1,125 individuals living in Beijing were surveyed about noise pollution and mental health. Proximity to major roads and higher reported noise pollution levels were associated with increased odds of mental health issues like anxiety and sleep disturbances. Railway and commercial noise were the most significant sources of mental distress. While subjective noise exposure data limited conclusions, the study suggests noise pollution is a public health concern with housing renovation and traffic noise warranting further regulation and abatement efforts to reduce health impacts.

1. MATRIX ASSIGNMENT TEMPLATE (EPI 50015)
Name: Kristen Septaric
Descriptive statement of the Environmental Health issue or
problem and specific population that was researched in the
literature review dissection and synthesis using the matrix
method:
Noise pollution is a nuisance and reduces the quality of life of
the urban population, who experience higher levels of noise
than
rural residents around the world.
Article
References
Year of
publication
Study Design
and Aim(s)
Recruitment and
final number
enrolled

2. Major results Limitations Implications for
Population Health
Barbosa,
A. S. M.
2005 Cross-
sectional;
assessing
hearing status
of workers
exposed to
urban noise
from vehicle
traffic,
compare
workers with
normal
hearing status
and those with
624 Transit
Engineering
Company
employees;
starting sample
1340 exposed
workers evaluated
at the
Occupational
Health Clinic of
the University of
São Paulo Hospital
das Clínicas
during 1997-1998,
only 627 able to

3. Prevalence of noise-
induced hearing loss
(NIHL) (28.5%),
working in higher noise
level areas (38.8%),
working in lower noise
areas (24.2%), NIHL
correlated with gender,
age, TECA position,
and prior exposure to
workplace noise
Data was obtained
using a
standardized
questionnaire, and
it was not possible
to get precise
measurements of
worker’s level of
noise exposure; no
information was
collected on noise
levels in previous
exposures or other
settings; degree of
exposure and
Noise mapping
demonstrated that
noise levels in
most areas of the
city exceeded
standards set for
noise. Elevated

4. levels of noise
were associated
with higher rates
of hearing loss.
Public health
officials need to
measure noise
levels in urban
suggestive
hearing loss
attend hearing
evaluations, 3
excluded for
having conductive
hearing loss
outcome was
measured
simultaneously, so
causality cannot be
established
areas to evaluate
whether they
meet or exceed
standards. If noise
is exceeding
standards, more
regulations on
traffic noise
should be
implemented.

5. Björk, J. 2006 Cross-
sectional;
investigate
residential
noise from
road traffic
and evaluate
its relationship
with
perceptions of
annoyance,
disturbance of
daily
activities, and
impact on
health in
general;
special
attention was
paid to the
health of those
most annoyed
and those
13,557 persons; A
random sample of
24,945 persons
from 60 stratified
regions of
southern Sweden
were sent a large
public health
survey 1999-2000,
13,604 responded
to the survey, and

6. geocodes were
only available for
13,557 persons
25% reported
occasional disturbance
from traffic noise
during relaxation time
and sleep in the highest
exposure levels; no
pattern was found
between noise exposure
and general health;
significant associations
were found between
annoyance from traffic
noise and issues
concentrating (p=0.03)
and treatment for
hypertension (p=0.02),
positive associations
were found between
noise exposure and
health problems for
women (hypertension),
immigrants (sleep),
unemployment (stress),
Participation was
low at just 54%
completing the
survey; those who
did not complete
the survey varied
significantly in
demographic

7. characteristics, thus
bias was potentially
introduced in the
association between
exposure and health
issues examined;
the questionnaire
itself may have
issues with validity
of self-reported
measures; any
misclassification of
hypertension status
could have biased
the results toward
Exposure to high
levels of noise
produced frequent
annoyance and
disturbances to
activities of daily
living; those
frequently
annoyed
experienced more
negative health
effects; the effects
of road traffic
noise on
disadvantaged
subpopulations
may be higher
than the normal
population so
special attention

