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  • The purpose of this assignment is to examine Clinical Decision Support Systems (CDSS) to determine their application in addressing health equity. Develop a presentation outlining task force goals and relevant information for implementing

    Week 4 paper
    The purpose of this assignment is to examine Clinical Decision Support Systems (CDSS) to determine their application in addressing health equity. Develop a presentation outlining task force goals and relevant information for implementing a CDSS system to improve equity of care and promote health for all patients.
    This assignment has indirect care experience requirements. The “Indirect Care Experience Hours” form, found in the Topic 3 Resources, will be used to document the indirect care
    experience hours completed in Topics 3, 4 and 5. As progress is made on this and subsequent
    assignments, update this form indicating the date(s) each section is completed. This form will
    be submitted in Topic 5. In your role as a nurse informaticist, you have been asked by the
    Chief Informatics Officer (CIO) to evaluate several clinical decision-making tools to be used
    by your organization’s stakeholders. The selected Clinical Decision Support Systems (CDSS)
    will be used to analyze the current state of health equity and information literacy in your
    organization.
    Your first step is to create a task force of stakeholders to participate in the CDSS selection
    process. Prepare a 10-12 slide PowerPoint presentation for the first task force meeting to
    include these agenda items:
     Reason for the Project: Explain the organizational need, reason for the project, rationale
    for implementing a clinical decision-making tool in your organization. Discuss how
    CDSS can improve health equity and information literacy in your organization.
     Task Force Selection: Explain why you have been selected to lead this project. In your
    speaker notes, explain the role of each stakeholder and why they were selected to serve
    on this task force.
     Research: Conduct research and identify one popular CDSS system used in the health
    care industry, include a description of the CDSS system.
     Basic Concepts of Systems: Review the information and communication technologies
    (in the electronic health record, mobile health, and telehealth systems). Select one
    communication technology and discuss how a clinical decision-making tool can be
    incorporated to improve health equity in patient care.
     Crucial Functionality: Describe the crucial functions of the selected CDSS. Explain
    why it is essential to the clinical workflow. Explain the impact of the CDSS on health
    information exchange, interoperability, and integration of health care.
     Task Force Communication: Describe how communication technologies support
    documentation of care and communication among providers and patients at all system
    levels. Discuss how communication technology will be used to communicate with the
    task force members during the project.

    Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student
    Success Center, for additional guidance on completing this assignment in the appropriate style.
    The title slide and reference slide are not included in the slide count. Include speaker notes
    below each content-related slide that represent what would be said if giving the presentation in
    person. Expand upon the information included in the slide and do not simply restate it. Please
    ensure the speaker notes include a minimum of 50-75 words.
    Cite a minimum of three sources to complete this assignment. Sources must be published within
    the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
    While APA style is not required for the body of this assignment, solid academic writing is expected,
    and documentation of sources should be presented using APA formatting guidelines, which can be
    found in the APA Style Guide, located in the Student Success Center.
    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. A link to the LopesWrite technical
    support articles is located in Class Resources if you need assistance.
    Benchmark Information
    This benchmark assignment assesses the following programmatic competencies:
    RN-BSN
    8.2: Use information and communication technology to gather data, create information, and generate
    knowledge.
    8.4: Use information and communication technology to support documentation of care and
    communication among providers, patients, and all system levels.
    American Association of Colleges of Nursing Core Competencies for Professional Nursing Education
    This assignment aligns to AACN Core Competencies 8.2 and 8.4

  • Week 4 Assignment What does your coachee need to do to achieve his or her objectives? Think about it like a staircase. What is the first step that is needed to get to the second step? What is the second

    This week, you and your coachee will work in tandem to achieve the desired objectives identified in Week 2. Through active listening, questioning, probing, and guiding, you will support your coachee to develop strategies and action steps for achieving the desired objectives. 

    Week 4 Assignment

    What does your coachee need to do to achieve his or her objectives? Think about it like a staircase. What is the first step that is needed to get to the second step? What is the second step that is needed to get to the third step, and so on, until the coachee is able reach the objective or goal at the top? Often, it is helpful to work backwards, moving from the objective down through smaller and smaller goals or action steps until the coachee can identify the most immediate action step to take.

     

    By the end of this coaching session, your coachee should have a clear plan for achieving the key objectives (identified in the first coaching session), a list of doable action items, and a clear understanding of the expected completed items for next week’s session. 

     

    For this third coaching session, submit a coaching report that provides the following information:

    • Recap the coaching session (1 to 2 pages)
      • Where did the session occur?
      • When did it occur?
      • Who was being coached?
      • Who was the coach?
      • Summarize the conversation. Who said what?
      • Any key details about the relationship or interaction that need to be recorded? (e.g., impressions, difficulties, opportunities, things that were missed, things to explore in the future, boundaries, parameters, etc.).

         

    • Analyzed a set of action plans for the coachee to achieve the first objectives (½ to 1 page).

       

    • Analyzed a set of action plans for the coachee to achieve the second objectives (½ to 1 page).

       

    • Clarify the action steps that you (as coach) need to complete prior to the next coaching session. For example, what information do you need to research? What resources do you need to locate? What follow ups do you need to complete? What skills do you need to refine (¼ to ½ page)?

       

    Submission Details:

    • Submit your report in a three- to five-page Microsoft Word document, using APA style.

    Due by 10/14/24 at 11pm CST 

    Requirements

    · 1. Make certain to include in text citations from your course text in addition to your outside leadership resources within your main  post. This adds credibility to your argument. [Textbook]: Zenger, J. H., & Stinnett, K. (2010). The extraordinary coach: How the best Leaders help others grow (1st ed.). McGraw Hill. ISBN: 9780071703406
     

    · 2. No plagiarism will be tolerated. Must be in 7th Edition APA format with cited sources within the last 5 years.
     

    · 3. No AI support, score must be 0% and less than < 10% score on Turnitin

  • To this point in the final project, you have assisted your coachee to (1) develop two professional objectives and assess their significance, (2) identify possible obstacles to the objectives, and (3) determine some possible strategies

    To this point in the final project, you have assisted your coachee to (1) develop two professional objectives and assess their significance, (2) identify possible obstacles to the objectives, and (3) determine some possible strategies and action steps for reaching the objectives. During the final week of the project, you will be moving towards closure in the coaching relationship and evaluating the effectiveness of your work with your coachee.

