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Running head: SELF-ASSESSMENT OF NURSING STANDRDS OF PRACTICE 1

Self-Assessment of Nursing Standards of Practice Christine Demler Ferris State University NURS 440

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Abstract Nursing and nurse case management is a profession that is closely monitored and regulated by the American Nurses Association (ANA) and the Case Management Society of America (CMSA). Both the ANA and CMSA provide nurses with the Standard of Professional Nursing Practices that all nurses should follow in their individual practice. I have discussed the ANA/CMSA scope and standard of practices. I have outlined my professional action plan with my goals and timelines of obtaining these goals.

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Self-Assessment of Nursing Standards of Practice Within this paper I plan to spell out my plan for professional action plan. I have developed goals and a timeline in order to achieve these goals. This paper discusses the Standard of Professional Nursing/Standards of Professional Performance and Case Management Practices. Many of the standards of practice co-mingle. Throughout my professional career I have continued my education and continue to develop my career. My career is a very important part of me and I want to be the best I can be. Standards of Professional Nursing/Case Management Practice Standard 1: Client Selection Process The case manager should identify and select clients who can most benefit from case management services available in a particular practice setting (CMSA, 2013). This can be done with the use of a high-risk screening process such as; has the client experienced a catastrophic accident and if so are they experiencing uncontrolled pain, do they experience cognitive deficits, is there a need for durable medical equipment, and is there a need for admission or a transition to a post-acute facility. Within my scope of practice I have many resources which to offer choices to my client and their families to choose from. I currently work with agencies and facilities all over the State of Michigan and Northern Ohio. Standard 2: Assessment The registered nurse collects comprehensive data pertinent to the healthcare consumers health and/or the situation, (ANA, 2010). In nursing and case management, a comprehensive assessment is crucial in order to collect the needed information required

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to setup the correct care plan for our patients. In my area of expertise, the initial assessment is where I obtain the needed information required which allows me to develop the correct treatment plan for my client. The initial assessment can take place in the hospital setting, a rehabilitation facility, their home or where ever they may be at the time of assessment. Standard 2: Diagnosis/Problem/Opportunity Identification The registered nurse analyzes the assessment data to determine the diagnoses or the issues, (ANA, 2010). The case manager should identify problems or opportunities that would benefit from case management interventions (CMSA, 2013). Diagnoses, problems and opportunities are determined from the information that has been obtained from the initial assessment. After I have made my initial assessment, I determine the diagnoses that are suitable for my client. The nursing diagnoses, problems and opportunities are somewhat similar to the medical diagnoses, whereas I review the medical diagnoses and the problems the client maybe experiencing; the information collected from the initial assessment and then make my determination of what the nursing diagnoses should consist of. Standard 3: Planning The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes, (ANA, 2010). The planning procedure follows the identification of the projected outcomes. The case manager should identify immediate, short term and long-term, and on-going needs, as well as develop appropriate and necessary case management strategies and goals to address those needs (CMSA, 2013).

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After my client and I discuss the outcomes they would like to see happen, I develop the plan that will allow those outcomes to occur. Standard 4: Monitoring The case manager should employ assessment and documentation to measure the clients response to the plan of care, (CMSA, 2013). This is done by ongoing collaboration with the client, their family, caregivers and any one providing healthcare for the individual client. If the client is in an inpatient rehabilitation facility or attends a rehabilitation program, monitoring is accomplished by team meetings that include the client and the entire team that is working with the individual. Standard 5: Outcomes Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation, (ANA, 2010). The case manager should maximize the clients health, wellness, safety, adaptation, and self-care through quality case management, client satisfaction, and cost-efficiency (CMSA, 2013). When setting up the care plan for my client, expected outcomes are discussed with them. During the initial assessment with the client, we discuss their goals and the outcomes they would like to see happen. Through that discussion, I identify the outcomes needed for my clients recovery. Standard 6: Implementation The registered nurse implements the identified plan, (ANA, 2010). The nurse/case manager also coordinates the delivery of the care. Part of the implementation of the plan consists of teaching, health promotion, consultation, prescriptive authority and

