School of Nursing and Midwifery

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Although it may appear strange, it is possible to plagiarise your own work! This occurs if students use material submitted for one assignment in a later piece of assessed work. It is, of course, possible that materials and sources you use for one programme of study or module will be relevant for a later piece of written work, and it is quite proper for you to look up those citations and any notes you made previously. However, what you hand in for the later assignment should still be an original piece of work and not a “cut and paste” from your former assignment.

Researching an Assignment

You have access to a considerable range of literature when preparing an assignment. In addition to the more traditional format of textbooks and academic journals, in the last ten years, novel electronic forms, such as the internet and e-journals have arrived on the scene. For recent events, you may also wish to use daily and Sunday newspapers, such as The Guardian and The Independent. Use and citation of web-pages is now perfectly acceptable. Indeed web pages are often the prime source of information about new developments from government bodies, such as the Department of Health, or professional organisations like the General Medical Council. However, when using “factual” material from a website, you must try to evaluate their content and think carefully about who runs the website and whether they are trying to put across a biased viewpoint.
This tutorial provides examples of correct use of citation and quotation, leading to a short written exercise, designed to help you avoid writing plagiarised text.

Good Citation Practice

In many assignments you need to develop an argument to answer a question. It is not sufficient to support your reasoning with “in my opinion” or “the popular view is”. You will usually bring in information from published sources. You should think critically about such material, and not accept everything that is published as “the Truth.” Even experts differ in their opinions on questions like:
“What are the best tools for assessing pressure risk?” or “Does evidence based practice have an impact upon patient outcomes ?”
While we will not expect you to provide conclusive answers to such questions, you will need to consider different, and possibly even contradictory, views. In some cases you may find that two conflicting articles quote rigorous original data to support their claims. You will need to evaluate and critically appraise these various views, and use them to write a reasoned argument. You may conclude that there is, indeed, no overall agreement, or that there are various answers, and conflicting evidence!
However, you need to make it clear from where your ideas and evidence originate. You do this by using citations in the text. Each citation must have a full reference at the end of your essay. This reference must be detailed enough for whoever is marking your essay to go and find the source if they wish to. There are two main ways to organise citations and references: if you read the British Medical Journal, you will see it uses a system of numbers in the text (the Vancouver referencing system). This system does have one disadvantage: if you add a new reference or change the order of your text, you need to renumber all the references! All School of Nursing and Midwifery courses use the Harvard system, where the citation in the text of your essay includes the author and the date, with all references in alphabetical order at the end. The recommended manner in which this should be used can be found in your programme handbook
The following examples describe situations where you should use a citation to acknowledge your sources:
1. You might use a citation to summarise the overall argument of a paper or even a book, where you do not need to invoke great detail:
In addition to the widely known links between lifestyle and heart disease, some authors have developed theories about the affects of poor nutrition in the womb on later adult cardio-vascular health (Barker, 1995).

2. You may wish to provide a source for a specific concept or idea:
We have known for many years that cigarette smoking is an independent risk factor for coronary artery disease, and analysis of subjects in the Framingham study, suggests that this may be due to the higher levels of plasma fibrinogen found in current, but not ex-smokers (Kannel et al., 1987).
3. You may wish to contrast two or more interpretations of primary data, a natural phenomenon or a social trend:
There has recently been a debate about the widespread use of low dose aspirin, except in those with a history of drug allergy or gastro-intestinal bleeding, as a preventative strategy in cardiovascular disease. Some authors feel that because of the problems of screening the whole population for risk factors, and based on current risk-benefit analyses, there is good evidence for offering all people aspirin therapy from about the age of fifty years (Elwood et al., 2005). But others argue that the data is inconclusive (and in fact completely lacking for those over 70), and that aspirin use should be targeted at those with other risk factors for vascular disease, rather than given as “blanket therapy” (Baigent, 2005).

4. You may wish to cite specific figures to support an argument you are developing, such as five year survival rates for cancer, or incidence rates for infectious diseases:

Although incidence of tuberculosis in England and Wales as a whole runs at about 10.9 per 100,000 population, in inner city areas with many immigrants, it may be much higher: in Leicester city, the 1998 notification rates were 152 per 100,000 (Watson and Moss, 2001).

Effective Use of Quotations

Citations link ideas expressed in your own words with the sources from which you have developed those ideas. In some places, however, you may wish to include small blocks of text verbatim (that is, word for word), from a source into your essay, keeping the author’s exact original language. Such direct quotations can be very useful, but should be used judiciously and sparingly: only a small part of your assignment, and certainly not more that 10% of the word count, should come in such form.
Only a few limited situations (e.g. Statute Law) justify more extensive verbatim quotation. Generally, the citation for a quotation should be more precise than for a summary, and must include either a page or paragraph number from the original source.
Examples where you might legitimately use a direct quotation are:
1. Where you wish to use an official definition, to clarify exactly what you mean by a technical term:
The original working definition for Clinical Governance was:

A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. (Dept of Health, 1998, p.33)
2. You may wish to use a short section from a classical or landmark paper, now regarded as a pivotal publication in the evolution of a concept:
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence. (Sackett at al., 1996 p. 71)
3. You may wish to preserve the wit or humour of the original prose, where re-wording would destroy these, such as the following comment by the American satirist and journalist HL Mencken:
The aim of medicine is surely not to make men virtuous: it is to safeguard and rescue them from the consequences of their vices (Daintith and Isaacs, 1990, p.128).
4. You may use direct quotations to show the diversity of views on a particular subject, and then go on to compare and critique such extremes:
In terms of quality, building up clinician-patient relationships through continuity of care is widely regarded as good practice, but to front line doctors:

continuity of care in general practice is a dying concept, while for consultants in hospital it has probably not existed for some time (Bulstrode, 1995, p.1144).
You will note that in all these cases, the quotation makes it clear which words come directly from the original source by indenting them and using italic font. For shorter phrases, you could also place the quotation in inverted commas:
An alternative to the evidence-based medicine school of thought is the concept of giving patients a greater voice, through the practice of “narrative-based medicine” (Greenhalgh and Hurwitz 1999, p.48)

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