| Course | NR 361 RN Information Systems in Healthcare |
|---|---|
| Week | 8 |
| Paper type | Course reflection paper |
| Length | About 1,110 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 361 Week 8
The Comment Box I Used to Trust: A Reflection on Coded Fields
Student Name
College of Nursing, Chamberlain University
NR 361: RN Information Systems in Healthcare
Instructor Name
Month Day, Year
The Comment Box I Used to Trust: A Reflection on Coded Fields
The Habit
For eight years as an admitting nurse on a medical unit, when a patient told me about an allergy reaction that did not fit the choices in the reaction list, I typed the patient's words into the comment box. My mother said I got a rash as a baby. It makes my stomach hurt. I passed out once but I think it was the needle. I thought this was the careful thing to do. The coded list felt crude, and the patient's own words seemed more honest than forcing them into a category that did not quite match. I still think the instinct was reasonable. Patients describe reactions in ways no list anticipates, and a nurse who respects that is doing something right.
What the Habit Looked Like on an Ordinary Admission
A typical example came on a Tuesday evening admission of a woman in her sixties with cellulitis. She said she was allergic to penicillin and, when I asked what happened, said her mother had told her she broke out in spots when she was little, and she had avoided penicillin ever since. I searched for penicillin, selected it, left the reaction as unknown because none of the options felt right for a story that old, and typed her account of spots in early childhood into the comment box. I felt I had captured her history faithfully. The admitting physician ordered vancomycin rather than a penicillin-class antibiotic, which may have been the right choice that night. What I did not do was give anyone downstream a structured reason to question the label, and I did not mention to the physician or the pharmacist that the allergy rested on a secondhand story from childhood. That conversation would have taken a minute.
What Replaced It
I now choose a coded reaction whenever one fits even approximately, choose the most accurate time-frame and severity the patient can give, and use the comment box only for detail that adds to a coded entry rather than replacing it. For a childhood rash, I choose rash, record the approximate age, and add the patient's words as a comment. For the patient who fainted during an injection, I talk it through with the patient and, if it was fainting from the needle rather than a reaction to the drug, record it in a way that does not label the drug as an allergen, and I tell the pharmacist.
What Changed My Mind
My view shifted during the workflow analysis in the second week, when I followed one penicillin allergy through the record from admission to discharge. I had never looked at what happened to my comments after I typed them. The coded allergen and coded reaction travel: they drive the drug-allergy alert, they appear on the discharge summary in structured form, and they import into the primary care clinic's record. My comments do not. At the clinic, a patient whose penicillin allergy I had carefully annotated as a vague childhood rash became penicillin, reaction unknown, and the next hospital admission imported that label back without the story. Reading that about a third of patients in one large health system had a drug allergy recorded, and that many entries lacked usable reaction information (Zhou et al., 2016), showed me that my careful comments were part of a widespread pattern, not an exception.
The reading on structure and narrative gave me words for what I had got wrong. Rosenbloom et al. (2011) describe the tension between structured data, which systems can reuse, and narrative, which carries nuance. I had been treating the comment box as the more careful choice, when for information that has to travel and be reused, it is where information goes to disappear.
Who Benefits and How They Would Notice
The person who benefits most is the patient, years from now. A patient whose penicillin allergy is recorded as a coded childhood rash with an approximate age can be identified by a pharmacist or an allergist as a low-risk label and offered evaluation. Most patients labeled penicillin-allergic are not allergic when evaluated, and a label that is never questioned leads to broader and less effective antibiotics (Blumenthal et al., 2019). The pharmacist on my unit would notice first, because the drug-allergy alerts for my patients would carry reaction information she can act on. The primary care clinic would notice when its allergy list shows a reaction and a date instead of unknown.
Where Else the Lesson Applies
The lesson is not only about allergies. I now look at every place where I type something important into a comment or a note and ask whether it needs to travel. Home medication lists, advance directive status and fall history all have structured fields that other systems read, and I have found myself describing each of them in free text at one time or another. Not everything belongs in a field; a patient's fears about going home, or the way a family talks about a decision, belong in narrative, where they can be read in context. The question I learned to ask is simply who will need this after me, and whether they will be able to find it. When the answer is a report, an alert or another hospital's system, the field wins.
How I Would Know I Am Still Doing It
I asked our informatics nurse whether I could see how often my allergy entries use coded reactions. She showed me a report that lists allergy entries by the user who entered them. In the month before this course ended, 31 of my 38 entries had coded reactions, compared with about half in a sample from last year that she pulled for comparison. I will ask for the same report in three months to see whether the habit has held when the course is no longer on my mind.
What Is Still Hard
Some patients cannot say what happened. An older patient with dementia whose daughter says he is allergic to sulfa, but nobody knows why, does not fit any coded reaction honestly. For those patients I still choose unknown, and I am not sure that is right. It keeps the label and loses nothing, but it also carries the label forward forever. I do not yet know how to document uncertainty in a way that travels, and I suspect the answer is a field the system does not have.
