Abstract
Introduction
Academic ethical awareness is a crucial prerequisite for practice, serving as the cornerstone for a professional demeanor in clinical settings and ensuring future adherence to nursing ethics.
Objectives
This study assessed academic ethical awareness as well as its related characteristics among undergraduate Nursing students of a private university in Nigeria.
Methods
A descriptive cross-sectional research design was utilized. The study was conducted among undergraduate nursing students of a private university in Nigeria. A convenience sample of 158 nursing students from 300 level to 500 level voluntarily participated in this study. Data were collected using the Academic Ethical Awareness Questionnaire and descriptive statistics, mean and standard deviation were employed to analysis the data collected.
Results
The mean age of nursing students was 21.1. Majority of the respondents were females, Christians and claimed average financial status with 87%, 94%, and 68%, respectively. Nursing students demonstrated moderate academic ethical awareness (69.5%), a mean score of 3.68 ± 0.81. They knew that revealing patient information in public places of the hospital, disregarding, slandering, or making fun of patients in face-to-face interaction, and having someone else attend class as a substitute were unethical behaviors with mean scores of 3.96, 3.90, 3.88, and 3.88, respectively. Academic ethical awareness was low for submitting cut and paste report, not paying attention in class and being late to class, with mean scores 1.81, 2.05, and 2.80, respectively. Gender, level of study, and satisfaction with Nursing as a course of choice are significant determinant of ethical academic awareness with P value of .018, .005, and .011, respectively.
Conclusion
Nursing students assessed demonstrated moderate academic ethical awareness. Improved instruction is required regarding the value of appropriate classroom behavior and emphasis on the implications of plagiarism in practice.
Introduction
Academic ethics is the presence of academic excellence and the state of being diligent, modest, having a good sense of responsibility, and avoiding learning behaviors that are inappropriate (Cho & Hwang, 2019). Academic ethical awareness is an important requirement in practice (Chung et al., 2019), it forms the foundation for professional attitude in clinical settings and it is important for future compliance with the ethics of nursing care (Barnhoorn et al., 2019). It is a crucial component of education for nursing students who will provide patients with morally sound nursing care in the future. In general, it refers to following all guidelines specified in the training manual and syllabus (Cho & Hwang, 2019).
Academic dishonesty encompasses more than just plagiarism and exam cheating; it also includes fabricating reports, indulging in unhealthy peer competition, and violating the rights of others (Kadayam et al., 2023; Yadav et al., 2019). The importance of professionalism education has been emphasized after research evidence showed that unprofessional behavior was strongly associated with future disciplinary action (Chung et al., 2019). Unprofessional behaviors in nursing can endanger patient safety, erode professional relationships, and create anxiety and disturbance (Ismail, 2018). Identifying and developing ethical content is necessary to improve the academic integrity of nursing students (Lee et al., 2017).
Review of Literature
Nurses are one of the largest frontline health workers that interact with patients in their various units while holding ethical standards. Ethics is a crucial part of nursing practice, and without maintaining the ethical rights of patients, quality care is incomplete (Jamal et al., 2023). Academic Ethical awareness is a critical component of nursing education as it shapes the moral compass of future healthcare professionals. Nursing students' understanding of ethical principles and their ability to apply them in academic and clinical settings are essential for providing safe and compassionate patient care. Academic ethics requires students to be diligent, thoughtful, and duty-driven enough to abstain from inappropriate learning behaviors and attitudes and strive for academic excellence (Cho & Hwang, 2019). Academic ethical awareness among nursing students refers to the understanding and application of ethical principles and values within the academic setting of nursing education. It involves developing a strong awareness of ethical standards, codes of conduct, and professional responsibilities that guide ethical decision-making and behavior in the field of nursing. Nursing students with high academic ethical awareness demonstrate the ability to recognize ethical dilemmas, uphold ethical standards, and navigate complex ethical issues that may arise in healthcare settings. They are trained to consider the ethical implications of their actions, prioritize patient well-being and autonomy, and adhere to ethical guidelines set forth by professional nursing organizations.