    Because of the short duration of the coaching practicum, concluding whether significant progress has been made towards achieving the desired outcomes might be unclear. However, as you complete your coaching interaction, it is important for you and your coachee to reflect on the process in which you engaged as a collaborative team, including how you will bring the coaching relationship to a close and what next steps the coachee will take. In other words, the reflection is about the quality of the process and next steps more than the success of reaching the objectives.

    Week 5 Assignment
    As the student-coach, you should address the following questions. 

    Assessment of Tasks and Process:

    • What tasks were identified and successfully completed by you and your coachee during the coaching relationship?

       

    • How would you assess your coachee’s participation, open-mindedness, and willingness to be coached?

       

    • Did you hold your coachee accountable for completions?
      • How did you do this?
      • Were your methods successful? Why?

         

    • How would you assess your effectiveness as a coach?
      • What specifically did you learn about yourself through this process?
      • What coaching strengths and weaknesses emerged through this process?
      • What did you learn from this coaching experience?

         

    • How did your coachee assess your effectiveness as a coach? What gaps exist, if any, between your self-assessment of your performance and your coachee’s assessment of your performance?

       

    • What would you do differently if you had the opportunity to re-do the coaching project?

       

    • What did you learn about the potential for coaching to enhance the professional development of individuals in an organization? To enhance the productivity of an organization?

       

    • If it were possible to do so, how would you infuse coaching into your organization?

       

    • How did this project affect your leadership knowledge and skills?

       

    • What is your overall assessment of this coaching process? Was it a valuable experience for you and your coachee? Why or why not? 

     
    Assessment of Next Steps

    • What next steps, if any, have you and your coachee agreed to work on?
    • Will your coachee continue the coaching process with a certified coach?
    • What next steps have you identified for yourself to continue your own professional development? 

     
    Assessment of Appropriate Closure

    • How did you close your coaching relationship?
    • How did you and your coachee feel about this relationship coming to a close?
    • Did you discuss this closure and your respective feelings with each other?
    • Does your coachee feel comfortable moving forward with the plans and objectives independent of the coaching relationship?
    • Have you ensured confidentiality of all communications and properly destroyed all written communications? 

    Submission Details:

    • Organize and submit your report in a five-to-seven-page Microsoft Word document, using APA style.

    Due by 10/20/24 at 7pm CST 

    Requirements

    · 1. Make certain to include in text citations from your course text in addition to your outside leadership resources within your main  post. This adds credibility to your argument. [Textbook]: Zenger, J. H., & Stinnett, K. (2010). The extraordinary coach: How the best Leaders help others grow (1st ed.). McGraw Hill. ISBN: 9780071703406
     

    · 2. No plagiarism will be tolerated. Must be in 7th Edition APA format with cited sources within the last 5 years

  • Role of Media in Terrorism Response For this session’s assignment, go to the Homeland Security Digital Library (https://www.hsdl.org/c/) to search their library for issues associated with

    Role of Media in Terrorism Response

    For this session’s assignment, go to the Homeland Security Digital Library (https://www.hsdl.org/c/) to search their library for issues associated with the media, social media, and terrorism in the United States. Use this and other scholarly resources to write a paper on the role of media in terrorism response. Focus your thoughts on how agencies use different formats of media in terrorism response as well as how the media influences the public response.

    Write a paper explaining your thinking on this topic. Your paper must be:

    Three to five pages in length (not including the cover page and reference page).

    Constructed using an introduction, body paragraphs, and a conclusion with quality college-level writing.

    Written in Word using APA format. (Make use of the APA assignment template (Word)). It should include the following:

    A cover page.

    Assignment written in an APA approved font and size, double spaced.

    In-text citations to support main points.

    A reference page with full APA references for each in-text citation used for support.

    Note: Refer to the APA & Turabian Requirements under your course Help tab for additional APA assistance .

    Supported by a minimum of two scholarly sources in addition to the Homeland Security Digital Library. The CCU library is one place for locating these resources.

  • Role of Media in Terrorism Response For this session’s assignment, go to the Homeland Security Digital Library (https://www.hsdl.org/c/) to search their library for issues associated with the media,

    Role of Media in Terrorism Response

    For this session’s assignment, go to the Homeland Security Digital Library (https://www.hsdl.org/c/) to search their library for issues associated with the media, social media, and terrorism in the United States. Use this and other scholarly resources to write a paper on the role of media in terrorism response. Focus your thoughts on how agencies use different formats of media in terrorism response as well as how the media influences the public response.

    Write a paper explaining your thinking on this topic. Your paper must be:

    Three to five pages in length (not including the cover page and reference page).

    Constructed using an introduction, body paragraphs, and a conclusion with quality college-level writing.

    Written in Word using APA format. (Make use of the APA assignment template (Word)). It should include the following:

    A cover page.

    Assignment written in an APA approved font and size, double spaced.

    In-text citations to support main points.

    A reference page with full APA references for each in-text citation used for support.

    Note: Refer to the APA & Turabian Requirements under your course Help tab for additional APA assistance .

    Supported by a minimum of two scholarly sources in addition to the Homeland Security Digital Library. The CCU library is one place for locating these resources.

  • Evidence Outcome Summary Synthesis Topic/PICO Question: In hospitalized patients with feeding tubes (nasogastric/orogastric) with initial x-ray verification of placement, does ongoing placement

    Evidence Outcome Summary

    Synthesis Topic/PICO Question: In hospitalized patients with feeding tubes (nasogastric/orogastric) with initial x-ray verification of placement, does ongoing placement verification prior to feeding/medication administration using pH testing of gastric aspirate as compared to current practice (audible air injection, distal tube length) impact the occurrence of adverse outcomes/events (e.g. delay in feeding/med admin, aspiration, etc.)

     


    Sources of Evidence

    LOE:

    Quality:

    One sentence summary of what the study is
    about

    Population:

    Setting:

    List the findings in bullet format

    Reason(s) you wouldn’t use this evidence

    Author’s conclusions and the bottom line
    result(s)?

    Do the results answer your question?

    (Use of pH as on-going confirmation
    method?)

     

    Additional comments

     

    1.      Perry, A., Kaiser, J., Krueger, K.,
    and the 2022 ENA CPG Committee (2023). Gastric Tube Placement Verification
    [Clinical practice guideline]. Emergency Nurses Association.

