3, and possibly 4 listed here: 1. Locate the list of student behaviors that warrant disciplinary action. 2. Define the student behaviors that warrant disciplinary action. 3. Identify personal perceptions of how to manage unethical student behaviors. 4. Review personal preparation levels of dealing with unethical student behaviors Faculty members were also able to draw upon any experiences that had evolved through their individual teaching careers while responding on the IRAT. O nce the IRAT was completed, it was collected and reviewed by the researcher and the instructor to assign participants to a team. The PowerPoint l esson A brief PowerPoint lesson was presented after the first IRAT was accomplished. The part of the lesson was designed to review the Learning Outcomes and to describe where to find the information that was assigned as a pre reading assignment. This time was used by faculty members to clarify any questions or concerns about the training session, the rea dings, or their role/responsibility in dealing with episodes of unethical or dishonest nursing student behaviors.

PAGE 70

7 0 Team s election Team selection was a random activity, completed by the instructor who first determined the number of participants, and computed the number of teams that were to be created so that each team consisted of five to seven participants. Teams were then carefully designed by the instructor, who reviewed answers to demographic item number eight on the IRAT Respondents were sorted into group s based on their completing, partially completing, or not completing the reading assignments before the learning session, and then randomly assigned to team s. Each team therefore consisted of a diversity of respondents who had totally, partially or h ad not prepared for the session by reading the assigned pages. Teams next selected a work space either in the lecture hall or the adjoining rooms and A ssurance Te st Individual participants were allowed to move their desks and chairs into a convenient configuration for verbal and visual communicat ion between each team member. Team application a ctivities Each new team, consisting of five to seven participants, was then issued one Group Readiness Assurance Test (GRAT) for the entire team, and team members reconsidered the same questions that had been completed by the individual faculty members. The team s worked independently to complete one GRAT per team by coming t o a team agreement on each of the 25 questions. In coming together as a team to answer the same questions that were completed individually, faculty members were able to discuss their own interpretations of the questions, clarify concerns, share experiences and eventually come to a consensus for at least the sake of the assignment on the Unethical or Dishonest Behavior column. This was designed to facilitate discussion and help achieve learning outcomes 4, 5 and 6 listed here:

PAGE 71

71 4. Review personal prepara tion levels of dealing with unethical student behaviors. 5. Discuss the steps involved in the student disciplinary process. 6. Value the need for faculty concurrence in dealing with unethical or dishonest student behaviors. When all the teams had comp leted the task, each team was asked to present their results to the entire group with immediate feedback from the class and the instructor. Discrepancies or gaps in team information were clarified by the instructor during and after the discussions, and w hen faculty participants still disagreed, teams were encourag ed by the instructor to present their rationale for class and instructor review. These appeals for consideration were verbally resolved as quickly as possible to ensure that faculty participants had a clear understanding of the information (the first 3 learning outcomes) in order to proceed to the next activity which incorporated the application of the learned information. The instructor moved between the team s to observe the interaction of the faculty participants as individuals and team members during the GRAT assignment, facilitating the interactions and answering questio ns about the learning outcomes. intr These activities were designed to reflect problems that were significant to this class of a djunct faculty members; specific choices that reflected the training session concepts (for example : using the Faculty Handbook and/or the Nursing Student Handbook(s) to identify which faculty action w as the best to deal with dishonest or unethical student behaviors ) and listing supporting evidence and including an explanation as to why that faculty acti on was chosen as the best; all teams were assigned the same problem to r e solve so comparisons were possible and meaningful; and team reports were delivered simultaneously s o that all faculty participants were involved in the discussion rather than some par ticipants finishing their team work while others were reporting.

PAGE 72

72 Evaluation Peer evaluation and grading, which is a component of TBL for students who are learning during multiple class meetings and requiring a grade for achievement, were not included for this session. Peer evaluation of team dynamics and evolution would be of lim ited value in this study d ue to only meeting once instead of meeting during multiple sessions throughout a semester and having no grading requirement during this one meeting The IRAT and GRAT I nstrument U sed pinions about and Extent of Involvement reported survey was administered to nursing students and listed 22 unethical behaviors; 11 from the classroom and 11 from the clinica l setting. Hilbert states (pg. 231) that content validity was assumed. The Hilbert list of behaviors required respondents to not only indicate a perception of unethical behavior using a yes/no scale, but also how many times the student had engaged in eac h behavior in the current school year. Hilbert reported an internal consistency calculation with a coefficient alpha for the 22 item tool of 0.668. Hilbert performed a series of t tests to compare the reports of unethical behaviors and gender, and unethi cal behaviors for transfer or non transfer students. Hilbert also performed a Pearson correlation on age and particular unethical behaviors, finding that younger students were more likely to help another student when individual work was required by the in structor. Finally, Hilbert also found two significant results through a series of chi square tests. First, there was a significant relationship between students who identified a behavior as cheating, and then having done that cheating behavior ; and secon d, there was a significant direct relationship between classroom dishonesty and clinical setting dishonesty.

PAGE 73

73 The current Individual Readiness Assessment Tool (IRAT) survey used in gathering quantitative evaluation data during the current training session ( Appendix B) included most of nursing in clinical or skills lab areas, nursing employment status outside of the college teaching responsibilities, an opinion of how likely a faculty member would take required follow up action when an episode of dishonest or unethical nursing behavior is discovered, and the name of the elementary school where the participant attended school. A seventh and eighth question require d a self report of the number of times that the faculty member took action on dishonest or unethical student behavior, and fulfillment of the assigned reading as a yes, no, or partial completion of the reading. The participant circle d the appropriate answe rs and wr o te in the name of their elementary school. The demographic questions were followed by 13 questions about classroom dishonest or unethical behaviors, and 12 questions about clinical dishonest or unethical behaviors totaling 25 questions Each o f the 25 questions w as posed for the following three categories: identification, preparedness, and willingness, totaling 75 responses per survey. (Appendix B) The classroom porti first five questions was included with hard copies of exams in Question 1, as all nursing courses routine ly deliver electronic exams rather than paper and pencil exams. Question 2 was altered to include question about copying from another test. Question 4 was exp anded to include unauthorized use of technology. Question 8 was adjusted by changing the purchasing of an assignment from a research firm to the more current term: a paper mill. Question 10 was an added question asking

PAGE 74

74 about helping a classmate who was f instructions had been given. Question 11 was altered to ask about making a graded paper reporting mistakes. Ques tions 3, 5, 6, 7, 9, and 12 were unchanged. The clinical portion of the survey had adjustments from the Hilbert tool also. Question 1 clinical assignment n ot only for being personally sick, but also due to a sick child when the neither the student nor the child was sick. Participation in clinical under the influence of prescription medications in Question 2 was extended to include over the counter medicatio ns. reporting an incident involving a client. Question 5 substituted the r ecording of falsified client additional item, again asking ab out reporting mistakes. Questions 7, 8, 9, 10, and 11 were uncha nged. These 25 questions ha d been piloted in an earlier survey, but were mainly derived from o (Polit & Beck, 2004) Alpha reliability was calculated for the entire survey and each of the two subsections (Classroom and Clinical) for both the Student and Faculty version of the survey. Omnibus reliability for the faculty survey wa Nursing student data resulted in an

PAGE 75

75 omnibus reliability for the student survey wi reliability of .904. Nursing students will not be included in the present study. These results demonstrate that the current tool is a reliable assessment of both student and faculty perceptions of academic dishonesty. Current study reliability will be reported in Chapter 4. The studied questions w ere ranked on a Likert rating scale of 1 through 5, rather than yes or no scale. The s cale lists the following descriptors while rating identification of unethical or dishonest behavior; preparedness to take action; and willingness to take action as follows: 1. Not at all; 2. A little bit; 3. Sometimes; 4. Mostly; an d 5. Extremely. The addition of the Likert scale help ed elicit variance, and provide a richer, deeper data set rather than a forced yes or no response about the honesty or ethics of the questions as Hilbert first presented them. The 13 classroom question s were listed on one side of one page, and the 12 clinical questions were listed on the back of the same page. A cover sheet with directions on how to complete the classroom and clinical questions w as stapled to the survey. Directions w ere also given ver bally by the instructor. This one page form is identified as the IRAT (Appendix: B). The GRAT wa s a derivative of the IRAT, listing the same questions, but omitting the demographic and elementary school responses. The teams w ere instructed to come to a n agreement on the same Likert scale, but w ere allowed to average the individual scores if the team c ould not agree by the end of the scheduled timeframe. Twenty to thirty minutes w ere allotted for this session. The IRAT and GRAT were followed by a brief tr aining session, proctored by the instructor. This time was used to deliver feedback and clarify any remaining concerns or

PAGE 76

76 questions in order to ensure consistency between the individuals. Five to ten minutes were allotted for this session. The final IRAT Evaluation w as repeat ed using the same 13 classroom and 12 clinical questions from the IRAT T as again r equired so the pre session IRAT and final IRAT evaluation results c ould be pair ed. The order of the classroom and clinical final IRAT questions was randomly scrambled in each section. The individual respondents w ere again requested to identify the behaviors as unethical or dishonest, preparedness to take action, and willingness to take action using the 1 through 5 Likert rating scale. Ten to fifteen minutes w ere allotted for this session. Application E xercises After optimal learning ha d been assured by using the IRAT, the GRAT, and after the feedback interval that follow ed the GRAT, faculty participants appl ied t he learned material and work ed in the same teams to process three case studies, described below. All teams receive d identical case studies (Appendix D) that describe d a dishonest or unethical episode of nursing student behavior. Th re e case studies were c ompleted consecutively, each team using approximately one hour for this application portion of the learning session. The teams each process ed the case stud ies independently and use d information that ha d been learned and reviewed, and collaborate d with mem bers of the team to recommend an action that the faculty should take. All teams then present ed their recommendations of proper faculty action (follow up), facilitated by the instructor. The presentation took the form of a gallery walk, in which teams use d a large piece of paper to outline their course of action in response to each case. They then post ed their response s for other teams to review discuss and critique This section took 45 minutes The three case studies (Appendix G ) were developed from the results of the Perceptions of Cheating in the Classroom and C linical survey (Marshall, 2012) The case studies

PAGE 77

77 include d : a clinical instructor who suspects a clinical student of falsifying the documentation of vital signs on the medical record; a clin ical instructor who is informed of two students who are discussing a recent lecture test, including test questions and possible answers, when one of the students has not yet taken that test; and a clinical instructor who observes a student performing in an impaired manner Final S urveys At the conclusion of the three hour training session, the instructor distributed the final Evaluation IRAT, instructing the participants to fill out the elementary school name and the 25 classroom and clinical questions. Th e IRAT w as then collected in an anonymous manner by the instructor. The faculty participants w ere verbally thanked for their participation and final questions were answered by the instructor before participants were released. A follow up survey was admi nistered to 31 (82%) of the remaining 38 participant s who attended one of three staff meetings three months after the training session Th e follow up survey was administered toward the end of the same semester using the same 25 questions on identification, preparedness and willingness to take action on unethical or dishonest nursing student behaviors. The questions were listed on the survey in a randomized manner and surveys were again collected anonymously to protect the identity of the respondents. Data Analysis The purpose of this study wa s to add to the knowledge base and to test a new idea in nursing faculty training by evaluating the impact of a faculty development session on: faculty identification of un ethical or dishonest nursing student behaviors, faculty perception of how prepared faculty are in dealing with dishonest and unethical nursing student behaviors, and faculty perceptions of taking action when dishonest or unethical nursing student behaviors are discovered. It wa

PAGE 78

78 improvements reported in the literature, that the adjunct nursing faculty development session w ould also result in faculty member improvement in learning about iden tifying, reacting to, and perceiving unethi cal nursing student behaviors. A quantitative method approach was utilized to optimize the significance of the and end of the development session, was used as baseline data that was then compared to quantitative data that w as collected at the three month follow up A review of the hypotheses being tested follows: Hypothesis #1: The null hypothesis states that the mean score for identification of dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis stat es that the mean score for identification of dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT. Hypothesis #2: Th e null hypothesis states that the mean score for the preparedness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score o n the Pre Intervention IRAT. The alternate hypothesis states that the mean score for the preparedness in dealing with dishonest or unethical nursing student behavior by adjunct nursing faculty on the foll ow up IRAT three months after the intervention is g reater than the mean score on the Pre Intervention IRAT.

PAGE 79

79 Hypothesis #3: The null hypothesis states that the mean score for the willingness in dealing with dishonest or unethical nursing student behavior by adjunct nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis states that the mean score for the willingness in dealing with dishonest or unethical nursing student behavior by adjunct nu rsing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT. The study evaluated the differences between individual faculty members and faculty unethical student behaviors, and the relationships between pre intervention IRAT surveys and final IRAT surveys on faculty conceptualizations of unethical student behaviors, and the development of an environment of awareness for professional expectation a nd follow through. It was predicted that the adjunct nursing faculty development session, using an adapted Team Based Learning (Michaelson et al., 1982) approach would result in a positive correlation of those who participated in the faculty development s ession in improving their understanding and agreement on what constitutes unethical nursing student behavior, and also what nursing faculty actions are to be performed when an unethical nursing student behavior is discovered, and report a n increased willin gness to take action when unethical or dishonest nursing student behavior is discovered. I mprovement was anticipat ed after the intervention, and results were again analyzed at the three month follow up to study if the intervention effect remained the same or changed. The quantitative IRAT result s w ere compared across the entire group for a baseline of data. The initial IRAT survey items were compared with the final IRAT items for each participant, using the elementary school as the identifier to pair the surveys for each of the 75 items on the

PAGE 80

80 i dentification of u nethical or d ishonest b ehaviors, p reparedness and w illingness. Three months later, t he f inal and follow up IRAT tool s were again compared by pairing the 75 responses based on the self reported elem entary school identification on each survey It should be noted that in the design of TBL by Michaelsen et al., (1982) there is an appeal step built into the process, utilized after the GRAT. The purpose of the appeal is to allow team members who have concurred on an answer to put together a rational presentation challenging an incorrect answer. This step reinforces processing and learning information, and improves communications, but it is designed to help in the grading process. Since this faculty member group is not being graded, a feedback/clarification session w as scheduled to ensure learning ha d taken place before moving to the application case studies, and the respondents w ere n ot be awarded a grade. Limitations In using the most available group of adjunct nursing faculty available, no guarantee c ould be made t hat the group that was studied wa s representative of the population from which it was drawn This results in a low external validity of the study, and ther efore generalizations to the population must be made with a full description of the study parameters so th at judgments can be made about the amount of bias that might skew the results To address this concern, the study might be replicated in future studi es to add to the body of knowledge about t eam b ased group l earning methods being applied to nursin g faculty to enhance learning. Researcher influence during the IRAT, GRAT, the case studies discussions and the final IRAT evaluation wa s possible since the r esearcher /instructor wa s present in the room when the data wa s being recorded by the participants. Participants could have change d their reactions and discussions during the researcher /instructor obser s to instruct and gui de students, but this w as challenged by the need to minimize researcher influence by not

PAGE 81

81 interfering nor interrupting the learning process during the team development sessions. Being cognizant of the difference between the instructor and researcher role h elp ed minimize the anticipated influence. Summary This descriptive study wa s designed to increase the knowledge base about the efficacy of a single group training session in teaching a n adjunct nursing faculty group about identifying and being prepared fo r and willing to tak e action when dishonest or unethical nursing student behaviors are observed. It w as presented in a three hour development session for a convenience sample of adjunct nursing faculty, at Palm Beach State College in Lake Worth, Florida. The purpose wa s to train adjunct nursing faculty, using an innovative training method that has been discussed in the literature and used successfully in the training of other large grou ps, but has not been heretofore studied nor reported on adjunct nursing faculty.

PAGE 82

82 CHAPTER 4 RESULTS Overview The purpose of this study was to evaluate the impact of a brief faculty development session on: adjunct nursi ng faculty perceptions of identifying dishonest and unethical nursing student behaviors; faculty perceptions of their preparation for taking action when dishonest or unethical nursing student behaviors are discovered; and, faculty willingness to take actio n when dishonest or unethical nursing student behaviors are discovered. This study included questions on behaviors in both the classroom and the clinical context. This chapter will describe the findings of the study. It will begin with a description of the sample, followed by inferential analysis of the hypothesis tests. Demographic Explanation of the Sample The sample consisted of adjunct faculty members recruited from one large southern state college Associate Degree in Nursing program. Following a ma ndatory two hour orientation routinely administered at the beginning of each semester for all new and returning nursing adjunct faculty members, 42 adjunct faculty members were invited to participate in the study. A brief description of the study was prov ided and the prospective participants were notified that those who remained for the session would be compensated for their participation by the state college at their standard hourly rate. Forty one volunteers (98%) chose to participate and were given the Informed Consent to sign. Thirty eight participants (90%) completed the entire training session. Following the collection of the signed Informed Consents the training session was initiated. The entire training session was completed within the scheduled three hour timeframe.

PAGE 83

83 Demographic information was gathered from the pre intervention IRAT or pretest, and results can be reviewed in Table 4 1. Questions included self reporting of gender, age, teaching experience, employment status, and how often action was taken when dishonest or unethical behaviors were discovered. Thirty eight of the 41 participants completed the post intervention final Evaluation IRAT (Individual Readiness Assurance Test) at the conclusion of the training session, resulting in 38 pa irs of pre intervention IRAT surveys and three unpaired IRATs due to three participants leaving the training session before completing the f inal IRAT evaluation. The follow up survey results were obtained three months after the initial training period res ulting in 31 (82%) of the 38 original post survey participants. Four of the 31 surveys were drastically incomplete, yielding 27 usable follow up surveys that could be paired with the pre intervention IRAT and post intervention final IRAT for the ANOVA anal ysis. F ollow up surveys were delivered to participants during mid and late semester team meetings and attrition was attributed to faculty no longer working at the college or not attending the on campus meetings. Descriptive Analysis Instrument The specifi c details of the survey development and the survey administration can be found in Chapter 3. The survey was comprised of 25 questions which sought faculty perceptions of their ability to identify dishonest and unethical nursing student behaviors; an addit ional 25 questions explored faculty perceptions of preparedness to take action when dishonest or unethical nursing student behaviors are discovered; and the final 25questions gathered faculty perceptions of their level of willingness to take action when di shonest or unethical nursing student behaviors are discovered. The same instrument was used to gather data for the pre intervention IRAT, the group GRAT, the post intervention f inal IRAT, and the follow up IRAT (Appendix B). The instrument

PAGE 84

84 reported cheating by nursing students and their opinions about behaviors that were or were not considered cheating in the nursing clinical and classroom courses. The tool had been piloted, subjected to construct validation by a team of experts, and was used during an earlier study (Marshall, 2012) to identify faculty and student perceptions of dishonest behavior. Likert scores from the four survey tools have been summarized in: IRAT Survey Results (Appe ndix E), GRAT Survey Results (Appendix F), Final IRAT Survey Results (Appendix G), and the follow up IRAT Survey Results (Appendix H). Means, standard deviations, and variances for the pre intervention IRAT, the GRAT, the final IRAT, and the follow up IRA T are summarized in Appendix I. (Polit & Beck, 2004) and found to be a reliable instrument (with reliabilities ranging from .72 .97), see Table 4 2. The omnibus reliability of the comb ined classroom and clinical area ranged from .88 to .97 for each of the assessment categories. Instrument R esults Each of the three survey administrations during the intervention perception of their ability to identify unethical or dish onest nursing student behavior, preparedness to take action when unethical or dishone st nursing student behavior was discovered, and willingness to take action when unethical or dishonest nursing student behavior was discovered. Twice the tool meas ured the faculty perceptions as individuals, and once, during the GRAT, as a team activity Although the entire group was instructed and/or debriefed after each of the three intervention surveys, the GRAT was included in the lesson plan as part of the act ual intervention, and was examined in this study as a comparison between the pre intervention and post intervention means (Table 4 3).

PAGE 85

85 The means for the IRAT, GRAT, and final IRAT survey tools were higher each time the tool was given, and the standard de viation generally became smaller, indicating an increasing agreement on the identification, preparedness and willingness levels of the participants each time the tool was given, see Table 4 3. The follow up survey means that were obtained three months aft er the intervention were uni versally smaller than the post intervention f inal IRAT means that were obtained at the conclusion of the intervention, but were higher than the pre intervention IRAT means. Pa rticipants contributing within team s using the GRAT w ere not individually identified, and therefore comparisons can only be generalized and cannot be paired directly with post intervention final IRAT means. The group intervention GRAT means and the post intervention final IRAT means are identical for Willin gness and Preparedness on the GRAT and the final IRAT, see Table 4 3. These identical results may be the consequence of individuals being unable to distinguish between being prepared to take action and being willing to take action in future situations whe n unethical or dishonest student behaviors are discovered, or by being influenced by the group conclusions This will be discussed in Chapter 5. Inferential Analysis of Research Questions A one tail dependent groups paired samples t test was used to compa re mean pre intervention IRAT scores with mean post intervention final IRAT scores. Subsequently, three months after the intervention, follow up data was gathered and analyzed. A one way within subjects ANOVA with repeated measures was calculated for the classroom, clinical, and omnibus sections of each of the three hypotheses. This analysis allows inferences about how a brief development session may or may not have impacted faculty perceptions. The following section presents the analysis of the data ga thered during and after that training session.