8. should be given
to these
populations when
most
vulnerable
and those with financial
issues (difficulty
concentrating)
the null; causality
was not able to be
established due to
the nature of the
study design
creating policy
and interventions
for reducing
exposure to high
levels of traffic
noise
Dratva, J. 2009 Cross-
sectional;
evaluate the
impact of
traffic-related
noise
annoyance on
health-related
quality of life,
investigate the

9. possible
gender-based
differences in
noise
perception and
annoyance,
and the
potential
impact they
may have on
the
relationship
between noise
and HRQL
5,021 persons;
8,047 participants
from an original
SAPALDIA
cohort study
conducted in
2001-2002 that
comprised a
random sample of
adults aged 18-60
years from 8
locations in
Switzerland were
sent a follow-up
survey; 5,672
persons returned
the survey; 88
were excluded for
missing
information on
noise annoyance

10. and 563 were
excluded for
reporting deafness
Of the entire study
population, 13%
reported high
annoyance due to
traffic noise; women
were more likely to
report high annoyance
to noise (adjOR 1.23,
95% CI 1.01-1.48), a
significant negative
association between
noise annoyance and
general health could
not be established, but
significant negative
associations were
observed for physical
functioning, role
physical, bodily pain,
vitality, social
functioning, role
emotional, and mental
health, mental
component and
physical component
summaries; significant
effect modification by
Study failed to cite
limitations
(limitation in
itself); only self-

11. reported measures
were collected;
information on the
actual level of noise
experienced by
study participants
unknown;
participants were
obtained from a
wide variety of
geographic
locations, and not
limited to urban
areas – thus level of
traffic density near
residential areas,
which could impact
annoyance scores,
varies widely
among participants;
causality cannot be
established due to
study design
Traffic-related
noise annoyance
is significantly
associated with
lower HRQL;
higher levels of
annoyance in
women suggests
higher
environmental
awareness;
women and

12. chronically ill
(more often
occurring in
women) should
be treated as
vulnerable
populations for
noise pollution;
gender
differences in
perceptions of
annoyance to
noise should be
taken into account
when designing
gender for physical
functioning, role
physical and physical
component summary;
effect modification by
chronic disease for both
summary scales
interventions to
reduce the impact
of traffic-related
noise on quality
of life

13. Kim, M. 2012 Ecological;
investigate the
association
between road
traffic noise
and potential
health effects
through the
use of
prediction
models for a
highly
urbanized area
1,152,550 (Fulton
County, GA
daytime
population) and
857,184 (Fulton
County, GA
nighttime
population);
aggregate data sets
were collected
from Fulton
County, Georgia
Department of
Transportation,
and the Atlanta
Regional
Commission from
2009-2011, city of
Mountain Park
was excluded due
to small portion of

14. 9.5% of the daytime
population were at risk
for being highly
annoyed in the
daytime; 2.3% of the
nighttime population
were at risk for having
high levels of sleep
disturbances; the city of
Atlanta was most
severely impacted by
road traffic noise
Determinations of
perceptions of noise
annoyance and
sleep disturbances
were made based
on equations
without any
validation from the
residents of the
county under
investigation; the
equations used
were designed from
surveys of
European countries
and may not reflect
the characteristics
of the US; buses
and motorcycles
were not included
in the traffic noise

15. Highly urbanized
areas may be
exposed to levels
of noise that put
them at risk for
being annoyed or
having sleep
disturbances,
which in turn
could affect other
aspects of health
and overall
quality of life;
policy makers
should work to
reduce ambient
traffic noise
levels in urban
areas to improve
QOL for residents
city being a part of
the county
assessments;
LandScan, the tool
used for collecting
population data,
may not accurately
reflect the
geographic
distribution of the
population; railway
and aircraft noise