References
Blumenthal, K. G., Peter, J. G., Trubiano, J. A., & Phillips, E. J. (2019). Antibiotic allergy. The Lancet, 393(10167), 183-198. https://doi.org/10.1016/S0140-6736(18)32218-9
Rosenbloom, S. T., Denny, J. C., Xu, H., Lorenzi, N., Stead, W. W., & Johnson, K. B. (2011). Data from clinical notes: A perspective on the tension between structure and flexible documentation. Journal of the American Medical Informatics Association, 18(2), 181-186. https://doi.org/10.1136/jamia.2010.007237
Zhou, L., Dhopeshwarkar, N., Blumenthal, K. G., Goss, F., Topaz, M., Slight, S. P., & Bates, D. W. (2016). Drug allergies documented in electronic health records of a large healthcare system. Allergy, 71(9), 1305-1313. https://doi.org/10.1111/all.12881
The Chamberlain NR 361 Week 8 instructions
The NR 361 final reflection asks you to consider how the course has affected your practice as a nurse working with information systems. Course materials usually specify a specific change, what caused it, its effect on patients or colleagues, how you will sustain it and APA citations. Name one habit, described fairly, including why it once made sense. Give an ordinary example of the old habit. State exactly what replaced it. Tie the change to a particular assignment or reading. Say who benefits and how they would notice. Find a way to check whether the change is holding. End with the case your new habit still cannot handle.
How this NR 361 Week 8 example is built
The habit section explains that, for eight years, reactions that did not fit the list went into the comment box in the patient's words. The example describes a Tuesday evening admission of a woman in her sixties with cellulitis whose penicillin allergy came from her mother's account. The next section states the new practice: a coded reaction, timeframe and severity, with the comment box only for detail that adds to the code. The cause is the Week 2 analysis, where the writer saw what happened to comment text, along with Rosenbloom and colleagues. The beneficiary section explains how a coded childhood rash can be found for allergy evaluation. The check uses the informatics nurse's report, and the last section covers patients who cannot say what happened.
Where the points sit in the NR 361 Week 8 rubric
Reflection rubrics in NR 361 typically weigh the clarity of the change, evidence of its cause, connection to course concepts, effect on patient care, a plan to sustain it, honesty about limits and APA. Clarity and evidence decide the grade, and this paper supplies both with one habit, an ordinary example and a named assignment as the cause. Course concepts are credited through structured versus narrative data. The patient care row scores because the beneficiary is a future patient who could have a label reviewed. Sustaining the change earns points through a report that counts coded entries, 31 of 38 against about half last year, with a recheck in three months. Ending on a real limit shows honest reflection.
NR 361 Week 8 help from the desk
The biggest loss on this reflection is a page about the course instead of practice, listing the weeks that were interesting. Next is a change claimed without a cause, as if it simply arrived. Students also ridicule their earlier selves, which reads as performance, or describe changes no one could verify. A plan to sustain the change should include a check, not a promise. Citing course readings briefly is enough. If your practice really did not change, describe what you noticed and why it did not stick. Name the habit you changed this term, and our writers can shape an NR 361 reflection around the report or reading that changed it.
Get a NR 361 Week 8 example written to your instructions
Send the Week 8 prompt with every question your section lists, and tell us one thing you actually do differently at the keyboard now. A custom example is written around that and returned inside 24 to 48 hours, and the first one is free. If nothing comes to mind, describe your unit and we will find a candidate worth writing about.
More NR 361 papers and RN-to-BSN samples
- NR 361 Week 1: Downstream Data Entry Discussion
- NR 361 Week 2: Penicillin Allergy EHR Workflow
- NR 361 Week 3: Continuous Pulse Oximetry Evaluation
- NR 361 Week 4: Tele-ICU Literature Review Matrix
- NR 361 Week 5: Pediatric Telephone Triage Analysis
- NR 361 Week 6: Cycle Tracking Health App Review
- NR 361 Week 7: Wound Measurement Informatics Proposal
- NR 393 Week 8: Reflection
- NR 360 Week 8: Barcode Scanner Trust Reflection
- NR 394 Week 8: Reflection
- NR 351 Week 8: Course Reflection on Using Sources
NR 361 Week 8 questions, answered
Can the reflection be written in first person?
Almost always yes, and in this genre it is expected. First person does not license loose writing though. The strongest sentences still carry a specific object: a field, a report, a colleague, a decision. If a paragraph could have been written by any nurse in any course, the pronoun is doing the work that evidence should be doing.
Do I need references in a reflection?
Check the prompt, since sections differ sharply on this. Where sources are asked for, attach them to the claim about practice rather than to the feelings around it. A professional standard or a competency statement supports a sentence about what the role requires; it cannot support a sentence about what you personally found difficult, and pairing them that way usually looks like padding.
What if my practice did not really change?
Then write that, carefully. A reflection saying the writer understands why an entry matters but still cannot complete it in the time available is a real finding, and it beats an invented transformation. Name the obstacle, say what would need to be true before the change could happen, and make the closing commitment about that obstacle instead of about technology in general.
Where can I find a free NR 361 Week 8 sample paper?
This page shows the complete Week 8 reflection on moving from the comment box to coded allergy reactions, with the example, the cause, the beneficiaries, the report check, the remaining difficulty and three references.
How does the writer check the change in the NR 361 Week 8 reflection?
With an informatics report of allergy entries by user, which showed 31 of 38 entries with coded reactions in the last month against about half last year, to be checked again in three months.