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NR 506 Week 2 Discussion Policy-Priority Selection

NR 506 Week 2 Discussion Policy-Priority Selection

NR 506 Week 2 Discussion Policy-Priority Selection

Identify your selected healthcare concern in your city or state that needs your advocacy with an elected official. What is the impetus and rationale for your selection? What is your solution to this concern? Describe the model of policy making that you feel would be best applied to your policy concern and the rationale for selecting this model.

I have been having a difficult time choosing my healthcare policy priority, mainly because I am worried that it is one that is being talked about by everyone lately. However, with that being said, I have chosen the Opioid Epidemic or the Opioid Overdose Crisis. I have chosen this  topic because it specifically has been a problem I have witnessed with patients, and people within surrounding communities.  It also is something that could be reduced if laws were different.

According to the National Institute on Drug Abuse (2018),  Each day 115 Americans die from opioid overdoses, which means nearly 42,000 people die annually from a preventable cause.  I grew up in a town of 1,000 people, so for me to see this amount of people die annually is baffling.

The estimated total “economic burden” for the US each year is $78.5 billion a year, as per The Center for Disease Control and Prevention, (2017). This is said to include the misuse of opioid prescriptions, cost of healthcare, loss of productivity, addiction alone, and the involvement of criminal justice (National Institute on Drug Abuse, 2018).

I think that as far as sources of healthcare policy, this policy would be at the Organizational level, because it would be required to meet FDA requirements, and have multiple organizations involved in decision making as  well as including  multiple organizations’ data. This would be a public policy.

This topic is important to me, because as nurses we all have a few patients that we say we will never forget. One of these patients for me was a 21 year old. He was admitted for altered mental status and was on a Narcan drip.  Once he began to wake up he told us that he had just tried a pill and this is what happened to him.  He stated it was his first time, and he had no previous history of drug abuse.  The doctor then decided to discharge him this day, and everyone chalked it up to a young college kid making a stupid choice and trying a pill that was given to him.”  Not 12 hours later the same young 21 year old ended up in the ER. He was being coded en route to the hospital, and after a long attempt at resuscitation, he did not make it.  This patient had access to Fentanyl patches and was apparently cutting them open and eating them.  This was a definite eye opening experience for me.  There are also been newspaper reports in a surrounding community about five to 10 Narcan kits being used each weekend.  It just amazes me that this situation has gotten so out of control over the last several years.

 

 

References:

National Institute on Drug Abuse. (2018). Opioid overdose crisis. Retrieved from: https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

The Center for Disease Control and Prevention. (2017). National Vitals Statistics System, Mortality. Retrieved from: https://wonder.cdc.gov

 

I think that there should be required follow up between the provider and patient once opiods are prescribed.  All too often a patient is discharged from the hospital with narcotics and the provider does not do any type of follow up other than refer them to follow up with their primary care provider. I think all providers whether it be inpatient/hospital setting or primary care providers, should be required to follow up with all of their patients who are on prescribed opioids. I  also think there should be documented non-opioid treatment attempts on all chronic opioid users as well.

With this being said, I do not think that opioids should not be used for acute patients. For example, if I came into the my physician’s office with a kidney stone or after I threw my back out, I would not expect them to attempt non-pharmacological treatment.  In instances like these, a small amount of narcotics should be able to be prescribed, but then the physician should be required to follow up within a given time frame, whether it be 24 hours or a week.  I think because the FDA is a federal agency, this should be done by everyone and not just by certain states. Of course, to make a change it’s not easily done at that level, so I think it would have to start slowly. I think I would first propose it to all hospital employed providers at my hospital. After that change was implemented and there was time for adequate data to be obtained, i would branch out to other facilities, and then eventually to the state level.

Many physicians will prescribe a patient a narcotic for an acute pain, but then continue to refill the medication for years “just because.” This contributes to the problem. I worked with a nurse years ago who had back pain and went to her PCP and was prescribed Norco. She became dependent on the Norco, and eventually  stole Dilaudid, Morphine, Norco, and many other drugs from the hospital. Of course she was caught and her license was disciplined, but the point is, this prescription started innocent, but due to a lack of follow up from her physician, the medication was continued to feed a habit, which could have been avoided had there been stricter follow up.

If the physicians were required to follow up and have documentation that was supportive of their reason for continuing the prescription, the numbers may decrease.  At a certain point, the physician could then potentially refer the patient to a pain specialist for some sort of treatment that was not an opioid.