16. was not examined
in the study,
although the noise
does contribute to
overall noise level
of the county; only
predictions, not
conclusive
evidence, can be
drawn from this
study, causality
cannot be
established due to
the study design
Vianna, K.
M. dP.
2015 Cross-
sectional;
evaluate the
perception and
annoyance
from noise in
urban
soundscapes
during leisure
180 individuals, 60
in each
soundscape, 30
exposed to high
and 30 exposed to
low levels of
noise; three visits
made to each of

17. scenario sites and
70% of participants
reported noticing noise
and 41.7% reported
some degree of
annoyance associated
with exposure to noise;
16.7% felt highly
annoyed; no
statistically significant
The Lden indicator
used to construct
the noise map may
not be
representative of
exposure levels in
all urban
soundscapes;
validity of the
The reactions of
individuals to
noise may be
different in
different
environments;
people tend to
find noise in the
home and work
time, at home,
and at work in

18. areas of high
and low
exposure to
noise
included randomly
selected
individuals over
the age of 20 years
who agreed to
answer the
questionnaire;
leisure scenario:
conducted in parks
during the week
and weekend;
work scenario:
conducted in
commercial
establishments
during slow times
of the day; home
scenario:
interviews
obtained during
evenings and
weekends in
selected housing
projects chosen in
partnership with
Camera do Porto
association between
exposure and presence
of chronic illness
observed for work

19. scenario; 97% of
workers reported being
adapted to urban noise;
individuals in the urban
soundscape exposed to
noise reported
significant annoyance
by noise at a rate 4
times higher when
compared to
individuals of a non-
exposed urban
soundscape; the degree
of annoyance regarding
road traffic
significantly increases
with increases in levels
of exposure
questionnaire in
assessing noise and
chronic conditions
may have been
affected by some
bias when
conducted in the
workplace;
noticeable language
barriers especially
amongst people
whose native
language was of
another origin made
completing the
survey difficult, as
a result Chinese-

20. speaking
individuals were
excluded – this
exclusion could
affect the
generalizability; the
small study size
may limit the
reliability of the
study; due to the
nature of the study
design, causality
could not be
established
environments to
be more annoying
than in leisure
activities;
adaptation or
becoming
“immune” to
noise may affect
emotional and
physiological
responses to noise
for those used to
living, working
and playing in
urban
environments;
public health
officials should
take into account
the different
scenarios in

21. which one spends
there time, find
the scenario with
the highest level
of exposure and
associated
outcomes, and
target that setting
for interventions
Stansfeld,
S. A.
2015 Literature
Review;
examine the
contributions
of
environmental
noise
exposure from
road, rail and
aircraft noise
on health,
relative to air
pollution
N/A; literature
review yielded 25
peer review
articles; search
conducted using
PubMed including
the following key

22. terms: “noise, air
pollution and
health;”
occupational
studies and studies
of hearing loss
were excluded
5 studies found
associations of road
traffic noise with
hypertension; 3 studies
found associations
between myocardial
infarction and road
traffic noise exposure,
but 1 of the studies
only found the
association for those
closest to the road; 3
studies found an
association between
aircraft noise and
myocardial infarction
and CVD hospital
admission rates; traffic
noise was not
associated with fatal
stroke; 1 study on road
traffic noise and 2
studies on aircraft noise
found an association
with all-cause mortality
There is a
possibility that

23. important studies
may not have been
included in the
literature review;
the review itself
does not help to
establish causality;
misclassification of
noise modelling
could have been a
source of bias;
exposure to
multiple noise
sources may not be
accounted for by
the studies; indoor
noise exposure was
not likely reflected
in the studies under
investigation; some
of the studies
lacked significant
power in their
attempt to test
significance;
temporal
misalignment may
be possible due to
inability to
establish causality
in most studies as
Existing literature
provides evidence
in support of
cardiovascular

