COLLEGE OF NURSING

AIIMS, NEW DELHI

MAIN SEMINAR
ON
“DECISION MAKING
&
PROBLEM SOLVING”

Moderator Submitted by :
Dr. Smita Das Vidusha Aswal
Associate professor M. Sc. Nursing 1st year
CON, AIIMS CON, AIIMS
Outlines

• Problem and problem solving

• Need of problem solving in nursing

• Purposes of problem solving

• Characteristic and essential features of problem solving

• Problem solving methods

• Principles of problem solving

• Problem solving process

• Approaches and barriers of problem solving

• Different techniques to help to develop problem solving skills

• Decision making

• Situation of decision making and levels of decision

• Decision making condition and process

• Decision making styles

• Risks and factors affecting decision making

• How to improve decision making

• Group decision making

• Techniques of group decision making

 INTRODUCTION

To cope with the realities of today’s health care system, nurses must be prepared to be critical
thinkers. They must be ready to welcome change and thrive in rapidly changing environment.
The term decision making was imported by Chester Barnard around middle of the past.

PROBLEM

“A matter or situation regarding as unwelcome or harmful and needing to be dealt with and
overcome”.

Problem solving is the highest level of learning. To solve problems a person must have a
clear idea of the problem or of the goal being sought and must able to recall previously
learned rules that relate to the same situation.

Problem solving is a process of overcoming difficulties that appears to interfere with the
attainment of goal. It is a procedure of making adjustment in spite of interferences. – Skinner

Problem solving is an analytical method to identify potential solutions to a situation. It is a

complex process and judgement calls or decisions, may have to be made on the way. The
primary goal is to find the solution. Gathering facts helps to make the solution more obvious.

Problem solving refers to a particular set of skills that can be used to define a problem,
general possible solutions to that problem and help you to achieve a positive outcome.

Effective Problem Solving helps you to avoid and resolve stressors.

NEED OF PROBLEM SOLVING IN NURSING

The development of a problem-solving approach to nursing has been one of the more
important changes that has taken place in nursing during the last decade. There has been a
major shift from nursing's traditional disease-oriented approach to care, to a patient-centred,
problem-solving approach. Traditional nursing is dominated by the medical model, that is,
the patient's nursing care is directed by doctors' orders (Clarke 1978, Boylan 1982).
Traditional practitioners see the patient as a repository of disease, the main goal being to
alleviate symptoms. Consequently, the curriculum for this type of nursing included the
didactic transmission of general nursing principles, coupled with the imparting of recipes of
specific nursing care to be used according to the patient's disease or symptoms.

PURPOSES OF PROBLEM SOLVING

  To train the student in the act of reasoning
 To give practical knowledge
 To discover new knowledge
 To solving a puzzling problem
 To improve student knowledge
 To help overcome the obstacles or inferences in the attainment of objectives
 To help an individual’s as well as society’s progress

CHARACTERISTICS OF PROBLEM SOLVING

1) It has process concept

2) Time sequence
3) Action commitment
4) Evaluation
5) Rational or scientific

ESSENTIAL FEATURES OF PROBLEM SOLVING

o The problem should be meaningful, interesting and worthwhile

o It should have correlation with life
o It should arise out of the real needs of students
o The problem should be clearly defined
o The solution of the problem should be found out by the student under the guidance of
the teacher

PROBLEM SOLVING METHODS

Problem solving is the basic skill identifying a problem and taking steps to resolve it.
Common sense is helpful in solving many problems; however when a problem is complex or
challenging to define we may need to use other methods of problem solving to solve
problem:

1. Trial and error method – is most common approach that tests ideas to decide which
methods work and which do not. Usually the results are completely unknown until
tried because the experimenter simply does not have sufficient information to
anticipate results. Alternatives are tried successfully until a solution to a problem is
found. Sometimes, you use trial and error to solve problems in our everyday life.
 Example -a new nurse is not aware of the different keys used to change the head end
of a patent’s bed up and down; she tries different alternatives before achieving her
task successfully.
Example – consider your dilemma if you have an allergy to unknown substance in
hand lotion but also have a problem with dry skin and wish to soften your hands. You
try one brand but develop a rash. You try another brand with the same. These trial
result in errors until you find a brand that works without causing a rash and you trial
is successful.
Although example shows, a trial and error process can be time consuming and may
even be detrimental. Trial an error may offer a practical means securing knowledge,
but it is fallible. This method is haphazard and the knowledge obtained is unrecorded
and hence, inaccessible in subsequent clinical situation.
2. Intuition and past experiences – Intuition is also known as information obtained
through sixth sense without conscious thinking but in this rationalizing the
information may not be obtained. If a particular course of action consistently resulted
in positive outcomes, the person’s past experience can determine how much risk he or
she will take in present circumstances.
3. Experimentation or scientific method – today’s society refers that only safe and
proven effective treatments can be given to those who are ill. Experimentation
involves testing a hypothesis or theory to enhance knowledge, understanding or
prediction. Scientist and healthcare researchers use a precise method to investigate
problems and arrive at solutions.

PRINCIPLES OF PROBLEM SOLVING

1) Ensure prompt attention

2) Separate large to resolve smaller problem
3) Follow policies to resolve smaller problems
4) Delegate smaller problem to subscribe
5) Consult with management
6) Consult with expert
7) Relaxed in approaching problem
8) Accept the problem

Principles of problem solving as a method of teaching

  Model as a useful problem-solving method:- Problem solving can be difficult and
sometimes tedious. Show students how to be patient and persistent, and how to follow
a structured method. Articulate your method as you use it so students see the
connections.
 Teach within a specific context:- Teach problem-solving skills in the context in
which this will be used by students (e.g. mole fraction calculations in a chemistry
course). Use real-life problems in explanations, examples and exams. Do not teach
problem solving as an independent, abstract skill.
 Help students understand the problem:- In order to solve problems, students need
to define the end goal. This step is crucial for successful learning of problem-solving
skills. If you succeed at helping students, answer the questions “what?” and “why?”,
finding the answer to “how?” will be easier.
 Take enough time:- When planning a lecture/tutorial, provide enough time for:
understanding the problem and defining the goal (both individually and as a class);
dealing with questions from you and your students; making, finding, and fixing
mistakes; and solving entire problems in a single session.
 Ask questions and make suggestions:- Ask students to predict “what would happen
if …” or explain why something happened. This will help them to develop analytical
and deductive thinking skills. Also ask questions and make suggestions about
strategies to encourage students to reflect on the problem-solving strategies that they
use.
 Link errors to misconceptions:- Use errors as evidence of misconceptions, not
carelessness or random guessing. Make an effort to isolate the misconception and
correct it, then teach students to do this by themselves. We can all learn from
mistakes.

PROBLEM SOLVING PROCESS

Seven steps process

1) Defining the problem

2) Gather information
3) Analyze the information
4) Develop solutions
5) Make decisions
6) Implementation decision
7) Evaluate the solution

1. Define the problem- the most important part in problem solving is defining the
problem. How problems are perceived determined the solutions or identifies needed
changes. Defining of a problem should be a descriptive statement, not a judgement or
conclusion. If one begins the statement of a problem with judgement, the solution
may be equally judgmental.
2. Gather information – problem solving begins with collecting facts. This information
gathering initiates a search for an additional facts that provide solution of the problem.
A careful, systematic, complete search facilitates the accomplishment of goals and
evaluates the possible effects of the solution. It may be combination of facts and
feelings. The manager should obtain relevant, valid, accurate and detailed descriptions
from appropriate people or sources and put the information in writing.
This step encourages people to report facts. The nurse manager have to give equal
chance to everyone to provide information, facts, ideas, experience and feelings.
Although this may not always provide objective information. To reduces
misinformation, allow everyone to express their thoughts and valuable suggestion
regarding the problem. Lack of time may prevent gathering data.
3. Analyzing – the manager should analyze the information only when all of them are
sorted into some orderly management as;
o Categorizing information in order
o List information form most important to least important.
o Set information into a time sequence like What happened first? Next? What
came before? What were the circumstances?
o Set the information in terms of cause and effect.
o Consider how long has the situation has been going.
o Classify the information into categories:
 Human factors such as personality, maturity, education, age,
relationships among people and problem outside the organization.
 Technical factors as nursing skills or the type of unit.
 Temporal factors as length of service, overtime, type of shift and
double shifts.
  Policy factors such as organizational procedures or rules applying to
the problem, legal issues, ethical issues.