In a study by Alnajjar and Abou Hashish (2021), it was revealed that nursing students had moderate academic ethical awareness, with academic level and integrated learning experiences positively impacting this. Cho and Hwang (2019) similarly found that nursing students had higher academic ethical awareness of behaviors relating to violating patient respect and confidentiality, but lower academic ethical awareness of inappropriate classroom behaviors. In terms of academic integrity, medical students were found to have a less concerned attitude toward punctuality, attendance, and skipping classes compared to nursing students (Ko et al., 2024). In a study on Korean medical students' attitudes toward academic misconduct by Chung et al. (2019), students showed a strict attitude toward academic misconduct such as cheating on examinations and disrespectful behavior in patient care, but they showed a less rigorous attitude toward dishonesty in clerkship tasks and irresponsibility in class. It was also identified that nursing students failed to regard getting examination questions from their friends who already took the examination, plagiarizing papers, or attending class as a substitute for another student as unethical academic behaviors (Cho & Hwang, 2019). Available literature suggests that unethical nurses' behavior may be influenced by poor academic ethical awareness and adherence to academic learning integrity during the education in school (Kadayam et al., 2023; LaDuke, 2013).
The nature of nursing presents an ethically challenging work environment for nurses in the healthcare system (Tuvesson & Lützén, 2016). All the literature on ethics in nursing practice emphasis strongly the need to prepare nursing students to meet ethical challenges in their future roles as nurses (Baykara et al., 2014; Cannaerts et al., 2014; Tuvesson & Lützén, 2016). Research has also indicated the significance of promptly identifying and correcting any professional behavior faults in students. Since unprofessional behavior at the undergraduate level and future practice are related, there is need for nursing students' academic ethical awareness to be rigorously explored. A strong academic ethical foundation enables students to advocate for patients, respect their rights, and make sound decisions in challenging situations. Moreover, academic ethical awareness promotes a culture of safety and trust within healthcare teams, contributing to better patient outcomes and satisfaction. By prioritizing academic ethical awareness, nursing students can uphold professional standards and contribute to a positive healthcare environment. As the healthcare landscape evolves, the demand for ethically competent nurses continues to grow. To reinforce nursing students' academic ethical awareness and integrity, the current status needs to be assessed. There is paucity of information on academic ethical awareness among nursing students in Nigeria, hence, this study was carried out to determine the academic ethical awareness of nursing students of a private university in Nigeria.
Methods
Design/Settings
A descriptive cross-sectional survey was employed using Google Forms with a built-in feature that allows respondents to submit only one response. Bowen University is a faith-based private University operated by the Nigerian Baptist Convention. The University is in Iwo, Osun State, Nigeria. Bowen is one of the oldest Private Institutions of higher education in Nigeria established in 2001. Undergraduate Nursing student of Bowen University in 300 level, 400 level, and 500 level were purposively selected for this study because these students at this time had completed their lectures in nursing ethics and have commenced clinical posting and therefore can express their experiences with patients' care. The population of undergraduate Nursing students in the three levels was 172.
Sample Size Determination
A slightly modified Cochran's Sample Size formula was used since the size of the population is known
Instrument
The instrument for the study consisted of two sections; section A focused on the sociodemographic characteristics which included some academic characteristics with 10 items and section B focused on academic ethical awareness of nursing students with 30 items. To measure academic ethical awareness, Kwon et al. (2013) validated instrument was used. The instrument comprised of 30 items in seven subscales: behaviors related to plagiarism (eight items), inappropriate behaviors in class (six items), behaviors violating the respect or confidentiality of patients (five items), dishonest behaviors during clinical practice (four items), free riding in group activities (four items), unfaithful behaviors in clinical practice (two items), and cheating on exams (one item). The mean score of each category was calculated by the 4-point Likert scale (1 = always, 2 = sometimes, 3 = seldom, and 4 = never). The maximum score was 4, and the minimum score was 1. Total scores of all questions were calculated with the number of questions. It means the higher scores indicated a greater level of academic ethical awareness. Instruction given to students about the scale is that (1; always) means the statement is perceived as academically ethical and one is allow to engage in it while (4; Never) means the statement is academically unethical and one should not engage in it. Overall, academic ethical awareness is low with percentage score of <50%, moderate (50–75%), and high (75%). The internal consistency reliability (Cronbach's alpha coefficient) of the instrument in the development study was 0.95.
