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Evidence-based practice in nursing

Evidence-based practice in nursing

Introduction

Evidence-based practice in nursing. Evidence-based practice involves finding the best research evidence to support an intervention, which is integrated with patient preferences and values and professional expertise, and then implemented. Once you have searched and found relevant and timely research studies, the next step is to evaluate the quality of their methods, design, and other elements and to explore the application of the evidence they provide in different scenarios and settings. It is of paramount importance to correctly identify the type of research methods used in the study—quantitative or qualitative, or a mixture of both—and to evaluate the study to ensure those methods are high-quality, valid, reliable, and accurate. Consequently, doctoral professionals must develop a working knowledge of how to identify and critically appraise specific, important elements of both quantitative and qualitative research studies. Rapid critical appraisal tools assist in developing this skill.

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Preparation

  • Review the media pieces in Weeks 1–3, focusing on the EBP process, the PICO(T) process, and the important step of critically appraising research evidence.
  • Review the following two quantitative and qualitative studies. You will describe the key elements of each study and complete a critical appraisal of each.
  • Locate the following tools, found in Appendix B in your Evidence-based practice in nursing and healthcare textbook. You will use these tools to complete the appropriate rapid critical appraisal for each study. Choose the tool that matches the methods and design of each study.
    • Rapid Critical Appraisal Questions for Randomized Controlled Trials (RCTs), page 711.
    • Rapid Critical Appraisal Questions for Qualitative Evidence, pages 715–716.

Note: Remember that you can submit all or a portion of your completed executive summary and both general overviews and critical appraisals to Smarthinking for feedback before you submit the final version for this assignment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

Instructions

Write a paper in which you:

  • Describe the key elements of a research study.
  • Complete a rapid critical appraisal of each study.
  • Write an executive summary that compares the two studies.
Document Format and Length

Your document should be 4–5 pages in length, including the overviews, rapid critical appraisals, and executive summary.

Supporting Evidence

Include at least two resources, other than the course textbook, to support your critical appraisals. Provide in-text citations and references in APA format for each study, the critical appraisal tools, and other resources used.

Assignment Grading

The following requirements correspond to the scoring guide criteria, so be sure to address each point. Read the performance-level descriptions in the scoring guide for each criterion to see how your work will be assessed.

  • Describe the key elements of a research study.
    • Include the study’s purpose, methods, design, results, and any other aspects of the study you think are noteworthy.
    • Consider how the study contributes to the scholarly literature.
  • Evaluate the quality of each study, using the appropriate rapid critical appraisal tool (RCA).
    • Create a table or other organized format for your answers to the questions on the RCA tool for each study.
    • What evidence supports your assertions and conclusions?
  • Compare a qualitative and quantitative study’s quality, significance, and the practical application of results (evidence) in a health care setting.
    • Consider the following questions to guide the comparison of these studies in your executive summary:
      • Which study provides the best overall evidence? What elements in the study led you to this conclusion?
      • Which study provides subjective information that could be integrated to make positive changes to services, processes, systems, or patient care?
      • What is the significance of each study’s results in a hospital setting? How do the results affect patients?
      • How could the evidence found in each study be applied in different health care settings? In the overall health care industry?
  • Support main points, assertions, arguments, or conclusions with relevant and credible evidence.

Nurse client relationships

Discussion Question: Nurse client relationships

Margaret Newman stated, the nurse and client become partners in living through the period of disharmony and emerging at a higher level of consciousness, the nurse client relationships often begin during periods of disruption, uncertainty, and unpredictability in patient’s lives.  Explore what she means by this statement. Then, reflect on a patient that you cared for that you could apply her theory to. Provide details of the interaction and outcomes.

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Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.

Assignment:

Leininger and Watson

Write a 1500-1750 word APA paper addressing each of the following points. Be sure to completely answer all the questions for each bullet point. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least two (2) sources and the textbook using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Case study #1

Mrs. Franklin-Jones was admitted from the Emergency Room to Cardiac Intensive Care one week ago with a diagnosis of acute myocardial infarction. She has recovered as expected and is moving to the cardiac step down unit today. She is talking with Nurse Julie Hernandez, as she gets settled in her new room, “I was really surprised when I got that bad pain in my chest! I knew I had high pressure but I just didn’t think it was that bad. I try to take my medicine like they told me to in the clinic but sometimes I forget. I guess that I need to study those papers they gave me about what foods I should eat and not eat. I better take care of myself! Momma had bad pressure and it killed her! Who knows—I may even have to learn to cook different than I was taught in Jamaica! I may have to let Tomas do the cooking. He’s got more time at home now than I do since he lost his job. There isn’t too much time between my shifts at the school cafeteria and my new housecleaning job. You know my sister is coming up from Jamaica to see me. I think she is bringing me some bush tea. That’ll set me right!”

