The chain of academic dishonesty model: Understanding misconduct in undergraduate nursing education

Background Academic dishonesty in undergraduate nursing education is a persistent, systemic problem with documented links to clinical misconduct and compromised patient safety. Despite growing awareness, existing responses remain largely reactive, focusing on detection and punishment rather than upstream prevention. Innovation/Major Points The chain of academic dishonesty (ChAD) model presents a novel conceptual framework that reinterprets academic misconduct through the lens of the public health chain of infection. Four interconnected domains are identified: environmental reservoirs, integrity drift behaviors, cultural normalization mechanisms, and high-stakes misconduct outcomes. Implications The ChAD model supports the design of proactive, systems-based integrity initiatives in U.S. undergraduate nursing programs. Interventions targeting each domain may interrupt escalating misconduct pathways and strengthen professional identity formation. Conclusions By reframing academic dishonesty as an epidemic sustained by institutional and cultural conditions, the ChAD model offers nursing educators a practical framework for understanding, preventing, and disrupting misconduct at multiple system levels.