“Decision making is a process that begins with the identification of the problem and ends with the evaluation of the choices and taking a course of action” (Bernard & Walsh, 1990)

Decisions are a means rather than ends.

They are used to achieve a goal.

When decisions are made, the goal is usually related to both tasks and relationships.

Those who make decisions must learn to cope with being right some of the time and also learn to live with imperfect solutions.

To make sound decisions, which is what people desire to do, the most important consideration is the criteria that are used to make the decision. Some examples of the criteria that might be used are:

1. Minimally impacts current operations,

2. Helps achieve important priorities,

3. Is consistent with values,

4. Is acceptable to those involved in the decision,

5. Can be implemented with the constraints (time,

resources, other priorities),

6. Considers pros, cons, and risks.

“A problem is a discrepancy between a desirable and an actual situation”.

Decisions are required to resolve this discrepancy.

Typically, decision making and problem solving are used interchangeably though decisions do not always focus on problems.

Decisions, however, are made when problems are solved.

Decision styles

Why is creativity important in the decision – making process.

Styles of decision making are affected by creativity or innovation.

The common types of styles are unilateral, individual, and authoritarian decision making, all of which focus on one person making a decision with limited or no input from others.

The opposite of this style is participative and consensus decision making. Here the emphasis is on including others in the decision making, even if an individual must make the final decision.

Other decision – making styles that have been described are: decisive, integrative, hierarchic, and flexible (Milgram, Spector, & Treger, 1999). These styles apply to managers and to staff. The difference in these four styles is in the amount of data that is used to make a decision and the options that are considered.

The decisive style depends on less data to arrive at one decision. The integrative style uses all available data and identifies multiple alternatives. The hierarchic style focuses on a large amount of information but arrives at one alternative or solution. The flexible style uses a small amount of data while generating multiple alternatives and may change as information is reinterpreted.

Systematic versus intuitive decision styles are two other approaches to decision making. Systematic decision makers form their decisions more logically and use a structured approach. Intuitive decision makers are at the other end of the spectrum; here the focus is on a trial and error approach. They may ignore information and change their alternatives if it does not feel right. This is the “gut” approach. Group decision making is another style that is used more today. It focuses more on synergy, which is the combination of people’s effort that results in an output which is greater than the sum of the parts. Multiple ideas and experiences come together to form a decision.

The decision - making process The decision making process is a dynamic process. The most effective decisions are made in collaboration with others in the organization. Collaboration between nurses and physicians also affects nurse’s participation as it provides greater opportunities for nurses to participate.

Nursing and Critical thinking

Nurse has become very complex with change occurring almost daily in nursing management and clinical practice.

This complex, changing environment often leads to stress for all levels of staff.

Managers and team leaders need to be particularly skilled in coping with stress and embrace opportunities to make change a positive experience for themselves, all staff, and the organization and to actively use critical thinking.

A more progressive, holistic way to define critical thinking is a commitment to look for the best way, based on the most current research and practice findings; for example, the best strategy to manage pain in a specific person or situation.

Critical thinking is reasoning in a manner that generates and examines questions and problems.

Intuition and feelings are considered as an individual weighs, clarifies and evaluates evidence, arguments and conclusions.

Those who use critical thinking incorporate the following in their thinking process:

Reasoning

Generates and examines questions and problems.

Intuition and feelings

Weighs, clarifies, and evaluates evidence.

Some strategies that can prevent dichotomous thinking and improve critical thinking include the following:

Replace “I don’t know” and “I’m not sure” with “I’ll

find out.”

Turn errors into opportunities.

Anticipate questions other might ask.

Ask, “What if?”

Look for flaws in one’s own thinking, and ask others

to identify

flaws (Alfaro – LeFevre, 2001).

Critical thinking should be part of problem solving and decision making in response to change.

Critical thinking skills:

Knowledge, experience, judgment and evaluation

Interpretation

Affective listening

Application of moral reasoning and values

Comprehension, application, analysis and synthesis

Awareness of self

Mistakes happen and we learn from them

How does one describe a critical thinker?

Some authorities have identified key traits.

Paul (1995) identifies the following four traits:1. Intellectual humility. The person is willing to

admit what is not known.2. Intellectual integrity. The person continually

evaluates his or her own thinking and is willing to admit when wrong.

3. Intellectual courage. The person is aware of the need to confront ideas fairly, even when negative reactions toward the ideas may be present.

4. Intellectual empathy. The person makes a conscious effort to understand others.