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treatment. Within my expertise of nursing, the plan is implemented by scheduling my client for the needed medical treatments and therapies. As my clients personnel case manager, I provide ongoing teaching, health promotion, schedule consultation with healthcare providers and therapies. Within my scope of practice, orders are obtained for all of the medical treatment and therapies provided to my client. Standard 7: Evaluation The registered nurse evaluates progress toward attainment of outcomes, (ANA, 2010). The nurse/case manager must continue to reassess and re-evaluate the patient/client and revise diagnoses as needed. With the revising of the diagnoses, the goals are to be re-evaluated and changed if necessary. As a nurse case manager, I am continually evaluating my clients overall plan of care and changing it as required. Standard 8: Termination of Case The case manager should appropriately terminate case management services based upon established case closure guidelines (CMSA, 2013). The termination of a case is determined after reviewing the clients progress and status with the client, family, caregivers, providers, payer and other appropriate parties. The termination is a mutual agreement that is made after the case manager and the client review the achievement of the targeted outcomes or maximum benefit is reached. Standards of Professional Performance Standard 8: Legal The case manager should adhere to applicable local, state, and federal laws, as well as employer policies, governing all aspects of case management practice, including

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client privacy and confidentiality rights (CMSA, 2013). Confidentiality and client privacy is always a priority. All local, federal and company policies related to the clients confidentiality and privacy are adhered to. All of my clients receive information regarding the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on admission. All clients sign Consent for Case Management Services and a Consent for Release of Information upon admission. Standard 9: Ethics The registered nurse practices ethically, (ANA, 2010). Case managers should behave and practice ethically, adhering to the tenets of the code of ethics that underlies his/her professional credential (e.g., nursing, social work, rehabilitation counseling, ect.) (CMSA, 2013). A code of ethics is used as a tool that guides the nurses/case managers profession. It is intended to guide the practice of registered nurses in all practice settings with all types of clients, (Chitty & Black, 2011). The code of ethics is designed to protect the patient, the healthcare system and the nurse. On a daily basis all individuals have to make ethical decisions whether we are making that decision in the capacity of a nurse or not. Respect for humans as a function of human dignity is the primary ethical responsibility for nurses in practice, (Chitty & Black, 2011). In my professional practice ethics is very important to me. I believe that all of my clients should be treated with dignity and respect. The relationship between the nurse and the patient/client should always be based on truth. As a nurse case manager for catastrophic accident victims, the majority of my clients have suffered a severe traumatic

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brain injury. Traumatic brain injury victims experience a great deal of paranoid behavior. Truth has to be an essential part of the nurse case management, client relationship. Standard 10: Advocacy The case manager should advocate for the client at the service-delivery, benefitsadministration, and policy-making levels (CMSA, 2013). The case manager facilitates the necessary care and appropriate services for the client. I consider myself a very strong advocate for my clients. I go to bat with the adjusters on a daily basis for my clients. I currently have a client that is in need of a hip replacement due to the injuries incurred during the accident. I have advocated for my client over and over with the doctor and the adjuster. My client is currently scheduled to be seen at the University of Michigan (U of M) Hospital Orthopedic Clinic for a hip replacement. That would not have happened if I would have not been diligent in my advocacy. Standard 11: Education/Qualifications/Cultural Competency Case managers should maintain competence in their area(s) of practice by having a current, active, and unrestricted licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline (CMSA, 2013). The registered nurse attains knowledge and competence that reflects current nursing practice, (ANA, 2010). The registered nurse continues to obtain knowledge throughout their practice. The case manager should be aware of, and responsive to, cultural and demographic diversity of the population and specific client profiles (CMSA, 2013). Nurses/case managers may seek knowledge through improving their professional skills, continuing

