Panorama BBC 30.4.2014

Response to highlighted poor care in care homes;”a woman slapped by a care worker who had previously been complained about for her poor attitude towards residents
the same woman, who has dementia and is partially paralysed after a stroke, was also repeatedly mocked and taunted by other care workers
cries for assistance from a resident suffering a terminal illness ignored as she sought help for the toilet, and her call bell for assistance left unplugged on one occasion
a resident bed-ridden with a chronic illness left lying in his own excrement after two care workers turned off his call bell without assisting him” (Holt 2014)

This situation is one often found in America, where, according to the 2013 Nursing Home Report Card, “1 in 5 nursing homes abused, neglected, or mistreated residents in almost half of all states” … about which Rich McIver (attorney) commented: “The quality of the care provided at nursing homes corresponds directly to the financial incentives faced by the ownership of nursing home chains” … “Because a nursing home’s revenue is fixed … they can only increase their profits by reducing their costs, which means cutting on the quality of the care they provide” … “Most times, this means cutting staff or hiring lower quality staff because they cut their staff’s pay. The only limitation on how far a corporate nursing home is willing to cut, comes in the form of government penalties for violations and the costs of lawsuits when their care falls below certain standards”. The majority of care homes in the UK are operated by debt-ridden private equity firms. The contention that abusive care is a minority occurrence can only come from someone speaking from the Ivory Tower of the CQC, who has never worked in a profit-comes-first hell hole. Put cameras in all rooms. Institute minimum staffing levels, and fine heavily if they are not met. Make it mandatory to report all abuse directly to the police. These things, of course, will not happen. Our corporation loving politicians will not regulate the ‘market’ in care.

lenin nightingale

When poor care becomes the norm

Individuals may have different perspectives of what actually is poor care- or what is unacceptable. This may be influenced by such factors as culture and attitudes .
Consider the following examples:
Patients with learning difficulties are lined up naked on a ward for a bath.
An old lady is fed her dinner whilst in a wet bed.
A gentleman is refused a clean incontinence pad during the night.
A lady dislikes the stew for dinner but is given nothing else.
Patients are restrained by belts .
All patients are got out of bed at 6am.

For some these may be totally unacceptable but not to others.

