| Course | NU743 Clinical Decision-Making and Collaboration |
|---|---|
| Unit | Unit 1 |
| Paper type | Reasoning narrative |
| Length | About 1,170 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NU743 Unit 1
Ninety Seconds at 0310: A Reasoning Narrative on Treating Suspected Pneumonia in Place for an 88-Year-Old Nursing Home Resident With Advanced Dementia, Taken Apart With Tanner's Model
[Student Name]
Purdue University Global
NU743: Clinical Decision-Making and Collaboration
Unit 1 Reasoning Narrative
[Instructor Name]
[Date]
The resident, nurse and facility are composite; times, vital signs and doses are bracketed.
The Call as It Came
At [0310] the charge nurse at [Maple Grove] nursing home called me. Mrs. [W.], [88], had a temperature of [38.4] degrees Celsius, a respiratory rate of [26], a pulse of [104], a blood pressure of [128/70] and a room-air oxygen saturation of [89] percent, down from her usual [95]. She had a new wet cough since the evening and was more sleepy than usual but woke to her name. She has advanced Alzheimer's disease, is bedbound, and needs help with every meal. Her physician orders for life-sustaining treatment, signed by her daughter as her health care agent, called for no intubation or resuscitation and for hospital transfer only if comfort could not be maintained in the facility.
Noticing
Tanner describes noticing as the clinician's initial grasp of a situation, shaped by expectations built from knowing the patient and from past experience (Tanner, 2006). I want to record what I noticed in the order I noticed it, because the order is the first finding.
The first thing I registered was the oxygen saturation of [89]. The second was the treatment order limiting transfer, which I had read two weeks earlier when she was admitted to my panel. The third was that she woke to her name. I did not register the pulse and blood pressure until the nurse repeated them. The saturation and the treatment order came first because they were the two facts that made this call different from the many fever calls I take at night.
What I did not notice at the time was her fluid intake. I did not ask about it until the next morning, when the day nurse told me she had taken almost nothing since lunch.
Interpreting
Tanner describes interpreting as making sense of what has been noticed, through analytic reasoning, intuitive pattern recognition or narrative thinking (Tanner, 2006). That night I held three possibilities, and I can defend each as something I actually considered.
The first was aspiration pneumonia, the pattern I recognized immediately: a bedbound woman with advanced dementia who needs feeding, a new wet cough, fever and a falling saturation. The second was a urinary infection with a respiratory rate raised by fever. The third was a pulmonary embolism, which I considered briefly and set aside because she had no swelling, the onset matched a cough, and she had been on prophylaxis after a recent hospitalization.
A fourth possibility was added the next morning, not at [0310]: that dehydration was worsening her drowsiness and would need treatment on its own. I record it here separately because claiming it for the night would make my reasoning look better than it was.
Pneumonia in advanced dementia carries meaning beyond the infection. In a prospective study of nursing home residents with advanced dementia, pneumonia, febrile episodes and eating problems were common, each was associated with high six-month mortality, and many residents received burdensome interventions near the end of life (Mitchell et al., 2009). I knew this as background when I took the call, and it shaped how I weighed transfer.
What decided the call was not the saturation alone but the saturation read against an order her daughter had already signed.
Responding
My response took shape in the next minute. The treatment order made transfer a last resort, and her vital signs, while abnormal, did not show that comfort could not be kept in the facility: she was not in distress, her blood pressure was normal, and she woke to her name. I also knew that the facility could provide oxygen, oral antibiotics and close nursing checks.
The evidence supported that choice. In a cluster randomized trial, nursing home residents with pneumonia treated under a clinical pathway in the facility, with oral antibiotics, portable chest radiographs, oxygen monitoring, rehydration and close nursing checks, were hospitalized about half as often as those receiving usual care, without a difference in mortality (Loeb et al., 2006).
I ordered oxygen by nasal cannula to keep her saturation at or above [92] percent, oral [amoxicillin-clavulanate] [875/125] mg twice daily, a portable chest radiograph and blood count in the morning, vital signs every [two] hours, and a call back if her saturation stayed below [90] on oxygen, her systolic pressure fell below [90], or she could not be roused. I told the nurse I would call her daughter at [0700].
Reflecting
Tanner describes reflection both in action, during the event, and on action, afterward (Tanner, 2006). Reflecting in action, I changed one thing during the call: when the nurse mentioned the wet cough came after dinner, I asked her to keep Mrs. [W.] upright and hold oral intake until morning, a thought prompted by the aspiration pattern.
Reflecting on action the next morning, I found two gaps. First, I had not asked about fluid intake, which mattered both for her drowsiness and for whether oral antibiotics would be absorbed; the day nurse started subcutaneous fluids after we spoke. Second, I had not called her daughter at [0310]. The treatment order spoke for her in advance, but her daughter told me later that she would have wanted to be woken. Next time, I will ask the family at admission whether they want a call at night for a change like this.
By the third day, Mrs. [W.]'s saturation was [94] percent on room air and she was eating a little. The chest radiograph had shown a right lower lobe infiltrate.
What Would Have Changed the Decision
Writing this out also made me state the conditions under which I would have chosen transfer, which I had held only loosely that night. If her systolic pressure had been below [90] despite fluids, if she could not be roused, or if her saturation had stayed below [88] on the facility's maximum oxygen, comfort could no longer have been kept in the facility, and her order would have allowed transfer. If she had shown distress that the staff could not relieve, such as severe breathlessness, I would have sent her for comfort as much as for treatment. Naming these thresholds in the call-back instructions turned an intuition into something the night nurse could act on without waiting for me.
