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CHAPTER
1
Decision Making, Problem
Solving, and Critical Thinking:
Requisites for Successful
Leadership and Management
1
2 UNIT 1 ■ A New Approach to Leadership and Management
To cope with the realities of today’s health care system, nurses must be prepared to
be critical thinkers. They must also be ready to welcome change and thrive in rap-
idly changing environments. Chapter 1 explores the primary requisites for success-
ful management and leadership: problem solving, critical thinking, and decision
making. Decision making is often thought to be synonymous with management
and is one of the criteria on which management expertise is judged. Much of any
manager’s time is spent critically examining issues, solving problems, and making
decisions. It is the authors’ belief that problem solving, decision making, and criti-
cal thinking are learned skills that improve with practice. So that the processes can
be consistently replicated, these learned skills rely heavily on established tools,
techniques, and strategies.
The quality of the leader–managers’ decisions is the factor that weighs most
heavily in their success or failure. Decision making is both the innermost leadership
activity and the core of management. Therefore, effective leaders and managers
must be able to answer the following questions:
• Do the circumstances warrant that a decision is required?
• How should the decision be made?
• Who should be involved in the decision-making process?
This unit describes the process of decision making in Chapter 1; explores the
development of management theory and management decision-making tools in
Chapter 2; and examines leadership theory from historical to contemporary per-
spectives in Chapter 3. Chapter 1 introduces the reader to problem solving,
decision making, and critical thinking and provides several problem-solving and
decision-making models that assist leaders and managers in making quality deci-
sions. It also introduces the learning exercise as a new approach for gaining skill in
management and leadership decision making.
conflict, used only decision-making skills. The decision maker might later choose
to address the real cause of the conflict or might decide to do nothing at all about
the problem. The decision has been made not to problem solve. This alternative
may be selected because of a lack of energy, time, or resources to solve the real prob-
lem adequately. In some situations, this is an appropriate decision.
Here is an example of a decision not to solve a problem. A nursing supervisor
has a staff nurse who has been absent a great deal during the last 3 months. How-
ever, the supervisor has reliable information that the nurse will be resigning soon to
return to school in another state. Because the problem will soon no longer exist, the
supervisor decides that the time and energy needed to correct the problem are not
warranted.
Critical thinking, sometimes referred to as reflective thinking, is related to evalu-
ation and has a broader scope than decision making and problem solving. “Critical
thinking is purposeful, outcome-directed thinking that is based on a body of
knowledge derived from research and other sources of evidence” (Ignatavicius,
2001, p. 38). Components of critical thinking include reasoning and creative analy-
sis. Ignatavicious (2001) has identified six cognitive skills used in critical thinking,
including evaluation and analysis (see Display 1.1).
Various theorists define critical thinking differently, but most agree that it is
more complex than problem solving or decision making, involves higher-order rea-
soning and evaluation, and has both a cognitive and affective component. The Insight, intuition,
authors believe that insight, intuition, empathy, and the willingness to take action empathy, and the
are additional components of critical thinking. These same skills are necessary to willingness to take
some degree in decision making and problem solving. See Display 1.2 for some action are components
additional characteristics of a critical thinker. of critical thinking.
problems and judge wisely by this trial-and-error method because much is left to
chance.
Some educators feel that people are not successful in problem solving and deci-
sion making because individuals are not taught how to reason insightfully from
multiple perspectives. Belcher (2000) maintains that managers’ critical thinking
skills can be improved by having students write management case studies for analy-
sis. She thinks that improved critical thinking skills have a positive effect on the
quality of a manager's decision making and problem solving skills. Ignatavicious
(2001) feels that anyone can learn critical thinking, but it is a long-term process
that must be practiced, nurtured, and reinforced.
Didactic
theory
Problem Personalized
solving learning
Group
process
process, which can be accomplished by the use of large and small groups and class-
room discussion. Lastly the material must be made real for the learner so that the
learning is internalized. This can be accomplished through writing exercises, per-
sonal exploration, values clarification, and risk-taking that is involved as case stud-
ies are examined.
This book was developed with the perspective that experiential learning pro-
vides mock experiences that have tremendous value in applying leadership and
management theory. Throughout this text the authors have included numerous
opportunities for readers to experience the real world of leadership and manage-
ment. Some of these learning situations, which are called learning exercises, include
case studies, writing exercises, specific management or leadership problems,
staffing and budgeting calculations, group discussion or problem solving, and
assessment of personal attitudes and values. Some exercises include opinions, spec-
ulation, and value judgments. Since almost all the learning exercises require critical
thinking, problem solving, or decision making to some degree, the remainder of
this chapter will focus on providing a theoretical foundation for leadership and
management problem solving.
