Ch. 1: Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning

Evaluating decision

By doing this, managers can learn more about their abilities and where the problem solving was faulty.

A structured approach

to problem solving and decision making increases clinical reasoning.

upper-left-brain dominance

truly are analytical thinkers who like working with factual data and numbers. These individuals deal with problems in a logical and rational way. Individuals with lower-left-brain dominance are highly organized and detail oriented. They prefer a stable work environment and value safety and security over risk taking.

Overcoming inexperience

use available resources, including current research and literature, to gain a fuller understanding of the issues involved. involve other people, such as experienced colleagues, mentors, trusted friends, and experts, to act as sounding boards and advisors. analyze decisions later to assess their success. By evaluating decisions, people learn from mistakes

Autonomy

It is likely that people seeking this may have much more experience at making decisions than those who fear it. Likewise, having made good or poor decisions in the past will influence a person's decision making.

Act/implement

It is not enough to gather adequate information, think logically, select from among many alternatives, and be aware of the influence of one's values. In the final analysis, one must

Permanent

It may help the reluctant decision maker to remember that even though decisions often have long-term consequences and far-reaching effects, they are not usually

Goal

Setting a decision ____ helps to prevent the decision maker from becoming sidetracked.

involving others in the process

confirms the adage that two heads are better than one. Because everyone thinks uniquely, increasing the number of people working on a problem increases the number of alternatives that can be generated.

Powerful people

in organizations are more likely to have decisions made (by themselves or their subordinates) that are congruent with their own preferences and values. the powerful also can inhibit the preferences of the less powerful.

people wielding little power

in organizations must always consider the preference of the powerful when they make management decisions

qualities of a successful decision maker

include courage, sensitivity, energy and creativity

cognitive skill

intuition may be perceived as this rather than a perception or knowing without knowing how.

Brainstorming

is another frequently used technique. The goal is to think of all possible alternatives, even those that may seem "off target." This can break through habitual or repressive thinking patterns and allow new ideas to surface.

Administrative support

is needed to access the resources, provide the support personnel, and sanction the necessary changes in policies, procedures, and practices for evidence-based data gathering to be a part of every nurse's practice

Problem solving

is part of decision making and is a systematic process that focuses on analyzing a difficult situation, always includes a decision-making step.

Inference

is part of deductive reasoning. People must carefully think through the information and the alternatives

Complex

it is especially important to determine goals and objectives when problems are _______

Overcoming individual preference

it is not enough to be self-aware; people also must be honest with themselves about their choices and their preferences for those choices. the successful decision maker must take some risks. Nearly every decision has some element of risk, and most decisions involve consequences and accountability.

computer simulation

known as discrete event simulation, which imitates the operation of a real-life system such as a hospital. The learner's actions in the simulation provide insight to the quality of the learner's decision making based on priority setting, timeliness of action, and patient outcomes.

Simulation

provides learners opportunities for problem solving that have little or no risk to patients or to organizational performance.

Experiential learning

provides mock experiences that have tremendous value in applying leadership and management theory.

Confirmation bias

refers to our tendency to search for and favor information that confirms our beliefs while simultaneously ignoring or devaluing information that contradicts our beliefs.The more someone believes he or she knows something, the more he or she filters and ignores information to the contrary.

The model selected

should be one with which the decision maker is familiar and one appropriate for the problem to be solved

Critical thinking

sometimes referred to as reflective thinking, is related to evaluation and has a broader scope than decision making and problem solving."the mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion". also involves reflecting on the meaning of statements, examining the offered evidence and reasoning, and forming judgments about facts.

didactic theory, problem solving, group process, and personalized learning

4 spheres of Marquis Huston model

Poor quality

A decision that is made without a clear objective in mind or a decision that is inconsistent with one's philosophy is likely to be

integrated ethical problem solving model

Although developed primarily for use in solving ethical problems, the model also works well as a general problem-solving model, structured approach to problem solving that includes an assessment of the problem, problem identification, the analysis and selection of the best alternative, and a means for evaluation.