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education, and independent learning programs. The nursing profession is a continuing education in its self. I attend multiple conferences per year and I am continually seeking to acquire knowledge. I participate in continuing education programs on a regular basis. I feel education is a very important part of my career and I like to share my learning opportunities with others in my profession. Standard 12: Evidence-Based Practice and Research/Research and Research Utilization The registered nurse integrates evidence and research findings into practice, (ANA, 2010). The registered nurse utilizes evidence-based nursing knowledge, including research findings, to guide practice, (ANA, 2010). Within the nursing profession evidence base practice is most important. As a nurse case manager I am always researching out new therapies and medical techniques that may help with my clients rehabilitation. The case manager should maintain familiarity with current research findings and be able to apply them, as appropriate, in his/her practice (CMSA, 2013). Evidence based practice decisions that are well researched can be the most beneficial for my clients. Standard 13: Quality of Practice/Resource Management and Stewardship The registered nurse contributes to quality of nursing practice, (ANA, 2010). The nurse demonstrates quality of practice by providing documentation in an ethical and responsible manner. Quality of practice is demonstrated through participation of the nurse through the quality of care they may provide. A nurse must be creative, innovative; team

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orientated, and demonstrates the ability to be a leader. The case manager should integrate factors related to quality, safety, access, and cost-effectiveness in assessing, monitoring, and evaluating resources for the clients care (CMSA, 2013). In my current position, providing documentation in an ethical and responsible manner is of most importance. Much of my documentation appears in court with my clients. I am currently participating in developing and implementing new policies and procedures to help with improving our quality of practice. Our company is in the mist of new and exciting changes. Standard 14: Communication The nurse communicates effectively in a variety of formats in all areas of practice, (ANA, 2010). The nurse maintains communication with other providers to minimize risks associated with transfers and transition in care delivery, (ANA, 2010). Communication is a very important part of effective nursing. Good communication skills are necessary when communicating directly with the health care team, patients/clients and families in order to promote good health care. As a nurse case manager part of my job is to foster good communication between the client, family, medical providers, insurance adjuster, attorney and other entities as applicable to enhance positive outcomes. Most of my clients experience difficulty speaking for themselves; therefore it is important that as the nurse case manager I have the ability to communicate effectively within my scope of practice.

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Standard 15: Leadership The registered nurse demonstrates leadership in the professional practice setting and the profession, (ANA, 2010). The nurse abides by the vision, the associated goals, and the plan to implement and measure progress of an individual healthcare consumer, or progress within the context of the healthcare organization, (ANA, 2010). The registered nurse is given the responsibility to oversee the nursing care that is provided and is responsible for the quality of care the patient/client receives. As a leader, one must demonstrate respect, trust and dignity with their patients/clients and colleagues. In my current practice, I play a leadership role as the older, more experienced nurse case manager. I am one of the case mangers that the staff can come to with questions. I have mentored many nursing colleagues over the years. I participate in many professional organizations. One of my favorite organizations is Rehabilitation Insurance Nurses Council (RINC) of Western Michigan. This is an organization that is involved with education on clients with traumatic brain injuries. Standard 16: Collaboration/Facilitation, and Coordination The case manager should facilitate coordination, communication, and collaboration with the client and other stakeholders in order to achieve goals and maximize positive client outcomes (CMSA, 2013). The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice, (ANA, 2010). The nurse communicates with the healthcare consumer, the family, and healthcare providers regarding healthcare and the nurses role in the provision of that care, (ANA, 2010). In my professional expertise, the nurse case manager is the

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collaborator of the assessment, planning, facilitation, and advocacy, and is a fundamental component of the healthcare team. The registered nurse partners with other team members in the collaboration process of team-building. The nurse promotes teambuilding, cooperation, respect and trust among the healthcare staff. The nurse case manager, with the health care team, identifies immediate, short-term, and long-term needs. The client, family, caregivers, providers, payers and other appropriate parties are always included in the decision making process. For instance, if I have a client that is in need of attendant care and medical transportation I present my client with multiple choices of agencies that will provide both the attendant care and the transportation in order for the client to receive what they need and to cut costs for the payer. Standard 17: Professional Practice Evaluation The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations, (ANA, 2010). The nurse interacts with peers and colleagues to enhance her or his own professional nursing practice or role performance, (ANA, 2010). The registered nurse is required by professional practice standards to provide the appropriate care per age and developmental status. Nurses are expected to provide the proper care to patients that are culturally and ethnically sensitive. The registered nurse must be able to interact well with their peers and colleagues.