6 UNIT 1 ■ A New Approach to Leadership and Management
Assess Diagnose
Evaluate Plan
Implement
8 UNIT 1 ■ A New Approach to Leadership and Management
model for solving leadership and management problems. Table 1.1 shows how closely
the nursing process parallels the decision-making process.
The weakness of the nursing process, like the traditional problem-solving
model, is in not requiring clearly stated objectives. Goals should be clearly stated in
the planning phase of the process, but this step is frequently omitted or obscured.
However, because nurses are familiar with this process and its proven effective-
ness, it continues to be recommended as an adapted theoretical process for leader-
ship and managerial decision making.
Many other excellent problem analysis and decision models exist. The model
selected should be one with which the decision maker is familiar and one appropri-
ate for the problem to be solved. Using models or processes consistently will
increase the likelihood that critical analysis will occur. By cultivating a scientific
approach, the quality of one’s management and leadership problem solving and
decision making will improve tremendously.
1. Assess 2. Recall
Possible
Gather Nursing
Patient Diagnosis
Data and
Interventions
4. Implement/ Patient
Evaluate 3. Plan
Implement Analyze
incorporates recall or cumulative knowledge that comes from education, both formal
and informal, as well as experience, in planning the decision. Inexperienced or novice
decision makers spend more time in the assessment, recall, and planning phases, where-
as experienced decision makers gather information, recall, and often leap directly to
implementation, because planning has become automatic. That novice nurses and expe-
rienced nurses process information differently has been supported by Benner (1994).
Ironically, this “leap” from information gathering to implementation may be the
greatest weakness of this model. In discussing intuitive decision making, Lamond
and Thompson (2000) warn that since the process is largely invisible, there is little
information to evaluate if the outcome of the decision is less than positive.
Think Logically
During the problem-solving process, one must draw inferences from information.
An inference is part of deductive reasoning. People must carefully think through
the information and the alternatives. Clancy (2003) states that among other things,
deep-seated biases often cloud effective decision making. Faulty logic at this point
may lead to poor-quality decisions. People think illogically primarily in three ways.
1. 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. An example of this thinking is when stereotypical state-
ments are used to justify arguments and decisions.
2. Affirming the consequences. In this type of illogical thinking, one decides that
if B is good but he or she is doing A, then A must not be good. For example,
if a new method is heralded as the best way to perform a nursing procedure
and the nurses on your unit are not using that technique, it is illogical to
assume that the technique currently used in your unit is wrong or bad.
3. 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. An example of this would be to argue that
because intuition plays a part in clinical and managerial nursing, then 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.
Various tools have been designed to assist managers with the important task of
analysis. Several of these tools are discussed later in Chapter 2. In analyzing possi-
ble solutions, individuals may want to look at the following questions:
1. What factors can you influence? How can you make the positive factors
more important and minimize the negative factors?
2. What are the financial implications in each alternative? The political implica-
tions? Who else will be affected by the decision and what support is available?
3. What are the weighting factors?
4. What is the best solution?
5. What are the means of evaluation?
6. What are the consequences of each alternative?
CHAPTER 1 ■ Decision Making, Problem Solving, and Critical Thinking: Requisites for Successful Leadership and Management 13
Values
Individual decisions are based on each person’s value system. No matter how objec-
tive the criteria, value judgments will always play a part in a person’s decision mak-
ing, either consciously or subconsciously. The alternatives generated and the final
choice selected are limited by each person’s value system. For some, certain choices
are not possible because of a person’s beliefs. Because values also influence percep-
tions, they invariably influence information gathering, information processing, and
final outcome (Marquis & Huston, 1995). Values also determine which problems
in one’s personal or professional life will be addressed or ignored.
Life Experience
Each person brings to the decision-making task past experiences that include edu-
cation and decision-making experience. The more mature the person and the
broader his or her background, the more alternatives he or she can identify. Each
time a new behavior or decision is observed, that possibility is added to the person’s
repertoire of choices. People vary in their desire for autonomy, so some nurses may
want more autonomy than others. It is likely that people seeking autonomy may
have much more experience at making decisions than those who fear autonomy.
Likewise, having made good or poor decisions in the past will influence a person’s
decision making.
Individual Preference
With all the alternatives a person considers in decision making, one alternative may
be preferred over another. The decision maker, for example, may see certain choic-
es as involving greater personal risk than others and therefore may choose the safer
alternative. Physical, economic, and emotional risks, and time and energy expendi-
tures, are types of personal risk and costs involved in decision making. For example,
those with limited finances or a reduced energy level may decide to select an alter-
native solution to a problem that would not have been their first choice had they
been able to overcome limited resources.
