The use of cognitive continuum theory and patient scenarios to explore nurse prescribers’ pharmacological knowledge and decision-making

Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review

“…Key strengths of the studies included the justification and appropriateness of the qualitative approaches and corresponding study designs. Two of the studies provided clear statements of study aims (32,33) ; this was absent in the third (40) . Study limitations were: a general lack of detail over recruitment strategies and processes (e.g.…”

“…Study limitations were: a general lack of detail over recruitment strategies and processes (e.g. one study described purposive sampling but with no further details of strata (40) ; no justification of sample size and consideration of saturation; and the absence in two of the studies of any theoretical underpinning in the construction of the data generation tools and data analysis (32,33) . The third study (40) applied to Hammond's Cognitive Continuum Theory which places the cognitive activities of decision-makers into six broad categories: scientific experiment; controlled trial; quasi-experiment; system aided judgement; peer-aided judgement; and intuitive judgement (41) .…”

“…While all studies reported aspects of prescribing decision-making, this was not the primary research aim for any. The aims centred around: use of evidence based guidelines in the management of otitis media (32) ; experience of consultations for respiratory tract infections (33) ; and exploring pharmacological knowledge and decisionmaking around given scenarios (40) . Studies were carried out in primary care almost exclusively among nurse prescribers (n=67); only one pharmacist prescriber and one physiotherapist prescriber were included in one focus group and results from the focus group were not differentiated according to profession (33) .…”

“…Experience in the role (32) , the use of evidence-based guidelines (32,33) and peer support and encouragement from doctors (40) helped participants to feel more knowledgeable and confident about their prescribing decisions, and also to resist patient pressure for antibiotics (34) . Evidence-based guidelines were useful in helping NMPs to resist this pressure (33) .…”

“…Offredy and colleagues identified poor knowledge despite participants claiming knowledge of medicines used in their own clinical areas. (40) . Others have highlighted that practising NMPs have identified a need for continuing professional development in the area of pharmacology and drug interactions (52) .…”