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Nurses and Patients and Plagiarism, Part 2

By Joy Jacobson

May 23, 2017

Matt Saunders, flickr

In the six years or so that I’ve blogged at HealthCetera, I’ve written about the use of reflective writing in clinical practice and education, and I’ve examined poems that elucidate aspects of health and health policy. And in that time the post of mine that has been viewed most often—by far—is one I wrote three years ago, “Nurses and Patients and Plagiarism: The Consequences Aren’t Merely Academic.”


Why is there such an enduring interest in plagiarism? My post looked at a couple of literature reviews that suggest academic dishonesty among nursing students may have implications for ethical nursing practice. A new search shows the problem is far from resolved.


Last November, for example, the UK weekly journal Nursing Standard reported the results of its investigation that found thousands of UK nursing students had committed academic fraud, 79% of the cases involving plagiarism (the article is free but requires a login).


And in March Australian researchers Lynch and colleagues published an integrative review on plagiarism in nursing education (login required) in Journal of Clinical Nursing. The study illuminates several fascinating aspects of the plagiarism problem in nursing:


  • Students’ cultural or language background does not affect their likelihood of plagiarizing.
  • Many nursing students simply do not understand the basics of referencing and paraphrasing.
  • Inadvertent or accidental plagiarism is common.
  • Students are more likely to plagiarize if they are at risk of failing a course.
  • As unethical behavior in academia becomes “neutralized” and then “normalized” to nursing students, they are more likely to continue to engage in unethical behavior, with serious implications for clinical practice.
  • Some faculty find it an “enormous burden” to deal with academic dishonesty.
  • The threat of punishment has not reduced plagiarism in nursing education.


That last point seems important to emphasize. Just today a writer in Inside Higher Ed, Jennifer A. Mott-Smith, suggests that unless a student submits a paper she paid someone to write or copied and pasted it entirely, academic plagiarism should not be punished—that it instead should be seen as a teaching opportunity to help students “continue to practice the difficult skill of using sources.”


That has been my approach as a writing instructor with nursing students. But this can’t mean pretending it’s not happening. Rather, it requires something extra from nursing faculty and institutions—namely, real time spent on teaching writing as a process in which the student learns to think. Otherwise, the copying culture will not abate.


I’d like to hear from others, both nursing students and faculty. Is plagiarism an issue for you? How have you handled it?

Joy Jacobson
Joy Jacobson is the CHMP’s poet-in-residence and cofounder of our Writing Reflective Narratives for Clinicians program.

Nurse Tina Carlson’s Poems on the Generational Consequences of War

By Joy Jacobson

April 28, 2017

It’s National Poetry Month for another minute or two, and since you probably haven’t dedicated as much time to memorizing poems as the month might suggest, I offer you absolution in the form of a poem composed by a woman whose work concerns itself with absolution.


Tina Carlson, Ojo Caliente, NM

Tina Carlson, a psychiatric nurse practitioner, released her first book of poems, Ground, Wind, This Body, through University of New Mexico Press in March. The book is a chronicle of sorts, one that winds through the wretchedness wrought by war and the deep, lifelong impression it leaves in the lives of a returning soldier’s children.

Tina is a dedicated nurse who works with the homeless in Albuquerque and a true poet—and what a combination: a carer both of human beings and of the language we use to shape and reshape our experience—who is also one of my dearest friends.


Try reading this poem aloud. It comes about midway through her book (offered here with the poet’s permission): 

Summer Nights


After rain, the earth shines in gratitude. We are nine,

awake on wet grass and the sky, a vast cup of stars.

Because our lives are small fires buried under dry fields,

the muddy homes of childhood, auditoriums of weeds, and trees.

Even discomfort glistens here.

The whole world breathes together, watches messages

pass across the wide face of the moon. We were born into wildness

after the war. Each year, watch the hillsides burn aspen yellow,

then the wind changes everything to brown.

For you, I am an arsonist.

Our fathers take aim at us behind doors with imaginary weapons,

still living in battle. Almost criminal, our desire to thrive in this world.

Our futures arrested, like the cat’s gift in the doorway:

birdlike, perfectly curled into the shape of an egg, gelatinous.

Even after several re-readings I am left breathless by that last image.


With the astonishing opening lines we begin in thankfulness for a thirst quenched, for the simplicity of wet grass and cupped stars—a childlike sweetness that gives way immediately to an underground fire. By line 3 we know we are in hell, navigating atemporally a place that by some unnamed grace makes even pain beautiful.


The poem doesn’t let on who “we” are, and so it allows me to step as a nine-year-old into that space. “For you, I am an arsonist,” the speaker says, implicating me in the near-criminality of a “desire to thrive,” despite our aborted future that has been left uncannily as a “gift.”


When the speaker states “We were born into wildness / after the war” she means the Second World War, but she could also be referencing our current landscape of perpetual War on Terror. Regardless, wildness in this poem’s universe is a two-headed thing, both a natural and a manmade chaos, one that helps us survive our wounded fathers and also nearly annihilates us.