PAGE 86

86 Research Question #1: Identification How does a faculty development session impact the adjunct nursing faculty in their identification of dishonest or unethical nursing student behaviors? The null hypothesis for Question 1 was: The mean score for identification of dishonest or unethical nursing student behavior by adjunct nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on t he Pre Intervention IRAT. The alternate hypothesis for Question 1 was: the mean score for identification of dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is greater tha n the mean score on the Pre Intervention IRAT. Classroom I dentification A paired samples t test was conducted to evaluate the differences between the mean pre intervention IRAT and the mean post intervention final IRAT scores for identification of dishones t or unethical nursing student behavior in the classroom, see Figure 4 1. The test was significant, t (36) = 3.02, p = .003. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.72 indicated a large (Green, Salkind, & Akey, 2000) effect size. A one way within subjects ANOVA with repeated measures was conducted with the factor being the pre intervention IRAT survey, the post intervention fi nal IRAT survey, and the follow up time per iods ; and the dependent variable being the IRAT scores for the identification of dishonest and unethical nursing student behavior. The means and standard deviations for the IRAT scores are presented in Table 4 4. A one tail F test for the multivariate AN OVA indicated a significant time effect, F (2, 25) = 6.12, p 2000) effect size. The null hypothesis was rejected; indicating that the team based group training

PAGE 87

87 intervention significantly improved nursi ng adjunct faculty ability to identify unethical or dishonest nursing student behavior in the classroom. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 26) = 10.27, p = al., 2000) effect size. A second follow up within subjects repeated contrast indicated no significant difference between the posttest and the follow up test, F (1, 26) = 1.93, p = .177. The results suggest the int and unethical nursing student behavior in the classroom and their ability to identify that behavior did not significantly change at the three month follow up period, see Figure 4 2. Clinical I dentification A paired samples t test was conducted to evaluate the differences between the mean pre intervention IRAT and the mean post intervention final IRAT scores for dishonest or unethical nursing student behavior in the clinical area, see Figure 4 3. The test was significant, t (35) = 3.47, p < .001. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.81, indicated a large (Green et al., 2000) effect size. A o ne way within subjects ANOVA with repeated measures was conducted with the factor being the pre inte rvention IRAT survey, the post intervention final IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the iden tification of dishonest and unethical nursing student behavior. The means and standard deviations for the IRAT scores are presented in Table 4 5. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 21) = 10.65, p < 2000) effect size. The null hypothesis was rejected; indicating that the team based group training

PAGE 88

88 intervention significantly improved nursing adjunct faculty ability to identify unethical or dishonest nursing student behavior in the clinical area. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 22) =21.21, p al., 2000) effect size. A second follow up within subjects repeated contrast indicated no significant difference between the posttest and the follow up test, F (1, 22) = 1.18, p = .289. The dentify dishonest and unethical nursing student behavior in the clinical area and their ability to identify that behavior did not significantly change at the three month follow up period, see Figure 4 4. Omnibus I dentification A paired samples t test was conducted to evaluate the differences between the mean pre intervention IRAT and the mean post intervention final IRAT scores for dishonest or unethical nursing student behavior in the classroom and clinical area combined, see Figure 4 5. The test was sig nificant, t (37) = 4.44, p = <.001. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.97, indicated a large (Green et al., 2000) effect size. A one way within subjects ANOVA with repeated measures was conducted with the factor being the pre inte rvention IRAT survey, the post intervention fi nal IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the identification of dishonest and uneth ical nursing student behavior. The means and standard deviations for the IRAT scores are presented in Table 4 6. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 23) = 25.30, p e (Green et al., 2000) effect size. The null hypothesis was rejected; indicating that the team based group training

PAGE 89

89 intervention significantly improved nursing adjunct faculty ability to identify unethical or dishonest nursing student behavior in the clas sroom and clinical area combined. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 24) = 49.85, p = < et al., 2000) effect size. A second follow up within subjects repeated contrast indicated no significant difference between the posttest and the follow up test, F (1, 24) = 2.94, p = .099. The results suggest the in and unethical nursing student behavior in the classroom and clinical combined areas, and their ability to identify that behavior did not significantly change at the three month f ollow up period, see Figure 4 6. Research Question #2: Preparedness How does a faculty development session impact the adjunct nursing faculty in their preparedness in dealing with dishonest or unethical nursing student behaviors? The null hypothesis for Q uestion 2 was: The mean score for the preparedness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Inter vention IRAT. The alternate hypothesis for Question 2 was: the mean score for the preparedness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT. Classroom Preparedness A paired samples t test was conducted to evaluate the differences between the mean pre intervention IRAT and the mean post intervention final IRAT scores of the faculty in dealing wit h dishonest or unethical nursing student behavior in the classroom, see Figure 4 7. The test

PAGE 90

90 was significant, t (35) = 3.60, p < .001. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.84, indicated a large (Green et al., 2000) effect size. A one way within subjects ANOVA with repeated measures was conduc ted with the factor being the pre inte rvention IRAT survey, the post intervention final IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the identification of dishonest and unethical nursing student behavior The means and standard deviations for the IRAT scores are presented in Table 4 7. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 24) = 5.22, p 2000) effect s ize. The null hypothesis was rejected; indicating that the team based group training intervention significantly improved nursing adjunct faculty preparedness to deal with unethical or dishonest nursing student behavior in the classroom. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 25) = 9.76, p al., 2000) effect size. A second follow up within subjects repeated contrast indic ated no significant difference between the posttest and the follow up test, F (1, 25) = 3.23, p = .084. The dishonest and unethical nursing student behavior in the classroom and their preparedness perception to deal with that behavior did not significantly change at the three month follow up period, see Figure 4 8. Clinical Preparedness A paired samples t test was conducted to evaluate the differences between th e mean pre intervention IRAT and the mean post intervention final IRAT scores of the preparedness of the faculty in dealing with dishonest or unethical nursing student behavior in the clinical area, see

PAGE 91

91 Figure 4 9. The test was significant, t (35) = 3.85, p = <.001. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.88, indicated a large (Green et al., 2000) effect size. A one way within subjects ANOVA with repeated measures was c onducted with the factor being the pre intervention IRAT survey, the post intervention final IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the identification of dishonest and unethical nursing student beh avior. The means and standard deviations for the IRAT scores are presented in Table 4 8. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 21) = 4.70, p 2000) eff ect size. The null hypothesis was rejected; indicating that the team based group training intervention significantly improved nursing adjunct faculty preparedness to deal with unethical or dishonest nursing student behavior in the clinical area. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 22) = 9.53, p al., 2000) effect size. A second follow up within subjects repeated contr ast indicated no significant difference between the posttest and the follow up test, F (1, 22) = .66, p = .425. The dishonest and unethical nursing student beh avior in the clinical area and their preparedness to deal with that behavior did not significantly change at the three month follow up period, see Figure 4 10. Omnibus Preparedness A paired samples t test was conducted to evaluate the differences between t he mean pre intervention IRAT and the mean post intervention final IRAT scores of the preparedness of faculty in dealing with dishonest or unethical nursing student behavior in the classroom and

PAGE 92

92 clinical areas combined, see Figure 4 11. The test was signi ficant, t (36) = 4.07, p = <.001. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.92, indicated a large (Green et al., 2000) effect size. A one way within subjects ANOVA with repeated measures was conducted with the factor being the pre inte rvention IRAT survey, the post intervention final IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the identification of dishonest and unethi cal nursing student behavior. The means and standard deviations for the IRAT scores are presented in Table 4 9. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 22) = 6.25, p Green et al., 2000) effect size. The null hypothesis was rejected; indicating that the team based group training intervention significantly improved nursing adjunct faculty preparedness to deal with unethical or dishonest nursing student behavior in the c lassroom and clinical area combined. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 23) = 11.25, p al., 2000) effect size. A second follow up within subjects repeated contrast indicated no significant difference between the posttest and the follow up test, F (1, 23) = .96, p = .337. The ith dishonest and unethical nursing student behavior in the classroom and clinical areas combined and their preparedness to deal with that behavior did not significantly change at the three month follow up period, see Figure 4 12. Research Question #3: Wil lingness How does a faculty development session impact the adjunct nursing faculty in their willingness in dealing with dishonest or unethical nursing student behaviors? The null hypothesis for Question 3 was: The mean score for the willingness in dealing with dishonest or

PAGE 93

93 unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is less than or equal to the mean score on the Pre Intervention IRAT. The alternate hypothesis for Question 3 was: t he mean score for the willingness in dealing with dishonest or unethical nursing student behavior by adjunc t nursing faculty on the follow up IRAT three months after the intervention is greater than the mean score on the Pre Intervention IRAT Classroom Wi llingness A paired samples t test was conducted to evaluate the differences between the mean pre intervention IRAT and the mean post intervention final IRAT scores of the faculty to deal with dishonest or unethical nursing student behavior in the classroom see Figure 4 13. The test was significant, t (35) = 2.98, p = .003. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.71, indicated a large (Green et al., 2000) effect size. A one way within subjects ANOVA with repeated measures was conducted with the factor being the pre inte rvention IRAT survey, the post intervention fi nal IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the id entification of dishonest and unethical nursing student behavior. The means and standard deviations for the IRAT scores are presented in Table 4 10. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 25) = 3.40, p = (Green et al., 2000) effect size. The null hypothesis was rejected; indicating that the team based group training intervention significantly improved nursing adjunct faculty willingness to deal with unethical or dishone st nursing student behavior in the classroom. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 26) = 6.14, p

PAGE 94

94 al., 2000) effect size. A second follow up within subjects repeated contrast indicated no significant difference between the posttest and the follow up test, F (1, 26) = 1.73, p = .200. The results suggest the intervention significantly improved particip dishonest and unethical nursing student behavior in the classroom and their willingness to deal with that behavior did not significantly change at the three month follow up period, see Figure 4 14. Clinical Willingness A pai red samples t test was conducted to evaluate the differences between the mean pre intervention IRAT and the mean post intervention final IRAT scores of the faculty to deal with dishonest or unethical nursing student behavior in the clinical area, see Figur e 4 15. The test was significant, t (34) = 4.79, p = <.001. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.94, indicated a large (Green et al., 2000) effect size. A one way w ithin subjects ANOVA with repeated measures was conducted with the factor being the pre interventi o n IRAT survey, the post intervention fi nal IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the identificati on of dishonest and unethical nursing student behavior. The means and standard deviations for the IRAT scores are presented in Table 4 11. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 22) = 9.82, p < .001, multi (Green et al., 2000) effect size. The null hypothesis was rejected; indicating that the team based group training intervention significantly improved nursing adjunct faculty willingness to deal with unethical or dishonest nursing student behavior in the clinical area. A follow up within subjects repeated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 23) = 19.56, p

PAGE 95

95 et al., 2000) effect size. A second follow up within subjects repeated contrast indicated no significant difference between the posttest and the follow up test, F (1, 23) = .25, p = .621. The results suggest the intervention significantly improved partic dishonest and unethical nursing student behavior in the clinical area and their willingness to deal with that behavior did not significantly change at the three month follow up period, see Figure 4 16. Omnibus Willingness A paired samples t test was conducted to evaluate the differences between the mean pre intervention IRAT and the mean post intervention final IRAT scores of the deal with dishonest or unethical nursing student behavior in the classroom and clinical areas co mbined, see Figure 4 17. The test was significant, t (35) = 3.82, p < .001. The mean score post intervention was higher than the mean score pre intervention. The standardized difference in means, d = 0.86, indicated a large (Green et al., 2000) effect s ize. A one way within subjects ANOVA with repeated measures was conducted with the factor being the pre inte rvention IRAT survey, the post intervention final IRAT survey, and the follow up time periods ; and the dependent variable being the IRAT scores for the identification of dishonest and unethical nursing student behavior. The means and standard deviations for the IRAT scores are presented in Table 4 12. A one tail F test for the multivariate ANOVA indicated a significant time effect, F (2, 23) = 4.88, p (Green et al., 2000) effect size. The null hypothesis was rejected ; indicating that the team based group training intervention significantly improved nursing adjunct faculty willingness to deal with unethical or dishonest nursing student behavior in the classroom and clinical area combined. A follow up within subjects rep eated contrast indicated a significant increase between the mean pretest and the mean posttest, F (1, 24) = 10.13, p

PAGE 96

96 al., 2000) effect size. A second follow up within subjects repeated contrast indicated no sign ificant difference between the posttest and the follow up test, F (1, 24) = .46, p = .504. The dishonest and unethical nursing student behavior in the classroom and clinical areas combined and their willingness to deal with that behavior did not significantly change at the three month follow up period, see Figure 4 18. Summary of Findings This chap t er presented the findings of the analysis of this study. The nul l hypothesis was rejected for each of the three parts of the three study questions with a large effect size for every studied variable and indicates that the brief training session had a statistically significantly positive impact on the adjunct faculty me behaviors, and their perceptions of being prepared and willing to take action when unethical or dishonest behaviors are discovered in both the classroom and clinical areas. This improved perception c ontinued fo r three months between the post intervention final survey and the follow up survey. These findings will be discussed in Chapter 5 along with the study impact and conclusions, the limitations of the study, and recommendations for further resear ch.

PAGE 97

97 Table 4 1 Demographic Information for IRAT Participants Characteristic Number (N=41) Gender Male 0 Female 41 (100%) Age 26 30 2 (5%) 31 35 2 (5%) 36 40 3 (7%) 41 45 7 (17%) 46 50 6 (15%) 51 55 5 (12%) Over 55 11 (27%) Not reported 5 (12%) Teaching Experience 0 1 4 (10%) 2 4 14 (34%) 5 7 10 (24%) 8 10 4 (10%) 11 15 3 (7%) 16+ 6 (15%) Working outside of adjunct role Yes 22 (54%) No 19 (46%) Takes action on unethical/dishonest behavior Never 2 (5%) Occasionally 14 (34%) Sometimes 6 (14%) Usually 6 (14%) Always 13 (32%) Number of actions last semester 0 21 (51%) 1 8 (20%) 2 8 (20%) 3 2 (5%) 4+ 1 (2%) Completed the reading assignment All 17 (41%) Partially 7 (18%) None 17 (41%)

PAGE 98

98 Table 4 Instrument Classroom Identification 0.85 Classroom Prepared 0.97 Classroom Willingness 0.96 Clinical Identification 0.94 Clinical Prepared 0.90 Clinical Willingness 0.72 Omnibus Identification 0.88 Omnibus Prepared 0.97 Omnibus Willingness 0.94 Table 4 3 Survey Mean Scores in the Classroom and Clinical Mean (Standard Deviation) Question Items PRE IRAT GRAT POST IRAT FOLLOW UP Classroom Identifying Unethical Dishonest Behavior 4.64 (.61) 4.85 (.19) 4.94 (.12) 4.88 (.16) Classroom Preparedness to take action 4.50 (.79) 4.82 (.17) 4.94 (.09) 4.83 (.25) Classroom Willingness to take action 4.61 (.72) 4.82 (.17) 4.94 (.09) 4.88 (.22) Clinical Identifying Unethical Dishonest Behavior 4.57 (.63) 4.86 (.13) 4.92 (.13) 4.83 (.18) Clinical Preparedness to take action 4.56 (.60) 4.83 (.11) 4.93 (.10) 4.88 (.17) Clinical Willingness to take action 4.70 (.32) 4.83 (.11) 4.93 (.10) 4.88 (.18)

PAGE 99

99 Table 4 4 Classroom Identification of Unethical or Dishonest Behavior Classroom Identification Mean Std. Deviation N Pre Intervention 4.7 5 .32 27 Post Intervention 4.94 .0 9 27 Three Month Follow U p 4.89 .1 6 27 Table 4 5 Clinical Identification of Unethical or Dishonest Behavior Clinical Identification Mean Std. Deviation N Pre Intervention 4.65 .28 23 Post Intervention 4.91 .12 23 Three Month Follow U p 4.86 .17 23 Table 4 6 Omnibus Identification of Unethical or Dishonest Behavior Omnibus Identification Mean Std. Deviation N Pre Intervention 4.69 .19 25 Post Intervention 4.93 .09 25 Three Month Follow U p 4.87 .16 25 Table 4 7 Classroom Preparedness to Deal w ith Unethical or Dishonest Behavior Classroom Preparedness Mean Std. Deviation N Pre Intervention 4.39 .90 26 Post Intervention 4.94 .09 26 Three Month Follow U p 4.84 .25 26 Table 4 8 Clinical Preparedness to Deal with Unethical or Dishonest Behavior Clinical Preparedness Mean Std. Deviation N Pre Intervention 4.51 .63 23 Post Intervention 4.92 .12 23 Three Month Follow U p 4.87 .18 23 Table 4 9 Omnibus Preparedness to Deal with Unethical or Dishonest Behavior Omnibus Preparedness Mean Std. Deviation N Pre Intervention 4.42 .73 24 Post Intervention 4.93 .09 24 Three Month Follow U p 4.89 .14 24

PAGE 100

100 Table 4 10 Classroom Willingness to Deal with Unethical or Dishonest Behavior Classroom Willingness Mean Std. Deviation N Pre Intervention 4.55 .81 27 Post Intervention 4.94 .08 27 Three Month Follow U p 4.88 .2 3 27 Table 4 1 1 Clinical Willingness to Deal with Unethical or Dishonest Behavior Clinical Willingness Mean Std. Deviation N Pre Intervention 4.67 .30 24 Post Intervention 4.91 .11 24 Three Month Follow U p 4.89 .19 24 Table 4 12 Omnibus Willingness to Deal with Unethical or Dishonest Behavior Omnibus Willingness Mean Std. Deviation N Pre Intervention 4.59 .53 25 Post Intervention 4.93 .08 25 Three Month Follow Up 4.90 .17 25

PAGE 101

101 Figure 4 1 Differences in Identification of Classroom Dishonest or Unethical Behaviors Pre Intervention and Post Intervention Figure 4 2 Differences in Classroom Identification of Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.64 4.94 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Classroom Identification 4.64 4.94 4.88 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom Identification

PAGE 102

102 Figure 4 3 Differences in Identification of Classroom and Clinical Dishonest or Unethical Behaviors Pre Intervention and Pos t Intervention Figure 4 4 Differences in Classroom and Clinical Identification of Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.64 4.94 4.57 4.92 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Classroom & Clinical Identification Classroom Clinical 4.64 4.94 4.88 4.57 4.92 4.83 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom & Clinical Identification Classroom Clinical

PAGE 103

103 Figure 4 5 Differences in Classroom, Clinical, and Omnibus Ident ification of Dishonest or Unethical Behaviors Pre Intervention and Post Intervention Figure 4 6 Differences in Classroom, Clinical and Omnibus Identification of Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.64 4.94 4.57 4.92 4.69 4.93 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Classroom, Clinical, & Omnibus Identification Classroom Clinical Omnibus 4.64 4.94 4.88 4.57 4.92 4.83 4.69 4.93 4.87 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom, Clinical, & Omnibus Identification Classroom Clinical Omnibus

PAGE 104

104 Figure 4 7 Differences in Classroom Preparedness to Take Action on Dishonest or Unethical Behaviors Pr e Intervention and Post Intervention Figure 4 8 Differences in Classroom Preparedness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.5 4.94 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Iinstruction Post-Instruction Classroom Preparedness Classroom 4.5 4.94 4.83 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom Preparedness Classroom

PAGE 105

105 Figure 4 9 Differences in Classroom and Clinical Preparedness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention Figure 4 10 Differences in Classroom and Clinical Preparedness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.5 4.94 4.56 4.93 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Iinstruction Post-Instruction Classroom & Clinical Preparedness Classroom Clinical 4.5 4.94 4.83 4.57 4.92 4.83 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom & Clinical Preparedness Classroom Clinical

PAGE 106

106 Figure 4 11 Differences in Classroom, Clinical, and Omnibus Preparedness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention Figure 4 12 Differences in Classroom, Clinical and Omnibus Preparedness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.5 4.94 4.56 4.93 4.42 4.93 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Iinstruction Post-Instruction Classroom & Clinical Omnibus Preparedness Classroom Clinical Omnibus 4.5 4.94 4.83 4.56 4.93 4.88 4.42 4.93 4.89 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom, Clinical, & Omnibus Preparedness Classroom Clinical Omnibus

PAGE 107

107 Figure 4 13 Differences in Classroom Willingness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention Figure 4 14 Differences in Classroom Willingness to Deal with Dishonest or Unethical Behaviors Pre Interven tion, Post Intervention and Three Month Follow Up 4.61 4.94 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Classroom Willingness Willingness 4.61 4.94 4.88 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow_Up Classroom Willingness Willingness

PAGE 108

108 Figure 4 15 Differences in Classroom and Clinical Willingness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention Figure 4 16 Differences in Classroom and Clinical Willingness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.61 4.94 4.7 4.93 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Classroom & Clinical Willingness Classroom Clinical 4.61 4.94 4.7 4.93 4.88 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom & Clinical Willingness Classroom Clinical

PAGE 109

109 Figure 4 17 Differences in Classroom, Clinical, and Omnibus Willingness to Take Action on Dishonest or Unethical Behaviors Pre Intervention and Post Intervention Figure 4 18 Differences in Classroom, Clinical and Omnibus Willingness to Deal with Dishonest or Unethical Behaviors Pre Intervention, Post Intervention and Three Month Follow Up 4.61 4.94 4.7 4.93 4.59 4.93 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Classroom, Clinical, & Omnibus Willingness Classroom Clinical Omnibus 4.61 4.94 4.7 4.93 4.88 4.59 4.93 4.9 4.3 4.4 4.5 4.6 4.7 4.8 4.9 5 Pre-Instruction Post-Instruction Follow-Up Classroom, Clinical, & Omnibus Willingness Classroom Clinical Omnibus

PAGE 110

110 CHAPTER 5 CONCLUSIONS Overview This three part study examined the impact of a brief team based group training session on adjunct nursing faculty perceptions of di shonest or unethical nursing student behaviors in both the classroom and the clinical contexts. Currently, Team Based Learning has been utilized successfully to train diverse student and customer groups (Michaelsen, et al., 2004), however there are no pub lished studies that have investigated applying a brief team based group learning approach for the instruction of nursing adjuncts in the identification, preparedness and willingness to deal wi th unprofessional behaviors. Often, unethical student behaviors are perceived and defined differently by faculty and s tudents (Higbee & Thomas, 2002; PeSymaco & Marcelo, 2003; Solomon & De Natale, 2000; Stern & Havlicek, 1986; Wajda Johnson, Handal, Brawer, & Fabricatore, 2001). In a ddition to this disconnect, faculty members frequently fail to agree about the specific actions that constitute unethical or dishonest behavior (Barrett & Cox, 2005; Birch et al, 1999; Bradshaw & Lowenstein, 1990; Hughes & McCabe, 2006a; Pickard, 2006; Pin cus & Schmelkin, 2003; Price, Dake, & Islam, 2001). Lack of faculty agreement on what constitutes cheating, and what to do about it, can result in a faculty who relax the rules of academic honesty and are then seen as promoting an environment that is safe for dishonest students, causing honest students to either resent that treatment or become cheaters (Firmin et al., 2007; Hughes & McCabe, 2006b; Ryan, 1998). This lack of consistency in dealing with dishonesty places honest students at a disadvantage whe n their honest work is compared to a dishonestly produced piece (Ryan, 1998). Team learning strategies that incorporate relevant, participative activities to improve an h,

PAGE 111

111 2004; Bergman, Rentsch, Small, davenport & Bergmen, 2012; Berland & Lee, 2012; Parmalee & Michaelsen, 2010; Sweet & Michaelsen, 2007). In an effort to understand and potentially address the faculty lack of consensus, adjunct nursing faculty perceptions were studied. Data was collected using a self reporting survey tool which was administered three times: immediately prior to, after, and then three months following group training. Quantitative analysis was conducted to ascertain the impact of the team based group learning session on nursing adjunct faculty perceptions. It was anticipated that the team based group training session would p ositively impact learning for this sample of adjunct nursing faculty, improving individual understanding and group consensus. This chapter will discuss the results of the analysis, and the implications for the use of team based group learning in the train ing of adjunct nursing faculty, and the broader potential applications related to the findings from this study regarding veracity and fidelity Research Question 1 Discussion How does a faculty development session impact the adjunct nursing faculty in thei r identification of dishonest or unethical nursing student behaviors? It is not uncommon for development sessions, targeting collegiate faculty, to result in an increased understanding of practice (Desimone, Porter, Garet, Yoon, & Birman, 2002; Desimone, 2011, Ruiz, 2010; Wallin, 2005). Survey data was collected in this study of a development session to measure adjunct behaviors. Results were analyzed to eva luate the impact of a brief team based group training session by collecting a baseline measure related to faculty perceptions. Data from pre session training was compared with perceptions at the conclusion of the training session. Those results were then compared with perception data three mont hs after the training session. Faculty historically are not in agreement about their perceptions of identifying dishonest or unethical

PAGE 112

112 student behaviors (Coren, 2011; Fontana, 2009; Jeffreys & Stier, 1995; Lewenson et al.,2005; Milliron & Sandoe, 2008; Throckmorton Belzer et al., 2001; Wideman, 2011), but it was anticipated that there would be a positive effect on nursing adjunct faculty perceptions of their ability to identify what constitutes dishonest or unethica l nursing student behaviors after the learning intervention. Data from this study indicated that there was a positive, significant effect associated with the training session for identification of unethical or dishonest nursing student behaviors in the cla ssroom ( p = .004), the clinical area ( p = <.001), and omnibus combination of classroom and clinical ( p = .<001) which did not significantly decline in the three month follow up results in the classroom ( p = .177), the clinical area ( p = .289) and the omnib us combination ( p = .099). Post intervention survey data, which was collected at the conclusion of the interv ention, was compared to the pre intervention survey data, and resulted in a large effect size (Green et al., 2000) in the classr The results from this brief, three hour group training session are consistent with published full semester group training session study results associated with T eam B ased Learn ing in non nursing populations, nursing student and faculty studies, and studies of adjunct faculty (Andersen & Strumel, 2011; Baldwin, 1997; Clark et al., 2008; Haidet & Fecile, 2006; Feingold et al., 2008; Rider et al., 2008; Sweet & Michaelsen, 2007; Thompson et al., 2007 ; Timmermans et al., 2012; Yang, Woomer, & Matthews, 2012;) in that perceptions of knowledge were improved own knowledge about unethical and dishonest beh aviors; reference the Nursing Student and Faculty Handbook s for examples of cheating; discuss relevant issues with colleagues; and work in teams that were each a smaller component of the larger group.

