IT IS A SOAP NOTE, PROFESSOR ONLY ACCEPTED CLASS RESOURCES.

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”
• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
• Diagnostics: HSV specimen obtained

Assessment:

• Chancre
• PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

To prepare:

With regard to the SOAP note case study provided:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or Why not?
• Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.

CALSS RESOURCES

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 16, “Breasts and Axillae” (pp. 350-369)
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

Chapter 18, “Female Genitalia” (pp. 416-465)
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.

Chapter 19, “Male Genitalia” (pp. 466-484)
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 5, “Amenorrhea” (pp. 47-60)
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.

Chapter 7, “Breast Pain” (pp. 73-80)
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge” (pp. 318-324)
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding” (pp. 419-433)
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching” (pp. 434-445)
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)Note: Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Physical Examination Objective Data Checklist was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Cucci, E. Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/ 

Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045
Retrieved from the Walden Library Databases.

Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.
Retrieved from the Walden Library databases.
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2012). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

Required Media

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)
Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.

Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)
In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)
The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)

Theory analysis is particularly helpful in research because it provides a clear idea of the form and structure of the theory in addition to the relevance of content, and inconsistencies and gaps present. The ‘missing links’ or inconsistencies are fruitful sources of new research ideas. They also point to the next hypotheses that need to be tested.
—Walker and Avant, 2011, p. 206

Nurse scientists often find that examining the literature is a productive way to see how existing frameworks and theories have been applied in other research studies. By engaging in this process, they may gain insights about a particular framework or theory, be able to identify gaps in research, or uncover new questions they are eager to explore.

In this Discussion, you analyze existing frameworks/theories using the procedure proposed by Walker and Avant. Your analysis should provide an objective understanding of the strengths and weaknesses of each framework or theory. This, in turn, should enable you to evaluate whether the framework/theory is useful for the purposes of your theoretical foundation for a program of research.

To prepare

• Review the information that Dr. Hathaway presents in the Week 1 media program, “Theoretical Foundation for Research,” regarding the phases of theory development and the similarities and differences between frameworks and theories.
• Search the literature and identify two frameworks/theories that may be useful for investigating your phenomenon of interest.
• Review the procedure for theory analysis presented in Chapter 12 of Walker and Avant (2011). Apply these steps to each framework/theory you have selected and identify the strengths and weaknesses of each framework/theory. Determine whether additional development or refinement is needed (i.e., for each framework, identify which aspects would require further research in order for it to meet the requirements of a theory).
• Evaluate the value of each framework/theory for addressing your phenomenon. Determine which framework/theory has the most potential for use as part of your theoretical foundation of your research.
• Think about any questions you have related to theory analysis and evaluation.

By Day 3

Post a description of the two frameworks/theories you analyzed and evaluated, and explain why each is considered either a framework or a theory. For framework(s) you have selected, explain which aspects would require further research to meet the requirements of a theory. Explain why one has the most potential for use in your theoretical foundation for research, noting its strengths and weaknesses. Also pose any questions that have arisen through your examination of frameworks/theories.

Read a selection of your colleagues’ postings.

Refer back to the interview and evaluation you conducted in the Topic 2 Family Health Assessment assignment. Identify the social determinates of health (SDOH) contributing to the family’s health status. In a 750-1,000-word paper, create a plan of action to incorporate health promotion strategies for this family. Include the following:

1. Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
2. Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions.
3. Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
4. Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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. Please refer to the directions in the Student Success Center.

 2 DQ 2

The Patient Protection and Affordable Care Act of 2010 (PPACA) contains many provisions that seek to intertwine the quality of care with the cost of care. Nurses’ education, skills and professional scope make them indispensable contributors to the successful implementation of evolving patient–centred care delivery models. One of the innovative healthcare delivery models is Accountable Care Organizations (ACOs). It is a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility for the quality and cost of care provided to its patients (HPI, n.d.). It is a group of providers that promotes accountability patient population and coordinates items and services under Medicare and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.

