NR 506 Week 5 Discussion Drivers of High Performance Healthcare Systems

NR 506 Week 5 Discussion Drivers of High-Performance Healthcare Systems

Select two drivers (for example quality, cost, and access) of high performance healthcare systems and apply it to your current work situation. The application could demonstrate the presence of the driver in a positive manner or it could acknowledge the presence of a concern.

In my opinion two drivers such as quality and cost are the most importance in high performance healthcare systems. However, it is hard for the two drivers to go hand in hand. One would think that in order to get high quality healthcare, it would cost more. In my current work situation there is always a staffing shortage in the ICU, probably because other departments RN cannot float to ICU since it is a specialty unit. It costs hospital to staff RNs in order to provide quality care and maintain the patients to nurse ratios. Not having adequate staff due to cost containment can jeopardize efficient quality healthcare. “Nurse staffing has a significant impact on both quality of care and cost due to nurses’ vital role as front‐line care providers, and insufficient staffing and unreasonable home healthcare costs can thus reduce health benefits through missed opportunities to improve patients’ health status” (Park, 2017).

People tend to associate things that are not costly with poor quality. Which comes to mind, the objective of the “Patient Protection and Affordable Care Act (ACA)” was to attain virtually worldwide health insurance coverage in the United States. ACA helped a lot of people get insurance for an affordable price. “On the supply side, concerns have been raised about whether there are sufficient numbers of primary care physicians to treat all of these newly insured patients” (Courtemanche et al., 2018). Now that everyone could be insured, the question is how will the quality of care be affected? What types of physicians will care for these patients. Time with patients will be compromised due to lack of time to see patients. I believe there must be a medium for quality of healthcare and cost.

References

Courtemanche C., Marton J., Ukert B., Yelowitz A., & Zapata D. (2018). Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health. Southern Economic Journal. 84(3), p660-691. 32p. DOI: 10.1002/soej.12245.

Park, C. S. (2017). Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis. Journal of Advanced Nursing. 73(8): 1838-1847. 10p.

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I would agree with you in the situation you presented about staffing ratios and that quality of care is thought to cost more. The truth it is always great to have the best ratio possible when it comes to staffing with nurses to patients. We have experienced how it is to be short on the floor and have the best staffing possible. I think though that it does not diminish the quality of care we try to give to our patients as nurses. Even when it has been short on the inpatient unit I use to work on we still received positive feedback from patients, and a lot of times understanding as well. Patients can tell when someone really cares or not an is providing quality care to them. I think that the cost of how important staffing is forgotten until something happens like a major fall or a sentinel event. Really that ends up costing the hospital more than just monetary losses, but other ones. Most of us in nursing are here to help people and be compassionate and supportive for our patients.

In terms of patients’ insurance coverage or economic status, I made sure to treat every person as equally as I could in regards to the care I provided for them. I cannot dictate the tests or other provision for the patient, but I can do the best I can and treat patients equally across the board. I do agree that each person should have equal access to healthcare in our country no matter what, and at the highest quality possible. Hopefully as we continue on our healthcare journey those who make these decisions will see that it takes spending money to save money, and when nurses are compensated better and treated better there will be a decrease in turnover.

There are many potential drivers in the healthcare system but two that are very important are cost and accessibility. The cost of healthcare can be a controversial issue for many individuals, which is why it is so important. The changing cost in healthcare can be for many reasons including pharmaceutical changes, technology innovations, healthcare reforms and even government expenditures (McGrail & Ahuja, 2017). This affects both the patient and the hospital on a daily basis. Our hospital has just opened its own pharmacy for the use of not only employees, but also the patients and the community. The goal for the pharmacy was to cut down the cost of prescribed medications for the patient and their families. The pharmacy has been open for about a year now and the feedback has been great. Patients are getting their prescriptions at half the cost of anywhere else, if not more. It does make me wonder however, why other places are charging such large amounts. I do feel that the pharmacy in the hospital is a positive driver in our hospital’s situation.

The second driver is access to healthcare. In our town, which is quite small and only has the rural hospital, there are two healthcare facilities or physicians’ offices. Both offices are open regular hours, 8am-5pm and provide no urgent or afterhours care. Due to this, in the evening and on weekends, the emergency room is very busy but not with trauma, with things likes ear infections, influenza and headaches. In our area, access to care outside of normal business hours is non-existent. This is a huge negative for the community, patients and even staff members. This can also tie back into the cost as well. Instead of the patient paying for a simple Doctor’s visit, the patient must pay an emergency room bill, which can sometimes be triple the amount. This may be a positive driver in terms of money for the hospital but definitely negative for the patient and patient care all together.

Reference

McGrail, K. Ahuja, M. (2017). What is bending the cost curve? An exploration of possible drivers and unintended consequences. Healthcare Policy, 13(2), 20-30.

Participation Guidelines

Due Date: First initial posting to the required threaded discussion topic is due by Wednesday, 11:59 pm MT. Peer and instructor responses are due by Sunday 11:59 pm MT. All posts for week 8 are due by the close of class on Wednesday 11:59 pm MT. Please note that the late assignment policy does not apply to the threaded discussions.

Total Points Possible: Varies with course, please see specific course syllabus. These guidelines are for a required threaded discussion worth 50 points. Please note that week 8 will be worth only 25 points.

