Chapter 5: Critical Thinking & Decision Making

How do nurse leaders & managers model critical thinking?

1. Use reflective thinking & provide guidance to staff in a credible manner will create a sense of truest & safety on the unit 2. Articulate the value & application of critical thinking 3. Encourage staff to analyze situations, challenge assumptions, explore alternative options, & embrace continuous improvement

What is the importance of critical thinking in nursing?

1. Vital in clinical practice & nursing leadership 2. Systematically frames the leader's thoughts, decisions, & actions

determining a problem or issue based on assessment data

Analysis

often overlap with gathering information because information is logically arranged & put into context for evaluation

Analyzing Information & Creating Alternatives (Step 2 of Decision Making)

problem solving strategy that capitalizes on the positive characteristics of an outcome by valuing & building on them

Appreciative Inquiry

use data to problem solve, make decisions, identify gaps in care, & identify patterns & variances related to the situation

Assessment (Managers using Nursing Process for Decision Making)

data collection in a systematic manner relative to an issue, situation, the work environment, or trends

Assessment (Nursing Process)

thinker holds true about the issue/problem

Assumptions

those that affect the work environment

Condition of Work Decisions

intellectually disciplined process of actively & skillfully conceptualizing, applying, analyzing, synthesizing, &/or evaluating information gathered from or generated by observation, experience, reflection, reasoning, or communication, as a guide to belief & action

Critical Thinking

listing options & factors; possible options/alternatives are listed on the rows of the table & factors impacting the decision are listed on the columns; a numerical score is assigned to each option to indicate poor to very good, or not likely to very likely

Decision Making Grid

DECIDE Model

Define the problem (if necessary) Establish the criteria Consider alternatives Identify the best alternatives Develop & implement a plan of action Evaluate & monitor the solution & feedback (if necessary)

leverage the best of what is & visions for the future & impact strategies that move towards the future; identify structures & processes necessary to make the dream a reality

Design

putting strengths into action, revising as necessary; focus on the positives & to empower everyone to sustain the vision

Destiny

data use to support & enhance decision making & document issues, problems & trends to help determine an individualized plan

Diagnosis/Analysis (Managers using Nursing Process for Decision Making)

identifying issues, problems, or trends, & validating them with stakeholders when possible

Diagnosis/Analysis (Nursing Process)

identify the strengths, best practices, & sources of excellence; involves storytelling

Discovery

What are the 4 Stages of Appreciative Inquiry?

Discovery, Dreaming, Design, & Destiny

envisioning a future that you really want; staff members think ahead & imagine a future based on the positives identified

Dreaming

use the results of evaluation analysis to make or recommend changes to policies & procedures as needed

Evaluation (Managers using Nursing Process for Decision Making)

ongoing evaluation of the outcomes in relation to structures, processes, nurse sensitive indicators, & stakeholder responses

Evaluation (Nursing Process)

determining whether expected outcomes have or have not been met

Evaluations

data or information provided to support the claims the thinker makes about the issue/problem

Evidence

the ability to justify actions with evidence

Explanation

includes communication & clarification to ensure that staff members know what is expected of them; checking on the timing & ensuring that the change is not overwhelming to staff; performing ongoing analysis & monitoring any circumstances that may require adjustments; evaluating suggestions from others; withdrawing a poor decision; admitting mistakes; sticking with the right decision

Following up on Implementation (Step 5 of Decision Making)

involves collecting information that will direct the decision making process & includes observation

Gathering Information (Step 1 of Decision Making)

central concepts, principles, & theories the thinker uses in reasoning about the issue/problem

Ideas

incorporate principles of systems management, new knowledge, & strategies to initiate change, achieve desired outcomes, & establish strategies to promote health, education, & a safe environment

Implementation (Managers using Nursing Process for Decision Making)

coordinating the implementation of a plan & associated processes in collaboration with the healthcare team in a safe & timely manner

Implementation (Nursing Process)

consists of taking the selected alternative & putting it into action

Implementing (Step 4 of Decision Making)

follow from the positions the thinker holds on the issue/problem

Implications & Consequences

drawing conclusions

Inference

clarifying data & circumstances to determine meaning & significance

Interpretation

inferences, reasoning, & lines of formulated thought that lead to the thinker's conclusions

Interpretations

instant understanding of knowledge without supporting evidence & based upon a background of similar situations