  • Using Leininger’s Culture Care Model, what factors in the story shared by Mrs. Franklin-Jones should be considered by Nurse Hernandez when planning for the patient’s discharge?
  • Why is the theory of Culture Care Diversity important in the delivery of nursing care for all patients?
  • Using Leininger’s Theory of Culture Care Diversity and Universality, develop a plan of care for Mrs. Franklin-Jones.
  • Discuss the strengths and limits to Leininger’s Theory.

Case Study #2

Claude Jean-Baptiste is recovering from post-hip replacement surgery and has been transferred to the Rehabilitation Institute adjacent to the hospital. When he enters the unit, he sees welcoming signs written in several languages including his own, Creole. Since there are no nurses on that shift that speak Creole, they use a language line to ask for translation services. During this initial nursing assessment, the translator informs Mr. Jean-Baptiste that the nurses invite him to have a relative at his side so that they can be sure to understand and meet his needs. He is asked about Haitian customs and beliefs that they might honor. Mr. Jean-Baptiste is encouraged to bring food and spiritual care items, and to share the warmth of his culture with the nursing staff.

  • Discuss assumptions of the Transpersonal Caring relationship. What is the nurse’s role?
  • How is love, as defined by Watson, evident in this caring moment?
  • How can the nurse creatively use self to create a healing environment?
  • Discuss the strengths and limits to Watson’s Theory.

Assignment Expectations:

Length: 1500 – 1750 words

Structure: Include a title page and reference page in APA format.  These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) outside scholarly sources and the textbook are required for this assignment.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Assignment sample 2

Write 5 pages thesis on the topic oklahoma city bombing

The magnitude of the blast can be estimated by the number of explosives in the van which was approximately 4800 pounds of destructive chemicals and a number of 168 people lost their lives, while thousands of other people were injured or moaning over their losses (Sherrow 6). Out of the 168 souls lost, 19 of them were children (The Federal Bureau of Investigation). Oklahoma City bombing was the most intense and serious case of domestic terrorism and demanded a thorough investigation and reporting regarding the reasons and factors which led to the upsetting incident.

According to reports, the bombing was planned by an ex-Army soldier and security guard, Timothy McVeigh. On the morning of the bombing, he loaded his truck with explosives made from a combination of hazardous and destructive chemicals. He then drove his car to the federal building where he parked the car in front of the building with a clear intention to commit mass murder. He then left the spot in another car. At 9.02 am the bomb exploded, according to the planned time set by McVeigh. Within moments of the bomb explosion, most of the federal building was brought down into the gravel and the shock wave from the blast was so intense that more than 300 buildings nearby were also damaged or destroyed (The Federal Bureau of Investigation). According to scientists, as the bomb exploded, super hot gas went upward through the building at a gigantic speed of 8,000 feet per second. The force was so intense that people were slammed against the walls with a force of 37 tons. And when the gas evaporated, a vacuum was created which shook the ground as if there was a “full-scale earthquake” (Sherrow 6-7). Thus, the explosion was of massive intensity which not only affected the federal building but also the buildings located in its close vicinity.

In view of the World Trade Centre bombing two years back, the instant suspicion of the federal government was on the Middle Eastern terrorists

Practicum Professional Development Objectives

Section 2: Practicum Professional Development Objectives

Refer to the instructions in Week 1 to create practicum professional development objectives that meet the requirements for this course.

Objective 1: Analyze three common barriers to effective communication, then compare and contrast two effective resolution strategies as defined in evidence-based literature.

Objective 2: Contrast units that have success with retention and recruitment of novice nursing staff and those who have high turnover; identifying factors of influence and comparing to peer reviewed literature.

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Assignment 1:
Practicum Professional Experience Plan (PPEP)Success comes from knowing that you did your best to become the best that you are capable of becoming.
— John Wooden, My Personal Best: Life Lessons from an All-American JourneyAs you considered in this week’s Discussion, your experiences in the practicum can provide a vital avenue for professional development.For this Assignment, you develop a Practicum Professional Experience Plan (PPEP) to outline how your involvement in the practicum will contribute to your growth as a professional and allow you to hone your specialization knowledge and skills. The PPEP consists of two or three objectives related to professional development that you will address during your Practicum Experience.Note: In the practicum manual these are referred to as your individualized learning objectives.To prepare:As necessary, review the information related to developing objectives provided in this week’s Learning Resources.Revisit the objective(s) you crafted for this week’s Discussion, and reflect on the ideas exchanged in this forum. Refine the objective(s) as needed, making sure they reflect the higher-order domains of Bloom’s Taxonomy (i.e., Application level and above). Note: You will be developing two to three professional development objectives for this assignment.Think more deeply about areas for which you would like to gain application-level experience and/or continued professional growth. How can your experiences in the practicum help you achieve these aims?Discuss your professional aims and your proposed practicum professional development objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.Download and save the Practicum Professional Experience Plan Form provided in this week’s Learning Resources.