Requirements:

Description of the Assignment

1. Initial posting: This is defined to be the initial post in which the student responds to the required threaded discussion topic. The first posting by a student within the required discussion area is considered to be the initial posting and will be evaluated using the rubric criteria. Scholarship in communication is expected. Required scholarly source(s) provide specific information that thoroughly address the required topic. For the initial posting, one scholarly source must be presented. The scholarly source must be an outside source. The student may use the required course textbook (s), assigned readings and lesson information in the initial post; however, these are not considered outside scholarly sources.

The initial posting must occur before Wednesday, 11:59 pm MT. Initial postings must be at a minimum of 300 words. References do not apply toward word count. ONLY in Week 8, the initial posting must be a minimum of 200 words with a scholarly reference. It remains due by Wednesday, 11:59 pm MT

2. Peer responses: As part of the threaded discussion requirements, the student must provide a substantive response to a peer. Substantive responses pose new ideas, ask questions, and/or generally add to the discussion topic in a meaningful and constructive way.

The peer response must occur on a separate day from the initial posting and instructor response (see below). This peer response must occur before Sunday, 11:59 pm MT. This response does not require a scholarly reference unless information is paraphrased and/or direct quotes are used, then APA guidelines apply. Peer responses must be a minimum of 150 words. References do not apply toward word count.

3. Instructor response: The student must respond to an instructor’s follow-up questions. The instructor’s question may be directed to the student or may be a question directed to another student in the section. The response must be comprehensive and scholarly in nature. Instructor responses must be a minimum of 150 words. References do not apply toward word count.

The response to the instructor must occur on a day different from the initial post and a day different from the peer response. Responses to the instructor must occur before Sunday, 11:59 pm MT.

4. For week 8 only: Students are expected to post a peer response or an instructor post but are not required to do both. These posts must be a minimum of 100 words. References do not apply toward word count. The peer or instructor response must be on a different day than the initial post and must occur before Wednesday, 11:50 pm MT due to the shorter week.

Posting Requirements:

The initial posting must be provided before Wednesday, 11:59 pm MT.
The initial posting must have at least one scholarly outside source that is cited within the posting and referenced. Required course textbooks, assigned readings and lesson information are not considered to be outside scholarly sources.
Initial posting must be a minimum of 300 words; peer responses and instructor responses a minimum 150 words.
The peer responses and instructor responses must be provided before Sunday, 11:59 pm MT.
All postings are substantive and relate to the graded threaded discussion topic.
Only one small quote (15 words or less) within the entire initial posting is accepted.
Postings must occur on 3 separate days.
For week 8 only: the required postings are amended due to the shorter week. Two posts are required. One initial post and either a peer response or an instructor response. Initial post must be a minimum of 200 words and the peer or instructor response must be a minimum of 100 words. Both posts are required to be on two separate days. All posts must be made by Wednesday, 11:59 pm MT

Criteria for Content

Scholarliness: In this category, the student will conduct a search of the current databases and locate valid, relevant, and reliable information for the required topic. Each reference must be scholarly.
Application of Course Knowledge: In this category, the student demonstrates the ability to analyze and apply principles, knowledge, and information learned in the course lesson and outside readings. This information is then applied to a real-life professional situation as an example.
Interactive Dialogue: In this category, the minimum requirements are to provide an initial posting to the graded threaded discussion topic by Wednesday, 11:59 pm MT of each week. In addition, one peer response and one instructor response are required. These postings must be completed by Sunday, 11:59 pm MT of each week. The initial posting, peer response, and instructor response must be on 3 separate days.
Grammar, Syntax, APA: Proper grammar, APA, and syntax is required for all posts. Students should follow the APA Manual 6th Edition. Additional APA information is available in Course Resources.
Participation Requirement: One initial posting, one peer response and one instructor response (for a total of 3 posts for the week) are required on 3 separate days.
Participation Deadline: The student must provide a substantive response to the graded threaded discussion topic. This must be posted by Wednesday, 11:59 pm MT of each week. Peer and instructor responses must be posted by Sunday, 11:59 pm MT.
For week 8 only: the required postings are amended due to the shorter week. Two posts are required. One initial post and either a peer response or an instructor response. Initial post must be a minimum of 200 words and the peer or instructor response must be a minimum of 100 words. Both posts are required to be on two separate days. All posts must be made by Wednesday, 11:59 pm MT.
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Criteria for Format and Special Instructions

Instructor reserves the right to submit any threaded discussion posting to TurnItIn in order to verify the originality.
When journals are used as the outside source of information, it is preferred that the journal be peer reviewed. The Chamberlain online librarian is very helpful in assisting you to find an article related to your topic. If you have questions concerning scholarly sources, please refer to the handout entitled “What is a scholarly source” located under “Course Resources” tab.
NR 506 Week 5 Discussion Drivers of High Performance Healthcare Systems
Web sites vary in quality and scholarship. It is the responsibility of the student to determine the scholarly nature of the web site. If the instructor determines that the site failed to demonstrate scholarship, points maybe deducted. Students are cautioned to use care regarding .com sites. Some .com sites are excellent such as American Heart Association, but others are built by individuals and scholarliness is lacking. It is recommended that you check with your instructor before using a .com website as a reference.
Only one small quote (15 words or less) within the entire initial posting is acceptable. It is expected that the student will paraphrase the information when presenting information from a scholarly source. The scholarly source(s) for the paraphrased information must be cited using APA format. Do not include a number of small quotes even if they are just a few words as your instructor considers a quote to be a quote no matter its limited size.
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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.