The largest benefit that accountable care could bring for the healthcare industry is to garner cost savings or reduce spending.  Another major benefit of ACOs is their ability to improve population health management and patient outcomes. A brief from the Center for Health Care Strategies and the Urban Health Research and Practice at Northeastern University shows that new healthcare delivery models like ACOs offer innovative methods for payers and providers to achieve better population health outcomes. Medicaid ACOs, for instance, have shown a greater focus on preventing disease and promoting wellness, which leads to stronger population health improvements. This reduces the likelihood that a disease would progress and lead to more costly hospital stays. The community gains a wide number of advantages including, improved patient outcomes, the better quality of care, greater engagement with providers, and an overall reduction in out-of-pocket costs.

Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes.

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years.

Research Article Critique, Part 2

Occupational Stressors, Stress Perception Levels, and Coping Styles of Medical Srugical RNs: A Generalized Perspective

(Wakim, 2014)

 

 

Your assigned article for critique is:

Wakim, N. (2014). Occupational stressors, stress perception levels, and coping styles of medical surgical RNs. Journal of Nursing Administration, 44(12), 632-639. doi:10.1097/NNA.0000000000000140

 

 

Instructions:  A major skill that is learned in this course is how to critically read and critique nursing research articles.  The purpose for critiquing an article is to critically evaluate the research process followed by the author(s) of the assigned article. This is an information-intensive, time-intensive process that is not learned overnight.   To demonstrate your skill at critiquing an article, you will complete this open-book multiple choice assignment.

Here’s how you should approach completing this week’s assignment to finish critiquing an article:

1.  First, do your assigned reading in Grove, Gray, and Burns (2015) and complete the reading worksheets early in the week.  This will introduce you to the critique skills you will need for the week.

2.  Skim the entire instructor assigned research article that has been posted on Blackboard for you so that you will have an idea of what it is about.  Lightly cross out the abstract for the article (you won’t be using it). Then, for this week, re-read carefully from the study design section through the end of the article.

3.  Print this document and find the best answer to each question below based on your Grove, Gray, and Burns (2015) assigned reading for the week and what you have read in the instructor assigned research article.

4.  Some of the questions in the critique assignment below will seem unfamiliar to you. Look up key terms from the question in your textbook.  Some examples of these terms might be: power analysis, inter-rater reliability, and generalization. You can also look in Chapter 12 for an example of a critical appraisal (or critique) of a quantitative research article.

5. Once you have completed this assignment “on paper”, go into blackboard and enter your answers by the assignment due date and time listed in the syllabus.  Ignore any wording from Blackboard that indicates that “this is a test” and carefully enter your answers from this document.

6.  You will have two access attempts to record your answers.  This is given to you so that if you encounter technical difficulties on your first attempt, or you would like a second attempt to try to improve your grade, you may do so.  You will not be able to see the questions that you missed when you submit your attempt.  Blackboard will record the highest grade from the two submissions.

If you have questions about this assignment, you can post them to your group discussion board for help.  Please do not post the exact question from the assignment below and ask the group for the answer as this would constitute academic dishonesty.

Questions 1 – 9: Sample.  (For help with these questions, refer to chapters:  9 & 12)

1.  What sampling method or plan was used by the authors in this study?

a.   Simple random sampling

b.   Systematic sampling

c.   Convenience sampling

d.   Network sampling

 

2.  According to Grove, Gray, and Burns (2015), what are the potential biases of this sampling method?

a.   This is a strong probability sampling method with very little potential for bias

b.   This method is used when an ordered list of all members of the population are available, and provides a random but not equal chance for inclusion in the study.

c.   This method provides little opportunity to control for bias because subjects are included in the study merely because they happen to be in the right place at the right time.

d.   This method is specific to the individuals who were recruited and the information gained cannot be generalized to others who don’t share these types of experiences.

e.   None of the above biases best describe the sampling method chosen by the author.

