This study showed that most participants (89.1%) had done at least one clinical dishonest behavior. This is less than the rate reported in a Korean (66%) ]13[ and an American (54%) ]10[ studies. Although the number of dishonest clinical behaviors reported in those studies was 10. In the study conducted by Schneider and McClung, 96% of nursing students were involved in at least one academic or clinical dishonest behavior ]14[.
The results of the present study showed that the most commonly performed dishonest clinical behaviors were the most commonly witnessed ones, which were “discussing patients in public places or with nonmedical personnel” and :recording or reporting vital signs that had not been taken or recalled accurately”. According to Bandura's social learning theory]20[, observing the behavior of others (peers in this study) can lead to engaging in that behavior.
The least frequency of dishonest behavior was related to giving the wrong drug without reporting it. Also, the results revealed that the mean score of students' perceptions of dishonest behavior related to drug therapy (items 10 and 11) was higher than other items. Furthermore, it was found that students were more likely to be sensitive to behaviors that have a direct impact on patients’ health and did not engage in such unethical behaviors due to fear of the health consequences for the patient and educational and legal consequences for themselves. However, they did not think talking about the patient in public places and recording inaccurate vital signs could be dangerous to the patient or could be considered a sign of immorality.
In addition, the results showed that the mean frequency of clinical dishonesty was significantly lower in females. This result is consistent with the findings of Krueger  and Amini et al ]21[ but contradicts with the findings of Park et al ]13[.
According to the results, the frequency of clinical dishonesty was related to being interested in nursing; thus, the frequency of these behaviors in students who chose "interested" and "somewhat interested" was less than of those chose "uninterested". Also, a study found that students who were satisfied with nursing were likely to have higher ethical awareness, be more faithful to their discipline and its ethics, and exhibit less dishonest behaviors ]22[. In Iran, students choose their field of study based on their scores on the National Entrance Exam. Thus, sometimes, they just want to become a university student, regardless of their interest, or they select nursing for its relatively good job market. Considering the importance of the nursing profession and its impact on the health of the community, it is recommended that nursing students be interviewed to ensure that they are interested in their field of study to prevent the entry of uninterested persons into nursing schools.
Also, the highest frequency of clinical dishonesty was observed among fourth-year students, which could be related to their more presence in the clinical setting, more workload, and less supervision by instructors. In the Iranian Nursing Curriculum, only senior students attend internships, do not have theoretical units, and are in the clinical setting almost 7 days a week. Krueger found that an increase in clinical work time was also associated with an increase in clinical dishonesty ]10[. Park et al also reported more dishonest clinical behaviors among senior students]13[.
According to the results of the present study, the age and GPA of students were not correlated with the frequency of their dishonest behaviors, which is in line with other studies]10, 13, 23[. Moreover, the results showed that witnessing clinical dishonesty had a significant positive relationship with dishonest clinical performance. That is, the more people witness their coworkers' unethical behavior, the more they do it. This result confirms Bandura's social learning theory.
The results of this study showed that the frequency of dishonest behavior was inversely correlated with its perceived severity as unethical behavior, indicating that nursing students' behaviors in the clinical setting are influenced by their beliefs and faiths. This can be promising for nursing educators and administrators, because it seems that by educating students about professional ethics can reduce their dishonest and unethical behaviors. Park et al found that perceived severity of fraudulent behaviors was predictive of classroom cheating ]13[, but it was not associated with clinical dishonesty ]13[.
The results of the present study demonstrated that the higher the perceived stress score in the clinical setting, the greater the frequency of clinical dishonesty. Nursing students may use academic dishonesty as a coping strategy to reduce stress]24[. People who engage in these behaviors are not morally troubled, but external factors and pressures, rather than the intrinsic nature of the individual, are the main reasons behind their dishonest behavior. Factors such as fear of failures, inefficiencies in clinical practice, competition with peers, and excessive expectations of educators lead to stress in nursing students ]24-26[, which can be the source of dishonest behavior. Since negative coping strategies lead to increased stress, nursing students should be educated on effective coping strategies to cope with clinical stresses.