To complete your Practicum Professional Experience Plan:Record the required information in each area of the Professional Practicum Experience Plan, including two or three objectives you will use to facilitate your professional development during the practicum.

Objective 3: Develop and prioritize a one-month productivity expense report that will be used to budget upcoming expenditures and incorporate a balanced unit financial statement in accordance with previous budgets and evidence based literature.

Resources

Cipriano, P. F., & Murphy, J. (2011). The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 286–289.
Note: Retrieved from the Walden Library databases. “Technology tools will continue to revolutionize how we plan, deliver, document, review, evaluate, and derive the evidence about care” (p. 289). This article examines how nurses can use information technology to transform nursing and redesign the health care system. It focuses on the use of technology to promote quality and notes that technology can also be used to address challenges in education, research, leadership, and policy.McKimm, J., & Swanwick, T. (2009). Setting learning objectives. British Journal of Hospital Medicine, 70(7), 406–409.
Note: Retrieved from the Walden Library databases. This article clarifies the terminology associated with learning objectives and explains how learning objectives relate to professional development and the transformation from novice to expert. It also introduces common pitfalls when setting learning objectives and provides suggestions for avoiding them.Murphy, J. (2011). The nursing informatics workforce: Who are they and what do they do? Nursing Economic$, 29(3), 150–153.
Note: Retrieved from the Walden Library databases. The author examines the nursing informatics workforce, explaining that professionals in this well-established specialty area can play an integral role in transforming health care.Sørensen, E. E., Delmar, C., & Pedersen, B. D. (2011). Leading nurses in dire straits: Head nurses’ navigation between nursing and leadership roles. Journal of Nursing Management, 19(4), 421–430.
Note: Retrieved from the Walden Library databases. “Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity” (p. 421). In this article, the authors examine how individuals in key professional roles negotiate between and apply nursing and leadership skills.

Case Study On Death And Dying

The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and acceptance of a diversity of faith expressions.

The purpose of this paper is to complete a comparative ethical analysis of George’s situation and decision from the perspective of two worldviews or religions: Christianity and a second religion of your choosing. For the second faith, choose a faith that is unfamiliar to you. Examples of faiths to choose from include Sikh, Baha’i, Buddhism, Shintoism, etc.

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In your comparative analysis, address all of the worldview questions in detail for Christianity and your selected faith. Once you have outlined the worldview of each religion, begin your ethical analysis from each perspective.

In a minimum of 2,000 words, provide an ethical analysis based upon the different belief systems, reinforcing major themes with insights gained from your research, and answering the following questions based on the research:

How would each religion interpret the nature of George’s malady and suffering? Is there a “why” to his disease and suffering? (i.e., is there a reason for why George is ill, beyond the reality of physical malady?)
In George’s analysis of his own life, how would each religion think about the value of his life as a person, and value of his life with ALS?
What sorts of values and considerations would each religion focus on in deliberating about whether or not George should opt for euthanasia?
Given the above, what options would be morally justified under each religion for George and why?
Finally, present and defend your own view.
Support your position by referencing from lectures, the Bible, and the textbooks for each religion. Each religion must have a primary source included.

A total of six references are required according to the specifications listed above. Incorporate the research into your writing in an appropriate, scholarly manner.

Prepare this assignment according to the guidelines found in the APA Style Guide

NO PLAGIARISM PLEASE

Assignment 2

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest. It is important that the community selected be one in which a CLC group member currently resides. Students residing in the chosen community should be assigned to perform the physical assessment of the community.

  1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
  2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype. Complete the “Provider Interview Acknowledgement Form” and submit with the group presentation.

Develop one set of interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.

Compile key findings from the interview, including the interview questions used, and submit with the group presentation.

PowerPoint Presentation

Within your group, create a PowerPoint presentation of 15-20 slides (slide count does not include title and reference slide) describing the chosen community interest.

Include the following in your presentation:

  1. Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level, ethnic, and phenomenological features of the community as well as types of social interactions, common goals and interests, barriers, and challenges, including any identified social determinates of health.
  2. Summary of community assessment: (a) funding sources and (b) partnerships.
  3. Summary of interview with community health/public health provider.
  4. Identification of an issue that is lacking or an opportunity for health promotion. The issue identified can be used for the Community Teaching Plan: Community Teaching Work Plan Proposal assignment.
  5. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.

In addition to submitting this assignment in the LoudCloud dropbox, email a copy of your submission to RNBSNclientcare@gcu.edu.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

When submitting this assignment, include the interview questions, the interview findings, completed “Provider Interview Acknowledgement Form,” and the community assessment PPT presentation.

