Research Ethics in Nursing Practices
Research Ethics in Nursing Practices
RESEARCH ETHICS
Introduction
Ethics is rooted in the ancient Greek philosophical inquiry of moral life. It refers to a system of
principles which can critically change previous considerations about choices and actions. It is
said that ethics is the branch of philosophy which deals with the dynamics of decision making
concerning what is right and wrong. Scientific research work, as all human activities, is
governed by individual, community and social values. Research ethics involve requirements on
daily work, the protection of dignity of subjects and the publication of the information in the
research.
However, when nurses participate in research, they have to cope with three value systems;
society; nursing and science. The societal values about human rights, the nursing culture based
on the ethic of caring and the researcher's values about scientific inquiry. According to Clarke
these values may conflict with the values of subjects, communities, and societies and create
tensions and dilemmas in nursing. In this chapter, the most important ethical issues will be
addressed. After a short description of the nature of nursing, and the advocacy role of nurses,
the writer will attempt to highlight the possible conflicts that nurses have to deal with, when
undertaking or participating in research.
Human experimentation has been conducted even before 18th century. However, the ethical
attitudes of researchers drawn the interest of society only after 1940's because of human
exploitation in several cases. Professional codes and laws were introduced since then in order to
prevent scientific abuses of human lives. The Nazi experiments led to the Nuremberg Code
(1947) which was the leading code for all subsequent codes made to protect human rights in
research. This code focuses on voluntary informed consent, liberty of withdrawal from research,
protection from physical and mental harm, or suffering and death. It also emphasizes the risk-
benefit balance. The only weak point of this code was the self-regulation of researchers which
can be abused in some research studies. All declarations followed, forbade non-therapeutic
research. It was only in 1964 with the declaration of Helsinki that the need for non-therapeutic
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research was initiated. The declaration emphasized the protection of subjects in this kind of
research and strongly proclaimed that the wellbeing of individuals is more important than
scientific and social interests. The American Nurses' Association (ANA) Guidelines for
Research, the Human Rights Guidelines for nurses in clinical and other research (1985) and the
Royal College of Nursing Code for nurses in research (1977) provide a strong assistance to
professional nurses as well as reassurance to patients, the public and society, of professionals‘
intentions.
Informed consent
Informed consent is the major ethical issue in conducting research. According to Armiger: "it
means that a person knowingly, voluntarily and intelligently, and in a clear and manifest way,
gives his consent‖.Informed consent is one of the means by which a patient's right to autonomy
is protected. Beauchamp and Childress define autonomy as the ability for self-determination in
action according to a personal plan. Informed consent seeks to incorporate the rights of
autonomous individuals through self- determination. It also seeks to prevent assaults on the
integrity of the patient and protect personal liberty and veracity. Of course individuals can make
informed decisions in order to participate in research voluntarily only if they have information
on the possible risks and benefits of the research free and informed consent needs to incorporate
an introduction to the study and its purpose as well as an explanation about the selection of the
research subjects and the procedures that will be followed. It is essential to describe any
physical harm or discomfort, any invasion of privacy and any threat to dignity as well as how
the subjects will be compensated in that case. In addition the subjects need to know any
expected benefits either to the subject or to science by gaining new knowledge.8 A disclosure of
alternatives is also required as for example in the Tuskegee study about syphilis. In this study,
rural black men were chosen as subjects in a study of syphilis. Although a cure for syphilis was
found after the start of the study, it was decided not to treat them and they had not been told that
penicillin was effective to their disease. The researcher must inform the subjects about the
methods which will be used to protect anonymity and confidentiality and indicate a person with
whom they can discuss the study. He must also provide a "Noncoercive Disclaimer" which
states that participation is voluntary and no penalties are involved in refusal to participate.
Moreover, the subject must be told that some information has been deliberately withheld in
order to avoid altered behaviors. The researcher must also take into account that persons with
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physical, cultural and emotional barriers may require a very simple language in order to
understand him. Finally, the freedom to withdraw must be explained. This is very important but
raises the issue of how difficult the subjects can withdraw after developing a personal and
sometimes friendly relationship with the researcher. With regard to withdrawal a researcher may
be in a dilemma in case many subjects choose to withdraw at an advanced stage of the study,
because this can affect the validity of the results. The Declaration of Helsinki provides some
help as it declares that the interest of the subject must always prevail over the interests of
society and science. According to this, the will of the subject must be respected at any cost for
the research.
