| Course | NR 528 Leading and Managing Evidence-Based Change in Nursing |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 570 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NR 528 Week 1
Week 1 Discussion: Initial Post
Our Head-of-Bed Change Did Not Stop in March. The Last Step Anyone Performed Was Taping an Angle Sticker to Bed 7
The Change That Stalled
Two years ago, our 24-bed progressive care unit agreed that every patient receiving continuous tube feeding would have the head of the bed raised to at least 30 degrees unless a physician documented a reason not to. The evidence was clear enough: guidelines for critically ill adults receiving enteral nutrition call for elevating the backrest to between 30 and 45 degrees when a patient's aspiration risk is high (McClave et al., 2016), and in one study of tube-fed critically ill patients, a protocol that included head-of-bed elevation was associated with much lower rates of aspiration and pneumonia than usual care (Metheny et al., 2010). We had a staff meeting, an email and a laminated sign. Last month, a patient on continuous feeding aspirated at night with his head of bed flat, and our manager asked, "When did the head-of-bed change stop?"
The Last Step Anyone Performed
Everyone guessed a month. I asked a different question: what was the last step anyone actually did? Working back through emails, the education tracker and the supply log, the sequence was: an evidence summary presented at the practice council in January; a teaching session at two staff meetings in February, attended mostly by day shift; laminated signs posted in March; and, in April, one charge nurse taped a protractor-style angle sticker to the side rail of bed 7 as a trial. That sticker was the last step. The plan had included stickers for every bed, a night-shift teaching session and a monthly audit. None of those happened. The change did not fade; it was never finished.
What That Tells Me
Two things. First, night shift, when patients are repositioned, bathed and turned flat, was never taught, and night is when our aspiration event happened. Second, the one tool that made the angle visible, a sticker showing 30 degrees at a glance, reached one bed. Without it, nurses judged the angle by eye, and bed angles are easy to overestimate. The fix is not a new campaign. It is to finish the steps we planned.
I checked this by looking at five beds with tube-fed patients on a Tuesday night at 0200. Two were flat after a linen change, one was at about 15 degrees and two were at 30 or above. That is a snapshot, not an audit, but it matches what the missing steps predict: the practice holds best where someone taught it and least where nobody did.
Question for the group: For a change on your unit that faded, what was the last step anyone performed, and what was supposed to come next?
Reply to Denise
You said your bedside handoff change "just stopped after a few months." If you look at your education records, did night shift get the same teaching as day shift? In my unit, that was the step that never happened, and it explained why the change died on nights first.
Reply to Paul
Your early mobility protocol sounds like it stalled when the physical therapist who championed it left. That is a useful answer, because it names the step: nobody was assigned to replace her role in the daily mobility huddle. Was the huddle itself still happening, or did it stop when she did?
References
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R., & Compher, C. (2016). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition, 40(2), 159-211. https://doi.org/10.1177/0148607115621863
Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18-25. https://doi.org/10.1097/NNR.0b013e3181c3ba05
The Chamberlain NR 528 Week 1 instructions
The opening forum of NR 528 asks you to describe an evidence-based change you have watched stall or fade in practice and to reflect on why it did not hold. Most prompts want a concrete example, a short account of what was planned and what happened, a link to leadership or change concepts from the readings, and a question for peers. You also reply to at least two classmates. The strongest posts avoid vague explanations such as staff resistance and trace the change step by step until they reach the point where work stopped. Records such as emails, rosters or supply requests make that trace credible. Cite at least one source on the practice itself, keep patient details out, and post within the dates and word count your instructor gives.
Inside the NR 528 Week 1 example
The sample opens with the practice and why the unit adopted it, supported by a nutrition support guideline and a study of tube-fed critically ill adults. The second section rebuilds the timeline from records: an evidence summary at council in January, day-shift teaching in February, signs in March and one trial sticker in April. It then states what the plan had promised and never delivered, stickers for every bed, a night session and monthly audits. A third section draws two lessons, that night shift was untaught and that the angle was invisible, and tests them with a five-bed spot check at 0200. The post ends by asking peers for their own last step. Replies to Denise and Paul extend the idea to their units.
Reading the NR 528 Week 1 grading rubric
Points in this first discussion usually go to a specific, relevant example, analysis that goes beyond description, use of course concepts or evidence, and replies that move a classmate's thinking forward. Graders tend to reward posts that explain why a change faded with evidence from the setting rather than opinion. A dated sequence of steps is persuasive because it shows analysis, not memory. Credit for scholarly support comes from a correctly cited source that actually relates to the practice discussed. Replies score best when they ask something the classmate can answer from their own unit, rather than offering agreement. Timeliness, professional tone, APA 7 citations and staying inside the word limit make up the rest of the grade in most sections.
Common NR 528 Week 1 mistakes, and how to avoid them
The mistake that most often costs points here is explaining a faded change with general causes, such as busy staff or poor buy-in, that could describe any unit. Find the actual last step instead. Another is picking a change you only heard about, which leaves you guessing at details; choose one you can reconstruct from records. Some students write a history of the evidence and forget the reflection. Others blame a colleague by name, which reads badly and misses the process. Keep the evidence short and relevant. When you reply, avoid praise with no substance. Ask your classmate what was supposed to come after their last step, since that question usually shows them the gap. Finally, post early enough that peers can answer you.
Get a NR 528 Week 1 example written to your instructions
Send the Week 1 prompt from your classroom, plus a couple of lines about the change 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. Colleagues and the unit itself are easy to leave out, and the post reads better without them.
More NR 528 papers and MSN samples
- NR 528 Week 2: Practice Problem Brief
- NR 528 Week 3: Stakeholder Analysis
- NR 528 Week 4: Implementation Plan
- NR 528 Week 5: Change Model Application
- NR 528 Week 6: Measurement Plan
- NR 528 Week 7: Barrier Mitigation Brief
- NR 528 Week 8: Sustainability Plan
- NR 527 Week 1: Discussion Post on One Lost Message
- NR 520 Week 1: Discussion Post Tracing a Habit
- NR 519 Week 1: Discussion Post, Insult to Finding
- NR 518 Week 1: Discussion Post, Exposure and Group
NR 528 Week 1 questions, answered
What if nobody can remember when anything happened?
Rebuild the order from things carrying a date of their own, and say in the post that this is how you did it. A document version, the month a form first appeared in the drawer, the term a new starter says they were taught it, a message you can still find. Approximate months, marked as approximate, read as careful work. Invented precision is the version that gets questioned.
How far back can the change be?
Far enough that the running order can still be recovered, which is usually two or three years at most. Older ones lose the middle of the sequence and the post turns into a memory. Very recent ones have the opposite problem, since the step that fails may not have come due yet, and a change three weeks old often leaves nothing to reconstruct.
Does the change have to have failed?
No, and one still running can be the better choice. The post then names the step that has slipped rather than the one that stopped: a refresher a month overdue, a second group still untrained, a check now happening on days and not on nights. In many sections that reads as the more honest example, because the writer has to say what is currently unfinished.
Where can I find a free NR 528 Week 1 sample paper?
Posted above together with replies to Denise and Paul, the tube-feeding post is the full NR 528 Week 1 sample, open to every reader. If your stalled change came from another unit or practice, describe it on our request form and a post tracing its last completed step can be drafted.
Which change should I pick for the NR 528 Week 1 discussion?
Pick a change you watched closely enough to rebuild from records such as emails, attendance lists or supply orders. The sample uses head-of-bed elevation because the unit's own documents showed exactly which planned steps never happened.