    LOE:
    Level II

    Quality:
    High

     

     

    ENA CPG, updated from its 2014, 2017 and 2019 version

    Lit search 2016-2226, total of 5980 items found, full
    review 211, 25 included in evidence analysis, 9 as background information

    -The
    use of auscultation is no longer recommended nor reliable

    -Reliability
    of the use of PH ranges from 84%-97%

    _Adding
    lipase increases sensitivity to 97.2% with 100% specificity (no bedside  test for lipase currently available)

    -**PPIs
    may reduce ability for PH confirmation

    -In
    pts over 4 weeks old, PH less than 5 is acceptable, if 5 or greater, XRay is
    required

     

     

     

    n/a

    -XRAY remains the gold standard-

    -PH testing when part of a mixed-method confirmation i.e.
    auscultation, tube marking, PH etc is an acceptable means to confirm NGT/OGT

    -Ph less than 5 
    appears to be a reasonable cut off

     

    yes

    Confirmation accuracy is greater when aspirate and
    non-aspirate methods used, recommend auscultate, aspirate for pH with visual
    inspection

    There is moderate evidence to support the use of PH testing
    as a component of a multiple-method bedside verification

     

    2.     
    Northington, et
    al (2022)

    LOE: V

    Quality: Weak

     

    Survey completed by 205 nurses in 166 institutions
    (pediatric) to determine how NG/OG placement is verified:  42% use pH, 24% use Xray

    Reporting a combination of
    radiograph and     pH measurement, 88% of pediatric
    nurses selected evidence-based methods for NGT placement verification
    placement.

    Weak-survey

    While progress has
    been made toward using the EBP methods of pH measurement and/or abdominal
    x-ray to verify NGT placement, further education is needed to establish this
    as a     standard of care among nursing organizations

    no

    An EBP standard of care needs to be established

    3.      Lin (2020)

    LOE:
    Level V (Systematic Review & Meta-Analysis of observational studies)

    Quality:
    Moderate

     

     

     

    To evaluate diagnostic performance of methods used to
    assess gastric tube placement verification in neonates, infants and children.

    – 8 studies, 911 participants, evaluated 9 index tests

    – pH testing with cutoff values ≤6 for gastric tube
    position confirmation was the only index test subjected to meta-analysis,
    with the summary sensitivity and specificity being 0.77 (95% confidence
    interval [CI] 0.56–0.90) and 0.42 (95% CI 0.16–0.73).

    –
    Other methods (color of aspirate, auscultation, carbon dioxide testing,
    ultrasound, bilirubin, pepsin, trypsin, separately or in combination with the
    above methods) showed great variations in sensitivities and specificities.

    – 6 out of 8 studies used for meta-analysis showed a high
    degree of heterogeneity for diagnostic estimates.

    – Revealed a moderate summary sensitivity and a low summary
    specificity for pH cutoffs ≤6. This finding suggests that pH ≤ 6 may not be
    sufficiently accurate to detect the gastric tube position, which does not
    support recommendations from multiple guidelines.

    – The conclusion of the inability of pH ≤ 6 for detection
    of gastric tube position in the studied population can only be drawn with
    caution because of the heterogeneity of studies.

    – Paucity of data and methodological variations in studies
    make it difficult to arrive at any conclusions regarding the diagnostic test
    accuracy of pH ≤ 4 or 5 and other index tests in detection of gastric tube
    placement.

    – Well-designed studies to strengthen current evidence are
    recommended.

    Yes/no-paucity of data

    The studies included in the meta-analysis had heterogeneity
    (3 different cutoff values, 2 types of instruments of pH meter and pH paper,
    different populations of fasting and fed) so the conclusion needs to be
    considered with caution (p. 658).

     

    pH testing with cutoff values ≤6 for gastric tube position
    confirmation was the only index test subjected to meta-analysis, with the
    summary sensitivity and specificity being 0.77 (95% confidence interval [CI]
    0.56–0.90) and 0.42 (95% CI 0.16–0.73).

     

    4.      Metheny (2019)

    LOE:
    Level V

    Quality:
    High

     

     

    This is a review of worldwide guidelines for placement
    verification of NG tubes.

     

     

    -All
    indicate radiographic confirmation as the gold-standard verification of
    initial placement.

    -11
    guidelines discuss pH as an adjunct method of placement verification; 9
    guidelines discuss specific safe cutoff values; 4 discuss pH ranges between 1
    and 4 as safe

    -Wide geographical variety of guidelines advocating for
    significantly varied methods of confirming placement.

    -Unable to confirm primary data of each contributing
    guideline author

    -Radiographic confirmation of initial placement cannot be
    replaced by other available methods

    -pH safe cutoff not established firmly, wide disagreement
    among guidelines.

    yes

    Helpful as an investigational look into global
    best-practice

    : pH is vetted as a method and ranked highly in terms of
    safety; does not advise against radiologic confirmation as default.

    5.     
    Dias et al.,
    2019

     

    LOE:
    IV

    Quality:  High

    Cross-sectional,
    double-blinded diagnostic test study. Sample: n = 162 neonates, average age
    32.92 gestational weeks.

    -No
    relationship between pH values with age or diet. -Aspirate: No relationship
    between aspirate color and placement -Use of gastric secretion inhibitor
    drug: pH was higher (>5.5), but only in small sample

    -Radiographic
    placement verification: 98.77% correct placement. -Comparison of pH test and
    radiographs: 96.25% sensitivity.

    -Accuracy
    of pH test with cutoff of 5.5 showed high sensitivity compared to x-ray
    verification.

    Population

    Accuracy of pH test with cutoff of 5.5 showed high
    sensitivity compared to x-ray verification.

    yes

    Neonates

    6.      Irving (2018)

    LOE:
    Level V

    Quality:
    High

     

    Presents
    the challenges of bedside NG-EAD (Nasogastric-enteral access device)
    placement and ongoing location verification.

     

    Review the current state of the science for verification of
    bedside placement of nasogastric tubes and ongoing assessment of tube
    location in children.

    Abdominal
    radiograph is the gold standard.

     

    In lieu of
    or when abdominal x-ray is not available, accurate measurement of enteral
    tube insertion length, gastric pH testing, and visual observation of gastric
    aspirate are acceptable non radiologic methods for assessing tube placement.

     

    Specificies children who are high risk (neonates, children
    with neurological impairment, children in an obtuded state, children who are
    encephalopathic, have a decreased gag reflex, or are sedated or critically
    ill) recommends an x-ray.

    Auscultation
    as a means of verifying NG-EAD placement is discouraged in the literature and
    is no longer supported by clinical practice organizations.

     

    Yes,
    speaks to our current practice.