 

3.  What was the final sample size reported by the authors for this study?

a.  200 participants

b.  84 participants

c.   159 participants

d.   161 participants

 

4.  Was a power analysis conducted?  If so, which statement best describes the results of the power analysis?

a.    The authors mention that an a priori power analysis was conducted, and 200 subjects were

determined to be needed for the study.

b.   The authors mention that a power analysis was conducted using four predictors and 1-way ANOVA using three independent groups for a needed sample size of 159.

c.   The authors do not report that a power analysis was conducted.

 

5.  Which of these statements would be considered an inclusion criterion for the sample in the research article?

a.   English-speaking

b.   Have at least two years of experience as a nurse

c.   Work on a Medical Surgical unit

d.   Be a member of the Medical Surgical Nurses Association

 

 

6.  Which of these statements would be considered to be exclusion criterion specifically identified by the author for the sample in the research article?

a.  The exclusion criteria were explained verbally during recruitment.

b.  History of depression/ mental health issue.

c.   Report of no stress related problems by the participant.

d.  Participants only worked on the night shift.

 

7.  What is the refusal rate for this study? (Hint: see page 253 in your text)

a.   161/200 X 100% = 80%

b.   84/159 X 100% = 53%

c.   unknown / cannot be calculated.

d.   39/200 x 100% = 19.5%

 

8.  Which of the following would be accurate for the attrition rate for this study?

a.   161/200  X 100% = 80%

b.   39/200 X 100% = 20%

c.   84/159 X 100% = 53%

d.   0%

 

9.   What was the setting for this research study?  Briefly describe the setting and indicate whether it was appropriate for conducting this study.

a.   The setting for this study was a partially controlled setting and was appropriate for this study’s research design.

b.   The setting for this study was not well described by the authors and therefore not appropriate for

conducting this study.

c.   The setting for this study was a highly controlled setting and was appropriate for this study’s research design.

d.   The setting for this study was a natural or field setting and was appropriate for this study’s research design.

 

Question 10 – 14: Measurement Methods.  (For help with these questions, refer to chapters 10 & 12.)

10.  Which ones of these questionnaires, scales, or physiologic measures is used in this research study?

(Select all that apply).

a.   The Ways of Coping Questionaire (WAYS)

b.  The Nursing Stress Scale (NSS)

c.   The Perceived Stress Scale (PSS)

d.   The Quality of Life Scale (QOLS)

 

11.  How do the authors describe the reliability of the Nursing Stress Scale (NSS) in previous studies?

a.   Two follow-up emails were sent to potential participants.

b.   they compared the odd and even questions on the test to determine their equivalence.

c.   a team of staff nurses was trained by the primary investigator to administer the questionnaire.

d.   they tested a group of subjects twice using the same questionnaire (test-retest reliability).

e. they computed a Cronbach’s alpha on the Nurse Stress Scale that was administered to this group of subjects.

 

12. How do the authors describe the validity of The Ways of Coping Questionnaire (WAYS).

a.    discriminant validity demonstrated that each subscale measured the same constructs.

b.   evidence of validity from contrasting groups because they gave it to spouses of MS nurses.

c.   no was no mention of determining the validity of WAYS questionnaire.

d.   The authors had experience with administering this questionnaire.

 

13.   What types of questionnaires or surveys were used in this research study?  (Select all that apply.)

a.  The authors developed the Professional Quality of Life Scale.

b.  Interviews were reportedly used, but the authors do not explain what was included in them.

c.  The authors developed their own questions to ask about demographic information.

d.   The authors report adding a few of their own questions at the end of the demographic questionnaire.

e.   This study did not use any questionnaires or surveys.

f.    The authors used previously developed questionnaires or surveys to measure the study

variables.

 

14.   Were any physiological measurements collected from the subjects for the purpose of this study?

a.   Yes

b.   No

 

Question 15- 16: Data Collection. (For help with these questions, refer to chapters 10 & 12)

 

15. Which one of the following best describes the data collection process used in this study?

a.   questionnaires / surveys were completed via the telephone.

b.   participants were given the questionnaires on enrollment in the study and asked to drop the sealed envelope in a locked box at the nurse’s station.

c.   questionnaires / surveys were mailed to the prospective participants and returned in a self-

addressed stamped envelope.

d.   nurse researchers interviewed the study participants in a focus group.