Inclusion and Exclusion Criteria
Undergraduate Nursing students that participated in the study were those in the clinical area in 300-level, 400-level, and 500-level classes who have completed their lectures in Nursing Ethics and have commenced clinical posting. Undergraduate nursing students who were unwilling to participate in the study or were indisposed during the period of data collection were excluded from the study.
Procedure for Data Collection
The survey link was disseminated through the three level advisers to the targeted population who met the inclusion criteria after getting approval from the Ethics and Research Committee of Bowen University Teaching Hospital Ogbomoso. Class announcements were used to increase the survey awareness to ensure that only registered university Nursing students participated. This process resulted in 158 completed surveys of students who met the stated inclusion criteria. Data were collected over four weeks in the mid second semester of 2022/2023 academic session.
Data Analysis
Data was analyzed using the Statistical Package for Social Sciences version 22.0. Descriptive statistics, mean, and standard deviation were employed to analysis the data collected. The difference between sociodemographic characteristics and academic ethical awareness was analyzed using T-tests and analysis of variances. Statistical significance was estimated at the .05 level.
Ethical Consideration
Ethical clearance for the study was obtained from the Ethics and Research Committee of Bowen University Teaching Hospital Ogbomoso, while administrative permit was obtained from the Head of Nursing Science. Ethical approval number was BUTH/REC-927. Participation was voluntary and students were assured of anonymity and confidentiality of their responses. They were also notified that refusal to participate would not in any form affect their academic achievement. Furthermore, they were informed that the data would be presented as group statistics and would not identify any individual respondent.
Results
Table 1 revealed that the age range was 18–27 years with a mean of 21.1 years. Majority of the respondents were females, Christians, and claimed average financial status with 87%, 94%, and 68%, respectively. Financial status is in the context of income level of parent. The most identify reason for choosing nursing was passion with 49% followed by lucrative nature of nursing/job security with 27%. Degree of academic stress was high with 73% and 63% were averagely satisfied with grades earned in the previous semester.
Sociodemographic Characteristics.
In Table 2, Nursing students demonstrated moderate academic ethical awareness (69.5%), a mean score of 3.68 ± 0.81. High ethical awareness was demonstrated in revealing patient information in public places of the hospital, disregarding, slandering, or making fun of patients in face-to-face interaction, having someone else attend class as a substitute, disregarding or offending patients in face-to-face interaction, revealing patient information online or in private gatherings and leaking or revealing patients' medical records outside the hospital with mean scores of 3.96, 3.90, 3.88, 3.88, 3.86, and 3.85, respectively. Academic ethical awareness was low for submitting cut and paste report, not paying attention in class and being late to class, with mean scores 1.81, 2.05, and 2.80, respectively.
Academic Ethical Awareness.
Table 3 shows that female students have a higher academic ethical awareness (3.75) than male students (3.62) (t = 5.1, p = .018). The 300-level students have a higher level of ethical awareness of 3.72 than the 400-level and 500-level Nursing students with 3.61 and 3.58, respectively. Gender, level of study, and satisfaction with Nursing as a course of choice are significant determinant of ethical academic awareness with p value of .018, .005, and .011, respectively.
Difference in Ethical Awareness in Relation to Sociodemographic.
Discussion
For nursing students to adhere to nursing care ethics and develop a suitably professional demeanor, academic ethical awareness is really important. The age range for participants in this study ranges from 18 to 27 years with a mean of 21.1 years. There were more females, this could be attributed to Nursing being generally perceived as a female profession. Bowen university where the study was conducted is a faith-based institution and this could be the reason for having majority of the study participants being Christians.
