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Unit Seven

Problem solving, Critical


thinking, Creativity, and
Decision making
1

Learning objectives
At the end of this unit, the learner will be able to;
1.Define problem solving, creativity, critical thinking
and decision making
2.Discuss critical thinking and problem solving.
3.Describe importance of critical thinking for
nurses.
4.List the five steps in the decision making process.
5.Describe at least six techniques to increase
creativity.
6.Identify at least two decision making tools.

Problem Solving

Problem Solving
If

you have a
problem at work,
it is a good idea
to sort things
out.
This is called
problem solving.
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Problem Solving

Basic intellectual process that has been


refined and systemized for the various
challenges people face.
Problem solving which involves a decision
making steps focused on trying to an
immediate problems which can be viewed
as a gap between what is? and what
should be?
Problem makes leader better, not bitter
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Problem Solving
If you think you have a problem at
work, there are a number of ways to
sort things out
Talk

to the person you are having a problem

with.
Talk to your supervisor to help you sort out
the problem.
Have a meeting with all the people who can
help you sort out the problem.

Problem Solving

Why is it important to solve


problems at work?

People can get cross.


Work does not get done.
People are unhappy at work.
Accidents can happen.
Contracts can be lost.
People leave work.
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Some Dos of problem solving


Do

say what the problem is for you.


Do listen to what the problem is for
the other person.
Do attack the problem, not the
person.
Do look for solutions that suit you
both.
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Some Donts of problem


solving
Dont

call people mean names.


Dont put people down.
Dont be angry or aggressive.
Dont stop listening.

1010

Approaches of problem
solving
Trial

and Error
Intuition
Nursing Process
Scientific method/Research process
Modified Scientific Method

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Problem Solving Steps


1.
2.
3.
4.
5.
6.

Define The Problem


Analyze The Problem
Generate Possible Solutions
Select The Best Solution
Plan For Implementation
Implement And Evaluate The
Solution
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Step One : Define The


Problem
Identify

the problem
Develop an accurate problem statement
Comparison against others
Monitor for weak signals
Comparison of current performance with
objectives or past performance
Checklists
Inverse brainstorming
Listing complaints
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Step Two: Analyze The


Problem
Dont

rush to a wrong
solution.
Highly critical step.
Common mistake to
immediately begin
generating solutions.
Must identify and
eliminate root causes
of problem.
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Step Two: Analyze The


Problem
Diagnostic Tools
Brainstorming
Flow Diagrams
Cause and Effect
Diagrams
Pareto Charts
Check Sheets
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Step Three : Generate


Alternative Solutions
How to Develop Alternatives:
Look at the data. What does it tell you?
Data will lead to some ideas
Data may not lead to best idea

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Step Three : Generate


Alternative Solutions
Question

each aspect of situation.


What is the job to be done?
Why is the job to be done?
Who should do the job?
Where should the job be done?
When should the job be done?
How should the job be done?
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Step Three : Generate


Alternative Solutions

Apply creativity to the situation.


Making new ways
Rearranging old ways
Form novel and useful ideas

Use

all idea sources available.

The worker involved.


In-house experts.
Written material
Outside experts
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Step Three : Generate


Alternative Solutions
Apply

some appropriate action

Eliminate (part, reason, job, activity)


Combine (parts, forms, jobs, functions)
Rearrange (sequence, location)
Simplify (foolproof, make obvious,
provide interlocks, remove steps,
reduce physical effort)
Brainstorm

for alternative solutions.


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Step Four : Select A Solution


Refer

back to original problem


statement. Consider:

Safety
Cost
Product performance
Better management information
Improved Technology
Time
Quality
Appearance
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Step Four : Select A


Solution
Some

questions to ask:

Will this completely resolve the problem?


Will this only satisfy part of the problem?
Will this prevent future occurrences?
Will this have little or no impact on the
problem?
Do we have the authority to implement?
Do we have the necessary resources?
How long will it take to implement?
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Step Five : Plan and


Implement Solution
Steps to ensure successful
implementation:
Work the most powerful forces
Prepare an action plan:

What will be done?


