| Course | NR 520 Applied Theoretical Foundations, Scientific Inquiry, and Decision-Making |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 580 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NR 520 Week 1
Week 1 Discussion: Initial Post
We Wake Every Patient at 0400 for Blood. I Followed the Habit Back and Found a Rounding Schedule, Not a Study
The Habit
I am the night charge nurse on a 30-bed adult medical unit at a teaching hospital. Every night at about 0400, a phlebotomist and our night nurses draw blood from nearly every patient on the unit: a blood count and chemistry panel for most, more for some. Many patients are asleep. Some are confused afterward and do not settle again. I have done this for eight years without asking why it happens at 0400, or why it happens for almost everyone.
Following the Trail Back
I asked four people. The phlebotomy supervisor said the 0400 round exists so that results are back before the medical teams round at 0700. The unit's policy binder contains a phlebotomy schedule but no reason for the time. The chief resident said the daily labs are ordered as "daily until discontinued" at admission and are rarely discontinued, since no resident wants to be the one who halts a test that later mattered. Our nurse educator said new nurses are taught the 0400 draw in orientation as part of the night routine.
So the trail ends at a rounding schedule and an order set default, not at a study. I did look for evidence. Hospital medicine's contribution to the Choosing Wisely campaign advises against repeating blood counts and chemistry panels once a patient is stable clinically and on the numbers (Bulger et al., 2013). In a large study of patients with heart attack, more blood drawn for tests was associated with a higher risk of hospital-acquired anemia (Salisbury et al., 2011). And across 39 Dutch hospitals, just over a third of 2,005 inpatients said staff had woken them, with nights running 83 minutes short of their usual sleep at home (Wesselius et al., 2018).
What the Trail Tells Me
The 0400 draw may still be the right time for some patients whose results change the morning plan. But for a patient admitted with cellulitis whose labs have been stable for three days, the draw is a habit supported by a schedule, not by evidence about that patient.
The trail also shows who could change it. The time of the draw belongs to the laboratory's phlebotomy schedule. Whether a patient is on the list belongs to the medical team's order. And whether the draw is timed with other care, such as a 0400 vital sign check, belongs to nursing. No one of the three owns the whole habit, which may be why it has lasted.
Question for the group: Pick one thing you do on every shift at a fixed time. Where does the trail end when you follow it back?
Reply to Priscilla
You traced two-hourly turning to a policy that cites a 2014 guideline. Did you read the guideline? Some recommend turning at intervals based on the individual's risk and support surface rather than a fixed two hours, which would mean the policy is stricter than its own source.
Reply to Andre
Your habit of checking bowel sounds after abdominal surgery traced back to your nursing school textbook. That is a common endpoint. Did you find anything on whether listening for bowel sounds predicts when patients can eat? It would be interesting to know whether the trail for your habit ends at a study or, like mine, at a routine.
References
Bulger, J., Nickel, W., Messler, J., Goldstein, J., O'Callaghan, J., Auron, M., & Gulati, M. (2013). Choosing wisely in adult hospital medicine: Five opportunities for improved healthcare value. Journal of Hospital Medicine, 8(9), 486-492. https://doi.org/10.1002/jhm.2063
Salisbury, A. C., Reid, K. J., Alexander, K. P., Masoudi, F. A., Lai, S.-M., Chan, P. S., Bach, R. G., Wang, T. Y., Spertus, J. A., & Kosiborod, M. (2011). Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction. Archives of Internal Medicine, 171(18), 1646-1653. https://doi.org/10.1001/archinternmed.2011.361
Wesselius, H. M., van den Ende, E. S., Alsma, J., ter Maaten, J. C., Schuit, S. C. E., Stassen, P. M., de Vries, O. J., Kaasjager, K. H. A. H., Haak, H. R., van Doormaal, F. F., Hoogerwerf, J. J., Terwee, C. B., van de Ven, P. M., Bosch, F. H., van Someren, E. J. W., & Nanayakkara, P. W. B. (2018). Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Internal Medicine, 178(9), 1201-1208. https://doi.org/10.1001/jamainternmed.2018.2669
What the NR 520 Week 1 assignment asks for
The opening NR 520 discussion asks you to pick a practice from your own work and trace its source. Prompts typically ask whether the practice rests on research, policy, tradition or authority, and how you found out. Replies to classmates are expected to extend their tracing. The strongest posts choose one concrete habit, name the people or documents consulted, and report honestly where the trail ends, even if that is an orientation checklist. Adding what the evidence says about the habit shows the gap between source and support. Keep patient details out. A current source or two, cited in APA 7, supports the post, and your section's deadlines for initial posts and replies apply as usual.