     

    Despite the accuracy of pH and enzyme testing, if NG-EAD
    placement or location is uncertain, an abdominal radiograph is warranted, as
    it is accepted as the confirmatory method to verify NGEAD placement.

    X-Ray is goldstandard

     

    pH is reliable method of verifying NG-EAD location in
    children

     

    radiograph recommended to confirm
    location when no aspirate is obtained

    Yes (children)

    Ph and noting distal tube length are acceptable for
    placement verification

    7.      Boullata (2017)

    LOE:
    Level V

    Quality:
    High

     

     

    Aspen Guidelines

    Do not rely on the auscultatory method alone to
    differentiate between gastric and respiratory placement or between gastric
    and small bowel placement.”; “Healthcare 
    professionals cannot rely on auscultatory methods to differentiate
    between gastric and bronchopulmonary tube placement because auscultatory
    methods cannot distinguish tubes improperly placed in the lung or coiled in
    the esophagus from properly positioned tubes.”

     

     

    Mark  the 
    exit  site  of 
    a  feeding  tube 
    at  the  time 
    of  the initial placement and
    document either the incremental marking on the tube or the external length of
    the tube in the medical record.” [does not give frequency]

     

     

     

     

     

     

     

    Gastric fluid typically is clear and colorless or grassy
    green or brown with a pH of 5 or less. 
    Several studies demonstrating the use of pH testing indicate a pH
    of  ≤5.5 from tube aspirate is adequate
    to check the position of the tube in the stomach.”

    Although observing for respiratory symptoms is warranted
    during EAD insertion, malpositioning may occur without any apparent symptoms.

     

    8.      Ni (2017)

    LOE:
    Level IV

    Quality:
    Moderate

     

    Using a decision analytical modelling approach to compare
    the relative safety of different methods used to verify the placement of NG
    tubes in the stomach.

    Population: 104 cases with documented feeding tube
    misplacement. Total of 2368 adverse event reports submitted to NRLS (National
    Reporting and Learning System)

    Setting: UK

     

    -UK already follows safety guideline that uses pH testing
    of NG tube aspirate as a method of initial placement verification followed by
    chest xrays but US does NOT

    -cost analysis not done

    -only focused on patients with successful aspirations

    -analysis assumed chest xrays were 100% accurate

    -excluded pediatric cases

    -before
    use of tube, using pH test cut-off of 5 is the safest way to verify enteral
    tube location

    Yes-adults

    Uses pH as method of initial verification.

    Yes,
    could provide guidance for using pH as a method of ongoing verification.

    9.      Clifford (2015)

    LOE:
    Level V (integrative review)

    Quality:
    Moderate

     

    Integrative review and synthesis of literature on the most
    accurate methods of enteral tube placement and placement verification along
    with recommendations for practice. 

    Lit Search bet May-August 2014 (CINAHL, MEDLINE, PubMEd:
    studies published Jan 2009-June 2014 in English only, limited to 0-18 year
    old patients).

    56 pediatric & adult articles

    7 national guidelines dating from 1993-2014

    -only xray gold standard verification method

    PH:

    -AACN recommends PH 5 or less for ongoing placement
    verification

    -feeding/meds can alter gastric pH, but evidence suggests
    there was no major difference in pH with patients on acid-blocking meds (p.
    157)

    Gastric aspirate appearance:

    -most helpful to determine stomach vs intestine placement,
    but use with other methods

    Tube marking:

    -marking does not confirm that tube has not moved/coiled so
    only use in conjunction with other methods

    Auscultation:

    -proven unreliable, suggest use of this method be
    discontinued

     

     

    Limitations:

    -lack of neonatal evidence

    -mostly low levels of evidence

    -outdated evidence (dating from 1993-2014)

    -UK sources of data included, but they have different
    practices (e.g. UK uses pH as first-line verification, xray as second-line)

    -place enteral tube via NEMU method

    -xray is gold standard but not practical for verification
    prior to each use of tube

    -no other verification method on its own is as accurate as
    xray

    -consider using combo of 2 or more methods of verification

    -use analysis of gastric aspirate color and pH along with
    assessment of tube marking to confirm there has been no migration

    -algorithm
    may help as decision making tool with follow up quality improvement studies
    and data collection

     

     

    10.   Boeykens (2014)

    LOE:
    Level IV

    Quality:
    High

     

     

    Prospective observational study to determine the
    reliability of pH measurement compared to auscultatory method (N 241)

    -98.9%
    accuracy compared to x-ray with pH ≤ 5

    -auscultation
    method elicited 94.2-72.1% accuracy

    -A pH
    of ≤ 5.5 aspirate reading is adequate to check the tube placement

    -Auscultatory
    method is unreliable

    A point of care testing for pH testing is cumbersome due to
    many regulatory requirements.

    However, with a new testing technology available this
    method could be used at bedside by clinical nurses

    pH
    testing is the 2nd best method compared to the gold standard of x-ray method
    for tube verification.

     

    Rather
    than using the auscultation method, bedside verification of feeding tube
    should be based on pH testing along with the tube length during insertion

     

     

    Using
    a cut off of ≤5.5 for gastric pH was reliable indicator of stomach placement
    even if patient was on antacids. Auscultation-only method is not as reliable
    as gastric pH testing or x-ray

    **

    There
    is insufficient evidence supporting the use of auscultation to confirm accurate
    gastric tube placement in the emergency department

    With
    the possibility of RightSpot technology/products availability, pH testing
    should be adopted as a safe practice for feeding tube bedside confirmation

    11.  
    Ellett et al.,
    2014

     LOE: II

    Quality: High

    Prospective comparative design, secondary analysis. Data
    originally from single blind randomized controlled trial. Sample: N = 276
    children, 24 weeks to 212 months of age requiring .nasogastric/orogastric
    tube placemen

    -pH meter vs paper had ICC
    agreement 0.76.

    -pH as a tool to verify GT
    placement in the stomach has specificity of 87-92.2% but cannot identify
    placement errors (esophagus or gastroesophageal junction).

    – Optimal method to determine
    correct tube placement in the stomach: lack of aspirate from tube
    (sensitivity 34.9%, PPV 66.7).

    -Aspirate alone led to multiple
    misidentified placement locations.