Another major ethical issue is obtaining an informed consent from groups with diminished
autonomy which will be further discussed later. From what has been discussed, it becomes clear
that disclosure, comprehension, competency and voluntariness are the four essential parts of
consent.
Beneficence- Do not harm
The ethical principle of beneficence refers to the Hippocratic "be of benefit, do not harm".
Beauchamp and Childress, suggest that
"the principle of beneficence includes the professional mandate to do effective and significant
research so as to better serve and promote the welfare of our constituents".
Beneficence is sometimes difficult to predict when creating a hypothesis especially in
qualitative research. Carr says that if the research findings prove that it was not beneficial as it s
expected, this can raise immense ethical considerations especially for nurses. Ford and Reutter
say that "beneficence relates to the benefits of the research, while non-maleficence relates to the
potential risks of participation". Nonmalificence requires a high level of sensitivity from the
researcher about what constitutes "harm". According to Burns and Grove "discomfort and harm
can be physiological, emotional, social and economic in nature".
When a researcher tries to learn intimate details of the participants lives he has to deal with
opening old wounds. Nonmalificence dictates both preventing intentional harm and minimizing
potential harm. A researcher must consider all possible consequences of the research and
balance the risks with proportionate benefit. The type, degree, and number of potential risks
must be assessed as well as the patient‘s value system which ranks various harms. The risk
benefit ratio can only be achieved by identifying these factors. If the risks outweigh the benefits,
the study should be [Link], debriefing at the end of a study, should be mentioned. Treece
and Treece say that debriefing refers to explaining the exact aim of the study and why the
disclosure was not full. Treece and Treece suggest that subjects should feel as much at ease as
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possible and express their feelings. In addition, Burns and Grove suggest that if the subjects
experienced a high level of discomfort, they should be debriefed or referred to appropriate
professional intervention as necessary.
In situations that are particularly complex, sensitive, and in which the participants are extremely
vulnerable, a Certificate of Confidentiality issued by the U.S. Department of Health and Human
Services (DHHS) may be useful to help ensure the privacy of research participants especially in
studies in which participants and researchers may be exposed to compelled legal disclosure of
research data.
The researchers must always bear in mind all psychological and social implications that a
breach of confidentiality may have on subjects. In order to protect participants, they have to
inform them on their rights, and use all possible coding systems that they regard appropriate in
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each case.
Advocacy in nursing
Advocacy primarily used in legal contexts, refers to the protection of human rights of people
who cannot defend them for themselves. The role of nurses as advocates is closely related to the
purpose of nursing, the nurses views about humans and the needs of persons in health care. In
literature advocacy is described in three different models: The rights protection model implies
that nurses helps persons to understand and exercise their rights. They also aim to protect and
enhance personal autonomy. The value based decision model suggests that nurses should not
impose decisions but assist persons to decide which choices are most consistent with their
values. They should also support the patients' confidence in their own decisions and prevent
limitations of their freedom. This model is considered by Gadow in the "existential advocacy"
which focuses on the clarification and reconsideration of the values of the patients by self-
examination. According to Fowler and Arrif this thesis is distinct from both "paternalistic and
consumer rights protection" and declares the fundamental rights of self-determination. However
according to Johnstone, Gadow does not provide adequate reasoning why self-determination is
the most important value or why the human rights claim to self-determination are quite different
from a patients‘ rights claim to self-determination. Last, the respect for persons model focuses
on human dignity, privacy and self-determined choices that the nurse has to protect if the person
is not autonomous or self-determining. Murphy argues that this model which she calls the
advocate model of the nurse-patient relationship, reflects the basic value of nursing which is the
best possible care for patients. However, nurses should not be considered as being in a solely
position to act as patients advocates.
According to Johnstone all professions with a morally significant relationship with a patient
ought to fulfill the role of the advocate. The ANA Code for nurses though, refers to the nursing
role of advocate in safeguarding the wellbeing of the client and the society. However, both the
nature of nursing which focuses on caring, preventing harm and protecting dignity and the
advocates role of nurses which calls for defending the rights of subjects, are sometimes
incongruent with the ethics in research.