How will it be done?
Where will it be done?
Who will do it?
When will it be done?
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Step Five : Plan and


Implement Solution
Develop

a tracking system:

Identify milestones or events


Assign completion dates
Identify reporting systems
Design

evaluation procedures
Implement the procedures

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Step Six : Evaluate The


Solution
Measure

results using procedures


established during implementation
Use data gathering:
Check sheets
Control charts
Time studies
Pareto analysis
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Problem Solving Strategies


Do

it yourself
Influence others
Assign someone
Do nothing
Combine knowledge

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Problem Solving Strategies


Do

it yourself

The problem solver should evaluate


his/her capabilities and expertise and
determine whether this is the preferred
option

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Problem Solving Strategies


Influence

Others
Allow the person owning the problem to
solve it
Eg. Conflict between 2 employees: The
nurse manager may bring the parties
together to discuss their issues
Interpersonal skills may be used to
assist in conflict resolution, but the
employees would be allowed to work
out their own solution.
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Problem Solving Strategies


Assign

someone
Delegation is the transferring to a
competent individual the authority
to perform a selected nursing task
in a selected situation.

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Problem Solving Strategies


Do

Nothing

Often a problem will subside on its own


The problem solver should recognize
when a problem has the potential to
resolve by itself and should consider
making a conscious effort not to
intervene

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Problem Solving Strategies


Combine

knowledge

Consultation, collaboration with an


expert
Talking through the situation

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Pitfalls in Problem-Solving
Failure to clearly identify the real
problem
Failure to eliminate preconceived ideas
in the identification of solutions
Failure to communicate
Failure to follow up
Failure to use appropriate resources

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Critical thinking

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Critical thinking
Successful

Intelligence depends on 3
thinking skills:
practical
analytical

THINKING
THINKING
SKILLS
SKILLS
creative
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Critical thinking
Critical:

means requiring careful


judgment.
Thinking: means to have an opinion, to
reflect on or ponder, to call to mind or
remember to devise a plan, to form a
mental picture of (image), to reason

34

Critical thinking
Analytical

thinking, purposeful, goaldirected thinking process that strives to


problem solve patient care issues through
the use of clinical reasoning.
Combines logic, intuition, and creativity
Essential to nursing practice
It is manifested when ever a nurse ask
why?, what?, and how?.
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Critical thinking
THINKING Vs CRITICAL THINKING
Critical

thinking is controlled, purposeful &


more likely to lead to obvious beneficial
results
Thinking is basically any mental activity;
can be aimless & uncontrolled; it may serve
a purpose, but we often arent aware of its
benefits; we might not even remember our
thoughts at all
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Critical thinking
No

matter which definition you


choose, critical thinking involves the
use of several concepts, including:
exploring, analyzing, prioritizing,
explaining, deciding, and evaluating
to identify solutions and determine a
course of action to solve patient care
problems.
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Critical thinking

38

Critical thinking
o

It is important for manager to assess their


staff members to think critically and
enhance their knowledge and skill
through;
o Staff development programs
o Coaching
o Role modeling

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Critical thinking

Critical thinking is
important for;
Problem solving
Creativity
Decision making
Clinical judgment
Critical thinking
is the concept
that link all the
above mentioned
concepts.
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WHAT IS CRITICAL THINKING


IN NURSING?
Purposeful,

goal-directed thinking aiming


to make judgments based on evidence
rather than conjecture.
It is based on principles of science & the
scientific method & develops strategies
that maximize human potential &
compensates for problems caused by
human nature.
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Why do we need to think


critically?
To make

accurate and appropriate clinical


decisions
To solve problems and find solutions
To plan care for each unique client and
client problem
To seek knowledge and use it to make
clinical decisions and problem solve
To be able to think creatively when
planning care for clients
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CHARACTERISTICS OF CRITICAL
THINKING

It is rational & reflective.


