Scientific Misconduct: Also an Issue in Nursing Science?Katharina Fierz, PhD, RPN1, Susan Gennaro, PhD, RN, FAAN2, Kris Dierickx, PhD3, Theo Van Achterberg, PhD,RN, FEANS4, Karen H. Morin, PhD, RN, FAAN, ANEF5, Sabina De Geest, PhD, RN, FAAN, FRCN, FEANS6, & forthe Editorial Board of Journal of Nursing Scholarship

1 Delta Mu, Scientific collaborator, Institute of Nursing Science, University of Basel, Basel, Switzerland2 Xi, Dean and Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA3 Kappa, Professor, Centre for Biomedical Ethics and Law, Faculty of medicine, KU Leuven, Belgium4 Professor, Centre for Health Services and Nursing Research, KU Leuven, Belgium and Scientific Institute for Quality of Healthcare, Radboud UniversityMedical Centre, the Netherlands5 Doctoral Program Director and Professor, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA6 Alpha Eta, Professor of Nursing and Director of the Institute of Nursing Science of the Faculty of Medicine at the University of Basel, Switzerland

Key wordsNursing, scientific misconduct, good scientific

conduct, intervention

CorrespondenceDr. Katharina Fierz, Institute of Nursing Science,

Bernoullistrasse 28, CH-4056 Basel,

Switzerland. E-mail: katharina.fierz@unibas.ch

Accepted: February 20, 2014

doi: 10.1111/jnu.12082

AbstractPurpose: Scientific misconduct (SMC) is an increasing concern in nursingscience. This article discusses the prevalence of SMC, risk factors and corre-lates of scientific misconduct in nursing science, and highlights interventionalapproaches to foster good scientific conduct.Methods: Using the “Fostering Research Integrity in Europe” report of theEuropean Science Foundation as a framework, we reviewed the literature inresearch integrity promotion.Findings: Although little empirical data exist regarding prevalence of scien-tific misconduct in the field of nursing science, available evidence suggests asimilar prevalence as elsewhere. In studies of prospective graduate nurses, 4%to 17% admit data falsification or fabrication, while 8.8% to 26.4% report pla-giarizing material. Risk factors for SMC exist at the macro, meso, and microlevels of the research system. Intervention research on preventing scientificmisconduct in nursing is limited, yet findings from the wider field of medicineand allied health professions suggest that honor codes, training programs, andclearly communicated misconduct control mechanisms and misconduct con-sequences improve ethical behavior.Conclusions: Scientific misconduct is a multilevel phenomenon. Interven-tions to decrease scientific misconduct must therefore target every level of thenursing research systems.Clinical Relevance: Scientific misconduct not only compromises scientificintegrity by distorting empirical evidence, but it might endanger patients. Be-cause nurses are involved in clinical research, raising their awareness of scien-tifically inappropriate behavior is essential.

In any field of research, the credibility of and public trustin research, research institutions, and researchers is basedon the premise that research is conducted properly andwith integrity, following a defined set of principles. De-viations from the principles of integrity result in researchmisconduct (European Science Foundation [ESF], 2010).Because risks for violating these rules may occur at ev-ery step of the research process (Merlo, Vahakangas, &Knudsen, 2008), scientific misconduct (SMC) can also

arise at any point (Steneck, 2007). Therefore, the purposeof this article is to raise awareness of nurse researchersabout the topic of SMC.

Good Scientific Conduct and ScientificMisconduct

In 2010, in an effort to enable better understandingof research integrity and its elements within and across

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countries, a forum of member organizations of the ESFpublished “Fostering Research Integrity in Europe.” Withthis publication, an international panel of experts devel-oped a structural backbone for good scientific practicein Europe (and beyond) by presenting an example of acode of conduct, guidelines for good research practices,a framework for research integrity governance, and a re-flection of SMC, based on the definition of SMC by theMedical Research Council (MRC), which states that,

Scientific misconduct means fabrication, falsification,plagiarism or deception in proposing, carrying out orreporting results of research and deliberate, danger-ous or negligent deviations from accepted practicein carrying out research. It includes failure to followestablished protocols if this failure results in unreason-able risk or harm to humans, other vertebrates or theenvironment and facilitating of misconduct in researchby collusion in, or concealment of, such actions byothers. (MRC, 2009, chapt. 2, p. 4)

The authors argue that good scientific conduct is in-trinsically tied to integrity principles (honesty, reliabil-ity, objectivity, impartiality-independence, open commu-nication, duty of care, and fairness), and violating theseprinciples leads to SMC (ESF, 2010). In this article, weunderstand the term scientific misconduct as behavior vi-olating the principles of integrity, as put forward in theESF report.