Second best solution

Although heuristics are often considered this as a result of relying heavily on intuition and nonscientific strategies, Bodemer, Hanoch, and Katsikopoulos (2015) suggest that heuristics can actually be more accurate, faster, and easier to apply in comparison to more complex strategies.

Nursing Process

Assess. Diagnose. Plan. Implement. Evaluate.

Individuality

Because decision making involves perceiving and evaluating, and people perceive by sensation and intuition and evaluate their perception by thinking and feeling, it is inevitable that this plays a part in decision making. everyone has different values and life experiences, and each person perceives and thinks differently, different decisions may be made given the same set of circumstances.

Personal values

Because these also influence perceptions, they invariably influence information gathering, information processing, and final outcome. they also determine which problems in one's personal or professional life will be addressed or ignored.

Courage

Courage is particularly important and involves the willingness to take risks.

Critical Elements in Decision Making

Define objectives clearly. Gather data carefully. Take the time necessary. Generate many alternatives. Think logically. Choose and act decisively.

Managerial Decision-Making Model

Determine the decision and the desired outcome (set objectives). Research and identify options. Compare and contrast these options and their consequences. Make a decision. Implement an action plan. Evaluate results.

Sensitivity

Good decision makers seem to have some sort of antenna that makes them particularly sensitive to situations and others.

Affirming the consequences

In this type of illogical thinking, one decides that if B is good and he or she is doing A, then A must not be good. For example, if a new method is heralded as the best way to perform a nursing procedure and the nurses on your unit are not using that technique, it is illogical to assume that the technique currently used in your unit is wrong or bad.

SWOT

strengths, weaknesses, opportunities, and threats (used in managerial decision making models)

Strategies for the New Nurse to Promote Evidence-Based Best Practice

Keep abreast of the evidence—subscribe to professional journals and read widely. Use and encourage use of multiple sources of evidence. Use evidence not only to support clinical interventions but also to support teaching strategies. Find established sources of evidence in your specialty—do not reinvent the wheel. Implement and evaluate nationally sanctioned clinical practice guidelines. Question and challenge nursing traditions and promote a spirit of risk taking. Dispel myths and traditions not supported by evidence. Collaborate with other nurses locally and globally. Interact with other disciplines to bring nursing evidence to the table.

rational decisions

Managers who are successful decision makers often attempt to make these types of decisions, much like the economic man. Because they realize that restricted knowledge and limited alternatives directly affect a decision's quality, these managers gather as much information as possible and generate many alternatives.

Acting

Many individuals choose to delay _____because they lack the courage to face the consequences of their choices.

oversimplification

New evidence suggests the existence of left or right brain dominance may be an

Objective

No matter how _________ the criteria, value judgments will always play a part in a person's decision making, either consciously or subconsciously.

Characteristics of a Critical Thinker

Open to New Ideas, Intuitive, Energetic, Analytical, Persistent, Assertive, Communicative, Flexible, Empathetic, Caring, Observant, Risk taker, Resourceful, "Outside-the-box" thinker, Creative, Insightful, Willing to take action, Outcome directed, Willing to change, Knowledgeable, Circular thinker

lack of self-awareness

Overcoming this through values clarification decreases confusion. People who understand their personal beliefs and feelings will have a conscious awareness of the values on which their decisions are based.

Energy

People must have the energy and desire to make things happen.

Traditional Problem-Solving (TPS)

Process Identify the problem. Gather data to analyze the causes and consequences of the problem. Explore alternative solutions. Evaluate the alternatives. Select the appropriate solution. Implement the solution. Evaluate the results.

choice not to do anything

Remember that one alternative in each decision should be this. When examining decisions to be made by using a formal process, it is often found that the status quo is the right alternative.