Because no amount of information is ever complete or comprehensive enough therefore

critical thinking skills are important to examine the assumptions, evidences and potential
value conflicts.

4. Develop solutions – group analyzes gathered information suggested, developing

numerous possible solutions and try to choose the best one to find out the solution of
the problem.
5. Make a decision – after reviewing the list of potential solutions, select the one that is
more feasible and satisfactory and has the fewer undesirable consequences. Some
solutions have t be put into effect quickly; matter of discipline or compromises in
patient’s safety.
Many solutions fails because the manager does not recognize the change process that
must be initiated before solutions can be implemented.
6. Implement the decision – implement the decision after selecting the best course of
action. If new or unexpected problem arises, evaluate every steps of implementation
carefully, also provide a workable solution just because some people may object.
7. Evaluate the solution - after the solution has been implemented, nurse should review
the plan instituted and compare the actual results and benefits to those of idealized
solution. The nurse must ask, is the solution being implemented? If so, are the results
better or worse than excepted? If they are better what changes have contributed to it’s
success? How can we ensure that the solution continues to be used and to work? Such
a periodic check-ups gives the nurse manager a valuable insight and experience to use
in other situations and keeps the problem solving process on course.
If the nurse manager evaluates the outcomes to ensure that the problem has indeed
been solved and builds on that experience, problem solving becomes expert skill that
the nurse can use throughout a management career.

APPROACHES OF PROBLEM SOLVING METHODS

1. Rationale:- One of the most common problem-solving approaches, the rational
approach is a multi-step process that works well for a wide range of problems. Many
other problem-solving techniques mirror or build off of its seven steps, so it may be
 helpful to begin with the rational approach before moving on to other techniques.
Here are the seven steps of the rational approach:
- Define the problem.
- Identify possible causes
- Brainstorm options to solve the problem.
- Select an option.
- Create an implementation plan.
- Execute the plan and monitor the results.
- Evaluate the solutions
2. Collaborative:- This approach involves including multiple people in the problem-
solving process. Brainstorming should include a diverse group of stakeholders: people
who are affected by the problem and/or may be affected by any changes made in an
attempt to solve it. Seek continuous feedback from these stakeholders as you monitor
the implementation of your solution to make sure it works well for everyone.
3. Historical :- The historical approach is helpful when the problem you're facing has
precedent within your field or industry. Researching how others have solved the
problem can guide you as you develop your own solution.
4. The Simplex Process:- The Simplex Process is an eight-step approach similar to the
rational approach, but tailored for situations in which you are unsure of what the
problem actually is. It begins with problem-finding and research, where users collect
the information necessary for defining the problem. Users then move through idea-
finding, evaluation and selection and planning. They then encourage their peers and
stakeholders to take active roles in implementing their plan, to soften any resistance to
change. Finally, users execute their plan and monitor the results.
5. The 5 way :- A five-step approach often employed in consulting firms, the issue-
based approach is useful when helping another person solve a problem they're facing.
The user first creates a proposal that defines the problem and inventories the client's
expectations. Next, the user diagrams the smaller issues that comprise the problem,
then uses this diagram to help them design a solution. The user then conducts
extensive research and synthesizes their data into a revised solution. Finally, they
present their materials to the client and demonstrate why their solution is effective.
6. Issue based:- This approach can help you get to the root of a complex problem. Begin
by asking why the problem occurred, and then ask the same question about your
response. For example, if you answer that productivity has stagnated because morale
 is low, follow up by asking, “why is morale low?” ask “why” a total of five times.
Doing so will help you find the problem's root cause.
7. Failure Mode and Effects Analysis (FEMA):- FEMA is unique among problem-
solving approaches in that its goal is generally to pre-empt problems. A team of
experts lists the functions of a product and then identifies every possible failure for
each function. The team estimates the probability that each failure will occur, then
rates its severity and detectability. The team uses these figures to calculate the risk
priority number of each failure, revealing which problems should be addressed first.
8. Means-End Analysis:- Means-end analysis is especially useful for big-picture
problems because it shifts the focus from the problem itself-which might feel
overwhelming to the goal that you want to achieve. After envisioning your goal, you
can work backward to identify the obstacles that lie in your path. Overcoming these
smaller obstacles one at a time makes solving a large problem more manageable.
Conversely, having an ultimate goal in mind can guide your decision-making as you
address the smaller obstacles in your path.