The overall academic ethical awareness in this study was (69.5%), a mean score of 3.68 ± 0.81, this contrasts with the findings of Cho and Hwang (2019) and Lee et al. (2017) in similar studies where academic ethical awareness among nursing students were 3.48 and 1.63, respectively. High ethical awareness was demonstrated in revealing patient information in public places of the hospital, disregarding, slandering, or making fun of patients in face-to-face interaction, having someone else attend class as a substitute, disregarding, or offending patients in face-to-face interaction, revealing patient information online or in private gatherings and leaking or revealing patients' medical records outside the hospital with mean scores of 3.96, 3.90, 3.88, 3.88, 3.86, and 3.85, respectively. Substitution of students will be difficult for because the number of students in each class is not so large, hence any substitution will be likely identified. This is similar to the findings of McCrink (2010) who concluded that nursing students in the United States were aware that sharing patient information with non-medical personnel in public places is unethical and also similar to the findings of Cho and Hwang (2019) and Theart and Smit (2012). This is unlike what Lee et al. (2017) found out where awareness was lowest for irresponsibility in the class and highest for cheating on examinations. In this study, academic ethical awareness was lowest for submitting cut and paste report, not paying attention in class and being late to class, with mean scores 1.81, 2.05, and 2.80, respectively. This could be because students do not understand the implications of cut and paste and they see it as unimportant. This agrees with the study by Lee et al. (2017), Kameran (2018) and Alnajjar and Abou Hashish (2021), where plagiarism was one of the most frequently engaged academic misconduct.
Female students have a higher academic ethical awareness than male students, this may be due to the large number of female students in comparison to the male students. This is similar to the study by Vengoechea et al. (2008) where female students were more aware of academic ethics than males. This contrasts with the findings of Cho and Hwang (2019) and Krueger (2014), where male students tended to have a higher level of academic ethical awareness than did female students.
The 300-level students have a higher level of ethical awareness of 3.72 than the 400-level and 500-level Nursing students with 3.61 and 3.58, respectively. The 300-level students are new in the clinical site and conscious of the strict standards and responsibilities of the school unlike the 400-level and 500-level students. This is supported by the findings of Vengoechea et al. (2008) and Cho and Hwang (2019), where higher years were more likely to engage in academic misconduct. This is in contrast to what was identified by where Alnajjar and Abou Hashish (2021) where senior students displayed a higher ethical awareness mean than juniors. Students with high satisfaction with Nursing as a course of choice exhibited better ethical awareness than those with low or medium satisfaction, this could be attributed to the motivation and interest that comes with high satisfaction.
Study Limitation
Nursing students of a private university were captured, hence, the results cannot be adequately generalized to nursing students in other regions with different culture. Including a qualitative method would have been of more advantage providing greater in-depth understanding about the different contexts of academic ethical awareness.
Recommendations
To address study limitations, recommendations identified include future studies encompassing more universities both private and public. The academic ethical awareness tool used was designed and developed for medical students, there may be need to develop ethical awareness measuring tool for nursing students which is specific to ethical concerns in nursing. In addition, employing a mixed-methods approach, combining quantitative surveys with qualitative, would provide more comprehensive information about ethical awareness among nursing students.
Conclusion
Undergraduate nursing students at Bowen University demonstrated moderate academic ethical awareness. The students knew that revealing patient information in public places of the hospital, disregarding, slandering, or making fun of patients in face-to-face interaction, and having someone else attend class as a substitute, were unethical behaviors. Academic ethical awareness was lowest for submitting cut and paste report, not paying attention in class and being late to class. Gender, level of study, and satisfaction with Nursing as a course of choice were significant determinant of ethical academic awareness among study participants. Students during orientation programs should be adequately informed on the need for right behaviors in class and the importance of arriving to class on time. Additionally, students should be made aware of the consequences of plagiarism.
Footnotes
Acknowledgments
Sincere appreciation goes to the Head of Nursing Sciences and all the level advisers for the assistance and support provided during data collection. The authors would also like to appreciate all the students that participated in the study.
Authors Contribution
All authors made a significant contribution to the work. Specifically, TOD: Formal Analysis, Software, Study design, Methodology, data collection, data entry, writing original draft, manuscript preparation. OIO: study conception, validation, methodology, review and editing. MIO: design, formal analysis, supervision, review and editing. GO: Methodology, software, review and editing. DO: methodology, validation, review and editing. CMN: Validation, supervision, methodology, original draft, review and editing.
Availability of Data and Material
The data used for analysis are available on secure and reasonable request.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethics Statement
The study was reviewed and approved by the Ethics and Research Committee of Bowen University Teaching Hospital Ogbomoso (BUTH/REC-927).
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