PAGE 113

113 of their perceptions upon which the team intervention initiated a deeper understanding. self efficacy, modeling and perceived collective efficacy (Hirsh, 2009; Sweet & Michaelsen, 2007) can help explain the results that demonstrated significant improvement in learning. In this study participants were able to improve self efficacy by discussi ng and clarifying their own perceptions, and accessing the actual definitions of dishonest behaviors in the Nursing Student and the Faculty Handbook s ostensibly expanding their previous understanding in a realistic but low stakes and collegial environmen t. Modeling was supported in the group activities when inexperienced individuals could discuss and compare their own understanding and ideas with those of their experienced peers, and collective efficacy was promoted by coming to a n improved group agreeme nt within each team and the entire group during the GRAT, the case study scenarios, and th also concur with published results about improvements in learning through professional development (Baker, 2010; Fit z gerald & Theilheimer, 2012; Hadre, 2010; Huston & Weaver, 2007) and team based learning (Andersen & Strumel, 2011; Feingold et al., 2008; Haidet & Fecile, 2006; Rider et al., 2008; Sibley & Parmalee, 2008; Sweet & Michaelsen, 2007; Thompson et al., 200 7). As discussed, the results on the post intervention final IRAT were significantly higher in the classroom, the clinical area, and the omnibus combination as compared to the pre intervention IRAT results, and did not significantly differ from the follow up intervention results. This analysis suggests that the brief team based group training session

PAGE 114

114 to identify unprofessional behaviors in nursing students, an d this improvement did not erode significantly over a three month period within this group. Research Question 2 Discussion How does a faculty development session impact the preparedness of adjunct nursing faculty in dealing with dishonest or unethical nurs ing student behaviors? This study also measured the impact of the team based group training session on faculty perceptions of preparedness to take action when dishonest or unethical nursing student behaviors are discovered. It was anticipated that the tr aining session would have a positive impact on faculty perceiving that they knew what to do (preparedness) when dishonest or unethical student f our levels of evaluation model, as describe d in Naugle, Naugle, & Naug le (2000) explains that in order for training programs to be effective, students move through four levels, including: Level 1 is student satisfaction, or the feelings the students have about the training, called Reaction ; Level 2 is learning proficiency, o r the degree to which learning the required material occurred, called Learning ; Level 3 is application skills, or : and Level 4 is overall program effectiveness, or line, called Results (Boyle & Crosby, 1997; Kirkpatrick, 1996; Watkins, Leigh, Foshay, & Kaufman, 1998). Participants were not surveyed about their satisfaction with the training ( Level 1 ), however thei r perceptions of their level of knowledge, preparedness and willingness was measured and analyzed ( Level 2 ). It should also be noted that the actual change in performance on the job ( Level 3 ), and the impact to the organization ( Level 4 and ostensibly in this study, on the profession of nursing) was not addressed, but could be studied at a later time. To evaluate the impact of the team based group training session, a baseline of quantitative data was gathered related to the faculty perceptions of their lev el of preparedness before the

PAGE 115

115 training and compared with perceptions after the session, (DeSilets & Dickerson, 2009) and again three months after the training session, which Kirkpatrick defines in Level 2 as measuring for the acquisition of knowledge, improving skills, or changing attitudes (Naugle et al., 2000 ) A successful intervention could potentially be applied to future training sessions for adjunct faculty, or other learner groups, to improve fa culty understanding and facilitate a faculty unethical s tudent behavior is determined. Data from this study indicated that there was a positive, significant effect associate d with the training session comparing the pre intervention IRAT with the post intervention final IRAT for the preparedness in dealing with unethical or dishonest nursing student behaviors in the classroom ( p = .007), the clinical area ( p = .011), and omnib us combination of classroom and clinical ( p = .004). Post intervention survey data, which was collected at the conclusion of the interv ention, was compared to the pre intervention survey data, and resulted in large effect sizes (Green et al., 2000) in the Of interest is that in each of the three measured areas the results did not significantly decline in the three month follow up survey data for the classroom ( p = .084), the clinical area ( p = .425) and the omnibus combination ( p = .337). These results indicate that the gains in perception of knowing what to do (preparedness ) i.e., the steps that are outlined in the Nursing Student and the Faculty Handbook s did n ot diminish significantly after three months from what was gained during the training session. This positive learning outcome is also consistent with other studies on the professional development of faculty after training (Devlin Scherer & Sardone, 2013; Huston & Weaver, 200 8 ; Ruiz, 2010; Wallin & Smith 2005).

PAGE 116

116 Survey data was used to assess perceptions in preparedness to take action. This differs of their ability to identify examples of cheating, studied in Question 1, in that preparedness to take action refers to the expectations of the institution, administration or other faculty members in taking action about dishonest or unethical nursing student behavior (s). The participant s wer e therefore responding to survey items about their level of knowledge of the behavior s or steps that they were to perform during a specific set of circumstances Level s 3 and 4 were not included in this study so the measurement of actual behavioral changes in responding to acts of dishonesty was not tracked to measure whether faculty members who did respond to dishonesty episodes did so in the manner that was outlined i n the Nursing Student Handbook Actual preparedness was not a component of this study and was not actually demonstrated; however the faculty perception of their levels of preparedness was measured bout improvements in learning through professional development (Baker, 2010; Fit z gerald & Theilheimer, 2012; Hadr 201 2 ; Huston & Weaver, 200 8 ). As reported in Chapter 4, the results on the post intervention final IRAT were significantly higher in the cl assroom, the clinical area, and the omnibus combination as compared to the pre intervention IRAT results, but not significantly different from the follow up intervention results. This indicates that adjunct of pr eparedness to deal with unethical or dishonest behavior during the training session to enforce the institution and that this significant gain from the intervention did not significantly decay during the three months after the intervention within this group. These outcomes suggest that the team based group training session was effective in significantly increasing faculty perception of being prepared to deal with

PAGE 117

117 unethical or dishonest nursing student behavior with a large effect, and this improvement in perception did not erode significantly over a three month period within this group. Research Question 3 Discussion How does a faculty development session impact the willingness of adjunct nursing faculty in dea ling with dishonest or unethical nursing student behaviors? Similar to the second research q uestion, Q uestion 3 sought to evaluate the manner in which a faculty a ction when dishonest or unethical nursing student behaviors are discovered. Willingness to take in the future (Chatzisarantis & Hagger, 2005). Ajzen (1991) describes intention as an indicat or of how much effort a person plans to exert toward the performance of a particular behavior in the future. Behavioral intention, as described by Desouza & Czerniak (2003), is consequently a function of a cluster of beliefs or an attitude toward performi ng the behavior and the subjective norm, or influence of significant others if the behavior is or is not performed (Chatzisarantis & Hagger, 2005; Chen & Chen, 2006). The influence of others affects the perceived value or degree of importance of an issue resulting in a high or low motivation to perform the behavior (Celuch & Dill, 2011; Randall, 1989). Faculty reported the perception of their willingness (intention to function in a particular manner) to take action, but actual implementation of the insti dishonest and unethical behaviors was not measured in this study. In their theory of reasoned action Fishbein and Ajzen (1975) posit that people will consider the available information and the implications of their actions, and this wi ll be done in a rational, sensible (Hausenblas, Carron, & Mack, 1997) and systematic manner (Randall, 1989). Ajzen (1991) continued to refine the theory of reasoned action by adding the concept of perceived behavioral control as an extension of the original theory, naming this the theory of planned

PAGE 118

118 behavior. Perceived behavioral control is the degree of ease or difficulty in conducting a behavior and indirectly effects beh avioral intentions (Hausenblas et al., 1997). These three concepts: A ttitude toward the behavior, subjective norms and perceptions of behavior can be used to examine the activities that occurred during the studied training session and begin to explain the significant, positive results. Information and experience s were exchanged between the instructor, the team members and the group members during the activities Collaboration and learning from peers has been articulated in the literature (Colbert, Brown, Choi & Thomas, 2008; Devlin Scherer & Sardone, 2013; Fit z gerald & Theilheimer, 2012; Huston & Weaver, 200 8 ) as a means to improve retention and achievement, and although retention was not studied, achievement of the learning outcomes was accomplished. Tea m and group c ollaboration and reflection seem to have occurred during the GRAT team activity, the presentations the solved case study problems and the concluding in dividual faculty participants to not only increase their understanding (learn) from the didactic portion of the training session, but from their team and group members Returning to the original assumption of the theory of reasoned action where people wil l consider the available information to develop their beliefs and attitudes, which then translate into intentions, and on into actions, it can be probably surmised that the increased agre ement resulted from learning during the training session, and therefo re helped participants increase their behavioral intentions This translates into understanding that an improvement in the perception of willingness (as determined by analysis of the study data) will possibly result in an improvement in behavior. Without actually measuring the actions that a faculty member undertakes when dishonest or unethical nursing

PAGE 119

119 student behavior is discovered, willingness was interpreted in this study as the perception of willingness, or the intention to behave in a particular mann er, which significantly increased. Data from this study indicated that there was a positive, significant effect associated with the training session for the willingness to deal with unethical or dishonest nursing student behaviors in the classroom ( p = .02 5), the clinical area ( p = <.001), and omnibus combination of classroom and clinical ( p = .009). Post intervention surv ey data was compared to the pre intervention data, and resulted in large and intervention final IRAT result showing improvement in perception of willingness to take action when compared to the pre intervention IRAT results again did not significantly decline in the three month follow up results in the classroom ( p = .20), the clinical area ( p = .621) and the omnibus combination ( p = .504),and, compares positively to findings in the liter ature where groups have been studied to improve faculty participant learning (Baker, 2010; Fit z gerald & Theilheimer, 2012; Hadr 201 2 ; Huston & Weaver, 200 8 ) Again, the results on the post intervention final IRAT survey were significantly higher in the c lassroom, the clinical area, and the omnibus combination as compared to the pre intervention IRAT results, but not significantly different from the follow up IRAT. Since the post intervention IRAT was significantly higher than the pre intervention, and th e follow up intervention results were not significantly different from the post intervention test, the Question with unethical or dishonest behavior and that th is significant gain from the intervention did not significantly decay during the three months after the intervention within this group.

PAGE 120

120 Implications for Nursing Practice Team Based Learning (TBL) has been specifically used successfully to train medical st udents, business students, nursing faculty and nursing students (Baldwin et al. 1997; Chung, et al., 2009; Holleman, et al., 2009; Michaelsen, et al., 2004; Michaelsen, et al., 2008; Rider et al. 2008; Timmermans et al., 2012). An analysis of the willin gness data again indicates that the team based group training session was an effective context to significantly increase faculty perception of being willing to deal with unethical or dishonest nursing student behavior with a large effect size and this imp rovement in perception did not erode significantly over a three month period within this group of adjunct nursing faculty Students who are dishonest during their schooling are more likely to be dishonest in their professions (Bradshaw & Lowenstein, 1990; Daniel et al., 1994; Davis et al., 2009; Elmore, 2009; Fass, 1986; Fontana, 2009; Gaberson, 1997; Gray & Smith, 1999; Hilbert, 1985; Langone, 2007; Lewenson et al., 2005; Nonis & Swift, 2001; Petress, 2003; Stern & Havlicek, 1986; Wilk & Bowllan, 2011). Nursing students who cheated their way through school and graduate to become registered nurses may not have mastered the necessary information to deliver safe patient care, and can actually be a danger to their patients (Langone, 2007; Le wenson, Truglio Londrigan, & Singleton, 2005; Stern & Havlicek, 1986; Wilk & Bowllan, 2011). Registered n urses are expected to behave professionally and ethically by society (Gallup Poll; Honesty/Ethics in Professions, 2012; Kelly, 1998; McCrink, 2010), ) and expected to practice with veracity and fidelity by their professional nursing organization; the ANA (American Nurses Association Code of Ethics for Nurses, Standard 7, 2010, p. 3) Therefore, nursing education programs must include ethical developme nt in their academic curricula (Cartwright et al. 1992; Ludwick & Silva, 1999; National League of Nursing; The Four Core Values, 2011). Yet nursing faculty members disagree on what constitutes unethical and dishonest nursing student behavior s

PAGE 121

121 ( Barrett & Cox, 2005; Cole & McCabe, 1996; Graham et al 1994; Higbee & Thomas, 2002; Muldoon, 2011; PeSymaco & Marcelo, 2003; Price et al., 2001). A training session using teams (Fiechtener & Michaelsen, 1984) was developed to impact adjunct nursing faculty percept ions on identifying and dealing with dishonest and unethical behaviors It was rooted in Michaelsen et al. Based Learning strategy (2008 ), and was found to be positively significant related to improving understanding as anticipated. It is understo od that improved faculty agreement on what constitutes cheating and knowledge about what to do about cheating in itself does not necessarily guarantee that newly acquired behaviors will be performed by individuals (Rozycki, 2010; West & Schwenk, 1996), how ever implications of these important findings for teaching and learning in adjunct nursing faculty groups, and potentially also in nursing faculty groups are discussed, and recommendations for future study are offered. Team B ased L earning in P rofessional D evelopment and C ontinuing E ducation Typical collegiate educational courses have focused on the teacher student relationship consisting of the educator organizing information and presenting huge amounts of data in a lecture format, students passively absorb ing information and proving their understanding on periodic multiple choice or true false exams ( Michaelsen et al., 1982; Michaelsen et al., 2008). S uccess of the t eam based group learning design in this study which is based on learner centered activities rather than instructor centered lectures, can be explained by applying several of the According to Knowles, adult learners have a need to know; adults resi st when others impose their wills on them; adults have a lifetime of experiences that can be acknowledged; adults learn things that they can apply to their real life situations; and adults are internally motived to learn (Merriam, 2001 ; Woodard, 2007 ). Dy namically engaging learners to actively participate in applying their knowledge to solve a significant, real

PAGE 122

122 adult education (Henschke, 2011) It is believed that the i mproved perceptions of facul ty knowledge that w ere demonstrated in this study were probably due to providing team based learning activities founded in actual clinical cheating examples a successf ul teaching and learning strategy in both non nursing and nursing courses (Andersen et al. 2011; Clark et al. 2008; Feingold et al., 2008; Holleman et al. 2009; Michaelsen et al., 1982; Timmermans et al. 2012). Haidet and Facile (2006) describe applyi ng TBL to continuing medical education settings, including workshops at specialty conferences and meetings for faculty and administrators; however there is no empirical evidence that has reported using brief TBL workshops or training sessions for adjunct n ursing faculty to date. The TBL successes that have been reported in the literature focus on sixteen week academic courses for a wide variety of context s including business, medicine, nursing, dental and online students (Bastick 1999 ; Michaelsen et al., 2004; Michaelsen et al., 2008; Sweet & Michaelsen, 2007) yet, positive results were also achieved during this three hour TBL adaptation, providing a platform for future applications and stud y The current study results have several pra ctical implications for more effective student learning, teaching practice, and program administration. Michaelsen et al (2008) instructional strategy was applied in the development of a three hour training session for 41 adjunct nursing faculty member s. Most nurses are accustomed to working together on teams or in small groups within their role as a registered nurse (Holleman et al., 2009 ). Using this carefully constructed team based training session resulted in a significant, positive impact on the perceptions of identification, preparedness and willingness of adjunct nursing faculty in dealing with dishonest or unethical nursing student behaviors.

PAGE 123

123 Each of the fifty United States has a professional licensing board that regulates how a student can bec ome a registered nurse ; the registered ; and requirements to maintain their state Registered Nurse (RN) license These regulations include lifelong learning after licensure known in nursing as continuing education (DeSilets, 1998; Stein, 1998). Many state requirements mandate that registered nurses seek a specific annual number of nursing continuing education units or hours as a condition to maintain current licensure and eligibility for emp loyment as a registered nurse. Most h ospitals offer continuing education and professional (staff) development to their employees to enhance their practice, either on a fee or non fee basis. Using this and other team based learning success es as a guide, t he team based group learning technique for professional development and continuing education can training, and potentially provide that facility with a positive return ( i.e., employee learning that does not significantly decay ov er time ) on their training investment of time, effort and money. Improving Nursing Adjunct Faculty Perceptions of Managing Student Cheating Nurses must practice ethically, or patients who are depending on them to perform nursing tasks can be seriously harm ed by nurses who may have never actually learned the task, but unethically cheated their way through school. P art time adjunct faculty need to model ethical behavior as nursing professionals and demonstrate that they value veracity or truthfulness and fidelity or trustworthiness and dependability ( American Nurses Association Code o f Ethics for Nurses, Standard 7, 2010) The results of this study indicate that a brief team based training session had a positive, significant impact on the perceptions of the convenience sample of adjunct nursing faculty participants, and could potentially be used to improve the perceptions of and clinical areas.

PAGE 124

124 The traini ng sessi on utilized the basic TBL tenets of backward designing the learning outcomes, based on an assessment of what learning needs were to be accomplished. New studies could also carefully construct team activities, utilizing the principles of andragogy which are incorporat ed to enable the adult learners to increase their understanding of how to apply their new knowledge to their own personal life, bring their considerable life long learning experiences to the process of team learning, and self direct the ir own intrinsic desire to increase their knowledge (Kroth, 2009; Merriam, 2001; Trotter, 2006; Woodard, 2007). Required in the team deep thinking and engaging, an d content focused discussions as outlined in TBL (Haidet & Facile, 2006; Parmelee & Michaelsen, 2010): 2. The Same problem: The identical problem must be presented to each of the teams in order to make outcome comparisons when the exercise is completed. 3. A Specific choice: Teams will process specific decisions to answer the application activity, or determine the answers to the significant problem. Properly designed appli cation activities will allow teams to make evaluations while processing their collective understanding, and through this process, will apply course or session concepts in order to explain and defend their answers to the significant problem. 4. A Simulta neous report: All teams will cease work on the problem simultaneously and report to the group in turn, focusing attention on each presentation. These carefully constructed lesson plans and application activities are designed to take advantage of the interc hange of experiences and collaboration between participants so that

PAGE 125

125 (Ally, 2004; Van Der Veer, 1986). This design could also be potentially used for full time n ursing faculty in the training of identification, preparedness, and willingness to deal with unethical or dishonest nursing student behaviors. Unlike huge classrooms or conferences where large numbers of participants have been traditionally lectured by an expert speaker and the learners passively listen, perhaps jotting down notes (Young, 2009), large numbers of adjunct faculty member s can be broken into dynamic working teams whose members take an active role in learning. This study agrees with the literat agreement and cognition (Fiechtner & Michaelsen, 1984; Parmalee & Michaelsen, 2010; Sweet & Michaelsen, 2007). Adjunct F aculty T eam s A djunct faculty members play a vita l role in the education of students. Adjuncts are contract ed by college s to teach part time, supplement ing the full time faculty and are considered by full time faculty to be an invaluable asset for bringing a wealth of current knowledge and expertise to the online, classroom, clinical, and laboratory venues (Charlier & Williams, 2011 ; Gaillard Kenny, 2006 ; Sweitzer, 2003 ) Adjunct faculty positions are seen as beneficial to the academic institution when their lower paid contracts can easily be terminate d during economic downturns compared to the more expensive tenured, full time educators ( Green, 2007; McLaughlin, 20 05 ; Wallin, 2004) The numbers of online courses that are being offered has increased rapidly over recent years, opening teaching positions for adjunct faculty that cannot or will not be filled by full time faculty (Dedman & Pearch, 2004) and creating a new position for a djuncts who take several part time adjunct positions, resulting in the adjunct working full time hours at combinations of institutions (Bedford, 2009).

