Chapter 1 - Notes Version of the PPT Slides PDF

# Chapter 1 - Notes Version of the PPT Slides ## Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning: Requisites for Successful Leadership and Management ### Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning **Decision making** * cognitive proces...

# Chapter 1 - Notes Version of the PPT Slides ## Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning: Requisites for Successful Leadership and Management ### Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning **Decision making** * cognitive process of choosing a particular course of action * complex * the thought process of selecting a logical choice from available options ### Problem solving * part of decision making * systematic process focusing on analyzing a difficult situation * decision making is the last step in the problem-solving process * decision making can occur without the full analysis required in problem solving. ### Critical Thinking or Reflective Thinking The mental process of actively and skillfully: * conceptualizing * applying * analyzing * synthesizing * evaluating information to reach an answer or conclusion. #### DISPLAY 1.1 Characteristics of a Critical Thinker/Reflective Thinker * Insight * Open to New Ideas * Intuitive * Energetic * Analytical * Flexible * 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 ### Clinical Reasoning Integrating and applying different types of knowledge to: * weigh evidence * critically think about arguments * reflect on the process used to arrive at diagnosis. ### Collaborative and reflective process that involves: * content-specific knowledge * engagement of the patient and family in understanding the clinical problem * incorporation of critical contextual factors. ### Learning to Enhance Decision-Making Skills * **Case studies:** provide stories that impart learning * **Simulations:** provide opportunities for learning with no risk to patients or organizational performance * It also appeared to enable the development of transferable, transformational leadership skills, improved students' critical thinking and clinical reasoning in complex care situations and aided in the development of students' self-efficacy and confidence in their own clinical abilities. (Lewis, Strachan & Smith, 2012) ### **Problem-based learning (PBL):** provides opportunities for learners to address and learn from authentic problems vicariously. ##### **Source**: Lewis, R., Strachan, A., & Smith, M. (2012). Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence. *Open Nursing Journal*, 6, 82-89. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415625/ ##### **Source**: Lewis, R., Strachan, A., & Smith, M. (2012). Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence. *Open Nursing Journal*, 6, 82-89. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415625/ ### Experiential Learning/Learning Exercises * Provides mock life experiences to learn from * Allows learners to apply leadership and management theory * Promotes whole brain thinking and improved problem- solving skills ## Problem-Solving versus Decision-Making Models ### The Traditional Problem-Solving Process * Identify the problem. * Gather data to identify the causes and consequences of the problem. * Explore alternative solutions. * Evaluate each alternative * Select appropriate solution * Implement solution * Evaluate results. ### Managerial Decision-Making Model * Determine the decision and the desired outcome (set objectives). * Research and identify options. * Compare and contrast these options and their consequences. * Make a decision. * Implement an action plan. * Evaluate 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 - use research. * Generate many alternatives. * Think logically * Choose and act decisively. ### Define Objectives Clearly * Decision makers often forge ahead in their problem-solving process without first determining their goals or objectives. * Time to pause and reflect on the purpose of the decision * Without a clear objective in mind or a decision that is inconsistent with one's philosophy is likely to be a poor-quality decision. * Sometimes the problem has been identified, but the wrong objectives are set. ### Gather Data Carefully * Learn how to process and obtain accurate information. * Confirmation bias refers to our tendency to search for and favor information that confirms our beliefs while simultaneously ignoring or devaluing information that contradicts our beliefs * Acquiring information always involves people, and no tool or mechanism is infallible to human error. * Must be vigilant that their own preferences and those of others are not mistaken for facts. * The nurse who becomes expert at acquiring adequate, appropriate, and accurate information will have a head start in becoming an expert decision maker and problem solver. ### Questions to Examine in Data Gathering * 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 is happening? * Why is it happening? What are the causes of the problem? Can I prioritize the causes? * What are the basic underlying issues? Areas of conflict? * What are the consequences of the problem? Which of these are most serious? ### Take the Time Necessary * Most current problem-solving