24. morbidity and
mortality from
road traffic and
aircraft noise
independent of air
pollution effects;
environmental
planning should
take into
considerations the
health impact of
noise when
designing
residential areas
in proximity to
busy roads and
airports; noise
pollution should
also be included
in environmental
policy targeting
air pollution
they are cross-
sectional in design;
burden of disease
evidence may not
be reliable or
generalizable to
large populations;
multiple
confounding factors
exist that could
alter the results of

25. the studies under
investigation
Ma, J.
2018 Cross-
sectional;
extend
literature by
exploring
socio-spatial
differences in
noise
pollution in
Beijing as
well as
examine the
relationship
between noise
pollution and
self-reported
mental health
1125 individuals;
50 household
members aged 18-
65 years old were
randomly selected
from 26
communities in
Beijing March-
May 2017,
selected for their
diversity in spatial
location, housing

26. condition,
community type
and built
environment; 155
participants were
excluded for
lacking complete
information on
Proximity to the main
road was a significant
indicator of urban
residents’ mental
disorders; those living
the furthest away from
a main road had lower
odds of anxiety, fatigue
and sleep disturbances;
a 62.7% increase in
self-reported mental
health disorders was
found for those with
reported high levels of
noise pollution verses
those with low levels of
reported noise; railway
and commercial noise
were the most
significant sources of
Subjective rather
than objective data
were collected on
noise exposure
since China lacks
noise pollution data

27. on a geographical
basis; without
objective data, the
mental health
outcomes may have
bias and not be
statistically
accurate; potential
confounding
variables such as
body mass index,
smoking and drug
use were not
included in the
More research is
needed into the
health effects of
noise pollution on
mental health;
housing
renovation and
road traffic
represent
significant
sources of noise
for those living in
urban
environments;
policy on
reducing noise
during renovation
projects and other
noise abatement
interventions is

28. socio-
demographics,
social networks,
housing conditions
and evaluations on
noise pollution
mental distress;
moderate to high noise
pollution from housing
renovation was
associated with
significantly worse
mental health than
those who reported low
levels of renovation
noise
study; causality
could not be
established due to
the nature of the
study design
needed to reduce
this significant
source of noise
pollution for
those living in
urban centers
Wu, J. 2019 Cross-
sectional;
analyze noise

29. distribution in
relation to
building
height of
residential
apartment
buildings
located
adjacent to
roadways and
evaluate the
effects of
environmental
noise on urban
residents
528 participants;
three apartment
buildings were
selected for their
proximity to a new
roadway
constructed in the
previous decade in
Guangzhou,
China; household
members were
randomly selected
from each of the
buildings with the
following number
of individuals
completing the
survey: 148 from
building A, 153
from building B,

30. and 227 from
building C
72% of participants
reported sensitivity to
noise; negative
perceptions of noise by
source type in order of
most to least negative
are as follows: traffic
noise, daily life,
construction,
entertainment and
industry; residents of
the building closest to
the Pazhou Bridge
(traffic center)
experienced greater
sensitivity to noise;
90% of the participants
reported noise having
an impact on their
physical comfort level,
with 21% reporting a
serious physical
impact; 65% of the
The noise
prediction model
used in the study
was created by the
research
investigators, thus
the tool may not be
reliable or
generalizable to

31. other settings;
measurements for
physical and
psychological
impact were based
on survey responses
and may result in
responder bias;
temporality
(causality) between
noise exposure and
health impacts
could not be
established due to
This study
provided
evidence of an
urban area
exceeding
national noise
standards set by
the government;
as a result, more
stringent penalties
should be in place
to enforce noise
standards in urban
settings to
promote the
health of urban
residents; noise
pollution effects
on local resident
populations
should be

32. considered in the
developmental
participants reported
noise having an impact
on their psychological
comfort; the most
common symptoms
included emotional
instability, low working
efficiency, fatigue, and
insomnia; noise levels
increase closer to the
ground level and
decrease slightly at the
highest floors in the
building; the noise
levels in the buildings
along the bridge far
exceeded national
standards for noise
levels both during the
day and at night
the exposure and
outcome being
conducted at the
same time
phase of any
major roadway,
railway, or airport
construction