PAGE 126

126 Jacobson (2013) posits that in order to support a successful environment for adjunct faculty, a collabor ative community of peers must be cultivated. This collaboration include s mentoring and training sessions that embraces prospects for active learning (Garet, Porter, Desimone, Birman, & Yoon, 2001), and take s advantage of networking opportunities with expe rienced peers ( Baker, 2010; Fitzgerald & Theilheimer, 2012; Huston & Weaver 2008 ; Woolforde, Lopez Lang, & Lumley, 2012 ) T he brief team based group learning format that was found to be successful for adjunct nursing faculty afforded participants the opportunity to not only attend the training session, but to work closely within the teams, networking and collaborating with their peers This team based format should also be studied in other adjunct faculty groups for its gener alizability to the larger adjunct faculty population and for its impact on learning, and could prove to be a valuable training tool to improve collegiality, collaboration, and understanding in this ever growing faculty group. T Faculty fail to identify and act upon episodes of dishonest behavior for numerous reasons including the sense of a lack of administrative support ( Coren, 2011; McCabe & Katz, 2009 ; Petress, 2003 ; Staats et al. 2009 ). Carefully construct ed team based learning groups c ould be developed for faculty and administrators to engage in planned learning outcomes In these learning teams participants reflect, interact, and collaborate on issues involving how unethical episodes are to be handled at the institution ; how much the institution values the production of honest, ethical students ; ethically is held by the administration. Working o n a diverse team made up of faculty and administrators i n determining the p roper steps to take in dealing with cheating behaviors would be more participative and interactive than simply taking a quiz on a Nursing Student or Faculty

PAGE 127

127 Handbook policy or could s Furthermore, combinations of faculty and student learning groups could apply the team based approach to the topic of cheating. Teams of faculty combined with students who work together to identify u nethical or dishonest behaviors could anticipate an improved understanding when this topic is mutually defined and openly discussed between the two different types of participants and the potentially different points of view Coming to a n improved consen sus between faculty and student group participants about professional behaviors (or other topics) may potentially relationships, conceivably culminating in improved understanding, colle giality, and professional expectations and decrease any student perception of faculty who do not treat all students equally with veracity and fidelity Professionalism and behaving ethically and honestly can then be arrived at in a communal manner, impro students strictly obeying rules mandated in a school handbook or policy just because they are there Behaviors that are internalized are more likely to be carried into professional careers, resulting in regist ered nurses who practic e honest, ethical nursing care. Limitations Teaching Experiences The sample included a number of instructors who had limited experience in both the clinical setting and in reporting unethical or dishonest behaviors. Most (68%) of the faculty respondents reported less than seven years of teaching in a clinical and/or skills lab class. Half (51%) of the respondents reported taking no action related to unethical or dishonest behavior within the last semester on the pr e intervention IRAT It is unknown if the faculty did not

PAGE 128

128 actually have an episode of unethical or dishonest nursing student behavior, or that the faculty member simply did not take action on unethical or dishonest behavior that had occurred. Classroom Experiences The reliability of the survey tool has been established in prior studies (Hilbert, 1985 tool with reliabilities ranging from .72 .97 for the pre i ntervention IRAT, see Table 4 2. The classroom willingness reliability (.96) however was higher than the clinical willingness reliability (.72) perhaps due to the fact that this subject sample was entirely made up of clinical adjunct instructors who did n ot teach in a classroom per se, but taught in mainly the clinical or skills laboratory venues Without experience in actual classroom unethical or dishonest events, these clinical experts may have been influenced by their imagining of what they think may happen, or how they might handle an unethical or dishonest incident of nursing student behavior in the classroom, rather than from an actual experience. Actual cheating incidents were not measured in the study. Convenience Sample This study took place at one large community college, with a convenience sample (Creswell, 2009) of 41 participants. The follow up IRAT survey was collected from 31 of the possible remaining 38 faculty who were still available out of the original 41 participants, however only 27 were usable since four of the 31 were grossly incomplete. Threats to the study results include subject bias since there is no randomization of subjects within the sample. Although assumptions of normalcy were made, no guarantee can be implied that the gr oup studied was representative of the population given that only the most convenient group of adjunct nursing faculty available was studied. This design resulted in limited external validity

PAGE 129

129 and therefore generalizations to the population must be made wit h a full description of t he study parameters. Researcher I nfluence In this study, the researcher also acted as the instructor during the training session. Researcher influence during the IRAT, GRAT, the case studies discussions answer act ivity, and the final IRAT was possible since the researcher was present in the room when the data was being recorded by the participants. Res earch bias ( 2006) includes response bias w here the participants may change their responses in order to please the interviewer or where participants believe they know the expected findings and change responses and behaviors and was a concern. carefull y designed to inform and guide participants (Mehra, 2002) researcher could minimize influence by not interfering or interrupting the learning process (Panucci & Wilkins, 2010) duri ng the team development sessions, which would conflict with the instructional goals and objectives. Being cognizant of the difference between the instructor role and researcher role may have helped minimize any anticipated influence (Sica, 2006) however this is unknown. It has already been noted that follow up intervention results three months after the training session in d icated no significant decline in identification, preparedness, or w illingness compared to the post intervention improvements. Since the follow up results did not differ significantly, perhaps the concern that participants were influenced to respond in a manner intended to please the instructor/researcher can be minimized.

PAGE 130

130 Recommendations for Further Re search Continuing Education and Professional Development Professional development is an ongoing practice for registered nurses and nursing faculty to promote advanced technical skills and a deeper understanding within their specialties ( DeSilets & Dickerso n, 2008 2011; Yoder Wise & Esquibel, 2011) Methods that are proven to be effective in changing attitudes and behaviors can have positive results for both the faculty and the institution (Colbert et al. 2008; Desimone, 2011; Desimone et al., 2012; Fitzg erald & Theilheimer 2012; Hadr 2010) and eventually have a positive impact on students and the profession of nursing. This brief team based group learning intervention was successful for this small group, but in order to establish this method as effec tive in the larger population, the study should be replicated on a wider scale. The research recommends the use of a control group, multiple administration sites and randomized selection of sites and participants in addition to separating the role of inst ructor and researcher. Additional variables that could be explored include institutional demographics, participant experience levels, gender type of nursing program (two, three, or four year degree programs), and even the number of actual episodes of dis honest or unethical behaviors that the participant has already addressed. Confounding variables could also be explored, including faculty members who have been involved in a student disciplinary action that resulted in a suspension or expulsion from the n ursing program since it has been reported in the literature (Coren, 2011; Petress, 2003 Staats et al. 2009 ) that faculty are reluctant to take action in the future if they have taken action in the past that was not supported or was reversed by administra tion Additionally, a mixed method or qualitative study component could explore t he behavior. It would be valuable to understand if and how faculty members are projecting their

PAGE 131

131 ow n personal values onto nursing student behaviors and how their actions might be affected by ind ividual preferences and biases. Levels 3 and 4 Analyses Dickerson, 2009 ; Kirkpatrick, 1996 ), the third and fourth levels of evaluation (behavior and results) are where the most valuable information about the true impact of training sessions can be obtained. These levels are often omitted in the design and evaluation of trainin g programs due to the expense and extended timeframe that this data takes to collect. A recommendation for future study would include the gathering of data to measure the actual changes in employee behaviors (Level 3), and the bottom line im pact on the fa cility (Level 4). In this study an example of the impact of the training session on faculty perceptions of identifying dishonest or unethical behaviors, and being prepared and willing to deal with those unprofessional behaviors, the training could be repl icated within a longitudinal study. Data would be gathered about the numbers of dishonest or unethical episodes before and after the training, and at periodic intervals to measure possible changes. Included in the study could be a determination of how th e cheating episodes had been handled before the training, compared to after the training, i.e., whether the facility policy/procedures were followed correctly. A single situation where team based group training could be identified in this analysis as the basis for L evel 4 ). Concluding Remarks Part time adjunct faculty members who teach at the community college level benefit from the structured presentation of professional development, especially when the session includes small group work (Wallin, 2007) The team based group learning technique which facilitates

PAGE 132

132 team and group work, peer int eraction, and modeling which seems to have led to increased knowledge and understanding was a successful method for this group of community college adjunct nursing faculty members to improve their ability to identify unethical or dishonest nursing student behaviors, and be prepared and willing to take action when unethical or dishonest behaviors were seen. This study has contributed to the body of research regarding the use of brief training sessions to influence adjunct nursing faculty perceptions of ident ification, preparedness and willingness to take action on unethical or dishonest nursing student behaviors. The results have found that there was a profound impact on adjunct nursing faculty perceptions after the training session in every tested area. Th is is an important finding that can potentially be applied to the training and professional development of any student group who typically is asked or mandated to participate in training sessions throughout their careers or in the academic setting Th is s hort training session, using a brief t eam b ased l earning approach, taking advantage of the experiences of seasoned faculty, and shar ing that experience and knowledge with newer nursing faculty in a safe, collaborative setting that is appreciated by profess ionals is grounded in the principles of successful andragogy Although Team Based Learning has been used successfully to train students, to the best of faculty development on any subject at this time. This study provides a f oundation for administrators and educators to broaden their understanding about improving adjunct nursing faculty agreement related to the identification of unethical or dishonest behavior, appropriate methods to address it, and potential willing ness to take action to help train nursing students to develop honest and ethical practices. Future research may contribute to these

PAGE 133

133 findings by exploring the generalizability of these results to the larger population s for studies in unethical or dishonest nursing student behaviors and other unlimited topics.

PAGE 134

134 APPENDIX A INFORMED CONSENT Protocol Title: Faculty Perception of Cheating and Unethical Behavior in the Classroom and Clinical Areas Please read this consent document carefully before you decide to participate. Purpose of the research study: The purpose of this study is to examine the responses of faculty about nursing student academic dishonesty and unethical behavior. What you will be asked to do in the study: Fill in answers on a surve y questionnaire individually and within a group that will be distr ibuted and collected in class. Time required: 3 hours Risks and Benefits: None Compensation: None Confidentiality: Your identity will be kept confidential to the extent provided by law. You r name will not be collected or linked to your survey, or used in any report. Voluntary participation: Your participation in this study is completely voluntary. There is no penalty for not participating. Right to withdraw from the study: You have the ri ght to withdraw from the study a t any time without consequence. Whom to contact if you have questions about the study: Prof DJ Marshall, Palm Beach State College, Lake Worth FL 33461 Erik W. Black, PhD 1701 SW 16th Ave Building A #2114 Gainesvill e, FL 32608 Whom to contact about your rights as a research participant in the study: IRB02 Office, Box 112250, University of Florida, Gainesville, FL 32611 2250; phone 392 0433. Agreement: I have read the procedure described above. I voluntarily agree to participate in the procedure and I have recei ved a copy of this description. P articipant: _____________________________________ Date: __________________ Principal Investigator: _____________________________ Date: __________________

PAGE 135

135 APPENDIX B IRAT

PAGE 136

136 Unethical Classroom & Clinical Lab Nursing Student Behaviors IRAT Demographics: Circle the item 1. Gender: Male Female 2. Age (optional): 18 25 26 30 31 35 36 40 41 45 46 50 51 55 56+ 3. Years of teaching in clinical and/or skills lab: 0 1 2 4 5 7 8 10 1 15 16+ 4. Working status: Are you employed in nursing outside the college adjunct t eaching role? Yes No 5. H ow often do you take action on unethical or dishonest student behaviors? Never Occasionally Sometimes Usually Always 6. Print the name of your Elementary School_____ __________________________________________________ ________________ 7. How many times in the last semester did you take action on dishonest or unethical student behavior? 0 1 2 3 4 o r more 8 Completed the reading assignment: ALL PARTIALLY NONE A STUDENT IN THE CLASSROOM : Use the 1 5 Scale (upper right hand corner box) to describe if the behavior is unethical or dishonest; and describe how prepared AND willing you are to take action. Complete each column before starting the next column Unethical/ Dis honest Behavior How prepared are you to take action? How willing are you to take action? 1. Getting electronic or hard copies of exams or exam questions from someone who has taken the exam 2. Prior to taking the exam, discussing the exam or receiving answers from a student who has already taken the exam 3. Allowing someone to copy from an exam or giving answers to another student during an exam 4. Using unauthorized notes, books, or technology during a closed book assignment or exam 5. Taking an exam for another student 6. Copying sentences or ideas from a reference source without referencing it in a paper 7. Adding items to a bibliography (reference list) that were not used in writing the paper 8. Turning in an assignment purchased from an online paper mill 9. Turning in an assignment that was done entirely, or in part, by someone else (but not a paper mill) falling behind 11. Making completed (graded) assignments available for someone who has not yet had the assignment 12. Working with another student on an assignment when the instructor did not allow it 13. Not reporting when mistakes are discovered in the classroom area 1 5 Scale : 1. Not at all 2. A little bit 3. Sometimes 4. Mostly 5. Extremely

PAGE 137

137 Unethical Classroom & Clinical Lab Nursing Student Behaviors IRAT A STUDENT IN THE CLINICAL LAB : Use the 1 5 Scale (upper right hand corner box) to describe if the behavior is unethical or dishonest; and describe how prepared AND willing you are to take action. Complete each column before starting the next column Unethical/ Unethical/Dis honest Behavior How prepared are you to take action? How willing are you to take action? 1. Calling out sick for themself or a sick child when the student or child was not sick 2. Coming to the clinical area while under the influence of drugs, alcohol, prescription medications, or over the counter agents 3. Avoiding the delivery of nursing care to a disagreeable patient that no one likes 4. Not reporting an incident involving a patient, even if no harm occurred 5. Recording patient data without actually obtaining the data properly 6. Using facility resources for personal use (internet surfing, printing copies, studying on duty) 7. Taking medications from the hospital for personal use 10. Failing to provide information to a patient about treatments, medications, or recommended health behaviors 11. Not questioning an order when in doubt 12. Not reporting when mistakes are discovered in the clinical lab area Adapted from Hilbert, G. (1985). Involvement of nursing students in unethical classroom and clinical behaviors. Journal of Pr ofessional Nursing, 1(4), 230 234 1 5 Scale : 1. Not at all 2. A little bit 3. Sometimes 4. Mostly 5. Extremely

PAGE 138

138 A PPENDIX C COPYRIGHT PERMISSION

PAGE 139

139 A PPENDIX D THREE CASE STUDY SCENARIOS Case Study 1 In reviewing the charting of a clinical student, the faculty member discovers that the vital signs for Mrs. Jones have not yet been charted. When the instructor questions the student about the lack of vital signs being documented in a timely fashion, the student says the vital signs will student issue, but within two minutes after speaking with the first student, the clinical instructor returns to continue to review charted by the student and are identical to the previous set of vital signs. The team is to evaluate this scenario and recommend what action (if any) to take involving the student.

PAGE 140

140 Cas e Study 2 A clinical student comes to you (the clinical instructor) to inform you that she has overheard two students discussing the unit lecture test that was given last week including specific questions and probable answers. The informing student is wi lling to come forward and gives you the names of the students who were discussing the test. You are aware that one of the students has been ill, and missed class last week, and therefore will probably be taking the make up exam sometime this week. The ma ke up exam is in essay and short answer format, whereas the test that was given last week was computerized and multiple choice. The teams will evaluate the scenario and recommend what action (if any) to take involving the nursing students.

PAGE 141

141 Case Study 3 A student has reported to class and seems to be slurring his words, seems sleepy, having a hard time focusing, is closing his eyes and putting his head on this desk. When he walked across the room, his gait was uneven, and he stumbled into the corner o f the table instead of moving around the edge. He explains to you that he was up all night studying for his pharmacology exam, but does not make eye contact. The teams will evaluate the scenario and recommend what action (if any) to take involving the n ursing student.

PAGE 142

142 A PPENDIX E PRE INTERVENTION INDIVID UAL IRAT RESULTS PRE INTERVENTION IRAT CLASSROOM N Range Minimum Maximum Mean Standard Deviation Variance 1. Getting electronic or hard copies of exams or exam questions from someone who has taken the exam Q1 Unethical Dishonest Class 40 4 1 5 4.83 .71 .50 Q1 Preparedness Class 38 4 1 5 4.58 .92 .85 Q1 Willingness Class 38 4 1 5 4.76 .75 .56 2. Prior to taking the exam, discussing the exam or receiving answers from a student who has already taken the exam Q2 Unethical Dishonest Class 40 4 1 5 4.63 .87 .75 Q2 Preparedness Class 38 3 2 5 4.39 .97 .95 Q2 Willingness Class 38 4 1 5 4.53 .92 .85 3. Allowing someone to copy from an exam or giving answers to another student during an exam Q3 Unethical Dishonest Class 40 4 1 5 4.85 .70 .49 Q3 Preparedness Class 38 3 2 5 4.66 .78 .61 Q3 Willingness Class 38 4 1 5 4.79 .74 .55 4. Using unauthorized notes, books, or technology during a closed book assignment or exam Q4 Unethical Dishonest Class 39 2 3 5 4.90 .38 .15 Q4 Preparedness Class 38 4 1 5 4.61 .89 .79 Q4 Willingness Class 38 4 1 5 4.79 .74 .55 5. Taking an exam for another student Q5 Unethical Dishonest Class 40 4 1 5 4.90 .63 .4 0 Q5 Preparedness Class 38 4 1 5 4.68 .87 .76 Q5 Willingness Class 38 4 1 5 4.84 .72 .52 6. Copying sentences or ideas from a reference source without referencing it in a paper Q6 Unethical Dishonest Class 40 2 3 5 4.49 .64 .40 Q6 Preparedness Class 39 4 1 5 4.44 .97 .94 Q6 Willingness Class 39 4 1 5 4.51 .91 .84 7. Adding items to a bibliography (reference list) that were not used in writing the paper Q7 Unethical Dishonest Class 40 2 3 5 4.50 .75 .56 Q7 Preparedness Class 39 4 1 5 4.38 1.02 1.03 Q7 Willingness Class 39 4 1 5 4.44 .97 .94 8. Turning in an assignment purchased from an online paper mill Q8 Unethical Dishonest Class 40 3 2 5 4.85 .58 .34 Q8 Preparedness Class 39 3 2 5 4.69 .80 .64 Q8 Willingness Class 39 4 1 5 4.82 .72 .52 9. Turning in an assignment that was done entirely or in part, by someone else (but not a paper mill) Q9 Unethical Dishonest Class 40 4 1 5 4.80 .72 .52 Q9 Preparedness Class 38 3 2 5 4.61 .82 .68 Q9 Willingness Class 38 4 1 5 4.79 .74 .55 Q10 Unethical Dishonest Class 40 4 1 5 4.33 1.02 1.05 Q10 Preparedness Class 38 3 2 5 4.16 1.15 1.33 Q10 Willingness Class 38 4 1 5 4.24 1.15 1.32 11. Making completed (graded) assignments available for someone who has not yet had the assignment Q11 Unethical Dishonest Class 40 4 1 5 4.70 .76 .57 Q11 Preparedness Class 38 3 2 5 4.58 .89 .79 Q11 Willingness Class 38 4 1 5 4.58 .92 .85 12. Working with another student on an assignment when the instructor did not allow it Q12 Unethical Dishonest Class 40 4 1 5 4.45 .99 .97 Q12 Preparedness Class 38 3 2 5 4.32 1.07 1.14 Q12 Willingness Class 38 4 1 5 4.39 1.08 1.16 13. Not reporting when mistakes are discovered in the classroom area Q13 Unethical Dishonest Class 39 4 1 5 4.21 .95 .90 Q13 Preparedness Class 37 3 2 5 4.24 .83 .69 Q13 Willingness Class 37 4 1 5 4.30 .91 .83

PAGE 143

143 PRE INTERVENTION IRAT C LINICAL N Range Minimum Maximum Mean Standard Deviation Variance 1. Calling out sick for themselves or a sick child when the student or child was not sick Q1 Unethical Dishonest Clinical 39 4 1 5 4.05 1.07 1.16 Q1 Preparedness Clinical 37 4 1 5 3.95 1.31 1.72 Q1 Willingness Clinical 37 4 1 5 4.03 1.28 1.64 2. Coming to the clinical area while under the influence of drugs, alcohol, prescription medications or OTC agents Q2 Unethical Dishonest Clinical 39 4 1 5 4.82 .72 .52 Q2 Preparedness Clinical 37 4 1 5 4.73 .87 .76 Q2 Willingness Clinical 37 4 1 5 4.81 .74 .5 5 3. Avoiding the delivery of nursing care to a disagreeable patient that no one likes Q3 Unethical Dishonest Clinical 39 4 1 5 4.46 .85 .73 Q3 Preparedness Clinical 37 3 2 5 4.54 .77 .59 Q3 Willingness Clinical 37 2 3 5 4.65 .63 .40 4. Not reporting an incident involving a patient, even if no harm occurred Q4 Unethical Dishonest Clinical 39 4 1 5 4.64 .78 .6 1 Q4 Preparedness Clinical 37 3 2 5 4.65 .72 .51 Q4 Willingness Clinical 37 2 3 5 4.78 .48 .23 5. Recording patient data without actually obtaining the data properly Q5 Unethical Dishonest Clinical 39 4 1 5 4.82 .68 .47 Q5 Preparedness Clinical 37 3 2 5 4.86 .54 .29 Q5 Willingness Clinical 37 1 4 5 4.97 .16 .03 6. Using facility resources for personal use (internet surfing, printing copies, studying on duty) Q6 Unethical Dishonest Clinical 39 4 1 5 4.08 .96 .92 Q6 Preparedness Clinical 37 3 2 5 4 .00 1.05 1.11 Q6 Willingness Clinical 37 3 2 5 4.16 .96 .92 7. Taking medications from the hospital for personal use Q7 Unethical Dishonest Clinical 39 4 1 5 4.74 .75 .56 Q7 Preparedness Clinical 37 3 2 5 4.76 .64 .41 Q7 Willingness Clinical 37 2 3 5 4.86 .42 .18 Q8 Unethical Dishonest Clinical 39 4 1 5 4.79 .73 .54 Q8 Preparedness Clinical 37 3 2 5 4.89 .52 .27 Q8 Willingness Clinical 37 1 4 5 4.95 .23 .05 Q9 Unethical Dishonest Clinical 39 4 1 5 4.79 .70 .48 Q9 Preparedness Clinical 37 4 1 5 4.70 .88 .77 Q9 Willingness Clinical 37 4 1 5 4.81 .70 .49 10. Failing to provide information to a patient about treatments, medications, or recommended health behaviors Q10 Unethical Dishonest Clinical 38 4 1 5 4.47 .86 .74 Q10 Preparedness Clinical 38 3 2 5 4.53 .76 .58 Q10 Willingness Clinical 37 2 3 5 4.65 .59 .35 11. No questioning an order when in doubt Q11 Unethical Dishonest Clinical 38 3 2 5 4.55 .76 .58 Q11 Preparedness Clinical 39 3 2 5 4.67 .70 .49 Q11 Willingness Clinical 38 2 3 5 4.76 .54 .29 12. Not reporting when mistakes are discovered in the clinical lab area Q12 Unethical Dishonest Clinical 39 4 1 5 4.59 .88 .77 Q12 Preparedness Clinical 37 3 2 5 4.78 .58 .34 Q12 Willingness Clinical 37 1 4 5 4.86 .35 .12

