NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Essay

NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Essay

NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Essay

The Psychiatric/ Mental health nurse performs complex functions in care delivery. They assess families and individuals comprehensively to determine areas of need, their physical and cognitive health, and their family cohesiveness. They work with the interprofessional team to fulfill these needs. Assessing families is somewhat complex and differs from individual analysis because the focus is to manage the family trauma and rewire the dysfunctional patterns in the family. This comprehensive psychiatric evaluation note focuses on Patti’s family and a dysfunctional pattern blamed on the arrival of her daughter, who had been left behind in Iran and recently rejoined the family.

CC: (chief complaint): “Chaos in Patti’s family since her daughter rejoined the family.”

HPI: A mother (Patti), her daughter, and the family therapists came to the healthcare facility complaining of chaos in the family since her daughter Shireen came to the US. The family immigrated from Iran 12 years ago, and a 10-year-old daughter was left behind before processing her visa and joining the family in the United States. Chaos (blaming, arguing, cursing) arose when she rejoined the family and told them of the trauma and abandonment she went through after she was left behind during the immigration. Patti complains that her children are out of control, and she no longer feels in charge. The family therapist states that Shireen, the 21-year-old, claims she needs more money than a therapist and refuses to attend all appointments. Shireen has been through trauma after being sexually and physically abused by her father when the mother chose to stay with the four kids in the US and not return to Iran. Patti is also attached to her culture; the daughters try to detach from their mother and live independently. Patti has had two foot surgeries, creating more family tension. Patti often feels hopeless, helpless, and detached from the children and has been advised to get psychiatric help. Patti admits to needing help to learn to detach from the kids and live independently because of her cultural affiliations.

Past Psychiatric History:

• General Statement: The client has a history of fights and disagreements in the family due to cultural problems and started family therapy about two years ago
• Caregivers (if applicable): Not applicable
• Hospitalizations: 2 years ago, after two-foot surgeries
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: Denies current and past substance use history.

Family Psychiatric/Substance Use History: History of domestic trauma (battery), child sexual, immigration trauma of leaving a child behind, fairly traumatic current illness for the mother

Psychosocial History: The client and her children were born in Iran and migrated to the US 12 years ago, leaving a daughter behind who rejoined them later. She has five children; the oldest daughter is a 24-year-old daughter, a 21-year-old daughter, an 18-year-old son who is a student, and a 15-year-old son. The 21-year-old got married recently. The oldest daughter works in promotional jobs and working on getting her real-estate job license. The father, back in Iran, remarried and did not admit her mistakes of abusing Shireen. Patti worked at caregiving and has not been involved in any current or past legal issues. After bringing her child for medical attention in the US, Patti decided to stay and ran away from her husband, who used to beat and abuse her as she protected the children. At home, she quarrels with the children, argues, and curses over issues such as the need for assistance, controlling the children’s lives and dogs, and spending personal time, and she admits that there is a need for change.

Medical History:

• Current Medications: None
• Allergies: No known drug or food allergies

• Reproductive Hx: She has four children. LMP three weeks ago, no pregnant or lactating, heterosexual.

ROS:

• GENERAL: The patient denies any recent weight gain, fatigue, weakness, fever, chills, or night sweats
• HEENT: Denies headaches or recent traumas. Eyes: Denies pain, itchiness, dryness, or drainage. Ears: Denies ear pain, drainage, ringing, loss of balance, or hearing changes. Nose: Denies any pain, drainage, or congestion. Throat: Denies pain swallowing, dryness, itchiness, or sputum production
• SKIN: Denies rashes, itchiness, swelling
• CARDIOVASCULAR: Denies palpitations, high blood pressure, or chest pain
• RESPIRATORY: Denies cough, wheezing, crackles, congestion, or shortness of breath
• GASTROINTESTINAL: Denies changes in appetite, constipation, diarrhea, or abdominal pain
• GENITOURINARY: Denies pain micturition, color or odor in urine, increased urgency or frequency
• NEUROLOGICAL: Denies headaches, syncope, or loss of coordination
• MUSCULOSKELETAL: Reports having had two previous leg surgeries, has excruciating pain hence movement problems
• HEMATOLOGIC: Denies easy bruising, uncontrollable bleeding,
• LYMPHATICS: Denies lymphadenopathy
• ENDOCRINOLOGIC: Denies cold or heat intolerance or excessive sweating

Physical exam: Not Applicable. Performing a physical exam may help determine any physical needs that would inform care delivery.