It involves healthy, constructive
skepticism.
It is autonomous.
It includes creative thinking.
It is fair thinking.
It focuses on what to believe & do.
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A Path to Critical/Analytical
Thinking

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Components of Critical
Thinking
Interpretation
Analysis
Inference
Explanation
Evaluation
Self-regulation

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Aspects of Critical Thinking


To develop

into an expert critical


thinker the nurse needs to use:
REFLECTION: purposefully thinking
back /recalling. Requires honest review
LANGUAGE: precise & clear resulting in
clear message
INTUITION: inner sensing that
something is so
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Levels of Critical Thinking


Basic

Critical Thinking: Thinking is


concrete and based on book, principles,
rules, policies (whatever they can read or
hear about).
Complex Critical Thinking: the nurse rely
less and less on their resource people and
think before asking them, come up with the
answers themselves.
Commitment: The nurse starts anticipating
patient needs independently.
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Critical Thinking
Competencies
General

critical thinking
competencies used by many
disciplines, in many everyday
situations.
Scientific method
Problem solving
Decision making
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Critical Thinking
Competencies
Specific

critical thinking in clinical


situations used by physicians,
nurses, and other health care
professionals.
Diagnostic reasoning/ Clinical inference
Clinical decision making

49

Critical Thinking
Competencies
Specific

critical thinking competency


used in nursing practice
Nursing Process
Assessment
Analysis (Nursing Diagnosis)
Planning
Implementation
Evaluation
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Critical Thinking Model


The

model helps to explain how nurses make


clinical judgments/ decisions in their clinical
practice that result in safe, effective, nursing
care. There are 5 components in this model of
critical thinking:
Knowledge base
Experience in nursing
Critical thinking competencies
Attitudes for critical thinking
Standards for critical thinking
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Developing Critical Thinking


Attitudes/Skills/
Not

easy
Not either or
Self-assessment
Tolerating dissonance and ambiguity
Seeking situations where good
thinking practiced
Creating environments that support
critical thinking
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Attitude/skills of critical
thinkers
They are:
Active thinkers.
Knowledgeable of their biases &
limitations.
Fair-minded.
Willing to exert a conscious effort to work
in a planful manner.

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Attitude/skills of critical
thinkers...
Good

communicators.
Empathetic.
Open-minded.
Independent thinkers.
Curious & insightful.
Humble.
Proactive.
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Attitude/skills of critical
thinkers...
Honest

with themselves & others, admitting


when their thinking may be flawed or
requires more thought.
Organized & systematic in their approach.
Flexible.
Cognizant of rules of logic
Realistic
Team players.
Creative & committed to excellence.
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Standards for Critical


Thinking
Universal

Intellectual Standards for


Critical Thinking:

Clarity
Accuracy
Precision
Depth
Breadth
Logic, applied to clinical reasoning
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Standards for Critical


Thinking
Intellectual

Standards 14 intellectual standards (Paul,1993) Nurses


use these when using the nursing process:
1.
2.
3.
4.
5.
6.

Confidence 7. Perseverance
Independence 8. Creativity
Fairness
9. Curiosity
Responsibility10. Integrity
Risk taking
11. Humility
Discipline
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Standards for Critical


Thinking
Professional

standards

Sound ethical standards


When critically thinking must have a sense of
their own values, beliefs, feelings and their
clients/ clients familys values, beliefs, feelings

Scientifically based practice with standards


developed by experts
Evidenced based practice
Standards developed as a result of evidence
These are minimum requirements that are
necessary to give quality effective care
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Creativity

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Innovation Vs Creativity
Innovation is the
implementation of new ideas
at the individual, group or
organizational level.
Creativity is the development
of ideas about products,
practices, services, or
procedures that are novel and
potentially useful to the
organization.

60

What Does It Take


to Be Creative?
Time
Hard work
Mental energy

61

Creativity needs
Curiosity
Flexibility
Passion,

inspiration
Singleness (following direction)
Looking ahead

62

Components of creativity
Cognitive

thinking: capacity to work


with information and solve problems
Approach to personal creativity
Emotional & motivational
Interpersonal relations: capacity to
participate in creativity process with
others
63

Characteristics of Creative
People

64

Creativity Enhancers

Focus on intrinsic
motivation
Creativity goals
Developmental
feedback
Supportive
supervision
Healthy competition
Participative
decision making
Autonomy

Hire creative people


Enriched, complex jobs
Provide resources
Clear organizational goals
Instructions to be creative
Recognize and reward
creativity
Encourage risk taking
No punishment for failure

65

Creativity Enhancers

Workforce
diversity
Internal and
external interaction
Diverse teams
skilled at working
together
Supportive climate

Organizational
culture that
promotes
innovation
Flexible, flat
structures
Close interaction
and relationships
with customers
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How Can Organizations Foster


Creativity?

