References
Clinical decision-making in nursing advanced practice: A case study from general practice
Abstract
Advanced nurse practitioners practice at a higher level of capability as autonomous and independent healthcare providers. This article looks at their role as clinical decision makers.
This case study highlights the advanced nurse practitioner's (ANPs) role in clinical decision-making, evidence-based practice, ethical care and antimicrobial stewardship. It demonstrates an understanding and the application of clinical decision making (CDM) in practice, highlighting the strengths and weaknesses of various models. The case study focuses on the management of urinary symptoms in a non-pregnant adult female patient attending a general practice nurse-led service. Combining the analytical and intuitive elements of cognitive continuum theory and applying the metacognitive ‘think and think again’ approach challenged the ANP's existing model of decision making resulting in shared and collaborative decision-making. The case study balances clinical guidelines with patient concerns, considering interpersonal, environmental, and intrapersonal factors in decision-making; and reflects on challenges, ethics, and contemporary healthcare issues, particularly in relation to antimicrobial stewardship.
Advanced Nurse Practitioners (ANPs) play an important role in navigating complex clinical scenarios, integrating decision-making models with ethical considerations and evidence-based practice to deliver comprehensive patient care (Lockwood et al., 2022). This paper explores the ANP's role in clinical decision-making, ethical care, and evidence-based practice and demonstrates how decision-making models were utilised to make important clinical decisions. It defines clinical decision-making (CDM) and its application in practice, outlining the strengths and weaknesses of various models. The case study highlights the ANP's management of urinary symptoms in a non-pregnant adult female, who requested antibiotics to address her symptoms, and highlights the ANPs role in diagnostic reasoning, ethical decision-making, and antimicrobial stewardship.
Balancing clinical guidelines with patient concerns, the case study considers interpersonal, environmental, and intrapersonal factors in decision-making, and reflects on challenges, ethics, and contemporary healthcare issues, particularly in relation to antimicrobial stewardship. Schön's model of reflection in and on action (Schön, 1983; Schön, 1987) played a key role in shaping the clinical decision-making process, enabling the ANP to critically reflect on practice and build self-awareness. This approach encouraged continuous learning by prompting the ANP to examine both their actions in real time (Schön, 1983) and their thoughts about those actions afterward (Schön, 1987), fostering deeper insights and improving clinical judgment.
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