| Course | NR 601 Primary Care of the Maturing and Aged Family Practicum |
|---|---|
| Week | 8 |
| Paper type | Practicum reflection |
| Length | About 900 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Family Nurse Practitioner (FNP) |
| Updated | October 2026 |
Free sample paper for NR 601 Week 8
Reflection: I Started the Practicum Chasing a Blood Pressure Number, and Two Patients Taught Me to Ask What a Medicine Is Doing Before Adding Another
Student Name
College of Nursing, Chamberlain University
NR 601: Primary Care of the Maturing and Aged Family Practicum
Instructor Name
Month Day, Year
Reflection: I Started the Practicum Chasing a Blood Pressure Number, and Two Patients Taught Me to Ask What a Medicine Is Doing Before Adding Another
Where I Started, as a Habit
I came into this practicum with a habit from eight years as a medical-surgical nurse: if a number was out of range, the job was to bring it into range. In my first weeks, I adjusted blood pressure medicines toward 130/80 for nearly every older patient with diabetes or kidney disease, because that was the guideline target and I knew it well. I seldom measured blood pressure standing.
The Encounter That Broke It
R.D., 81, had fallen twice. Seated pressure was at target. When I measured it standing, it fell by 26 points and R.D. said the room was spinning. I had been about to praise the control. The number I was proud of was the number knocking R.D. over.
The second patient, W.K., 84, asked for a bladder pill. My first instinct was to choose one. My preceptor asked me to draw a timeline first. The timeline showed that the bladder problem began a week after a diuretic, which began a week after an amlodipine increase. I had nearly added the fourth step to a prescribing cascade (Rochon & Gurwitz, 1997).
What I did then and what I would do now, side by side:
With R.D., I would have kept the thiazide and added a reminder to rise slowly. Now I would stop the thiazide and accept a higher seated pressure, because the fall is a nearer threat than the benefit of the lower target (Tinetti et al., 2014).
With W.K., I would have prescribed a bladder medicine. Now I would reduce the amlodipine and stop the diuretic, because the urgency came from the medicines.
The Rule I Work by Now
Before treating a new symptom in an older adult, ask whether a medicine caused it. Before lowering a number, ask what the lower number will cost the patient this year. And measure blood pressure standing in every older adult on blood pressure medicines.
What Is Still Unresolved
I do not yet know how to talk with a patient who wants every number at target. One patient in my practicum, a retired engineer, wanted the A1c below 6.5% and the pressure below 120 and was willing to tolerate dizziness to get there. I explained the trade-off and the patient disagreed. I did not know whether to defer to the patient's choice or press harder. My preceptor said that a patient can choose risk if the risk is understood, and that my job was to make sure it was. I am not sure I did that well.
I also have not resolved how to deprescribe when the original prescriber is a specialist. R.D.'s omeprazole was started in hospital and nobody has reviewed it. I feel confident stopping an over-the-counter sleep aid; I feel less confident stopping something another clinician started, even when it has no indication.
What My Preceptor Showed Me
My preceptor's method was simple and I had not seen it before: for every new complaint in an older patient, draw a line across the page with every medicine change and every symptom on it, in date order. It takes three minutes. With W.K. it took less, and it changed the decision. I now draw that line before I write an assessment.
What I Got Wrong Along the Way
Early in the practicum, I suggested a sleep aid to an 88-year-old with insomnia, a prescription one that I thought was safer than the over-the-counter products. My preceptor asked what I expected it to do at 03:00 when the patient got up to urinate. I had not thought about the patient at 03:00, only about the patient at bedtime. Falls in older adults so often come from several risks combining at one moment (Tinetti & Kumar, 2010) that I now try to picture the patient at the riskiest hour before prescribing anything sedating.
One Thing That Changes in Practice
Every older adult on a blood pressure medicine will have a standing pressure measured at every visit I lead. I have asked the medical assistants at my practicum site to add standing readings to the rooming routine for patients over 75 on these medicines, and they have agreed to try it for a month.
What I Will Keep From Nursing
Not everything in my nursing habit was wrong. I still notice when an older patient is not themselves, as with the 86-year-old with pneumonia in my first week, and I still trust a family member who says something is off. What has changed is what I do next, and in what order: count the breathing rate, measure the pressure standing and draw the medicine timeline.
How I Will Know It Worked
At the end of that month, I will count how many patients over 75 on blood pressure medicines had a standing reading recorded and how many had a drop of 20 points or more. If the routine finds even one R.D., it will have been worth the minute it takes.