Plagiarism, data fabrication, and data falsification areforms of SMC, which always indicates major violations ofthe principles of integrity (ESF, 2010). Another categoryof misdemeanors, often referred to as questionable re-search practices (QRPs), may or may not violate researchintegrity principles and relates to disputable practiceswith regard to handling data, research procedures, andreviewing and editorial issues (Horner & Minifie, 2011),or ethical breaches such as authorship violations, unde-clared conflicts of interest, and ghostwriting (Krimsky,2007). Some of these behaviors may violate researchintegrity principles and, thus, represent SMC; however,sloppiness, a lack of checks, or the wrong decisions in theprocess of data processing and analyses may simply be anexpression of ignorance or a lack of supervision and re-view rather than intentional deception. Due to the diffi-culty in assessing intentionality, differentiating between“honest errors . . . [and] outright fraud” (Nylenna &Simonsen, 2006, p. 1883) is often challenging, especiallyfor QRPs. Therefore, to evaluate and respond appropri-ately to misconduct, one should not only consider thedegree of deliberateness, but also the seriousness of thedeviation from good practice and the consequences forpatients, society, and science (ESF, 2010).

Because fabrication, falsification, and plagiarism repre-sent serious violations of the principles of scientific in-tegrity, improper dealing with these behaviors by su-pervisors or institutions must also be seen as mis-conduct (ESF, 2010). The protection of whistleblow-ers (a person who “blows the whistle” by disclosinginformation that he or she reasonably believes is ev-idence of unethical conduct of research; GovernmentAccountability Project, 2006 is a first priority in this re-gard. Whistleblowing may still have far-reaching conse-quences, as a 2010 survey of research coordinators’ expe-riences with SMC showed: 6.5% of those who reportedmisconduct were not adequately protected and werefired or experienced otherwise negative consequences(Habermann, Broome, Pryor, & Ziner, 2010).

Prevalence and Expressions of ScientificMisconduct

The best known manifestations of SMC are data fab-rication, data falsification, and plagiarism (FFP; Judson,2004). Data fabrication and falsification may occur dur-ing the data collection and analysis process, and repre-sent serious violations of almost all principles of scien-tific integrity. Plagiarism relates to the publication phaseand violates, for instance, the principle of honesty or fair-ness (by undue appropriation of someone else’s intellec-tual property).

Scientific Misconduct Is a Concern in NursingScience

SMC is a phenomenon that also occurs in nursing sci-ence, as Broome, Dougherty, Freda, Kearney, and Baggs(2010) showed in an anonymous online survey of 1,675nursing journal reviewers. The researchers found thatconflicts of interest with topics of papers reviewed or withauthors of papers reviewed were experienced by 23% ofreviewers. Additionally, 24% of reviewers expressed con-cerns about insufficient protection of study participants(human or animals), and 21% expressed concerns aboutduplicate publication or other forms of plagiarism.

Accurately gauging prevalence and incidence of SMCis difficult due to the delicateness of the topic, which mayinfluence the honesty of survey participants. Moreover,only detected cases can be integrated in incidence reports.Considering these difficulties, analyzing retractions of pa-pers is an interesting alternative, although these numbersadmittedly only represent the tip of the iceberg (Kornfeld,2012). One recent publication noted a roughly 10-foldincrease of retracted articles (corrected for total articlespublished) from biomedical and life science journals since

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1977 (Fang, Steen, & Casadevall, 2012). Of the 2,047 re-tractions from journals indexed in PubMed by May 2012,67.4% had been pulled due to SMC. Even though num-bers of retracted articles from nursing journals are smallin this publication (only four articles were retracted forplagiarism or duplicate publication), we suspect that theproblem is larger in the nursing community than thesedata suggest. Only recently, a number of publications bynurse scientists have been retracted due to FFP (Chan,2011; Graham, 2010; Weber, 2009).