33. Written Narrative of Literature Synthesis (1-2 paragraphs,
approximately 250 words): Major collective findings that
pertain directly to the environmental health problem / issue
researched through the literature review dissection and
synthesis, based upon the categories of column headings in the
matrix:
The current body of literature on noise pollution in urban areas
provides evidence in support of an association between high
noise
levels and negative health outcomes including annoyance,
mental health disorders, sleep disturbances, hypertension and
other
related cardiovascular diseases. Noise level measurements taken
in many urban residential areas throughout the world exceed
standards set by respective legislation. This finding
demonstrates the need for better policy on noise abatement for
urban areas as
well as more stringent penalties for violating noise standards.
Traffic-related noise and proximity to noise source (i.e. major
roadway) represent the bulk of noise pollution reviewed in
literature thus far. More research is needed into the
contributions to noise
pollution from sources such as aircraft, construction, housing
renovation and sounds from the indoors. Primary public health
interventions should target environmental planning of major
roadways, railways and airports to minimize noise for local
residents.
As a secondary strategy, public health officials should then
target policy to control the existing sources of noise.
The major limitation of this literature review is that the

34. majority of articles included are cross-sectional, and none of the
studies
were able to establish a temporal relationship between noise
exposure and negative health outcomes. This limitation is due to
the
lack of causal studies (RCT, cohort etc.) in current literature. A
thorough search was completed using Academic Search
Complete
and PubMed for any articles containing the key words of “noise
pollution,” “noise,” “noise exposure,” “health outcome,”
“health,”
and “urban.” Despite this thorough search, I was only able to
find cross-sectional, ecological and literature review studies.
My
search was validated through the literature review paper
included in my review which contained primarily cross-
sectional studies
and no studies that established causality. Although randomized
control trials would not be appropriate for studying urban noise
exposure, more research is needed using cohort and case-control
study designs to investigate any causal associations that may
exist.
References
Barbosa, A. S. M., & Cardoso, M. R. A. (2005). Hearing loss
among workers exposed to road traffic noise in the city of São

35. Paulo in
Brazil. Auris Nasus Layrnx, 32, 17-21.
doi:10.1016/j.anl.2004.11.012
Björk, J., Ardö, J., Stroh, E., Östergren, P.-O., Albin, M.
(2006). Road traffic noise in southern Sweden and its relation to
annoyance,
disturbance of daily activities and health. Scandinavian Journal
of Work, Environment & Health, 32(5), 392-401.
Dratva, J., Zemp, E., Dietrich, D. F., Bridevaux, P-O., Rochat,
T., Schindler, C., Gerbase, M. W. (2009). Impact of road traffic
noise
annoyance on health-related quality of life: results from a
population-based study. Quality of Life Research, 19, 37-46.
doi:
10.1007/s11136-009-9571-2.
Kim, M., Changg, S. I., Seong, J. C., Holt, J. B., Park, T. H.,
Ko, J. H., & Croft, J. B. (2012). Road traffic noise: Annoyance,
sleep
disturbance, and public health implications. American Journal
of Preventative Medicine, 43(4), 353-360.
http://dx.doi.org/10.1016/j.amepre.2012.06.014
Ma, J., Li, C., Kwan, M-P., & Chai, Y. (2018). A multilevel
analysis of perceived noise pollution, geographic contexts and
mental

