IDENTIFYING THE PROBLEMS OF SPECIFY

UNITS AND DEVELOP A PLAN OF ACTION

BY PROBLEM SOLVING APPROACH
PROBLEM SOLVING

INTRODUCTION

Problem solving is a mental process and is part of the larger problem process that includes
problem finding and problem shaping. Considered the most complex of all intellectual functions,
problem solving has been defined as higher-order cognitive process that requires the modulation
and control of more routine or fundamental skills. Problem solving occurs when an organism or
an artificial intelligence system needs to move from a given state to a desired goal state.

DEFINITION

A nurse manger’s most effective leadership skill is problem solving ability. A problem is a
situation for which an individual has no ready response in her or his behavioral repertoire. An
optimist might see a problem as a poorly defined opportunity for improvement in a situation.
Although a problem is a provocative situation for which a person has no ready response, the
problem’s solution need not consist of wholly new knowledge, skills, or attitudes. Often, an
effective problem solution is merely a new combination of existing ideas and abilities.

Or

At this point, one may be wondering about the relationship between decision-making and
problem-solving. The first step in decision-making was to identify the problem. But problem-
solving can involve the making of several decisions. The best way to define the relationship
between the two is to define the steps of problem-solving.
PRINCIPLES OF PROBLEM SOLVING

Problem solving like other managerial activities is facilitated by proper organization. In

organizing subordinates, problem-solving efforts, a manager should observe the following
principles:

 To resolve problems affecting organizational efficiency, the manager should separate

large problems from small ones, use policy to solve the smaller problems, and conserve
managerial time for solving major problems.
 The manager should delegate smaller problems to subordinates and teach them to solve
these by applying existing agency rules.
 In resolving operational problems, the manager should consult internal and external
experts, so that solutions will be based on current knowledge.
 Problem solutions are most effective when the manager approaches problems in relaxed
fashion and refuses to solve problems under stress.
 It is impossible to anticipate all eventualities or to expect 100 percent accuracy in
diagnosing and resolving problems. Therefore, it is unwise to agonize over selecting a
solution.

To conserve time, a nurse manager should ensure that job descriptions and personnel-evaluation
forms specify employees’ responsibilities for problem-solving. The manager should be explicit
in assigning problem-solving responsibility to particular employees and prepare detailed agendas
for problem-solving meetings. The manager should show appreciation for unacceptable, as well
as acceptable, ideas generated during employees’ search for a problem solution. An official
format should be used in presenting and reviewing proposed solutions to ensure that all
employees’ proposals receive equal consideration.

A manager can enhance staff nurses’ problem solving by teaching them multiple problem-
solving techniques. Adults learn best through immediate application and experimentation with
newly acquired information. Therefore problem-solving instruction should include in-basket
exercises, where nurses are given information about real-life nursing problems, which they must
solve by using existing resources. When problem-solving instruction is given in groups,
coworkers can serve as a reference source while the nurse learns new techniques; and the
primary work group can be strengthened for problem-solving in quality circles.

Inaccurate problem definition is the principal cause for poor problem-solving. Teaching nurses to
follow a step-by-step problem-solving process will improve solution quality, even for employees
incapable of analytical or creative thought. To maximize the transfer of training, the manager-
trainer should call attention to the type of solution that solves the problem in each in-basket
vignette and discuss probable effects of using the same solution for a problem on the nursing
unit.

CHARACTERISTICS OF SKILLFUL PROBLEM-SOLVING

 In decentralizing authority for clinical decisions, a manager should delegate the

responsibility to the most capable nurses.
 Creative solutions are generated by nurses with clinical expertise, understanding of the
problem’s long-range effects and skill in symbolic expression.
 Highly creative persons are characterized by their wide range of interests and their
knowledge of several subjects. Persons with research skills are inclined to be politically
liberal, cognitively complex, and reflective.
 Nurses use different approaches to problem-solving. Some prefer a serial approach, in
which they tackle problems in sequence, completely resolving one before turning to the
next. Others survey all existing problems, rank them by importance, and solve one at a
time in order of priority. Still, others group problems according to the resources needed to
investigate and remedy each, then solve a group of related problems simultaneously.
 Creative persons become intrigued by related problems during investigation of the
primary problem and, so redesign the search to branch in several directions and work on
several problems at once, each at a different stage of resolution.

IDENTIFY THE PROBLEMS OF SPECIFY UNITS

A. Psychological problems:

1. Moving from “Novice to Expert”

One of the challenges for beginning nurses is pressure to function as an expert without adequate
knowledge and skills.
Janice (2004) identified six different roles which nurses perform while they move from the sate
of being a Novice to Expert.

 The helping role

 The teaching-coaching function
 The diagnostic and monitoring function
 Effective management of rapidly changing situation
 Administering and monitoring therapeutic interventions and regimens
 Monitoring and ensuring the quality of health care practice and organizational work-role
competencies.