Data Fabrication

Data fabrication refers to the “making up [of data] . . .for the purpose of deception” (Merriam-Webster.com,n.d.). In a meta-analysis of 18 surveys, Fanelli (2009)reported a pooled average of 1.97% (N = 7, 95% con-fidence interval [CI]: 0.86–4.45) of scientists who self-reported having fabricated or falsified data. Although theprevalence of data fabrication in nursing research is notspecifically known and it seems to be relatively infre-quent, the exposure of such practices in nursing con-texts raises alarms, as did the recent retraction of a 2011nursing research article (Vitale, 2011) for data fabrica-tion and plagiarism. Moreover, confirmed reports existof nurses fabricating laboratory data, patient records, orintervention results (National Institutes of Health [NIH],2004, 2010).

Data Falsification

Data falsification, that is, the “willful distortion ofdata or results” (Fanelli, 2009, p. e5738), includes dataadjustment, trimming, or omission, for example, tosupport a hypothesis, or manipulate data distribution.Examples include the deliberate use of inappropriate sta-tistical tests, labels, or terminology, data dredging (alsoknown as “fishing trip,” i.e., scanning a data set for statis-tically significant associations or differences and report-ing them as if they were projected in advance), or fail-ing to report negative results (Marco & Larkin, 2000).While only 1.06% (95% CI: 0.31–3.51; pooled weightedestimate) of researchers admitted having falsified or fab-ricated data, these behaviors were observed by 12.34%(95% CI: 8.43–17.71) of researchers in this research envi-ronment (Fanelli, 2009), suggesting that, while the prac-tice of misconduct is rather common, it is not a topicthat people share with their colleagues. A 2009 surveyshed more light on nursing, with 17% of nursing stu-dent undergraduates and 4% of graduates self-reporting“falsifying or fabricating laboratory or research data”(McCabe, 2009, p. 618), data that can be perceived asalarming.

Plagiarism

The U.S. Department of Health and Human Services’Office of Research Integrity (ORI) defines plagiarism asboth

The theft or misappropriation of intellectual propertyand the substantial unattributed textual copying of an-other’s work. . . . The theft or misappropriation of intel-lectual property includes the unauthorized use of ideasor unique methods obtained by a privileged commu-nication. . . . Substantial unattributed textual copyingof another’s work means the unattributed verbatimor nearly verbatim copying of sentences and para-graphs which materially mislead the ordinary readerregarding the contributions of the author. (ORI, 1994)

The ORI, furthermore, provides an excellent overview ofplagiarism (ORI, 2013).

Plagiarism of text. This widely known form of pla-giarism refers to the near or verbatim copying of textwithout appropriate citations. With a vast range of infor-mation available via the Internet, and nonverbatim copy-ing, which is difficult to trace, unethical writing practicesare a tempting, low-risk substitute for legitimate author-ship (Kenny, 2007).

Nursing students are, unfortunately, not immune toplagiarism, as shown by a prospective study started in2007 investigating 16 methods of classroom cheatingand text plagiarism (e.g., “copying a few sentences froma written source without citing it”; McCabe, 2009, p.617). Twenty-four percent of undergraduate and 19%of graduate-level nursing students reported plagiarism,while 28% of undergraduates and 20% of graduates re-ported copying of sentences from Web sources. No signif-icant differences in prevalence rates between graduatesand undergraduates were observed in terms of plagia-rism and copying from Web sources. Although not statis-tically significant, summary scores of all 16 measured be-haviors suggested that, overall, cheating behaviors weremore prevalent in undergraduates than in graduates(72% vs. 48%).

Comparing nursing students with other student groupsrevealed no differences in terms of plagiarism or overallcheating behavior (McCabe, 2009). McCrink (2010) sur-veyed 193 associate degree second-year nursing studentsand found that the prevalence of “paraphrasing or copy-ing material from another source without referencing thesource” was substantial: 26.4% of the surveyed studentsreported that they “seldom” and 8.8% indicated “some-times” engaged in this behavior (McCrink, 2010, p.656),again highlighting that nursing science is also confrontedwith major issues in view of this aspect of SMC.