One lone voice amongst the staff may question poor practice. Yet others declare there is nothing wrong.
The reason for failing to question practice may well be team issues, such as adherence to the group. Another reason has been highlighted within my work. This is that poor care has become the norm.
Priellip et al (2010) explored this within anaesthetics and found that short cuts in practice were not questioned by other staff. Vaughan in Prielipp et al refers to this as “normalization of deviance”. “Normalization of deviance breaks the safety culture,substituting a slippery slope of tolerating more and more errors and accepting more and more risk, always in the interest of efficiency and on-time schedules” (Prielipp et al). Examples in anesthesia include removing vital monitors before the patient is awake and failing to wash hands. Whilst Prielipp refers to patient safety, this consideration may well extend further into aspects such as dignity and quality of life, which are vital considerations within care.
Vaughan proposed the term “normalizing deviance” following the Challenger space shuttle explosion in 1986, in which astronauts died. This was despite NASA knowing for many years of a defect. Vaughan proposes various reasons for this method of acceptance in healthcare including ; inefficient rules, imperfect knowledge, “for the good of the patient”, or workers afraid to speak up for fear of being reprimanded . This is evident within nursing, where staff may be wrongly accused, as in backstabbing or the treatment of whistleblowers (Dimon 2014) .
The norm may not be accepted by everyone even if adhered to, but enforced by the most dominant team members. Hence, certain staff members often prefer to work together .
Could it simply be acceptance of a lower standard and an excuse for poor care? Consider potting up medication as an example of poor practice. Potting up is when medication is put out in many pots at once and taken to patients – not on an individual basis, hence errors are more likely and undetected errors. A busy nurse may even delegate this task to the care assistant.
Nurses do have a responsibility to report this procedure according to nurse registration guidelines.
Banja (2010) further analyses normalizing deviance regarding healthcare, stating that deviance in healthcare “is virtually never carried out with criminal or malicious intent”. It appears that people convince themselves that the patient will come to no harm; a form of rationalization. This may also occur when caring for ones own children; some parents may allow Johnny to run around the streets alone at 6years of age , but not others. This is where risk taking is involved. Some individuals take more risks than others depending on their philosophy, upbringing or experiences.
In nursing should risk assessments be undertaken for any deviations from the required procedure, or would some managers and staff regard this as risky to themselves because they are then admitting what the situation is? If they feel unable to undertake such an assessment, then one may question why do it at all?
Is this why so many cases of medical errors or mistreatment of patients are never investigated by management or professionals? This may illustrate a difference in expectations and experiences of patients, relatives and staff. For example, a relative may consider the death of the patient to have been totally unavoidable and catastrophic, but staff may regard the death as a normal risk of treatment and care. The point of accepting lower standards extends further the points raised by Goffman (1961) who described the acceptable treatments of individuals within institutions, including excess routine, like bath times, bedtimes, and patient uniforms. As Goffman states “our status is backed by the solid buildings of the world, while our sense of personal identity often resides in the cracks “ (p28). People do need a sense of belonging which is threatened by opposing the “norm”. Banja also discusses institutionalization, socialization and rationalization further.
For a manager to correct deviations it may be troublesome and promote even worse results, such as staff leaving . This is akin to “turning a blind eye” to some issues. For example, the manager may well be aware that patients are lined up naked for a bath, or staff have an unofficial break in the bathroom.
Banja proposes recommendations including focus groups and staff education. In the UK, the government and campaigners call for transparency- this may well be one area in which it could apply. Staff and students need to be supported to address any disagreements or deviancy from the required standards . Involving relatives and patients on focus groups would help the situation as they do have different perspectives. Staff are not always aware of how their approach to care and actions they take may actually affect the patient or relative. Those who have had personal experiences are often more aware and may have a greater degree of empathy, as particularly may be the case within mental health nursing.
Could the concept of “normalizing deviance” pertain to care in general? This could explain the scenario of “we always do it this way”. It could well be the staff’s self protective mechanism, with them becoming immune to poor standards of care. So much easier to go to work and return home with a pay packet; no questions asked – “the ostrich syndrome”. In deviance individuals are considered as commodities, objects or numbers.
Consider your day at work. Is there anything in practice that you really would like to question?
It could well be that, this practice has always been the norm when exploring history or culture, in particular the care of the mentally ill, where, many years ago individuals were restrained, and still are in some countries . In Somalia, for example mentally ill patients may still be put in a cage with hyenas as a form of treatment (Hooper 2013).
Culture is adherence to the norms of a group (Durkheim 1993), defining how a nurse behaves and his or her attitude. In nursing, culture is a major determinator of patient outcomes, including cultural differences within countries.
Have some cases of poor care become the norm, or have they always been the norm?

Banja J (2010) The Normalization of Deviance in Healthcare Delivery 10.06
Dimon C (2014) Nursing Backstabbers
Durkheim E (1993) Ethics and the Sociology of Morals Prometheus books
Goffman E (1961 ) Asylums Penguin
Prielipp, R. C. Magro, M. Morell, R. C. Brull, S. J. (2010). The Normalization of Deviance: Do We (Un)Knowingly Accept Doing The Wrong Thing? IAANA Journal. August v. 78 n. 4 pp.1499-1502
Hooper R (2013) Where Hyenas are Used to Treat Mental Illness 17 .10 bbcnews
Vauhan D (2011) The Normalisation of Deviance Chapter Twelve
Vaughan D Professionalism/ The Normalisation of deviance wikibooks

Carol Dimon 2014 c

Nursing Backstabbers

“They smile in your face
All the time they want to take your place” (Song The Backstabbers O’Jays)

