Beyond a linear assumption: A systematic review of academic and clinical dishonesty in nursing education

Academic and clinical dishonesty remain persistent concerns in nursing education. While both have been widely studied, it is unclear whether they are empirically associated in a consistent manner or represent distinct behaviors shaped by different contexts. This systematic review examines whether academic and clinical dishonesty are empirically and conceptually associated among nursing students and under what conditions such links occur.

Following PRISMA 2020 guidelines and PROSPERO protocol, six databases were systematically searched for peer-reviewed empirical studies (2005-2025). Screening and data extraction were conducted independently in duplicate, and methodological quality was assessed using Mixed Methods Appraisal Tool.

Eight studies were included. Four reported significant statistical associations between academic and clinical dishonesty, two identified predictive relationships, and two highlighted conceptual distinctions without statistical association. Overall, the findings indicate a heterogeneous body of evidence comprising correlational, predictive, and perceptual perspectives, rather than a single, uniform relationship between academic and clinical dishonesty.

The evidence indicates a heterogeneous and context-dependent relationship between academic and clinical dishonesty rather than a single developmental pathway. These behaviors appear to emerge through multiple, context-dependent processes rather than shared progression. Addressing integrity in nursing education as a multidimensional construct, embedded in both academic and clinical environments, may better support professional development.