| Course | NR 505 Advanced Research Methods: Evidence-Based Practice |
|---|---|
| Week | 3 |
| Paper type | Research design comparison |
| Length | About 1,130 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NR 505 Week 3
One Question About Gastric Residual Checks, Two Designs Run Against It: An Individually Randomized Noninferiority Trial and a Stepped-Wedge Cluster Trial Across Six ICUs, and What Each Trades Away
Student Name
College of Nursing, Chamberlain University
NR 505: Advanced Research Methods: Evidence-Based Practice
Instructor Name
Month Day, Year
One Question About Gastric Residual Checks, Two Designs Run Against It: An Individually Randomized Noninferiority Trial and a Stepped-Wedge Cluster Trial Across Six ICUs, and What Each Trades Away
One Question, Held Still
The question, carried unchanged from last week, is whether omitting routine gastric residual volume measurement in ventilated adults on early gastric tube feeding, compared with measurement every four hours and a hold above 250 mL, increases the percentage of prescribed calories delivered without increasing ventilator-associated pneumonia over the first seven days.
This paper describes two designs as they would actually run against that question, at the same level of detail, and then accounts for what each buys and gives up. The first is an individually randomized noninferiority trial, the design Reignier et al. (2013) used. The second is a stepped-wedge cluster randomized trial across six ICUs in my health system. Neither is simply better. They trade different kinds of validity, and the question is which trade suits the decision my system has to make.
Design A: Individual Randomization, as It Would Run
Who is enrolled. Every adult in the six ICUs who is intubated, expected to be ventilated for more than 48 hours and started on gastric feeding within 48 hours, with consent from the patient's surrogate.
What is assigned. Each patient is randomly allocated, by a central web system that nurses cannot predict, to no residual monitoring or to measurement every four hours with a hold above 250 mL. The bedside nurse knows the assignment, because the intervention is a nursing action that cannot be hidden.
When measurement happens. Calories delivered are calculated daily from the pump record for seven days. Pneumonia is judged at the end of the seven days by two physicians who review the records with all mention of residual volume removed, so they do not know the group.
What it buys. Random allocation by patient makes the two groups similar in everything, measured and unmeasured, except the monitoring routine. If calories differ, the routine is the most likely explanation. That is high internal validity.
Design B: Stepped-Wedge Clusters, as It Would Run
Who is enrolled. The same patients in the same six ICUs, but the unit of randomization is the ICU, not the patient.
What is assigned. All six ICUs begin with current practice. Every two months, one randomly chosen ICU switches to no residual monitoring, until by month twelve all six have switched. Each ICU contributes data from before and after its switch, and at every point in time some ICUs are on each practice (Hemming et al., 2015).
When measurement happens. Calorie delivery and pneumonia are measured in the same way as in Design A, continuously across the fourteen months.
What it buys. The practice changes for a whole unit at once, which is how practice actually changes. Nurses on a switched unit follow one routine for every patient. Consent may be handled differently, because the intervention is a unit policy rather than something done to one patient, although that would need an ethics board's approval. And every ICU ends up with the new practice, which makes staff and leaders more willing to take part.
The Trade Between the Two Validities
Design A buys internal validity and pays for it in external validity. Its patients are those whose surrogates consented, which in ICU trials often excludes the sickest patients with no family present. Its practice is artificial: on the same unit, on the same night, one nurse measures residuals for one patient and not for the patient next door. A result from that setting tells us what the routine does under trial conditions, but it may not tell us what happens when a unit adopts the practice.
Design B buys external validity and pays for it in internal validity. Its practice is realistic and its population is broader. But because the switch happens over time, anything else that changes over those fourteen months, a new dietitian, a new feeding pump, a winter surge of respiratory illness, can be mistaken for an effect of stopping residual checks. The design includes each ICU's own before-and-after, and the analysis can adjust for time, but it cannot remove time trends as cleanly as randomization of individual patients does.
A Named Threat, Not a Category
The threat that most weakens Design A is contamination between arms. It is not a generic concern about bias; it is a specific mechanism on my unit. Nurses who stop measuring residuals for one patient, and see that nothing bad happens, are likely to relax how strictly they hold feeds for their control-group patients on the same shift. Nurses who measure residuals for a control patient may be tempted to check an intervention patient's tube "just to be sure." Either way, the two arms drift toward each other, and a real difference in calories would shrink. In a noninferiority trial, that drift is especially dangerous, because it makes the arms look similar and so makes noninferiority easier to show even if the practices truly differ.
The threat that most weakens Design B is a secular trend in feeding practice. My health system is currently rolling out a nutrition protocol that raises early calorie targets. If that rollout happens during the trial, calorie delivery would rise in every ICU over time, and the ICUs that switched later would look better simply because they switched after the protocol arrived. The stepped-wedge analysis can model time, but a large change mid-trial would be hard to separate from the effect of stopping residual checks.
