Ch 9 - Thinking Critically, Making Decisions, Solving Problems

Which situation requires an adaptive decision? 1. The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state. 2. The nurse has made a medication error on an experimental medication. 3. The nursing student makes an error when changing a client dressing. 4. The nurse manager scheduled too many nurses for the client census on the night shift, and all of the nurses scheduled have already been asked to take a low-census unpaid day off this month.

Correct Answer: 1 Rationale 1: Adaptive decisions must be made when the situation is unusual and there is no clear-cut policy for decision making. Rationale 2: Making a medication error is not an unusual situation, and a policy exists for handling this issue. Rationale 3: A policy exists for handling procedure errors. Rationale 4: A policy exists for handling staffing errors.

The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation? 1. Creativity 2. Problem solving 3. Brainstorming 4. Decision making

Correct Answer: 1 Rationale 1: Creativity is a part of the critical-thinking process that fosters the development and implementation of new approaches to different situations. Rationale 2: Problem solving implies there is a problem that needs a solution. Rationale 3: Brainstorming generates diverse ideas with many superficial solutions. Rationale 4: Decision making identifies one effective strategy that is not necessarily innovative.

The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration? 1. Are there different situational effects or contexts to be considered? 2. How has the problem usually been handled? 3. What is the easiest and least expensive alternative? 4. Can the problem be solved using the nursing process?

Correct Answer: 1 Rationale 1: Critical thinking involves choosing the best alternative from several, depending on the situation in which the problem occurred. This is the context of the problem. Rationale 2: Handling the problem the way it's usually handled may be easy but would not involve critical thinking. Rationale 3: Choosing the easiest or least expensive alternative may be easy but would not involve critical thinking. Rationale 4: The nursing process should be used in critical thinking, but the changing situation is the more defining and specific characteristic of critical thinking.

Part of the facility's performance evaluation is based on the nurse's strength in the three types of decisions. During a nurse manager's performance evaluation the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information? Select all that apply. 1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions." 4. "I am strongest in making decisions when the problems are very unusual or unclear." 5. "I make good decisions when the situation is novel."

Correct Answer: 1,2,3 Rationale 1: Routine decisions are based on policies and rules. Rationale 2: Routine decisions are based on procedures. Rationale 3: Adaptive decisions are often modifications of well-known problems or solutions. Rationale 4: Solving unusual or unclear problems requires innovative decision making. Rationale 5: Novel situations require innovative decision-making abilities.

Which statements by a nurse in the emergency department are examples of groupthink? Select all that apply. 1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work." 4. "We need to consider the workload of the intensive care unit nurses." 5. "Does anyone else have any ideas to discuss?"

Correct Answer: 1,2,3 Rationale 1: Suppression of dissent and new ideas occurs with groupthink. Rationale 2: Stereotyping outsiders is a symptom of groupthink. Rationale 3: There is a strong tendency in groupthink to seek concurrence. Rationale 4: Considering the opinion of others is not a symptom of groupthink. Rationale 5: Leadership controls the discussion and numbers of topics to be discussed in groupthink.

A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? Select all that apply. 1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care. 5. Ignore the situation.

Correct Answer: 1,2,3,4 Rationale 1: Many situations resolve themselves with time. Rationale 2: Support from the manager is important and may lead to self-solving of the problem. Rationale 3: Depending on the problem, the nurses may need information, time off, or problem-solving practice. Rationale 4: The manager should intervene if client care begins to suffer. Rationale 5: The manager must manage this situation.

Currently clients on a unit are bathed in the morning between 8:00 am and 11:00 am. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 pm and 9:00 pm. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change? Select all that apply. 1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 3. "I read a research article that reported that clients sleep better if they have been bathed right before bedtime." 4. "The physician staff will be upset if we change our morning routine." 5. "If we let them change this, they will want to make lots of other changes, too."

Correct Answer: 1,2,4,5 Rationale 1: This is an underlying assumption about why this change is being considered. Rationale 2: This speaker assumes that everyone likes to bathe right before bed, not taking into consideration that some like to bathe in the morning. Rationale 3: A research article report is not an assumption, but is based on evidence. Rationale 4: This is an assumption that might well be erroneous. Rationale 5: This is an assumption.

A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? Select all that apply. 1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Create a spreadsheet for nurses to complete describing their creative efforts. 4. Assign each nurse 15 minutes of a staff meeting to talk about his or her creative efforts. 5. Be receptive to ideas even if they seem strange at the beginning.

Correct Answer: 1,2,5 Rationale 1: Exposure to new ideas and a fresh environment outside the facility increases creativity. Rationale 2: Freedom is necessary to support the creative process. Rationale 3: Filling in a spreadsheet is a bureaucratic, regimented strategy that will not foster creativity. Rationale 4: Making creativity an assignment is a sure way to stifle it. Rationale 5: Being receptive to new ideas encourages creativity.

Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? Select all that apply. 1. A decision made by a group is often better than a decision made by one person. 2. A decision made by an individual results in greater commitment. 3. Groups can provide more input into the process. 4. A decision made by a group can create a greater obligation to achieve results. 5. Routine decisions are more often made by individuals.

Correct Answer: 1,3,4,5 Rationale 1: Decisions made by groups are often better than those made by individuals because there is more input into the process. Rationale 2: There is no evidence to support that a decision made by an individual results in greater commitment. Rationale 3: Decisions made by groups are often better than those made by individuals because there is more input into the process. Rationale 4: The peer pressure of a group can create a greater commitment or feeling of obligation to achieve results. Rationale 5: Routine decisions are often made by individuals, with no group input necessary.

Which statements exemplify the attributes of critical thinking essential to nurses? Select all that apply. 1. "I am always curious about why we do things the way we do." 2. "I think we need to hurry up and make a decision." 3. "Can you help me understand your perspective a little better?" 4. "I don't think that your concern is necessarily pertinent to this issue." 5. "I don't think I can make that decision until I have more information."

Correct Answer: 1,3,5 Rationale 1: Curiosity and a willingness to examine underlying assumptions are characteristic of a critical thinker. Rationale 2: A critical thinker is not in a hurry to make a decision but waits until all the facts are known and can be considered. Rationale 3: The critical thinker considers the possible alternative perspectives. Rationale 4: The critical thinker does not discount the concerns of others who have knowledge of the issue. Rationale 5: The critical thinker collects and analyzes the facts before considering any decision.

A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity? Select all that apply. 1. The manager has historically used trial and error as a decision-making strategy. 2. The manager takes unnecessary risks when staffing the unit. 3. The manager is not concerned when staff members arrive late to work. 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit. 5. The manager does not consider the advice of the unit co-manager when making a decision.

Correct Answer: 1,4 Rationale 1: A history of ineffective trial and error solutions to problems tends to make the manager rigid. Rationale 2: Generally, fear of risk taking is characteristic of a rigid management style. Rationale 3: Rigidity in personality often translates to rigidity in management style. A rigid manager would be upset if staff members routinely came to work late. Rationale 4: Using old ways of thinking to solve new problems is characteristic of rigid management. Rationale 5: Rigid managers typically prefer to make decisions independently.

A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect? 1. Assessment 2. Diagnosis 3. Planning 4. Evaluation

Correct Answer: 2 Rationale 1: Assessment is collecting the evidence. Rationale 2: Suspending judgment is equivalent to the diagnosis step. Rationale 3: Planning would occur when information is collected and analyzed and a course of action is being determined. Rationale 4: Deciding which hypothesis is correct is evaluation.

A nurse working in a rehabilitation center notices clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem? 1. Calling local beverage distributors to inquire about service pricing 2. Asking all employees to write down their ideas about a solution 3. Determining what type of drinks most clients might want 4. Encouraging clients to bring a drink from home

Correct Answer: 2 Rationale 1: Calling a local beverage distributor is a "classic" way to address this problem and does not engage the creativity of the staff. Rationale 2: Asking others to think about different options opens up the possibilities beyond one individual's ideas. This is part of the preparation stage of creativity. Rationale 3: Finding out the drink preferences of the clients is part of the standard information gathering stage of providing drinks and does not reflect creativity. Rationale 4: Simply encouraging clients to bring a drink from home is not a creative approach to solving this problem.

Which statement indicates understanding of how a nurse could improve personal decision-making skills? 1. "We should gather a group together to make important unit decisions to ensure fairness." 2. "I should practice making decisions by developing potential solutions and then choosing one." 3. "We can make a decision and then ask for input from others to make sure it was the right choice." 4. "I know I will never be able to improve my decision-making skills because I am not a strong person."

Correct Answer: 2 Rationale 1: Depending on a group is not likely to help the nurse improve personal decision-making skills. Rationale 2: Practicing making decisions will increase the nurse's experience, comfort, and overall skill. Rationale 3: Including a "we" in this process is not as likely to improve the nurse's personal decision-making skills as making an individual decision. Asking for input to make certain the choice was correct indicates lack of certainty. Rationale 4: Decision-making skills can be learned regardless of one's perceived personal strength.