How the NR 520 Week 1 example is put together
The example states the habit precisely: a nightly draw for nearly every patient on a 30-bed unit. It then reports four sources in turn, each with what it said, and concludes that the practice rests on a schedule and a default order. A short paragraph sets out published evidence on repetitive testing, blood loss from phlebotomy and sleep in hospital, with numbers from each study. Another paragraph notes that the time, the orders and the clustering of care belong to three different groups, which may explain why the habit persists. A question invites classmates to trace their own fixed-time routines. The replies check a classmate's guideline and ask another whether a textbook practice predicts anything.
Where the points sit in the NR 520 Week 1 rubric
The discussion rubric for this course usually rewards a clearly described practice, an honest account of its source, use of evidence to evaluate it and substantive replies. Graders look for specifics: who or what was consulted, and what each said. Claiming a routine is research-based, without showing the trail, tends to score lower. Evidence should be current and cited correctly. Replies score when they test a classmate's claim, for example by asking whether the cited source says what the classmate thinks. Writing quality and meeting the posting schedule complete the grade, and a post that admits the trail ends at habit is usually rated higher than one that implies a certainty it has not shown.
NR 520 Week 1 help from the desk
The most frequent mistake is choosing a practice too broad to trace, such as fall prevention, and ending with a general statement about evidence-based practice. Pick one habit with a time or a number attached. Another is stopping at the first source, often a policy, without asking where the policy came from. Students also confuse a source with support: a policy is a source, but it may not be supported by evidence. Report what you actually found, even if it is unimpressive. In replies, check whether a classmate's cited guideline really says what they claim. Finally, notice who owns the habit. Practices that belong to several groups often continue because no single group can change them.
Get a NR 520 Week 1 example written to your instructions
Send the discussion prompt from your classroom and the practice you want followed back. A custom Week 1 post is written to that prompt and returned inside 24 to 48 hours, the first one free. If the habit belongs to a real workplace, keep the unit and the names out of it; a described shift carries the point just as well.
More NR 520 papers and MSN samples
- NR 520 Week 2: Framework Comparison
- NR 520 Week 3: Applied Theory Case
- NR 520 Week 4: Ways of Knowing Essay
- NR 520 Week 5: Decision Analysis
- NR 520 Week 6: Inquiry Problem Statement
- NR 520 Week 7: Ethical Decision Brief
- NR 520 Week 8: Applied Decision Paper
- NR 519 Week 1: Discussion Post, Insult to Finding
- NR 518 Week 1: Discussion Post, Exposure and Group
- NR 516 Week 1: Discussion Post on a Ward Habit
- NR 513 Week 1: Discussion Post on Credential Duties
NR 520 Week 1 questions, answered
Does the practice have to be one I follow myself?
It works better if it is. The week asks you to name a source, and the honest answer for your own routines is often that you cannot, which is exactly the observation being invited. A practice lifted from an article arrives with its reference in hand and produces a tidy post with nothing in it. Pick something you do without thinking about it.
Can I bring in a theorist this early?
You can name one, though the week rarely rewards it. Week 1 is about the knowledge already sitting under your practice, not about anybody's model of that knowledge. If a theorist genuinely explains why your unit does something, a sentence saying so is enough; a paragraph summarizing their work replaces the observation the post existed to make.
My unit's rule turned out to have no source. Is that a weak post?
That is usually the strongest version. A rule surviving without anyone able to say where it started is a real finding about how practice knowledge travels, and it is more interesting than a rule with a tidy reference behind it. Say how you looked, say what you found, and resist the pull to invent a justification the unit has never given.
Where can I find a free NR 520 Week 1 sample paper?
Printed above with both replies, the 0400 blood-draw entry is the full NR 520 Week 1 sample and it can be read without charge. Nurses tracing a different routine can describe it on the request page and receive a matching post.
What habit should I trace for the NR 520 Week 1 discussion?
Pick something done at a fixed time or in a fixed way on every shift, such as a lab draw, a turning schedule or a bath routine. The sample traces the nightly 0400 draw because its time and scope are specific.