The Choice, and What It Gives Up
The individually randomized trial has already been done in France, and it found that stopping residual checks did not increase pneumonia beyond the prespecified margin and increased the share of patients reaching their calorie goal (Reignier et al., 2013). My system does not need to repeat that trial to learn whether the practice works under trial conditions. What it needs to know is whether the practice holds up when whole units adopt it, with our patients and our staffing.
For that decision, I would choose the stepped-wedge design. It gives up some internal validity, and I would try to protect it by fixing the start date of the new nutrition protocol before the trial began, recording any other change in feeding practice during the fourteen months, and including time in the analysis. What it gains is an answer about the thing my system is actually deciding: a unit policy, across six ICUs, for all patients.
References
Hemming, K., Haines, T. P., Chilton, P. J., Girling, A. J., & Lilford, R. J. (2015). The stepped wedge cluster randomised trial: Rationale, design, analysis, and reporting. BMJ, 350, Article h391. https://doi.org/10.1136/bmj.h391
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
The Chamberlain NR 505 Week 3 instructions
The Week 3 paper has you compare two research designs that could address your PICOT question. Graders look for both designs described, their strengths and weaknesses, threats to validity, the design you would choose and why, and APA. Keep the question fixed and run both designs against it. Describe each at the same level of detail. Explain what each design buys and what it gives up, using internal and external validity. Name each design's main threat as a specific mechanism in your setting rather than a category of bias. Choose one for the decision you actually face, and say what you would do to protect what it gives up.
Inside the NR 505 Week 3 example
The question section carries last week's question unchanged. Design A enrolls each eligible adult, randomizes by a central web system and measures calories daily and pneumonia at seven days by two physicians reading records with residual mentions removed. Design B uses the same patients but randomizes ICUs, switching one every two months until all six have changed. The validity section explains the trade between the two. The threat section names contamination for Design A, since nurses caring for both arms may carry habits across, and a secular trend for Design B, since a nutrition protocol is rolling out. The choice section notes that the French trial already answered the individual question and chooses the stepped-wedge design for the system's decision, fixing its start date to limit the trend.
Where the points sit in the NR 505 Week 3 rubric
Design comparison rubrics in NR 505 usually score accurate description of both designs, analysis of validity, identification of threats, a justified choice and APA. Matching rather than ranking is the row graders look for, and the paper earns it by describing both designs at equal depth and showing what each buys. Validity is credited through internal and external trade-offs. Threats score because each is a mechanism specific to the unit. The choice earns points because it fits the decision the system faces and admits what it gives up. Hemming and colleagues explain the stepped-wedge design, and Reignier and colleagues provide the existing trial. Two references complete APA.
Common NR 505 Week 3 mistakes, and how to avoid them
The comparison that ranks instead of matching loses most, usually as a paragraph explaining that the randomized design sits higher on the hierarchy and therefore wins. Lopsided description, where one design gets a page and the other a line, is another common loss. Students also name threats as categories, such as selection bias, without saying how they would happen, or choose a design that does not fit the decision. A randomized trial is not always better for a practice decision. The designs do not have to be published studies. A fair pairing holds the question fixed. Send your PICOT question and an NR 505 design comparison can run two designs against it.
Get a NR 505 Week 3 example written to your instructions
Send the Week 3 assignment as your classroom shows it, including whether the two designs are named for you and whether a table is wanted alongside the prose, and a custom NR 505 design comparison comes back inside 24 to 48 hours. The first one is free, written to your question rather than to a generic one.
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NR 505 Week 3 questions, answered
Is a randomized trial always the better design?
Better at one job. Random assignment is the strongest way to make two groups comparable on everything you did not think to measure, and that is why it answers effectiveness questions well. It answers almost nothing about how common a condition is, what people make of a treatment, or how something behaves outside a controlled setting, and a comparison paper that misses this is arguing a ranking rather than a fit.
Do the two designs have to be real published studies?
In most sections they are designs rather than published papers, which is the point: you are arguing about what a method can do, not reporting what somebody found. Where the prompt does ask for two real studies, the same argument applies, and the studies are used as instances of their designs rather than summarized for their results.
What counts as a fair pairing of designs?
Two designs that could plausibly both be proposed for the same question. Setting a randomized trial against a case report is not a comparison, because nobody was choosing between them. A cohort against a case-control, a trial against a pragmatic before-and-after study, or an interview study against a focus group study all give the paper something to weigh.
Where can I find a free NR 505 Week 3 sample paper?
The complete Week 3 comparison of an individually randomized trial and a stepped-wedge trial for gastric residual checks, with the validity trade, the named threats, the choice and two references, is shown here.
Which design does the NR 505 Week 3 paper choose, and why?
The stepped-wedge cluster trial, because the individual question has already been answered and the health system's decision is whether to change practice unit by unit.