Effect of gender

Research does suggest, however, that men and women do have different structures and wiring in the brain and that men and women may use their brains differently. For example, Harvard researchers have found that parts of the frontal lobe, responsible for problem solving and decision making, and the limbic cortex, responsible for regulating emotions, are larger in women. Men also have approximately 6.5 times more gray matter in the brain than women, but women have about 10 times more white matter than men. Researchers believe that men may think more with their gray matter, whereas women think more with the white matter. This use of white matter may allow a woman's brain to work faster than a man's

Integrated Ethical Problem-Solving Model

State the problem. Collect additional information and analyze the problem. Develop alternatives and analyze and compare them. Select the best alternative and justify your decision. Develop strategies to successfully implement a chosen alternative and take action. Evaluate the outcomes and prevent a similar occurrence.

Creativity

Successful decision makers tend to be creative thinkers. They develop new ways to solve problems.

four overlapping spheres

The Marquis-Huston model comprises these, each being an essential component for teaching leadership and management. (didactic theory, problem solving, group process, and personalized learning)

identifying the problem

The acquisition of information begins with this or the occasion for the decision and continues throughout the problem-solving process.

Individual preference

The decision maker, for example, may see certain choices as involving greater personal risk than others and therefore may choose the safer alternative.

Life experience

The more mature the person and the broader his or her background, the more alternatives he or she can identify. Each time a new behavior or decision is observed, that possibility is added to the person's repertoire of choices.

number of alternatives

The more of these that can be generated, the greater the chance that the final decision will be sound.

personalized learning

This can be accomplished through writing exercises, personal exploration, and values clarification, along with risk taking, as case studies are examined. Makes the information relatable and real

Arguing from analogy

This thinking applies a component that is present in two separate concepts and then states that because A is present in B, then A and B are alike in all respects. An example of this would be to argue that because intuition plays a part in clinical and managerial nursing, then any characteristic present in a good clinical nurse also should be present in a good nurse-manager. However, this is not necessarily true; a good nurse-manager does not necessarily possess all the same skills as a good nurse-clinician.

Overgeneralizing

This type of "crooked" thinking occurs when one believes that because A has a particular characteristic, every other A also has the same characteristic. This kind of thinking is exemplified when stereotypical statements are used to justify arguments and decisions.

Heterogeneous

Use of these rather than homogeneous groups will usually result in better quality decision making.

Questions to Examine in Data Gathering

What is the setting? What is the problem? Where is it a problem? When is it a problem? Who is affected by the problem? What is happening? Why is it happening? What are the causes of the problem? Can the causes be prioritized? What are the basic underlying issues? What are the areas of conflict? What are the consequences of the problem? Which is the most serious?

clinical reasoning

When nurses integrate and apply different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at a diagnosis, this is known as this, and is a collaborative and reflective process that involves content-specific knowledge, engagement of the patient and family in understanding the clinical problem, and incorporation of critical contextual factors

work together

abilities in subjects such as math are strongest when both halves of the brain do this. Indeed, both sides of the brain collaborate to perform a broad variety of tasks and the two hemispheres communicate through the corpus callosum

managerial decision-making models

aka rational decision-making models.

Problem based learning

also provides opportunities for individuals to address and learn from authentic problems vicariously. Typically, learners meet in small groups to discuss and analyze real-life problems. Thus, they learn by problem solving.

Managerial decision making step 4

alternatives are rank ordered on the basis of the analysis done in step 3 so that problem solvers can make a choice

Evidence-based decision making

and evidence-based practice should be viewed as imperatives for all nurses today as well as for the profession in general. It is important to recognize that the implementation of evidence-based best practices is not just an individual, staff nurse-level pursuit

Insight, intuition, empathy, and the willingness to take action

are components of critical thinking.

upper-right-brain dominance

big picture thinkers who looked for hidden possibilities and were futuristic in their thinking. They were thought to frequently rely on intuition to solve problems and are willing to take risks to seek new solutions to problems. Individuals with lower-right-brain dominance experienced facts and problem solved in a more emotional way than the other three types. They were sympathetic, kinesthetic, and empathetic and focused more on interpersonal aspects of decision making

recognition-primed decision (RPD) model

blends intuition and analysis, but pattern recognition and experience guide decision makers when time is limited or systematic rational decision making is not possible, attempts to understand how humans make relatively quick decisions in complex, real-world settings such as firefighting and critical care nursing without having to compare options.