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In my work place all nurses participate in peer review. We also participate in selfevaluations prior to our evaluation from our nurse manager. The self-evaluation allows the nurse to identify their strengths and weaknesses. Standard 18: Resource Utilization The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible, (ANA, 2010). The nurse assists the healthcare consumer and family in identifying and securing appropriate services to address needs across the healthcare continuum, (ANA, 2010). Nurses need to provide the necessary care and yet be resourceful at the same time. Delegation is a very useful tool if it is done correctly. When delegating elements of care to others, the nurse must always keep in mind he or she is still responsible for the patients/clients total care. The nurse must be an advocate for their patient/client. They must advocate for the best possible care while taking into consideration the resources availability, cost to the patient/client or payer, risks involved, and the benefits of the treatment or care. As a nurse case manager my role is to advocate for my client and access quality healthcare to promote optimal levels of health and well-being, while ensuring improvement in safety, medication reconciliation, and adherence to the treatment plan. I assist with scheduling appointments, facilitate transportation to medical appointments if applicable, obtain durable medical equipment as necessary, and monitor the receipt and intake of medication. I assist in obtaining homecare when required. When advocating for my clients needs, I must also keep in mind the need to be resourceful with the cost of the healthcare needed.

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Standard 19: Environmental Health The registered nurse practices in an environmentally safe and healthy manner, (ANA, 2010). The nurse promotes a safe environment for the patients/clients, families, colleagues and the community. Nurses utilize scientific evidence to assist in avoiding a safety risk when using new products or a new treatment for their patients/clients. As a nurse case manager safety is always a concern. Many of my clients cannot ambulate without assistance or perform active daily living activities without a great deal of assistance. Whether my client is already home or is hospitalized, I make a home visit to evaluate for any environmental hazards. If there appears to be a safety or environmental hazard, I will arrange for the proper therapies to evaluate and make their recommendations for the client. Professional Goals Short-Term Goals I have several goals I hope to achieve within the next couple of years. The first goal is to finish the RN to BSN program. I plan to take my last two classes in the winter semester and graduate in the spring of 2014. My second goal is to obtain my board certification for case management within one year. My third goal is to step into a nursing supervisor position with Right Consulting Group for whom I am currently employed and co-own. I have experience in supervision and would like to share my experience with my fellow colleagues. Right Consulting Group is a consulting group made up of registered nurse case managers. We work with clients that have experienced a catastrophic accident, either auto or motorcycle, along with Workmans Compensation cases. My

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forth goal is to setup a non-profit organization to assist accident victims with their replacement service needs. The organization will be made up of volunteers that will provide transportation allowing the clients to go to the grocery store or just run errands. The volunteers may assist the clients with their household chores that they are unable to perform due to the injuries they have sustained. Long-Term Goals In the next ten years, my number one goal is to continue being a partner in Right Consulting Group. Ten years from now my husband will already be retired and I would like to be able to spend quality time with my husband, children, and grandchildren. I will always be active in the nursing profession at some level, whether it is sitting behind a desk doing quality control or writing, reviewing, and implementing policies and procedures. My nursing profession is and has always been very important. Evaluation I will measure my progress toward my goals one goal at a time. I am known to be a pusher and I intend to continue pushing myself towards my set goals until they are met. Obtaining my BSN is the first step in obtaining the rest of my professional goals. Conclusion In conclusion I feel the Standard of Practice, Standards of Professional Performance, and Standards of Practice for Case Management are very important tools and guidelines to follow. Nursing/Case Management is a respected profession and following set standards and guidelines helps to keep our profession in order.