A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent? 1. Group problem solving 2. Critical thinking 3. Groupthink 4. Satisficing

Correct Answer: 2 Rationale 1: Group problem solving implies that a problem exists, which is not the case in this situation. The task force is comparing two models of practice, not solving a problem. Rationale 2: Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified. Rationale 3: Groupthink is a negative phenomenon that occurs in highly cohesive groups that become isolated. There is no evidence that groupthink has occurred in this situation. Rationale 4: Satisficing is a type of decision-making strategy that identifies a strategy that is minimally acceptable. There is no evidence that satisficing has occurred in this situation.

A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept? 1. Evidence 2. An underlying assumption 3. An alternative perspective 4. An inquiring attitude

Correct Answer: 2 Rationale 1: Scientific evidence shows that milk is not tolerated by all adults. This action is not based in science. Rationale 2: The nurse's assumption is that milk is good for adults. Rationale 3: The nurse has not considered the alternative perspective that milk is not tolerated by some adults. Rationale 4: An inquiring attitude would lead the nurse to investigate research about adult tolerance to milk.

A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior? 1. This nurse is too inexperienced to realize the behavior is inappropriate. 2. This nurse is learning to be creative. 3. This nurse believes that new nurses are more knowledgeable than those who have worked several years. 4. This nurse misunderstands the work of the committee.

Correct Answer: 2 Rationale 1: This behavior is not inappropriate. Rationale 2: Challenging details is a part of the preparation portion of learning to be creative. Rationale 3: There is no indication that this is the belief of this nurse. Rationale 4: There is no indication that this nurse does not understand the work of the committee.

A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? Select all that apply. 1. There is risk associated with the decision. 2. The alternatives are known. 3. The conditions of each alternative are clear. 4. Possible consequences of alternatives are not known. 5. The decision is complex and dynamic.

Correct Answer: 2,3 Rationale 1: With decisions made under certainty, there is little if any risk. Rationale 2: When a decision is made under certainty, the possible alternatives are known. Rationale 3: When a decision is made under certainty, the conditions surrounding possible alternatives are clear. Rationale 4: If possible consequences of alternatives are not known, the decision is being made under conditions of uncertainty. Rationale 5: Complex and dynamic decisions are those made under uncertainty.

Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Select all that apply. 1. Experimentation 2. Intuition 3. Satisficing 4. Past experience 5. Trial-and-error method

Correct Answer: 2,4 Rationale 1: Experimentation involves testing a theory to produce a prediction. Rationale 2: Intuition and past experiences enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. Rationale 3: Satisficing involves choosing a solution to meet minimum standards of care. Rationale 4: Intuition and past experience enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. Rationale 5: The trial-and-error method is not based on prior experience; rather, one approach after another is tried until the problem is solved.

A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability? 1. When disagreements occur on the unit, the manager privately asks the dissenters to be silent about the issue at meetings. 2. Tell staff members that they must present one opinion regarding the solutions they desire. 3. Demonstrate a genuine desire to find our why there is dissention. 4. Develop "tunnel vision" when it comes to problems on the unit.

Correct Answer: 3 Rationale 1: Managers should not assume that only one opinion can be voiced and that others will be silent. Rationale 2: Managers should not assume that only one opinion can be voiced. Rationale 3: Good managers start out with a commitment to find out why others disagree. Rationale 4: Tunnel vision makes it difficult to see things from another perspective and will not encourage staff to avoid preconceived ideas.

The nursing group has been charged with the task of solving a patient care problem on the units. Which step should this group take first in this process? 1. Investigate what has already been tried to solve the issue. 2. Brainstorm about potential solutions. 3. Gather information to define the problem. 4. Categorize information in order of reliability.

Correct Answer: 3 Rationale 1: Once the problem has been identified, the group would then look at solutions that have already been tried. Rationale 2: Brainstorming is used to develop solutions after information about the problem is analyzed. Rationale 3: Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem. Rationale 4: Information cannot be sorted into an orderly arrangement until it has been collected.

Which action by the nurse manager is a demonstration of satisficing? 1. The nurse manager works with the staffing schedule until all requested days off are honored. 2. The nurse manager reposts a job opening because no applicants were a good fit for the current unit staff. 3. The nurse manager agrees with a proposed budget that does not provide badly needed new client beds. 4. The nurse manager insists on firing a nurse who is chronically late to work.

Correct Answer: 3 Rationale 1: Satisficing would not involve extra effort to honor requested days off. Rationale 2: If the nurse manager was satisficing, someone would be hired, even if the fit was not good. Rationale 3: This is an example of satisficing. An example of not satisficing would be the nurse manager not agreeing with the budget until funding for the beds was provided. Rationale 4: A nurse manager who is satisficing would provide continued counseling, work with the nurse, make excuses, and retain the nurse on staff.