and decision-making theories argue that human decision making is largely based on the quick, automatic, and intuitive processes. * Although trivial decisions can be made fairly quickly, slower, more controlled deliberation is needed when outcomes may have significant consequences. ### Use an Evidence-Based Approach * Data gathering sources include textbooks, periodicals, experts in the field, colleagues, and current research. * Most experts agree that the best practices in nursing care and decision making are also evidence-based practices. * Many practicing nurses feel they do not have the time, access, or expertise needed to search and analyze the research literature to answer clinical questions. * Too few nurses understand what best practices and evidence-based practice are all about, and many organizational cultures do not support nurses who seek out and use research to change long-standing practices rooted in tradition rather than in science. ### Strategies for New Nurses to Promote Evidence-Based Practice * Keep abreast of the evidence. * Use multiple sources of evidence. * Use evidence to support clinical interventions and teaching strategies. * Find established sources of evidence. * Implement and evaluate nationally sanctioned clinical practice guidelines. * Question and challenge nursing traditions. * Dispel myths and traditions not supported by evidence. * Collaborate with other nurses locally and globally. * Interact with other disciplines to bring nursing evidence to the table. ### Generate Many Alternatives * Definition of decision making implies that there are at least two choices in every decision. * Unfortunately, many problem solvers limit their choices to two when many more options usually are available. * One alternative in each decision should be the choice not to do anything. * It is often found that the status quo is the right alternative. * Increasing the number of people working on a problem increases the number of alternatives that can be generated. * Brainstorming is a frequently used technique. ### Think Logically * People must carefully think through the information and the alternatives. * Faulty logic at this point may lead to poor-quality decisions. ### People Think Illogically in Three Ways * **Overgeneralizing:** This type of “crooked” thinking occurs when one believes that because A has a particular characteristic, every other A also has the same characteristic. * **Affirming the consequences:** In this type of illogical thinking, one decides that if B is good and they are doing A, then A must not be good. * **Arguing from analogy:** This thinking applies a component that is present in two separate concepts and then states that because A is present in B, then A and B are alike in all respects. * **Example**: Any characteristic present in a good clinical nurse also should be present in a good nurse-manager. However, this is not necessarily true; a good nurse-manager does not necessarily possess all the same skills as a good nurse-clinician. ### Frequent Errors Made in Decision Making * Failure to use science , logic, and empirical evidence in making decisions * Not considering enough alternatives ### Choose and Act Decisively * In the final analysis, one must act. * Individual's delay acting because they do not want to face the consequences of their choices. * It may help the reluctant decision maker to remember that even though decisions often have long-term consequences and far-reaching effects, they are not usually cast in stone. * Judgments found to be ineffective or inappropriate can be changed. * By later evaluating decisions, nurses can learn more about their abilities and where the problem solving was faulty. * Through continued decision making, people develop improved decision-making skills. ### Nursing Process: A Problem-Solving and Decision-Making Model * Assess. * Analysis/ Diagnose. * Plan. * Implement. * Evaluate. ### Feedback Mechanism of the Nursing Process [A diagram is here, containing the following words] * Assess * Diagnose * Evaluate * Implement * Plan ### TABLE 1.1 COMPARING THE DECISION-MAKING PROCESS WITH THE NURSING PROCESS | Decision-Making Process | Simplified Nursing Process | |---|---| | Identify the decision. | Assess. | | Collect data. | | | Identify criteria for decision. | Plan. | | Identify alternatives. | | | Choose alternative. | Implement. | | Implement alternative. | | | Evaluate steps in decision. | Evaluate. | ### DISPLAY 1.5 Integrated Ethical Problem-Solving Model * State the problem. * Collect additional information and analyze the problem. * Develop alternatives and analyze and compare them. * Select the best alternative and justify your decision. * Develop strategies to successfully implement a chosen alternative and take action. * Evaluate the outcomes and prevent a similar occurrence. ### Questions Asked in Analyzing Solutions * What factors can you influence? How can you accentuate the positive factors and minimize the negative factors? * What are the financial, political, time, and resource implications of each possible solution? * What are the weighting factors? * What is the best solution? * What are the means of evaluation? * What are the consequences of each alternative? ### Intuitive