NRS-427V.R.ProviderInterviewAcknowledgementForm_10-14-13.doc NRS427V.R.FunctionalHealthPatternsCommAssessment_Student_10-14-13.doc

Diary Of Medical Mission Trip

Throughout this course, you have viewed the “Diary of Medical Mission Trip” videos dealing with the catastrophic earthquake in Haiti in 2010. Reflect on this natural disaster by answering the following questions:

  1.  Propose one example of a nursing intervention related to the disaster from each of the following levels: primary prevention, secondary prevention, and tertiary prevention. Provide innovative examples that have not been discussed by a previous student.
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  3. Under which phase of the disaster do the three proposed interventions fall? Explain why you chose that phase.
  4. With what people or agencies would you work in facilitating the proposed interventions and why?

Link to the “Diary of Medical Mission Trip” videos:

http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs427v_nrs427v.php

Assignment 2

Part 1. The Systems Development Life Cycle for Implementation

In a 2-page narrative, address the following:

Explain each step of the systems development life cycle (SDLC) for a nursing informatics project. (1 page)

Explain why nurse leaders should be involved in each step of the SDLC by identifying at least two ways that nurse leaders can contribute to best practices for implementation of nursing informatics projects. Be specific and provide examples. (1 page)
Part 2. Job and Role Description of the Nurse in Systems Development and Implementation

Develop a 1- to 2-page job and role description for a graduate level nurse to guide his/her participation on the implementation team for a new nursing documentation system. The job and role description should be based on the systems development life cycle (SDLC) stages and tasks, and should clearly define how this individual will participate in and impact each of the steps.

Define the role of the nurse in the planning and defining requirements stage of the SDLC. (1–2 paragraphs)
Define the role of the nurse in the analysis stage of the SDLC. (1–2 paragraphs)
Define the role of the nurse in the design of the new system stage of the SDLC. (1–2 paragraphs)
Define the role of the nurse in the implementation stage of the SDLC. (1–2 paragraphs)
Define the role of the nurse in the testing and maintenance stages of the SLDC. (1–2 paragraphs)

Nursing case study analysis

Nursing case study analysis

Question 1 A patient asks the nurse practitioner about food sources such as soybeans and soy products. The nurse practitioner understands that these foods are considered

A) phytoestrogens.

B) monotherapy.

C) taboo.

D) inappropriate

Question 2 A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to

A) the mother regarding why the boy needs to take the medications.

B) both the boy and his mother regarding all medication issued.

C) the boy by telling him not to worry about the medications and to take them as directed

D) The mother and be sure to reinforce the need to force the medications, if her sondoes not want to take them

Question 3 A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?

A) Cardiac dysrhythmia
B) Hypertensive crisis
C) Nephrotoxicity
D) Hypokalemia

Question 4 A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should

A) cool the medication prior to administration.
B) use sterile technique when applying the medication.
C) allow the child to apply the medication if possible.
D) use clean technique only when applying the medication.

Question 5 A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is

A) a hepatotoxic response.
B) an idiosyncratic response.
C) a paradoxical response.
D) an allergic response.

Question 6 A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the

A) deltoid muscle.
B) rectus femoris muscle.
C) ventrogluteal muscle.
D) dorsogluteal muscle.

Question 7 A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects

A) breast cancer

B) PMS

C) pain in the heart

D) cancerous breast tenderness

Question 8 A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of

A) alcohol.
B) trans fat.
C) caffeine.
D) grapefruit juice.

Question 9 A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?

A) Renal function
B) Hepatic function
C) Respiratory function
D) Cardiac function

Question 10 A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.

A) Monophasic

B) Triphasic OC

C) Ortho Tri-Cyclen

D) Biphasic OC

Question 11 A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem?

A) Anxiety
B) Respiratory depression
C) Obesity
D) ADHD

Question 12 A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using

A) body surface area.
B) weight.
C) age in months.
D) age in years.

Question 13 A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?

A) Decreased myocardial contraction
B) Decreased heart rate
C) Increased cardiac conduction
D) Increased intranodal conduction time

Question 14 A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?

A) That the infant’s skin has greater permeability than that of an adult
B) That there is less body surface area to be concerned about
C) That there is decreased absorption rates of topical drugs in infants
D) That there is a lower concentration of water in an infant’s body compared with an adult

Question 15 A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?

A) “I walk two blocks to school every day.”
B) “I am on the middle school track team.”
C) “We live in a two-story house.”
D) “My mother is going to give me my insulin.”

Question 16 A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to

A) the inability of infants and children and describe symptoms of adverse drug reactions.
B) increased body surface area relative to body volume in infants and children.
C) increased heart rate and subsequently rapid drug distribution among infants and children.
D) immature liver and kidney function in infants and children.

Question 17 A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication

A) for 20 days.

B) once a day.

C) every day until the infection is gone.

D) for 30 days.

Question 18 To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?

