Problem-Solving Processes

Four-step model for defining problems

--Establish the need for a solution --Justify the need --Contextualize the problem --Write the problem statement

Team-Initiated Problem Solving (TIPS) model

--Identify potential problems --Develop hypotheses --Discuss and select solutions --Develop and implement action plan --Evaluate and revise action plan

Common downfalls of the problem-solving process

--Improper identification of the problem --Patching (the process of focusing on fixing a symptom of the problem instead of solving the problem itself)

Four steps in diagnosing a problem before implementing problem-solving

--Know the facts --Separate the facts from interpretation --Be objective and descriptive --Determine the scope of the problem

Categories problems usually fall under (the four Ms)

--Manpower --Methods --Machines --Materials

The clinical nurse manager in the intensive care unit is creating a new staffing matrix to address shortage concerns. Which attribute may interfere with this problem-solving process? 1) Using a structured approach 2) Incorporating personal beliefs 3) Basing decisions on facts only 4) Considering how a mentor may approach the problem

2) Incorporating personal beliefs Rationale: Professional knowledge should be utilized, but personal values and personal beliefs should not be included in the decision-making process. This can inhibit the problem-solving process and deviate from the actual issue at hand.

The chief nursing officer (CNO) is working with a committee to resolve nursing ratio problems in the hospital. The CNO is likely to generate several viable solutions by performing which actions? 1) Including personal values 2) Thinking outside of the box 3) Considering everyone's views 4) Remaining firm with decisions 5) Showing a willingness to adjust

2) Thinking outside of the box Rationale: Creativity allows the CNO to identify a wide range of solutions, increasing the chance of successfully resolving the issue. 3) Considering everyone's views Rationale: Open-mindedness allows the CNO to identify a wide range of solutions, increasing the chance of successfully resolving the issue. 5) Showing a willingness to adjust Rationale: Flexibility allows the CNO to identify a wide range of solutions, increasing the chance of successfully resolving the issue.

The nurse manager overhears a staff nurse say, "Our bosses are so clueless. They have no idea about my cultural background or the background of our patients." Which is an appropriate action for the manager to take? 1) Confront the nurse about the comment, asking for specific examples of the concern 2) Schedule a meeting with the staff, sharing that all cultures are valued and important 3) Host a luncheon, asking each nurse to bring a food item representing their culture 4) Request the nurse's personal background information from the human resources department

3) Host a luncheon, asking each nurse to bring a food item representing their culture Rationale: Hosting a luncheon with a diversity focus shows that the nurse manager wants to learn about the cultures of the staff and helps the staff know that their respective cultures are valued and celebrated.

The nurse manager of an orthopedic floor is trying to address an inadequate documentation of patient teaching. Which statements by the nurse manager represent steps in a team-initiated approach to problem-solving model? 1) "I will investigate if this problem has occurred on other floors, and if so, how they addressed it." 2) "I will evaluate the potential reasons why nurses on the floor are inadequately documenting patient teaching." 3) "Inadequate documentation must be due to inexperienced graduates; I should hire more experienced nurses." 4) "I am going to write a list of creative ways to implement a new training program on documenting patient teaching." 5) "The nurses know that documentation is important. Therefore, if it wasn't documented, the patient teaching was not completed."

1) "I will investigate if this problem has occurred on other floors, and if so, how they addressed it." Rationale: Asking about problems and successful solutions on other floors is an important part of the "gather data" step of the team-initiated approach to problem-solving model. 2) "I will evaluate the potential reasons why nurses on the floor are inadequately documenting patient teaching." Rationale: Evaluating the cause of the problem is an example of the "analyze data" step of the team-initiated approach to problem-solving model. 4) "I am going to write a list of creative ways to implement a new training program on documenting patient teaching." Rationale: Thinking of ways to implement a new training program refers to the "develop solutions" step in the team-initiated approach to problem-solving model.

The charge nurse of a busy outpatient unit is faced with several issues requiring attention during the shift. Which technique is important as an initial approach by the charge nurse to address these issues? 1) Determine which problems are the most critical 2) Delegate the issues to other nursing staff during the shift 3) Begin with the problems that will take the longest to resolve 4) Create a schedule to address all of the issues during the shift

1) Determine which problems are the most critical Rationale: The nurse should begin by using a triage method and determine which problems are the most critical and need attention now.

Which actions by the nurse leader constitute an essential component of effective problem-solving? 1) Utilizing a triage approach to identify which patient problems are the most critical 2) Implementing the same care plan for each of five patients with right-sided hemiplegia due to stroke 3) Reaching outside the organization to get ideas from a colleague about new problem-solving techniques 4) Designing a special staff education session to address the lack of quality of documentation on the unit 5) Instructing nurses on a telemetry to consult with the charge nurse each time there is any type of faulty equipment on the unit

1) Utilizing a triage approach to identify which patient problems are the most critical Rationale: Ranking problems and identifying the most important first is an example of a strategic approach to effective problem-solving. 3) Reaching outside the organization to get ideas from a colleague about new problem-solving techniques Rationale: Getting information from someone with a new idea is a tactical method of effective problem-solving. 4) Designing a special staff education session to address the lack of quality of documentation on the unit Rationale: Using a new approach to a problem, such as designing a new education training session, is an example of a strategic approach to effective problem-solving.

A clinical supervisor has noticed that charting is frequently incomplete, with an increase in staff call-outs and a decrease in patient satisfaction scores. Which tools can the nurse manager use to determine the cause of this problem? 1) Patching 2) Fishbone diagram 3) The 5 Whys approach 4) Problem-definition process 5) Contextualizing the problem

2) Fishbone diagram Rationale: The fishbone diagram is a tool used to identify the root cause of a problem by using a diagram to connect a problem to all possible causes. 3) The 5 Whys approach Rationale: The 5 Whys is a tool used to identify the root cause of reoccurring problems by asking why something is happening until it has been asked at least 5 times.

The nurse leader has determined that hospital policies for routine diabetic care are outdated. Which actions by the nurse leader indicate use of the TIPS model to solve this problem? Select all that apply. 1) Determining the best solution is the most cost-effective 2) Consulting the diabetic nurse educator to get ideas on how to implement changes 3) Eliminating all potential solutions that have not worked for other organizations in the past 4) Reading journal articles to identify the latest clinical studies for effective treatment of diabetes in the hospital setting 5) Putting a plan in place for a group training session to educate nurses on the new policies and being prepared to offer individual training sessions if necessary

2) Consulting the diabetic nurse educator to get ideas on how to implement changes Rationale: Once a problem is identified, the TIPS model can be followed to gather data about potential solutions. This includes consulting experts in the field. 4) Reading journal articles to identify the latest clinical studies for effective treatment of diabetes in the hospital setting Rationale: Once a problem is identified, the TIPS method can be followed to gather data about potential solutions. This includes reading the latest literature related to the problem. 5) Putting a plan in place for a group training session to educate nurses on the new policies and being prepared to offer individual training sessions if necessary. Rationale: The TIPS model for problem-solving involves implementing a final solution (such as group training sessions), but also putting a contingency plan in place (such as individual training sessions) if Plan A does not solve the problem completely.

A task force was generated to address the problem of extended patient wait times in the emergency department (ED). The group identified that the source of the problem was a shortage of bedside equipment, and was given a budget to resolve this issue. What is the next step for the task force in the problem-definition process? 1) Justify the need 2) Contextualize the problem 3) Establish a need for solution 4) Write the problem statement

2) Contextualize the problem Rationale: A need for a solution has been established and justified, as the task force recognizes that there is an equipment shortage and patient needs are not being met. Therefore, the next step in the process is to contextualize the problem.