| Course | NRNP 6831 Management of Specialized and Complex Populations |
|---|---|
| Week | Week 6 |
| Paper type | Discussion post with two peer replies |
| Length | About 600 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6831 Week 6
Week 6 Discussion: Initial Post
Fundoplication or Jejunal Feeds: Who Holds the Decision for a 10-Year-Old With Recurrent Aspiration?
Jayden is a composite 10-year-old with severe neurological impairment from a hypoxic brain injury in infancy. He is nonverbal, does not sit without support, and has been fed by gastrostomy since age 3. He had four admissions for aspiration pneumonia in the past year, with reflux thought to be the main cause. His surgeon recommends a laparoscopic fundoplication to stop reflux at its source. His gastroenterologist recommends converting the gastrostomy to a gastrojejunal tube so that feeds bypass the stomach. Both have given reasons, and both have told his parents their option is the better one.
Each option, in terms the family would weigh. Fundoplication means an operation and general anesthesia, keeps feeding into the stomach, and allows bolus feeds that fit around the day, but the wrap can loosen over time and may cause retching or bloating. A gastrojejunal tube avoids surgery, but feeds must run slowly by pump for many hours a day, often overnight, the tube can clog or slip back into the stomach, and each replacement means a trip to interventional radiology. The evidence does not settle it. A cohort study of children with neurologic impairment and reflux found similar rates of later aspiration pneumonia and death after a first fundoplication and after a first gastrojejunal tube, and concluded that neither was clearly better (Srivastava et al., 2009). The ESPGHAN guideline for children with neurological impairment also presents both as options (Romano et al., 2017).
Because the evidence is balanced, the decision belongs with the family, and my role in primary care is to set it up. Neither specialist should hold it alone, because each sees the problem through the procedure they offer. I would use the three-talk model to structure a joint visit (Elwyn et al., 2017). In team talk, I would tell his parents that there is a real choice, that the evidence does not favor one option, and that we will make it together. In option talk, I would lay the two options side by side in the terms above, with the uncertainty named rather than hidden. In decision talk, I would ask what matters most to them.
His parents have already told us two things. They want fewer hospital stays, and they want to keep giving him small tastes of pudding and yogurt, which he clearly enjoys. Those values can tip the choice. If tastes for pleasure matter and his parents want to avoid overnight pump feeds, fundoplication may fit their day better. If avoiding surgery matters more, the tube may. Either way, the choice is theirs to make with full information.
I would document who attended, the options discussed, the uncertainty in the evidence, the values the family expressed, the decision, and a date to review it after the next winter season.
Reply to Olivia
Olivia, your case of the teenager choosing between a spinal fusion and continued bracing was clear on the options. I wondered whose voice was missing. Your post describes the surgeon, the orthopedic nurse, and her mother, but not the teenager herself, who at 15 can say what she is willing to trade. How would you bring her into decision talk?
Reply to Daniel
Daniel, I agree that the palliative care team should be part of your decision about a tracheostomy for the infant in your case. The voice I did not hear was the home nursing agency's. If they cannot staff nights, the family's day after the decision looks very different. Would you include them before the decision, or only after it is made?
References
Elwyn, G., Durand, M. A., Song, J., Aarts, J., Barr, P. J., Berger, Z., Cochran, N., Frosch, D., Galasiński, D., Gulbrandsen, P., Han, P. K. J., Härter, M., Kinnersley, P., Lloyd, A., Mishra, M., Perestelo-Perez, L., Scholl, I., Tomori, K., Trevena, L., . . . Van der Weijden, T. (2017). A three-talk model for shared decision making: Multistage consultation process. BMJ, 359, Article j4891. https://doi.org/10.1136/bmj.j4891
Romano, C., van Wynckel, M., Hulst, J., Broekaert, I., Bronsky, J., Dall'Oglio, L., Mis, N. F., Hojsak, I., Orel, R., Papadopoulou, A., Schaeppi, M., Thapar, N., Wilschanski, M., Sullivan, P., & Gottrand, F. (2017). European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. Journal of Pediatric Gastroenterology and Nutrition, 65(2), 242-264. https://doi.org/10.1097/MPG.0000000000001646
Srivastava, R., Downey, E. C., O'Gorman, M., Feola, P., Samore, M., Holubkov, R., Mundorff, M., James, B. C., Rosenbaum, P., Young, P. C., & Dean, J. M. (2009). Impact of fundoplication versus gastrojejunal feeding tubes on mortality and in preventing aspiration pneumonia in young children with neurologic impairment who have gastroesophageal reflux disease. Pediatrics, 123(1), 338-345. https://doi.org/10.1542/peds.2007-1740
The Walden NRNP 6831 Week 6 instructions
The sixth NRNP 6831 thread often presents a disagreement between specialists about a child with complex needs and asks who should lead the decision and how. You describe the options fairly, avoid siding with one expert early, propose a shared decision process with the family and explain primary care's role. Faculty reward holding the disagreement open. Cite a shared decision making model and comparative evidence in APA 7. The post need not recommend one option. Replies should test the process or the role. The initial post goes up midweek. The family's values should be at the center of the process. NRNP 6831 faculty want each option's effect on daily life at home described alongside its clinical benefits.