Decision-Making Models * There are theorists who suggest that intuition should always be used as an adjunct to empirical or rational decision-making models. * Experienced (expert) nurses often report that gut-level feelings (intuition) encourage them to take appropriate strategic action that impacts patient outcomes, although intuition generally serves as an adjunct to decision making founded on a nurse's scientific knowledge base. Intuition then can and should be used in conjunction with evidence-based practice. * Krishnan (2018) agrees, noting that as nurses work in ever-changing health-care environments, neither logical thinking nor intuition are adequate to describe the dynamic processes nurses use in clinical decision making. * Thus, the cognitive processes used in decision making are neither completely analytical nor completely intuitive (see Examining the Evidence 1.1). * Always back it up with science/ebp ### Successful Decision Makers * **Self-Awareness:** Individual's ability to assess their own strengths and weaknesses. * **Courageous:** Very brave * **Sensitivity:** Good decision makers seem to have some sort of antenna that makes them particularly sensitive to situations and others. * **Energy:** People must have the energy and desire to make things happen. * **Creativity:** Successful decision makers tend to be creative thinkers. They develop new ways to solve problems. ### Successful Decision Maker **Understands:** * Gender - use parts of the brains differently * Personal individual values – influence perceptions, information gathering, information processing, and final outcome. * Life experience – education and decision-making experience. The more mature the person and the broader his or her background, the more alternatives they she can identify. Seek or fear autonomy. * Preferences and willingness to take risk - may see certain choices as involving greater personal risk than others and therefore may choose the safer alternative. * Brain hemisphere dominance - Individuals think differently, intuitive/creative, or analytical/linear. * Predominant thinking style – based on brain dominance ### Types of Decision Making * Recurrent and routine problem solving * Satisficing "good enough” so that they “work * The “best” choice for many decisions is often found to be too costly in terms of time or resources, so another less costly but workable solution is found. * Maximizing or optimal mode ### Decision-Making Tools * **Decision Grid** - allows one to visually examine the alternatives and compare each against the same criteria. Although any criterion may be selected, the same criteria are used to analyze each alternative. * **Payoff Tables** - have a cost-profit-volume relationship and are very helpful when some quantitative information is available, such as an item's cost or predicted use. Because decisions are often tied to the outcome of other events, management analysts have developed decision trees. * **Consequence Tables** demonstrate how various alternatives create different consequences. A consequence table lists the objectives for solving a problem down one side of a table and rates how each alternative would meet the desired objective. * **Logic Models** are schematics or pictures of how programs are intended to operate. The schematic typically includes resources, processes, and desired outcomes and depicts exactly what the relationships are between the three components. * **Program Evaluation and Review Technique - PERT** is a popular tool to determine the timing of decisions. ### Example of a Decision Tree [A decision tree is here, containing the following words] * POSSIBLE EVENTS * ALTERNATIVE ACTIONS * Increased demand for procedures * Decreased demand for procedures * Hire regular staff * Decision point (last event to occur) * Variables affecting the direction of the decision tree: * Revenue from procedures * Costs * First-year expected value ### Figure 1.3 ### A decision grid. | Alternative | Financial effect | Political effect | Departmental effect | Time | Decision | | -------------- | -------------- | ------------- | ------------------- | ---- | -------- | | #1 | -------------- | ------------- | ------------------- | ---- | -------- | | #2 | -------------- | ------------- | ------------------- | ---- | -------- | | #3 | -------------- | ------------- | ------------------- | ---- | -------- | | #4 | -------------- | ------------- | ------------------- | ---- | -------- | ##### Copyright©2015 Walters Kluwer Health | Lippinott Williams & Wilkins ### Consequence Table ### TABLE 1.3 A Consequence Table | Objectives for Problem Solving | Alternative 1 | Alternative 2 | Alternative 3 | |---|---|---|---| | 1. Reduces the number of falls | X | X | X | | 2. Meets regulatory standards | X | X | X | | 3. Is cost-effective | X | X | X | | 4. Fits present policy guidelines | X | X | X | | Decision Score | | | | ##### Copyright ©2015 Wolters Kluwer Health | Lippincott Williams & Wilkins ### To Make Better Decisions * Use a systematic decision- making process whenever possible. **Information in PPT slides and notes retrieved from the textbook for the course**: Huston, C. J. (2024). _Leadership roles and management functions in nursing_ (11th ed.). Wolters Kluwer