36. health in Beijing. International Journal of Environmental
Research and Public Health, 15(7), 1479.
doi: 10.3390/ijerph15071479.
Stansfeld, S. A. Noise effects on health in the context of air
pollution exposure. International Journal of Environmental
Research and
Public Health, 12, 12735-12760, doi:10.3390/ijerph121012735.
Vianna, K. M. dP., Cardoso, M. R. A., & Rodrigues, R. M. C.
(2015). Noise pollution and annoyance: An urban soundscapes
study.
Noise and Health, 17(76), 125-133.
Wu, J., Zou, C., He, S., Sun, X., Wang, X., & Yan, Q. (2019).
Traffic noise exposure of high-rise residential buildings in
urban area.
Environmental Science and Pollution Research, 26, 8502-8515.
https://doi.org/10.1007/s11356-019-04640-1
http://dx.doi.org/10.1016/j.amepre.2012.06.014
https://dx-doi-
org.proxy.library.kent.edu/10.3390%2Fijerph15071479
https://doi.org/10.1007/s11356-019-04640-1
Sample Nursing Care Plan
Student Name: Sally Jones Date:

37. 1/17/12
Patient (initials only): R. N.
Patient Medical Diagnosis: Stroke
Nursing Diagnosis (use PES format): Impaired physical
immobility related to motor track dysfunction as evidenced by
weakness and lack of coordination
Assessment Data
(Include at least three-five subjective and/or objective pieces
of data that lead to the nursing diagnosis)
Goals & Outcome
(Two statements are required for each nursing diagnosis. Must
be Patient and/or family focused; measurable; time-specific; and
reasonable.)
Nursing Interventions
(List at least two nursing or collaborative interventions with
rationale for each goal & outcome.)
Rationale
(Provide reason why intervention is indicated/therapeutic;
provide references.)
Outcome Evaluation & Replanning
(Was goal(s) met? How would you revise the plan of care
according the patient’s response to current plan of care?)
1. +2 weakness on left
upper and lower
extremity

38. 2. Inability to walk without
assistance (patient
shuffles when walks and
gets confused as to
which leg needs to
move to propel forward)
Statement #1: Patient will perform ROM exercises each hour
during the shift.
Statement #2: Patient will ambulate from bed to door twice by

39. the end of shift.
1. Educate pt about importance of ROM exercises. Rationale:
If pt understands the importance of ROM exercises (to maintain
and hopefully increase strength), the pt is more likely to
participate in exercises (Potter & Perry, p. 4).
2. Assist pt w/ ROM exercises while teaching him how to
perform ROM exercises.
3. Consult with physical therapist for strength training and
development of a mobility plan
1. Determine amount of assistance needed to get patient out of
bed and ambulate.
2. Clear walkway of hazards. Pt is at risk for falls so clearing
hazards will provide a safe path to ambulate (Potter & Perry, p.
3).
1. If patient understands the important of ROM exercises (to
maintain and hopefully increase strength), the patient is more
likely to participate in exercises (Potter & Perry, p. 4).

40. 2. Pt needs to be instructed on how to perform ROM exercises,
and performing the exercises while instructing the patient will
solidify his understanding so he can perform exercises on his
own (Potter & Perry, p. 5).
3. Techniques such as gait training, strength training, and
exercise to improve balance and coordination can be very
helpful for rehabilitation patients (Tempin, Tempkin, &
Goodman, 1997)
1. Weakness and lack of coordination can cause the pt to be off
balance which would put him at risk for a fall. Determining
level if assistance needed before trying to assist out of bed and
ambulate will prevent a fall for the patient (Potter & Perry, p.
2).
2. Pt is at risk for falls so clearing hazards will provide a safe
path to ambulate (Potter & Perry, p. 3).
Outcome #1: Pt partially met goals. He was open to and
understanding of the need to perform ROM exercises, but he
still needs guidance in how to perform. Will continue to with
current plan.