I think the topic you picked is very important right now and the more people talking the more change there can hopefully be made.  I grew up and currently live in the suburbs of Cleveland, OH, and have worked at one of the major hospitals in inner city Cleveland.  There are a lot of drugs in this area, and not just in the city, but in the suburbs as well.  The Opioid Crisis has really taken this area and the state of Ohio by storm.  The CDC found Ohio to be the second leading state in drug overdose deaths in 2016.(CDC, 2017)  This number continues to climb and I am not sure when it will start to get better.  I do have a personal experience with this crisis in the fact that my oldest nephew died of a heroin overdose in 2015 at the age of 23.  We were close growing up because we were only 8 years apart and my sister, his mother was 15 years older than me.  This has been very hard on our family especially because we did not know what to do to help him when he was using, and so like so many families we had to experience the worst part of this epidemic.  Besides this I have also been a nurse to many young patients in the hospital who had endocarditis due to the use of opioids intravenously.  One patient on my floor was in their mid-twenties and was in because they needed a 2nd aortic valve replacement surgery due to IV heroin use.  Before the patient was placed on the unit I worked on the patient ad her boyfriend had been shooting up heroin in the other hospital room she was staying in, but left AMA because boyfriend was kicked out of the hospital.  I know a lot of people might disagree with me, the opioid addiction is a disease, and the death or addiction is preventable.

Since the passing of my nephew, my mom is very involved in different groups related working to fight the opioid epidemic, or have more successful outcomes.  In the area I live in my mom has helped police stations be introduced to a program called Safe Passages.  This program allows people to go to the police station and ask for help specifically for opioid addiction and they are found detox and treatment and it is paid for.  It started with just a few police stations in my area and is spreading rapidly and has had success stories.  The first person they had was a pregnant girl who turned her self in, no questions asked no trouble, was able to get help and has been clean for at least a year.  In another hospital in my area they are trying to get to the people who overdose right away and offer them help.  These are programs that are showing success and need to be spread all over the United States.  Something else I believe is that there are a lot of players in the healthcare industry that have attributed to the opioid crisis.  Pharmaceutical companies that had really pushed this drugs on doctors to prescribed them, insurance companies for being willing to cover the cost of these medications over alternative therapies, and the utilization of them from providers.  In a study done about alternative therapies it was find that there were 44% of people were more likely to still be using opioids when being prescribed opioid analgesics within 7 days of discharge post-op.(White, Elvir Lazo, Lidia, & Xuezhao, 2017)  I have seen that providers, especially now, want to use alternatives to medication to help with pain management, but a road block is insurance companies and being able to give some coverage to be affordable for patients.  Not only are many alternatives covered or given enough time, but it cost with patient needing transportation, time off work, or just time out of their day.  A pill that makes someone feel better is easier, but not better.  Even though having to pay more upfront there is a long term benefit and would be cost effective.  “A simple, safe, and effective non-invasive pain therapy without side effects could significantly reduce the dependence on oral opioid-containing medications in the post-discharge period after surgery. These non-pharmacologic therapies would also be cost-effective alternatives to opioids for treating chronic pain not responding to non-opioid analgesic medications.”(White, et al., 2017, p.8) We have all seen how opioid addiction has cost the healthcare system time and time again.

References:

The Center For Disease Control and Prevention. (2017).  Drug Overdose Death Data.  Retrieved from: https://www.cdc.gov/drugoverdose/data/statedeaths.html 

White, P. F., Elvir Lazo, O. L., Lidia, G., & Xuezhao, C. (2017). Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management. F1000Research, 6http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.12688/f1000research.12324.1 Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1992878433?accountid=147674Links to an external site.

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Grading Rubric

Performance Category 100% or highest level of performance

100%

16 points

Very good or high level of performance

88%

14 points

Acceptable level of performance

81%

13 points

Inadequate demonstration of expectations

68%

11 points

Deficient level of performance

56%

9 points

Failing level

of performance

55% or less

0 points

 Total Points Possible= 50           16 Points    14 Points 13 Points        11 Points           9 Points          0 Points
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic topics.

Presentation of information was exceptional and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was minimally demonstrated in all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in one of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in two of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in three or more of the following elements

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
 16 Points  14 Points  13 Points 11 Points 9 Points  0 Points
Application of Course Knowledge

Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations

Presentation of information was exceptional and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was minimally demonstrated in the all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in one of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from and scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in two of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in three of the following elements

  • Applies principles, knowledge and information and scholarly resources to the required topic.
  • Applies facts, principles or concepts learned scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
 10 Points 9 Points  6 Points 0 Points
Interactive Dialogue

Initial post should be a minimum of 300 words (references do not count toward word count)

The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count)

Responses are substantive and relate to the topic.

Demonstrated all of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 3 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 2 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 1 or less of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.

8 Points

7 Points

 6 Points

        5 Points          4 Points

 0 Points

Grammar, Syntax, APA

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

Error is defined to be a unique APA error. Same type of error is only counted as one error.

The following was present:

  • 0-3 errors in APA format

AND

  • Responses have 0-3 grammatical, spelling or punctuation errors

AND

  • Writing style is generally clear, focused on topic,and facilitates communication.
The following was present:

  • 4-6 errors in APA format.

AND/OR

  • Responses have 4-5 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is somewhat focused on topic.
The following was present:

  • 7-9 errors in APA format.