PAGE 144

144 APPENDIX F GRAT RESULTS GRAT INTERVENTION C LASSROOM N Range Minimum Maximum Mean Standard Deviation Variance 1. Getting electronic or hard copies of exams or exam questions from someone who has taken the exam Q1 Unethical Dishonest Class 6 0 5 5 5 .00 0 0 Q1 Preparedness Class 6 0 5 5 5 .00 0 0 Q1 Willingness Class 6 0 5 5 5 .00 0 0 2. Prior to taking the exam, discussing the exam or receiving answers from a student who has already taken the exam Q2 Unethical Dishonest Class 6 1 4 5 4.83 .41 .17 Q2 Preparedness Class 6 1 4 5 4.83 .41 .17 Q2 Willingness Class 6 1 4 5 4.83 .4 1 .17 3. Allowing someone to copy from an exam or giving answers to another student during an exam Q3 Unethical Dishonest Class 6 0 5 5 5 .00 0 0 Q3 Preparedness Class 6 0 5 5 5 .00 0 0 Q3 Willingness Class 6 0 5 5 5 .00 0 0 4. Using unauthorized notes, books, or technology during a closed book assignment or exam Q4 Unethical Dishonest Class 6 0 5 5 5.00 0 0 Q4 Preparedness Class 6 0 5 5 5.00 0 0 Q4 Willingness Class 6 0 5 5 5.00 0 0 5. Taking an exam for another student Q5 Unethical Dishonest Class 6 0 5 5 5.00 0 0 Q5 Preparedness Class 6 0 5 5 5.00 0 0 Q5 Willingness Class 6 0 5 5 5.00 0 0 6. Copying sentences or ideas from a reference source without referencing it in a paper Q6 Unethical Dishonest Class 6 1 4 5 4.83 .41 .17 Q6 Preparedness Class 6 2 3 5 4.5 0 .8 4 .70 Q6 Willingness Class 6 2 3 5 4.5 0 .84 .70 7. Adding items to a bibliography (reference list) that were not used in writing the paper Q7 Unethical Dishonest Class 6 1 4 5 4.67 .52 .27 Q7 Preparedness Class 6 1 4 5 4.67 .52 .27 Q7 Willingness Class 6 1 4 5 4.67 .52 .27 8. Turning in an assignment purchased from an online paper mill Q8 Unethical Dishonest Class 6 0 5 5 5.00 0 0 Q8 Preparedness Class 6 0 5 5 5.00 0 0 Q8 Willingness Class 6 0 5 5 5.00 0 0 9. Turning in an assignment that was done entirely or in part, by someone else (but not a paper mill) Q9 Unethical Dishonest Class 6 0 5 5 5.00 0 0 Q9 Preparedness Class 6 0 5 5 5.00 0 0 Q9 Willingness Class 6 0 5 5 5.00 0 0 Q10 Unethical Dishonest Class 6 1 4 5 4.67 .52 .27 Q10 Preparedness Class 6 1 4 5 4.67 .52 .27 Q10 Willingness Class 6 1 4 5 4.67 .52 .27 11. Making completed (graded) assignments available for someone who has not yet had the assignment Q11 Unethical Dishonest Class 6 1 4 5 4.83 .41 .17 Q11 Preparedness Class 6 1 4 5 4.83 .41 .17 Q11 Willingness Class 6 1 4 5 4.83 .41 .17 12. Working with another student on an assignment when the instructor did not allow it Q12 Unethical Dishonest Class 6 1 4 5 4.67 .52 .27 Q12 Preparedness Class 6 1 4 5 4.67 .52 .27 Q12 Willingness Class 6 1 4 5 4.67 .52 .27 13. Not reporting when mistakes are discovered in the classroom area Q13 Unethical Dishonest Class 6 1 4 5 4.5 0 .55 .3 Q13 Preparedness Class 6 1 4 5 4.5 0 .55 .3 Q13 Willingness Class 6 1 4 5 4.5 0 .55 .3

PAGE 145

145 GRAT INTERVENTION CLINICAL N Range Minimum Maximum Mean Standard Deviation Variance 1. Calling out sick for themselves or a sick child when the student or child was not sick Q1 Unethical Dishonest Clinical 6 1 4 5 4.83 .41 .17 Q1 Preparedness Clinical 6 1 4 5 4.83 .41 .17 Q1 Willingness Clinical 6 1 4 5 4.83 .41 .17 2. Coming to the clinical area while under the influence of drugs, alcohol, prescription medications or OTC agents Q2 Unethical Dishonest Clinical 6 0 5 5 5.00 0 0 Q2 Preparedness Clinical 6 0 5 5 5.00 0 0 Q2 Willingness Clinical 6 0 5 5 5.00 0 0 3. Avoiding the delivery of nursing care to a disagreeable patient that no one likes Q3 Unethical Dishonest Clinical 6 2 3 5 4.67 .82 .67 Q3 Preparedness Clinical 6 2 3 5 4.67 .82 .67 Q3 Willingness Clinical 6 2 3 5 4.67 .82 .67 4. Not reporting an incident involving a patient, even if no harm occurred Q4 Unethical Dishonest Clinical 6 0 5 5 5.00 0 0 Q4 Preparedness Clinical 6 0 5 5 5.00 0 0 Q4 Willingness Clinical 6 0 5 5 5.00 0 0 5. Recording patient data without actually obtaining the data properly Q5 Unethical Dishonest Clinical 6 0 5 5 5.00 0 0 Q5 Preparedness Clinical 6 0 5 5 5.00 0 0 Q5 Willingness Clinical 6 0 5 5 5.00 0 0 6. Using facility resources for personal use (internet surfing, printing copies, studying on duty) Q6 Unethical Dishonest Clinical 6 2 3 5 4.33 .82 .67 Q6 Preparedness Clinical 6 2 3 5 4.33 .82 .67 Q6 Willingness Clinical 6 2 3 5 4.33 .82 .67 7. Taking medications from the hospital for personal use Q7 Unethical Dishonest Clinical 6 0 5 5 5.00 0 0 Q7 Preparedness Clinical 6 0 5 5 5.00 0 0 Q7 Willingness Clinical 6 0 5 5 5.00 0 0 Q8 Unethical Dishonest Clinical 6 0 5 5 5.00 0 0 Q8 Preparedness Clinical 6 0 5 5 5.00 0 0 Q8 Willingness Clinical 6 0 5 5 5.00 0 0 Q9 Unethical Dishonest Clinical 6 0 5 5 5.00 0 0 Q9 Preparedness Clinical 6 0 5 5 5.00 0 0 Q9 Willingness Clinical 6 0 5 5 5.00 0 0 10. Failing to provide information to a patient about treatments, medications, or recommended health behaviors Q10 Unethical Dishonest Clinical 6 1 4 5 4.67 .5 2 .27 Q10 Preparedness Clinical 6 2 3 5 4.33 .8 2 .67 Q10 Willingness Clinical 6 2 3 5 4.33 .8 2 .67 11. No questioning an order when in doubt Q11 Unethical Dishonest Clinical 6 0 5 5 5.00 0 0 Q11 Preparedness Clinical 6 0 5 5 5.00 0 0 Q11 Willingness Clinical 6 0 5 5 5.00 0 0 12. Not reporting when mistakes are discovered in the clinical lab area Q12 Unethical Dishonest Clinical 6 1 4 5 4.83 .4 1 .17 Q12 Preparedness Clinical 6 1 4 5 4.83 .41 .1 7 Q12 Willingness Clinical 6 1 4 5 4.83 .4 1 .1 7

PAGE 146

146 APPENDIX G POST INTEVENTION FINAL IRAT RESULTS POST INTEVENTION FINAL C LASSROOM N Range Minimum Maximum Mean Standard Deviation Variance 1. Getting electronic or hard copies of exams or exam questions from someone who has taken the exam Q1 Unethical Dishonest Class 38 0 5 5 5.00 0 0 Q1 Preparedness Class 38 0 5 5 5.00 0 0 Q1 Willingness Class 38 0 5 5 5.00 0 0 2. Prior to taking the exam, discussing the exam or receiving answers from a student who has already taken the exam Q2 Unethical Dishonest Class 38 0 5 5 5.00 0 0 Q2 Preparedness Class 38 0 5 5 5.00 0 0 Q2 Willingness Class 38 0 5 5 5.00 0 0 3. Allowing someone to copy from an exam or giving answers to another student during an exam Q3 Unethical Dishonest Class 38 0 5 5 5.00 0 0 Q3 Preparedness Class 38 0 5 5 5.00 0 0 Q3 Willingness Class 38 0 5 5 5.00 0 0 4. Using unauthorized notes, books, or technology during a closed book assignment or exam Q4 Unethical Dishonest Class 38 0 5 5 5.00 0 0 Q4 Preparedness Class 38 0 5 5 5.00 0 0 Q4 Willingness Class 38 0 5 5 5.00 0 0 5. Taking an exam for another student Q5 Unethical Dishonest Class 38 0 5 5 5.00 0 0 Q5 Preparedness Class 38 0 5 5 5.00 0 0 Q5 Willingness Class 38 0 5 5 5.00 0 0 6. Copying sentences or ideas from a reference source without referencing it in a paper Q6 Unethical Dishonest Class 38 1 4 5 4.84 .37 .14 Q6 Preparedness Class 38 1 4 5 4.84 .37 .14 Q6 Willingness Class 38 1 4 5 4.84 .37 .14 7. Adding items to a bibliography (reference list) that were not used in writing the paper Q7 Unethical Dishonest Class 38 1 4 5 4.82 .39 .16 Q7 Preparedness Class 38 1 4 5 4.84 .37 .14 Q7 Willingness Class 38 1 4 5 4.84 .37 .14 8. Turning in an assignment purchased from an online paper mill Q8 Unethical Dishonest Class 38 0 5 5 5.00 0 0 Q8 Preparedness Class 38 0 5 5 5.00 0 0 Q8 Willingness Class 38 0 5 5 5.00 0 0 9. Turning in an assignment that was done entirely or in part, by someone else (but not a paper mill) Q9 Unethical Dishonest Class 38 0 5 5 5.00 0 0 Q9 Preparedness Class 38 0 5 5 5.00 0 0 Q9 Willingness Class 38 0 5 5 5.00 0 0 Q10 Unethical Dishonest Class 38 1 4 5 4.76 .43 .19 Q10 Preparedness Class 38 1 4 5 4.79 .41 .17 Q10 Willingness Class 38 1 4 5 4.79 .41 .17 11. Making completed (graded) assignments available for someone who has not yet had the assignment Q11 Unethical Dishonest Class 38 1 4 5 4.97 .16 .03 Q11 Preparedness Class 38 0 5 5 5.00 0 0 Q11 Willingness Class 38 0 5 5 5.00 0 0 12. Working with another student on an assignment when the instructor did not allow it Q12 Unethical Dishonest Class 38 1 4 5 4.92 .27 .08 Q12 Preparedness Class 38 1 4 5 4.95 .23 .05 Q12 Willingness Class 38 1 4 5 4.95 .23 .05 13. Not reporting when mistakes are discovered in the classroom area Q13 Unethical Dishonest Class 38 1 4 5 4.84 .37 .14 Q13 Preparedness Class 38 1 4 5 4.84 .37 .14 Q13 Willingness Class 38 1 4 5 4.84 .37 .14

PAGE 147

147 POST INTEVENTION FINAL C LINICAL N Range Minimum Maximum Mean Standard Deviation Variance 1. Calling out sick for themselves or a sick child when the student or child was not sick Q1 Unethical Dishonest Clinical 38 4 1 5 4.6 6 .7 5 .5 6 Q1 Preparedness Clinical 38 1 4 5 4.7 9 .41 .17 Q1 Willingness Clinical 38 1 4 5 4.7 9 .41 .17 2. Coming to the clinical area while under the influence of drugs, alcohol, prescription medications or OTC agents Q2 Unethical Dishonest Clinical 38 0 5 5 5.00 0 0 Q2 Preparedness Clinical 38 0 5 5 5.00 0 0 Q2 Willingness Clinical 38 0 5 5 5.00 0 0 3. Avoiding the delivery of nursing care to a disagreeable patient that no one likes Q3 Unethical Dishonest Clinical 38 1 4 5 4.89 .31 .10 Q3 Preparedness Clinical 38 1 4 5 4.89 .31 .10 Q3 Willingness Clinical 38 1 4 5 4.89 .31 .10 4. Not reporting an incident involving a patient, even if no harm occurred Q4 Unethical Dishonest Clinical 38 1 4 5 4.97 .16 .026 Q4 Preparedness Clinical 38 0 5 5 5.00 0 0 Q4 Willingness Clinical 38 0 5 5 5.00 0 0 5. Recording patient data without actually obtaining the data properly Q5 Unethical Dishonest Clinical 38 0 5 5 5.00 0 0 Q5 Preparedness Clinical 38 0 5 5 5.00 0 0 Q5 Willingness Clinical 38 0 5 5 5.00 0 0 6. Using facility resources for personal use (internet surfing, printing copies, studying on duty) Q6 Unethical Dishonest Clinical 38 3 2 5 4.79 .58 .33 Q6 Preparedness Clinical 38 3 2 5 4.79 .58 .33 Q6 Willingness Clinical 38 3 2 5 4.79 .58 .33 7. Taking medications from the hospital for personal use Q7 Unethical Dishonest Clinical 38 0 5 5 5.00 0 0 Q7 Preparedness Clinical 38 0 5 5 5.00 0 0 Q7 Willingness Clinical 38 0 5 5 5.00 0 0 Q8 Unethical Dishonest Clinical 38 0 5 5 5.00 0 0 Q8 Preparedness Clinical 38 0 5 5 5.00 0 0 Q8 Willingness Clinical 38 0 5 5 5.00 0 0 Q9 Unethical Dishonest Clinical 38 0 5 5 5.00 0 0 Q9 Preparedness Clinical 38 0 5 5 5.00 0 0 Q9 Willingness Clinical 38 0 5 5 5.00 0 0 10. Failing to provide information to a patient about treatments, medications, or recommended health behaviors Q10 Unethical Dishonest Clinical 38 1 4 5 4.82 .39 .15 Q10 Preparedness Clinical 38 2 3 5 4.74 .55 .31 Q10 Willingness Clinical 38 2 3 5 4.74 .55 .31 11. No questioning an order when in doubt Q11 Unethical Dishonest Clinical 38 1 4 5 4.95 .23 .05 Q11 Preparedness Clinical 38 1 4 5 4.98 .16 .03 Q11 Willingness Clinical 38 1 4 5 4.97 .16 .03 12. Not reporting when mistakes are discovered in the clinical lab area Q12 Unethical Dishonest Clinical 38 1 4 5 4.92 .27 .08 Q12 Preparedness Clinical 38 1 4 5 4.97 .16 .03 Q12 Willingness Clinical 38 1 4 5 4.97 .16 .03

PAGE 148

148 APPENDIX H THREE MONTH FOLLOW UP IRAT RESULTS THREE MONTH FOLLOW UP C LASSROOM N Range Minimum Maximum Mean Standard Deviation Variance 1. Getting electronic or hard copies of exams or exam questions from someone who has taken the exam Q1 Unethical Dishonest Class 27 0 5 5 5 .00 .1 9 0 Q1 Preparedness Class 27 0 5 5 4.9 0 .1 9 .03 Q1 Willingness Class 27 1 4 5 4.9 7 .18 .03 2. Prior to taking the exam, discussing the exam or receiving answers from a student who has already taken the exam Q2 Unethical Dishonest Class 27 2 3 5 4.8 7 .43 .1 9 Q2 Preparedness Class 27 1 4 5 4. 90 .3 1 10 Q2 Willingness Class 27 1 4 5 4.9 0 .3 1 10 3. Allowing someone to copy from an exam or giving answers to another student during an exam Q3 Unethical Dishonest Class 27 0 5 5 5 .00 0 0 Q3 Preparedness Class 27 0 5 5 4.9 7 .1 9 .03 Q3 Willingness Class 27 0 5 5 5 .00 0 0 4. Using unauthorized notes, books, or technology during a closed book assignment or exam Q4 Unethical Dishonest Class 27 2 3 5 4.93 .3 7 .13 Q4 Preparedness Class 27 1 4 5 4.93 .2 6 .0 7 Q4 Willingness Class 27 1 4 5 4.93 .25 .06 5. Taking an exam for another student Q5 Unethical Dishonest Class 27 0 5 5 5 .00 0 0 Q5 Preparedness Class 27 0 5 5 4.9 7 .1 9 .03 Q5 Willingness Class 27 0 5 5 5 .00 0 0 6. Copying sentences or ideas from a reference source without referencing it in a paper Q6 Unethical Dishonest Class 27 2 3 5 4.83 46 .21 Q6 Preparedness Class 27 2 3 5 4.7 6 .51 .26 Q6 Willingness Class 27 1 4 5 4.8 7 .3 5 .12 7. Adding items to a bibliography (reference list) that were not used in writing the paper Q7 Unethical Dishonest Class 27 1 4 5 4.83 .59 .35 Q7 Preparedness Class 27 1 4 5 4.79 .6 2 .38 Q7 Willingness Class 27 1 4 5 4.83 .59 .35 8. Turning in an assignment purchased from an online paper mill Q8 Unethical Dishonest Class 27 0 5 5 5 .00 0 0 Q8 Preparedness Class 27 2 3 5 4.79 .4 1 .1 7 Q8 Willingness Class 27 1 4 5 4.9 7 .18 .03 9. Turning in an assignment that was done entirely or in part, by someone else (but not a paper mill) Q9 Unethical Dishonest Class 27 1 4 5 4.9 7 .18 .03 Q9 Preparedness Class 27 1 4 5 4.93 .2 6 .0 7 Q9 Willingness Class 27 1 4 5 4. 9 7 .18 .03 Q10 Unethical Dishonest Class 27 3 2 5 4.7 0 .65 .42 Q10 Preparedness Class 27 3 2 5 4.6 6 .72 .52 Q10 Willingness Class 27 3 2 5 4.7 0 .79 .63 11. Making completed (graded) assignments available for someone who has not yet had the assignment Q11 Unethical Dishonest Class 27 1 4 5 4.9 0 .40 .16 Q11 Preparedness Class 27 1 4 5 4.72 .6 5 .42 Q11 Willingness Class 27 1 4 5 4.83 .59 .35 12. Working with another student on an assignment when the instructor did not allow it Q12 Unethical Dishonest Class 27 1 4 5 4.83 .3 8 .14 Q12 Preparedness Class 27 2 3 5 4.6 9 .60 .3 7 Q12 Willingness Class 27 1 4 5 4.7 7 .6 3 .39 13. Not reporting when mistakes are discovered in the classroom area Q13 Unethical Dishonest Class 27 1 4 5 4.63 .49 .24 Q13 Preparedness Class 27 1 4 5 4.6 6 .48 .23 Q13 Willingness Class 27 1 4 5 4.33 .4 5 .20

PAGE 149

149 THREE MONTH FOLLOW UP C LINICAL N Range Minimum Maximum Mean Standard Deviation Variance 1. Calling out sick for themselves or a sick child when the student or child was not sick Q1 Unethical Dishonest Clinical 27 2 3 5 4.5 6 70 .4 9 Q1 Preparedness Clinical 27 2 3 5 4.59 .69 .48 Q1 Willingness Clinical 27 2 3 5 4.64 .6 8 .46 2. Coming to the clinical area while under the influence of drugs, alcohol, prescription medications or OTC agents Q2 Unethical Dishonest Clinical 27 0 5 5 5.00 0 0 Q2 Preparedness Clinical 27 0 5 5 5.00 0 0 Q2 Willingness Clinical 27 0 5 5 5.00 0 0 3. Avoiding the delivery of nursing care to a disagreeable patient that no one likes Q3 Unethical Dishonest Clinical 27 1 4 5 4.89 .32 .10 Q3 Preparedness Clinical 27 1 4 5 4.92 .27 .07 Q3 Willingness Clinical 27 2 3 5 4.89 .42 .42 4. Not reporting an incident involving a patient, even if no harm occurred Q4 Unethical Dishonest Clinical 27 1 4 5 4.93 .27 .07 Q4 Preparedness Clinical 27 1 4 5 4.85 .36 .13 Q4 Willingness Clinical 27 1 4 5 4.86 .36 .13 5. Recording patient data without actually obtaining the data properly Q5 Unethical Dishonest Clinical 27 0 5 5 5.00 0 0 Q5 Preparedness Clinical 27 0 5 5 5.00 0 0 Q5 Willingness Clinical 27 0 5 5 5.00 0 0 6. Using facility resources for personal use (internet surfing, printing copies, studying on duty) Q6 Unethical Dishonest Clinical 27 2 3 5 4.52 .70 .49 Q6 Preparedness Clinical 27 2 3 5 4.59 .69 .48 Q6 Willingness Clinical 27 2 3 5 4.60 .69 .47 7. Taking medications from the hospital for personal use Q7 Unethical Dishonest Clinical 27 0 5 5 5.00 0 0 Q7 Preparedness Clinical 27 0 5 5 5.00 0 0 Q7 Willingness Clinical 27 0 5 5 5.00 0 0 Q8 Unethical Dishonest Clinical 27 0 5 5 5.00 0 0 Q8 Preparedness Clinical 27 0 5 5 5.00 0 0 Q8 Willingness Clinical 27 0 5 5 5.00 0 0 Q9 Unethical Dishonest Clinical 27 1 4 5 4.92 .27 .07 Q9 Preparedness Clinical 27 1 4 5 4.89 .32 .10 Q9 Willingness Clinical 27 1 4 5 4.89 .31 .10 10. Failing to provide information to a patient about treatments, medications, or recommended health behaviors Q10 Unethical Dishonest Clinical 27 2 3 5 4.59 .69 .48 Q10 Preparedness Clinical 27 2 3 5 4.70 .61 .37 Q10 Willingness Clinical 27 2 3 5 4.71 .60 .36 11. No questioning an order when in doubt Q11 Unethical Dishonest Clinical 27 3 2 5 4.67 .68 .46 Q11 Preparedness Clinical 27 3 2 5 4.74 .66 .43 Q11 Willingness Clinical 27 3 2 5 4.75 65 .65 12. Not reporting when mistakes are discovered in the clinical lab area Q12 Unethical Dishonest Clinical 27 1 4 5 4.93 .27 .07 Q12 Preparedness Clinical 27 1 4 5 4.93 .27 .07 Q12 Willingness Clinical 27 1 4 5 4.93 .26 .26

PAGE 150

150 APPENDIX I PRE INTERVENTION IRAT, G RAT, POST INTERVENTION FINAL I RAT, AND FOLLOW UP IRAT MEANS STANDARD DEVIA TIONS, AND VARIANCES

