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Decision Making, Problem Solving, Critical Thinking & Clinical

Reasoning

Definitions

Decision making is a complex, cognitive process often defined as choosing a particular course of action

Problem solving is part of decision making. A systematic process that focuses on analyzing a difficult situation. Problem solving always includes a decision-making step

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Critical Thinking (reflective thinking): is a mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion. It involves both cognitive and affective components

Clinical Reasoning: Integrating and applying different types of knowledge to weigh evidence, critically think about arguments and reflect upon the process used to arrive at a diagnosis. It uses both knowledge and experience to make decisions at the point of service.

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Vicarious learning to increase PS and DM skills

Case studies

Simulation

Problem-based learning

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Theoretical Approaches to PS &DM

Most individuals rely on discrete, often unconscious processes known as heuristics: (use trial and error or rule-of- thumb) quick PS

A structured approach The best way to make quality decisions: prevents trial and error, focus on alternatives and increases clinical reasoning. (apply theoretical models)

1. Identify the problem

2. Gather data

3. Explore alternatives

4. Evaluate the alternatives

5. Select the appropriate

solution

6. Implement the solution.

7. Evaluate the results

1.Traditional Problem-

Solving Process

Weakness

The amount of time needed for proper implementation.

Lack of an initial objective-setting step.

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Eliminates the weakness of the traditional model by adding a

goal-setting step

1. Determine decision & set objectives

2. Identify options

3. Compare options & consequences

4. Make a decision

5. Implement action plan

6. Evaluate results

2. Managerial Decision-Making Models

3. The Nursing Process

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Theoretical Approaches to PS & DM

Decision-Making Process

Identify the decision

Collect data

Identify criteria for decision

Identify alternatives

Choose alternative

Implement alternative

Evaluate steps in decision

Simplified Nursing Process

Assess

Plan

Implement

Evaluate

State problem

Collect info & analyze problem

Develop, analyze

alternatives

Select, justify alternative

Develop strategies to implement

Evaluate and prevent

occurrence

4.Integrated ethical PS model

• Requires the identification of strategies to prevent problem

recurrence

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5.Intuitive DM model

Is a rapid, automatic process of recognizing familiar problems instantly and using experience to identify solutions

Use of gut feeling to take appropriate action that impact outcomes

Should be

founded on scientific knowledge

Used in conjunction with evidence-based practice

Used when time is limited or systematic DM is not possible

Critical Elements in PS and DM Define Objectives Clearly Gather Data Carefully

Setting, problem (what and where, when), who is affected, what is happening, underlying issues, consequences…

Take the time necessary Use an evidence-based approach Generate Many Alternatives

At least two ↑ Number of people working on the problem. Brainstorming

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Think Logically Draw inferences from information People think illogically in 3 ways:

Overgeneralizing: A has a characteristic >> all As are the same Affirming the consequences: B is good then

A is bad Arguing from analogy: A is present in B

then A & B are alike Choose and Act Decisively

Individual Variations In D M Gender o Men & women have different structures and wiring in the

brains and use brains differently: Parts of frontal lobe, limbic cortex and white matter are larger in women. Grey matter is larger in men

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Values consciously or subconsciously values influence

perception, information gathering, processing and final outcome address or ignore problems

Life Experience

e.g. ↑ life experience → ↑ alternatives. Good or bad previous decisions affect future

decisions. Autonomy more experience for DM

Individual Preference Preferring one alternative over another due to: Individual risks such as physical, economic, and emotional risks, and time and energy expenditures.

Brain Hemisphere Dominance and Thinking Style

Analytical thinker: linear, left-brain thinkers (think Systematically)

Intuitive thinker: creative,, right-brain thinkers (think intuitively)

Organization needs all types of thinkers

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Overcoming Individual Vulnerability in Decision Making Values Values clarification decreases confusion, through

understanding their personal beliefs and feelings Life experience Use available resources, Involve other people, Analyze

decisions Individual Preference self-awareness, honesty, and risk taking Individual Ways of Thinking Use both types of thinkers, use group process, talking

management problems over with others, and developing whole-brain thinking

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Qualities of Successful Decision Makers: Courage Sensitivity Energy Creativity

Decision Making in Organizations

Effect of Organizational Power on Decision Making

Decisions of powerful people in organizations → congruent with their own preferences and values.

People having little power in organizations → consider the preference of the powerful.

The powerful also can inhibit the preferences of the less powerful.

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Decision Making in Organizations

Rational and Administrative Decision Making

Economic Man (Rational)

Administrative Man

Economic Man (Rational)

Very rational decisions.

Complete knowledge of the problem or decision situation.

Complete list of possible alternatives.

Rational system of ordering preference of alternatives.

Selects the decision that will maximize utility function

Administrative Man

Decisions that are good enough.

Knowledge is always fragmented.

Impossible to predict all alternatives accurately.

Usually chooses from among a few alternatives.

The final choice is “satisficing” rather than maximizing.

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Decision Making Tools

Decision Grid

Allows one to visually examine the alternatives and compare each against the same criteria.

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Decision Making Tools

Payoff Tables

Have a cost – profit relationships and the probabilities of certain outcomes using current information and historical data.

Decision Trees

Is a graphic method that can help managers visualize the alternatives available, outcomes, information needs for a specific problem over time.

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Decision Making Tools

Consequence Tables

List the objectives for solving a problem down one side of a table and rates how each alternative would meet the desired objective.

Objectives for problem

solving

Alternative 1 Alternative 2 Alternative 3

1. Reduce the number of falls

2. Meets regulatory standards

3. Is cost effective

4. Fits present policy guidelines

Decision Score

X

X

X

X

X

X

X

X

X

Decision Making Tools

Logic Models

Schematic or picture of how program is intended to operate. Schematic includes resources, processes, and desired outcomes and depicts exactly what the relationships are between the three components.

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Decision Making Tools

Program Evaluation and Review Technique (PERT)

A flowchart that predicts when events and activities must take place if a final event is to occur.

Network system model for planning and control under uncertain conditions.

See figure 1-5

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Pitfalls in Using Decision Making Tools

Confirmation Bias: is a tendency to affirm one’s initial impression and preferences as other alternatives are evaluated.

Individuals past influence current decisions

Biases can be reduced by using correct decision making style and involving others when appropriate.