AND/OR

  • Responses have 6-7 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is slightly focused on topic making discussion difficult to understand.
The following was present:

  • 10- 12 errors in APA format

AND/OR

  • Responses have 8-9 grammatical, spelling and punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.
The following was present:

  • 13 – 15 errors in APA format

AND/OR

  • Responses have 8-10 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.

AND/OR

  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.
The following was present:

  • 16 to greater errors in APA format.

AND/OR

  • Responses have more than 10 grammatical, spelling or punctuation errors.

AND/OR

  • Writing style does not facilitate communication
0 Points Deducted 5 Points Lost
Participation

Requirements

Demonstrated the following:

  • Initial, peer, and faculty postings were made on 3 separate days
Failed to demonstrate the following:

  • Initial, peer, and faculty postings were made on 3 separate days
0 Points Lost 5 Points Lost
Due Date Requirements Demonstrated all of the following:

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.

Demonstrates one or less of the following.

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.

Grading Rubric Guidelines Week 8 ONLY

Performance Category

100% or highest level of performance

100%

Very good or high level of performance

88%

Acceptable level of performance

81%

Inadequate demonstration of expectations

68%

Deficient level of performance

56%

Failing level of performance

55% or less

       8 Points         7 Points

      6 Points

          5 Points          4 Points          0 Points
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic topics.

Presentation of information was exceptional and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was minimally demonstrated in all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in one of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in two of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in three or more of the following elements

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
        8 Points        7 Points       6 Points          5 Points         4 Points       0 Points
Application of Course Knowledge

Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations

Presentation of information was exceptional and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.

Application of information is comprehensive and specific to the required topic.

Presentation of information was minimally demonstrated in the all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in one of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from and scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in two of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in three of the following elements

  • Applies principles, knowledge and information and scholarly resources to the required topic.
  • Applies facts, principles or concepts learned scholarly resources to a professional experience.

Application of information is comprehensive and specific to the required topic.

Interactive Dialogue

For Week 8 only:

Initial post should be a minimum of 200 words (references do not count toward word count)

The peer and instructor responses must be a minimum of 100 words each (references do not count toward word count)

Responses are substantive and relate to the topic.

Demonstrated all of the following:

  • Initial post must be a minimum of 200 words.
  • The peer or instructor responses must be a minimum of 100 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 3 of the following:

  • Initial post must be a minimum of 200 words.
  • The peer or instructor responses must be a minimum of 100 words each.
  • Responses are substantive
Demonstrated 2 of the following:

  • Initial post must be a minimum of 200 words.
  • The peer or instructor responses must be a minimum of 100 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 1 or less of the following:

  • Initial post must be a minimum of 200 words.
  • The peer or instructor responses must be a minimum of 100 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
     4 Points 3 Points
      2 Points       0 Points
Grammar, Syntax, APA

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

Error is defined to be a unique APA error. Same type of error is only counted as one error.

The following was present:

  • 0-4 errors in APA format

AND

  • Responses have 0-4 grammatical, spelling or punctuation errors

AND

  • Writing style is generally clear, focused on topic, and facilitates communication.
The following was present:

  • 5-9 errors in APA format.

AND/OR

  • Responses have 5-9 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is slightly focused on topic making discussion difficult to understand
The following was present:

  • 10- 13 errors in APA format

AND/OR

  • Responses have 10-13 grammatical, spelling and punctuation errors.

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand
The following was present:

  • 14 to greater errors in APA format.

AND/OR

  • Responses have more than 14 grammatical, spelling or punctuation errors.

AND/OR

  • Writing style does not facilitate communication
         0 Points   5 Points Lost
Participation Requirements For Week 8 ONLY:

Demonstrated the following:

  • Initial, and peer or faculty postings were made on 2 separate days
Failed to demonstrate the following:

  • Initial, and peer or faculty postings were made on 2 separate days
    0 Points Lost      5 Points Lost
 Requirements For Week 8 ONLY:

Demonstrated all of the following:

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer or one instructor response is to be posted within the course no later than Wednesday, 11:59 pm MT

Demonstrates one or less of the following.

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.
  • A minimum of one peer or one instructor response is to be posted within the course no later than Wednesday, 11:59 pm MT.

NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 pm MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 pm MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 pm MT Wednesday of the eighth week.

*Scholarly source: Per the APA Guidelines in Course Resources, only scholarly sources should be used in assignments and threaded discussions. These include peer reviewed publications, government reports, or sources written by a professional or scholar in the field. Your textbook and lesson are not considered to be an outside scholarly source. For the discussions, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer reviewed nursing journal. You are encouraged to use the Chamberlain library and search one of the available data bases for a peer reviewed journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These web sites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality. For example American Heart Association is a .com site with scholarship and quality. It is the responsibility of the student to determine the scholarship and quality of any .com site. Ask your instructor before using any site that you are unsure of. If the instructor determines that the site does not demonstrate scholarship or quality, points will be deducted for not using scholarly sources. Current outside scholarly sources are required for the initial posting. This is defined to be 5 years or less. Instructor permission must be obtained if using a source that is older than 5 years.