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Plagiarism of ideas. This form of plagiarism refersto the unintentional or intentional use of intellectualproperty; that is, thought produced by others without cit-ing it appropriately. The danger of unintentional plagia-rism is specifically imminent: after reading hundreds oftexts, involving thousands of ideas, tracing the origin ofan apparently new perspective and a new twist can beburied in a reader’s thought processes and later sprout upindistinguishable from original thought. To our knowl-edge, no prevalence figures are available for this kind ofplagiarism in general or in nursing scientific writing sinceit is also admittedly rather difficult to trace.

Other forms of plagiarism. While the presen-tation of someone else’s work as one’s own is wellknown as plagiarism, so also is the unreferenced reuseof one’s own thoughts and texts. For instance, dupli-cate publication, that is, the publication of all or partsof one manuscript in separate journals is considered self-plagiarism and is a subject of ongoing discussion withinthe broader research community (iThenticate, 2011).

Other Forms of Misconduct

Bad data practices. Although bad data practices(e.g., management and storage) and research procedures(e.g., good care of and respect for research participants,following protocols, obtaining informed consent, care-ful and responsible decisions about research design, andanalysis; ESF, 2010) are less often publicly discussed asFFP, they seem to occur frequently. Responding to a 2005national survey of research coordinators and managers(64% of whom were clinical research-certified registerednurses), using the Scientific Misconduct Questionnaire—Revised (Broome, Pryor, Habermann, Pulley, & Kincaid,2005), 18% of clinical research professionals indicatedthey had first-hand experience not only with FFP, butalso with research misconduct such as “protocol viola-tions related to subject enrollment” (35.5%) or “inten-tional protocol violations related to procedures” (42.8%),“coercion of potential subjects” (26.3%), “disagreementabout authorship” (40.2%), or “pressures from a studysponsor” (24.8%; Pryor, Habermann, & Broome, 2007,p. 367).

In a later qualitative study, conducted with a sub-sample (n = 266) of participants of the aforementionedstudy, predominantly nurse research coordinators wereincluded and reported misconduct cases they had wit-nessed first-hand. Over 70% of reported misconductcases related to protocol (50%) or consent (26.6%) vi-olations, 13.9% referred to fabrication, and 5% to falsifi-cation of data (Habermann et al., 2010).

Publication-related misconduct. Publication-rel-ated misconduct includes bad authorship practices suchas repeated publication or “salami slicing,” ghostwriting,and reviewing and editorial concerns such as the dis-closure of conflicts of interest (ESF, 2010). Ghostwritinginvolves claiming authorship of another’s work (Roth-schild, 2011) and is, therefore, to be seen as a violation ofthe principles of honesty and fairness. Employing (med-ical) ghostwriters is not only common among studentsand researchers, but often driven by the pharmaceuticalindustry to promote new drugs (Matheson, 2011); thispractice could potentially and negatively influence pa-tient care.

Failure to disclose conflicts of interest andghostwriting. Failure to disclose conflicts of interestinvolves withholding facts (not limited to funding ar-rangements) that could impact the interpretation of thepublished material (Alfonso et al., 2012). Ghostwritingand the failure to disclose conflicts of interest are un-ethical, since both potentially bias research outcomes(Krimsky, 2007). Ghostwriters have identified nurses as“one of my company’s biggest customer bases. I’ve writ-ten case-management plans, reports on nursing ethics,and essays on why nurse practitioners are lighting theway to the future of medicine” (Dante, 2010, p.10).