41. Outcome #2: Patient exceeded goal: he walked 4 times. Wil
modify plan to increase distance (to nurses’ station).
Medication Preparation Log (MPL)
Student
Name________________________________________________
_
Clinical Rotation
Date__________________________________________
Patient Initials
Room #
Code Status
Allergies

42. Diagnosis
Relevant Medical/Surgical History
Drug
Dose/Range
Route
Time
Reason for RX
Top 4 Side Effects

43. Nursing Care Plan Form
Student Name
Date

44. Patient (initials only)
Patient Medical Diagnosis
Nursing Diagnosis (use PES/PE format)
Assessment Data
(Include at least three-five subjective and/or objective pieces
of data that lead to the nursing diagnosis)Goals & Outcome
(Two statements are required for each nursing diagnosis. Must
be Patient and/or family focused; measurable; time-specific; and
reasonable.)
Nursing Interventions
(List at least three nursing or collaborative interventions with
rationale for each goal & outcome.)Rationale
(Provide reason why intervention is indicated / therapeutic;
provide references.)
Outcome Evaluation & Re-planning
(Was goal met? How would you revise the plan of care
according the patient’s response to current plan?)
1.
2.
3.
Statement #1

45. Statement #2
1.
2.
3.
1.
2.
3.
1.

46. 2.
3.
1.
2.
3.
Outcome #1
Outcome #2

47. EVALUATION CRITERIA FOR NURSING CARE PLANS
(NCP)
At least one nursing care plan (or update of care plan) will be
evaluated per week on a pass-fail basis –
fails will be required to revise until final care plan is adequate
DAY 1 CARE PLAN IS A DRAFT – FACULTY TO REVIEW
FOR SUGGESTIONS TOWARD FINAL PRODUCT – PASS-
FAIL EVALUATION WILL BE ON DAY 2 CARE PLAN
Patient Profile Database Form (30%)
______Assessment: All subjective and objective data are
documented on form (10%)
______Pathophysiology: Should be based onthe medical
diagnosis (10%)
______Laboratory Data: Noted as normal or abnormal and
reason abnormal (10%)
Medication Preparation Log (10%)
______ Medications:
Nursing Care Plan Forms (60%)
______Nursing Diagnosis Statements: (15% points possible-
see breakdown below)
_____Three statements are written(1 %/statement for
a total of 3 possible points)
_____Only NANDA-approved nursing diagnoses are
used (1 %/statement for
a total of 3 % possible)

48. _____ Statements are written in PES (for actual
diagnoses) or PE (for potential or “at risk”
diagnoses) format (1%/statement for a total of
3% possible)
_____Diagnosis is supported by assessment data
(1%/statement for a total of 3% possible)
_____Nursing diagnoses are listed from highest to lowest
priority. Life threatening
diagnoses (e.g. ABCs, infection, etc.) come
first, then safety, then allothers.
Usually existing problems come before “risk
for" problems (1%/ statement for a
total of 3% possible)
______Plan: Goals and Outcomes Statements: (12 % possible-
see breakdown below)
_____Two statements are required for each nursing
diagnosis statement(2 %/ statement for a total of 6% possible)
_____Statements are prioritized (1%/set of goals for a
total of 3% possible)
_____Statements are written in SMART format (1 %/
statement for a total of 3% possible)
______ Nursing Interventions with Rationale: (24 % possible-
see breakdown below)
_____ Each goal has two interventions (1%/goal for a
total of 8% possible)
_____ Each intervention has a rationale with a
reference (1%/goal for a total of 8% possible)
_____ Statements are specific (what, when, how much, how
often) (1% per goal for total of 8% possible)
______Evaluation: (9 %)
State if goal has been met; if not met or partially met, discuss
whether will continue or modify plan(9%)

49. Final Grade: ___________ Date:____________ Instructor
signature: __________________________
Evaluation minimum 85% required for a rating of ‘pass’, if not,
student must rewrite care plan by end of clinical rotation. After
that, it may consider as “fail”.
MATRIX ASSIGNMENT TEMPLATE
Name:
Descriptive statement of the Environmental Health issue or
problem and specific population that was researched in the
literature review dissection and synthesis using the matrix
method:
Article References
Year of publication
Study Design and Aim(s)
Recruitment and final number enrolled
Major results
Limitations
Implications for Population Health
(List articles from oldest to newest to see improvements /
consistencies over time with a glance of the matrix)
([A]Study Design: List: Cohort; case control; randomized
controlled trial; quazi-experimental; cross sectional; ecological.
[B] Aim(s): Major aim(s) pertaining directly to the EHS you are
researching)
Recruitment
process and final number enrolled)