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The Standards of Professional Performance describe a competent level of behavior in the professional role, including activities related to ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental health. All Registered nurses are expected to engage in professional role activities, including leadership, appropriate to their education and position. Registered nurses are accountable for their peers, and ultimately to society, (ANA, 2010). The Standard of Practice for Case Management articulates that The underlying premise of case management is based in the fact that, when an individual reaches optimal level of wellness and functional capability, everyone benefits: the individuals being served, their support systems, the health care delivery systems and the various reimbursement services. Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of services resources and facilitation (CMSA, 2013). After reviewing the Standard of Practice, Standards of Professional Performance, and Standards of Practice for Case Management I feel as a nurse and a nurse case manager I follow the Standards of Practice closely. I strive very hard to be the best possible nurse case manager I can be. I am very proud to be part of such a great profession.

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Reference
Chitty, K. & Black, B. (2011). Professional Nursing Concepts & Challenges Maryland heights: Saunders Elsevier. CMSA. (2013). Standards of practice for case management Little Rock: CMSA Case management society of America. American Nursing Association (ANA). (2010). Scope and Standards of Practice Silverspring: American Nursing Association.

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CHECKLIST FOR SUBMITTING PAPERS

DATE, TIME, & INITIAL

PROOFREAD FOR: APA ISSUES

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1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)] 2. Running head: Does the Running head: have a small h? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2 from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40] 3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41] 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use Introduction as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42] 5. Margins: Did you leave 1 on all sides? [p. 229]

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6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59] 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229] 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.

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9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a persons name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88] 10. Typeface: Did you use Times New Roman 12-point font? [p. 228]

11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106111]. Remember, no abbreviations in the title of the paper. 12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing many timesthis is what you are supposed to be doing! [p. 170] 13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this: The variables that impact the etiology and the human response to various disease states will be explored (Bell-Scriber, 2007, p. 1). Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172]

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14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172] 15. Paraphrase: A paraphrase citation would look like this: Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007). It may also look like this: Bell-Scriber (2007) found that [p. 171 and multiple examples in text on p. 40-59] For multiple references within the same paragraph see page 174 re: use of year.

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16. Headings: Did you check your headings for proper levels? [p. 62-63].

17. General Guidelines for References:

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A. Did you start the References on a new page? [p. 37] B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same. C. Is your reference list double spaced with hanging indents? [p. 37] D. Formatting of different types of titles: see page 185. E. Check formatting of all types of authors and sources before submitting your paper.

PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE 11/22/13 CD,AB 11/22/13 CD,AB 11/22/13 CD,AB 11/22/13 CD,AB 11/22/13 CD,AB 11/22/13 CD,AB 11/22/13 CD,AB 11/22/13 25. Stay in subject agreement. When referring to 1 nurse, dont refer to the nurse as they or them. Also, in referring to a human, dont refer to the person as that, but rather 24. Do not use etc. or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.? 23. Did you check to make sure there are no hyphens and broken words in the right margin? 21. Conversational tone: Dont write as if you are talking to someone in a casual way. For example, Well so I couldnt believe nurses did such things! or I was in total shock over that. Did you stay in a formal/professional tone? 22. Avoid contractions. i.e. dont, cant, wont, etc. Did you spell these out? 19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesnt make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this? 20. Wordiness: check for the words that, and the. If not necessary, did you omit? 18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.)

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who. For example: The nurse that gave the injection. Should be The nurse who gave the injection Did you check for subject agreement? 26. Dont refer to us, we, our, within the paperthis is not about you and me. Be clear in identifying. For example dont say Our profession uses empirical data to support . . Instead say The nursing profession uses empirical data.. 27. Did you check your sentences to make sure you did not end them with a preposition? For example, I witnessed activities that I was not happy with. Instead, I witnessed activities with which I was not happy. 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

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29. Did you have other people read your paper? Did they find any areas confusing?

30. Did you include a summary or conclusion heading and section to wrap up your paper?

31. Does your paper have sentence fragments? Do you have complete sentences?

32. Did you check apostrophes for correct possessive use. Dont use apostrophes unless it is showing possession and then be sure it is in the correct location. The exception is with the word it. Its = it is. Its is possessive.

Signing below indicates you have proofread your paper for the errors in the checklist:

Christine Demler

DATE: 11/22/13

A peer needs to proofread your paper checking for errors in the listed areas and sign below: Amanda Badgley DATE: 11/22/13