PAGE 151

151 CLASSROOM Identifying Unethical Dishonest Behavior Mean Standard Deviation Variance IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP Q1 Identifying UD 4.83 5 .00 5 .00 5 .00 .71 0 0 .19 .51 0 0 0 Q2 Identifying UD 4.63 4.83 5 .00 4.8 7 .87 .41 0 .43 .66 .1 7 0 .1 9 Q3 Identifying UD 4.85 5 .00 5 .00 5 .00 .70 0 0 0 .71 0 0 0 Q4 Identifying UD 4.78 5 .00 5 .00 4.93 .38 0 0 .37 .63 0 0 .13 Q5 Identifying UD 4.9 0 5.00 5 .00 5 .00 .63 0 0 0 .62 0 0 0 Q6 Identifying UD 4.49 4.83 4.84 4.83 .64 .41 .37 .46 .61 .1 7 .14 .21 Q7 Identifying UD 4.5 0 4.6 7 4.82 4.83 .75 .52 .39 .59 .64 .2 7 .15 .35 Q8 Identifying UD 4.85 5 .00 5 .00 5 .00 .58 0 0 0 .66 0 0 0 Q9 Identifying UD 4.8 0 5 .00 5 .00 4.9 7 .72 0 0 .18 .65 0 0 .03 Q10 Identifying UD 4.33 4.6 7 4.76 4.7 0 1.02 .52 .43 .65 .67 .2 7 .19 .42 Q11 Identifying UD 4.7 0 4.83 4.97 4.9 0 .76 .41 .16 .40 .71 .1 7 .03 .16 Q12 Identifying UD 4.45 4.6 7 4.92 4.83 .99 .52 .27 .38 .73 .2 7 .08 .14 Q13 Identifying UD 4.1 0 4.5 0 4.84 4.63 .95 .55 .37 .49 .76 .30 .14 .24 Average 4.63 4.85 4.94 4.88 0.75 0.26 0.15 .32 0.66 0.12 .06 .14 CLASSROOM Preparedness IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP Q1 Preparedness 4.35 5 .00 5 .00 4.97 .92 0 0 .19 .6 8 0 0 .03 Q2 Preparedness 4.18 4.83 5 .00 4.90 .97 .41 0 .31 .73 .1 7 0 .10 Q3 Preparedness 4.43 5 .00 5 .00 4.97 .78 0 0 .19 .70 0 0 .03 Q4 Preparedness 4.38 5 .00 5 .00 4.93 .89 0 0 .26 .65 0 0 .0 7 Q5 Preparedness 4.45 5 .00 5 .00 4.97 .87 0 0 .19 .63 0 0 .03 Q6 Preparedness 4.33 4.5 0 4.84 4.76 .97 .84 .37 .51 .63 .7 0 .14 .26 Q7 Preparedness 4.28 4.6 7 4.84 4.79 1.02 .52 .37 .62 .66 .2 7 .14 .38 Q8 Preparedness 4.58 5 .00 5 .00 4.90 .80 0 0 .4 1 .66 0 0 .1 7 Q9 Preparedness 4.38 5 .00 5 .00 4.9 .82 0 0 .26 .65 0 0 .0 7 Q10 Preparedness 3.95 4.6 7 4.79 4.66 1.15 .52 .41 .72 .69 .2 7 .17 .52 Q11 Preparedness 4.35 4.83 5 .00 4.72 .89 .41 0 .65 .72 .1 7 0 .42 Q12 Preparedness 4.1 0 4.6 7 4.95 4.69 1.07 .52 .23 .60 .74 .2 7 .05 .37 Q13 Preparedness 3.93 4.5 0 4.84 4.66 .83 .55 .37 .48 .76 .3 0 .1 4 .23 Average 4.28 4.82 4.94 4.83 0.92 0.29 0.13 .41 0.6 8 0.16 .05 .21

PAGE 152

15 2 CLASSROOM Willingness Mean Standard Deviation Variance IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP Q1 Willingness 4.53 5.00 5.00 4.97 .75 0 0 .18 .64 0 0 .03 Q2 Willingness 4.30 4.83 5.00 4.9. .92 .41 0 .31 .75 .17 0 .09 Q3 Willingness 4.55 5.00 5.00 5.00 .74 0 0 0 .68 0 0 0 Q4 Willingness 4.55 5.00 5.00 4.93 .74 0 0 .25 .64 0 0 .06 Q5 Willingness 4.60 5.00 5.00 5.00 .72 0 0 0 .62 0 0 0 Q6 Willingness 4.40 4.50 4.84 4.87 .91 .84 .37 .35 .64 .7 .14 .12 Q7 Willingness 4.33 4.67 4.84 4.83 .97 .52 .37 .59 .68 .27 .14 .35 Q8 Willingness 4.70 5.00 5.00 4.97 .72 0 0 .18 .66 0 0 .03 Q9 Willingness 4.55 5.00 5.00 4.97 .74 0 0 .18 .65 0 0 .03 Q10 Willingness 4.03 4.67 4.79 4.70 1.15 .52 .41 .79 .72 .27 .17 .63 Q11 Willingness 4.35 4.83 5.00 4.83 .92 .41 0 .59 .72 .17 0 .35 Q12 Willingness 4.18 4.67 4.95 4.77 1.08 .52 .23 .63 .75 .26 .05 .39 Q13 Willingness 3.98 4.50 4.84 4.33 .91 .55 .37 .45 .76 .30 .14 .20 Average 4.39 4.82 4.94 4.85 0.87 0.29 0.13 .35 0.68 0.16 0.05 .18

PAGE 153

153 CLINICAL Identifying Unethical Dishonest Behavior Mean Standard Deviation Variance IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINA L FOLLOW UP Q1 Identifying UD 3.95 4.83 4.66 4.5 6 1.07 .4 1 .75 .70 .7 8 .1 7 .56 .4 9 Q2 Identifying UD 4.7 0 5 .00 5 .00 5 .00 0.72 0 0 0 .8 3 0 0 0 Q3 Identifying UD 4.35 4.6 7 4.89 4.8 9 .85 .8 2 .31 .32 .8 2 .6 7 .10 .10 Q4 Identifying UD 4.5 3 5 .00 4.97 4.93 .7 8 0 .16 .27 .80 0 .03 .0 1 Q5 Identifying UD 4.7 0 5 .00 5 .00 5 .00 .68 0 0 0 .7 7 0 0 0 Q6 Identifying UD 3.9 8 4. 33 4.79 4.52 .9 6 .8 2 .58 .70 .9 2 .6 7 .33 .49 Q7 Identifying UD 4.6 3 5 .00 5 .00 5 .00 .75 0 0 0 .78 0 0 0 Q8 Identifying UD 4.6 8 5 .00 5 .00 5 .00 .73 0 0 0 .76 0 0 0 Q9 Identifying UD 4.6 8 5 .00 5 .00 4.92 70 0 0 .27 .7 5 0 0 .07 Q10 Identifying UD 4.25 4.6 7 4.82 4.59 .86 .5 .39 .69 .74 .2 7 .15 .48 Q11 Identifying UD 4.3 3 5 .00 4.95 4.6 7 .76 0 .23 .68 .73 0 .05 .46 Q12 Identifying UD 4.4 8 4.8 3 4.92 4.93 .88 .41 .27 .27 .72 .1 7 .08 .07 Average 4.5 7 4.86 4.9 2 4.83 0.81 0.2 5 0.22 .32 0.78 0.16 0.11 .19 Item Mean Standard Deviation Variance CLINICAL Preparedness IRAT GRAT FINA L FOLLOW UP IRAT GRAT FINAL FOLLO W UP IRAT GRAT FINAL FOLLOW UP Q1 Preparedness 3.65 4.83 4.79 4.59 1.3 1 .41 .41 .69389 .8 1 .1 7 .17 .48 Q2 Preparedness 4.3 8 5 .00 5 .00 5 .00 .87 0 0 0 .82 0 0 0 Q3 Preparedness 4.2 0 4.6 7 4.89 4.93 .7 7 .82 .31 .27 .83 .6 7 .10 .07 Q4 Preparedness 4.3 0 5 .00 5 .00 4.85 .7 2 0 0 .36 .80 0 0 .13 Q5 Preparedness 4.5 0 5 .00 5 .00 5 .00 .5 4 0 0 0 .77 0 0 0 Q6 Preparedness 3.7 0 4.33 4.79 4.59 1.05 .8 .58 .69 .78 .6 7 .33 .48 Q7 Preparedness 4.4 0 5 .00 5 .00 5 .00 .64 0 0 0 .78 0 0 0 Q8 Preparedness 4.5 3 5 .00 5 .00 5 .00 .5 2 0 0 0 .76 0 0 0 Q9 Preparedness 4.35 5 .00 5 .00 4.8 9 .88 0 0 .32 .75 0 0 .10 Q10 Preparedness 4.3 0 4.33 4.74 4.70 .76 .82 .55 .61 .74 .6 7 .31 .37 Q11 Preparedness 4.55 5 .00 4.98 4.74 .70 0 .16 .66 .73 0 .03 .43 Q12 Preparedness 4.4 3 4.83 4.97 4.93 .58 .41 .16 .27 .72 .1 7 .03 .07 Average 4.27 4.83 4.93 4.85 0.7 8 0.27 0.18 .32 0.77 0.195 .08 .18

PAGE 154

154 CLINICAL Willingness IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLLOW UP IRAT GRAT FINAL FOLL W UP Q1 Willingness 3.7 8 4.83 4.7 9 4.64 1.2 8 .41 .41 .68 .83 .1 7 .17 .46 Q2 Willingness 4.45 5 .00 5.00 5 .00 .74 0 0 0 .82 0 0 0 Q3 Willingness 4.3 0 4.6 7 4.89 4.89 .63 .82 .31 .42 .81 .6 7 .10 .42 Q4 Willingness 4.4 3 5 .00 5 .00 4.8 6 .48 0 0 .36 .79 0 0 .1 3 Q5 Willingness 4.6 0 5 .00 5 .00 5 .00 .16 0 0 0 .76 0 0 0 Q6 Willingness 3.85 4.33 4.79 4.6 1 .96 .82 .58 .69 .79 .6 7 .33 .47 Q7 Willingness 4.5 0 5 .00 5 .00 5 .00 .4 2 0 0 0 .7 7 0 0 0 Q8 Willingness 4.5 8 5 .00 5 .00 5 .00 .2 3 0 0 0 .75 0 0 0 Q9 Willingness 4.45 5 .00 5 .00 4.89 .70 0 0 .31 .74 0 0 1 0 Q10 Willingness 4.3 0 4.33 4.74 4.71 .5 9 .82 .55 .60 .73 .6 7 .31 .36 Q11 Willingness 4.5 3 5 .00 4.98 4.75 .54 0 .16 6 5 .72 0 .03 45 Q12 Willingness 4.5 0 4.83 4.97 4.9 3 .35 .41 .16 .26 .75 .1 7 .03 .2 2 Average 4.35 4.83 4.93 4.8 6 0.5 9 0.27 0.18 .3 3 .77 0.20 .08 .24

PAGE 155

155 APPENDIX J UNIVERSITY OF FLORIDA INSTITUTIONAL REVIEW BOARD PERMISSION UFIRB 02 Social & Behavioral Research Protocol Submission Form This form must be typed. Send this form and the supporting documents to IRB02, PO Box 112250, Gainesville, FL 32611. Should you have questions about completing this form, call 352 392 0433. Title of Protocol: Perceptions of Unethical Classroom and Clinical Behavior Survey Principal Investigator: Deborah J Marshall UFID # Degree / Title: MSN, MEd, Professor Mailing Address: ( If on campus include PO Box address ): 4200 E Congress MS #31 Lake Worth, FL 33461 Email: Department: Nursing Palm Beach State College Telephone #: 561.868.3440 FAX 561.868.3452 Co Investigator(s): None UFID#: Email: Supervisor (If PI is student) : Dr Erik Black UFID#: Degree / Title: PhD, Educational Technology Assistant Professor Mailing Address: ( If on campus include PO Box address ): 1701 SW 16 th Ave, Bldg A, Rm 2113 Gainesville, FL Email : Department: Education Telephone #: 352.334.1357 Date of Proposed Research: January 1, 2013 December 31, 2013 Source of Funding (A copy of the grant proposal must be submitted with this protocol if funding is involved): None Scientific Purpose of the Study: To individually and collectively survey clinical and skills lab nursing faculty about their perceptions of academically dishonest and unethical nursing student behaviors from a list of 25 questions, and to measure how the surveys compare. Describe the Research Methodology in Non Technical Language: ( Explain what will be done with or to the research participant. ) These 3 surveys are a continuation of a study (#2011 U 1209) conducted in Spring semester, 2012. Survey administration will be c onducted by the researcher and will occur at Palm Beach State College, Lake Worth Florida. Individuals will be informed that participation is optional, have the study described to them and be administered an informed consent document. After obtaining infor med consent, a 25 question anonymous and confidential survey will be administered (see attached) to individual faculty members. This first survey, including 7 demographic questions, will be followed by a group survey, and then a final individual survey dur ing an orientation session in the spring semester of 2013. Surveys will be collected by the researcher. by this researcher. Hilbert, G. (19 85). Involvement of nursing students in unethical classroom and clinical behaviors. Journal of Professional Nursing, 1 (4), 230 234.

PAGE 156

156 Describe Potential Benefits: Determining differences in faculty perceptions of academic dishonest and unethical nursing student behaviors can help identify where steps can be taken to design curriculum to openly address the differences, and help faculty to guide students in their understanding of professional behaviors. It is believed that honest and ethical behaviors in sc hool will facilitate professional, ethical behaviors in later practice. The long term benefits are that there will be more ethical, professional registered nurses caring for patients. Describe Potential Risks: ( If risk of physical, psychological or econom ic harm may be involved, describe the steps taken to protect participant.) None. Participation is voluntary and anonymous. Results will be collected and researchers will be unable to identify individual subjects, so participation will not yield an advantag e and non and third surveys will allow for a comparison of the two surveys, thereby allowing the researcher to measure differences, but not to specifically identify individual participants. Describe How Participant(s) Will Be Recruited: A convenience sample of Lake Worth campus adjunct faculty members will be attending a required orientation (synchronous) two hour orientation session, and will be asked if they would participate in the following survey session. Those who choose to participate will be issued the surveys. Those who choose not to participate will be dismissed and can leave the area. Maximum Number of Participants (to be approached with consent) 60 Age Range of Participants: 25 70 Amount of Compensation/ course credit: None Describe the Informed Consent Process. (Attach a Copy of the Informed Consent Document. See http://irb.ufl.edu/irb02/samples.html for examples of consent.) (SIGNATURE SECTION) Principal Investigator(s) Signature: Deborah J Marshall Date: Nov 19, 2012 Co Investigator(s) Signature(s): Date: Date: Nov 20, 2012 Department Chair Signature: Date:

PAGE 157

157 A PPENDIX K PALM BEACH STATE COL LEGE RESEARCH STUDY APPRO VAL

PAGE 158

158 LIST OF REFERENCES Ahles, C. B., & Bosworth, C. C. ( 2004). The perception and reality of student and workplace teams. Journalism Mass Communication Educator, 59 (1), 42 59. Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50 179 211. Ally, M. (2004). Foundations of educational theory for online learning. Athabasca University. Ret rieved from: http://cde.athabascau.ca/online_book/ch1.html American Nurses Association: American Nurses Credentialing Center, (201 3 ). Retrieved from : http://www.nursecredentialing.org/Certific ation.aspx American Nurses Association: American Nurses Credentialing Center, (2013). Retrieved from: http://www.nursecredentialing.org/Accreditation American Nurses Association Code of Ethics for Nurses, Standard 7. (2010). Retrieved from http://www.nur singworld.org.lp.hscl.ufl.edu/MainMenuCategories/EthicsStandards/Ethics Position Statements/ Nursess Role in Ethics and Human Rights.pdf American Nurses Association Continuing Professional Development, (2012). Retrieved from h ttp://www.nursingworld.org/Ma inMenuCategories/CertificationandAccreditation/Contin uing Professional Development American Nurses Association Position Statement, (2012). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics Position Statements/ Nursess Ro le in Ethics and Human Rights.pdf American Nurses Association Professional Role Competence, (2008). Retrieved from http://www.nursingworld.org.lp.hscl.ufl.edu/MainMenuCategories/Policy Advocacy/Positions and Resolutions/ANAPositionStatements/Position Stat ements Alphabetically/Professional Role Competence.html American Nurses Association Professional Standards, (2012). Retrieved from http://www.nursingworld.org.lp.hscl.ufl.edu/MainMenuCategories/ThePracticeofProfessio nalNursing/NursingStandards Amsberry, D (2010). Deconstructing plagiarism: International students and textual borrowing practices. Reference Librarian, 51 (1), 31 44. Anderman, E. M., & Murdock, T. B. (2007). Psychology of academic cheating Burlington, MA: Elsevier Academic Press. Andersen, E. A., Stumpel, C., Fensom, I., & Andrews, W. (2011). Implementing team based learning in large classes: Nurse educators' experiences. International Journal of Nursing Education Scholarship, 8 (1), 1 16. DOI : 10.2202/1548 923X.2197

PAGE 159

159 Badke, W. (2 002). International student: Information literacy or academic literacy? Academic Exchange 60 65. Bailey, P. A. (2001). Academic misconduct: Responses from deans and nurse educators. Journal of Nursing Education, 40 (3), 124 131. Baker, S. L. (2010). Nurse educator orientation: Professional development that promotes retention. Journal of Continuing Education in Nursing, 41 (9), 413 417. Baldwin, T. T., Bedell, M., D., & Johnson, J. L. (1997). The social fabric of a team based M.B.A. program: Network effects on student satisfaction and performance. Academy of Management Journal, 40 (6), 1369 1397. Baly, M. (1986). News focus: Shattering the Nightingale myth. Nursing Times, 82 (24), 16 18. Bandura, A. (1977). Social learning theory Englewood Cliffs, NJ: Prentice Hall. Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist, 44 1175 1184. DOI : 10.1037/0003 066X.44.9.1175 Bar At least they're learning something': The hazy line between colla boration and collusion. Assessment & Evaluation in Higher Education, 30 (2), 107 122. DOI : 10.1080/0260293042000264226 Bastick, T. (1999 ). Rewarding shared experiences: Assessing individual contributions to team based work. Fort Lauderdale, FL: Internat ional Association for Continuing Education and Training (IACET 1999 Conference) Baumgart, A. J., & Kirkwood, R. (1990). Social reform versus education reform: University nursing education in Canada, 1919 1960. Journal of Advanced Nursing, 15 (5), 510 5 16. DOI : 10.1111/1365 2648.ep8530307 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 (1), 20 27. Beckett, A., Gilbertson, S., & Greenwood, S. (2007). Doi ng the right thing: Nursing students, relational practice, and moral agency. Journal of Nursing Education, 46 (1), 28 32. Bedford, L. A. (2009). The professional adjunct: An emerging trend in onlin e instruction. Online Journal of Distance Learning Administration, 12 (3). Retrieved from http://www.westga.edu/~distance/ojdla/fall123/bedford123.html Bergman, J. Z, Rentsch, J. R., Small, E. E., Davenport, S. W., & Bergman, S. M. (2012). The shared leadership process in decision making teams. The Journal of Social Psychology, 152 (1), 17 42.

PAGE 160

160 Berland, L. K., & Lee, V. R. (2012). In pursuit of consensus: Disagreement and legi timization during small group argumentation. International Journal of Science Education, 34 (12), 1857 1882. Birch, M., Elliott, D., & Trankel, M. A. (1999). Black and white and shades of gray: A portrait of the ethical professor. Ethics & Behavior, 9 (3 ), 243. Black, E. W., Greaser, J., & Dawson, K. (2008). Academic dishonesty in traditional and online classrooms: Does the "media equation" hold true? Journal of Asynchronous Learning Networks, 12 (3 4), 23 30. Bond, A. E., Mandleco, B., & Warnick, M. L (2004). At the heart of nursing: Stories reflect the professional values in AACN's essentials document. Nurse Educator, 29 (2), 84 88. DOI : 10.1097/00006223 200403000 00012 Bouville, M. (2010). Why is cheating wrong? Studies in Philosophy and Educati on, 29 (1), 67 76. Boyle, M. A., & Crosby, R. (1997). Academic program evaluation: Lessons from business and industry. Journal of Industrial Teacher Education, 34 81 85. Bradshaw, M. J., & Lowenstein, A. J. (1990). Perspectives on academic dishonesty. Nurse Educator, 15 (5), 10 15. Brown, D. L. (2002). Cheating must be okay: Everybody does it. Nurse Educator, 27 (1), 6 8. Brown, B. S., & Emmett, D. (2001). Explaining variations in the level of academic dishonesty in studies of college students: Some n ew evidence. College Student Journal, 35 (4), 529 538. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012 13 Edition, Glossary. Retrieved from: http://www.bl s.gov/ooh/about/glossary.htm Burrus, R. T., McGoldrick, K., & Schuhmann, P. W. (2007). Self reports of student cheating: Does a definition of cheating matter? Journal of Economic Education, 38 (1), 3 16. DOI : 10.3200/JECE.38.1.3 17 Callahan, D. (2004). The cheating culture: Why more Americans are doing wrong and getting ahead Orlando, FL: Harcourt. Caprio, M. W., Dubowsky, N., Warasila, R. L., Cheatwood, D. D., & Costa, F. T. (1998). Adjunct faculty: A multidimensional perspective on the important wor k of part time faculty. Journal of College Science Teaching, 28 (3), 166 173. Carter, S. L., & Punyanunt Carter, N. (2006). Acceptability of treatments for cheating in the college classroom. Journal of Instructional Psychology, 33 (3), 212 216. Cartwrigh t, T., Davson Galle, P., & Holden, R. J. (1992). Moral philosophy and nursing curricula: Indoctrination of the new breed. Journal of Nursing Education, 31 (5), 225 228.

