Rubrics for Process Paper
Write in a Word Document, using APA format (Adapted for T5/2020)
Case presentation (10 points)
- Medical Diagnosis- (Pathophysiology of medical diagnosis including definition, signs &symptoms, and treatment/diagnostic measures) cite your sources. Explain why this topic is important to you. (8)
- Past medical history, Chief Complaints/Date, Relevant Labs Reports and Relevant Data (2)
Nursing Process
Assessment-(10 points)
- What subjective or Objective data was present with this type of patient?(2)
- What did you glean from the chart? (2)
- What information from report was most useful? (2)
- Was there any aspect of your education that helped with this assessment decision? (3)
- Explain why? (1)
Diagnosis (10 points)
- Develop Nursing diagnoses related to medical diagnoses (include primary physical, psychosocial and education nursing diagnosis). (4)
- Why did you choose them for this patient? (1)
- Did you agree with them? (1)
- Did you speak to the preceptor about adding, deleting, or modifying them?(2)
- How did care planning at Stratford help with this? Explain your response. (2)
Planning-(10 points)
- How would you plan your care for such a patient? (2)
- Do you foresee any difficulties with planning when caring for this patient and what or how would it impact your care process? (4)
- Did your plan for this patient change as the day progressed? (2)
Implementing- (10 points)
- What institutional resources played a factor in accomplishing your plan? (2
- What are the Nursing Considerations for this medical diagnosis? (Are there particular aspects that should be monitored such as lab values or etc.?)(4)
- What are some tasks that could be delegated if any, for this type of patient? Talk about that decision). (4)
Evaluation-(10 points
- Identify one best practice that could impact your care for this patient’s quality of care or patient’s safety. (4)
- What have you learned from choosing and presenting this medical diagnosis? (1)
- How did your patient do? How did you do? (1)
- Were there any institutional barriers and/or facilitators during your shifts? (4)
Format- (20 points)
- 4-10 pages (5)
- Double-spaced with 1” margins (5)
- 12-point font (5)
- Spelling and grammar correct (5)
- APA and references (5)