Thinking Styles
In a group discussion, examine how each individual in the group thinks.
Do you have a majority of individuals with right- or left-brain dominance
in your group? Do more women than men belong to one group? Discuss
what type of thinkers are represented in your family. Did most individuals
in your group have a variety of thinkers in their family?
Values
Being confused and unclear about one’s values may affect decision-making abili-
ty (Huston & Marquis, 1995). Overcoming a lack of self-awareness through val-
ues clarification decreases confusion. People who understand their personal
beliefs and feelings will have a conscious awareness of the values on which their
decisions are based. This awareness is an essential component of decision making
and critical thinking. Therefore, to be successful problem solvers, managers must
periodically examine their values. Values clarification exercises are included in
Chapter 7.
16 UNIT 1 ■ A New Approach to Leadership and Management
Life Experience
It is difficult to overcome inexperience when making decisions. Benner (1994)
refers to this lack of experience as “reason in transition.” However, a person can do
some things to decrease this area of vulnerability. First, use available resources,
including current research and literature, to gain a fuller understanding of the issues
involved. Second, involve other people, such as experienced colleagues, trusted
friends, or superiors, to act as sounding boards and advisors. Third, analyze deci-
sions later to assess their success. By evaluating decisions, people learn from mis-
takes and are able to overcome inexperience.
Individual Preference
Overcoming this area of vulnerability involves self-awareness, honesty, and risk
taking. The need for self-awareness was discussed previously, but it is not enough to
be self-aware; people also must be honest with themselves about their choices and
their preferences for those choices. Additionally, the successful decision maker
must take some risks. Nearly every decision has some element of risk, and most
involve consequences and accountability. Those who are able to do the right but
unpopular thing and who dare to stand alone will emerge as leaders.
including individuals who sometimes have strange ideas and are “out of the box”
thinkers (Ignatavicius, 2001).
Makes decisions in a very rational Makes decisions that are good enough.
manner.
Has complete knowledge of the Because complete knowledge is not possible,
problem or decision situation. knowledge is always fragmented.
Has a complete list of possible Because consequences of alternatives
alternatives. occur in the future, they are impossible
to predict accurately.
Has a rational system of ordering Usually chooses from among a few
preference of alternatives. alternatives, not all possible ones.
Selects the decision that will The final choice is “satisficing” rather than
maximize utility function. maximizing.
Adapted from Simon, 1965.
that restricted knowledge and limited alternatives directly affect a decision’s quali-
ty, these managers gather as much information as possible and generate many alter-
natives. Simon believed that the economic model was an unrealistic description of
organizational decision making. The complexity of acquiring information makes it
impossible for the human brain to store and retain the amount of information that
is available for each decision. Because of time constraints and the difficulty of
assimilating large amounts of information, most management decisions are made
using the administrative model of decision making. The administrative person
never has complete knowledge and generates fewer alternatives. Simon argued that
the administrative person carries out decisions that are only “satisficing,” a term
used to describe decisions that may not be ideal but result in solutions that have
adequate outcomes. These managers want decisions to be “good enough” so that
they “work,” but they are less concerned that the alternative selected is the optimal
choice. 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.
SUMMARY
This chapter has discussed effective decision making, problem solving, and critical
thinking as requisites for being a successful leader and manager. The effective
leader–manager is aware of the need for sensitivity in decision making. The suc-
cessful decision maker possesses courage, energy, and creativity. It is a leadership
skill to recognize the appropriate people to include in decision making and to use a
suitable theoretical model for the decision situation.
The manager should develop a systematic, scientific approach to problem solv-
ing that begins with a fixed goal and ends with an evaluation step. Managers who
make quality decisions are effective administrators.
CHAPTER 1 ■ Decision Making, Problem Solving, and Critical Thinking: Requisites for Successful Leadership and Management 19
❊ Key Concepts
• The professional decision maker is self-aware, courageous, sensitive, ener-
getic, and creative.
• The professional approach to problem solving begins with a fixed goal and
ends with an evaluation process.
• The successful decision maker understands the significance that each per-
son’s values, life experience, preferences, and way of thinking have on select-
ed alternatives.
• The critical thinker is aware of areas of vulnerability that hinder successful
decision making and makes efforts to avoid the pitfalls of faulty logic in his
or her data gathering.
• The act of making and evaluating decisions increases the expertise of the
decision maker.
• There are many models for improving decision making. Using a model
reduces trial and error and increases the probability that decisions made will
be sound.
• Left- and right-brain dominance influences to some degree how individuals
think.
• Two major considerations in organizational decision making are how power
affects decision making and whether management decision making needs to
only be “satisficing.”
Profile Examining
Examine the process you used to decide to become a nurse. Would you
describe it as fitting a profile of the economic or the administrative
model?
A
Learning Exercise 1.9
Web Links
Judgment and Decision Making
http://www.sjdm.org
Promotes the study of normative, descriptive theories of decision processes.
http://www.hooah4health.com/spirit/decisions.htm
Free tools you can use to solve problems and make decisions in your life.
Mission Critical
http://www.sjsu.edu/depts/itl
The goal of this site is to teach visitors the basic concepts of critical thinking, deductive
reasoning, and finding faults in dubious arguments. The site provides tutorials, exercises,
and links to related Web sites.
References
Belcher, J. V. R. (2000). Improving managers’ critical thinking skills. Journal of Nursing
Administration, 30(7/8), 351–353.
Benner, P. (1994, July 17). Engaged reasoning: Critical evaluation of critical thinking. Paper
presented at Improving the Quality of Thinking in a Changing World, The Sixth Inter-
national Conference on Thinking, Cambridge, Massachusetts.
Clancy, T. R. (2003). The art of decision-making. Journal of Nursing Administration, 33(6),
343–349.
Good, B. (2002). A call for creative teaching and learning. Creative Nursing, 8(4), 4–9.
Hansten, R., & Washburn, M. (2000). Intuition in professional practice. Journal of Nursing
Administration, 30(4), 185–189.
Harrison, E. F. (1981). The managerial decision-making process (2nd ed.). Boston: Houghton
Mifflin.
Huston, C. J. (1990). What makes the difference? Attributes of the exceptional nurse.
Nursing 20(5), 170–171.
Huston, C. J., & Marquis, B. L. (1995). Seven steps to successful decision-making. Ameri-
can Journal of Nursing, 95(5), 65–68.
Ignatavicius, D. D. (2001). Critical thinking skills for at-the-bedside nurse. Nursing Man-
agement, 32(1), 37–39.
Lamond, D., & Thompson, C. (2000). Intuition and analysis in decision making and
choice. Journal of Nursing Scholarship, 32(4) 411–414.
Marquis, B. L., & Huston, C. J. (1994, March). Decisions, decisions. Advanced Practice
Nurse, 1, 46–49.
Munhall, P. K. (1999). From “out of the box” to “fitting in.” Journal of Nursing Scholarship,
31(2), 102.
Pesut, D. J., & Herman, J. (1998). OPT: Transformation of nursing process for contempo-
rary practice. Nursing Outlook, 46(1), 29–36.
Romiszowski, A. J. (1981). Designing instructional systems. New York: HarperCollins Col-
lege Publishers.
Rudan, V. T. (2003). The best of both worlds: A consideration of gender in team building.
Journal of Nursing Administration, 33(3), 179–186.
Simon, H. A. (1965). The shape of automation for man and management. New York: Harper
Textbooks.
CHAPTER 1 ■ Decision Making, Problem Solving, and Critical Thinking: Requisites for Successful Leadership and Management 23
Bibliography
Bohinc, M., & Gradisar, M. (2003). Decision-making model for nursing. Journal of Nursing
Administration, 33(12), 627–638.
Chau, J. P. C., Chang, A. M., Lee, I. F. K., Ip, W. Y., Lee, D. T. F., & Wootton, Y. (2001).
Effects of videotaped vignettes on enhancing students’ critical thinking ability in a bac-
calaureate nursing programme. Journal of Advanced Nursing, 36(1), 112–120.
Contino, D. S. (2003). Notes from the field. What’s your perspective-past, present, or
future? Nursing Management, 34(6), 49–51.
Daly, W. M. (2001). The development of an alternative method in the assessment of criti-
cal thinking as an outcome of nursing education. Journal of Advanced Nursing, 36(1),
120–131.
Graf, C. M. (2003). Patients’ needs for nursing care: Beyond staffing ratios. Journal of Nurs-
ing Administration 33(2), 76–81.
Florida, R. (2002). The Rise of the Creative Class. New York: Basic Books.
Havens, D. S. & Vasey, J. (2003). Measuring staff nurse decisional involvement: The deci-
sional involvement scale. Journal of Nursing Administration, 33(6), 331–337.
Krairiksh, M & Anthony, M. K. (2001). Benefits and outcomes of staff nurses’ participa-
tion in decision making. Journal of Nursing Administration, 31(1), 16–23.
Omery, A. J. (2003). Advice nursing practice: On the quality of evidence. Journal of Nursing
Administration, 33(6), 353–360.
Ritter-Teitel, J. (2003). Nursing administrative research: The underpinning of decisive lead-
ership. Journal of Nursing Administration, 33(5), 257–259.