| Course | NR 505 Advanced Research Methods: Evidence-Based Practice |
|---|---|
| Week | 1 |
| Paper type | Discussion post with one reply |
| Length | About 570 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NR 505 Week 1
Week 1 Discussion: A Routine and the Evidence It Assumes
Every Four Hours, a 60 mL Syringe on the Feeding Tube: The Causal Claim Inside Our Gastric Residual Check and the Trial That Tested It
Initial Post
The routine, stated as an action. On our 20-bed medical intensive care unit, every four hours the nurse caring for a ventilated patient on tube feeding stops the pump, draws back the stomach contents through the feeding tube with a 60 mL syringe, measures the volume, and returns it. If the volume is over 250 mL, our policy says to hold the feeding for two hours and recheck. I have done this thousands of times in six years without once asking what it was supposed to prove.
The claim hiding inside it. Written down, the routine makes a causal claim: that checking gastric residual volume, and holding feeds when it is high, prevents patients from aspirating stomach contents and developing ventilator-associated pneumonia (VAP). There is a second, smaller claim about frequency: that a high residual is common enough, and a reliable enough sign of trouble, to be worth checking six times a day. Neither claim is stated in our policy. Both have to be true for the routine to make sense.
The design that claim requires. A claim that a practice prevents an outcome is a claim about cause, and the design that can test it best is a randomized controlled trial: patients randomly assigned to have their residuals monitored or not, with VAP counted by someone who does not know which group each patient was in. An observational study showing that patients with high residuals get more pneumonia would not be enough, because sicker patients might have both high residuals and more pneumonia for reasons unrelated to the check.
Where the evidence actually sits. That trial has been done. Reignier et al. (2013) randomized 452 ventilated adults in nine French ICUs to routine residual monitoring or none. VAP occurred in 16.7% of patients without monitoring and 15.8% with it, a difference that stayed inside the 10-point margin the investigators had set in advance for judging no monitoring not worse, and the unmonitored group was more likely to receive its full calorie goal. So the evidence of the right design suggests that the routine does not prevent the outcome it is meant to prevent, and may cost patients nutrition. I also learned that the trial was designed to show that stopping the check was not worse, rather than that it was better, which is a detail I want to understand properly later in the course.
My question for the group: if the best-designed evidence says a routine does not do what it claims, what else would you need to see before your unit stopped it?
Reply to a Classmate
Priya, you chose the routine of waking post-surgical patients every four hours overnight for vital signs, and you said the evidence is "mostly surveys of nurses." I think that tells us something about the design as well as the answer. A survey can tell us how often nurses do the checks and what they believe, which is frequency evidence. It cannot tell us whether skipping the checks for stable patients would miss deterioration, which is the causal claim inside the routine. Would a cluster trial by unit be possible, where some units move stable patients to fewer overnight checks and others do not?
References
Reignier, J., Mercier, E., Le Gouge, A., Boulain, T., Desachy, A., Bellec, F., Clavel, M., Frat, J.-P., Plantefeve, G., Quenot, J.-P., & Lascarrou, J.-B. (2013). Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: A randomized controlled trial. JAMA, 309(3), 249-256. https://doi.org/10.1001/jama.2012.196377
Reading the NR 505 Week 1 instructions
The first NR 505 discussion has you identify a practice routine and examine the evidence behind it. The usual list includes the routine stated as an action, the claim it makes, the kind of study that could test that claim, the evidence that exists, a question for classmates and a reply. Write the routine as something someone does, with times and equipment. Write out the claim inside it in one sentence. Name the design that claim would require before you look for evidence. Report what the strongest available study found, with its numbers. Leave a question about what else would be needed to change practice. In replies, compare the design behind a classmate's routine with the claim it makes.
How this NR 505 Week 1 example is built
The post opens with the routine: every four hours the nurse stops the feed, aspirates with a 60 mL syringe and holds feeding above a threshold. The second paragraph writes out the hidden claim that this prevents pneumonia. The third explains that a claim about prevention is causal and calls for a randomized trial. The fourth reports Reignier and colleagues' trial in nine French ICUs, which found that stopping residual monitoring did not increase pneumonia and improved feeding. The question asks what else a unit would need before stopping. The reply tells Priya that surveys of nurses can describe beliefs about waking patients overnight but cannot test whether the routine prevents harm, and suggests what kind of study could.
Reading the NR 505 Week 1 grading rubric
Discussion grading in NR 505 typically covers each prompt element, understanding of research design, accurate use of evidence, critical thinking, peer engagement and APA, with posting dates counted. Matching a claim to the design that can test it is the skill this week rewards, and the post does so before presenting any evidence. Evidence use is credited because the trial is reported with its size, setting and finding. Critical thinking scores through the question about what else would be needed. The routine is credited for being stated as an action. The reply earns its points by comparing designs rather than agreeing. One complete reference covers APA.
NR 505 Week 1 help: mistakes that cost points
The loss that runs deepest here is a post that argues about the routine instead of its evidence, defending or attacking it on experience. Another loss is naming evidence without saying what design it uses. Students also state routines vaguely, skip the hidden claim or cite studies that cannot test the claim, such as surveys for a question about cause. You do not have to prove the routine wrong. A routine from your own workplace works well with details changed. If your routine has no study behind it, that is a finding worth reporting. Describe a routine you do every shift, and an NR 505 Week 1 post can write out the claim inside it.
Get a NR 505 Week 1 example written to your instructions
Send the Week 1 prompt exactly as your classroom words it, with the required element list and any word count, and a custom NR 505 discussion post is written to it and returned inside 24 to 48 hours. The first one is free. Name the routine you have in mind and the example is built around that one instead of a stand-in.
More NR 505 papers and MSN samples
- NR 505 Week 2: PICOT Question Write-up
- NR 505 Week 3: Research Design Comparison
- NR 505 Week 4: Qualitative Study Appraisal
- NR 505 Week 5: Quantitative Study Appraisal
- NR 505 Week 6: Measurement and Sampling Write-up
- NR 505 Week 7: Research Ethics Analysis
- NR 505 Week 8: Evidence-based Practice Proposal
- NR 506 Week 1: Discussion Post
- NR 504 Week 1: Leadership Role Discussion Post
- NR 506NP Week 1: Discussion Post
- NR 503 Week 1: Epidemiology Rate Discussion Post
NR 505 Week 1 questions, answered
Do I have to prove the routine is wrong?
No, and posts that set out to prove it usually go badly. The week is asking where a practice gets its authority, and the honest answer is often that nobody in the section knows. Saying so, then naming the study that would settle it, earns more than an argument built on a source you found in ten minutes.
Can I write about something from my own workplace?
Usually yes, and it makes a better post than a topic lifted from a reading. Keep the description at the level of the practice rather than the patient, and say what kind of unit it happens on rather than naming the place. What the week wants is a routine somebody could recognize from the description, not a case.
My routine turned out to have no study behind it. Is that a problem?
It is the most interesting result you can get in Week 1. Plenty of practice rests on consensus documents, on habit, or on a single old paper everyone cites and nobody has read. Name what it rests on, then name the design that would put it on firmer ground, and the post has done exactly what the week asked.
Where can I find a free NR 505 Week 1 sample paper?
The complete Week 1 post on four-hourly gastric residual checks, with the hidden claim, the design it needs, the French trial, the question for classmates, the reply to Priya and the reference, appears on this page.
What claim does the NR 505 Week 1 post find inside the routine?
That checking gastric residual volume and holding feeds when it is high prevents ventilator-associated pneumonia, a causal claim that needs a randomized trial to test.