The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential? 1. Obtain funding for a simulation mannequin. 2. Write standardized scripts for volunteers who will portray clients. 3. Add more information to existing care plans as the study unfolds. 4. Assign client care debate topics to teams of three or four students.

Correct Answer: 3 Rationale 1: Simulation mannequins are not essential for problem-based learning. Rationale 2: It is not essential to have a person who portrays a client in order to conduct problem-based learning. Rationale 3: Problem-based learning exists when students are exposed to "what comes next" in a case study. Additional information is revealed as the case study progresses. Rationale 4: Debates are a way to encourage innovation but are not essential for problem-based learning.

The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use? 1. Political decision-making model 2. Experimentation process 3. Rational decision-making model 4. Trial-and-error method

Correct Answer: 3 Rationale 1: The premise of the political decision-making model is that decisions align with the interests of powerful stakeholders such as hospital boards and regulatory bodies. Rationale 2: Experimentation involves the use of a pilot project to test the effectiveness of a solution. Rationale 3: The rational decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes. Rationale 4: The trial-and-error method is used by inexperienced managers and involves the application of one solution after another to improve a problem.

At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced? 1. Do not suggest any solution that is prohibitively expensive. 2. Suggest only ideas that the group has not already tried. 3. Do not critique any ideas presented. 4. Limit the session to the first 15 ideas.

Correct Answer: 3 Rationale 1: While all organizations are governed by a budget, what is "prohibitive" to one committee member may not be so to another. All solutions should be expressed. Rationale 2: Sometimes an "old" solution is workable. Rationale 3: Brainstorming is for idea generation only. Idea critique will follow in another session. Rationale 4: The idea of brainstorming is to generate lots of ideas quickly. It would be better to limit the time than to limit the number of ideas.

Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? Select all that apply. 1. "I would like to change the format we use for shift report, but I'm afraid it would upset staff members who have been here a long time." 2. "This is the decision I have made, and there is no room for discussion." 3. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 4. "I am certain that our new assignment system is going to make the workload more equitable." 5. "I know this week has been rough. I feel a little like sandpaper myself."

Correct Answer: 3,4,5 Rationale 1: Basing decisions on placating staff indicates the leader is insecure and does not energize staff or promote creativity. Rationale 2: The leader who does not value input from staff will not promote creativity. Rationale 3: The leader who recognizes the staff's efforts and sacrifices is more likely to energize the staff. Rationale 4: Optimism is crucial to energizing staff and promoting creativity. Rationale 5: Humor is a good method to help energize staff and promote creativity.

The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a 2-week gap in the meetings to allow which portion of the creative process to occur? 1. Farsight 2. Verification 3. Preparation 4. Incubation

Correct Answer: 4 Rationale 1: Farsight is not part of this process. Rationale 2: Verification is evaluation of the solution's effectiveness. Rationale 3: Preparation is planning time. Rationale 4: The period of lapsed time before a decision is made is the "incubation" time.

The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. After reviewing the statistics, the manager finds that option A is more cost-effective than option B but decides to implement option B because it seems safer. Which option best describes the basis of this decision? 1. Probability 2. Probability analysis 3. Objective probability 4. Subjective probability

Correct Answer: 4 Rationale 1: Probability is the likelihood, expressed as a percentage, that an event will or will not occur. Rationale 2: Probability analysis is a method of calculating expected risk; this is the method the nurse used to compare the two options. Rationale 3: Objective probability is the likelihood that an event will or will not occur, based on facts and reliable information. Rationale 4: Even though option A is more cost-effective, the manager believes option B to be in the best interest of the unit. Subjective probability is the likelihood that an event will or will not occur based on personal judgment and beliefs.

A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement? 1. Emergency department nurses do not make professional client handoff reports. 2. Long-term-care facility nurses lack the education to make complete assessments prior to client transfers. 3. Housekeepers are getting sloppy about cleaning rooms. 4. Unit clerks have made 10 transcription errors in the last 6 months.

Correct Answer: 4 Rationale 1: This is a judgment statement. Rationale 2: This is a judgment statement. Rationale 3: "Getting sloppy" is a judgment statement. Rationale 4: A good problem statement reflects the facts without judgment as to cause.

The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity? 1. Watch others implement creative solutions. 2. Work with a group to implement a creative solution. 3. Evaluate the effectiveness of creative solutions. 4. Practice the steps of the process as often as possible.

Correct Answer: 4 Rationale 1: Watching others implement creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. Rationale 2: Working with a group to implement a creative solution would be helpful in improving the nurse's creativity, but it is not the best of these choices. Rationale 3: Evaluating the effectiveness of creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. Rationale 4: The most effective of these methods would be practicing the steps. Creativity is a skill that can be learned and improved through practice, just like technical skills.