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Conflicts in nurses
Beneficence-Non malificence
A common feature in professional conduct codes and those specific to research is the principle
of non-malificence. The ANA Code of conduct declares that the nurse protects the clients and
the public from unethical, incompetent or illegal practice of any person. This statement raises
the issue of advocacy when nurses have to protect patients from the researchers‘ incompetence
or unethical behavior. Even if nurses are certain about the incompetence of the investigator,
which is usually very difficult, they have to deal with serious dilemmas. First they have to
consider the fact that if patient learn that they are exposed to professional misconduct, they may
lose faith in health care. Jameton though, believes that patient should be informed as they will
appreciate the trust shown to him by frankness. If the researcher does not inform or compensate
patient then nurses have to decide between the duty to safeguard the well-being of patient and
be loyal to them, and the loyalty to colleagues.
However, even if nurses decide that their duty of caring and being loyal to the patient is more
important, they may have to deal with the hierarchical and bureaucratic systems of institutions
which demand loyalty to subordinates to the institution. In case the incompetent researcher is a
higher status professional, nurses may be obliged to show loyalty, but this can conflict with
loyalty to patients. Consequently, nurses may feel that their patients are vulnerable and exposed
and that they cannot prevent it because they do not have a voice or power to resist. This is
merely why many authors believe that it may not be possible for nurses to act as advocates of
subjects in research. Many support the idea that the prohibition from the advocacy role comes
from the origins and development of nursing as a women‘s occupation dominated by medicine
in a bureaucratic system.
Another possible issue of conflict is that the caring nature of nursing with regard to the right of
patients to the best treatment/care is sometimes conflicting with the aim of research in non
therapeutic studies. According to the Belmond commission the general aim of practice is to
enhance the well being of individuals while the purpose of research is to contribute to general
knowledge. This distinction highlights the differences in the aims of a nurse practitioner and a
researcher. It is therefore very difficult for nurses to be engaged in studies whose aim is not
directly beneficial to the subject. They must though, consider that these studies may generate
and refine nursing knowledge.
Another problem that nurses may have to face is taking part in randomized control trials.
According to Brink and Wood dedicated nurses are finding themselves under pressure when
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they are asked to exclude some patients from an obvious beneficial treatment such as relaxation
techniques for relief of post operative pain. So, they suggest that whenever it is possible to
predict such problems for nurses, the control data should be collected before introducing the
beneficial variable. Skodol Wilson implies that there should be some provisions for alternative
effective care. [Finally, Brink and Wood recommend that withholding benefits can be rectified
at the end of an experiment. This compensation must be planned in advance so that enough
money and time will be available.
In order to prevent human exploitation, ethics committees were introduced. The criteria on
which the proposals are to be judged are the physical and mental discomfort or harm of subject,
the qualifications and experience of the supervisor, the scientific value, the adequate consent
procedures and the adequate information given to subjects. Clark warns that there is a danger
that the members may have vested interests in a research. The success of any ethics committee
will always depend on the commitment and moral competency of its members. If instead of the
patient and his needs, the central aims of the committee are personal interests, profits and
academic prestige, then nurses will have none to share their concerns with, and deal with their
dilemmas in research. Nurses, need a greater accessibility to committees and demand a
multidisciplinary synthesis in order to deal with very difficult cases. Moreover, the committees
should be less strict so as not to prevent knowledge development in nursing
Confidentiality
The issue of confidentiality which is stated as very important in the Hippocratic oath, is another
possible issue of conflict for nurses either as practitioners or researchers. Clause 10 of the ICN
Code for nurses emphasizes that all information obtained during nursing practice should be kept
secret apart from cases that it should be reported in a court, or in cases that the interests of
society are important. On the other hand the ICN Code for nurses in research states that:
"Nurses acting as data collectors must recognize that they are now committed to two separate
roles " .
According to the professional code they cannot reveal confidential information not even to the
members of the research team. It is important therefore, to seek advice in ethics committees to
get approval for disseminating the results of the data collection including an account of what
happened. In addition, they have to deal with the issue of anonymity when some features of the
research make the subjects easy to identify. It is very important that nurses always bear in mind
that they should protect the privacy of the patient. The trust showed to them must not be
jeopardized. Patients reveal information concerning their body and mind and expect them to be
used only in a therapeutic manner. When dilemmas according to confidentiality arise, trust as a
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basic element of a therapeutic relationship should be considered and maintained.