Intuitive Thinking

identify expected outcomes for a plan developed to address issues, problems, or trends

Outcome Identification (Managers using Nursing Process for Decision Making)

includes identifying expected outcomes for an individualized plan of care

Outcome Identification (Nursing Process)

those that affect direct patient care

Patient Care Decisions

design the plan by considering the current statutes, rules, regulations, & standards & integrating the best practices

Planning (Managers use Nursing Process for Decision Making)

development of individualized plan in partnership with members of the healthcare team & the appropriate stakeholders

Planning (Nursing Process)

frame of reverence or world view the thinker holds about the issue/problem

Point of View

question, concern, or issue being thought about by the thinker

Problem

consists of the act of identifying a problem & implementing an active systematic process to solve that problem

Problem Solving

process of finding solutions to difficult complex issues & look closely at problems, failures, & negative outcomes, & then find a solution

Problem Solving

What are the advantages of Reflective Thinking?

Promotes shared decision making among staff, considers different perspectives & frames of reference, & creates some meaning from the relevant information/opinions

goal; what do you want to accomplish

Purpose

inclusion of staff nurses in decision making related to patient care & work methods at the unit & organizational levels

Shared Decision Making

SWOT acronym

Strengths Weaknesses Opportunities Threats

to examine in detail the constitution/structure of something (esp. information) for the purpose of explanation or interpretation

analyzing

make a formal application or request

applying

form an idea

conceptualizing

End product of Appreciative Inquiry =

culture change or the development of a vision/plan

process of choosing the best alternatives to achieve individual & organizational objectives; dynamic process & must include EBP

decision making

What are the advantages of Shared Governance Model?

empowers nurses; impacts nurse satisfaction, recruitment, & retention

to form an idea or value when you assess

evaluating

How do nurse leaders & managers that use Reflective Thinking act?

forces them to take a step back, assess the situation, & think about how to solve the problem

How do nurse leaders & managers use Shared Decision Making?

requires them to involve nurses in decisions about hiring, scheduling, & performance evaluation (appraisals), & general unit discussions

What are the advantages of Intuitive Thinking?

results in quick action to deliver safe, effective care, used to assist in assessments of situations, & used in concert with critical thinking

ability to do something well or with expertise

skill

combine a number of things (information) into a coherent whole

synthesizing

What is the focus of Gathering Information in the decision making process?

to gather data that are worthwhile & pertinent to the decision to be made

providing nurse leaders & managers a systematic way to collect & manage data & assist in visualizing alternatives

tools for decision making

How do nurse leaders & managers that use Intuitive Thinking act?

use as they deal with day to day unit level situations

How do nurse leaders & managers that use Reactive Thinking act?

use automatic, thoughtless responses to solve problems

process of examining one's practice for strengths & weaknesses in critical thinking & promotion continuous improvement

Self Regulation

What are the 6 Steps of the Nursing Process that nurse leaders & managers use?

1. Assessment 2. Diagnosis (Analysis) 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation

What are the 3 Decision Making Models?

1. DECIDE Model 2. Decision Making Grid 3. SWOT Analysis

What are the 5 steps to Decision Making?

1. Gathering Information 2. Analyzing Information & Creating Alternatives 3. Selecting a Preferred Alternative 4. Implementing 5. Following up on Implementation

What are the 2 types of decision making?

1. Patient Care Decisions 2. Condition of Work Decisions

8 Steps of the Critical Thinking in Process

1. Problem 2. Purpose 3. Point of View 4. Assumptions 5. Ideas 6. Evidence 7. Interpretations 8. Implications & Conseequences

What kind of thinking does a nurse leader & manager want to avoid?

Reactive Thinking

automatic or kneejerk reaction to situations that has consequences leading to vague or inaccurate reasoning, sloppy, & superficial thinking, & poor nursing practice

Reactive Thinking

What are the 3 types of thinking?

Reactive, Reflective, & Intuitive

consists of deliberate thinking & understanding using one's own personal experiences & knowledge, & it involves assessing what is known, what needs to be known, & how to bridge the gap between the two

Reflective Thinking

What are the disadvantages of Reactive Thinking?

Results in errors, results in ineffective decision making, & restricts innovation

tool is frequently used in marketing & organizational strategic planning but can be very useful in decision making for nurses

SWOT Analysis

comes about during analysis when often the best alternative emerges

Selecting a Preferred Alternative (Step 3 of Decision Making)