Such antipodal tensions abound in this poem, as throughout the book. Redemption is almost always at hand, as in these brilliant lines, in which it seems that the entire world is being born and dying at the same time:

The whole world breathes together, watches messages

pass across the wide face of the moon.

Yesterday was Poem in Your Pocket Day, but it’s not too late to print this one out, or another of her poems from the book, “Ojo Caliente: Metamorphoses,” that recently appeared on Verse Daily. Carry it with you. Give it to a colleague. Read it to a friend over lunch.


I asked Tina what it’s been like to have this book published. She said by email: “Having this book out in the world was initially terrifying. So much was never supposed to be spoken. But the book itself, like a child, has its own life now, and wants the secrets to be over and the war wounds to be healed.”


Poetry has often served to bear witness and to speak the unspeakable.


I’ve been reading Tina Carlson’s numinous poems for more than 20 years. It thrills me that now you can read them, too.

Joy Jacobson
Joy Jacobson is the CHMP’s poet-in-residence and cofounder of our Writing Reflective Narratives for Clinicians program.

Nurse Practitioner Veneta Masson on the Value of Poetry and Stories

By Joy Jacobson

March 17, 2017

Yesterday, the Trump administration released its proposed federal budget, which an incisive Twitter user described as “what a cartoon villain would propose.”


  • It would cut the Environmental Protection Agency by 31% and Health and Human Services by 16%.
  • The National Institutes of Health would lose $6 billion.
  • It would decimate support for after-school programs, Meals-on-Wheels, and the neediest college students.
  • And among so many other deprivations, it would kill the National Endowment for the Arts and the National Endowment for the Humanities.


The proposed cuts are all of a piece in their cravenness and cynicism, serving to boost military spending and so-called homeland security. For a strong analysis of this proposal’s radical conservatism, I recommend this piece at the Intercept.


Because I want to talk about poetry and stories.


Veneta Masson

This week the Annals of Internal Medicine announced it had chosen “Tinnitus” by Veneta Masson as the best poem it published in 2016. On Wednesday I spoke with Veneta, a poet and essayist, a nurse practitioner, and an instructor in ethics at Georgetown University, about the value of poetry and narrative in nursing, medicine, and health policy. Our discussion wasn’t overtly political, but I’m grateful today for the quiet affirmation she offered of the arts.


I asked her about the synergies being made between the literary arts and the health care industry. The Association of Writers and Writing Programs, for example, recently held its annual conference in Washington, DC, where Veneta presented on a panel called Crossing the Line: Writing as a Healing Practice. This seems significant: for years the arts have penetrated various health care arenas, but now issues related to health and health care are making their way into the country’s biggest conference for professional and student writers and writing faculty.


“Writing gives you new energy for your work,” Veneta said. “It’s like you need to do this to resolve what’s unresolved in the mind and heart. One time I was writing about a mistake I made or what could have been a mistake and the guilt about what I could have done. I had to find a way to put myself at rest. In that case it was in the form of a poem.”


Veneta told me about a Literature and Medicine group at George Washington University that met for dinner to discuss one of her books of poems. “I had written about an immigrant woman and her child, and a man approached me afterward. He said, ‘I couldn’t say this in the group, but I felt you were writing about my mother.’ What more could a writer want, as far as connecting with another person?”


Indeed, those connections appear to be neurological, as well as sociological. Veneta mentioned an article written by physician and fiction writer Louise Aronson, Story as Evidence, Evidence as Story, published in 2015 in JAMA. Aronson writes:


Mounting data, and the entire historical record across cultures and continents, suggest that human beings are uniquely wired for story and that stories, with their linking of the cognitive to the emotive, are often both more memorable and more persuasive than other sorts of information.


Veneta’s prize-winning Annals poem is behind a paywall, but she gave me permission to reprint another poem first published in the online journal Pulse, called The Whole Story. It’s a beautiful melding of narrative momentum and lyric concision. With just a few images and happenings she makes a world I want to inhabit, one with sunflowers and war talk, plus the unexpected poignancy of a shy bride waiting her turn at the door to a funeral.


After I spent hours fretting over the proposed budget, reading Veneta Masson’s poem restored me, somehow, to my right mind and to a couple of simple truths: humans need poetry, and health care is stories.


The Whole Story


After she died

there was talk of war

the stock market crashed

the cat didn’t eat for three days

her youngest came home from school in tears

her husband grew a beard.


I do not lie when I tell you these things

nor do I tell the whole story.


I do not say that her funeral day dawned bright

and unrepentant


or that all the sunflowers in the city

were gathered at her wake.


I do not mention the ruffled bride

also in white, waiting discreetly outside

the door of the chapel.


I do not tell how, at the gravesite

smiling children blew

soap bubbles over her casket


and how they were not buried with her

but were borne up and away,

carried gently on a light wind.


And check out Veneta’s Notebook, her observations of matters literary, medical, and otherwise. In one entry she writes about writing: “that’s where I find out what I’m thinking and (like Descartes) what’s true and what isn’t.”


Joy Jacobson
Joy Jacobson is the CHMP’s poet-in-residence and cofounder of our Writing Reflective Narratives for Clinicians program.