References
Rochon, P. A., & Gurwitz, J. H. (1997). Optimising drug treatment for elderly people: The prescribing cascade. BMJ, 315(7115), 1096-1099. https://doi.org/10.1136/bmj.315.7115.1096
Tinetti, M. E., & Kumar, C. (2010). The patient who falls: "It's always a trade-off." JAMA, 303(3), 258-266. https://doi.org/10.1001/jama.2009.2024
Tinetti, M. E., Han, L., Lee, D. S. H., McAvay, G. J., Peduzzi, P., Gross, C. P., Zhou, B., & Lin, H. (2014). Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Internal Medicine, 174(4), 588-595. https://doi.org/10.1001/jamainternmed.2013.14764
NR 601 Week 8 instructions, in plain terms
The Week 8 reflection should admit something. Name a patient encounter, state what you did or would have done at the time, then state what you would do now, with the reason between the two. The reason is usually a specific piece of knowledge, such as recognizing that a new symptom was a medicine effect or that the number being chased was causing harm. State the rule you now work by. Say what is still unresolved. Name one change in practice. Most rubrics mark down a reflection made of appreciation for the course, growth claimed without a case and a change described but never explained.
How this NR 601 Week 8 example is built
The sample opens with a habit from medical-surgical nursing: bring every number into range. The encounter with R.D., whose seated pressure was at target while the standing pressure fell 26 points, breaks it. W.K.'s request for a bladder pill, and a preceptor's timeline, nearly adds a fourth step to a cascade. Then and now are set side by side for both. The rule now followed is stated in three parts. A mistake with a sleep aid and the timeline method are described. What remains unresolved includes a patient who wanted every number at target. One change, standing pressures at rooming for patients over 75, is set with a way to count its effect.
Reading the NR 601 Week 8 grading rubric
The reflection that loses most is made entirely of appreciation, and this one contains no thanks at all. Growth asserted without a case costs the next share, while two named encounters carry the change. A change described but never explained loses a row, and the reason sits between each then and now. Partly answered prompts lose marks, and the unresolved section answers the hardest one honestly. Admitting a specific mistake earns credit. A practice change with a way to measure it completes the criteria. Describing the preceptor's timeline method shows where the new habit came from. Saying what the writer keeps from nursing shows the change is a refinement, not a rejection.
Common NR 601 Week 8 mistakes, and how to avoid them
Weak NR 601 Week 8 reflections describe how much the writer learned without naming a patient. Others claim to think more holistically with no moment where the old approach failed. Many describe a change without saying what caused it. Few admit what is still unclear. Practice changes are often vague. Choose one or two encounters, write what you did then and what you would do now with the reason between and state the rule you now follow. Name one thing you will do differently and how you will know it worked. If your encounters differ, send them, and a matching sample reflection can be drafted. Include one mistake and what corrected it.
Get a NR 601 Week 8 example written to your instructions
Send the Week 8 prompt as your classroom words it, along with the encounter you want the reflection built around, and a custom example comes back inside 24 to 48 hours, free the first time. The example supplies the shape only, since the weeks it looks back on have to be your own.
More NR 601 papers and FNP samples
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- NR 601 Week 5: Deprescribing Write-Up
- NR 601 Week 6: Patient-Goal Care Plan
- NR 601 Week 7: Prescribing Cascade Case Analysis
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NR 601 Week 8 questions, answered
Can a reflection be written in the first person?
In almost every section it has to be. This is one of the few graduate assignments where I is expected, and third person makes the writing stilted without making it more academic. Formatting and citation rules usually still apply, so any claim about practice that leans on evidence still carries a source even inside a personal account.
Is it safe to write about something that went badly?
It is usually the better paper, provided the account stays at the level of judgment rather than identity. Describe the decision, the reasoning behind it and what you would do now. Leave out names, dates, sites and anything that would let a reader work out who was involved. Graders reward the willingness to examine a call that was wrong.
How many changes should the reflection cover?
One examined properly beats four listed. A single decision followed from the habit that produced it through to the rule that replaced it fills the word count and demonstrates the thinking a rubric asks for. Where a prompt names several parts, cover each part, but let one of them carry the weight of the paper.
Where can I find a free NR 601 Week 8 sample paper?
The full practicum reflection on chasing blood pressure targets and prescribing cascades is published on this page.
What practice change does the NR 601 Week 8 reflection name?
Measuring standing blood pressure at every visit for patients over 75 on blood pressure medicines, added to the medical assistants' rooming routine for a month.