Clinical decision-making in nursing advanced practice: A case study from general practice

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.