How this NRNP 6831 Week 6 example is built
Written to about five hundred and fifty words, the initial post carries two replies beneath it. The case paragraph is short: the child's baseline, the frequency of pneumonias over the past year, the current feeding route, and the two recommendations with the reasoning each specialist gave. The post presents each option by what it offers, what it risks and what it changes for daily care at home, including tube care, feeding schedules and hospital visits for tube problems. It then argues that neither specialist holds the decision alone and that the primary care clinician's role is to set up a shared decision with the parents, using Elwyn's three-talk model to structure it. Values the family has expressed, such as fewer hospital stays and keeping small tastes of food for pleasure, are placed at the center.
Where the marks sit in the NRNP 6831 Week 6 rubric
Siding with one specialist early is the commonest way to lose this thread's argument marks, because the week asks for a genuine expert disagreement to be held open long enough to be shared. Posts that present the options only in clinical terms, with nothing about the day-to-day care each creates, leave out the family's side of the trade-off. Shared decision-making named but never structured, leaving the conversation itself unplanned, earns partial credit. Faculty look for uncertainty to be stated honestly where the evidence is mixed. Posts that assign the decision to 'the team' without saying who convenes it repeat the coordination failure the course studies. Replies that pick a side in a classmate's disagreement instead of examining the process collect less. Citation age and length take the remainder.
NRNP 6831 Week 6 help: mistakes that cost marks
Posts lose argument marks when they side with surgery or gastroenterology in the first paragraph. Lay out both fairly. Another common gap is leaving the family out of the decision structure. Put their goals first. Writers also name shared decision making without a model. Use the three-talk steps. Avoid claiming one option is clearly superior when evidence is limited. Note what each option means for daily care at home. In replies, ask who else should be at the meeting. Close with the first step of convening. Writers also forget Jayden's own comfort and quality of life as the deciding values. Center them. Each procedure's risks for a child who aspirates often also need a line.
Get a NRNP 6831 Week 6 example written to your instructions
Paste in the Week 6 prompt and rubric and describe the disagreement your scenario sets, and a post returns weighing both positions and structuring the family's decision, replies attached. Payment is waived on a first request, and it returns in 24 to 48 hours. Every detail of this boy, his pneumonias and his parents' wishes is a teaching fabrication.
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NRNP 6831 Week 6 questions, answered
What is Elwyn's three-talk model?
Glyn Elwyn and colleagues developed this widely taught model of shared decision-making. Team talk establishes that a choice exists and that clinician and family will make it together; option talk compares the alternatives and their trade-offs; decision talk draws out what matters most to the family and reaches a decision. In the example it shows how primary care could convene a choice two specialists have split.
Does the post recommend surgery or a feeding tube change?
No. The example deliberately leaves the clinical choice open, because the thread asks how a disputed decision should be held, not which answer is right. Recommending one route would also turn the page into clinical advice about a recognizable kind of child. Your course readings cover the evidence on each option; the post uses that evidence to frame a conversation rather than to settle it.
Why is primary care the one to convene the decision?
In the example, primary care is the medical home and the only clinician who knows the family's life outside both specialties. The post argues that makes it the natural convener, not the decider. Some sections argue instead for a complex care program or a palliative care team in that role, and a well-supported case for either can score as well if the process is made explicit.
Where can I find a free NRNP 6831 Week 6 sample paper?
The fundoplication versus jejunal feeds post is shown here with both options held open, the three-talk process and replies to Olivia and Daniel.
Which two options do specialists recommend in NRNP 6831 Week 6?
Surgery recommends fundoplication and gastroenterology recommends converting to jejunal feeds.