A) A preterm neonate who has apnea
B) A 34-year-old woman with a diagnosis of gastric ulcerations
C) A school-age child with severe ADHD
D) A 52-year-old man with narcolepsy

Question 19 A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?

A) A 38-year-old Caucasian woman with glaucoma
B) A 60-year-old African-American man who experiences angina
C) A 48-year-old Caucasian man who has adult-onset diabetes
D) A 28-year-old African-American woman with hyperthyroidism

Question 20 A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should

A) teach the boy about the fact that he will feel much better after he takes his medications.
B) have the mother hold the child firmly and sooth him while the drugs are administered.
C) offer a choice between liquid and chewable medications, if possible.
D) insert a central intravenous line.

Question 21 The recommended treatment for trichomoniasis is

A) Flagyl.

B) Diflucan.

C) Meclizine.

D) Amoxicillan

Question 22 A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?

A) “Most people don’t know that marijuana can be just as addictive as heroin or cocaine over time.”
B) “Marijuana can easily interact with other drugs and cause potentially fatal reactions.”
C) “Every year, thousands of Americans end up in emergency departments with marijuana overdoses.”
D) “Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes.”

Question 23 A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops

A) at the back of the mouth.
B) in the buccal pouch.
C) under the tongue.
D) on top of the tongue.

Question 24 A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an

A) electrocardiogram (ECG).
B) electromyelogram (EMG).
C) electroencephalogram (EEG).
D) electrophysiologic study (EPS).

Question 25 A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be

A) height and weight.
B) Vision.
C) body temperature.
D) blood pressure.

Question 26 A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause

A) orange-tinged urine.
B) staining of permanent teeth.
C) sleep deprivation.
D) deep muscle pain.

Question 27 A nurse is administering drugs to a 10-year-old child who has multiple health problems.The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)

A) Age
B) Weight
C) Disease process
D) Diet
E) Route of administration

ACDE

Question 28 The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?

A) Having nurses check their math calculations with a colleague before administering a drug.
B) Ensuring that a full assessment takes place no more than 30 minutes before giving a drug.
C) Recording drug administration in both the nurse’s notes and the medication administration record (MAR)
D) Avoiding intravenous administration of drugs whenever possible.

Question 29 A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?

A) “Do you ever use alcohol or drugs?”
B) “How much do you weigh?”
C) “On a scale of zero to ten, what level of pain is acceptable to you?”
D) “Did Tylenol or other over-the-counter pain remedies ever relieve your pain?”

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Question 30 A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. The nurse will inform the patient that during sibutramine therapy she should

A) abstain from sex.
B) obtain a pap smear .
C) use adequate contraception.
D) take a pregnancy test every month.

Question 31 A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?

A) Take the drug on a full stomach
B) Avoid high noise levels
C) Take the drug for one full week before coming in contact with allergens
D) Drink plenty of fluids.

Question 32 A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis.The nurse practitioner is aware that

A) trichomoniasis is an incurable disease.

B) trichomoniasis discharge is typically thin and clear.

C) asymptomatic women are diagnosed with trichomoniasis by a routine pap smear.

D) it is unusual to have an odor with trichomoniasis

Question 33 A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?

A) The mother and grandmother’s understanding about the drugs
B) How clean the house is
C) The health status of the other children
D) Where the medications will be stored

Question 34 A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should

A) have the parent gently force the child’s mouth open.
B) give the drug in a pill form.
C) involve the child in a play therapy session, and then tell the child that the medicine is candy.
D) offer the child a flavored ice chip or ice pop prior to administering the drug.

Question 35 A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy.These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?

A) Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity
B) Impaired maternal nutrition as a result of drug use
C) Vasoconstriction leading to reduced placental blood flow
D) Hypoxia as a result of a prolonged second stage of labor

Question 36 A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following?

A) Bloody stools
B) Bradycardia
C) Constipation
D) Hypoglycemia

Question 37 A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient?

A) “Take this drug once each day on an empty stomach.”
B) “It’s best to take a dose of sibutramine after each meal.”
C) “This drug will help you to lose weight without having to exercise or change your normal diet.”
D) “Take a dose when you feel like you are tempted to binge on food.”

Question 38 A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?

A) 1000 mg

B) 2000 mg

C) 3000 mg

D) 4000 mg

Question 39 A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?

A) A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects.
B) A child’s gastric pH is decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects.
C) A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.
D) A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.

Question 40 An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis.Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation?

A) Caregiver Role Strain
B) Ineffective Family Therapeutic Regimen Management
C) Delayed Growth and Development
D) Knowledge Deficit

Write an essay on nursing informatics

Please Check the Competencies: Write an essay on nursing informatics

Overview

 

Write 3–5 pages in which you describe a nursing informatics best practices policy for effective and safe data use in a nursing practice setting or organization.

