Assessing antibiotic prescribing in nurse practitioners: Applied cognitive task analysis

Area of Science:

• Health Sciences
• Medical Education
• Pharmacology

Background:

• Antibiotic prescribing is a complex decision-making process critical for minimizing antimicrobial resistance.
• Little is known about the cognitive strategies new Nurse Practitioners (NPs) employ during antibiotic prescribing.

Purpose of the Study:

• To identify the cognitive demands associated with complex antibiotic prescribing.
• To explore the cognitive strategies utilized by new NPs in New Zealand when prescribing antibiotics.

Main Methods:

• A qualitative approach using Applied Cognitive Task Analysis (ACTA) methodology.
• In-depth interviews, including task diagram interviews and knowledge audits, were conducted with five recently registered NPs.
• Data analysis followed the ACTA protocol.

Main Results:

• Four key cognitive elements were identified, highlighting the complexities of antibiotic prescribing.
• These elements include managing uncertainty, navigating insufficient guidance, individualizing treatment plans, and ensuring treatment efficacy and continuity of care.
• Specific challenges involve complex patients, diagnostic uncertainty, lack of guidelines, patient expectations, and follow-up care.

Conclusions:

• The Applied Cognitive Task Analysis (ACTA) framework provides insight into new NPs' antibiotic prescribing practices.
• Findings can inform the development of targeted professional development and resources to support safe antibiotic prescribing.
• Further research should explore the impact of educational resources and clinical pathways on diagnostic uncertainty in NP curricula.