Authorship issues. The conferment of unmeritedauthorship, for instance, via unnecessarily long authorlists or courtesy authorships, represents another formof misconduct. The website of the Committee on Pub-lication Ethics is an excellent resource in this regard(http://publicationethics.org/about). To provide a uni-form set of criteria on legitimate authorship, the Interna-tional Committee of Medical Journal Editors (ICMJE) in1991 formulated the Uniform Requirements for Manuscripts(ICMJE, 1991). Since 1991, this document has been re-vised several times; the current version was issued inDecember 2013 and renamed as Recommendations for theConduct, Reporting, Editing, and Publication of Scholarly Workin Medical Journals (ICMJE, 2013). According to the Rec-

ommendations, in order to qualify for authorship or co-authorship of a scholarly paper, four conditions must bemet: a researcher must contribute significantly to “theconception or design of the work; or the acquisition, anal-ysis, or interpretation of data for the work; AND draftingthe work or revising it critically for important intellec-tual content.” The author must provide “final approval ofthe version of an article to be published; AND agreementto be accountable for all aspects of the work in ensur-ing that questions related to the accuracy or integrity ofany part of the work are appropriately investigated and

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resolved.” The ICMJE explicitly states: “the acquisition offunding; general supervision of a research group or gen-eral administrative support do not qualify for authorship”because “fewer than all four of the above criteria are met”(ICMJE, 2013, p. 2f).

While the ICMJE criteria are generally accepted byeditors, they may not reflect current practice among re-searchers. In 2005, for example, 10% of surveyed re-searchers reported having assigned authorship inappro-priately in the past 3 years (Martinson, Anderson, & deVries, 2005). The sequence of authors on an author listis a matter of ongoing dispute and its management is farfrom consistent across countries and continents. Based onan analysis of existing guidelines, the Swiss Academies ofArts and Sciences (2013) recently published recommen-dations for authorship in scientific publications.

Consequences of Scientific Misconduct

SMC can have far-reaching consequences for patients,the individual researcher, the research group, the re-search institution, and the entire scientific community.Patients may be put at risk or be harmed if healthcareproviders rely on evidence based on faked or altereddata or the ongoing use of retracted publications (Steen,2011). Individual research careers might be harmed orruined. Research groups’ credibility can be seriously dam-aged. Moreover, misconduct undermines public trust inscience and those engaged in it (Martinson et al., 2005).

Economic costs arising from deceptive practices arestaggering (iThenticate, 2012); a single investigationcan cost as much as $525,000. In 2010 alone, SMCinvestigations in the United States cost $110 million(Michaelek, Hutson, Wicher, & Trump, 2010).

Risk Factors and Correlates of ScientificMisconduct

Although risk factors for SMC repeatedly are discussedby experts in editorials and other publications, empiricalevidence relating to risk factors for scientific misbehavioris scarce in all fields of research practice, including nurs-ing (Ganske, 2010; Harper, 2006; Hart & Morgan, 2010;Mundt, 2008; Pryor, Habermann, & Broome, 2007).

Overall, scientific behavior is influenced by the greatersystem in which research organizations operate (macrolevel), the organizations and research groups within thissystem (meso level), and the individuals actually con-ducting research projects (micro level; Martinson, 2007;Nylenna & Simonsen, 2006). Risk factors exist on allthese levels and are intertwined. For instance, academicpromotion policies on the macro level increasingly cre-

ate pressure to produce on the meso and the micro lev-els (Martinson, 2007; Martinson, Crain, Anderson, & DeVries, 2009; Nylenna & Simonsen, 2006). In a 2006–2007survey involving 1,703 early- and mid-career scientistsfrom the biomedical, clinical, biological, and behavioralsciences and major research universities, Martinson et al.(2009) found that institutional pressure (meso level) togenerate grant money contributed significantly to ethi-cally questionable research practices of researchers (microlevel; Martinson et al., 2009). A 2004–2005 study includ-ing data from 1,645 research coordinators—most of themnurses—identified negative institutional climate as an im-portant contributor to unethical behavior, as was institu-tional pressure to generate grant money and to producedata (Pryor et al., 2007).

The pressure to produce is, however, only one of sev-eral factors at the meso level identified by Davis, Riske-Morris, and Diaz (2007), who assessed causes of SMC byscreening 104 closed files of suspected misconduct casesinvestigated by the ORI. Using cluster analysis, the re-searchers structured the 44 causes given by offenders andalso identified “non-collegial work environment,” “poorcommunication,” “insufficient supervision,” or “inappro-priate responsibility” as workplace-related clusters of mis-conduct causes (Davis et al., 2007, p. 408).

