| Course | NR 520 Applied Theoretical Foundations, Scientific Inquiry, and Decision-Making |
|---|---|
| Week | 8 |
| Paper type | Applied decision paper |
| Length | About 1,110 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NR 520 Week 8
Applied Decision Paper: Why Stopping Unneeded Daily Labs and Timing the Rest by Need Was the Right Choice for Our Unit, Argued Before a Reader Looking for the Seam
Student Name
College of Nursing, Chamberlain University
NR 520: Applied Theoretical Foundations, Scientific Inquiry, and Decision-Making
Instructor Name
Month Day, Year
Applied Decision Paper: Why Stopping Unneeded Daily Labs and Timing the Rest by Need Was the Right Choice for Our Unit, Argued Before a Reader Looking for the Seam
The Choice and the Claim
Our 30-bed medical unit's practice council chose to change how morning laboratory tests are ordered and drawn. Daily tests will now expire after 48 hours unless a physician renews them with a reason; patients whose results will change the morning plan will still be drawn at 0400; and everyone else will either join the 0600 vital-sign round or not be drawn. This paper argues that the choice was right. It shows how two frameworks shaped the questions the council asked, how evidence and a local audit ruled out the other two options, what ethical constraint bounded the decision, and what the council still does not know. A reader who would have kept the old routine should be able to find exactly where we disagree.
How the Frameworks Shaped the Questions
Two frameworks were used, and each asked a question the other could not. Kolcaba's theory of comfort directed attention to the patient's needs for relief and ease across physical, psychospiritual, sociocultural and environmental contexts (Kolcaba, 2001). Applied to individual patients on the unit, it asked what the 0400 draw meant to them: lost sleep, fear on waking in the dark, the sense that care was happening to them rather than for them. Donabedian's model of structure, process and outcome (Donabedian, 1988) directed attention to the system: an order set whose default was daily tests until stopped, a blood-drawing timetable fixed to fit the physicians' morning rounds, and outcomes that no one measured. Comfort theory produced the reasons to change; the quality model produced the target, the order set default, and the measures.
How Evidence Shut Two Options Down
Three options were considered. Keeping the 0400 round unchanged was the option that almost won, on the strength of early results for morning decisions. It was shut down by two kinds of evidence. Hospitalists' own specialty society has urged its members to stop repeating routine blood work in patients whose condition and results have settled (Bulger et al., 2013), and reviews of repetitive testing describe many such tests as low value (Eaton et al., 2017). The unit's own chart review then found that, among daily tests in patients stable for 48 hours, a small minority led to a change in treatment by noon, below the threshold the council had agreed in advance would justify stopping routine tests.
Moving every draw to 0600 was shut down on feasibility and scope. It would have given every patient more sleep, and sleep in hospital is already short, as a national Dutch survey of inpatients made clear (Wesselius et al., 2018). But it would have delayed results for the patients whose decisions depended on them, pushed phlebotomy's burden onto other units, and left unneeded tests in place.
The Ethical Constraint
One constraint bounded every option: a patient with capacity who refuses a blood draw, at any time, is not drawn. This was not a new rule but it became visible during the term, when a patient refused his 0400 draw and the team arranged a later time rather than override him. The ANA Code of Ethics places that constraint in the respect owed to every person's worth and right to decide (American Nurses Association, 2025). The chosen option respects it better than the others, because it reduces the number of draws a patient might have to refuse and gives nurses a sanctioned alternative time to offer.
The Additional Benefit
Fewer draws also mean less blood taken from patients who are already unwell. Among myocardial infarction patients in a multicenter registry, each 50 mL of diagnostic blood loss raised the risk of moderate to severe anemia acquired in hospital by 18% (Salisbury et al., 2011). Our unit's patients differ from that population, and the council did not rely on this finding, but it is consistent with everything else the council weighed.
Where the Seam Is
A skeptical reader will look for the place where the argument is weakest, and it is here: the council does not know how often stopping a routine test will delay the detection of an unexpected abnormal result. The chart review measured how often tests changed treatment, not how often a test that changed nothing still provided reassurance, nor how often a stopped test would have caught a problem early. That uncertainty is real. The council addressed it in three ways: patients receiving treatments that affect electrolytes or blood counts stay on the early list by rule, physicians can renew any test with a reason, and the council will review every case in which an abnormal result was caught only after the hour the old 0400 draw would have revealed it, reporting monthly for six months. If such cases are more than rare, the decision will be reopened.
The other seam is dependence on people. The option works only if physicians renew thoughtfully, nurses sort patients each night and phlebotomy runs two smaller rounds. If any of those falters, the unit could end up with the costs of the new system and the habits of the old one.
A reader who agrees with the choice should also notice its modesty. It changes a default, not a culture, and it will take months of measured practice before anyone can say it has changed how the unit thinks about a blood test.
Conclusion
The choice was right because it addressed both problems the term revealed, tests that were not needed and tests drawn at a harmful time, while keeping early results for the patients whose care depended on them. Each framework contributed something the other lacked, the evidence and local audit closed the alternatives, and the ethical constraint set a limit no option could cross. The remaining uncertainty is named, measured and tied to a rule for reopening the decision. A reader who still prefers the old routine now knows exactly what evidence would change our minds: a pattern of delayed detection that the monthly review is designed to find.