Diagnostic results: No diagnostic tests were ordered

Assessment:

Mental Status Examination: Patti is a 40-year-old lady who appears the stated age. She is cooperative throughout the encounter. She has dressed appropriately and portrays no tics or other abnormal facial movements. In addition, her speech is coherent, clear, and in appreciable volume and tone. The thought process has no tangentiality, circumstantiality, thought block, or flight of ideas. She reported her mood as happy and displayed a broad congruent affect throughout the encounter. She denies any tactile, auditory, or visual hallucinations or illusions. She does not display delusional thinking or suicidal or homicidal ideations. She is alert and well-oriented to time, place, person, and occasion. Her immediate recall and ratio, recent, and remote memories are intact. In addition, she has good insight and judgment. She denies sleep or appetite changes.

Differential Diagnoses:

Adjustment Disorder with Depressed Mood

According to DSM-5, adjustment disorder is diagnosed when emotional and behavioral symptoms are in response to an identifiable stressor, occurring within three months of the stress onset (APA, 2022). The patient is often tearful, hopeless, and helpless and even exhibits bizarre behavior, such as demanding kids to spend time with her. This family has been experiencing disturbances since the daughter came from Iran. O’Donnell et al. (2019) note that behaviors such as aggression, demanding character, hopelessness, helplessness, cursing, and shouting are clinical manifestations of the adjustment disorder. The family is trying to adjust to the new realities, especially when trying to understand their sister and all the trouble she went through in Iran. Patti is also trying to cope with stressful changes, from an inability to work after two surgeries affecting her walking ability. She also needs adjustment to the new reality that she cannot entirely rely on the children for all her needs or be controlling or too demanding because they are already grown-ups. Thus, this is the primary diagnosis for this patient.

Dependent Personality Disorder

The condition presents with an excessive need to be cared for by others. It involves submissiveness and a need for constant reassurance, and the inability to make decisions (Heintz et al., 2021). The DSM 5 states that a person with this disorder displays a fearful and anxious presentation, excessive need, and dependence on others (APA, 2022). Patti has dependent behavior, but hers is more controlling than fearful. She demands that her children spend all day with her. However, she admits that she is unhappy they are arguing and fighting with her children because she loves them. She does not display a submissive and fearful character, thus ruling out the diagnosis.

Acute Stress Reaction

Acute stress disorder is caused by exposure to traumatic events that involve death, serious injury, sexual violence, and other symptoms, which must begin within three days of the event but last more than three days but subside within a month (APA, 2022). It must cause distress or impairment. Shahrour and Dardas (2020) note that acute stress can cause significant distress and occurs when individuals feel out of control. The daughter’s arrival, the stories she gave the family, and the blaming and the illness could have caused acute stress to the mother. She also presents as being depressive, hopeless, and helpless at times. However, these symptoms have persisted for more than a month, ruling out the diagnoses.

Case Formulation and Treatment Plan: Initiating Patti’s individual psychotherapy and family therapy every two weeks to help the client live a more independent life away from her children and to ensure her children support her as she learns to live independently. Hoffman and Stein (2022) note that psychotherapy is an effective treatment for adjustment disorders as it helps patients deal with the patterns responsible for them. The recommendations were discussed with the family therapists, who agreed with the treatment plan and promised to cooperate. The family also consents to the arrangement for better family outcomes for this troublesome family. Returning to the clinic in four weeks will help the healthcare providers assess change and make other management decisions for better health outcomes.

Reflections

Working with this family and therapist was a complex activity that I could have improved in many ways. I agree with the preceptor’s diagnosis because Patti presents with a need for psychiatric interventions, as seen in her portrayal of maladjustment behaviors. In the future, I will ensure I listen to the family keenly before trying to start conversations. I will also establish some background rules to prevent patients from fighting or disagreeing harshly in the room, which can impede care delivery. The care provider must ensure a therapeutic environment for effective problem management (Wheeler, 2020). Culture is essential to any individual, and these children also need to understand their mother and be supportive as she adjusts to the new realities. Thus, their involvement in family therapy is crucial. Educating the patient on identifying other sources of social support, such as community and religious groups, would also help relieve the overreliance on her children.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Heintz, H. L., Freedberg, A. L., & Harper, D. G. (2021). Dependent personality in depressed older adults: a case report and systematic review. Journal of Geriatric Psychiatry and Neurology, 34(5), 445-453. https://doi.org/10.1177/0891988720933361

Hoffman, J., & Stein, D. J. (2022). What are the pharmacotherapeutic options for an adjustment disorder? Expert Opinion on Pharmacotherapy, 23(6), 643-646. https://doi.org/10.1080/14656566.2022.2033209

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International journal of Environmental Research And Public Health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537

Shahrour, G., & Dardas, L. A. (2020). Acute stress disorder, coping self‐efficacy and subsequent psychological distress among nurses amid COVID‐19. Journal of Nursing Management, 28(7), 1686–1695. https://doi.org/10.1111/jonm.13124

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A  how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

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INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.
In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS
• Read rating descriptions to see the grading standards!

In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
• Read rating descriptions to see the grading standards!

In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Read rating descriptions to see the grading standards!
Reflect on this case. Include what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)
EXEMPLAR BEGINS HERE
CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why they are presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.
HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication, and referral reason. For example:
N.M. is a 34-year-old Asian male who presents for psychotherapeutic evaluation for anxiety. He is currently prescribed sertraline by (?) which he finds ineffective. His PCP referred him for evaluation and treatment.
Or
P.H. is a 16-year-old Hispanic female who presents for psychotherapeutic evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her mental health provider for evaluation and treatment.
Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, the duration, the frequency, the severity, and the impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders. You will complete a psychiatric ROS to rule out other psychiatric illnesses.
Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP.
General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.
Caregivers are listed if applicable.
Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?
Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)
Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. (Or, you could document both.)
Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.
Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information (be sure to include a reader’s key to your genogram) or write up in narrative form.
Psychosocial History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:
• Where patient was born, who raised the patient
• Number of brothers/sisters (what order is the patient within siblings)
• Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?
• Educational Level
• Hobbies
• Work History: currently working/profession, disabled, unemployed, retired?
• Legal history: past hx, any current issues?
• Trauma history: Any childhood or adult history of trauma?
• Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

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Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.
Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.
Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns
Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).
Assessment
Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudo hallucinations, illusions, etc.), cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.
He is an 8 yo African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.
Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?
Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Case Formulation and Treatment Plan.
Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions with psychotherapy, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. *see an example below—you will modify to your practice so there may be information excluded/included—what does your preceptor document?
Example:
Initiation of (what form/type) of individual, group, or family psychotherapy and frequency.
Documentation of any resources you provide for patient education or coping/relaxation skills, homework for next appointment.
Client has emergency numbers: Emergency Services 911, the Client’s Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

Reviewed hospital records/therapist records for collaborative information; Reviewed PCP report (only if actually available)

Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (This relates to informed consent; you will need to assess their understanding and agreement.)

Follow up with PCP as needed and/or for:

Write out what psychotherapy testing or screening ordered/conducted, rationale for ordering

Any other community or provider referrals

Return to clinic:

Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care OR if one-time evaluation, say so and any other follow up plans.
References (move to begin on next page)
You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

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Criteria	Ratings					Pts
Document the following for the family in the video, using the Comprehensive Evaluation Note Template: • Chief complaint• History of present illness• Past psychiatric history• Substance use history• Family psychiatric/substance use history• Psychosocial history/Developmental history• Medical history• Review of systems (ROS) • Physical assessment (if applicable)	20 to >17.0 pts Excellent 90%– 100% The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. The response addresses each of the required elements and demonstrates thoughtful consideration of the client family’s situation and culture.		17 to >15.0 pts Good 80%–89% The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family.	15 to >13.0 pts Fair 70%–79% The assignment includes a description of the subjective and objective information for the client family but is somewhat general or contains small inaccuracies.	13 to >0 pts Poor 0%–69% The assignment includes a description of the subjective and objective information for the client family but is vague or contains many inaccuracies. Or, several of the required elements are missing.	20 pts
•  Mental status exam • Differential diagnoses— Include a minimum of three differential diagnoses and include how you derived at each diagnosis in accordance with DSM-5-TR diagnostic criteria	20 to >17.0 pts Excellent 90%– 100% The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the family in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.	17 to >15.0 pts Good 80%–89% The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.		15 to >13.0 pts Fair 70%–79% The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.	13 to >0 pts Poor 0%–69% The response provides an incomplete or inaccurate description of the results of the mental status exam and/or explanation of the differential diagnoses. Or, assessment documentation is missing.	20 pts

 

Criteria	Ratings					Pts
•  Case formulation• Treatment plan that includes psychotherapy interventions	25 to >22.0 pts Excellent 90%– 100% Case formulation is thorough, thoughtful, and demonstrate critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. The response demonstrates thoughtful consideration of the client family’s situation and culture.	22 to >19.0 pts Good 80%–89% Case formulation demonstrates critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions.	19 to >17.0 pts Fair 70%–79% Case formulation is somewhat general or does not demonstrate critical thinking…. The assignment includes a treatment plan for the client family that includes psychotherapy interventions but is somewhat general or contains small inaccuracies.		17 to >0 pts Poor 0%– 69% The assignment provides a vague and/or inaccurate description of the case formulation and treatment plan for the client family. Or, many of the required elements are missing.	25 pts
• A psychotherapy genogram for the family	20 to >17.0 pts Excellent 90%– 100% The assignment includes an accurate, clear, and complete genogram of the client family. The documentation style is consistent and a key is provided.	17 to >15.0 pts Good 80%–89% The assignment includes an accurate genogram of the client family. The documentation style is consistent and a key is provided.	15 to >13.0 pts Fair 70%–79% The assignment includes a genogram of the client family but is somewhat limited or contains factual inaccuracies or inconsistencies in documentation style.		13 to >0 pts Poor 0%– 69% The genogram provided is vague or contains many inaccuracies. Or, the genogram is missing.	20 pts
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well- developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused— neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided	5 to >4.0 pts Excellent 90%– 100% Paragraphs and sentences follow writing standards for flow, continuity, and clarity………….. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	4 to >3.0 pts Good 80%–89% Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.	3 to >2.0 pts Fair 70%–79% Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%– 79% of the time….. Purpose, introduction, and conclusion of the assignment are vague or off topic.	2 to >0 pts Poor 0%–69% Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time No purpose statement, introduction, or conclusion were provided.		5 pts

 

Criteria	Ratings									Pts
which delineate all required criteria.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 pts Excellent 90%–100% Uses correct grammar, spelling, and punctuation with no errors.	4 to >3.0 pts Good 80%– 89% Contains 1 or 2 grammar, spelling, and punctuation errors.			3 to >2.0 pts Fair 70%–79% Contains 3 or 4 grammar, spelling, and punctuation errors.			2 to >0 pts Poor 0%–69% Contains many (≥5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.		5 pts
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 to >4.0 pts Excellent 90%– 100% Uses correct APA format with no errors.		4 to >3.0 pts Good 80%–89% Contains 1 or 2 APA format errors.			3 to >2.0 pts Fair 70%–79% Contains 3 or 4 APA format errors.			2 to >0 pts Poor 0%–69% Contains many (≥5) APA format errors.	5 pts
Total Points: 100