50. (Major statistical results pertaining to primary aims)
(Major sources of potential epidemiological bias)
(Major findings pertaining directly to the EHS issue you are
researching; can include professional Public Health practice,
policy, and research)
(1)
(2)
(3)
(4)
(5)

51. (6)
(7)
Written Narrative of Literature Synthesis: A one to two
paragraph synthesis of the major collective findings that pertain
directly to the Environmental Health problem / issue researched
through the literature review dissection and synthesis. It is
recommended to read every column heading vertically from top
to bottom and write a brief summary of the findings seen across
the literature over time from each heading category including,
types of study designs utilized, study populations and
recruitment strategies, major results, major epidemiological
limitations, and implications for future public health practice,
research, and policy.

52. The literature review dissection assignment will include
reviewing a minimum of 7 peer-reviewed articles about a
specific environmental population health problem or issue,
using the matrix method for performing a literature review.
Summary of Assignment Students will perform a search of the
peer-reviewed scientific literature about a specific
environmental health (EH) problem or issue for an identified
population, use the matrix method to dissect and synthesize the
literature about this topic, and write a 1-2 paragraph, brief
narrative synthesis of the findings. Primary studies will be
entered into the provided matrix document and dissected
according to major components of scientific research. The
matrix method allows users to see trends in the literature, across
studies, over time, with collective synthesis occurring by a
glance through the major components of the research that have
been dissected in the matrix. Matrixes are used commonly for
systematic analysis and synthesis of literature for professional
practice, research, and non-scientific purposes. The following
criteria are required: I. Basic literature search information (10
points): 1. A statement of the exact Environmental Health
problem or issue in a specific population that was searched in
the literature review. II. Matrix Tables (45 points): 1.Matrixes
must contain a minimum of seven column headings, with the
following titles and information: a “references” column that
contains a reference for each study including the Author (s)
name, article title, journal name, volume and page numbers; (2)
a column containing the year of article publication listed by the
oldest published studies first; (3) a column containing the type
of study design; (4); a column containing the recruitment

53. process with the final number enrolled; (5) a column containing
the major statistical results; (6) a column containing study
limitations, (i.e., potential sources of bias); and (7) a column
containing implications for population health (See matrix
template for assignment usage). 2. Students will be required to
abstract in their matrix tables a minimum of 7 peer-reviewed
published scientific articles within the prior 15 years, with at
least 3 of these studies published within the prior 5 years that
are analytic (causal designs). 3. In general, stronger study
designs that consist of analytic (causal) study designs, such as
randomized controlled trials, cohorts, case controls, or
quaziexperimental studies are preferred to studies from which
causation cannot be inferred, such as cross sectional and
ecological study designs. If published research consisting of
causal studies are not available due to the nature of your
environmental health topic, please note this in the written
narrative for the literature review. III. Written Narrative
Synthesis of Major Findings (45 points): 1. The matrix will be
accompanied by an approximate 250 word or 1-2 paragraph,
written summary that will discuss the major collective findings
across the literature that were dissected and synthesized through
your literature review using the Matrix as a tool. The summary
will include the following components. 2. Collective (shared)
trends of findings seen across the studies over time with major
understandings gained about the selected EH issue or problem.
Specifically, this will include collective trends seen across
types of study designs, major statistical findings, and
limitations. A final requirement includes a description of the
major implications of the studies taken together with respect to
the EH issue or problem as applied to public health professional
practice, policy, and future research, which is needed to more
effectively promote population health in the specific topic of
your literature review.
https://write.smumn.edu/home/writing-resources/forms-of-
writing/

54. Literature Review