DECISION MAKING,

PROBLEM SOLVING CRITICAL TRIAD

CHAPTER ONE
AND CRITICAL
PART ONE POINTS
Decision making
Problem solving
Critical thinking
Clinical reasoning
Heuristic problem solving
Problem solving methods
Economic man / Administrative man
Satisficing / Optimizing
LEE IACOCCA ONCE SAID:

“If I had to sum up in one

word the qualities of a good
manager, I’d say it all comes
down to decisions.”
 A complex, cognitive process
of choosing a particular course
of action; the thought process
of selecting a logical choice

DECISION from available options

MAKING
 Part of decision
making; systematic
process focusing on
analyzing a difficult
situation involving
higher order reasoning
and evaluation.

PROBLEM SOLVING
 Integrating and applying different
types of knowledge to weigh
evidence, critically think about
arguments, and reflect on the
process used to arrive at
diagnosis

CLINICAL Collaborative and reflective

process that involves content-
specific knowledge, engagement
REASONI of the patient and family in
understanding the clinical

NG
problem, and incorporation of
critical contextual factors

Leads to deliberative decision

making and sound clinical
judgment
 The mental process of actively
and skillfully conceptualizing,
applying, analyzing,
synthesizing, and evaluating
information to reach an answer
or conclusion

CRITICAL
THINKING
COMPONENTS OF CRITICAL
THINKING
Specific Knowledge about a topic
Experience
Competencies generating generating a hypothsis
Attitudes
Intellectual Standards and Professional Standards scope and standards
 Insight
Intuition
Empathy for px and
fam
Willingness to take
action to put critical
thinking to work

CHARACTERISTICS OF
CRITICAL THINKING
Trial and Error
DID YOU
Theory and Hunch USE
HEURISTI
Past Experience – Life
Experiences -Intuition
C
PROBLEM
Self Solving SOLVING?
 Provides mock life
experiences to learn
from
Allows learners to
apply leadership and
management theory
Promotes whole brain
thinking and improved
problem- solving skills

EXPERIENTIAL
LEARNING
SUCCESSFU
L DECISION
MAKERS
Self-aware
Courageous
Sensitive
Successful Decision Makers
Energetic
Creative
 WHICH
STATEMEN
T IS TRUE A. It is a simple approach to decision making.
REGARDIN B. It is narrower in scope than decision making

G C.
D.
It requires reasoning and creative analysis.
It is a synonym for the problem-solving process.

CRITICAL
THINKING
?
 Think for a minute about the
last major decision you made…

???
 Recurrent and routine problem
solving
Satisficing
Maximizing or optimizing mode

TYPES OF
DECISION MAKING
 1. No clear objective
or goal for decision
2. Faulty data
gathering

FREQUENT ERRORS
IN DECISION MAKING
 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 DO YOU NEED What are the consequences of the
problem?
TO KNOW FOR DATA Which of these are most serious?

GATHERING
 Was this poor decision made
because necessary information
was intentionally or
unintentionally withheld from
you?

IDENTIFY A POOR
DECISION YOU RECENTLY
MADE DUE TO DATA
GATHERING
MORE ERRORS IN
DECISION MAKING
3. Failure to use science, logic, and
empirical evidence in making decisions
4. Not considering enough alternatives
ERRORS
CONTINUED
5. Faulty logic or “crooked thinking”
6. Not assessing or ignoring the quality
of the decision making that is required
 7. Lack of self-awareness
8. Too much time spent
identifying the problem
9. Refusal to act
10. Using outcome only for
evaluation

AND SOME MORE

ERRORS IN
DECISION MAKING
SO….
It is not enough to gather
adequate information,
think logically, select
from among many
alternatives, and be
aware of the influence of
one’s values. In the final
analysis, one must act.
DECISION-MAKING
VARIABLES
If we all use the same decision-making or problem-solving model
and are given the same information, will we all reach the same
decision? Why or why not?
Decision-Making Variables Multiple
stakeholders
Gender
Value
Judgments
Intangibles

Nurse Manager
Thinking style as
Decision Maker Experience

Interdisciplinary Risk and

Input Uncertainty

Long-term
Implications
Personal preferences
WHAT IS YOUR RISK
QUOTIENT
IN DECISION MAKING?
 Some people fail to use
any type of systematic
examination of the
problem or its
alternatives for
solution.
Instead, they rely on
discrete, often
unconscious processes
known as heuristics.
Heuristics refers to
using a “trial-and-error”
or “rule-of-thumb”
RIGHT BRAIN VS approach to problem
solving.

LEFT BRAIN
 Use a systematic decision-
making process whenever
possible.