Hire creative &


diverse workforce

Provide resources
esp. time

Design complex &


challenging jobs

Set clear
org. goals

Be Creative!

Set creativity
goals

Use diverse
teams

Recognize &
reward creativity

Create the right


org. culture
67

Management Style and


Creativity
Encourage

risk taking
Provide autonomy
Encourage productivity- sweat
equity
Supportive supervision, climate, and
work group
Participative leadership
68

Organization Design
and Creativity
Flexible
Flat
Structures
That promote
Internal &
External
Interaction

Close Contact
With Customers
69

Creativity Killers
Excessive

focus on extrinsic motivation


Limits set by superiors
Critical evaluation
Close, controlling supervision
Competition in a win-lose situation
Control of decision making
Control of information
70

Creative Thinking Techniques


Brainstorming

Rules

Expressiveness - Say whatever ideas come


to mind without focusing on constraints
Non-evaluation - No criticism allowed; all
are valuable
Quantity - Produce as many ideas as
possible
Building - Expand on other
peoples ideas
71

Creative Thinking Techniques

Brain writing
Hybrid of both individual and group
brainstorming
Produces more ideas than brainstorming

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Creative Thinking Techniques


Shift your perspective
Take a risk
Set the stage
Be curious
Be spontaneous

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Stages of the creative process


Wallas model
1.Preparation:- Define the problem, need, or
desire, and gather any information. Set up
criteria for verifying the solution's
acceptability.
2.Incubation:- Repetition of the same
thoughts. No new ideas or interpretations.
Reexamine the situation and review the data
collected. Last in minutes, weeks, even
years.
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Stages of the creative


process
Wallas model
3. Illumination/Insight/:- Seeing the
entire concept or entity all at once. Very
brief, involving a tremendous rush of
insights within a few minutes or hours.
4. Verification:- Experimentation of
solution (succeeded or failed).
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Forms of creativity
Combinational:

Unfamiliar combination

of familiar ideas.
Exploratory: Exploration within an
established Conceptual space.
Transformational: Arises from a
deliberate transformation of the
conceptual space.
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Barriers to Creative Thinking


Resistance

to change, rigid mind-set, practice


guided by tradition, habit, routines
Stereotypical perceptions of clients
Fear of making mistakes
Unwillingness to take risks or look for alternative
strategies
Decision making without sufficient data or
supported by rationale
Failure to evaluate effectiveness of nursing
actions
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Decision Making

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Decision Making
It

is a purposeful and goal directed


effort that uses a systematic process
to choose among two or more options
to solve specific problem.
Not all decision making begins with a
problem situation, instead the hallmark
of decision making is the identification
and selection of alternatives.
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Decision Making
Poor

quality decision is likely if the


objectives are not clearly identified
or if they are inconsistent with the
value of an individual or
organization.

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Rational decision making


Single, welldefined goal
is to be achieved
Problem is
clear and
unambiguous

All alternatives
and consequences
are known

Preferences
are clear

Preferences
are constant
and stable

Rational
Decision
Making

Final choice
will maximize
payoff

No time or cost
constraints exist
81

Characteristics of effective
decision making process
Systematic,

comprehensive way of

thinking.
Predetermined consequences of
implemented decision.
Much positive outcomes and fewer
negative consequences.
Based on a goal-oriented" analysis of the
situation
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Characteristics of the
decision
Effective:

Meets the pre-stablished

GOALS
Realistic: Physically possible, fits
circumstances
Feasible: Possible to carry out with

83

WHAT ARE THE 3 CONDITIONS


IN DECISION MAKING?
Freedom
Rationality
Voluntarity

84

WHAT IS CLINICAL DECISION


MAKING COMPOSED OF?
Cue
Hypothesis
Knowledge

base
Nursing intervention
Search
Assumption
85

Decision Making Process


Step 1: Identify the problem
Defining

the problem. What is wrong?


Where is improvement needed?
Begins when the nurse manager
perceives a gap between what is actually
happening and what should be
happening.
The nurse manager can identify the
problem by analyzing situation.
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Decision Making Process

What is the desirable situation?