2. Reality shock

One problem confronted by the new graduates is the seeming impossibility of delivering quality
care within the constraints of the system as it exists. The person undergoing such stress is less
able to perceive the entire situation and to problems effectively.

3. Burnout

Burnout is a form of chronic stress related to one’s job. It can be identified by feelings of
hopelessness and powerlessness, and is accompanied by a decreased ability to function both on
the job and in personal life. Burnout is more frequent in nurses who work in particularly stressful
areas of nursing. It also occurs when staffing is inadequate or interpersonal relationships are
strained. The main causes for burnout are conflict between ideals and reality, practicing nursing
in areas that have high mortality rates, inadequate staffing, staying overtime, skipping breaks and
lunch and running throughout the shift.

4. Discrimination

Discrimination relates to treating other differently based on stereotypes about groups of people.
Discrimination may occur regarding racial or ethnic background, gender or sex, sexual
orientation and/ or age. Men in nursing have expressed concern about sex discrimination. They
are not allowed to care for women clients, or restrictions are placed on them in terms of
obtaining consent from each client. Female nurses care for men clients in all situations. This has
been accepted because women are commonly seen in nursing and the public associates
mothering role with nursing.

5. Mandatory overtime

Mandatory overtime is another way that hospitals deal with poor staffing. It creates a loss of
control for the nurse over the ability to schedule non-work activities, including essential family
functions. This also puts safe patient care at risk because of nurse’s fatigue and subsequent loss
of ability to concentrate and make good decisions.

6. Floating

Nurses are sometimes required to ‘float’ from the area in which they normally practice to another
nursing unit. It reduces nurse’s competence also affects quality nursing care.

B. Physical problems:

1. Harassment and violence

Violence includes a range of behavior from verbal abuse, threats and unwanted sexual attacks to
physical assault and at the extreme, homicide. According to OSHA, two thirds of non-fatal
workplace assaults happen in health and social services facilities, the majority of these are
assaults by clients on nursing staff, and more in psychiatric mental health setting than in other
settings. The WHO has identified violence as a worldwide problem, which threatens the effective
delivery of health care (WHO 2002). Both men and women may be the objects of sexual
harassment.

Sexual harassment is a concern in nursing. Harassers in the health care workplace may be clients,
coworkers, or physicians. The most dangerous settings for violence are psychiatric units and
nursing homes, where patients are often confused, disoriented or suffering from mental ailments
as well as emergency rooms, where long waits for care can anger patients, and the people with
them.

2. Infection as an Occupational hazard

Transmission of infection is a major concern for the nurses when caring for infected clients. The
higher danger for nurses lies in those clients who have not been diagnosed as having an infection
and for whom specific infection-control measures have therefore not been prescribed.

3. Needle stick injuries

Needle stick injuries especially those with large-bore needles (e.g. bone-marrow aspiration
needles) continue to be the most frequent source of infection transmission.

4. Hazardous chemical agents

Nurses working in operation rooms should seek information regarding anaesthetic gases that can
increase the risk of foetal malformation and spontaneous abortion in pregnant women who are
exposed to them on a regular basis. Chemotherapeutic agents used in the treatment of cancer are
extremely toxic and nurses who work in setting where such agents are prepared and administered
should seek additional education regarding their administration, not only in relation to the
client’s safety but also personal safety. Contact with any medication, especially antibiotics,
during preparation and administration may cause the nurse to develop sensitivity leading to
hand-rash for example. Some medications are absorbed through the skin and may produce an
undesirable effect. Cleansing agents and disinfectants used in the hospital may also be hazardous
if used improperly.

5. Back injuries

Nursing includes providing direct care to incapacitated individuals; hence back injuries are a
common occupational hazard.

6. Bioterrorism

Most biological attacks will be covert, meaning that there will be no warning. Therefore, it is
important that nurses should know and understand what bioterrorism is and how to identify a
potential event because health care workers in hospitals and clinics may have the first
opportunity to recognize the covert event. An alert nurse can save lives, including her own.
Anthrax, botulism, plague and smallpox are considered the four top agents for potential
bioterrorism because plague and smallpox can be disseminated to a population via airborne
release.
STEPS IN THE PROCESS