Traditional Problem-Solving Process

Managerial or Rational Decision-
Making Model
Nursing Process
Integrated Ethical Problem-Solving
PROBLEM SOLVING Model

METHODS
 Simon: Types
of
Management
decision
makers
SIMON: TYPES
OF
MANAGEMENT
DECISION
MAKING
ECONOMIC MAN ADMINISTRATIVE
MAN
COMPARISON OF ECONOMIC MAN
AND ADMINISTRATIVE MAN
Economic Man Administrative Man

Makes decision in rational manner Makes decision that are good enough
Has complete knowledge of situation Knowledge is always fragmented
Has complete list of possible Impossible to predict consequences of
alternatives alternatives
Has rational system of ordering Usually chooses from among a few
preferences of alternatives alternatives, not all possible ones
Selects the decision that will maximize The final choice is “Satisficing” rather
utility function than maximizing
DECISION MAKING STRATEGIES

Satisficin Satisficing decision involves choosing

any solution that will minimally meet

g the desired objective.

Optimizin Optimizing decision involves

comparing all available solutions
g against the objective and choosing the
best that meets the objective.
 Define objectives clearly

ELEMENT Gather data carefully

S OF Take time necessary

PROBLEM Generate many alternatives

SOLVING Think logically

Choose and act decisively

THE MOST
IMPORTAN
T
COMPONE A.Define the problem
B.Develop solutions
NT OF A C.Gather information
PROBLEM D.Analyze the information

IS TO:
 Implement and evaluate
nationally sanctioned clinical
practice guidelines.
Question and challenge
nursing traditions and promote
a spirit of risk taking.
Dispel myths and traditions not
supported by evidence.
Collaborate with other nurses
locally and globally.
STRATEGIES TO Interact with other disciplines
to bring nursing evidence to
PROMOTE EVIDENCE- the table.
BASED BEST PRACTICE
WALKING AROUND THE ELEPHANT

Godfrey Sax
 Making the decision

Decision grid

Decision tree

Cause and effect

diagram (fishbone)

Program evaluation and

review technique (PERT)

Types of management

PART TWO POINTS decisions

 Objective quality of a decision

Acceptability of the decision

to the group who will be
JUDGING THE affected by it
EFFECTIVENESS
OF A DECISION Is the decision defensible?

Result of the decision

assessed
 Cause and Effect Diagram (Fishbone)
Decision Grids
Decision Tree
Program Evaluation and Review
Technique (PERT)

QUANTITATIVE
DECISION-MAKING
TOOLS
DECISION GRIDS (WHICH NURSE
WILL I HIRE?)
Alterna- BSN Previous Previous Organiza-
critical care ACLS tion part
tives 25% nurs. exp
exp. 30% 15% 10%
20%

#1
Nurse A

#2
Nurse B

#3
Nurse C

#4
Nurse D
DECISION
TREE
 PERT CHART
NUR NUR NUR COM.
2050 3020 4050 HEALTH
Done Done 4120
Desired
Goal:
Graduation
wk 1 wk 5 wk 8

NUR4040 Exam I Exam II Graduation

Exam III
wk 11
passed

wk 2 wk 4 wk 8
Begin Obj. Half Lit Review
clinical completed Requirements
completed
met:
All obj.
Wk 7 completed
CONSEQUENCE TABLE
MATCHING
A. Selecting a decision that is adequate
to meet the required objective
1.Trial and error
B. The first solution that seems promising
is tried
2. Decision Grid
C. Selecting best option after reviewing
3. Fish bone
competing alternative solutions
4. Satisficing decision
D. Graphic figures used to help assess
potential causes of problems
5. Optimizing decision
E. Graphic model comparing options against
the same criteria
AN OUTPATIENT
SURGERY
MANAGER IS
EVALUATING
INFUSION a. Select the least expensive brand
PUMPS FOR b. Use a decision-making tool to evaluate brands
c. Ask the nursing staff which brand they prefer
THE OPERATING d. Select the vendor the institution usually buys from
ROOM. THE
MANAGER
SHOULD:
TYPES OF MANAGEMENT
DECISIONS
Strategic Decisions long term goals top level executives
Administrative Decisions midlevel managers on the floor for quality + px care
Operational Decisions first level day to day
PITFALLS TO DECISION MAKING

Resistance to change
Inadequate fact finding
Time constraints
Poor communication
Failing to systematically follow the steps
 RAINBOW HOSPITAL
HAS MADE A
COMMITMENT TO
BUILD A NEW
CARDIAC A. Strategic Decisions
B. Administrative Decisions
CATH LAB TO BE C. Operational Decisions
COMPLETED IN D. Satisficing Decisions
JANUARY,2025.
ESTIMATED COST
WILL BE
$1.5 MILLION. WHAT
TYPE OF DECISION IS
THIS?
Decisions related to unit
A. Strategic Decisions
staffing, unit practice,
and unit supplies that are B. Administrative Decisions
made by the first line C. Operational Decisions
manager in accordance D. Satisficing Decisions
with his/her job
description and authority
are called: