Course Number: | NR512 |
---|---|
Course Title: | Fundamentals of Nursing Informatics |
Course Credits: | 3 credits |
Prerequisite: | NR500 |
Course Number: | NR512 |
---|---|
Course Title: | Fundamentals of Nursing Informatics |
Course Credits: | 3 credits |
Prerequisite: | NR500 |
This course provides foundational and introductory knowledge regarding informatics with an emphasis on developing an understanding of concepts of nursing informatics (NI) and becoming knowledgeable and competent with basic skills needed in patient care and educational settings. Basic nursing informatics (NI) skills support the application and distribution of data/information to generate knowledge used in decision-making to plan, design, analyze, and facilitate the nursing process to enhance safe, quality health care. The NI synthesizes and integrates nursing science with computer, information, and cognitive sciences. Students will explore informatics-based health applications in a virtual learning environment (VLE) developed to improved informatics skills and knowledge in order to better support decision making in the areas of nursing such as: clinical, administrative, research, quality and safety, health policy and education.
The following books are required for this course:
McGonigle, D. & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett.
Sipes, C. (2016). Project management for the advanced practice nurse. Retrieved from https://online.vitalsource.com
.
American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
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The following books are required for this course:
Author, A. A., & Author, B. B. (year of publication). Title of textbook in italics (X ed.). City, ST: Publisher.
Information regarding supplementary material, software, etc.
The following book is required across all FNP courses:
American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
The following book is recommended across all FNP courses:
Goroll, A. H., & Mulley, A. G. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). China: Wolters Kluwer.
To obtain all your books and supplies, visit the online Chamberlain bookstore at https://bookstore.chamberlain.edu/.
Program Outcomes of Chamberlain nursing programs can be found in the Program Descriptions section of your College Catalog. You can access your College Catalog at http://www.chamberlain.edu/msncatalog.
The MSN program outcomes are aligned with the American Association of Colleges of Nursing publication, The Essentials of Master's Education in Nursing (2011). Upon completion of the MSN degree program, the graduate will be able to:
1
Practice safe, high-quality advanced nursing care based on concepts and knowledge from nursing and related disciplines.
2
Construct processes for leading and promoting quality improvement and safety in advanced nursing practice and healthcare delivery.
3
Use contemporary communication modalities effectively in advanced nursing roles.
4
Evaluate the design, implementation and outcomes of strategies developed to meet healthcare needs.
5
Develop a plan for lifelong personal and professional growth that integrates professional values regarding scholarship, service and global engagement.
6
Apply legal, ethical and human-caring principles to situations in advanced nursing practice.
7
Design patient-centered care models and delivery systems using the best available scientific evidence.
8
Manage human, fiscal and physical resources to achieve and support individual and organizational goals.
9
Compose a plan for systematic inquiry and dissemination of findings to support advanced nursing practice, patient-care innovation, and the nursing profession.
10
Collaborate interprofessionally in research, education, practice, health policy and leadership to improve population health outcomes.
11
Apply principles of informatics to manage data and information in order to support effective decision making.
Chamberlain College of Nursing courses are built to align course content with specific Course Outcomes (COs). The COs define the learning objectives that the student will be required to comprehend and demonstrate by course completion. The COs that will be covered in detail each week can be found in the Overview page in that particular week. Whenever possible, a reference will be made from a particular assignment or discussion back to the CO that it emphasizes.
Upon completion of this course, the student will be able to do the following.
1
Define key terms in informatics, healthcare informatics, and nursing informatics. (PO 3)
2
Demonstrate synthesis of nursing and non-nursing science with information and computer technologies. (PO 1, 11)
3
Examine the ethical/legal issues arising in NI practice while using, designing, managing, upgrading, and building information systems. (PO 4, 6)
4
Exemplify professional values and scholarship to support professional and personal development. (PO 5)
5
Explore the roles, competencies and skills associated with nursing informatics while collaborating as part of the healthcare team. (PO 2, 11)
6
Describe the information and knowledge needs of nurses in all practice domains and settings, electronic health records (EHRs), and patient-care information technology (IT). (PO 4)
7
Explore trends and issues in NI and their impact on nursing practice in all domains. (PO 9, 11)
8
Discuss the value of using standardized terminology while supporting the nursing profession in all of its practice settings. (PO 5, 11)
Week, COs, and Topics | Readings | Assignments |
---|---|---|
Week 1 CO1, 2 Introduction to Nursing Informatics (NI) | McGonigle, D. & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett.
American Association of Colleges of Nursing QSEN Consortium. (2012). Graduate-level QSEN competencies: Knowledge, skills and attitudes. link to article McGonigle, D., Hunter, K., Sipes, C., & Hebda, T. (2014). Why nurses need to understand nursing informatics. AORN Journal, 100(3), 324-327 doi:10.1016/j.aorn.2014.06.012 link to article Matney, S. A., Avant, K., & Staggers, N. (2016). Toward an understanding of wisdom in nursing. Online Journal Of Issues In Nursing, 21(1), 7 doi:10.3912/OJIN.Vol21No01PPT02 link to article Optional reading: American Association of Colleges of Nursing (AACN) (2013). Crosswalk of the master’s essentials with the baccalaureate and DNP essentials. link to article | Pre-TANIC (TIGER Self-assessment of Nursing Informatics Competencies) self-assessment Pre-orientation to the Virtual Learning Environment (VLE) Graded Discussions |
Week 2 CO 1, 2, 8 Overview of Nursing Informatics (AACN Essential 5: 1, 2, 4, and 5) | McGonigle, D. & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett.
Matney, S. A., Avant, K., & Staggers, N. (2016). Toward an understanding of wisdom in nursing. Online Journal Of Issues In Nursing, 21(1), 7 doi:10.3912/OJIN.Vol21No01PPT02 link to article | Second Life (SL) Orientation in World Informatics Key Terms Quiz Graded Discussions |
Week 3 | McGonigle, D. & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett.
Kish, L. (2015). 8 takeaways from Topol's latest: 'The Patient Will See You Now: The Future of Medicine is in Your Hands'. link to article Hudson, K., Taylor, L., & Jeffries, P. (2013). Incorporating i nformatics in clinical education through clinical s imulations. link to article | Scavenger Hunt in Second Life Graded Discussions |
Week 4 CO 2, 5, 7,9 Current Trends (AACN Essential 5: 2, 4, and 5) | McGonigle, D. & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett.
| Scavenger Hunt in Second Life Graded Discussions |
Week 5 CO 2, 5, 7, 9 Information and Knowledge Needs of Nurses in the 21st Century | Sipes, C. (2016). Project management for the advanced practice nurse. Retrieved from http//:online.vitalsource.com
Website Exploration: Visit the following site http://www.fiercehealthcare.com/it (explore healthcare technology news on CPOE, EMRs, E-prescribing, HIE, PHRs, HIT stimulus, and other health IT news) Visit the following site www.fierceemr.com (this site contains weekly newsletter on EMRs, meaningful use, ARRA and privacy. Select 1 of 5 Topics/Popular Content of the Week to use in the weekly discussions) | HealthIT Topic paper assignment Select a Topic/Popular Content of the Week from http://www.fiercehealthit.com Graded Discussions |
Week 6 CO 2, 3, 6, 7, 9 Legislative Aspects of Nursing Informatics | Sipes, C. (2016). Project management for the advanced practice nurse. Retrieved from http//:online.vitalsource.com
Big Data: Brennan, P. F., & Bakken, S. (2015). Nursing needs big data and big data needs nursing. Journal Of Nursing Scholarship, 47(5), 477-484. doi:10.1111/jnu.12159. link to article New Trends: Bailey, E. (2016). IBM's CNO Judy Murphy on mobile tech in big data. Healthcare IT News. link to webinar Miliard, M. (2016) Meaningful use will likely end in 2016, CMS chief Andy Slavitt says. Healthcare IT News. link to article Website Exploration: Visit the following site www.fierceemr.com (this site contains weekly newsletter on EMRs, meaningful use, ARRA and privacy. Select 1 of 5 Topics/Popular Content of the Week to use in the weekly discussions) Visit the following site http://www.fiercehealthcare.com/it (explore healthcare technology news on CPOE, EMRs, E-prescribing, HIE, PHRs, HIT stimulus, and other health IT news) | Narrated PowerPoint presentation Graded Discussions |
Week 7 CO 6, 7 Trends and Issues | Website Exploration: Visit the following site: http://www.fiercemobilehealthcare.com (this site includes topics such as accuracy of data from wearable devices, using Smartphones to improve staff efficiency, hurdles using digital health such as security) Please be sure to read the following: Mottl, J. (2016, January). 3 hurdles facing digital health IoT innovations. FierceMobile Healthcare. link to article Bowman,D. (2016, March). Nursing Informatics Director Rosemary Ventura: Tailored smartphone improves staff efficiency. FierceMobile Healthcare. link to article Mottl, J. (2016, March). Accuracy concerns could give provider pause about using data from consumer wearables. FierceMobile Healthcare. link to article | Post-TANIC self-assessment Graded Discussions |
Week 8 CO 7 Trends and Issues | Cocchi, R. (2016). Top 10 issues impacting healthcare industry in 2016. Healthcare Business & Technology. link to site Website Exploration: Visit the following site http://www.healthcarebusinesstech.com/category/electronic-health-records/This site contains information on electronic health records (EHRs - trends and challenges) | Reflection |
Quizzes, tests, and exams are scheduled throughout this course - see the Assignments pages in the weeks they are given for the time and date they will be available.
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.
In the event of an emergency that prevents timely submission of an assignment, students may petition their instructor for a waiver of the late submission grade reduction. The instructor will review the student’s rationale for the request and make a determination based on the merits of the student’s appeal. Consideration of the student’s total course performance to date will be a contributing factor in the determination. Students should continue to attend class, actively participate, and complete other assignments while the appeal is pending.
This Policy applies to assignments that contribute to the numerical calculation of the course letter grade.
The maximum score in this class is 1,000 points. The categories, which contribute to your final grade, are weighted as follows.
Graded Item | Points | Weighting |
---|---|---|
Discussion (50 points, Weeks 1–7; 25 points, Week 8) | 375 | 37.5% |
Pre/Post Self-assessment of TIGER Nursing Informatics Competencies (Weeks 1 and 7- 25 points each) | 50 | 5% |
Orientation to Second Life (Week 1 & 2) | 50 | 5% |
Informatics Key Terms Quiz (Week 2) | 50 | 5% |
Scavenger Hunt Worksheet (Weeks 3 & 4) | 200 | 20% |
HealthIT Topic of Week Assignment (Week 5) | 125 | 12.5% |
Narrated PowerPoint Presentation Assignment (Week 6) | 150 | 15% |
Total | 1,000 | 100% |
No extra credit assignments are permitted for any reason.
All of your course requirements are graded using points. At the end of the course, the points are converted to a letter grade using the scale in the table below. Percentages of 0.5% or higher are not raised to the next whole number. A final grade of 76% (letter grade C) is required to pass the course.
Letter Grade | Points | Percentage |
---|---|---|
A | 940–1,000 | 94% to 100% |
A- | 920–939 | 92% to 93% |
B+ | 890–919 | 89% to 91% |
B | 860–889 | 86% to 88% |
B- | 840–859 | 84% to 85% |
C+ | 810–839 | 81% to 83% |
C | 760–809 | 76% to 80% |
F | 759 and below | 75% and below |
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 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.
Students agree that, by taking this course, all required papers may be subject to submission for textual similarity review to Turnitin.com for the detection of plagiarism. All submitted papers will be included as source documents in the Turnitin.com reference database solely for the purpose of detecting plagiarism of such papers. Use of the Turnitin.com service is subject to the Terms and Conditions of Use posted on the Turnitin.com site.
The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD's ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.
Each weekly threaded discussion is worth up to 25 points. Students must post a minimum of two times in each graded thread. The two posts in each individual thread must be on separate days. The student must provide an answer to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded thread topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion thread in which late entry occurs (up to a 10-point deduction for that week). Subsequent posts, including essential responses to peers, must occur by the Sunday deadline, 11:59 p.m. MT of each week.
Good writing calls for the limited use of direct quotes. Direct quotes in Threaded Discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the Grammar, Syntax, APA category.
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 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.
The Threaded Discussion Grading Grid and Rubric document can be found in Course Resources.
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.
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:
Criteria for Content
Criteria for Format and Special Instructions
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:
| Presentation of information was good, but was superficial in places and included all of the following elements:
| Presentation of information was minimally demonstrated in all of the following elements:
| Presentation of information is unsatisfactory in one of the following elements:
| Presentation of information is unsatisfactory in two of the following elements:
| Presentation of information is unsatisfactory in three or more of the following elements
|
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:
| Presentation of information was good, but was superficial in places and included all of the following elements:
| Presentation of information was minimally demonstrated in the all of the following elements:
| Presentation of information is unsatisfactory in one of the following elements:
| Presentation of information is unsatisfactory in two of the following elements:
| Presentation of information is unsatisfactory in three of the following elements
|
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:
| Demonstrated 3 of the following:
| Demonstrated 2 of the following:
| Demonstrated 1 or less of the following:
| ||
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:
AND
AND
| The following was present:
AND/OR
AND/OR
| The following was present:
AND/OR
AND/OR
| The following was present:
AND/OR
AND/OR
| The following was present:
AND/OR
AND/OR
AND/OR
| The following was present:
AND/OR
AND/OR
|
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:
| Demonstrates one or less of the following.
| ||||
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:
| Presentation of information was good, but was superficial in places and included all of the following elements:
| Presentation of information was minimally demonstrated in all of the following elements:
| Presentation of information is unsatisfactory in one of the following elements:
| Presentation of information is unsatisfactory in two of the following elements:
| Presentation of information is unsatisfactory in three or more of the following elements
|
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:
| Presentation of information was good, but was superficial in places and included all of the following elements:
| Presentation of information was minimally demonstrated in the all of the following elements:
| Presentation of information is unsatisfactory in one of the following elements:
| Presentation of information is unsatisfactory in two of the following elements:
| Presentation of information is unsatisfactory in three of the following elements
|
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:
| Demonstrated 3 of the following:
| Demonstrated 2 of the following:
| Demonstrated 1 or less of the following:
| ||
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:
AND
AND
| The following was present:
AND/OR
AND/OR
| The following was present:
AND/OR
AND/OR
| The following was present:
AND/OR
AND/OR
| ||
0 Points | 5 Points Lost | |||||
Participation Requirements | For Week 8 ONLY: Demonstrated the following:
| Failed to demonstrate the following:
| ||||
0 Points Lost | 5 Points Lost | |||||
Requirements | For Week 8 ONLY: Demonstrated all of the following:
| Demonstrates one or less of the following.
|
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.
The purpose of the Webliography is to provide students with annotated bibliographies of world wide websites relevant to their courses. These websites are not meant to be all inclusive of what is available for each course's subjects and have not been sanctioned as academically rigorous or scholarly by Chamberlain College of Nursing. Please exercise caution when using these websites for course assignments and references.