DECISION MAKING, PROBLEM SOLVING, AND CRITICAL THINKING

OBJECTIVES:

1. Apply decision making to clinical situations.2. Explain how problem solving, critical thinking relate to decision making.3. Apply decision-making tools and technology to nursing care.4. Facilitate group decision making using various techniques.5. Examine limitations to effective decision making.

PROBLEM SOLVING is a systematic process that focuses on analyzing a difficult situation. Always includes a decision-making step

DECISION MAKING Is a complex, cognitive process often defined as choosing a particular course of action. (Webster’s definition) to “judge or settle” Is considering and selecting interventions from a list of actions that facilitate the

achievement of desired outcome.

CRITICAL INTUITIVE THINKING THINKING

REFLECTIVE THINKING

Critical thinking, intuitive thinking and reflective thinking are incorporated through-out the decision-making process.

STEPS OF DECISION-MAKING PROCESS:

STEP 1: Identify the need for a decision.STEP 2: Determine the goal or outcome.STEP 3: Identify alternatives or actions along with the benefits and consequences of each actionSTEP 4: Decide which action to implement.STEP 5: Evaluate the decision.

DIFFERENCE BETWEEN DECISION MAKING AND PROBLEM SOLVING

DECISION MAKING PROBLEM SOLVING

Occur without the full analysis required in problem solving.

Usually triggered by a problem but often handled in a manner that does not eliminate the problem

Is the last step in the problem-solving process

Problem solving attempts to identify the root of the problem in the situation

Much time and energy are spent on identifying the real problem

THEORETICAL APPROACHES TO PROBLEM SOLVING AND DECISION MAKING

DECISIONMAKING

FOUR ACCEPTABLE PROBLEM-SOLVING MODELS:

1. Traditional Problem-Solving Model – is widely used and is perhaps the most well known of the various models

7 steps of traditional Problem-Solving Weakness of Problem-Solving Models:

1. Identify the problem2. Gather data to analyze the causes

and consequences of the problem3. Explore alternative solutions4. Evaluate the alternatives5. Select the appropriate solution6. Implement the solution7. Evaluate the results

Lack effective because of time constraint

Lack of an initial objective-setting step.

2. Managerial Decision Making Model – a modified traditional model, eliminates the weakness of the traditional model by adding a goal setting step

HARRISON (1981) HAS DELINEATED THE FOLLOWING STEPS IN THE MANAGERIAL DECISION-MAKING PROCESS:

3. Nursing Process – provides another theoretical system for solving problems and decision making. Educators have identified the nursing process as an effective decision-making model

COMPARING THE DECISION-MAKING PROCESS WITH THE NURSING PROCESS

DECISION-MAKING PROCESS SIMPLIFIED NURSING PROCESS Identify the decision Collect data ASSESS Identify criteria for decision Identify alternatives PLAN Choose alternative Implement alternative IMPLEMENT Evaluate steps in decision EVALUATE

4. Intuitive Decision-Making Model – recently identifies one characteristic of an expert critical thinker that intuition can be overpowered by emotions.

Set Objectives Search for alternatives Evaluate alternatives Choose. Implement. Follow up and control.

INTUITIVE DECISION MAKING MODEL

1. ASSESS 2. RECALL

4.IMPLEMENT/EVALUATE 3. PLAN

5. The Moral Decision-Making Model Developed model for an ethical decision making incorporating the nursing process

and principle of biomedical ethics. Useful in clarifying ethical problems that result from conflicting obligation.

This model is represented by the mnemonic M O R A L

M – MANAGE THE DILEMMA.- Collect data about the ethical problem and who should be involve in the decision

making process

O – OUTLINE OPTIONS.- Identify alternatives and analyze the causes and consequences of each.

R – REVIEW CRITERIA AND RESOLVE.- Weigh the options against the values of those involved in the decision.

A – AFFIRM POSITION AND ACT.- Develop the implementation strategy

L – LOOK BACK.- Evaluate the decision making

ETHICAL DECISION MAKING MODEL

1. Situation Assessment Procedure2. Identify ethical issues and problems3. Identify and analyze available alternatives for action4. Select one alternative5. Justify the selection.

CRITICAL ELEMENTS IN DECISION MAKING

PATIENT

POSSIBLE NURISNG DIAGNOSIS AND INTERVENTIONS

ANALYZE SYNTHESIZE EXERCISE

JUDGEMENT

GATHER PATIENT DATA

IMPLEMENT FOLLOW

THROUGH EVALUATE

INDIVIDUAL VARIATIONS IN DECISION MAKING:

1. VALUES – “individual decisions are based on each person’s value system”2. LIFE EXPERIENCE – “past experiences which includes education and decision making

experience.”3. INDIVIDUAL PREFERENCE - choosing alternatives, one alternative may be preferred over

another.4. INDIVIDUAL WAYS OF THINKING AND DECISION MAKING

Some think systematically – ANALYTICAL THINKERS Others think intuitively – RIGHT OR LEFT HEMISPHERE DOMINANCE Analytical Linear – LEFT BRAIN THINKERS ROSS INFORMATION DIFFERENTLY THAN

CREATIVE Intuitive – RIGHT BRAIN THINKERS. INTUITION IS THE ABILITY TO UNDERSTAND THE

POSSIBLITIES INHERENT IN A SITATION

SUGGESTIONS TO HELP DECREASE INDIVIDUAL SUBJECTIVITY AND INCREASE OBJECTIVITY IN DECISION MAKING:

1. VALUES – one who is confused about his own values may affect his decision making ability.2. LIFE EXPERIENCE - lack of experience refers as “reason in transition”.