What are the presenting symptoms?
What are the discrepancies?
Who is involved?
When? Where ? How?
Develop Feasible hypotheses, and
elimination of hypotheses that fail to
conform to the facts.
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Decision Making Process


Feasible hypotheses should be
further tested for causal validity.
By analyzing available information,
manager should begin exploring
possible solutions.

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Decision Making Process


Step 2: Explore alternatives

If situation is not covered by policy,


manager must draw on his education
and experience, but it may be
inadequate.
More experienced manager had more
alternatives to be suggested for solving
a variety of problems.
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Decision Making Process


Step 2: Explore alternatives

Health care is changing rapidly


manager should learn how others are
solving similar problems.
This can be done through continuing
education, professional meetings,
review of the literature, and
brainstorming with staff.
90

Decision Making Process


Step 3: Choose most desirable
alternative

One alternative is not always clearly


superior to all others.
Manager must try to balance multiple
factors such as pt. safety, staff
acceptance, morale, public acceptance,
cost, and risk of failure. The following
questions may be asked:
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Decision Making Process


Step 3: Choose most desirable
alternative
- Will this decision accomplish the stated
objectives? (yes or no)
- Dose it maximize effectiveness and
efficiency? use available resources
before seeking outside assistance.
- Can the decision be implemented?
If not, it will not solve the problem
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Decision Making Process


Step 4: Implement decision

The manager will need to communicate


the decision to appropriate staff
smoothly to win the cooperation.

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Decision Making Process


Step 5: Evaluate results

Evaluate the results of the chosen


alternative.
Be alert: solutions to old problems
sometimes create new problems, so
you need additional decisions.

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Decision making models

The decision method you used


depends on the following
circumstances.
Is the situation routine, predictable,
complex, and uncertain?
Is the goal of the decision to make a
decision conservatively (just good
enough) or optimally?
95

Decision making models


Based on the above assumption there
are four decision making model.
I. Normative or Prescriptive DM model
II. Descriptive/ Behavioral DM model
III.Satisfying/ Conservative DM model
IV.Optimal DM model

96

Decision making models


I.

Normative or Prescriptive DM model


Used when the outcome is predictable,
the problem/situation is well structured.
Information is objective.
The decision is already prescribed.
Example: if one student get F, the
student should take the course again
by adding.
97

Decision making models


II. Descriptive/ Behavioral DM model
Used when the situation is complex,
unpredictable, and uncertain.
You dont know the outcome.
Information is subjective and every
person define or interprets into
different direction.
98

Decision making models


III. Satisfying/ Conservative DM model
Used when information is gathered to
meet the minimum requirement for the
objective of decision.
This model is appropriate when
critical, urgent, immediate answer
were needed within a short period of
time.
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Decision making models


IV. Optimal DM model
The solutions/decisions are selected
based on optimal requirement for
objective decision.
Appropriate in the situation that needs
time.
This model is appropriate when noncritical, urgent, immediate answer were
needed within a short period of time.
100

Decision making style


The situation and circumstances
should dictate which decision making
style is most appropriate.
To select an appropriate decision
making style, the nurse manager
should look at the following decision
rules.

101

Decision making style


1.
2.

3.

The importance of the decision quality


to the institutional success.
The degree to which the manager
process the information and skills to
decision.
The degree to which the followers
have the necessary information to
generate a quality decision.
102

Decision making style


4. The degree to which the problem is
structured.
5. The importance of followers commitment.
6. The likelihood that an autocratic would be
accepted.
7. The strength of followers commitment to
institutional goals.
8. The likelihood of followers conflict over the
final decision.
103

Decision making style


Based

on the above mentioned rules


there are three DM styles. These are;
1. Autocratic
2. Democratic
3. Anarchic
Based the stated rules characterize them.
104

Types of decisions

Decisions made in the nursing service can


be categorized depending upon the
following criteria
How much time the manager spends in
making decision?
What proportion of the organization
must be involved in making decision?
The organization function/ the nursing
functions on which they focus.
105

Types of decisions...
On

the basis of these, there are three


classifications:
1. Ends -Means
2. Administrative-Operational
3. Programmed-Non-programmed

106

Types of decisions...
1. Ends-Means
Ends: deals with the determination of
desired individual or organizational
results to be achieved.
Means: decisions deal with strategic
or operational programmes, activities
that will accomplish desired results.
107