     

     

     

    Aspirate alone led to multiple misidentified placement
    locations

    12.   Stock et al., 2008

    LOE:
    6

    Quality:
    Weak

    Design: prospective, observational study Sample: n=404
    children

    -No difference in pH for
    gastroenteritis vs. non-gastroenteritis

    . -Tube placement confirmed by pH
    alone in > 84%. pH higher than 4 was associated with incorrect placement;
    however, all pts. did not receive radiograph for confirmation

     

    pH testing only useful if aspirate can be obtained

     

    Children, single ED

    13.  
    Northwell
    System policy (adult/peds) June 2023

     

     

    An X-ray verification is required
    to confirm placement prior to initiations of feedings/medication
    administration.

    For non-high risk pediatric
    patients, pH testing may be used to confirm placement

    -Ng/Og bedside confirmation prior
    to Xray may consist of pH with a value between 1-5.5

     

     

     

     

     

    14.  
    Northwell
    Nursing Clinical Competency, “Nasogastric Tube Maintenance” 12/19

     

    Attaches a syringe with 10-20 mL of air to the end of the tub.

    – Injects air while auscultating the abdomen with a stethoscope.

    – Listens for “whooshing” sound

    – Aspirates stomach contents and notes amount, color,
    consistency, and odor

    – If unsure of placement obtains order for x-ray to confirm
    placement.

     

     

     

     

    Does not match with policy or standards of practice

  • Evidence Outcome Summary Synthesis Topic/PICO Question: In hospitalized patients with feeding tubes (nasogastric/orogastric) with initial x-ray verification of placement, does ongoing placem

    Evidence Outcome Summary

    Synthesis Topic/PICO Question: In hospitalized patients with feeding tubes (nasogastric/orogastric) with initial x-ray verification of placement, does ongoing placement verification prior to feeding/medication administration using pH testing of gastric aspirate as compared to current practice (audible air injection, distal tube length) impact the occurrence of adverse outcomes/events (e.g. delay in feeding/med admin, aspiration, etc.)

     


    Sources of Evidence

    LOE:

    Quality:

    One sentence summary of what the study is
    about

    Population:

    Setting:

    List the findings in bullet format

    Reason(s) you wouldn’t use this evidence

    Author’s conclusions and the bottom line
    result(s)?

    Do the results answer your question?

    (Use of pH as on-going confirmation
    method?)

     

    Additional comments

     

    1.      Perry, A., Kaiser, J., Krueger, K.,
    and the 2022 ENA CPG Committee (2023). Gastric Tube Placement Verification
    [Clinical practice guideline]. Emergency Nurses Association.

    LOE:
    Level II

    Quality:
    High

     

     

    ENA CPG, updated from its 2014, 2017 and 2019 version

    Lit search 2016-2226, total of 5980 items found, full
    review 211, 25 included in evidence analysis, 9 as background information

    -The
    use of auscultation is no longer recommended nor reliable

    -Reliability
    of the use of PH ranges from 84%-97%

    _Adding
    lipase increases sensitivity to 97.2% with 100% specificity (no bedside  test for lipase currently available)

    -**PPIs
    may reduce ability for PH confirmation

    -In
    pts over 4 weeks old, PH less than 5 is acceptable, if 5 or greater, XRay is
    required

     

     

     

    n/a

    -XRAY remains the gold standard-

    -PH testing when part of a mixed-method confirmation i.e.
    auscultation, tube marking, PH etc is an acceptable means to confirm NGT/OGT

    -Ph less than 5 
    appears to be a reasonable cut off

     

    yes

    Confirmation accuracy is greater when aspirate and
    non-aspirate methods used, recommend auscultate, aspirate for pH with visual
    inspection

    There is moderate evidence to support the use of PH testing
    as a component of a multiple-method bedside verification

     

    2.     
    Northington, et
    al (2022)

    LOE: V

    Quality: Weak

     

    Survey completed by 205 nurses in 166 institutions
    (pediatric) to determine how NG/OG placement is verified:  42% use pH, 24% use Xray

    Reporting a combination of
    radiograph and     pH measurement, 88% of pediatric
    nurses selected evidence-based methods for NGT placement verification
    placement.

    Weak-survey

    While progress has
    been made toward using the EBP methods of pH measurement and/or abdominal
    x-ray to verify NGT placement, further education is needed to establish this
    as a     standard of care among nursing organizations

    no

    An EBP standard of care needs to be established

    3.      Lin (2020)

    LOE:
    Level V (Systematic Review & Meta-Analysis of observational studies)

    Quality:
    Moderate

     

     

     

    To evaluate diagnostic performance of methods used to
    assess gastric tube placement verification in neonates, infants and children.

    – 8 studies, 911 participants, evaluated 9 index tests

    – pH testing with cutoff values ≤6 for gastric tube
    position confirmation was the only index test subjected to meta-analysis,
    with the summary sensitivity and specificity being 0.77 (95% confidence
    interval [CI] 0.56–0.90) and 0.42 (95% CI 0.16–0.73).

    –
    Other methods (color of aspirate, auscultation, carbon dioxide testing,
    ultrasound, bilirubin, pepsin, trypsin, separately or in combination with the
    above methods) showed great variations in sensitivities and specificities.

    – 6 out of 8 studies used for meta-analysis showed a high
    degree of heterogeneity for diagnostic estimates.

    – Revealed a moderate summary sensitivity and a low summary
    specificity for pH cutoffs ≤6. This finding suggests that pH ≤ 6 may not be
    sufficiently accurate to detect the gastric tube position, which does not
    support recommendations from multiple guidelines.

    – The conclusion of the inability of pH ≤ 6 for detection
    of gastric tube position in the studied population can only be drawn with
    caution because of the heterogeneity of studies.

    – Paucity of data and methodological variations in studies
    make it difficult to arrive at any conclusions regarding the diagnostic test
    accuracy of pH ≤ 4 or 5 and other index tests in detection of gastric tube
    placement.

    – Well-designed studies to strengthen current evidence are
    recommended.

    Yes/no-paucity of data

    The studies included in the meta-analysis had heterogeneity
    (3 different cutoff values, 2 types of instruments of pH meter and pH paper,
    different populations of fasting and fed) so the conclusion needs to be
    considered with caution (p. 658).

     

    pH testing with cutoff values ≤6 for gastric tube position
    confirmation was the only index test subjected to meta-analysis, with the
    summary sensitivity and specificity being 0.77 (95% confidence interval [CI]
    0.56–0.90) and 0.42 (95% CI 0.16–0.73).

     

    4.      Metheny (2019)

    LOE:
    Level V

    Quality:
    High

     

     

    This is a review of worldwide guidelines for placement
    verification of NG tubes.

     

     

    -All
    indicate radiographic confirmation as the gold-standard verification of
    initial placement.

