Week 13 Discussion 1: The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines Week 13 Discussion 1 The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines Week 13 Discussion 1: The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.” The 34-year-old pregnant female is in desperate need of assistance with medication compliance. She is exhibiting signs of uncontrolled hypertension that can lead to preeclampsia during pregnancy. Preeclampsia can lead to complications for mother and baby, such as preterm labor, decreased fetal growth, and placental abruption (CDC.2021). The technique of motivational interviewing could be beneficial in developing behaviors to promote medication compliance. Motivational interviewing (MI) is a skilled technique, that has specific qualities such as guided communication style, with effective listening, while providing advice and information (Rollnick et al., 2008). MI helps to empower people by giving them the chance to tell their story, the meaning of their story, the relevance of their story, and the capacity to change (Rollnick et al., 2008). MI is a technique that is respectful and supports a natural process of change while promoting the patient’s autonomy (Rollnick et al., 2008). This patient could benefit from this process because she will be able to express why she does not feel she needs to take high blood pressure medications, why she feels it does not work, and if she understands the risks of high blood pressure for her and her fetus. The practitioner will follow the steps of MI, asking, listening, and then informing with an ultimate outcome of the patient realizing that she wants to be compliant with her medications to help herself and her baby. There are challenges with using motivational interviewing. The full history of the patient is not presented in this case but some diagnosis may affect how a patient responds to MI. If a patient has a history of depression, schizophrenia, or bipolar disorder motivational interviewing may fail (Rollnick et al., 2018). A patient needs to have some degree of self-motivation for the process to work and depression can limit a patient’s internal motivation. Mental illness can also cause a patient to feel mistrust and confusion with process of MI (Rollnick et al., 2018). A full history of patient needs to be assessed before determining if MI is an appropriate technique to initate change. An APRN has the opportunity to motivate adults into adopting healthy changes to promote overall wellness and decrease the risk of developing chronic illnesses. The initial goal of motivating a patient to change is to develop a positive trusting rapport with the patient through motivational interviewing (Heath, 2017). The American Academy of Family Physicians (AAFP) states motivational interviewing is a method of changing the direction of the conversation in order to stimulate the individuals desire to change and give the patient confidence to do so (Searight, 2018). Studies show that motivational interviewing centered around a specific topic such as smoking cessation and or medication compliance will take the practitioner around 15 minutes and will result in a significant increase in patient willingness and compliance (Searight, 2018). An APRN just taking a few extra minutes could make an importance difference and have a final result of promoting this patient’s overall health and a better outcome for her baby. References Center for Disease Control and Prevention (2021, May 6) High Blood Pressure During Pregnancy. https://www.cdc.gov/bloodpressure/pregnancy.htm Heath, S. (2017, Aug 15) Top 4 Patient Motivation Techniques to Health Improvements. https://patientengagementhit.com/news/top-4-patient-motivation-techniques-for- health- improvement Rollnick, S. Miller, W., & Butler, C. (2008) Motivational Interviewing in Health Care. The Guilford Press. Searight, R. (2018) Counseling Patients In Primary Care: Evidence Based Strategies. Am Fam Physician 98(12) 719-728. https://www.aafp.org/afp/2018/1215/p719.html Value: 100 points Due: Initial Post by Day 3, Reply Post by Day 7 Grading Category: Discussions Initial Post Watch the Motivational Interview of a woman who is pregnant and continuing to drink alcohol. Motivational Interviewing: Discussing Alcohol Use in Pregnancy Video (17:37 minutes) Motivational Interviewing: Discussing Alcohol Use in Pregnancy Video Transcript Consider what you learned from the video, along with other content that has been discussed in this course. For your initial post, choose one of the three scenarios presented below and answer the following questions. (Please include at least three scholarly sources within your initial post): Questions: As an APRN, how could you positively affect the health of the woman in the scenario you chose? What would be the pros and cons of utilizing the technique of Motivational Interviewing with the woman in the scenario. Trial the techniques you have read about over the previous few weeks related to Motivational Interviewing with a coworker, family or friend. What was this experience like? Do you see benefits to becoming more comfortable with this technique? Why or why not? Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads Scenarios: A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.” Sumar has just found out she is pregnant and presents to the local free clinic. She is a 26-year-old G2P0AB1, and her first OB appointment is in two weeks. Sumar thinks she is about 12 to 14 weeks pregnant. She has come to the clinic complaining of indigestion. You notice the strong smell of cigarette smoke, and she admits she smokes one pack of cigarettes a day but states she is smoking less now since she started vaping. You are seeing a 19-year-old female for STI screening. When reviewing her health and sexual history to determine her risk, she indicates she has had several new partners over the past six months and that she has not been using condoms but does have an IUD. She has started smoking marijuana and has dabbled with some other prescription medications over the previous two months. She is worried about having contracted an STI because she has noticed some “cauliflower” type bumps “down there” and would like to be tested. Reply Posts Reply to at least two of your classmates on two separate days (minimum) who chose the two other topics utilizing at least two scholarly references per peer post. What did you learn from your experience with Motivational Interviewing this week that could help your peer better address the preventive guidelines for the women in the scenario? Please refer to the Grading Rubric for details on how this activity will be graded. Posting to the Discussion Forum Select the appropriate Thread. Select Reply. Create your post. Select Post to Forum. A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.” Wow there is a lot of information in this scenario that the APRN needs to be aware of. This patient presents with swollen ankles and shortness of breath and a cough she can’t control. On top of this, she has a hx of HTN which she took her medication irregularly prior to her pregnancy and now she has stopped it completely. Certainly in this case, treating her medically is the first action to take in working with someone who needs to make changes in their behavior. Does this patient have CHF, a PE, or Pre-eclampsia? Only additional testing can answer those questions. Certainly the next step is educating her on the HTN and the need for her medication to continue for her safety and the baby’s. With Motivational interviewing (MI), the APRN can begin to question this patient as she stabilizes, as to why she was concerned about stopping her medications. Therapists can support their patients with MI as well as other techniques such as Mindfulness to encouraging her to use her own resources to take action to start making changes (Corey, 2021). MI focuses on the present and future conditions and assists patients to find ways to achieve their own goals (Corey, 2021). References Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:Week 13 Discussion 1: The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines Corey, G. (2021). Theory and practice of counseling and psychotherapy. Cengage. 308 words Discussion Question Rubric Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Note: The value of each of the criterion on this rubric represents a point range. (example: 17-0 points) Discussion Question Rubric – 100 Points Criteria Exemplary Exceeds Expectations Advanced Meets Expectations Intermediate Needs Improvement Novice Inadequate Total Points Quality of Initial Post Provides clear examples supported by course content and references. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. All instruction requirements noted. 40 points Components are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints. Meets all requirements within the discussion instructions. Cites two references. 35 points Components are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development. Is missing one component/requirement of the discussion instructions. Cites one reference, or references do not clearly support content. Most instruction requirements are noted. 31 points Absent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. No references cited. Missing several instruction requirements. Submits post late. 27 points 40 Peer Response Post Offers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation. All instruction requirements noted. 40 points Evidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post. Response is supported by course content and a minimum of one scholarly reference per each peer post. All instruction requirements noted. 35 points Lacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight. Missing reference from one peer post. Partially followed instructions regarding number of reply posts. Most instruction requirements are noted. 31 points Post is primarily a summation of peer’s post without further synthesis of course content. Demonstrates incomplete understanding of content and/or inadequate preparation. Did not follow instructions regarding number of reply posts. Missing reference from peer posts. Missing several instruction requirements. Submits post late. 27 points 40 Frequency of Distribution Initial post and peer post(s) made on multiple separate days. All instruction requirements noted. 10 points Initial post and peer post(s) made on multiple separate days. 8 points Minimum of two post options (initial and/or peer) made on separate days. 7 points All posts made on same day. Submission demonstrates inadequate preparation. No post submitted. 6 points 10 Organization Well-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas. 5 points Organized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow. 4 points Poor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 points Illogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points 5 APA, Grammar, and Spelling Correct APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 points Correct and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 points Three to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 points Five or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points 5 Total Points 100 Order Now