Types of decisions...
2. Administrative-Operational
Administrative: made by senior
management, which have significant
impact throughout the organization.
Operational: are generally made by mid
level and first line managers and
address day to day operational
activities of a particular organizational.
108

Types of decisions...
3. Programmed-Non-programmed
Programmed:- these are repetitive and
routine in nature. Since they can be
programmed, procedures, rules and often
manuals are formulated to cover those
situations.
Non-programmed:- unique and nonroutine. This can be used in
emergency/urgent situation.
109

Conditions that initiate


decision making
These are;
1. Opportunity
2. Threat
3. Crisis
4. Deviation
5. Improvement

110

Ways of Decision Making


1.
2.

3.
4.

Relying on tradition: based on past


decision making
May appeal to authority: based on
suggestions from an expert/a higher
level management
Prior reasoning: based on assumption
Logical decision making: is a rational,
intelligent and systematic approach
111

Factors Influencing Decision


Making
1. Decision makers attribute
Knowledge, experience, and
judgment
Perception and personality
Values and philosophy

112

Factors Influencing Decision


Making
2. The Situation
Urgency of solution and time
pressures
Magnitude and importance
Structure and uncertainty and
risk
Cost benefit
113

Factors Influencing Decision


Making
3. Environmental Constraints
External
Internal

114

Decision Making Tools


There are many tools. The most common
are:
1. Probability theory:- is the likelihood that
an event or outcome will actually occur.
2. Decision tree:- are graphic decision
making tools used to evaluate decisions
containing a series of steps
115

Deciding to decide
1. Is the problem easy to deal with?
Tip: avoid being bogged down in
trivial details. Effective managers
reserve decision making techniques
for problems that require them.
2. Might the problem resolve itself.
Tip: prioritize and rank problems in
order of importance.
116

Deciding to decide
3. Is it my decision?
Tip: the closer to the origin of the problem
the decision is the better. Before
deciding ask the following questions:
Does the issue affect other
departments?
Will it have a major impact on the
superior's area of responsibility?
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Deciding to decide
Does it need further information from
higher level?
Does it involve serious breach of my
departments budget?
Is this problem outside my area of
responsibility or authority?
If the answer to any of these questions
is 'YES' pass it to your superior.
118

Barriers to Effect DecisionMaking


1. Easy recall: the more easily can recall the
event, the more frequently they believe it
occur.
2. Easy search: not to put effort to seek
information from the appropriate sources.
3. Misconception of chance: Most people
do not understand the nature of random
events.
119

Barriers to Effect DecisionMaking


4. Confirmation gap/bias: bending
evidence to fit ones beliefs.
5. Relaxed avoidance: the manager
decides not to decide or act after noting
that the consequences of inaction will
not be serious.

120

Barriers to Effect DecisionMaking


6. Defensive avoidance: Faced with a
problem and unable to find a good
solution based on past experience, this
manager seeks a way out.
7. Panic: the manager feels pressurized
not only by the problem but also time.

121

Use of Technology in Decision


Making
Technology

can support, but not take


over, the decision-making process.
Clinical practitioners should evaluate
technology before adopting it.
Other staff on which technology will
have an impact should have input into
decisions on its adoption.
122

The Nurses Role in Patient


Decision Making
Patients

are increasingly
knowledgeable about health care and
involved in treatment decisions.
Nurses must be aware of patients
rights in making decisions about
their treatments and must assist
patients in their decision making.

123

The Nurses Role in Patient


Decision Making
Nurses

must recognize when


patients are lacking information and
implement teaching in such cases.
Nurses may need to collaborate with
others to determine what information
has been shared with the patient and
family.

124

Strategies to Improve
Decision Making
Make

certain you have all necessary


information to make a proper
decision.
Consider alternatives.
Do not be afraid to revise a decision if
circumstances change.
Anticipate questions and outcomes.
125

Strategies to Improve
Decision Making
Keep

notes and other information for


reference.
Consider the pros and cons of the
decision.
Consider how your decision will
affect the people involved.
Do not get caught up in unnecessary
details or issues.
126

Common Errors in Decision


Making
Over-confidence

Framing

Hindsight

Confirmation

Self-serving

Selective

Randomness

perception
Anchoring
Immediate
gratification

Representation
Availability

127