Intuition

can and should be used in conjunction with evidence-based practice and that it deserves to be acknowledged as a factor in achieving good outcomes within clinical practice, and is a rapid, automatic process of recognizing familiar problems instantly and using experience to identify solutions.

case studies

can assist in learning didactic material by identifying what learners need

Facts

can be misleading if they are presented in a seductive manner, if they are taken out of context, or if they are past oriented.

evidence based

can be used synonymously with research based or science based

formal process and structure

can benefit the decision-making process, as they force decision makers to be specific about options and to separate probabilities from values

Individual variations in decision making

can include gender, culture, values, life experience, person preference, brain hemisphere thinking style, etc.

expert networks

communities of top thinkers, managers, and scientists—can help make decisions. Such network panels are typically made up of researchers, health-care professionals, attorneys, and industry executives.

Ida Jean Orlando

created the nursing process

Problem solve

decision has been made not to ________ _____. This alternative may be selected because of a lack of energy, time, or resources to solve the real problem.

quality of any decision making strategy

depends on the environment

Brain hemisphere dominance

suggested that analytical, linear, left-brain thinkers process information differently from creative, intuitive, right-brain thinkers. Left-brain thinkers were supposed to be better at processing language, logic, and numbers, whereas right-brain thinkers excelled at nonverbal ideation and creativity.

Marquis Huston model

desired outcome for decision making and critical thinking in management is an interaction between learners and others that results in the ability to critically examine management and leadership issues. learning of appropriate social/professional behaviors rather than a mere acquisition of knowledge, occurs best in groups, using a PBL approach.

Research on simulation

found that the majority of students who successfully recognized cues in human patient simulation were able to make correct judgments and decisions in clinical practice and allows students to apply and improve the critically important "nontechnical" skills of communication, teamwork, leadership, and decision making.

didactic material

learners retain this more readily when it is personalized or when they can relate to the material being presented

TPS weakness

lies in the amount of time needed for proper implementation.

weakness of the nursing process

like the traditional problem-solving model, is in not requiring clearly stated objectives. Goals should be clearly stated in the planning phase of the process, but this step is frequently omitted or obscured

quality of the decisions

made by leader-managers make is the factor that often weighs most heavily in their success or failure

vulnerability

managers and leaders must become aware of their own __________ and recognize how it influences and limits the quality of their decision making. essential component of decision making and critical thinking.

greatest strength of nursing process

may be its multiple venues for feedback

Case studies

may be thought of as stories that impart learning, particularly those that unfold or progress over time, are becoming much more common in nursing education because they provide a more interactive learning experience for students than the traditional didactic approach.

EBP

most experts agree that the best practices in nursing care and decision making are also

Heuristics

most individuals rely on discrete, often unconscious processes known as _________, which allows them to solve problems more quickly and to build on experiences they have gained in their lives. Involves trial-and-error methods or a rule-of-thumb approach to problem solving rather than set rules.

a balance

must be found between the limitations of choice posed by the power structure within the organization and totally independent decision making that could lead to organizational chaos.

human error

no tool or mechanism is infallible to this

Experienced (expert) nurses

often report that gut-level feelings (intuition) encourage them to take appropriate strategic action that impacts patient outcomes

Decision making

often thought to be synonymous with management and is one of the criteria on which management expertise is judged, complex, cognitive process often defined as choosing a particular course of action, both an innermost leadership activity and the core of management

Overgeneralizing, affirming consequences, arguing from analogy

people think illogically in three ways.

PBL

problem-based learning