Competition among researchers may not only inspirethinking but also produce insecurity and mistrust, as par-ticipants in a survey by Anderson, Ronning, De Vries, andMartinson (2007) reported. By analyzing focus group in-terview data of 51 scientists, the authors concluded thatwithin a research group, competition can engender mis-trust among colleagues, leading to increases in question-able and negligent practices of the individual researcher.Financial incentives by an organization and even thepromise of personal fame (Jaffer & Cameron, 2006) mayfurther contribute to individualism and secrecy instead ofa culture of collective openness, the latter being perceivedas one of the most important elements fostering researchintegrity on the meso level (Judson, 2004).

Although nurses were not explicitly mentioned in thissurvey, it is likely that similar risk factors operate within anursing science environment and may lead to distress andSMC, as inspection of a study from 2010 shows. In situa-tions where a person knows what is correct to do but—forinstitutional reasons—is forced to do the incorrect thing,moral distress occurs and was identified as a causal factorfor misconduct for academic nursing students (Ganske,2010; Jameton, 1984). Inadequate ethics education wasidentified as a risk factor for misconduct in young alliedhealth and nursing students (Mundt, 2008), so makingstaff available for teaching, mentoring, and supervisionof students is an important meso-level intervention thatneeds attention. Time constraints due to high workloads

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of student supervisors affecting senior staff (Mitchell &Carroll, 2008) can curtail mentoring and adequate super-vision of junior researchers.

The Promotion of Scientific Integrity andGood Research Practice

Given the multilevel intertwined risk factors for SMC,the prevention of SMC should also take a multilevelapproach, including every level of the research system(Nylenna & Simonsen, 2006). A multilevel approach thuscalls for involvement of individual researchers (microlevel), institutions (meso level), and the entire scientificcommunity (macro level). Empirical evidence on theefficacy or effectiveness of such interventions, however,is generally scarce and remains focused primarily onmeso-level interventions targeting individuals’ attitudesand behaviors, teaching activities, and knowledge trans-fer. Empirical data are predominantly cross-sectional,and evaluations of interventions to enhance researchconduct are mainly quasi-experimental, and usually lackcontrol groups.

The ESF (2010) suggests that research integrity can beimproved by implementing changes on multiple levels.On the macro level the commitment of governmentsand institutions to the promotion of good scientificconduct is an important element. This encompasses theprovision of an environment, which enables integrity inresearch and in which misconduct is clearly not accepted.Agreement on core definitions, a national mandate forintegrity governance, fair and transparent processes,and assigned responsibilities in terms of prevention,investigation, and consequences of misconduct onnational and international levels are further elements.Exchange and pooling of information across institutionsand countries can be institutionalized to support bestpractices.

Examples of interventions to improve scientific in-tegrity can be found in Table 1 (found with the onlineversion of this article), ordered according to the ele-ments of a framework for research integrity governancepresented by the ESF and the level within the researchenterprise (ESF, 2010).

Responding to calls for a clear set of ethical rules, in theUnited States, the ORI developed and established policiesand regulations defining responsible research-relatedconduct and initiated an open discussion on responsesto research misconduct (Steneck, 2007; Steneck &Bulger, 2007). The ORI provides transparent and easilyaccessible guidance and information resources for allresearchers, including nurse researchers. Moreover, inrecent years, governments promoted the registration

of clinical trials to increase transparency and fostergood scientific conduct (e.g., in the European Union,the website hosted by European Medicines Agency:www.clinicaltrialsregister.eu). Partially to prevent un-necessary duplications and wasting money, but also tohelp trace unpublished studies and to prevent changinghypotheses and elements of designs in retrospect, suchregistries are part of national or international integritygovernance.

In Europe, the formerly mentioned publication “Fos-tering Research Integrity in Europe” by the ESF is animportant step in the right direction, since a recentpublication revealed that, partly as a consequence ofthe political system within Europe, regulations andguidelines in terms of definition, prevention, and conse-quences of SMC are far from consistent across Europeancountries (Godecharle, Nemery, & Dierickx, 2013).