 

16.  If there were more than one data collector for the study, would an estimation of inter-rater reliability be an important concept for the authors to report on for this study?

a.   yes, and the authors reported their efforts to achieve inter-rater reliability.

b.   yes, but the authors do not discuss any efforts to achieve inter-rater reliability.

c.   no, the issue of inter-rater reliability does not apply here.

 

Question 17 – 19:  Data Analysis. (For help with these questions, refer to chapters 11 & 12)

17.  What descriptive statistics are used in this study?  (Select all that apply).

a.   mean

b.   median

c.   mode

d.   standard deviation

e.   z-scores

f.   percentage distributions

 

18.  What inferential statistics were used to examine the data obtained from the subjects?  (Select all that apply)

a.   Bivariate correlational analysis

b.   Factor Analysis

c.    t-Test

d.   Chi-Square

e.   ANCOVA

f.   ANOVA

g.   regression analysis

h.   None of the above inferential statistics were used in this study.

 

19.  What is the level of significance (alpha) set at for this study?

a.   .05 or 5%

b.   .10 or 90%

c    .01 or 1%

d.   an alpha level or level of significance chosen by the authors was not specifically mentioned in the text

of the article.

 

Question 20-25: Researcher’s Interpretation of the Findings. (For help with these questions, refer to chapters 11 & 12)

 

20.  There are several statistically significant findings in this study. Which of these statements from the article would be considered a significant and predicted result? (select all that apply)

a.   As MS nurses’ perceptions of their stress increases, their use of ways to cope increases (r = .357, P<.00)

b.   Younger nurses have lower levels of perceived stress, per post hoc Tukey analysis.

c.   Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses when dealing with occupational stressors.

d.  The stress perception level is thus determined by the type of occupational stressor that the nurse is

exposed to.

21.  Which of these statements from the article would be considered a non-significant result. (Select all that apply)

a.   The older the nurse, the higher the level of stress.

b.   There was no difference between the scores on ways of coping related to age cohorts (F₂₁₅₈ = 1.12, P=.33)

c.   Age, years of experience, and educational levels are not significant factors in levels of perceived stress among MS nurses.

              d.   Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses

when dealing with occupational stressors.

 

 

22.  Which one of these statements from the article would be considered clinically important?

a.    According to this study results, a high level of occupational stress is not a known factor for nursing

turnover in MS nurses.

b.   Younger nurses have better coping skills to combat perceived stress compared to more

experienced nurses.

c.   Baby boomers reported higher use of self-controlling behaviors when dealing with occupational

stressors compared with Gen X and Gen Y.

d.   Six participants were removed from the study due to incomplete surveys.

 

23.  Which statements below implied from the article would be considered a limitation of the study? (Select all that apply)

a.   The researchers utilized a qualitative method in the research design.

b.   Lack of standardization of the conditions of administering the instruments.

c.   A small sample size with a low response rate.

d.   A measure of social desirability in giving responses as the participants worked with the researcher.

 

24.  Which one of these statements would be considered a statement regarding generalization of these results?

a.   The results indicated that there were high levels of perceived stress in this group of MS nurses and can be generalized to all MS nurses in the United States.

b.   The survey was mailed only to MS nurses who were members of the Medical Surgical Nurses Association (MSNA).

c.    A convenience sample of MS nurses decreases generalizability.

d.    The use of a power analysis influenced the generalization of the results to all MS nurses.

 

 

25.  Which one of these statements from the article would be considered a recommendation for future studies?  (Select al that apply.)

a.   Future development of programs to help relieve the occupational stress in MS nurses.

              b.   Research to discover why older nurses have a higher perceived stress compared to younger nurses.

c.   Sufficiently educating nursing leaders in generational differences.

 

d.   Identification of occupational stressors, perceived stress, and coping styles among generational cohorts.