Use available resources Involve other people Analyze decisions later to assess their success

3. INDIVIDUAL PREFERENCES – self awareness, honesty and risk taking.4. INDIVIDUAL WAYS OF THINKING

People making decision alone are frequently handicapped because they are not able to understand problem fully or make decision from both an analytical and intuitive perspective.

In most organization, both types of thinkers may be found.

QUALITIES OF SUCCESSFUL DECISION MAKER♥ COURAGE♥ SENSITIVITY♥ ENERGY♥ CREATIVITY

EFFECTS OF ORGANIZATIONAL POWER IN DECISION MAKINGA. Powerful people in organizationB. People with little powerC. Powerful capable of inhibiting the preferences of less powerful

RATIONAL AND ADMINISTRATIVE DECISION MAKING

Define objectives clearly Gather data carefully Generate many alternatives Think logically - People think illogically primarily in three ways:

Over generalizing Affirming consequences Arguing from analogy

Choose and act decisively

Most managerial decisions were based on a careful, scientific, and objective thought process and managers made decisions in a rational manner.

Most managers made many decisions that did not fit the objective rationality theory.

COMPARING ECONOMIC MAN WITH THE ADMINISTRATIVE MAN

ECONOMIC ADMINISTRATIVEMakes decision in a very rational mannerHas complete knowledge of the problem or decision situationHas a complete list of possible alternativesHas a rational system of ordering preference of alternativesSelects the decision that will maximize utility function

Makes decisions that are good enoughBecause complete knowledge is not possible, knowledge is always fragmented.Because consequences of alternatives occur in the future, they are impossible to predict accuratelyUsually chooses from among a few alternatives, not all possible ones.The final choice is “satisfying” rather than maximizing

MANAGEMENT DECISION MAKING TECHNOLOGY

Selective technology that is most helpful for beginning managers:1. QUANTITATIVE DECISION – Making tools:

1.1 DECISION GRIDS: Allows one to visually examine the alternatives and compare each against

the same criteria.

A DECISION GRIDALTERNATIV

EFINANCIAL

EFFECTPOLITICAL

EFFECTDEPARTMENTAL

EFFECTTIME DECISIONS

#1#2#3#4

1.2 PAY-OFF TABLES: Cost profit volume relationship Very helpful when some quantitative information is available such as

item’s cost or predicted use.

1.3 DECISION TREES

Used to plot a decision over time “Allows visualization of various outcomes”

A DECISION TREE

1.4 PROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT) A popular tool to determine the timing of decisions A flow chart that predicts when events and activities must take place if a

final event is to occur.

PITFALLS IN USING DECISION MAKING TOOLS:

There is a strong tendency for managers to favor first impressions when making a decision Tendency to called confirmation biases. Tendency to affirm one’s initial impression and

preference as other alternatives are evaluated.

MINIMIZING PITFALLS Choosing the correct decision making style and involvi9ng others when appropriate

VARIABLES TO DETERMINE DECISION-MAKING STYLE

1. The information rule2. The goal congruence rule3. The unstructured problem rule4. The acceptance rule5. The conflict rule

CRITICAL THINKING– referred to as reflective thinking, is related to evaluation and has a broader scope than decision making and problem solving.

DECISION POINT(last event to occur)

hire regular staff

Increased demand for procedures

decrease demands for procedures

pay overtime and on-call wages

increase demand for staffs

decreased demand for staffs

POSSIBLE EVENTS

ALTERNATIVE ACTIONS

KNOWLEDGE EXPERIENCE

COMMON SENSE

CRITICAL THINKING COMPETENCIES

1. GENERAL CRITICAL THINKING COMPETENCIES2. SPECIFIC CRITICAL THINKING EXPERIENCES

CRITICAL THINKING MODELS

COMPONENTS OF CRITICAL THINKING:

Reasoning and Creative Analysis Insight Intuition Empathy Willingness to take action

CHARACTERISTICS OF A CRITICAL THINKER

♠ Opens to new ideas Intuitive♠

♠ energetic ♠ assertive communicator persistent♠

♠ analytical

empathic♠ flexible♠

♠ caring observant♠ risk taker♠

♠ resourceful♠ “out of the box” thinker

creative♠ insightful♠

♠ willing to take action outcome directed♠ willing to change♠

♠ knowledgeable

NORJETALEXIS M CABRERA, ADZU BSN IV ------------------------------------- LEADERSHIP AND MGT`

CRITICAL THINKING

CRITICAL THINKING

CREATIVITYPROBLEM SOLVING

DECISION MAKING