Informed consent
Nurses involved in research, have to consider many ethical problems relating to the issue of
informed consent. The ICN code for nurses in research, states that nurses as practitioners may
be called upon to witness that informed and voluntary consent has been obtained from the
subjects of research. It suggests that they should make sure that patients have fully understood
what has been proposed, which means that they are aware of potential risks or discomforts.
Nurses who spend more time with patients are in a good position to judge it. In addition, they
must ascertain that patients have understood their right to withdraw at any time. In order to
maintain the self-determination of patients, nurses must be fully informed themselves about the
study and its purpose. The patient's consent should be obtained freely, with full awareness of
implications. If nurses find out that it was not obtained in an appropriate manner, they should
inform patient and refuse co-operation. Webb suggests that the informed consent is an
obligation of the researcher and no nurse should obtain it on behalf of another professional, nor
agree to give the explanation as a substitute. If a nurse tries to get consent, then the persons will
feel obliged to participate, either because information is coming from their career that they trust
and depend on, or, because they feel grateful for the care they are receiving.
Another conflicting issue is that giving information to patients is accepted as a major role of the
nurse; but if for the sake of a research, nurses have to withhold information, this may create
conflicts when they have to decide whether to participate or not. Hurst suggests that if nurses
cannot tell patients about the true research objectives, they should provide a full explanation at
the end of data collection. Provided, of course, that a supervisor body has decided that
disclosure should not be full in order not to invalidate the research outcome.
Consent, can however, be a major ethical issue for nurses when it involves persons with
diminished autonomy, such as children, aged, mentally ill etc. Nurses should ascertain that
consent has been obtained either from the individual, when possible, or, by relatives or
guardians. They must also protect the dignity and privacy of such groups who are more
vulnerable to loss of dignity and privacy. Nurses taking part in research on children should be
alert, in order to notice any verbal or non verbal dissent which warrants exclusion of the child
from the study (even if this creates conflicts with the researcher. In the same prospect, nurses
must act as advocates when vulnerable groups are used in research, and not prevent it.
According to Levine, restricting these groups from research could end in disadvantaging those
populations, even further, especially when research involves no risk and a high potential for
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benefit.
Researcher role conflict
With regard to nurse researchers, the International Council of Nurses declares that they are not
responsible for the care of patients. They should only intervene in case that "a harmful situation
appears imminent". This statement is not congruent with the culture of nursing which is
"intertwined with the ethic of caring". The commitment of nurses to caring, may create
dilemmas according to the conflict between the researcher's and clinician's role.
If a researcher nurse provides physical or psychological care during an interview, the results
will be biased and generalization will be difficult. Another issue raised from the ICN statement,
is to determine when a "harmful situation appears imminent" and the intervention of the
researcher is required. The declaration of Helsinki says that the interest of the individual should
prevail over the interests of society of science. This can solve some of the ethical dilemmas of
the nurse, but in case the situation is not lifethreatening, the conflict remains. Burns and Grove
suggest that in case that support from the researcher is required, then, it should be given, but the
subjects should be excluded from the research. They also recommend that another alternative is
to seek help in other professionals to proceed with the data collection. Nevertheless, most health
professionals, no matter how skilled they are in supportive techniques will provide some care if
they feel that it is needed in a certain case.
Conclusions:
Ethical issues, conflicting values, and ambiguity in decision making, are recurrently emerging
from literature review on nursing research. Because of lack of clarity in ethical standards,
researcher must develop an awareness of these issues and an effective framework to deal with
problems involving human rights. This is necessary in order to come into terms with the issue of
the researcher's values relative to the individual's rights versus the interests of society.
Professional codes, laws, regulations, and ethics committees can provide some guidance but the
final determinant of how research is performed, rests with the researcher's value system and
moral code. To prepare future nurses, ethics in research, must receive special attention in
nursing curricula. The criticism and uncertainties that arise, should be rather encouraged than
suppressed in nursing education. Hunt suggests that in order to liberate nursing from its
"technocratic impasse" ethics should be broadly interpreted as an arena of new ideas which can
change professional hierarchies, to open cross-disciplinary discussions, and question the
concepts "abnormality", "patient" and " illness". He also declares that nursing, not as a
biomedical branch, but as a science and art of caring, is able to start the redefinition of research
in health care which was in the recent history dominated by the biomedical "paradigm".
