Ch 1 Nursing Leadership: Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning: Requistes for successful leadership and management

Critical Thinking

"Mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion. More complex than problem solving or decision making. Involves higher-order reasoning and evaluation. Includes both cognitive and affective component (Insight, intuition, empathy, willingness to take action)

Which statement demonstrates a characteristic of critical thinker? Select all that apply

"Since that didn't work effectively, let's try something else? "The solution has to be something that the patient is willing to do? "I'll talk to the patient's PCP about the problem"

Five rights of delegation

1. Right task: Is this a task that can be delegated by a nurse? 2. Right circumstance: Considering the setting and available resources, should delegation take place? 3. Right person: Is the task being delegate by the right person to the right person? 4. Right direction/communication: Is the nurse providing a clear, concise description of the task, including limits and expectations? 5. Right supervision: Once the task has been delegated, is appropriate supervision maintained/

Program Evaluation and review technique (PERT)

A popular tool to determine the timing of decisions. It is essentially a flowchart that predicts when events and activities must take place if a final event is to occur.

What does a decision grid allow the decision maker to do?

A) Examine alternatives visually and compare each against the same criteria

Which statement regarding decision making is true?

A) They are subject to human error.

What is heuristics?

A) discrete, unconscious process to allow individuals to solve problems quickly

Tasks delegated to AP

ADLs; bathing; grooming; dressing; toileting; ambulating; feeding (without swallowing precautions); positioning; bed making; specimen collection; intake and output (I&O); vital signs (for stable clients)

What is a characteristic of a left brain thinker?

Analytic

Questions to ask when gathering data for a decision that can lead to the best decision possible?

Because decisions are based on knowledge and information available at the time, it is important to learn how to process and obtain accurate information. Remember, Facts can be misleading. 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 and Why is it happening? Are there any underlying issues and/or conflicts? What are the consequences and are they serious?

Decision Tree

Because decisions are often tied to the outcome of other events. Management analysts have developed these. Used to plot a decision over time and allow visualization of various outcomes.

Decision Making

Best described as choosing a particular course of action. The last step in solving a problem, but one might make several decisions without solving a problem.

Priority setting requires that decisions be made regarding order in which what occurs?

Clients are seen Assessments are completed Interventions are provided Steps in a client procedure are completed Components of client care are completed

What are qualities surmised to make a successful decision maker?

Courage - willingness to take risk Sensitivity - good decision makers are sensitive to situations and others. Energy - people must have energy and desire to make things happen. Creativity - successful decision makers tend to be creative thinkers. They develop new ways to solve problems

What effect of organizational power on decision making is often reflected in the tendency of staff?

D) Having private beliefs that are separate from corporate ones

One of the nurses on the unit said, "Male patients have a low threshold for pain." This is an example of what type of illogical thinking?

D) Overgeneralizing

What needs to be considered in evaluating the quality of ones decisions?

D) Will the evaluation be helpful in increasing one's decision-making skills?

Critical Elements in Decision Making

Define objective clearly Gather data carefully Generate many alternative Think logically Choose and act decisively

Individual Variations: Life Experiences

Each person brings to the decision-making task past experiences that include education and decision-making experience

Individual Variations: Values

Individuals decisions are based on each person's value system Being confused and unclear about one's values may affect decision making ability

Why is critical thinking especially important to nurses?

Information becomes obsolete quickly Complexity of the profession Limited number of hours for theory and clinical education Information overload Conflicting responsibilities

Why is it important to define objectives

It is important to determine goals and objectives when problems are complex If a decision lacks a clear objective or if an objective is not consistent with the individual or organization's stated philosophy, a poor-quality decision is likely.

Individual Variations: Gender

Men and women think differently Individuals think differently There is no evidence that any one thinking style is better

Clinical Reasoning

Mental process used when analyzing elements of a clinical situation and using analysis to make a decision.

Tasks delegated to LPN

Monitoring findings (as input to the RN's ongoing assessment); reinforcing client teaching from a standard care plan; performing tracheostomy care; suctioning; checking nasogastric tube potency; administering enteral feedings; inserting urinary catheter; administering medications (excluding IV medications in some states)

Problem Solving

Part of decision making, a systematic process that focuses on analyzing a difficult situation. Problem solving always includes a decision making step.

Effect of organizational Power?

Powerful people in organizations are more likely to have decisions made that are congruent with their own preferences and values. The ability of the powerful to influence individual decision making in an organization often requires adopting a private personality and an organizational personality

Clinical Judgement

The decision made regarding a course of action based on a critical analysis of data when nursing knowledge is applied to a clinical situation. Used to analyze data and related evidence, ascertain meaning of the data and evidence, determine client outcomes desired and/or achieved as indicated by EBP

Brainstorming

The goal is to bring all options to the table and not limit any possible alternatives. The greater the number of options to a problem, the greater the chance that the final decision will be sound. Sometimes the status quo is the right decision

Consequence Tables

Used to demonstrate how various alternatives create different consequences. It list the objectives for solving a problem down one side of a table and rates how each alternative would meet the desired objective

Which problem solving learning strategy provides the learner with the most realistic, risk free learning environment?

a) case studies

What is a weakness of the traditional problem- solving method?

a) its need for implementation time

Decision Grid

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

Logic Models

are schematics or pictures of how programs are intended to operate. Includes resources, processes, and desired outcomes and depicts exactly what the relationships are between the three components.

If decision making is triggered by a problem with what does it end?

b) A chosen course of action

Which of the following statement are true regarding decision making?

b) decisions are greatly influenced by each persons value system

What does knowledge about good decision making lead one to believe

b) effective decision makers are sensitive to the situation and to others

What is the value of using a structured approach to problem solving for the novice nurse

b) supports the acquisition of clinical reasoning

Which statement concerning the role of the powerful organizational decision making is true?

b) they make decisions made that are in congruence with their own values

What is the advantage of using a payoff table when applicable?

c) it assists in visualization of the available historic and current data

What statement is true regarding leadership?

c) it involves choosing between courses of action

Which statement is true regarding critical thinking?

c) it requires reasoning and creative analysis

What is the best definition of decision making

c) one step in problem solving process

What influences the quality of a decision most often

c) questions asked and alternatives generated

Payoff Table

have a cost-profit-volume relationship. Helpful when some quantitative information is available. To use, one must determine probabilities and use historical data.

Why do our values often cause personal conflict in decision making?

our values often collide with one another

Airway Breathing Circulation Framework

■ The ABC framework identifies, in order, the three basic needs for sustaining life: ☐ An open airway is necessary for breathing, so it is the highest priority. ☐ Breathing is necessary for oxygenation of the blood to occur. ☐ Circulation is necessary for oxygenated blood to reach the body's tissues. ■ The severity of clinical manifestations should also be considered when determining priorities. A severe circulation problem may take priority over a minor breathing problem. ■ Some frameworks also include a "D" for disability, addressing the high priority given for prevention of disabilities.

Acute vs. Chronic/Urgent vs. Nonurgent/Stable vs. Unstable

■A client who has an acute problem takes priority over a client who has a chronic problem. ■A client who has an urgent need takes priority over a client who has a nonurgent need. ■A client who has unstable findings takes priority over a client who has stable findings

●Good time management

◯Facilitates greater productivity. ◯Decreases work-related stress. ◯Helps ensure the provision of quality and appropriately prioritized client care. ◯Enhances satisfaction with care provided.

●Poor time management

◯Impairs productivity. ◯Leads to feelings of being overwhelmed and stressed. ◯Increases omission of important tasks. ◯Creates dissatisfaction with care provided