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By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 2: Identify strategies and best practices for using informatics in nursing and health care.
    • Describe the best practices needed to promote and support data security.
    • Describe the ethical standards needed to promote patient confidentiality.
    • Describe regulatory requirements that promote and support positive patient outcomes related to a specific population.
    • Describe the types of behaviors and skills nurse leaders need to guide the use of information technology and research for improved patient-care outcomes.
  • Competency 4: Communicate in a manner that is consistent with expectations of a nursing professional.
    • Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics.

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

  • How do nurses develop best practice?
  • How does research support best practice?
  • What are best practices in your organization that you think are exemplars for improving patient care?
  • What nursing roles should be in place to support the use of evidenced-based practice?
  • How would you describe the concept of meaningful use and technology adoption stages: electronic health records (EHR) incentive programs, and how does this fit within the context of best practice?
  • What are the main points to consider as you review The Health Insurance Portability and Accountability Act (HIPAA), and why is this best practice?
  • How does the Patient Safety and Quality Improvement Act (PSQIA) support patient safety and improved patient outcomes?

Assessment Instructions

 

Imagine an organization asks you to contribute to the development of an information system best-practices policy to help maintain patient safety and patient confidentiality in their practice setting. The organization wants you to create a document to help the group better understand why an informatics policy is needed and the practices that should be included in the policy.

A nursing informatics best-practices document can serve multiple purposes, such as a handout for new-hire orientation or as a background report given to a committee tasked with creating or updating a nursing informatics best-practices policy.

Preparation

To expand your understanding of nursing informatics best practices within the industry, research the most current information about the topics of nursing best-practices documents and nursing informatics best practices.

Using different methods (Web search, for example), locate 4–6 scholarly articles related to best practices designed to support positive patient outcomes related to the following areas:

  • The meaning of secure data practices.
  • Ethical standards needed to promote and support data security.
  • Patient confidentiality.
  • Regulatory requirements.
  • Behaviors and skills nurse leaders need to guide the use of information technology and research for improved patient-care outcomes.

Directions

Create a description of a nursing informatics best-practices policy document designed to define and encourage effective and safe data use in a practice setting or organization.

  • Purpose Statement: Statement of why an organization would create the policy. Include any reasons and intent that supports the creation of an informatics best-practices policy.
  • Best Practices Definitions and Descriptions:
    • Definitions of secure practices, data security, and patient confidentiality.
    • Ethical standards.
    • Regulatory requirements.
  • Implementation:
    • Behaviors – describe the behaviors nurse leaders will need to demonstrate that will guide implementation of the policy.
    • Skills required – describe the skills needed to ensure policy adherence.

Format your document using the professional format and style (corporate identity) used in your organization or practice setting. Note: If you are not currently working in an organizational setting, follow the formatting instructions below.

Additional Requirements

  • Written communication: Ensure written communication is free of errors that detract from the overall message.
  • APA formatting: Format resources and citations according to current APA style and formatting guidelines.
  • Number of resources: Cite a minimum of four peer-reviewed resources.
  • Length: Submit 3–5 typed, double-spaced pages.
  • Font and font size: Use Times New Roman, 12 point.

Nursing ethics in clinical practice

Nursing ethics in clinical practice

The purpose of this task is to explore how nursing ethics, self-advocacy, and professional accountability can be applied in clinical practice. Using the provided case scenario, you will be required to think about how ethical concepts can be used to make clinical decisions and explore the differences in personal and professional beliefs. You will develop personalized stress management plans that rely on the use of adaptive coping strategies to ensure personal health and well-being.

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SCENARIO You have been working as a nurse in the adult oncology unit for the past year. You have developed a close relationship with many of your patients, but Mr. Newcomb has a special place in your heart. He has been diagnosed with stage 4 pancreatic cancer and has undergone aggressive chemotherapy. Each day his wife has come to the unit to be with her husband. They have been married for over 40 years and share a deep love.  Mr. and Mrs. Newcomb have made the decision to no longer continue with treatment and have decided that hospice care is needed. Over the past few days, you have watched Mr. Newcomb’s health decline, and you can tell from your experience that he does not have much time left to live. Mr. Newcomb has been very open about discussing his death, and you have had the opportunity to learn about his life and the legacy he will leave behind.  While you are completing your rounds, you stop in Mr. Newcomb’s room to see how he is doing. You ask, “Is there anything else I can do for you?” Mr. Newcomb has rarely asked for anything, but today he has one request. Mr. Newcomb states, “Before I die, I would like to see my mistress one more time. Mrs. Newcomb is always here. Do you think you could tell her that I will be busy for a few hours tomorrow so I can make arrangements to see my mistress one more time?”

Reflect on the following questions before you begin working on this task:

•   What would you do in this scenario?

•   How can your knowledge of ethical principles be utilized to determine your response to Mr. Newcomb?

•   How would this affect you as a nurse and direct provider of care for Mr. Newcomb?