 The steps of the problem-solving process are the same as the steps of the nursing process
and the decision-making process: assess and analyse, plan, implement and evaluate.
Assessment includes systematic collection, organization and analysis of data related to a
specific problem or need. It involves logical fact-finding, questioning all sources and
differentiating between objective facts and subjective feelings, opinions and assumptions.
Knowledge and experience guide the data collection and analysis of data. Before the
process goes any further assessment should also determine whether a commitment exists
to implement a decision or an action. Making certain that there is no readily apparent
solution also saves the time of all the people who may become involved in problem-
solving. Once the problem is identified, it must be determined whether it requires other
than routine handling- that is, whether it is a rare or unique situation rather than a
recurrent one. This leads to the second step of problem-solving planning.
 Planning involves several phases. In nursing terms we determine priorities, set goals and
measurable objectives, and plan interventions. Management literature essentially says the
 same thing: break the problem down into components and establish priorities; develop
alternative courses of action; determine probable outcomes for each alternative; decide
which course is best in relation to resources goals, risks, and the like; and decide on and
make a plan of action with a time table for implementation.
 When determining priorities, nurses should relate the problem to the corporate mission.
Decisions involve choosing among alternative courses of action. They must have an
acceptable effect on those directly involved, other areas affected, and the entire
organization. Plans should include when and how to alter a course of action when
undesired results occur.
 The third step is implementation of the plan. The nurse should keep informed of the
status of the process because it is unlikely that she or he will be directly involved. This is
the one step in the process most likely to be delegated to subordinates. Implementation
requires knowledge and skills appropriate to the specific alternatives selected.
 Evaluation, the final step in problem-solving, includes determining how closely goals and
objectives were met, the success or failure of actions taken in resolving the problem, and
whether the plan should be terminated because the problem has been resolved or whether
it should be continued, with or without modification.

Effective problem-solving requires that the practitioner be frequently at a high cognitive

level: the level of abstract thinking.

APPROACHES TO PROBLEM SOLVING

Approaches to problem solving

 Desired results

Management problems

Approaches

Routine Scientific Decisional Creative Quantitative

Traditional Identify proposition Define desired results Define problem Define problem

S.O.P Acquire prelim. Observation Define problem Prepare for creativity Construct a model

Abide by superior’s State tentative solutions Draw alternatives Encourage ideas Evaluate model

Order Investigate propositions Evaluate alternatives Permit innovation Place needed constraints

using current knowledge over use of methods.

and experiments

Classify data Select best one Verify & evaluate Implement the solution

Implement the best one

Evaluate Implement Terminal solution

Tentative sol. to proposition

Adjust and state soln. to proposition

Implement

Evaluate

There are five main approaches to problem solving

1. Routine
2. Scientific
3. Decisional
 4. Creative
5. Quantitative

These approaches are strategies for problem solving and any one approach may be suitable for
the given situation.

1. Routine approach

This approach deals with problem solving on traditional methods.

a. What has always been in the past, when such situation occurred? If we do it now the
same way we may succeed.
b. There is Standard Operating Procedures (SOP) in many departments of the hospital.
These SOPs tell that what should be in a particular situation. How is it done? Who does
it? When will it be done? Step by step approach to deal with the problems.
c. Another way of problem solving based on the traditional methods is, to have regards for
the superior officer’s opinion and orders. Whatever they direct, instruct or order, presume
that they are correct and follow it 100%. Such methods are of great value in medical care
setting, like where the treatment of the patient is concerned.

2. Scientific approach

The first step in this approach is to identify the problem. Second step is preliminary observation
regarding the proposed scheme. Then we have to derive solutions to the problems. With the use
of current knowledge and with controlled experiments investigate the proposition. The data so
collected are classified and analyzed. On the basis of analysis a tentative solution is drawn. The
solution so derived is implemented in that situation. After implementation it is evaluated for its
relevance.

3. Decisional approach

This is one of the most popular and also common approaches to deal with the problems. First of
all we have to state as to what is the desired result. After making definition of the problem,
various possible alternatives are sorted out then each alternative is evaluated from the point of
view of its suitability and relevance. The best alternative is selected and implemented in the
given situation. For any given situation several decisions can be made.

4. Creative approach

First step is to define the problem and decisions makers study the information, people and
facilities involved and concentrate on interactions and outputs from the inputs. Creativity and
innovations of idea is given due consideration. This method uses the ability to develop new ideas
and to implement them. The core theme is to create and apply new idea. It represents a new way
of achieving the desired result without being prejudice.

5. Quantitative approach

Problem solving is done by construction of mathematical models. First define the problem and
construct a mathematical model and derive a solution from the model. Evaluate the model as
well as the solution drawn from the model and implement the solution to solve the problem. The
computer is of great help, when the mathematics is complex and the calculations are of large
volume.

Conclusion:

In problem solving, the nurse obtains information that clarifies the nature of the problem and
suggests possible solutions. The nurse then carefully evaluates the possible solutions and chooses
the best one to implement. The situation is carefully monitored over time to ensure its initial and
continued effectiveness. The nurse may also encounter a similar problem in a different client
situation where an alternative solution is determined to be the most effective. Therefore problem-
solving for one situation contributes to the nures’s body of knowledge for problem solving in
similar situations.

Bibliography

1. AG Chandorkar. Hospital Administration and planning.2nd edition. New Delhi: Paras

medical publishers; 2009.
2. Audrey Berman. Shirlee Snyder. Barbara Kozier. Glenora Erb. Fundamentals of nursing.
 8th edition. New Delhi: Pearson education; 2008
3. The Nursing Journal of India Volume C (7) July 2009