What the council chose, then, is not the end of the question but a better starting point for it: a routine that has to justify itself every 48 hours instead of one that continues because nobody stopped it.
References
American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/
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
Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.1988.03410120089033
Eaton, K. P., Levy, K., Soong, C., Pahwa, A. K., Petrilli, C., Ziemba, J. B., Cho, H. J., Alban, R., Blanck, J. F., & Parsons, A. S. (2017). Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Internal Medicine, 177(12), 1833-1839. https://doi.org/10.1001/jamainternmed.2017.5152
Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92. https://doi.org/10.1067/mno.2001.110268
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
Reading the NR 520 Week 8 instructions
The final paper asks you to argue for a decision using the course's theory, evidence and ethics. Prompts typically ask you to present the decision, explain the frameworks and evidence that support it, address alternatives and ethical considerations, discuss implementation and evaluation, and acknowledge limitations. The paper should be persuasive to a skeptical reader, which means naming the weakest point in your own argument. Draw on your earlier assignments as evidence. Current sources and any local data should be cited in APA 7. Expect a longer paper than in earlier weeks, and confirm any required headings and the minimum count of scholarly sources for your section.
How the NR 520 Week 8 example is put together
The example states the choice and its claim in the first paragraph. A section shows how comfort theory produced the reasons for change and the quality model produced the target and measures. Another shows how professional guidance, a review of repetitive testing and a local chart review closed the option that almost won, and why feasibility and scope ruled out moving all draws. The ethical constraint, never drawing from a patient who refuses, is explained with the ANA Code. A short section adds evidence on phlebotomy blood loss. The seam section names the unmeasured risk and the dependence on people. The conclusion states what would change the council's mind.
NR 520 Week 8 rubric: what full points look like
The rubric for the applied decision paper usually rewards a clear argument, integration of theory and evidence, fair treatment of alternatives, ethical reasoning, and honest discussion of limitations and evaluation. Graders reward papers that name their own weakest point and explain how it will be monitored. Integration of earlier coursework is often a criterion. Evidence should be current and appropriately weighted, including local data. Organization matters in a longer paper, and a conclusion that ties back to the argument helps graders see it whole. Citations and references should follow APA 7 throughout, including any local reports. A named test of the decision, stated in advance, usually lifts the limitations score.
NR 520 Week 8 help: mistakes that cost points
The biggest mistake is a paper that argues for a decision without addressing the strongest alternative or its own weaknesses. A skeptical reader will find the seam; show it first. Another is listing frameworks and evidence without showing how each shaped the decision. Students also treat ethics as a separate section rather than as a limit on every option. Keep figures consistent with earlier assignments. Do not overstate a local audit; say what it measured and what it did not. Finally, end with what would change your mind. A decision paper that sets out its own test reads as scholarship, while one that only defends reads as advocacy. Name the reader you are trying to persuade and write to their strongest objection.
Get a NR 520 Week 8 example written to your instructions
Send the final assignment prompt, the page count, and the case you have been building on all term. A custom Week 8 paper is written to it and returned inside 24 to 48 hours, the first one free. If earlier weeks went somewhere you now regret, say so and the finished version shows a cleaner line through the same material.
More NR 520 papers and MSN samples
- NR 520 Week 1: Discussion Post Tracing a Habit
- NR 520 Week 2: Framework Comparison, One Blood Draw
- NR 520 Week 3: Applied Theory Case, Comfort Theory
- NR 520 Week 4: Ways of Knowing Essay
- NR 520 Week 5: Decision Analysis, Morning Labs
- NR 520 Week 6: Inquiry Problem Statement
- NR 520 Week 7: Ethical Decision Brief, Refused Draw
- NR 519 Week 8: Continuum Synthesis Paper
- NR 518 Week 8: Population Health Paper on Silicosis
- NR 516 Week 8: Practice Question Paper on Flushing
- NR 513 Week 8: Role Enhancement Plan
NR 520 Week 8 questions, answered
Should the Week 8 case be the one I used earlier?
Usually yes, and continuity is a real advantage, since the framework and the reading are already yours. Check the prompt, because some sections require a fresh situation. If you do carry the case forward, the paper still has to stand alone for a reader who has not seen your earlier weeks, which means restating the situation rather than referring back to it.
How long should the objection section be?
Long enough that the objection sounds like it came from someone who means it, which is often a fifth of the paper. Shorter than that and it reads as a formality. The proportion matters less than the quality of the objection chosen, so pick the criticism you would least like to receive and answer that one.
What if the evidence does not settle the question?
Then the paper says so and decides anyway, which is the situation this course spends eight weeks preparing you for. Unsettled evidence is a finding, not a failure, and it changes what the decision rests on rather than removing the need to make one. State what the evidence supports, state what it leaves open, and defend the choice on the grounds that remain.
Where can I find a free NR 520 Week 8 sample paper?
The morning labs decision paper above is the complete NR 520 Week 8 sample, open to all. If your term built toward a different decision, send your earlier papers through the request form and a final paper drawn from them is prepared.
Should the NR 520 final paper admit its weaknesses?
Yes. The sample names the unmeasured risk of delayed detection and its dependence on people changing habits, then explains how both will be monitored, which makes the argument stronger rather than weaker.