| Course | NR 449 Evidence Based Practice |
|---|---|
| Week | 1 |
| Paper type | Discussion post with one reply |
| Length | About 550 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 449 Week 1
Week 1 Discussion: A Routine the Evidence Settled Long Ago
The Whoosh Test Before Every Tube Feeding
Initial Post
The routine I want to write about is the whoosh test. On my medical unit, before a feeding or a medication goes down a nasogastric tube, many nurses push 20 to 30 milliliters of air into the tube with a syringe while listening over the stomach with a stethoscope. If we hear a gurgle, we treat the tube as being in the stomach. I learned it in orientation, I have watched it done at the start of almost every shift, and I have done it myself more times than I can count.
The evidence against it is not in dispute. Auscultation cannot reliably tell whether a tube is in the stomach, the esophagus, the small bowel or the lung, because air pushed into a tube in the airway can produce a sound over the upper abdomen that is indistinguishable from a gastric gurgle. Every major guideline reviewed by Metheny et al. (2019) advises against relying on auscultation to confirm placement, recommending a radiograph to confirm initial placement of a blindly inserted tube and pH testing of aspirate or other methods to check position before use.
So why is it still done every shift? I asked myself what conditions would lead a careful nurse to keep doing it, and the answers on my unit are physical before they are attitudes. First, pH strips are not stocked on the unit; they live in the central supply room and have to be requested, while a stethoscope is around every nurse's neck. Second, our electronic record's tube assessment screen has a dropdown for placement verification whose first option is auscultation, and choosing any other option opens a required free-text box. Third, aspirating gastric contents for a pH test often fails with small-bore tubes, which collapse under suction, so a nurse who tries the right method at 0200 and gets nothing back falls back on the method that always produces an answer. Fourth, the X-ray confirmation happens once, at insertion, and nobody owns the question of whether the tube has moved since.
None of those reasons is ignorance. Most nurses on my unit could tell you the whoosh test is unreliable. The routine survives because it is the fastest option the environment offers and the only one that never fails to give a result. If I wanted to change it, I would start with the supply cupboard and the dropdown, not with an in-service. Has anyone seen a unit where the screen or the supplies were changed and the practice followed?
Reply to a Classmate
Your routine of keeping patients flat for hours after a femoral sheath is removed is a good example, and I think the persistence answer you gave, that cardiologists order it, is only part of it. On my old unit the order set defaulted to six hours of bed rest even after the cardiology group changed its own protocol, because nobody updated the order set, and the nurses followed the order set. If the default in your system still reflects the old practice, the cardiologists may not know it is still being carried out in their name. Did you check when the order set was last revised?
References
Metheny, N. A., Krieger, M. M., Healey, F., & Meert, K. L. (2019). A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart & Lung, 48(3), 226-235. https://doi.org/10.1016/j.hrtlng.2019.01.003
Reading the NR 449 Week 1 instructions
The opening NR 449 forum has you identify a nursing practice that persists despite evidence and consider why. Most prompts ask for a specific routine, a brief statement of what the evidence shows, an analysis of why the practice continues, a cited source and an answer to one peer. Name the routine at the level a colleague would recognize, with details such as volume or timing. Settle the evidence in a sentence or two with a citation. Spend most of the post on why careful nurses keep doing it. Look for physical causes, such as supplies, screens and equipment, before attitudes. Avoid concluding that the problem is ignorance. In your reply, add a cause your classmate missed.
How the NR 449 Week 1 example is put together
The opening paragraph describes the whoosh test with the syringe volume and the sound. The second states that air pushed into the tube can be heard whether the tip sits in the stomach, esophagus, small bowel or lung, citing Metheny and colleagues. The third asks why the routine survives and lists four causes: pH strips that must be requested from central supply, a dropdown that defaults to auscultation and opens a required box for anything else, small-bore tubes that collapse when aspirated at 0200 and an X-ray that checks placement only at insertion. The fourth concludes that the routine survives because it is the fastest option the environment offers, not because nurses do not know better. The reply adds an order set default to a classmate's femoral sheath example.
Reading the NR 449 Week 1 grading rubric
Discussion grading in NR 449 usually covers each prompt element, accurate summary of evidence, depth of analysis, application to practice, a scholarly source, peer engagement and APA, with timely posting. Depth of analysis outweighs the rest, and the post earns it by naming four physical causes rather than blaming knowledge. Evidence is credited because it is settled briefly with a review of guidelines. Application scores through details only someone on the unit would know, such as where the strips live. The scholarly row is met by Metheny and colleagues. Peer engagement earns points for adding a second cause, an order set default, to a classmate's routine. One complete reference covers APA.
Common NR 449 Week 1 mistakes, and how to avoid them
The costliest post treats the problem as ignorance, summarizing research and recommending education without naming anything someone could change on Monday. Another loss is spending most of the post on the evidence and little on why the practice persists. Students also choose a practice where the evidence is still debated, or blame colleagues by name. The practice should be one you see or take part in. If you cannot find a settled example, look at routines tied to equipment or order sets. Citations should be few and focused. If a routine on your unit seems to outlast its evidence, describe it and an NR 449 Week 1 post can trace its physical causes.
Get a NR 449 Week 1 example written to your instructions
Send the Week 1 prompt from your classroom and a line about the routine you have in mind, and a custom example is written to that prompt and returned inside 24 to 48 hours. The first one is free. Anything your employer counts about that routine stays on your side of the line.
More NR 449 papers and RN-to-BSN samples
- NR 449 Week 2: Practice Problem Statement
- NR 449 Week 3: Evidence Summary
- NR 449 Week 4: Stakeholder Analysis
- NR 449 Week 5: Barrier Analysis
- NR 449 Week 6: Practice Change Proposal
- NR 449 Week 7: Evaluation Plan
- NR 449 Week 8: Dissemination Brief
- NR 451 Week 1: Discussion Post
- NR 447 Week 1: Charge Nurse Leadership Discussion
- NR 446 Week 1: Interprofessional Team Stall Post
- NR 300A Week 1: Independent Study Project Outline
NR 449 Week 1 questions, answered
Does the practice have to be one I take part in?
Usually yes, and the post gains from it. A routine you have performed yourself can be described in the detail that makes the persistence question answerable, and naming it is an observation rather than an accusation. Describe the unit by type and leave employers, managers and colleagues unnamed, which most sections require anyway and which keeps the post reading as analysis.
What if I cannot find a practice where the evidence is settled?
Look at what should have been withdrawn rather than at what is missing. Routines outliving their evidence are usually additions nobody ever removed: a check kept after its reason expired, a restriction carried over from an older protocol, a form that outlived the system it once fed. Those are easier to spot than gaps and they suit this week better.
How much of the post should be citations?
Less than students expect here. One source establishing that the finding is settled does the whole job, and a second helps only if it says something about why practice lags behind. Sections that set a citation count are worth following exactly, but the marks in this thread sit in the cause you propose, not in the size of the reference list.
Where can I find a free NR 449 Week 1 sample paper?
The complete Week 1 post on the whoosh test, with the settled evidence, four physical reasons it persists, the reply about order set defaults and the reference, is available here.
Why does the whoosh test persist according to the NR 449 Week 1 post?
Because pH strips are stocked away from the unit, the record's first option is auscultation, small-bore tubes collapse when aspirated and the X-ray checks placement only once, making the old method the fastest one available.