REQUIREMENTS Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.     You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A.  Summarize how the principles of beneficence, non-maleficence, autonomy, and justice apply to the scenario by doing the following:

1.  Describe how you would respond to Mr. Newcomb’s request.

2.  Evaluate how you applied the principles of beneficence, non-maleficence, autonomy, and justice to the scenario.

3.  Examine how personal beliefs and values influenced your response to the scenario.

4.  Describe three strategies to promote self-care.

B.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

C.  Demonstrate professional communication in the content and presentation of your submission.

Attached is the submission of a previous student that was approved, please use this as a guide to the standard being sought.

Write my nursing essay

Write my nursing essay

As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.

With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.

In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.

To Prepare:

Review the Resources on healthcare policy and regulatory/legislative topics related to health and nursing informatics.
Consider the role of the nurse informaticist in relation to a healthcare organization’s compliance with various policies and regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA).
Research and select one health or nursing informatics policy (within the past 5 years) or regulation for further study.
The Assignment: (1 page)

Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:

Briefly and generally explain the policy or regulation you selected.
Address the impact of the policy or regulation you selected on system implementation.
Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.
Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.

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Discussion

1. Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

 

 

2. Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the Systems Development Life Cycle (SDLC) when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.

Shadow Health Reflection

Shadow Health Reflection

Advocacy Through Legislation

Nurses often become motivated to change aspects within the larger health care system based on their real-world experience. As such, many nurses take on an advocacy role to influence a change in regulations, policies, and laws that govern the larger health care system.

For this assignment, identify a problem or concern in your state, community, or organization that has the capacity for advocacy through legislation. Research the issue and use the “Advocacy Through Legislation” template to complete this assignment.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

AttachmentsNRS-440V-RS4-AdvocacyThroughLegislation.docx

Week 4 assignmet should be interesting for you. It is a form, but please, still follow APA rules for citations and references. PLease the form, it is attached to tasks under week 4. below is a copy of it so you can see what to expect. Think of an idea that needs changed, research the literature and what does the evidence say about this? Next, who can you talk to about it and how can you get funding? See below for the form questions, and yes there is a rubric.

My suggestion, work smart, not hard. The form is provided, so use it! Please remember to put your name on it, and save the doc with your inititals or name (please). As always, if any questions, please ask me!

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Problem

In no more than 250 words, describe the problem, who is affected, and the current ramifications. Explain the consequences if the issue continues.

Idea for Addressing Solution

In no more than 250 words, outline your idea for addressing the issue and explain why legislation is the best course for advocacy.

Research the Issue

Perform research and compile information for your idea. Present substantive evidence-based findings that support your idea for addressing the problem (studies, research, and reports). Include any similar legislation introduced or passed in other states.

Evidence 1

Literature review here

Evidence 2

 

Stakeholder Support

Discuss the stakeholders who would support the proposed idea and explain why they would be in support.

Stakeholder(s) Supporting 1

Stakeholder(s) Supporting 2

 

Stakeholder Opposition

Discuss the stakeholders who would oppose the proposed idea. Explain why they would be in opposition and how you would prepare to debate or converse about these considerations.

Stakeholder(s) Opposed 1

Stakeholder(s) Opposed 2

 

Financial Incentives/Costs

In no more than 250 words, summarize the financial impact for the issue and the idea (added costs, cost savings, increased revenue, etc.). Provided support.

Legislature: Information Needed and Process for Proposal

Discuss the how to advocate for your proposal using legislation. Include the following: give me names in your state

Provide the name and complete contact information for the legislator.

Describe the steps for how you would present this to your legislator.

Outline the process if your legislator chooses to introduce your idea as a bill to congress.

Christian Principles and Nursing Advocacy

In no more than 250 words, discuss how principles of a Christian worldview lend support to legislative advocacy in health care without bias. Be specific as to how these principles help advocate for inclusiveness and positive health outcomes for all populations, including those more vulnerable, without regard to gender, sexual orientation, culture, race, religion/belief, etc.