Today’s society as many declare may be reflected by attitudes to the most vulnerable, including old people, mentally ill, people with learning difficulties. Even Kant announced this hundreds of years ago (1700s).
In nursing many undertake the role for reasons including- the course is free, power, compassion, prestige, management, or pay (education).
The fact that many have different reasons for becoming a nurse may well define their approach to patients, in addition to other factors such as culture (Dimon 2013).
In nursing the majority of nurses and care workers are female. This may well reflect the fact that caring is regarded as a feminine role (Noddings 1984) . This has a huge effect on nursing. Gender influences attitudes and behaviour as many researchers document( Maslach et al 1987 ). Women are considered to adhere to group norms more (Steffensmeier, Alan 1996), whilst men are more assertive. So how does this affect nursing?
It is possible that more men are prepared to question or raise issues than women.
It is also possible that men may be listened to more due to their assertiveness.
Good ideas in nursing are often ridiculed, or the individual who suggested them is ousted, unless the idea is favoured by the majority. When questioning why others get everybody out of bed at 6am, a nurse will not be flavour of the month .
The old hierarchy of the sergeant major approach still exists in nursing , with people afraid to question their all powerful leader.
If a nurse raises issues, there have been cases where he or she has been falsely reported to the NMC, for relatively trivial reasons.
This reflects society, in which politicians encourage people to be responsible for themselves; “me, myself and I syndrome”. All compete for that high position or greater wealth, and in order to do so are prepared to “stab others in the back”. Of course, this is well evident in other professions, such as education.
What can be done about it? There are some genuine individuals who refuse to adhere to the herd come what may. These people are often termed “whistleblowers” and are often destroyed either personally or professionally. This backstabbing extends to writers, alternative news reporters, or anybody with alternative views. This is the real problem in care and society. All are failing to speak out of fear, and are following the herd. Unfortunately, many cannot see amongst the smog of false accusations.
Self- aggrandisement explains the common practice of plagiarism amongst academics and students (Dimon 2013). Life has become a competitive race. Ask yourself- would you assist a colleague?
Dimon C (2013) The Commodity of Care Cloister House Press Free updates
Dimon C (2013) Plagiarism or Bust?
Maslach C, Santee RT, Wade C (1987) Individuation, Gender Role, and Dissent Psychology 53(6) p1088-1093
Noddings N (1984) A Feminine Approach to Ethics and Moral Education University of California Press
Steffensmeier D, Allen E (1996) Gender and Crime: Toward A Gendered Theory of Female Offending Ann Rev Social 22 p459-87

Carol Dimon 2014

Version 2  in Nursesfyi 2014 Issue 13

Plagiarism or Bust?

Carol Dimon Copyright 2013

Acknowledgements- my highly academic colleague T.I.M who remains independent, Professor Roger Watson (Hull University) who mentioned the interventions utilised by journals and CORE, colleagues who made me aware this issue is greater than I thought. I had taken it personally!!

The individuals who responded to the questionnaire. Surveymonkey which is extremely useful.

“No conflict of interest has been declared by the author”

“This research received no specific grant from any funding agency in the public, commercial, or not-for-profit-services.”


This study explores the acceptance of academic plagiarism within several countries and all fields. Academics are considered as being lecturers, professors or PHD students. Whilst most studies explore plagiarism amongst students (Ashworth et al 2008) plagiarism amongst academics is well known (Changgeng 2007) and appears to be an accepted part of the role. Yet what are the implications of this? The study uses questionnaire via survey monkey and analysis of some published articles to explore this topic. Whilst there are several limitations such as low response, it does indicate areas for further research and thought for the whole field of academia.


This study will explore academic plagiarism. It was triggered by the researcher’s personal experiences and also, talking to other academics. Plagiarism applied to more than merely copying. It has much higher implications than failing to award the original author credibility. Indeed, many original authors today, are no longer alive. So what are the implications? Is it merely accepted amongst academics? Has it been accepted as part of their role? Are they actually expected to plagiarise? This is a start to explore this phenomenon.


Confusion surrounds the definition of plagiarism ( Poyner 2007 ), many types being defined including deliberate or negligent (Poyner 2007). Then why is it such a big deal??

Most authors refer to plagiarism as occurring amongst students (Ashworth et al 2008). Yet there are authors who do address plagiarism amongst academics (Lewis et al 2011). Indeed this occurs in all countries such as China (Chenggang 2007) and all faculties such as science (Lewis et al 2011).There may well be cultural influences to plagiarism (Osipian 2008) depending upon political corruption for example. Further there may be an educational influence with Chinese students being taught to adhere to one text and not to critique ( Hayes and Dintrona nd ) Whilst some do explore via research (Lewis et al 2011), there are few research projects which explore the whole phenomena. Is it broader than we think? There is historical existence of plagiarism such as Shakespeare (milner nd ). However, is it avoidable? Does it mean merely building upon an idea of somebody else? Is there no original thought anymore? (Fish 2010) Even in art we have accusations of copied paintings (Alberge 2010); yet where does it end? In music there are only so many bars, so it is not totally avoidable (Irvin nd ) to repeat music. Some may unintentionally plagiarise yet others, may do so intentionally. Yet plagiarism may well be beneficial .Consider Orwell (1984); Animal Farm is said to have been based on a Russian book (Owen 2009). Orwell gained far more publications than the Russian book would have done. Is plagiarism fuelled by a business orientation of Universities (Popenici 2012) and aim to sell more copies? Indeed, reputable authors are published more easily (Chenggang 2007).This may be because more copies of their work are sold than an unknown person. After all, publishers are businesses. Unfortunately, individuals who have an original idea, may never personally achieve. Further, some journals may actually adopt the idea of an unknown author but give it to a more well known author to write (Das, Punjabi 2011 ).Although there are methods of identifying plagiarism used by individuals, Universities and journals such as Turnitin, the software may wrongly identify people (Zimmerman 2008 ). Nor does it identify an unpublished idea or piece of work. Yet that too, may well be plagiarism.

There are also legal and moral issues involved which may be emphasised by the focus upon Human Rights. There have indeed been some cases won in a court of law for example (Lewis et al 2011 ) but not everybody can afford such court cases and plagiarism may be difficult to prove. Yet there are copyright agencies that for a fee will protect ideas and pieces of work for a set period of time.


This exploratory study aims to explore the acceptance of plagiarism amongst academics. There is evidence that it occurs but are they willing to discuss it and consider whether it is acceptable or not?


The study utilised survey design. A questionnaire was displayed on survey monkey, following a pre test amongst academics. Published papers were analysed for indications of good practice. Results were analysed quantitavely and thematically .


Respondents were openly given the option to respond via Linkedin, the researcher’s website and twitter. Also individuals were asked to mention it to colleagues thus forming a snowball sample. No names, places of work or personal details were taken. It is beyond the scope of this study to consider such variables as this.

A request was displayed on linkedin, for published articles in any field or country. This was to prevent bias selection of the researcher. 5 were obtained. In addition, one author was recommended by a colleague as an example of good practice and this too was analysed.


Various authors concerning ethics were considered ( Johnson, Christenson 2011 ).

Surveymonkey ethical proforma was adhered to with consent being requested. The researcher was not informed of names or emails by surveymonkey. They may also withdraw consent at anytime. The aim of analysis the articles, was not to indicate whether the author’s had plagiarised or not but to consider possible indications of good practice.

Data analysis

Data was analysed via survey monkey and displayed in bar charts. There was also themetic analysis of the open responses.

The articles were analysed for use of references, footnotes and acknowledgements.

Validity and reliability

The questionnaire was pre tested by 6 academics who were largely unknown by the researcher and volunteered via Linkedin. They suggested some helpful alterations. The results were validated by an academic colleague. The researcher also bracketed preformed opinions which may bias the study such as any personal experiences of plagiarism.

Analysis of the articles was also supported by the academic colleague.


Whilst the number of respondents was small; 29, the results are of significance and indicate the need for further research. Academic plagiarism does occur amongst academics. There is confusion surrounding the definition of plagiarism but most respondents considered it to refer to direct copying of published work, rather than unpublished. It is largely considered to be unacceptable but occurs for various reasons such as lack of knowledge of the one who plagiarises.

Articles did indicate the use of methods such as references, footnotes and acknowledgements.


Whilst there are several limitations to this study such as the sample size, several conclusions may be drawn. The majority indicate that plagiarism refers to direct copying of sentences, papers or published ideas. If plagiarism is to refer to largely published information, it is to be remembered that others do have access to this and it may be identified by the use of software. Perhaps an additional question would have asked if the articles were published or unpublished. Yet there is a limit on survey monkey, to the number of unless questions one is able to pay an additional fee. Indeed 42% indicate that plagiarism does not refer to an unpublished idea but as one respondent commented, it is good practice to acknowledge the individual. One does suggest that it is impossible to copyright an idea. Yet copyright registration bodies do exist that will do so for a fee. One suggests that plagiarism also refers to fabrication of results which is supported in the literature (Lewis et al 2011 ). This indicates that plagiarism extends beyond mere copying and has huge implications involving dishonesty and misleading the readers.

There was little response to question 6 regarding the acceptance of plagiarism. This may possibly be due to the lack of definition of plagiarism or the broadness of the question. Most however, felt that plagiarism occurs amongst students rather than academics. Responses indicate that plagiarism is “fraud” and “stifles ingenuity”. It may however, enable ideas to be “built upon”. 12 respondents are aware that plagiarism occurs amongst academics and 4 had knowingly copied work themselves. This indicates the confusion that surrounds the issue or that individuals may be reluctant to question acceptability. It may also depend upon the individual situation of plagiarism. Further exploration is required to ascertain whether or not this was thought to be acceptable but this is not supported by some other responses such as reasons for plagiarism. There were however, 16 additional comments made by respondents, in response to question 6. The majority declared that plagiarism is not acceptable. One said it is acceptable to take somebody else’s idea.

Various reasons were suggested for plagiarism including lack of knowledge of the one who plagiarises, laziness, pressure, culture and accidental; fuelled by the use of websites. All reasons are supported by the literature discussed in the literature review. The reason “lack of knowledge of the one who plagiarises”, warrants further investigation. Is this a defence mechanism with the author pleading ignorance? Some of the reasons given in question 10, are related to one another. For example, completion, fame and money. There may be an overriding factor of “survival of the fittest” (Darwin 1859). A new breed of lecturer is possibly emerging aiming to progress in their career at all costs. In fact, the most knowledgeable lecturers, may be asked to leave as a consequence for fear of being a threat to the others. The same could well be said of other professions. Indeed, a question could be asked concerning how individuals adapt to their work role thus “Would you plagiarise, in order to maintain your position if you were not in danger of repercussions?” Many lecturers today, feel insecure and are under pressure and stress as discussed earlier. Much depends upon the number of student intake. In 2012, the student applications to UK Universities reduced by 8.7% (Vasager 2012 ) which is reflective of many factors including finances, prospects and job availability.

Most respondents thought that education needs to be improved concerning plagiarism and the use of software packages may assist to prevent it. Although, as discussed in the literature review, software results may be misleading. Whilst this suggests there is a need to prevent plagiarism, again most respondents considered plagiarism to occur amongst students. Interestingly 4 respondents used software to check their own work which is good practice and indicates how it may occur unintentionally. This may however, be means of proving their statements and verifying originality.


Whilst this was a small study with some limitations, a number of interesting points are highlighted. Plagiarism does not merely prevent the original writer gaining recognition but it also “stifles ingenuity”, as commented by one respondent. Indeed a number of cases may indicate this. Here is one example;

Sternberg (1998) identifies 7 types of love. Yet many years previously, the same types were identified by other authors including the Bible and classical Greek texts. It is important to recognise the socio-cultural factors that existed at the time the work was originally done.

I remember as a young man reading commentaries regarding Greek words for different kinds of love mentioned in the Bible, as examples, phileo, which can be translated as to be a friend ……. to be fond of an individual; a matter of sentiment or feeling, storge …….. natural affection between kinfolk; eros ……… (egotistical) sexual love; agape ………. esteem, principle, or duty, rather than attraction or charm ……. So, when Mr. Sternberg ‘identifies’ Liking – friendship where one enjoys the company of another; Companionate Love – most people feel companionate love toward their family members; Infatuation – passion without intimacy; Empty Love – a couple stay together for family reasons (duty), it is not as if these concepts have not been discussed since time immemorial. What modern ‘acadaemia’ allows is for anyone to be a ‘cocktail-mixer’; call old things by new names, mix (synthesise) them together slightly differently from anyone else, and, hey presto!, you too can be the ‘Harvey Wallbanger’ of acadaemia!; quoted by endless streams of google academics. Classical Greek texts contain much of what is today re-hashed as ‘new ideas’; they themselves a continuum of concept-tweeking. Nothing changes. (T.I.M. An independent academic)

There are other examples such as Maslow’s hierarchy of needs which may have been based upon the work of Carl Jung amongst others.

Evidence both literature and responses, indicates widespread occurrence of plagiarism amongst academics within all countries and faculties. There is however, lack of awareness or acknowledgement of what plagiarism is. Individuals seem to be unaware of the full implications or effects of plagiarism.

By quoting facts as though they are one’s own or recent findings, may result in the wrong facts being accepted and readers being misled. It also prevents the reader or researcher, from sourcing the original citation and thus further validating it or drawing additional conclusions. In this way, research and knowledge, may well be restricted by the repetition of commonly cited facts or authors. This is further unaided by the reliance upon web based searches which only search so far back.

The question may well be why does one become an academic or what is expected of an academic? Does it refer to somebody who produces original work or does it refer to somebody who cites a vast number of references or plagiarises ?There is indeed, huge pressure on academics to produce publications, research and conference presentations. It may be very tempting for them to use the work of another. Also there may well be a lack of praise for individuals who do create their own work. Therefore some individuals, may fear proposing an original idea for fear of being ridiculed. Such pressure on academics may be enhanced by the business goal of Universities ( 2012 ). Plagiarism extends beyond acknowledging an individual; this is a materialistic mode of thought. It is building upon and sourcing ideas’ to verify the facts thus ideas are not merely repeated and thinking is promoted.

Despite the need to acknowledge possibly unknown individuals, many journals will only publish the work of commissioned authors or those who are well known and linked to universities. One article actually describes a case (Changgeng 2007 ) of the rejection submitted to a journal . It was later accepted when more professional affiliation to an establishment was falsified . Journals do use methods to detect plagiarism such as software , which is to be recommended. Yet it remains difficult for unknown authors to publish their work or ideas thus increasing their vulnerability of plagiarism.

The fact that few individuals were prepared to respond to the questionnaire, despite wide advertising across the world, may indicate that people are reluctant to discuss the issue. It may also be unaided by the independent status of the researcher. Research undertaken by Professors in Universities gains more credibility and response (Changgeng 2007). There also seems to be a race regarding the citation of references and use of the greatest number. Changgeng (2007) discusses the demand by journals for a vast number of references. Yet on the other hand, earlier references are ignored and work rejected if it is cited.

Plagiarism may well be a misnomer , placing emphasis upon the use of references with the aim of giving credibility to the original author. There are clearly additional factors and it has far wider implications than this. There may be different degrees of plagiarism for example, minor such as an idea, intermediate such as references or major referring to full copied sentences or paragraphs.

There may also be additional perspectives to consider. Authors may indeed over-reference bringing into question; what is referencing? Changgeng (2007) discusses the real need to refer constantly to history . It is what we do with the references that matters. Also readers may well misinterpret what they have read either unintentionally or fuelled by bias. For example the term “self-actualisation” described by earlier authors such as Jung, was redefined by Maslow. Whilst this is not plagiarism, if the original author is referenced, it surely is the opposite?

Based upon this study, a number of tentative recommendations may be made. These include; there is a need for a greater degree of honesty and openness within the profession with less stress and pressure placed upon academic staff. The whole aim of the academic role needs to be reviewed which has implications for the whole of society. There needs to be greater awareness of earlier work such as Vladeck 1980 who referred to quality of care in USA. Plagiarism also implies the neglect of history and possible re-invention of the wheel. Research and writing must also be encouraged amongst independent individuals who are not fortunate enough to be attached to a University. This will dissolve elitism and encourage broader thinking. There is a need to reconsider education and policies surrounding plagiarism and allocate praise to academics who involve and acknowledge unknown individuals.

Avoiding Plagiarism is about caring- about priorities-about truth. If one cares, one establishes correct priorities and aims for truth, not glory. “Subdued ingenuity” says it all (one respondent).

We are chasing materialism not humanism. That is life’s dichotomy. We are teaching the young to gain qualifications in order to get a job and money. This is not the answer. Take pride in acknowledging somebody else. Plagiarism is theft and illustrative of the wrong priorities. Yet is it totally avoidable? It may well have become the norm.


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