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.
(Websters 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 action
STEP 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





DECISION
MAKING



THEORETICAL APPROACHES TO PROBLEM SOLVING AND DECISION MAKING

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 problem
2. Gather data to analyze the causes
and consequences of the problem
3. Explore alternative solutions
4. Evaluate the alternatives
5. Select the appropriate solution
6. Implement the solution
7. 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








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

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

INTUITIVE DECISION MAKING MODEL

1. ASSESS 2. RECALL




q +


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 Procedure
2. Identify ethical issues and problems
3. Identify and analyze available alternatives for action
4. Select one alternative
5. Justify the selection.




PATIENT
POSSIBLE NURISNG
DIAGNOSIS AND
INTERVENTIONS
* ANALYZE
* SYNTHESIZE
* EXERCISE
JUDGEMENT
GATHER PATIENT
DATA
* IMPLEMENT
* FOLLOW
THROUGH
* EVALUATE
CRITICAL ELEMENTS IN DECISION MAKING













INDIVIDUAL VARIATIONS IN DECISION MAKING:

1. VALUES individual decisions are based on each persons 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 MAKING
A. Powerful people in organization
B. People with little power
C. Powerful capable of inhibiting the preferences of less powerful



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

RATIONAL AND ADMINISTRATIVE DECISION MAKING

O Most managerial decisions were based on a careful, scientific, and objective thought
process and managers made decisions in a rational manner.
O Most managers made many decisions that did not fit the objective rationality theory.

COMPARING ECONOMIC MAN WITH THE ADMINISTRATIVE MAN

ECONOMIC ADMINISTRATIVE
Makes decision in a very rational manner
Has complete knowledge of the problem or
decision situation
Has a complete list of possible alternatives
Has a rational system of ordering preference of
alternatives
Selects the decision that will maximize utility
function

Makes decisions that are good enough
Because complete knowledge is not possible,
knowledge is always fragmented.
Because consequences of alternatives occur in the
future, they are impossible to predict accurately
Usually 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 GRID
ALTERNATIVE FINANCIAL
EFFECT
POLITICAL
EFFECT
DEPARTMENTAL
EFFECT
TIME DECISIONS
#1
#2
#3
#4

1.2 PAY-OFF TABLES:
Cost profit volume relationship
Very helpful when some quantitative information is available such as
items 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 ones 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 rule
2. The goal congruence rule
3. The unstructured problem rule
4. The acceptance rule
5. The conflict rule






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





KNOWLEDGE EXPERIENCE







COMMON SENSE

CRITICAL THINKING COMPETENCIES

1. GENERAL CRITICAL THINKING COMPETENCIES
2. 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
CREATIVITY
PROBLEM
SOLVING
DECISION
MAKING