What the Narrative Shows
Taking ninety seconds apart showed that my decision rested on pattern recognition, a prior reading of the treatment order and background knowledge of pneumonia in advanced dementia, and that it was right for her. It also showed that my noticing was narrow at [0310]: I heard the numbers that fit the pattern and missed the one, intake, that did not. Tanner's model made that visible because it asks what was noticed before it asks what was decided.
References
Loeb, M., Carusone, S. C., Goeree, R., Walter, S. D., Brazil, K., Krueger, P., Simor, A., Moss, L., & Marrie, T. (2006). Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: A randomized controlled trial. JAMA, 295(21), 2503-2510. https://doi.org/10.1001/jama.295.21.2503
Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., Volicer, L., Givens, J. L., & Hamel, M. B. (2009). The clinical course of advanced dementia. New England Journal of Medicine, 361(16), 1529-1538. https://doi.org/10.1056/NEJMoa0902234
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04
Reading the NU 743 Unit 1 instructions
The first NU743 assignment asks you to reconstruct a single clinical decision and examine how it was reached. Most sections name Tanner's clinical judgment model or another framework and expect the case as it arrived, the order in which findings were noticed, the hypotheses considered, the response, and reflection in and on action. Around 1,200 to 1,500 words in first person, past tense, is typical. Faculty reward narratives that keep what was known at the time separate from reasons supplied afterward, cite evidence where it shaped the decision, and treat gaps in the author's own reasoning honestly. The decision need not have been correct; what matters is an accurate account of how it was made, and brackets around every dose and value keep the example from reading as a recommendation.
How this NU743 Unit 1 example is built
A case section gives the nurse's report and the resident's treatment order. Noticing lists what registered first, the saturation and the order, and what was missed, her fluid intake. Interpreting sets out three hypotheses held that night and marks a fourth as added the next morning, with evidence on the course of advanced dementia; the highlighted sentence explains what decided the call. Responding describes oxygen, oral antibiotics and call-back thresholds, supported by a randomized trial of a nursing home pneumonia pathway. Reflecting records one change made during the call and two gaps found afterward. A section states the conditions that would have meant transfer, and a closing section explains what Tanner's model made visible.
NU743 Unit 1 rubric: what earns full points
Reasoning narratives are often assessed on fidelity to the framework, honesty about timing, clinical reasoning, use of evidence and reflection. Fidelity earns credit when each heading does its intended work, for example noticing reported in the order it occurred. Honesty about timing rewards a clear line between what was held at the moment and what was added later. Clinical reasoning is judged on the hypotheses considered and how the response followed from them. Evidence points go to sources that shaped the decision, cited where they apply. Reflection is credited when it names specific gaps and turns them into changes in practice. First-person voice, past tense and concise writing are expected, and faculty often check that no identifying details remain.
NU743 Unit 1 help from the desk
A frequent weakness is presenting the reasoning as tidier than it was, attributing to the night thoughts that came the next day. Another is listing hypotheses without saying which were actually considered. Some narratives describe the framework rather than using it, so the headings become labels. Others cite evidence in a block unrelated to the decision. Many reflections conclude that the decision was right and stop, missing what the account reveals about attention. And patient details sometimes remain identifiable. Record the order of noticing, mark later additions as later, tie each action to the reason you had then, and let the reflection find at least one thing you did not see at the time.
Get an NU743 Unit 1 example written to your instructions
Because the graded narrative has to be about a decision you made, the sample works a composite one built to your prompt and rubric, so pass along both. The first custom sample is free, arrives within 24-48h, and keeps its reasoning in the order it happened rather than an order that flatters it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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- NU743 Unit 7: Interprofessional Conflict Analysis
- NU743 Unit 8: Colleague Communication Piece
- NU743 Unit 9: Seminar Reflection
- NU743 Unit 10: Integrated Case Report
- NU733 Unit 1: Issue Analysis, Homelessness Deaths
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- NU703 Unit 1: Discussion Post, What the DNP Adds
NU743 Unit 1 questions, answered
Does the decision in a reasoning narrative have to have been correct?
No, and a decision that went wrong often makes the better narrative, since the reflecting section then has something to examine. What faculty read for is whether the account of how it was reached is accurate. A wrong call described honestly usually scores higher than a right one described as flawless deliberation it never was.
Is Tanner's model required, or can another framework organize the narrative?
Sections vary. Some prompts name Tanner's clinical judgment model, others leave the framework open, and a few ask for dual-process language instead. The sample uses whatever your prompt names; if it names none, Tanner suits a nursing reasoning narrative well because its reflecting phase gives the admission of error a defined place in the paper.
How is a real resident kept out of the sample?
Nothing in it comes from a chart. The resident, the facility and the night are composites, and every value and medication appears in brackets so none of it reads as a dosing or transfer recommendation. Your own narrative draws on your own practice, and protecting the people in it, by altering details that could identify them, remains your responsibility.
Where can I find a free NU743 Unit 1 sample paper?
The full NU743 Unit 1 reasoning narrative is on this page, with the call as it came, noticing, interpreting, responding and reflecting, the thresholds for transfer and what the narrative shows, plus three references. A narrative built around a call you took yourself is something we can help shape.
Why treat in place in NU743 Unit 1?
Her treatment order limited transfer to situations where comfort could not be kept in the facility, she was not in distress, and the facility could give oxygen and oral antibiotics. A randomized trial of a nursing home pneumonia pathway found about half as many hospitalizations without a difference in deaths.