PAGE 161

161 Case Di Leonardi, B., & Beil, M. (2012). Moving forward with a clear definition of co ntinuing competence. The Journal of Continuing Education in Nursing, 43 (8), 346 351. Celuch, K., & Dill, A. (2011). An extension of the t heory of r easoned a ction in ethical decision contexts: The roll of normative influence and ethical judgment. Journal of Education for Business, 86 201 207. The Center for Academic Integrity. (1999). The fundamental values of academic integrity Durham, NC. Charlier, H. D., & Williams, M. R. (2011). The reliance on and demand for adjunct faculty Community College Review, 39 (2), 160 180. DOI : 10.1177/0091552111405839 Chatzisarantis, N. L., & Hagger, M. S. (2005). Effects of a brief intervention based on the theory of planned behavior on leisure time physical activity participation. Journal of Sport & Exercise Psychology, 27 470 487. Chen, T., & Chen, T. (2006). Examination of attitudes towards teaching online courses based on theo ry of reasoned action of university faculty in Taiwan. British Journal of Educational Technology, 37 (5), 683 693. Christe, B. (2003). Designing online courses to discourage dishonesty. Educause Quarterly, 4 54 58. Chung, E., Rhee, J., Baik, Y., & Oh Su n, A. (2009). The effect of team based learning in medical ethics education. Medical Teacher, 31 1013 1017. DOI : 10.3109/01421590802590553 Clark, M. C., Nguyen, H. T., Bray, C., & Levine, R. E. (2008). Team based learning in an undergraduate nursing c ourse. Journal of Nursing Education, 47 (3), 111 117. DOI : 10.3928/01484834 20080301 02 Clark, C. M., & Springer, P. J. (2007). Incivility in nursing education: A descriptive study of definitions and prevalence. Journal of Nursing Education, 46 (1), 7 15. Colbert, J. A., Brown, R. S., Choi, S., & Thomas, S. (2008). An investigation of the impacts of teacher driven professional development on pedagogy and student learning. Teacher Education Quarterly, 35 (2), 135 154 Cole, S., & McCabe, D. L. (1996). Issues in academic integrity. New Directions for Student Services, (73), 67 77. DOI : 10.1002/ss.37119967307 Continuing Education (CE) and Pre Licensing Education. (n.d.). In MyFloridaCFO.com. Retrieved from http://www.myfloridacfo.com/division/agents/licensure/education/#.UZkLA1_D_Gg Continuing Education. (2012). In The Florida Department of Health, Medical Quality Assurance, Continuing Education Requi rements. Retrieved from http://doh.state.fl.us/mqa/ceu.html

PAGE 162

162 Continuing Education Requirements. (2013). In The Florida Board of Engineers Retrieved from http://www.fbpe.org/continuing education/continuing education ce requirements Coren, A. (2011). Turning a blind eye: Faculty who ignore student cheating. Journal of Academic Ethics, 9 (4), 291 305. DOI : 10.1007/s10805 011 9147 y Correa, M. (2011). Academic dishonesty in the second language classroom: Instructors' perspectives. Modern Journal of Language Teaching Methods, 1 (1), 65 79. Creech, C. J. (2008). Are we moving toward an expanded role for part time faculty? Nurse Educator, 33 (1), 31 34. Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3 rd ed.). Thousand Oaks, CA: SAGE Publications. Crown, D. F., & Spiller, M. S. (1998). Learning from the lite rature on collegiate cheating: A review of empirical research. Journal of Business Ethics, 17 (6), 683 700. Daniel, L. G., Adams, B. N., & Smith, N. M. (1994). Academic misconduct among nursing students: A multivariate investigation. Journal of Professi onal Nursing, 10 (5), 278 288. DOI : 10.1016/8755 7223(94)90053 1 Davis, A. J. (1991). The sources of a practice code of ethics for nurses. Journal of Advanced Nursing, 16 (11), 1358 1362. DOI : 10.1111/1365 2648.ep8529652 Davis, S. F., Drinan, P. F., & Ga llant, T. B. (2009). Cheating in school: What we know and what we can do Chichester, United Kingdom: John Wiley and Sons Ltd. Day, R. A., Field, P. A., Campbell, I. E., & Reutter, L. (2005). Students' evolving beliefs about nursing: From entry to gradu ation in a four year baccalaureate programme. N urse Education Today, 25 (8), 636 643. DeAngelis, W. J. 1. (2011). Disobedient and disloyal college and university administrators: Liability to their institution for subverting student academic and disciplin ary codes. Education & Law Journal, 21 (1), 1 19. Dedman, D., & Pearch, W. J. (2004). Perspectives on adjunct and other non tenure faculty. Community College Enterprise, 10 (1), 23 33. DeSilets, L. D. (1998). Accreditation of continuing education: The critical elements. Journal of Continuing Education in Nursing, 29 (5), 204 210. DeSilets, L. D., & Dickerson, P. S. (2008). Impacting the changing health care environment through collaboration and continuing education: The nursing 2015 initiative example. Journal of Continuing Education in Nursing, 39 (12), 528 529. DeSilets, L. D., & Dickerson, P. S. (2009). Connecting the dots. Journal of Continuing Education in Nursing, 40 (12), 532 533.

PAGE 163

163 DeSilets, L. D., & Dickerson, P. S. (2011). Continuing nursing education: Enhancing professional development. Journal of Continuing Education in Nursing, 41 (3), 100 101. Desimone, L. M. (2011). A primer on effective professional development. Phi Delta Kappan, 92 (6), 68 71. Desimone, L. M., Porter, A. C., Garet, M. S. Yoon, K. S., & Birman, B. F. (2002). Effects of year longitudinal study. Educational Evaluation & Policy Analysis, Summer 2002, 24 (2 ), 81 112. DOI : 10.3102/01623737024002081 Desouza, J. M., & Czerniak, C. M. (2003). about collaborative reflective practice. J ournal of Science Teacher Education, 14 (2), 75 96. Devlin Scherer, R. & Sardone, N. B. (2013). Collaboration as form of professional development: Improving learning for faculty and students College Teaching, 61 (1) 30 37. Diers, D. (1982). Between science and humanity. Yale Alumni Magazine, 45 (5), 8 12. Din. L., & Grg l, R. S. (2002). Teaching ethics in nursing. Nursing Ethics, 9 (3), 259 268. Dock, L. L., & Stewart, I. M. (1931). A short history of nursing: From the earliest times to the present day (3rd ed.). New York: G.P. Putnam's Sons. Donley, R., & Flaherty, M J. (2008). Revisiting the American Nurses Association's first position on education for nurses: A comparative analysis of the first and second position statements on the education of nurses. The Online Journal of Issues in Nursing, 13 (2). DOI : 10.3912 / OJIN.Vol13No02PPT04 Egenes, K. J., & Burgess, W. (2001). A history of nursing. Faithfully yours: A history of nursing in Illinois (p. 1 26). Eley, D., Eley, R., Bertello, M., & Rogers Clark, C. (2012). Why did I become a nurse? personality traits and r easons for entering nursing. Journal of Advanced Nursing, 68 (7), 1546 1555. DOI : 10.1111/j.1365 2648.2012.05955.x Elmore, R. (2009). Academic dishonesty and intention to cheat: A model on active versus passive academic dishonesty as perceived by busines s students. Journal of Academic Educational Leadership, 13 (2), 17 26. Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Supply (2005). American Association of Colleges of Nursing. Re trieved from: http://www.aacn.nche.edu/publications/white papers/faculty shortages

PAGE 164

164 Fairman, J. A., & Okoye, S. M. (2011). Nursing for the future, from the past: Two reports on nursing from the Institute of Medicine. Journal of Nursing Education, 50 (6), 305 311. DOI : 10.3928/01484834 20110519 02 Fass, R. A. (1986). By honor bound: Encouraging academic honesty. Educational Record, 67 32 35. Faulkender, P. J., Range L. M., Hamilton, M., Strehlow, M., Jackson, S., Blanchard, E., & Dean, P. (1994). The case of the stolen psychology test: An analysis of an actual cheating incident. Ethics & Behavior, 4 (3), 209. Feinberg, J. M. (2009). Perception of cheaters: The ro le of past and present academic achievement. Ethics & Behavior, 19 (4), 310 322. DOI : 10.1080/10508420903035299 Feingold, C. E., Cobb, M. D., Givens, R. H., Arnold, J., Joslin, S., & Keller, J. L. (2008). Student perceptions of team learning in nursing e ducation. Journal of Nursing Education, 47 (5), 214 222. DOI : 10.3928/01484834 20080501 03 Fiechtner, S. B., & Michaelsen, L. K. (1984). Giving students a part in the process: An innovative approach to team learning. College Student Journal, 18 335 344 Findlow, S., (2012). Higher education change and professional academic identity in newly 'academic' disciplines: The case of nurse education. Higher Education, 63 (1), 117 133. DOI : 10.1007/s10734 011 9449 4 Firmin, M. W., Burger, A., & Blosser, M. (20 07). Cognitive responses of students who witness classroom cheating. Journal of Instructional Psychology, 34 (2), 110 116. Fishbein, M., & Ajzen, I. (1975). Belief, attitude i ntention and b ehavior: An i ntroduction to t heory and r esearch Reading, MA: Addison Wesley. Fitzgerald, M. M ., & Theilheimer, R. (2012). Moving toward teamwork through professional development activities Early Childhood Education Journal, 41 (2), 103 113. Fontana, J. S. (2009). dishonesty. Journal of Nursing Education, 48 (4), 181 185. Fowler, M. (Ed.). (2010). Guide to the Code of Ethics for Nurses: Interpretation and application Silver Springs, MD: American Nurses Association. Franklyn Stokes, A., & Newstead, S. E. (1995). Undergraduate cheating: Who does what and why? Studies in Higher Education, 20 (2), 159. Gaberson, K. B. (1997). Academic dishonesty among nursing students. Nursing Forum, 32 (3), 14 20. DOI : 10.1111/j.1744 6198.1997.tb00205.x Gaillard Kenny, S. (2006). Adjunct faculty in distance education: What program managers should know. Distance Learning, 3 (1), 9 16.

PAGE 165

165 Gallup Poll. ( Nov 29 201 2 ). Honesty/Ethics in Professions Retrieved from http://www.gallup.com/poll/1654/honesty ethics professions.aspx Gardner, W. M., Roper, J. T., Gonzalez, C. C., & Simpson, R. G. (1988). Analysis of cheating on academic assignme nts. The Psychological Record, 38 543 555. Garet, M. S., Porter, A. C. Desimone, L., Birman, B. F., & Yoon, K. S. (2 001). What makes professional development effective? Results from a national sample of teachers. American Educational Research Journal, 38 (4), 915 945. DOI : 10.3102/00028312038004915 Gewertz, C. (2007). Poll raises questions about extent of teen cheating. Education Week, 27 (16), 8. Glen, S. (1999). Educating for interprofessional collaboration: Teaching about values. Nursing Ethics, 6 (3), 202 213. Gomez, D. S. (2001). Putting the shame back in student cheating. The Education Digest, 67 (4), 15 21. Gosnell, D. J. (2002). Overview: Entry into practice. The Online Journal of Issues in Nursing, 7 (2). K., & Steffen, S. (1994). Cheating at small colleges: An examination of student and faculty attitudes and behaviors. Journal of College Student Development, 35 255 260. Gray, M., & Smith, L. N. (1999). The professional socialization of diploma of hi gher education in nursing students (project 2000): A longitudinal qualitative study. Journal of Advanced Nursing, 29 (3), 639 647. DOI : 10.1046/j.1365 2648.1999.00932.x Green, D. W. (2007). Adjunct faculty and the continuing quest for quality. New Direc tions for Community Colleges, 140 29 39. Green, S. B., Salkind, N. J., & Akey, T. M. (2000). Using SPSS for Windows: Analyzing and understanding data Upper Saddle River, NJ: Prentice Hall. Grijalva, T. C., Nowell, C., & Kerkvliet, J. (2006). Academic honesty and online courses. College Student Journal, 40 (1), 180 185. Hadjioannou, X. (2007). Bringing the background to the foreground: What do classroom environments that support authentic discussions look like: American Educational Research Journal, 44 (2), 370 399. Haidet, P., & Fecile, M. L. (2006). Team based learning: A promising strategy to foster active learning in cancer education. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 21 (3), 125 12 8.

PAGE 166

166 Hanson, K. S. (1989). The emergence of liberal education in nursing education, 1893 to 1923. Journal of Professional Nursing, 5 (2), 83 91. DOI : 10.1016/S8755 7223(89)80011 0 Hanson, K. S. (1991). An analysis of the historical context of liberal educ ation in nursing education from 1924 to 1939. Journal of Professional Nursing, 7 (6), 341 350. DOI : 10.1016/8755 7223(91)90011 9 Hard, S. F., Conway, J. M., & Moran, A. C. (2006). Faculty and college student beliefs about the frequency of student academi c misconduct. Journal of Higher Education, 77 (6), 1058 1080. DOI : 10.1353/jhe.2006.0048 Hardr, P. L. (2012). Community college faculty motivation for basic research, teaching research, and professional development. Community College Journal of Researc h & Practice, 36 (8), 539 561. DOI : 10.1080/10668920902973362 Harmon, O. R, & Lambrinos, J. (2008). Are online exams an invitation to cheat? Journal of Economic Education, 39 (2), 116 125. Harper, M. G. (2006). High tech cheating. Nurse Educator Today, 26 (8), 672 679. Hart, L., & Morgan, L. (2010). Academic integrity in an online registered nurse to baccalaureate in nursing program. Journal of Continuing Education in Nursing, 41 (11), 498 505. Hausenblas, H. A., Carron, A. V., & Mack, D. E. (1997). Application of the Theories of Reasoned Action and Planned Behavior to exercise behavior: A meta analysis. Journal of Sport & Exercise Psychology, 19 36 51. Henschke, J. A. (2011). Considerations regarding the future of andragogy. Adult Learning, 22 (1), 34 37. Higbee, J. L., & Thomas, P. V. (2002). Student and faculty perceptions of behaviors that constitute cheating. NASPA Journal (Online), 40 (1), 39 52. Hilbert, G. A. (1985). Involvement of nursing students in unethical classroom and clinical behaviors. Journal of Professional Nursing, 1 (4), 230 234. Hilbert, G. A. (1988). Moral development and unethical behavior among nursing students. Journal of Professional Nursing, 4 (3), 163 167. Hinshaw, A. S. (2001). A continuing challenge: The shorta ge of educationally prepared nursing faculty. The Online Journal of Issues in Nursing, 6 (1). Retrieved from: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T ableofContents/Volume62001/No1Jan01/ShortageofEducationalFaculty.html Hirsh, S. (2009). Rich learning opportunities exist in a tough economy. Journal of S taff Development, 30 (3), 57 58.

PAGE 167

167 Holleman, G., Poot, E., Mintjes de Groot, J., & van Achterberg, T. (2009). The relevance of team characteristics and team directed strategies in the implementation of nursing innovations: A literature review. Internationa l Journal of Nursing Studies, 46 1256 1264. Holliday, M. E., & Parker, D. L. (1997). Florence Nightingale, feminism and nursing. Journal of Advanced Nursing, 26 (3), 483 488. DOI : 10.1111/1365 2648.ep4514162 Hughes, J. M. C., & McCabe, D. L. (2006a). A cademic misconduct within higher education in Canada. Canadian Journal of Higher Education, 36 (2), 1 21. Hughes, J. M. C., & McCabe, D. L. (2006b). Understanding academic misconduct. Canadian Journal of Higher Education, 36 (1), 49 63. Huston, T., & We aver, C. L. (2008). Peer coaching: Professional development for experienced faculty. Innovative Higher Education, 33 (1), 5 20. DOI : 10.1007/s10755 007 9061 9 Jacobson, K. N. (2013). Building the roadmap to adjunct faculty success. Techniques, 88 (4), 10 11. Jeffreys, M. R., & Stier, L. A. (1995). Speaking against student academic dishonesty: A communication model for nurse educators. Journal of Nursing Education, 34 (7), 297 304. Joel, L. A. (2002). Education for entry into nursing practice: Revisite d for the 21st century. Online Journal of Issues in Nursing, 7 (2). Judd, D., Sitzman, K., & Davis, G. M. (2010). A history of American nursing: Trends and eras Burlington, MA: Jones and Bartlett Publishing. Kasprzak, J., & Nixon, M. (2004). Cheating i n cyberspace: Maintaining quality in online education. Association for the Advancement of Computing in Education, 12 (1), 85 89. Keith Spiegel, P., Tabachnick, B. G., Whitley Jr., B. E., & Washburn, J. (1998). Why professors ignore cheating: Opinions of a national sample of psychology instructors. Ethics & Behavior, 8 (3), 215. Kelly, B. (1992). Professional ethics as perceived by American nursing undergraduates. Journal of Advanced Nursing, 17 (1), 10 15. Kelly, B. (1998). Preserving moral integrity: A follow up study with new graduate nurses. Journal of Advanced Nursing, 28 (5), 1134 1145. Kerkvliet, J., & Sigmund, C. L. (1999). Can we control cheating in the classroom? Journal of Economic Education, 30 (4), 331 343. DOI : 10.2307/1182947 Kidder, M. M., & Cornelius, P. B. (2006). Licensure is not synonymous with professionalism: Nurse Educator, 31 (1), 15 19.

PAGE 168

168 Kirkpatrick, D. (1996). level model. Training and Development, 50 (1), 54 59. Kohn, A. (2007). Who's cheating whom? Phi Delta Kappan, 89 (2), 88 97. Krampitz, S. D. (1983). Historical development of baccalaureate nursing education in the American university: 1899 1935. Western Journal of Nursing Research, 5 (4), 371 380. Kroth, M (2009). Analysis of andragogy and its search for a measurable instrument. Journal of Adult Education, 38 (1), 1 11. Laird, E. (2001). Internet plagiarism: We all pay the price. Chronicle of Higher Educatio n, 47 (44), B 5. Langone, M. (2007). Promoting integrity among nursing students. Journal of Nursing Education, 46 (1), 45 47. Levy, E. S., & Rakovski, C. C. (2006). Academic dishonesty: A zero tolerance professor and student registration choices. Researc h in Higher Education, 47 (6), 735 754. DOI : 10.1007/s11162 006 9013 8 Lewenson, S. B., Truglio Londrigan, M., & Singleton, J. (2005). Practice what you teach: A case study of ethical conduct in the academic setting. Journal of Professional Nursing, 21 (2 ), 89 96. DOI : 10.1016/j.profnurs.2005.01.006 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 (3), 323 336. DOI : 10.1080/10508420701519387 Lucas, G. M., & Friedrich, J. (2005). Individual differences in workplace deviance and integrity as predictors of academic dishonesty. Ethics & Behavior, 15 (1), 15 35. DOI : 10.1207/s15327019eb1501_2 Ludwick, R., & Silva, M. C. (1999). Ethics column: Overview and summary. The Online Journal of Issues in Nursing, 4 (2). Lupton, R. A., Chapman, K. J., & Weiss, J. E. (2000). A cross national exploration of business emic dishonesty. Journal of Education for Business, 75 (4), 231 235. Mahaffey, E. H. (2002). The relevance of associate degree nursing education: Past, present, future. Online Journal of Issues in Nursing, 7 (2). Marcus, J. (2011). Foreign student rule breaking: Culture clash or survival skills. Times Higher Education, 20 (19), 20. Marriner Tomey, A. (1990). Historical development of doctoral programs from the middle ages to nursing education today Nursing and Health Care, 11 (3), 133 137.

PAGE 169

169 Marshall, D. J. (2012). Nursing student and faculty perceptions of academic dishonesty (Unpublished doctoral qualifying project). University of Florida, Gainesville. Martin, D. E., Rao, A., & Sloan, L. R. (2009). Plagiarism, integrity, and wo rkplace deviance: A criterion study. Ethics & Behavior, 19 (1), 36 50. Mastin, D. F., Peszka, J., & Lilly, D. R. (2009). Online academic integrity. Teaching of Psychology, 36 (3), 174 178. DOI : 10.1080/00986280902739768 Martinez, D. M., Desiderio, M. F. & Papakonstantinou, A. (2010). Teaching: A job or a profession? The perceptions of educators. Educational Forum, 74 (4), 289 296. Mayer, R. E. (2004). Should there be a three strikes rule against pure discovery learning? American Psychologist, 59 (1), 14 19. McAlpine, H. (1996). Critical reflections about professional ethical stances: Have we lost sight of the major objectives? Journal of Nursing Education, 35 119 126. McAuley, E. (1985). Modeling and self Jou rnal of Sport Psychology, 7 283 295. McCabe, D. L. (1999). Academic dishonesty among high school students. Adolescence, 34 (136), 681 681. McCabe, D. L. (2009). Academic dishonesty in nursing schools: An empirical investigation. Journal of Nursing Ed ucation, 48 (11), 614 623. McCabe, D., & Katz, D. (2009). Curbing cheating. Education Digest, 75 (1), 16 19. McCabe, D. L., & Pavela, G. (2004). Ten (updated) principles of academic integrity: How faculty can foster student honesty. Change, 36 (3), 10 15 DOI : 10.1080/00091380409605574 McCabe, D. L., & Trevio, L. K. (1993). Academic dishonesty: Honor codes and other contextual influences. Journal of Higher Education, 64 522 538. DOI : 10.2307/2959991 McCabe, D. L., & Trevio, L. K. (1996). What we know about cheating in college. Change, 28 28 33. McCabe, D. L., Trevio, L. K., & Butterfield, K. D. (1999). Academic integrity in honor code and non honor code environments: A qualitative investigation. Journal of Higher Education, 70 (2), 211 234. D OI : 10.2307/2649128 McCabe, D. L., Trevio, L. K., & Butterfield, K. D. (2001a). Cheating in academic institutions: A decade of research. Ethics & Behavior, 11 (3), 219 232.

PAGE 170

170 McCabe, D. L., Trevio, L. K., & Butterfield, K. D. (2001b). Dishonesty in acad emic environments: The influence of peer reporting requirements. Journal of Higher Education, 72 (1), 29 45. DOI : 10.2307/2649132 McCrink, A. (2010). Academic misconduct in nursing students: Behaviors, attitudes, rationalizations, and cultural identity Journal of Nursing Education, 49 (11), 653 659. DOI : 10.3928/01484834 20100831 03 McLaughlin, F. (2005). Adjunct faculty at the community college: Second class professoriate? Teaching English in the Two Year College, 33 (2), 185 194. McMahon, K. K. (2010 ). Team based learning In W. Jefferies & K. Huggett (Eds.), An introduction to medical teaching (pp. 55 64). New York, NY: Springer Science and Business Media. DOI : 10.1007/978 90 481 3641 4_5 Mehra, B. (2002). Bias in qualitative research: Voices fro m an online classroom. The Qualitative Report, 7 (1). Merriam, S. B. (2001). Andragogy and self directed learning: Pillars of adult learning theory. New Directions for Adult and Continuing Education, 89 3 13. Merriam, S. B., Caffarella, R. S., & Baumgartner, L. M. (2007). Learning in adulthood: A comprehensive guide (3rd ed.). San Francisco, CA: Jossey Bass. Michaelsen, L. K., Knight, A. B., & Fink, L. D. (2004). Team based learning: A transformative use of small groups. Sterling, VA: Stylus. Michaelsen, L. K., Parmelee, D. X., McMahon, K. K., & Levine, R. E. (2008). Team based learning for health profession education. Sterling, VA: Stylus. Michaelsen, L. K., Watson, W., Cragin, J. P., & Fink L. D. (1982). Team learning: A potential soluti on to the problems of large classes. Exchange: The Organizational Behavior Teaching Journal, 7 (1), 13 22. Miller, A., Shoptaugh, C., & Parkerson, A. (2008). Under reporting of cheating in research using volunteer college students. College Student Journa l, 42 (2), 326 339. Miller, A., Shoptaugh, C., & Wooldridge, J. (2011). Reasons not to cheat, academic Integrity responsibility, and frequency of cheating. The Journal of Experimental Education 79, 169 184. Milliron, V., & Sandoe, K. (2008). The Net G eneration cheating challenge. Innovate: Journal of Online Education, 4 (6). Misra, R., McKean, M., West, S., & Russo, T. (2000). Academic stress of college students: Comparison of student and faculty perceptions. College Student Journal, 34 (2), 236 245. Muldoon, M. (2011). Is collaboration cheating? Faculty Matters Nov, 2011.