Initiatives aiming at the promotion of good sci-entific conduct mainly target journal editors of theentire scientific community or of a specific disci-pline. To raise awareness of the topic among journaleditors, the Committee on Publication Ethics (COPE;http://publicationethics.org/) initiated a forum mainly foreditors to discuss issues related to SMC and good practice.COPE also provides supportive materials and proceduresto deal with known or suspected misconduct. Theseresources are freely accessible for the entire researchcommunity. Increasingly, in an effort to facilitate goodscientific conduct in terms of openness and transparency,journals require the use of reporting guidelines, such asConsolidated Standards of Reporting Trials (CONSORT;Schulz, Altman, & Moher, 2010), from their authors.

Moreover, the ICMJE-issued Recommendationsprovide editors and authors with clear criteria for au-thorship and have been widely adopted by biomedicaland nursing journals (including the Journal of Nursing

Scholarship) as a basis both to grant authorship and tosolve disputes on the topic (ICMJE, 2013). Becauseknowledge of these guidelines will have a global in-fluence on academic careers, the recommendationsshould be required reading in every research departmentand by each researcher. Other organizations, such asthe International Academy of Nurse Editors, also pro-vide information for nursing, specifically about ethicalpublication.

The freely accessible websites of ICMJE, COPE,equator network, and ORI are only a few examplesof resources to improve scientific integrity across alllevels of research. Open-access websites focusing onplagiarism and writing are an additional resource opento individuals as well as institutions and provide excel-lent resources to learn about plagiarism (see ClinicalResources section).

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Embedding Principles of Good ResearchPractice Into the Culture of Science andScholarship

Although the effectiveness of honor codes, ethicalstatements, and pledges has only been investigated us-ing a nonequivalent control group of nursing students,their use appears to reinforce good scientific conduct. Ininstitutions with such codes, the incidence of cheatingwas 25% to 50% lower than in institutions without them(McCabe & Trevino, 2002). (For examples of honor codessee, e.g., Scanlan 2006, p. 180f.)

An instructional intervention to improve psychologystudents’ scientific writing skills was evaluated using bothbefore and after measurements of beliefs and attitudes aswell as focus groups, and showed a significant decrease ofunintentional plagiarism, specifically among 1st-year un-dergraduates. Focus groups, furthermore, revealed that86% of students believed the instruction helped themavoid plagiarism (Elander, Pittam, Lusher, Fox, & Payne,2010).

Ethics training has also been found to be effective inraising awareness in graduate allied health students (nonurses were included). In a post-test study with com-parison groups, an ethics course significantly increasedawareness of unacceptable scientific behavior (Mundt,2008). Ethics training has also been evaluated in com-bination with mentoring in one study in terms of its ef-fect on scientific conduct. Based on data from a nationalU.S. survey, the relationships between training in re-search ethics, mentoring in five domains specific to schol-arly activities, and questionable behavior were exploredin mid-career and early-career biomedical and social sci-ence researchers. Overall, results revealed little connec-tion between ethics training and subsequent conduct.Mentoring showed both positive and negative results(Anderson, Horn, et al., 2007).

In addition to ethics training, mentoring, and honestydeclarations, which some evidence suggests may promotea culture of integrity, decrease SMC, and facilitate goodscientific behavior, faculty role modeling and strong andvisible administrative support for upholding ethical stan-dards are further potential strategies suggested to estab-lish a culture of integrity and support (Kenny, 2007;Scanlan, 2006). In the study on research coordinators’experiences with SMC, Pryor et al. (2007) found someindications that the openly communicated commitmentof an institution was associated with adherence to ethicalstandards by researchers.

Given the potential of the academic setting to be dis-tressing for young nurse researchers (Ganske, 2010), theprovision of an environment of trust and collaborationand continuous teaching about the ethical conduct of re-

search is specifically important. Data from a 3-year actionresearch program in psychology undergraduates showedthat an interactive, intensive intervention “offered stu-dents social and emotional as well as academic supportand opportunities to form relationships with peers andstaff” (Reddy et al., 2008, p. 40).

The ESF (2010) also suggests making datasets availableafter publication in order to enable pooling and exchangeof information across research groups and countries pro-motes research integrity. Although this practice is not atall common in biomedical and nursing research, in otherareas of research this is widely accepted as good practice(e.g., in astronomy).