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Principles of research ethics:
There are a number of ethical principles that should be taken into account when performing
undergraduate and master's level dissertation research. At the core, these ethical principles stress
the need to
(a) do good (known as beneficence) and
(b) do no harm (known as non-malfeasance). In practice, these ethical principles mean that as
a researcher, you need to:
Obtain informed consent from potential research participants;
Minimize the risk of harm to participants;
Protect their anonymity and confidentiality;
Avoid using deceptive practices; and
Give participants the right to withdraw from your research. This article discusses these
five ethical principles and their practical implications when carrying out dissertation
research.
When you look at these five basic ethical principles, it may appear obvious that your
dissertation should include these. However, there are many instances where it is not
possible or desirable to obtain informed consent from research participants. Similarly, there may
be instances where you seek permission from participantsnot to protect their anonymity.
participants not to protect their anonymity. More often than not, such choices should reflect
the research strategy that you adopt to guide your dissertation.
Broadly speaking, your dissertation research should not only aim to do good (i.e., beneficence),
but also avoid doing any harm(i.e., non-malfeasance). Whilst ethical requirements in research
can vary across countries, these are the basic principles of research ethics. This is important not
only for ethical reasons, but also practical ones, since a failure to meet such basic
principles may lead to your research being (a) criticized, potentially leading to a lower mark,
and/or (b) rejected by your supervisor or Ethics Committee, costing you valuable time. In the
sections that follow, we discuss the five of the main practicalethical principles that stem from
these basic principles. Each of these basic principles of research ethics is discussed in turn:
Dissertation research should not harm participants. Where there is the possibility that
participants could be harmed or put in a position of discomfort, there must be strong
justifications for this. Such scenarios will also require (a) additional planning to illustrate how
participant harm (or discomfort) will be reduced, (b) informed consent, and (c) detailed
debriefing.
There are a number of types of harm that participants can be subjected to. These include:
Typically, it is not harm that we need to think about since a researcher does not intentionally go
out to cause harm. Rather, it is the risk of harm that you should try to minimize. In order to
minimizing the risk of harm you should think about:
We discuss each of these ethical principles in the sections that follow, explaining (a) what they
mean and (b) instances where they should (and should not) be followed.
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One of the foundations of research ethics is the idea of informed consent. Simply put, informed
consent means that participants should understand that (a) they are taking part in research
and (b) what the research requires of them. Such information may include the purpose of the
research, the methods being used, the possible outcomes of the research, as well as associated
demands, discomforts, inconveniences and risks that the participants may face. Whilst is it not
possible to know exactly what information a potential participant would (or would not) want to
know, you should aim not to leave out any material information; that is, information that you
feel would influence whether consent would (or would not) be granted.
Another component of informed consent is the principle that participants should be volunteers,
taking part without having been coerced and deceived. Where informed consent cannot be
obtained from participants, you must explain why this is the case. You should also be aware that
there are instances informed consent is not necessarily needed orneedsto be relaxed. These
include certain educational, organizational and naturalistic research settings.
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An alternative is to remove identifiers (e.g., vernacular terms, names, geographical cues, etc.) or
provide proxies when writing up. However, such a stripping of identifiable information may not
always be possible to anticipate at the outset of your dissertation when thinking about issues of
research ethics. This is not only a consideration for dissertations following a qualitative research
design, but also a quantitative research design.
Forexample:
Imagine that your dissertation used a quantitative research design and a survey as your
main research method. In the process of analyzing your data, it is possible that when examining
relationships between variables (i.e., questions in your survey), a person's identity and responses
could be inferred. For instance, imagine that you were comparing responses amongst employees
within an organization based on specific age groups. There may only be a small group (or just
one employee) within a particular age group (e.g., over 70 years old), which could enable others
to identify the responses of this individual (or small group of employees).Therefore, you need to
consider ways of overcoming such problems, such as: (a) aggregating data in tables
and (b) setting rules that ensure a minimum number of units are present before data/information
can be presented.
A further alternative is to seek permission for access to data and analysis to be restricted to the
published material, perhaps only allowing it to be viewed by those individuals marking your
work. If the work is later published, adjustments would then need to be made to protect the
confidentiality of participants.