Advocacy Through Legislation

No of Criteria: 11 Achievement Levels: 5CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less Than Satisfactory75.00 %Satisfactory79.00 %Good89.00 %Excellent100.00 %Content100.0     Problem, Those Affected, Current Ramifications, and Consequences if Problem Continues15.0A description of the problem, those affected, current ramifications, and consequences if the issue continues is omitted.A partial or vague discussion of the problem, those affected, current ramifications, and consequences if the issue continues is presented. Why the problem would be best addressed through legislation is unclear.A summary of the problem, those affected, current ramifications, and consequences if the issue continues is presented. There are some omissions and inaccuracies. Rationale is needed.A discussion of the problem, those affected, current ramifications, and consequences if the issue continues is presented. Some rationale is needed.A well-develop discussion of the problem, those affected, current ramifications, and consequences if the issue continues is presented. Strong and compelling rationale is provided. Insight into the problem and consequences is demonstrated.Idea for Addressing Solution10.0Idea for addressing the issue and why legislation is the best course for advocacy is omitted.Idea for addressing the issue is vague. Why legislation is the best course for advocacy is unclear. There are major omissions.Idea for addressing the issue is generally outlined. Why legislation is the best course for advocacy is summarized. There are some minor omissions. Rationale is needed.Idea for addressing the issue is outlined. Why legislation is the best course for advocacy is generally explained. Some rationale is needed.A logical and well-developed idea for addressing the issue is outlined. Why legislation is the best course for advocacy is thoroughly explained. Strong and compelling rationale is provided.Research Supporting Solution for Problem15.0Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are omitted.Some support for the idea and its effectiveness in addressing the problem is presented. Findings presented are not substantiated, or do not provide evidence-based support for the idea.Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are generally presented. More information is needed. There are some inaccuracies.Idea for addressing the issue is outlined. Why legislation is the best course for advocacy is generally explained. Some rationale is needed. Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are presented. There are minor inaccuracies. Some detail is needed.Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are presented and demonstrate strong and compiling support for the idea.Stakeholder Support10.0Stakeholders in support the proposed idea are omitted.At least one stakeholder in support of the proposed idea is presented. The assignment criteria are largely incomplete.Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are generally presented. More information is needed. There are some inaccuracies.General stakeholders in support of the proposed idea are presented. It is unclear why they are in support of the idea. More information is needed.Key stakeholders in support of the proposed idea are presented. It is generally clear why they are in support of the idea. Some detail or rationale is needed.All significant stakeholders in support of the proposed idea are presented and a well-supported explanation of why they are in support of the idea are provided.Stakeholder Opposition10.0Stakeholders in opposition to the proposed idea are omitted.At least one stakeholder in support of the proposed idea is presented. The assignment criteria are largely incomplete.At least one stakeholder in opposition to the proposed idea is presented. The assignment criteria are largely incomplete.General stakeholders in opposition to the proposed idea are presented. Explanation for why they are opposed to the idea and strategies for debating or conversing with opposing stakeholders is vague.Key stakeholders in opposition to the proposed idea are presented. A general explanation for why they are opposed to the idea and strategies for debating or conversing with opposing stakeholders is presented.All significant stakeholders in opposition to the proposed idea are presented. A well-supported explanation for why they are opposed to the idea and strategies for debating or conversing with opposing stakeholders is presented.Financial Incentives and Costs10.0The financial impact for the issue and idea is omitted.The financial impact for the issue and idea is only partially presented. The assignment criteria are largely incomplete.The financial impact for the issue and idea is outlined. More information or support is needed for claims.The financial impact for the issue and idea is summarized. Support for claims is generally supported.The financial impact for the issue and idea is clearly summarized. Strong rationale and support for claims is provided.Legislature Process and Information for Proposal10.0Legislative information needed and process to advocate for proposal are omitted.Legislative information needed and process to advocate for proposal are largely incomplete.Legislative information needed and process to advocate for proposal are generally outlined.There are some inaccuracies or omissions.The financial impact for the issue and idea is summarized. Support for claims is generally supported.Legislative information needed and process to advocate for proposal are presented. Information or detail is needed in some areas for accuracy or clarity.Legislative information needed and process to advocate for proposal are clearly and logically presented. The legislative process is clearly understood and insight into legislative advocacy is demonstrated.Christian Principles and Nursing Advocacy10.0A discussion of how Christian principles supporting unbiased advocacy for health care legislation is omitted.A discussion of how Christian principles support unbiased advocacy for health care legislation is incomplete. It is unclear how the principles support positive patient outcomes and inclusiveness for all populations.A summary of how Christian principles support unbiased advocacy for health care legislation is presented. Some rationale or information is needed to demonstrate how the principles support positive patient outcomes and inclusiveness for all populations.A discussion of how Christian principles support unbiased advocacy for health care legislation is presented. The discussion generally demonstrates how the principles support positive patient outcomes and inclusiveness for all populations. Some detail or information is needed for clarity.A well-developed discussion of how Christian principles support unbiased advocacy for health care legislation is presented. The discussion demonstrates an ability to act impartially and in the interest of promoting inclusive patient care without regard to gender, sexual orientation, culture, race, religion, or belief.Research5.0No outside sources were used to support the assignment.Few outside sources were used to support the assignment. Limited research is apparent.Research is adequate. Sources are standard in relevance, quality of outside sources, and/or timeliness.Research is timely and relevant, and addresses all of the issues stated in the assignment criteria.Research is supportive of the rationale presented. Sources are distinctive. Addresses all of the issues stated in the assignment criteria.Mechanics of Writing (includes spelling, punctuation, grammar, and language use)2.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is employed.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.The writer is clearly in command of standard, written, academic English.Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)3.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage  100