Dealing With Allegations of ResearchMalpractice or Poor Research Conduct

The use of duplication software services is fairly com-mon nowadays. The Journal of Nursing Scholarship usessuch a resource, and each submitted manuscript is com-pared to the articles stored in the service’s database. Ifplagiarism is suspected, it is the editor’s decision to fur-ther pursue the case. The editor may, for instance, decideto contact an author and work on the correct quotationtechnique, or in cases where multiple papers are beingpublished by the same author and duplicative materialexists, the editor might ask the author to cite the origi-nally published work rather than repeat what is alreadypublished elsewhere. However, whereas current softwarecan only identify duplication of text, and not undue ap-propriation of ideas, according to Professor D. Weber-Wulff (personal communication, October 21, 2010), at-tentive reading can expose both and is essential to un-cover plagiarism.

The impact of plagiarism detection software use onethical behavior has been assessed in two studies (Bilic-Zulle, Azman, Frkovic, & Petrovecki, 2008; Marshall,Taylor, Hothersall, & Perez-Martin, 2011). In the absenceof data from nursing, examples from medical and pub-lic health students are provided. More specifically, inthe study conducted between 2001 and 2005 (Bilic-Zulleet al., 2008), three medical student cohorts (2001–2002:n = 111; 2002–2003: n = 87; 2004–2005: n = 92) wereasked to write an original essay. In the first cohort, thiswas the only information received. In the second co-hort, the assignment was supplemented with informa-tion about plagiarism, and in the third cohort, studentswere additionally informed about the use of a plagia-rism detection system and consequences in case of de-tected plagiarism. Only the combined information issuedto the third cohort showed a significantly lower incidenceof plagiarism compared to the previous cohorts (2%, as

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Scientific Misconduct and Nursing Fierz et al.

opposed to 17% and 21%, respectively; p < .001; Bilic-Zulle et al., 2008). Monitoring assignments of master’sof public health students between 2006 and 2009 withplagiarism detection software indicated that only provid-ing an interactive seminar on plagiarism in addition toadvice and admonition that all submissions were subjectto plagiarism detection resulted in sustained reductionsin plagiarism incidence (Marshall et al., 2011). These re-sults confirm findings from a mail-based survey of early-and mid-career scientists from different fields, in whichthe perception of fairly applied and clearly communicatedprocesses by scientists contributed to good scientific con-duct (Martinson, Crain, De Vries, & Anderson, 2010).

Conclusions and Recommendations forFurther Action and Research

Despite the clear importance of SMC in nursing, littleevidence exists on interventions’ effects in this field. Al-though we may rely, to some extent, on evidence fromother health professions, first-hand research is essential.Interventions should target the governmental, organiza-tional, and individual level and facilitate the commitmentto ethical principles of good scientific conduct on all lev-els, agreement on these principles and responsibilities, aswell as consequences in case of misconduct in a concertedmanner. Therefore, it is important for nursing to continuethe scientific integrity discourse, to strive for agreed-onintegrity principles, and to increase endeavors to prevent,investigate, and consent on consequences of SMC.

Acknowledgements

We thank Chris Shultis for editing this article.

Clinical Resources� European Science Foundation: www.esf.org� Office of Research Integrity: http://ori.hhs.gov� National Institutes of Health. Research Integrity:

http://grants.nih.gov/grants/research integrity/index.htm

� International Academy of Nurse Editors: http://nursingeditors.com

� International Committee of Medical Journal Edi-tors: http://icmje.org

� Committee on Publication Ethics: http://publicationethics.org/

� Reporting guidelines: http://www.equator-network.org/

� Website on plagiarism and writing: http://www.plagiarism.org/

� To track retractions: http://retractionwatch.com/� Clinical trial register by European Medicines

Agency: www.clinicaltrialsregister.eu� iThenticate Resources: http://www.ithenticate.

com/resources� List and test of duplication software systems: http://

plagiat.htw-berlin.de/software-en/

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Supporting Information

Additional Supporting Information may be found inthe online version of this article at the publisher’s website:

Table 1: Elements of a framework for research in-tegrity governance presented by the European ScienceFoundation (ESF; 2010).

10 Journal of Nursing Scholarship, 2014; 46:4, 1–10.C© 2014 Sigma Theta Tau International