There are also a wide range of potential legal protections that may affect what research you can
and cannot perform, how you must treated the data of research participants, and so forth. In
other words, you don‘t simply have a duty to protect the data you collect from participants; you
may also have (in some cases) a legal responsibility to do so. Since this varies from country-to-
country, you should ask your dissertation supervisor or Ethics Committee for advice (or a legal
professional).
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At first sight, deceptive practices fly in the face of informed consent. After all, how can
participants know (a) that they are taking part in research and (b) what the research requires of
them if they are being deceived? This is part of what makes the use of deceptive practices
controversial. For this reason, in most circumstances, dissertation research should avoid any
kinds of deceptive practices. However, this is not always the case.
It is not feasible to let everyone in a particular research setting know what you are doing.
Overt observation or knowledge of the purpose of the research may alter the particular
phenomenon that is being studied.
It is not feasible to let everyone in a particular research setting know what you are doing
By feasibility, we are not talking about the cost of doing research. Instead, we mean that it is
not practically possible to let everyone in a particular research setting know what you are doing.
This is most likely to be the case where research involves observation, rather than direct
contact with participants, especially in a public or online setting. There are a number of obvious
instances where this may be the case:
Clearly, in these cases, where individuals are coming and going, it may simply be impossible to
let everyone know what you are doing. You may not be intentionally trying to engage
in deceptive practices, but clearly participants are not giving you their informed consent.
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Overt observation or knowledge of the purpose of the research may alter the particular
phenomenon that is being studied
Where observations or a participant? Knowledge of the true purpose of the research have the
potential to alter the particular phenomenon that you are interested in, this is a major concern in
terms of the quality of your findings.
Therefore, when you think about whether to engage in covert research and possibly deceptive
practices, you should think about the extent to which this could be beneficial in your
dissertation, not research in general; that is, everything from the research paradigm that guides
your dissertation through to the data analysis techniques you choose affect issues of research
ethics in your dissertation.
With the exception of those instances of covert observation where is not feasible to let everyone
that is being observed know what you are doing, research participants should always have
the right to withdraw from the research process. Furthermore, participants should have the right
to withdraw at any stage in the research process. When a participant chooses to withdraw from
the research process, they should not be pressured or coerced in any way to try and stop them
from withdrawing.
If your supervisor and/or Ethics Committee expect you to complete an Ethics Consent Form, it
is likely that you will have to let participants know that they have the right to withdraw at any
time
They support important social and moral values, such as the principle of doing no harm
to others.
Plagiarism is the most common issue that every academic writer faces while writing
their research paper or dissertation. The famous plagiarism checking tools such
as Duplichecker and Turnitin are classifying the plagiarisms into 10 common types
before generating the report. In this article, we are going to find out the 10 types of
1. “Clone” – Plagiarism
Cloning plagiarism is also called identical copying. In Cloning, one person copies
another work (word-for-word) without any change and claim as his own work.
2. “Remix” – Plagiarism
In the remix type of plagiarism, one person collects information from various sources
and mix all together as a single document then claim the work as their own work.
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3. “Ctrl+C” – Plagiarism
In the written document a significant portion of text copied from any single source
4. “Hybrid” – Plagiarism
In the hybrid type of plagiarism, perfectly cited source documents are copied and
5. “Find-Replace” – Plagiarism
Changing the most common keywords and phrases in the copied content and not
making any changes in the essential document is called “Find and Replace” – kind of
plagiarism.
6. “Recycle” – Plagiarism
Recycle is also called self-plagiarism. It refers to the act of borrowing from one’s own
7. “Mashup” – Plagiarism
When the written document is copied from more than one source and all are mixed
together without any proper citation then it is called mashup kind of plagiarism
“404 Error” – plagiarism is the eighth most important type. In this, a person creates a
document by copying from various sources and prepare as a single document with the
citation. but if the citation is inaccurate or it will lead to non-existing resources then it
9. “Aggregator” – Plagiarism
In this type of plagiarism, the written document includes all the proper citation but it
Read and understand the original document several times before start explaining
about it.
Give proper citation to all the sources (Books, Journal, Website, Video, and so on).
In case of citing online sources, Include the accessed date and appropriate URL in the
reference.
Common phrases and definition need to be quoted and cited without any
modification.
document.
Finally, take a plagiarism report from any one of the famous plagiarism software to
Hope, this will help academic writers to know about the 10 common types of
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