    -11
    guidelines discuss pH as an adjunct method of placement verification; 9
    guidelines discuss specific safe cutoff values; 4 discuss pH ranges between 1
    and 4 as safe

    -Wide geographical variety of guidelines advocating for
    significantly varied methods of confirming placement.

    -Unable to confirm primary data of each contributing
    guideline author

    -Radiographic confirmation of initial placement cannot be
    replaced by other available methods

    -pH safe cutoff not established firmly, wide disagreement
    among guidelines.

    yes

    Helpful as an investigational look into global
    best-practice

    : pH is vetted as a method and ranked highly in terms of
    safety; does not advise against radiologic confirmation as default.

    5.     
    Dias et al.,
    2019

     

    LOE:
    IV

    Quality:  High

    Cross-sectional,
    double-blinded diagnostic test study. Sample: n = 162 neonates, average age
    32.92 gestational weeks.

    -No
    relationship between pH values with age or diet. -Aspirate: No relationship
    between aspirate color and placement -Use of gastric secretion inhibitor
    drug: pH was higher (>5.5), but only in small sample

    -Radiographic
    placement verification: 98.77% correct placement. -Comparison of pH test and
    radiographs: 96.25% sensitivity.

    -Accuracy
    of pH test with cutoff of 5.5 showed high sensitivity compared to x-ray
    verification.

    Population

    Accuracy of pH test with cutoff of 5.5 showed high
    sensitivity compared to x-ray verification.

    yes

    Neonates

    6.      Irving (2018)

    LOE:
    Level V

    Quality:
    High

     

    Presents
    the challenges of bedside NG-EAD (Nasogastric-enteral access device)
    placement and ongoing location verification.

     

    Review the current state of the science for verification of
    bedside placement of nasogastric tubes and ongoing assessment of tube
    location in children.

    Abdominal
    radiograph is the gold standard.

     

    In lieu of
    or when abdominal x-ray is not available, accurate measurement of enteral
    tube insertion length, gastric pH testing, and visual observation of gastric
    aspirate are acceptable non radiologic methods for assessing tube placement.

     

    Specificies children who are high risk (neonates, children
    with neurological impairment, children in an obtuded state, children who are
    encephalopathic, have a decreased gag reflex, or are sedated or critically
    ill) recommends an x-ray.

    Auscultation
    as a means of verifying NG-EAD placement is discouraged in the literature and
    is no longer supported by clinical practice organizations.

     

    Yes,
    speaks to our current practice.

     

    Despite the accuracy of pH and enzyme testing, if NG-EAD
    placement or location is uncertain, an abdominal radiograph is warranted, as
    it is accepted as the confirmatory method to verify NGEAD placement.

    X-Ray is goldstandard

     

    pH is reliable method of verifying NG-EAD location in
    children

     

    radiograph recommended to confirm
    location when no aspirate is obtained

    Yes (children)

    Ph and noting distal tube length are acceptable for
    placement verification

    7.      Boullata (2017)

    LOE:
    Level V

    Quality:
    High

     

     

    Aspen Guidelines

    Do not rely on the auscultatory method alone to
    differentiate between gastric and respiratory placement or between gastric
    and small bowel placement.”; “Healthcare 
    professionals cannot rely on auscultatory methods to differentiate
    between gastric and bronchopulmonary tube placement because auscultatory
    methods cannot distinguish tubes improperly placed in the lung or coiled in
    the esophagus from properly positioned tubes.”

     

     

    Mark  the 
    exit  site  of 
    a  feeding  tube 
    at  the  time 
    of  the initial placement and
    document either the incremental marking on the tube or the external length of
    the tube in the medical record.” [does not give frequency]

     

     

     

     

     

     

     

    Gastric fluid typically is clear and colorless or grassy
    green or brown with a pH of 5 or less. 
    Several studies demonstrating the use of pH testing indicate a pH
    of  ≤5.5 from tube aspirate is adequate
    to check the position of the tube in the stomach.”

    Although observing for respiratory symptoms is warranted
    during EAD insertion, malpositioning may occur without any apparent symptoms.

     

    8.      Ni (2017)

    LOE:
    Level IV

    Quality:
    Moderate

     

    Using a decision analytical modelling approach to compare
    the relative safety of different methods used to verify the placement of NG
    tubes in the stomach.

    Population: 104 cases with documented feeding tube
    misplacement. Total of 2368 adverse event reports submitted to NRLS (National
    Reporting and Learning System)

    Setting: UK

     

    -UK already follows safety guideline that uses pH testing
    of NG tube aspirate as a method of initial placement verification followed by
    chest xrays but US does NOT

    -cost analysis not done

    -only focused on patients with successful aspirations

    -analysis assumed chest xrays were 100% accurate

    -excluded pediatric cases

    -before
    use of tube, using pH test cut-off of 5 is the safest way to verify enteral
    tube location

    Yes-adults

    Uses pH as method of initial verification.

    Yes,
    could provide guidance for using pH as a method of ongoing verification.

    9.      Clifford (2015)

    LOE:
    Level V (integrative review)

    Quality:
    Moderate

     

    Integrative review and synthesis of literature on the most
    accurate methods of enteral tube placement and placement verification along
    with recommendations for practice. 

    Lit Search bet May-August 2014 (CINAHL, MEDLINE, PubMEd:
    studies published Jan 2009-June 2014 in English only, limited to 0-18 year
    old patients).

    56 pediatric & adult articles

    7 national guidelines dating from 1993-2014

    -only xray gold standard verification method

    PH:

    -AACN recommends PH 5 or less for ongoing placement
    verification

    -feeding/meds can alter gastric pH, but evidence suggests
    there was no major difference in pH with patients on acid-blocking meds (p.
    157)

    Gastric aspirate appearance:

    -most helpful to determine stomach vs intestine placement,
    but use with other methods

    Tube marking:

    -marking does not confirm that tube has not moved/coiled so
    only use in conjunction with other methods

    Auscultation:

    -proven unreliable, suggest use of this method be
    discontinued

     

     

    Limitations:

    -lack of neonatal evidence

    -mostly low levels of evidence

    -outdated evidence (dating from 1993-2014)

    -UK sources of data included, but they have different
    practices (e.g. UK uses pH as first-line verification, xray as second-line)

    -place enteral tube via NEMU method

    -xray is gold standard but not practical for verification
    prior to each use of tube

    -no other verification method on its own is as accurate as
    xray

    -consider using combo of 2 or more methods of verification

    -use analysis of gastric aspirate color and pH along with
    assessment of tube marking to confirm there has been no migration

    -algorithm
    may help as decision making tool with follow up quality improvement studies
    and data collection

     

     

    10.   Boeykens (2014)

    LOE:
    Level IV

    Quality:
    High

     

     

    Prospective observational study to determine the
    reliability of pH measurement compared to auscultatory method (N 241)

    -98.9%
    accuracy compared to x-ray with pH ≤ 5

    -auscultation
    method elicited 94.2-72.1% accuracy

    -A pH
    of ≤ 5.5 aspirate reading is adequate to check the tube placement

    -Auscultatory
    method is unreliable

    A point of care testing for pH testing is cumbersome due to
    many regulatory requirements.

    However, with a new testing technology available this
    method could be used at bedside by clinical nurses

    pH
    testing is the 2nd best method compared to the gold standard of x-ray method
    for tube verification.

     

    Rather
    than using the auscultation method, bedside verification of feeding tube
    should be based on pH testing along with the tube length during insertion

     

     

    Using
    a cut off of ≤5.5 for gastric pH was reliable indicator of stomach placement
    even if patient was on antacids. Auscultation-only method is not as reliable
    as gastric pH testing or x-ray

    **

    There
    is insufficient evidence supporting the use of auscultation to confirm accurate
    gastric tube placement in the emergency department

    With
    the possibility of RightSpot technology/products availability, pH testing
    should be adopted as a safe practice for feeding tube bedside confirmation

    11.  
    Ellett et al.,
    2014

     LOE: II

    Quality: High

    Prospective comparative design, secondary analysis. Data
    originally from single blind randomized controlled trial. Sample: N = 276
    children, 24 weeks to 212 months of age requiring .nasogastric/orogastric
    tube placemen

    -pH meter vs paper had ICC
    agreement 0.76.

    -pH as a tool to verify GT
    placement in the stomach has specificity of 87-92.2% but cannot identify
    placement errors (esophagus or gastroesophageal junction).

    – Optimal method to determine
    correct tube placement in the stomach: lack of aspirate from tube
    (sensitivity 34.9%, PPV 66.7).

    -Aspirate alone led to multiple
    misidentified placement locations.

     

     

     

    Aspirate alone led to multiple misidentified placement
    locations

    12.   Stock et al., 2008

    LOE:
    6

    Quality:
    Weak

    Design: prospective, observational study Sample: n=404
    children

    -No difference in pH for
    gastroenteritis vs. non-gastroenteritis

    . -Tube placement confirmed by pH
    alone in > 84%. pH higher than 4 was associated with incorrect placement;
    however, all pts. did not receive radiograph for confirmation

     

    pH testing only useful if aspirate can be obtained

     

    Children, single ED

    13.  
    Northwell
    System policy (adult/peds) June 2023

     

     

    An X-ray verification is required
    to confirm placement prior to initiations of feedings/medication
    administration.

    For non-high risk pediatric
    patients, pH testing may be used to confirm placement

    -Ng/Og bedside confirmation prior
    to Xray may consist of pH with a value between 1-5.5

     

     

     

     

     

    14.  
    Northwell
    Nursing Clinical Competency, “Nasogastric Tube Maintenance” 12/19

     

    Attaches a syringe with 10-20 mL of air to the end of the tub.

    – Injects air while auscultating the abdomen with a stethoscope.

    – Listens for “whooshing” sound

    – Aspirates stomach contents and notes amount, color,
    consistency, and odor

    – If unsure of placement obtains order for x-ray to confirm
    placement.

     

     

     

     

    Does not match with policy or standards of practice

  • Quantitative risk analysis is mandatory for many private organizations and government agencies in medium- and large-scale projects. Due to its advantages recognized by both practitioners and academics, Monte Carlo simulation

    Assignment Overview

    Quantitative risk analysis is mandatory for many private organizations and government agencies in medium- and large-scale projects. Due to its advantages recognized by both practitioners and academics, Monte Carlo simulation has become a widely applied technique in quantitative risk analysis. This assignment will introduce students to Primavera Risk Analysis (formerly known as Pertmaster and Primavera Pertmaster) and how probability theory is applied in quantitative risk analysis.

    This assignment is associated with the following course learning outcomes:

    • Analyze risks using quantitative methods for the purpose of risk exposure and prioritization and communicate their impact to stakeholders
    • Recommend risks for risk response planning or watch list
    • Devise a risk response plan based on appropriate techniques and strategies that would meet stakeholders’ expectations
    • Execute the risk management plan to continuously monitor risks and risk responses

    Assignment Instructions

    Part 1. Follow the instructions provided in Canvas>Modules>Resources for Primavera Risk Analysis and download Primavera Risk Analysis to your computer. Primavera Risk Analysis runs on Windows operating systems. You cannot install it on a Mac OS without splitting your machine. If you are a Mac user, you can install Windows applications on your Mac by doing one of the following:

    1. You can install Windows 10 on your Mac with Boot Camp Assistant.
    2. You can install Parallels or VMware Fusion on your Mac to split your operating system.
    3. You can also install Primavera Risk Analysis on a virtual machine.

    Part 2. Create a Word document with APA title page and answer the following questions:

    1. How can Primavera Risk Analysis help project managers increase the probability of project success?
    2. How does Primavera Risk Analysis work? And what are its limitations?

    Hint: Answering these questions requires you to conduct some research and explore the software application. Some useful sources include the University library, Oracle website, and the Help menu of the software.

    Part 3. The application of probability distributions to project schedule and cost models

    1. What is your understanding of the following probability distributions? Discuss how each can impact a project schedule and/or cost.
    a. BetaPert
    b. Triangle
    c. Normal
    d. Uniform

    Part 4. Performing a Monte Carlo simulation for a project case

    1. In this part of the assignment, you will perform a Monte Carlo simulation for the project case you selected during the first week of the class. If you did not create a performance measurement baseline for your project case, update and use the template provided in Canvas>Modules>Performance Measurement Baseline Templates. Make sure that the finish date of your project baseline is set on a future date (e.g., October 14, 2050). Based on your experience and your research so far, you can decide on the probability distribution (s) and the number of iterations for your simulation. Please explain the rational for your decisions.
    2. Your task is to examine, discuss, analyze, and interpret the results from the simulation.
    • What information have you obtained from the results of the simulation?
    • Explain how the results of the simulation may affect your commitment to the most likely completion date of the project.
    • What did you learn from the Tornado graph?

    Your pper should be written as an esay with topical headers; it should not be formatted in a Q&A format. These sections represent the minimal items that you would want to address. From your readings and your lectures, you will be exposed to other topics that may be relevant to this pper, and you would do well to consider those in writing the esay. As part of my evaluation process (see attached rubric), ppers which cite peer reviewed sources as opposed to general websites or articles are considered a higher quality of source.

    Below are some key guidelines you will want to ensure you follow in writing the pper. Think of this list as a quality control checklist, along with the attached grading rubric.

    • There is no page limit for this pper
    • Include a title page and reference listing

    Pper format complies with APA 6 or 7 guidelines (e.g., Time New Roman (12 points font) and with 1-inch margins on all sides). Double-space is NOT required.

    • If you are unfamiliar with APA 6 or 7 guidelines, please review the sample pper at the following link: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/documents/20200128APA7ProfPaper.pdf(Links to an external site.)Links to an external site.
       (Links to an external site.)Links to an external site.
    • Also, you will find additional resources listed in the syllabus
    • No more than 15 percent of pper is comprised of outside sources or direct quotes
    • Pper fully addresses the four parts of the assignment
    • Pper is not written in a Question-and-Answer format, but makes appropriate use of headers and formatting in compliance with APA 6 or 7 guidelines
    • Pper evidences reflection of the individual author relative to the broader discipline
    • Pper is free of grammatical errors

    Please be sure to review the attached rubric which will be used to grade the assignment. The rubric, along with the assignment instructions, will ensure that you have a clear understanding of the requirements of the assignment.

     Watch these videos before submitting this assignment:
    https://youtu.be/2gvwLZQ1vNULinks to an external site. 

     https://youtu.be/ofREMXk3FYM
     

  • IT544-2: Analyze the cybersecurity software development life cycle (SDLC). Scenario You recently took a position as a cybersecurity analyst for a small software company. The software company currently has three commercially available

    IT544-2: Analyze the cybersecurity software development life cycle (SDLC).

    Scenario

    You recently took a position as a cybersecurity analyst for a small software company. The software company currently has three commercially available off-the-shelf software products that are sold to businesses and/or organizations (B2B). They can range from small companies to very large companies, including those in the Fortune 500. One of their products has been identified by CERT to have several vulnerabilities. Since this event occurred, the chief cybersecurity officer (CCSO) suspects that not enough security is built into the software development process used at the company. You have been asked by the CCSO to conduct a cyberattack surface analysis on one of their Web-based products in an effort to improve the software development process.

    For the assignment, assume that the presentation layer resides on a dedicated server in the company’s DMZ. The other two layers of the software are behind the corporate firewall and can reside on one or two dedicated servers. The Web application is accessible from the Internet and is browser based. Firefox, Chrome, Internet Explorer, and Safari are the supported browsers.

    Assignment Instructions

    For Assignment purposes, select a multi-layered (presentation layer, business layer, and database layer) web-based open source project in place of the software company’s web-based product. In place of the open source project, if you are familiar with another web-based system that meets the requirements, then discuss using it with your instructor.

    Examples of multi-layered open source projects/products include:

    • Office Libre
    • Facebook
    • Mozilla Firefox
    • GIMP (for web development)
    • Audacity
    • WordPress
    • MySQL

    You will conduct a cyberattack surface analysis on the system/application you selected. Focus your analysis from an external cyberattack point of view. It is not necessary to focus on end user cyberattacks (social engineering attacks, etc.).

    • Define the cyberattack surface (including operating systems and web servers) by identifying and mapping the cyberattack vectors.
      • Categorize what was identified
      • Describe three use cases that involve the attack surfaces
    • Create a graphic representation of the attack surface with labels (Use Visio or any other open source diagramming or drawing tool).
    • Discuss how the attack surface can be reduced.

    Your attack surface analysis can be done mentally and on paper or you can use an open source attack surface analyzer (OWASP’s Zap is one example).

    Assignment Requirements:

    • 3–4 pages of content (exclusive of title page and reference page), double-spaced in 12pt Times New Roman font, using correct APA formatting and including a title page and reference page
    • At least one credible source.
    • Correct spelling and grammar.
    • Correct APA formatting.

  • Case Studies provide students with real-world scenarios to analyze and apply theoretical knowledge gained in the course. Students will develop critical thinking skills, enhance problem-solving abilities, and gain practical insights into educationa

    Case Study #3 Discussion Question

    Purpose

    Case Studies provide students with real-world scenarios to analyze and apply theoretical knowledge gained in the course. Students will develop critical thinking skills, enhance problem-solving abilities, and gain practical insights into educational contexts through these assignments.

    Action Items

    1. Read this Leadership Challenge:
      • As the principal of Washington Middle School, you are entrusted with overseeing the educational journey of a diverse group of students, ensuring their academic growth and well-being. In this capacity, you encounter a delicate situation brought forth by April, one of your beginning seventh-grade teachers.
        April approaches you with a sense of concern, bearing a computer printout containing the results of fall testing, including scores on a group test of intelligence for all the seventh-grade students in her class. These printouts have been disseminated to all teachers in the school by the guidance department as part of the school’s data-sharing protocols.
        Accompanying the printout are notes from two parents, expressing a keen interest in meeting with April to discuss their child’s scores. One parent, in particular, emphasizes the desire to understand “how smart Jason really is,” indicating a significant level of importance attached to the test results.
        As April presents the printouts and parental requests, she seeks your guidance and advice on how to proceed in this sensitive matter.
    2. Think about the following questions:

    A.              What do the intelligence test scores tell you about these students?

    B.              How do you suggest that April respond to the request from the parents?

    C.              Do you need to talk to the guidance department about the purpose of the data?

    D.              Do you need a school policy on testing results?

     

     

     

     

     

    Discussion 4-1 Discussion Questions

    Purpose

    This assignment is intended to help you learn to explore the complexities of decision-making in uncertain and continually evolving environments.

    Action Items

    Initial Post

    1. Read the assigned material for this module, and conduct additional library research to find 1-2 more articles related to decision-making and uncertainty. 
    2. In about 2 paragraphs, and appropriately citing your sources, address the following:
      1. Explain your perception of uncertainty and what it means in a workplace environment.
      2. Explain and describe why decision-making is challenging, even for skilled leaders, when conditions are uncertain.
      3. Finally, share your ideas on how leaders and managers can strengthen the quality of their decisions when conditions are uncertain and likely to evolve.