PAGE 171

171 Mundava, M., & Chaudhuri, J. (2007). Understanding plagiarism: The role of librarians at the University of Tennessee in assisting students to practice fair use of information. College & Research Libraries News, 68 (3), 170 173. National Council of State Boards of Nursing Learning Extension, (2012). Retrieved from http://learningext.com/pages/home National League of Nursing Accr editation Commission Accreditation Manual (2013). Retrieved from http://www.nlnac.org/manuals/SC2013_ASSOCIATE.pdf National League of Nursing Accreditation Commission Purpose Statement, (2 012). Retrieved f rom http://www.nlnac.org/About%20NLNAC/AboutNLNAC.htm#MISSION National League of Nursing Accreditation Commission Mission Statement and Goals, (2012). Retrieved from http://www.nlnac.org/About%20NLNAC/AboutNLNAC.htm#MISSION National League of Nursing The Four Core Values, (2011). Retrieved from http://www.nln.org/aboutnln/corevalues.htm Naugle, K. A., Naugle, L. B., & Naugle, R. J. (2000). of evaluating teacher performance. Education, 121 (1), 135 144. Newstead, S., E., Fr anklyn Stokes, A., & Armstead, P. (1996). Individual differences in student cheating. Journal of Educational Psychology, 88 (2), 229 241. Nonis, S. A., & Swift, C. O. (2001). An examination of the relationship between academic dishonesty and workplace di shonesty: A multicampus investigation. Journal of Education for Business, 77 (2), 69 77. DOI : 10.1080/08832320109599052 Nowell, C., & Laufer, D. (1997). Undergraduate student cheating in the fields of business and economics. Journal of Economic Educatio n, 3 12. Nuss, E. M. (1984). Academic integrity: Comparing faculty and student attitudes. Improving College & University Teaching, 32 140 144. Olson, M. H., & Hergenhahn, B. R. (2005) An introduction to theories of learning (7 th ed.). Ipswich, MA: Pe arson/Prentice Hall. O'Malley, K. J., Moran, B. J., Haidet, P., Seidel, C. L., Schneider, V., Morgan, R. O., Richards, B. (2003). Validation of an observation instrument for measuring student engagement in health professional settings. Evaluation & the Health Professions, 26 (1), 86 103. DOI : 10.1177/0163278702250093 Ormrod, J. E. (1999). Social learning theory. Human learning (3rd ed.). Upper Saddle River, NJ: Prentice Hall.

PAGE 172

172 D. A. (2010). Imitation is the sincerest form of cheating: The influence of direct knowledge and attitudes on academic dishonesty. Ethics & Behavior, 20 (1), 47 64. Orsolini Hain, L., & Water s V. (2009). Education evolution: A historical perspective of associate degree nursing. Journal of Nursing Education, 48 (5), 266 271. Ostapczuk, M., Moshagen, M., Zhao, Z., & Musch, J. (2009). Assessing sensitive attributes using the randomized response technique: Evidence for the importance of response symmetry. Journal of Educational and Behavioral Statistics, 34 (2), 267 287. DOI : 10.3102/1076998609332747 Palmer, I. S. (1985). Origins of education for nurses. Nursing Forum, 22 (3), 102 110. Panucci, C. J. & Wilkins, E. G. (2010). Identifying and avoiding bias in research. Plastic and Reconstructive Surgery, 126 (2), 619 625 DOI :10.1097/PRS.0b013e3181de24bc Papadakis, M. A., Teherani, A., Banach, M. A., Knettler, T. R., Rattner, S. L., Stern, D. T., Hodgson, C. S. (2005). D isciplinary action by medical boards and prior behavior in medical school. The New England Journal of Medicine, 353 (25), 2673 2682. Parameswaran, A., & Devi, P. (2006). Student plagiarism and faculty responsibility in undergraduate engineering labs. Hig her Education Research & Development, 25 (3), 263 276. DOI : 10.1080/07294360600793036 Parmelee, D. X., & Michaelsen, L. K. (2010). Twelve tips for Doi ng effective team based learning (TBL). Medical Teacher, 32 (2), 118 122. DOI : 10.3109/01421590903548562 Patton, M. Q. (1987). How to use qualitative methods in evaluation Newbury Park, CA: Sage Publications. PeSymaco, L., & Marcelo, E. (2003). Faculty perception on student academic honesty. College Student Journal, 37 (3), 327 333. Petress, K. C. (2003 ). Academic dishonesty: A plague on our profession. Education, 123 (3), 624 627. Petry, L. (1943). U.S. Cadet Nurse Corps. American Journal of Nursing, 43 (8), 704 708. Pickard, J. (2006). Staff and student attitudes to plagiarism at University College Northampton. Assessment & Evaluation in Higher Education, 31 (2), 215 232. DOI : 10.1080/02602930500262528 Pincus, H. S., & Schmelkin, L. P. (2003). Faculty perceptions of academic dishonesty: A multidimensional scaling analysis. Journal of Higher Educa tion, 74 (2), 196 209. DOI : 10.1353/jhe.2003.0017

PAGE 173

173 Pino, N. W., & Smith, W. L. (2003). College students and academic dishonesty. College Student Journal, 37 (4), 490 500. Polit, D. F., & Beck, C. T. (2008). In Kogut H. (Ed.), Nursing research: Generating and assessing evidence for nursing practice (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins. Price, J. H., Dake, J. A., & Islam, R. (2001). Selected ethical issues in research and publication: Perceptions of health education faculty. Health Education & Behavior, 28 (1), 51 64. DOI : 10.1177/109019810102800106 Raines, D. S., Ricci, P., Brown, S. L., Eggenberger, T., Hindle, T., & Schiff, M. (2011). Cheating in online courses: The student definition. The Journal of Effective Teaching, 11 (1), 80 89. Randall, D. M. (1989). Taking stock: Can the t heory of r easoned a ction explain unethical conduct? Journal of Business Ethics, 8 873 882. Randolph, P. (2007). Academic integrity. Arizona State Board of Nursing Regulatory Journal, 2 (1), 10. Resea rch Bias. (2006). Evidence Based Practice in the Health Sciences: Evidence Based Nursing Tutorial Information Services Department of the Library of the Health Sciences Chicago, University of Illinois at Chicago Retrieved from http://ebp.lib.uic.edu/nursing/node/22 Resick, C., Martin, G., Keating, M., Dickson, M., Kwan, H., & Peng, C. (2011). What ethical leadership means to me: Asian, American, and European perspectives. Journal of Business Ethics, 101 (3), 435, 457. Rider, E. A., & Brashers, V. (2006). Team based learning : A strategy for inter professional collaboration. Medical Education, 40 459 498. Rider, E. A., Brashers, V. L., & Costanza, M. E. (2008). Using interprofessional team b ased learning to develop health care policy. Medical Education, 42 513 543. Roig, M. (2001). Plagiarism and paraphrasing criteria of college and university professors. Ethics & Behavior, 11 (3), 307 323. Rosseter, R. (2012). Nursing shortage. American A ssociation for the Colleges of Nursing. Found in Contributing Factors Impacting the Nursing Shortage Retrieved from: http://www.aacn.nche.edu/media relations/fact shee ts/nursing shortage Rozycki, E. G. (2010). Lack of consensus on education: What are its dimensions? Educational Horizons, 88 (3), 135 140. Ruby, J. (1999). History of higher education: Educational reform and the emergence of the nursing professorate. J ournal of Nursing Education, 38 (1), 23 27.

PAGE 174

174 Ruiz, E. A. (2010). The professional development of community college faculty. Community College Journal of Research and Practice, 34 (6), 517 521. DOI : 10.1080/10668920902852137 Russikoff, K., Fucaloro, L., & Salkauskiene, D. (2003). Plagiarism as a cross cultural phomenon. CalPly Journal of Interdisciplinary Studies 16, 109 120. Ryan, J. (1998). Student plagiarism in an online world. ASEE Prism, 8 (4), 20 24. Sapp, D. A. (2002). Towards an international and intercultural understanding of plagiarism and academic dishonesty in composition: Reflections from the People's Republic of China. Issues in Writing, 13 (1), 58 79. Scheers, N. J., & Dayton, C. M. (1987). Improved estimation o f academic cheating behavior using the randomized response technique. Research in Higher Education, 26 (1), 61 69. DOI : 10.1007/BF00991933 Schneider, A. (1999). Chronicle of Higher Education, 45 (2 0), A8 A10. Schriner, J. G., & Harris, I. (1984). Professionalism among nurse educators. Journal of Nursing Education, 23 (6), 252 258. Semple, M., Kenkre, J., & Achilles, J. (2004). Student fraud: The need for clear regulations for dismissal or transfe r from healthcare training programmes for students who are not of good character. NT Research, 9 (4), 272 280. Shipley, L. J. (2009). Academic and professional dishonesty: Student views of cheating in the classroom and on the job. Journalism & Mass Comm unication Educator, 64 (1), 39 53. Sibley, J., & Parmelee, D. X. (2008). Knowledge is no longer enough: Enhancing professional education with team based learning. New Directions for Teaching & Learning, 2008 (116), 41 53. Sica, G. T. ( 2006). Bias in res earch studies. Radiology, 238 780 789. DOI :10.1148/radiol.2383041109 Simon, C. A., Carr, J. R., McCullough, S. M., Morgan, S. J., Oleson, T., & Ressel, M. (2003). The other side of academic dishonesty: The relationship between faculty skepticism, gende r and strategies for managing student academic dishonesty cases. Assessment & Evaluation in Higher Education, 28 (2), 193. Sims, R. L. (1995). The severity of academic dishonesty: A comparison of faculty and student views. Psychology in the Schools, 32 233 238. DOI : 10.1002/1520 6807(199507)32:3<233::AID PITS2310320311>3.0.CO;2 H Sisk, R. J., (2011). Team based learning: Systematic research review. Journal of Nursing Education, 50 (12), 665 669. DOI : 10.3928/01484834 20111017 01

PAGE 175

175 Slavin, R. E. (1996). Research on cooperative learning and achievement: What we know, what we need to know. Contemporary Educational Psychology, 21 43 79. DOI : 10.1006/ceps.1996.0004 Smith, T. G. (2009). A policy perspective on the entry into practice issue. The Online Journal of Issues in Nursing, 15 (1). DOI : 10.3912/OJIN.Vol15No01PPT01 Snyder, M. G. (2004). Cyber ethics: Pirates in the classroom. Science Activities, 41 (3), 3 4. Solomon, M. R., & De Natale, M. L. (2000). Academic dishonesty and professional practice : A convocation. Nurse Educator, 25 (6), 270 271. Sparks, S. D. (2011). Studies shed light on how cheating impedes learning. Education Week, 30 (26), 1 16. Spiller, S., & Crown, D. F. (1995). Changes over time in academic dishonesty at the collegiate le vel. Psychological Reports, 76 763 768. Staats, S., Hupp, J. M., Wallace, H., & Gresley, J. (2009). Ethics Behavior, 19 (3), 171 183. Standing, L. G., & Shearson, C. G. (2010). Does the order of questionnaire items change subjects' responses? An example involving a cheating survey. North American Journal of Psychology, 12 (3), 603 614. Starr, P. (1982). The social transformation of Am erican medicine New York: Basic Books. Stearns, S. A. (2001). The student Ethics and Behavior, 11 (3), 275 285. Stein, A. M. (1998). History of continuing nursing education in the United States. Jo urnal of Continuing Education in Nursing, 29 (6), 245 252. Stern, E. B., & Havlicek, L. (1986). Academic misconduct: Results of faculty and undergraduate student surveys. Journal of Allied Health, 15 (2), 129 142. Sternberg, R. J. (2011). Slip sliding aw ay, down the ethical slope. Chronicle of Higher Education, 57 (19). Straw, J. (2000). Keep your eyes off the screen: Online cheating and what can we do about it. Academic Exchange Quarterly, 4 (30), 21. Stuber McEwen, D., Wiseley, P., & Hoggatt, S. (2009) Point, click, and cheat: Frequency and type of academic dishonesty in the virtual classroom. Online Journal of Distance Learning Administration, 12 (3), 1 10.

PAGE 176

176 Sweet, M., & Michaelsen, L. (2007). How group dynamics research can inform the theory and practice of postsecondary small group learning. Educational Psychology Review, 19 (1), 31 47. DOI : 10.1007/s10648 006 9035 y Sweet, M., & Michaelsen, L. K. (2012). What is TBL? Retrieved from http://www.teambasedlearning.org/ Sweitzer, H. F. (2003). Getting off to a g ood start: Faculty development in professional programs. Journal of Continuing Education in Nursing, 34 (6). Tanner, C. A. (2004). Moral decline or pragmatic decision making? Cheating and plagiarism in perspective. Journal of Nursing Education, 43 (7), 291 292. Tellings, A. E. (2006). an appeal for concealin g them. Ethics Behavior, 16 (4), 363 375. Thompson, B. M., Schneider, V. F., Haidet, P., Levine, R. E., McMahon, K. K., Perkowski, L. C., & Richards, B. F. (2007). Team based learning at ten medical schools: Two years later. Medical Education, 41 (3), 250 257. DOI : 10.1111/j.1365 2929.2006.02684.x Throckmorton Belzer, L., Keith Spiegel, P., & Wrangham, J. (2001). Student response to a collective penalty for reported cheating: A case study. Ethics Behavior, 11 (3), 343 348. Timmermans, O., Van Linge, R., Van Petegem, P., Van Rompaey, B., & Denekens, J. (2012). Team learning and innovation in nursing, a review of the literature. Nurse Education Today, 32 65 70. Tittle, C R., & Rowe, A. R. (1974 ). Fear and the student cheater. Change 47 48. Trenholm, S. (2007). A review of cheating in fully asynchronous online courses: A math or fact based course perspective Journal of Educational Technology Systems, 35 (3), 281 300. Trotter, Y. D. (2006). Adult learning Theories: Impacting professional development programs. Delta Kappa Gamma Bulletin, 72 (2), 8 13. Trushnell, J., Byrne, K., & Simpson, R. (2011). Cheating behaviors, the internet and education undergraduate students. Journal of Computer Assisted Learning DOI : 10.1111/j.1365 2729.2011.00424.x Tsui, L., & Gao, E. (2006). The efficacy of seminar courses. Journal of College Student Retention: Research, Theory & Practice, 8 (2), 149 170. Turner, S. L., & Rufo, M. K. (1992). An overview of nursing ethics for nurse educators. The Journal of Contin uing Education in Nursing, 23 (6), 272 277. Van Der Veer, R. (1986). Psychological Reports, 59 (2), 527 536.

PAGE 177

177 Viens, D. C. (1989). A history of nursing's code of ethics. Nursing Outlook, 37 (1), 45 49. Vilchez, M., & Th irunarayanan. M. O. (2011). Cheating in online courses: A qualitative study. International Journal of Instructional Technology, 8 (1), 49 56. Volpe, R., Davidson, L., & Bell, M. C. (2008). Faculty attitudes and behaviors concerning student cheating. Co llege Student Journal, 42 (1), 164 175. Wajda Johnston, V., Handal, P. J., Brawer, P. A., & Fabricatore, A. N. (2001). Academic dishonesty at the graduate level. Ethics & Behavior, 11 (3), 287 305. Walker, M., & Townley, C. (2012). Contract cheating: A new challenge for academic honesty? Journal of Academic Ethics, 10 27 44. DOI : 10.1007/S10805 012 9150 y Wallin, D. L. (2004). Valuing professional colleagues: Adjunct faculty in community and technical colleges. Community College Journal of Research and Practice, 28 373 391. DOI : 10.1080/10668920490424087 Wallin, D. L. (2007). Part Time faculty and professional development: Notes from the field. New Directions for Community Colleges, (140), 67 73. Wallin, D. L., & Smith, C. L. (2005). Professiona l development needs of full time faculty in technical colleges. Community College Journal of Research and Practice, 29 (2), 87 108. DOI : 10.1080/10668920590524238 Watkins, R., Leigh, D., Foshay, R., & Kaufman, R. (1998). Kirkpatrick plus: Evaluation and continuous improvement with a community focus. Education and Technology Research and Development, 46 (4), 90 96. Wenger, E. (2009). A social theory of learning. In K. Illeris (Ed.), Contemporary theories of learning: Learn ing theorists in their own words (pp. 209 218). New York, NY: Routledge. West, C. T., Jr., & Schwenk, C. R. (1996). Top management team strategic consensus, demographic homogeneity and firm performance: A report of resounding nonfindings. Strategic Management Journal, 17 571 576. White, G. (2001). The code of ethics for nurses. American Journal of Nursing, 101 (10), 74 75. Whitley, B. E. (2001). Gender differences in affective responses to having cheated: The mediating role of attitudes. Ethics & Behavior, 11 (3), 249 259. Whitley, B. E., & Keith Spiegel, P. (2001). Academic integrity as an institutional issue. Ethics & Behavior, 11 (3), 325 342. Wideman, M., (2011). Caring or collusion? academic dishonesty in a school of nursing. Canadian Jou rnal of Higher Education, 41 (2), 28 43.

PAGE 178

178 Wilk, N., & Bowllan, N. (2011). Student generated behavioral guidelines to inform ethical practice: A quality improvement project. Nurse Educator, 36 (6), 271 275. DOI : 10.1097/NNE.0b013e3182333fbb Wilkinson, J. M ., & Treas, L. S. (2011). Fundamentals of nursing: Theory, concepts and applications (2nd ed.). Philadelphia, PA: F.A.Davis and Company. Woodard, C. A. (2007). Using adult learning theory for new hire training. Journal of Adult Education, 36 (1), 44 47. Woolforde, L., Lopez Zang, D., & Lumley, L. (2012). The nursing professional development series: Addressing the learning needs of nurse educators. The Journal of Continuing Education in Nursing, 43 (9), 391 392. DOI : 10.3928/00220124 20120822 03 World Health Organization (2005). Curriculum for the foundation years in postgraduate education and training: A paper for consultation. London, England. Retrieved from http://www.who.int/clie ntsafety/news/curriculum.pdf Wotring, K. E., & Bol, L. (2011). Generational differences among community college students in their evaluation of academic cheating. Community College Journal of Research and Practice, 35 (9), 724 735. DOI : 10.1080/10668920 802095910 Wowra, S. A. (2007). Moral identities, social anxiety, and academic dishonesty among American college students. Ethics & Behavior, 17 (3), 303 321. Wryobeck, J. M., & Whitley, B. E. (1999). Educational value orientation and peer perceptions of cheaters. Ethics & Behavior, 9 (3), 231 242. Xueqin, J. (2002). Chinese academics consider a 'culture of copying'. Chronicle of Higher Education, 48 (36), A45 A46. Yang, K., Woomer, G. R., & Matthews, J. T. (2012). Collaborative learning among undergr aduate students in community health nursing. Nurse Education in Practice, 12 (2), 72 76. DOI : 10.1016/j.nepr.2011.07.005 Yoder Wise, P., & Esquibel, K. (2011). The future of nursing and continuing education. Journal of Continuing Ed u cation in Nursing, 4 2 (3), 99 100. Young, J. (2009). When computers leave classrooms, so does boredom. The Chronicle of Higher Education, 55 (42), A1 A13. Zilm, G. (1993). Nursing science: Affiliation with the university. Journal of Advanced Nursing, 18 (10), 1663 1664. DOI : 10.1046/j.1365 2648.1993.18101663.x Zimmerman, B. J. (2000). Self efficacy: An essential motive to learn. Contemporary Educational Psychology, 25 82 91. DOI : 10.1006/ceps.1999.1016

PAGE 179

179 BIOGRAPHICAL SKETCH Deborah J. Marshall has been a r egister ed n urs e since 1974, earning an a ssociate and b accalaureate, or two plus two degree s in nursing from Purdue University. She used her nursing training to work in several emergency departments, and extended her experience as a Nurse Manager hospital sup ervisor, and nurse educator. Moving into education, she completed her first m n ursing with a functional minor in n ursing e ducation from the University of South Florida, after which she entered the United States Air Force as a Captain. When the United States became engaged in the first Persian Gulf War, she was deployed to a medical/surgical hospital based in the United Arab Emirates. From there she was able to continue to train nurses in the field, and upon returning to the U.S., she successfu lly completed Center, becoming the second nurse in the Air Force to achieve this distinction. The next two Air Force assignments resulted in her being assigned as the Officer in Charge o f the Nursing Staff Development department first in America, and then in RAF Lakenheath, England where she was responsible for the staff development and continuing education for all medical personnel including physicians, nurses, Em ergency Medical Technicians, and para rescue jumpers. After her honorable discharge from the Air Force, she focused on family matters until the attacks of 9/11, when she returned to nursing to again fulfill her passion for teaching, directing the nursing e ducation department at Montgomery General Hospital, near Washington D.C. before coming to Florida to establish her teaching and Department Chair position at Palm Beach State College. It is at Palm Beach where she developed a desire to incorporate current technology and teaching strategies in and out of the classroom, and completed her second m e ducation as a platform to achieve the degree of Doctor of Education from the University of Florida. She has worked passionately to improve her understandi ng of nursing

PAGE 180

180 student cheating during her study entitled: Adjunct Nursing Faculty Perceptions of and Reactions to Unethical or Dishonest Nursing Student Behaviors in the Classroom and Clinical Areas in order to attempt to improve adjunct faculty perceptio ns of their role in dealing with student cheaters, and to lessen nursing student cheating. Deborah is the daughter of Glenn and Jean Haller, who throughout their lifetimes, encouraged and supported her in her quest for education. Unfortunately, her mothe r passed away just a few months before the completion of her doctoral work and never saw her graduate She is also the mother of Christopher and Kevin Catron, who have always been a source of pride to her, in their lifetime achievements, their service to their country, and their thoughtful and steadfast support and encouragement.