Critical Thinking and Decision Making

Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning

• Decision making is a cognitive process, a thought process of selecting a logical choice from available options.
• Decision making is complex.
• Problem solving is a part of decision making.
• Problem solving involves a systematic analysis of a difficult situation.
• Decision making can occur without comprehensive problem-solving analysis.

Critical Thinking/Reflective Thinking

• Critical thinking is an active and skillful mental process.
• This process involves conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach a conclusion.

Characteristics of a Critical Thinker/Reflective Thinker

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

Problem Solving vs. Decision Making Models

• Problem-Solving Process: Identifying a problem, gathering data on causes and consequences, exploring solutions, evaluating solutions, selecting a solution, implementing the solution, and evaluating results.
• Managerial Decision-Making Model: Defining and setting objectives, researching options, comparing and contrasting options and their consequences, making a decision, implementing an action plan, and evaluating results.

Critical Elements in Problem Solving and Decision Making

• State a clear objective.
• Gather data carefully.
• Take the time necessary.
• Use an evidence-based approach.
• Generate many alternatives.
• Think logically.
• Choose and act decisively
• Define objectives clearly

Gather Data Carefully

• Nurses must accurately acquire information, recognizing potential biases and errors.
• Nurses must be aware that their own preferences and those of others may not be the facts when collecting data.
• Problems may sometimes be identified incorrectly, but objectives must be appropriately established. (Focus on the accurate gathering of information.)

Questions to Examine in Data Gathering

• What is the setting?
• What is the problem?
• Where is the problem?
• When is the problem?
• Who is affected by the problem?
• What is happening?
• Why is it happening? (Causes and priorities of the causes.)
• What are the underlying issues? (Areas of conflict)
• What are the consequences of the problem? (Seriousness of consequences)

Take the Time Necessary

• Humans often rely on quick, automatic, and intuitive processes during decision-making, though critical thinking demands more deliberate consideration.
• Slower, controlled deliberations are needed when outcomes have significant consequences

Use Evidence-Based Approach

• Utilize various sources such as textbooks, periodicals, experts, and current research.

Strategies for New Nurses to Promote Evidence-Based Practice

• Staying informed about the latest evidence
• Using multiple sources of evidence
• Implementing and evaluating guidelines
• Challenging nursing traditions with evidence
• Collaborating with other nurses

Generate Many Alternatives

• Decisions often involve more than two choices.
• One option should always be determining whether to do nothing at all.
• Brainstorming effectively expands the decision-making pool of options.

Think Logically

• Carefully consider information and alternatives.
• Avoid illogical thinking by avoiding overgeneralizations and affirming the consequences.
• Avoid arguments from analogy.

Define Objectives Clearly

• A clear definition of objectives allows for the development of well-defined solutions.
• Without clear objectives, decisions are less likely to meet one's goals and can reflect biases and personal preferences, not true best practice.

Frequent Errors Made in Decision Making (in Decision Making)

• Failure to utilize science, logic, and evidence in decisions.
• Not considering sufficient alternatives
• Hesitation to act decisively

Clinical Reasoning

• Integrating different types of knowledge to: weigh evidence, think critically about arguments, and reflect on processes used to arrive at diagnosis.
• A collaborative and reflective process that involves content-specific knowledge, patient/family engagement, and incorporation of critical contextual factors.
• Leads to deliberate decision making and sound clinical judgement.

Learning to Enhance Decision-Making Skills

• Case studies provide learning opportunities without risk to patients or organizational performance.
• Simulations provide safe learning environments.
• Problem-based learning (PBL) enables learning from authentic problems vicariously.

Experiential Learning/Learning Exercises

• Provides mock life experiences to learn from.
• Allows application of leadership and management theories.
• Promotes whole-brain thinking and improved problem-solving skills.

Ethical Problem-Solving Model

• The ethical problem-solving model involves these steps: Stating the problem, collecting additional information and analyzing the problem, developing and analyzing alternatives, selecting the best alternative, implementing, and evaluating the outcomes to prevent recurrences.

Decision-Making Process

• Identifying the decision
• Collecting data
• Identifying the criteria for decision
• Identifying the alternatives
• Choosing the alternative
• Implementing the alternative
• Evaluating the steps in the decision

Integrated Ethical Problem-Solving Model

• State the problem
• Collect and analyze additional information
• Develop alternatives and compare them
• Select the best alternative
• Develop strategies to implement the chosen alternative
• Evaluate the outcome and prevent future occurrences.

Intuitive Decision-Making Models

• The use of intuition should be considered as an adjunct, or an addition to, other decision-making models.
• Intuitive models involve gut feelings and experience, while aiding decision-making in complex situations.

Successful Decision Makers

• Self-Awareness
• Courageous
• Sensitivity
• Energy
• Creativity