Week 13 Discussion 1: The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines Week 13 Discussion 1 The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines Week 13 Discussion 1: The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.” The 34-year-old pregnant female is in desperate need of assistance with medication compliance. She is exhibiting signs of uncontrolled hypertension that can lead to preeclampsia during pregnancy. Preeclampsia can lead to complications for mother and baby, such as preterm labor, decreased fetal growth, and placental abruption (CDC.2021). The technique of motivational interviewing could be beneficial in developing behaviors to promote medication compliance. Motivational interviewing (MI) is a skilled technique, that has specific qualities such as guided communication style, with effective listening, while providing advice and information (Rollnick et al., 2008). MI helps to empower people by giving them the chance to tell their story, the meaning of their story, the relevance of their story, and the capacity to change (Rollnick et al., 2008). MI is a technique that is respectful and supports a natural process of change while promoting the patient’s autonomy (Rollnick et al., 2008). This patient could benefit from this process because she will be able to express why she does not feel she needs to take high blood pressure medications, why she feels it does not work, and if she understands the risks of high blood pressure for her and her fetus. The practitioner will follow the steps of MI, asking, listening, and then informing with an ultimate outcome of the patient realizing that she wants to be compliant with her medications to help herself and her baby. There are challenges with using motivational interviewing. The full history of the patient is not presented in this case but some diagnosis may affect how a patient responds to MI. If a patient has a history of depression, schizophrenia, or bipolar disorder motivational interviewing may fail (Rollnick et al., 2018). A patient needs to have some degree of self-motivation for the process to work and depression can limit a patient’s internal motivation. Mental illness can also cause a patient to feel mistrust and confusion with process of MI (Rollnick et al., 2018). A full history of patient needs to be assessed before determining if MI is an appropriate technique to initate change. An APRN has the opportunity to motivate adults into adopting healthy changes to promote overall wellness and decrease the risk of developing chronic illnesses. The initial goal of motivating a patient to change is to develop a positive trusting rapport with the patient through motivational interviewing (Heath, 2017). The American Academy of Family Physicians (AAFP) states motivational interviewing is a method of changing the direction of the conversation in order to stimulate the individuals desire to change and give the patient confidence to do so (Searight, 2018). Studies show that motivational interviewing centered around a specific topic such as smoking cessation and or medication compliance will take the practitioner around 15 minutes and will result in a significant increase in patient willingness and compliance (Searight, 2018). An APRN just taking a few extra minutes could make an importance difference and have a final result of promoting this patient’s overall health and a better outcome for her baby. References Center for Disease Control and Prevention (2021, May 6) High Blood Pressure During Pregnancy. https://www.cdc.gov/bloodpressure/pregnancy.htm Heath, S. (2017, Aug 15) Top 4 Patient Motivation Techniques to Health Improvements. https://patientengagementhit.com/news/top-4-patient-motivation-techniques-for- health- improvement Rollnick, S. Miller, W., & Butler, C. (2008) Motivational Interviewing in Health Care. The Guilford Press. Searight, R. (2018) Counseling Patients In Primary Care: Evidence Based Strategies. Am Fam Physician 98(12) 719-728. https://www.aafp.org/afp/2018/1215/p719.html Value: 100 points Due: Initial Post by Day 3, Reply Post by Day 7 Grading Category: Discussions Initial Post Watch the Motivational Interview of a woman who is pregnant and continuing to drink alcohol. Motivational Interviewing: Discussing Alcohol Use in Pregnancy Video (17:37 minutes) Motivational Interviewing: Discussing Alcohol Use in Pregnancy Video Transcript Consider what you learned from the video, along with other content that has been discussed in this course. For your initial post, choose one of the three scenarios presented below and answer the following questions. (Please include at least three scholarly sources within your initial post): Questions: As an APRN, how could you positively affect the health of the woman in the scenario you chose? What would be the pros and cons of utilizing the technique of Motivational Interviewing with the woman in the scenario. Trial the techniques you have read about over the previous few weeks related to Motivational Interviewing with a coworker, family or friend. What was this experience like? Do you see benefits to becoming more comfortable with this technique? Why or why not? Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads Scenarios: A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.” Sumar has just found out she is pregnant and presents to the local free clinic. She is a 26-year-old G2P0AB1, and her first OB appointment is in two weeks. Sumar thinks she is about 12 to 14 weeks pregnant. She has come to the clinic complaining of indigestion. You notice the strong smell of cigarette smoke, and she admits she smokes one pack of cigarettes a day but states she is smoking less now since she started vaping. You are seeing a 19-year-old female for STI screening. When reviewing her health and sexual history to determine her risk, she indicates she has had several new partners over the past six months and that she has not been using condoms but does have an IUD. She has started smoking marijuana and has dabbled with some other prescription medications over the previous two months. She is worried about having contracted an STI because she has noticed some “cauliflower” type bumps “down there” and would like to be tested. Reply Posts Reply to at least two of your classmates on two separate days (minimum) who chose the two other topics utilizing at least two scholarly references per peer post. What did you learn from your experience with Motivational Interviewing this week that could help your peer better address the preventive guidelines for the women in the scenario? Please refer to the Grading Rubric for details on how this activity will be graded. Posting to the Discussion Forum Select the appropriate Thread. Select Reply. Create your post. Select Post to Forum. A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.” Wow there is a lot of information in this scenario that the APRN needs to be aware of. This patient presents with swollen ankles and shortness of breath and a cough she can’t control. On top of this, she has a hx of HTN which she took her medication irregularly prior to her pregnancy and now she has stopped it completely. Certainly in this case, treating her medically is the first action to take in working with someone who needs to make changes in their behavior. Does this patient have CHF, a PE, or Pre-eclampsia? Only additional testing can answer those questions. Certainly the next step is educating her on the HTN and the need for her medication to continue for her safety and the baby’s. With Motivational interviewing (MI), the APRN can begin to question this patient as she stabilizes, as to why she was concerned about stopping her medications. Therapists can support their patients with MI as well as other techniques such as Mindfulness to encouraging her to use her own resources to take action to start making changes (Corey, 2021). MI focuses on the present and future conditions and assists patients to find ways to achieve their own goals (Corey, 2021). References Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:Week 13 Discussion 1: The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines Corey, G. (2021). Theory and practice of counseling and psychotherapy. Cengage. 308 words Discussion Question Rubric Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Note: The value of each of the criterion on this rubric represents a point range. (example: 17-0 points) Discussion Question Rubric – 100 Points Criteria Exemplary Exceeds Expectations Advanced Meets Expectations Intermediate Needs Improvement Novice Inadequate Total Points Quality of Initial Post Provides clear examples supported by course content and references. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. All instruction requirements noted. 40 points Components are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints. Meets all requirements within the discussion instructions. Cites two references. 35 points Components are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development. Is missing one component/requirement of the discussion instructions. Cites one reference, or references do not clearly support content. Most instruction requirements are noted. 31 points Absent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. No references cited. Missing several instruction requirements. Submits post late. 27 points 40 Peer Response Post Offers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation. All instruction requirements noted. 40 points Evidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post. Response is supported by course content and a minimum of one scholarly reference per each peer post. All instruction requirements noted. 35 points Lacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight. Missing reference from one peer post. Partially followed instructions regarding number of reply posts. Most instruction requirements are noted. 31 points Post is primarily a summation of peer’s post without further synthesis of course content. Demonstrates incomplete understanding of content and/or inadequate preparation. Did not follow instructions regarding number of reply posts. Missing reference from peer posts. Missing several instruction requirements. Submits post late. 27 points 40 Frequency of Distribution Initial post and peer post(s) made on multiple separate days. All instruction requirements noted. 10 points Initial post and peer post(s) made on multiple separate days. 8 points Minimum of two post options (initial and/or peer) made on separate days. 7 points All posts made on same day. Submission demonstrates inadequate preparation. No post submitted. 6 points 10 Organization Well-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas. 5 points Organized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow. 4 points Poor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 points Illogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points 5 APA, Grammar, and Spelling Correct APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 points Correct and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 points Three to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 points Five or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points 5 Total Points 100 Order Now
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