RESEARCH INPUT

Factors Influencing on Problem Solving Ability of Nursing Students Experiencing Simulation

Practice

Hyun Hee Jo and Won Ju Hwang

Published on 17 September 2022

Abstract: It has become important for nurses to implement self-leadership and exercise
critical thinking in problem-solving to address the health issues of patients. This has led to a
need for nursing education programs in which nursing students learn to embrace self-
leadership and self-evaluation approaches to develop their skills. Within 260 nursing
undergraduates with experience in simulation practice as study subjects, a self-reporting
survey was conducted on self-leadership, goal commitment, critical thinking, and problem-
solving skills. An analysis was conducted using the SPSS/WIN 21.0 program. t-test and
ANOVA were conducted to validate the difference between problem-solving abilities.
Multiple regression was conducted to examine the impact of these variables on problem-
solving skills. The variables of religion, satisfaction with major, goal commitment, and
critical thinking were found to have a significant impact on problem-solving abilities.
The results were as follows: critical thinking (β = 0.36, p < 0.05), goal commitment (β = 0.28,
p < 0.05), and explanatory power of 41%. To improve the nursing undergraduates’ problem-
solving abilities through simulation practice, there needs to be a method that supports them in
setting goals with self-leadership and enhance goal commitment. The method also needs to
support the development of their critical thinking and curiosity for questions deriving from
experiencing diverse programs in order to deliver effective outcomes.

COMMON BARRIERS TO PROBLEM SOLVING

The most common factors that researchers have identified as barriers in problem solving are:

1) Mental set – e.g. “ if your tool is a hammer, you’ll see every problem as a nail.
2) Lack of clarity in stating the problem- failure to recognize the problem.
3) Inadequate data and not getting the needed information
4) Scarce of information source
5) Lack of resources-men, money and material
6) Premature testing of alternative solutions or premature choices makes hasty choice.
7) Pressure or stress
8) Team attitudes like competency, interest, trust and doubts. Members afraid to be
judged based on their skills.
9) Limited time
10) Personality or attitude off manager to solve the problem

Understanding the barriers to problem solving can assist a person in becoming more
successful. However, it should be noted that overcoming these barriers will enhance your
ability to solve the problems but will not always guarantee success.

RESEARCH INPUT

Worry Impairs the Problem-Solving Process: Results from an Experimental Study

Sandra J. Lleraa, Michelle G. Newman

Published on 2020 December

Methodology: Both high (n = 96) and low (n = 89) trait worriers described a current problem
in their lives. They were then randomly assigned to contemplate their problem in a worrisome
(n = 60) or objective (n = 63) manner or to engage in a diaphragmatic breathing task (n = 62).
All participants subsequently generated solutions and then selected their most effective
solution. Next, they rated their confidence in the solution’s effectiveness, their likelihood to
implement the solution, and their current anxiety/worry. Experimenters uninformed of
condition also rated solution effectiveness.

Results: The worry induction led to lower reported confidence in solutions for high trait
worry participants, and lower experimenter-rated effectiveness of solutions for all
participants, relative to objective thinking. Further, state worry predicted less reported
intention to implement solutions, while controlling for trait worry. Finally, worrying about
the problem led to more elevated worry and anxiety after solving the problem compared to
the other two conditions.

Conclusions: Overall, the worry induction impaired problem solving on multiple levels, and
this was true for both high and low trait worriers.

DIFFERENT TECHNIQUES TO HELP DEVELOPING PROBLEM

SOLVING SKILLS

 Brainstorming
 Spider diagram
 Force-field analysis
 Different views
 SWOT analysis (S- strength, W- weaknesses, O- opportunities, T- threats)
 Six thinking hats –( process, objects, positive, creative, feeling and negative)
 Red hat- emotional thinking
 Yellow hat- positive thinking
 Black hat- critical thinking
 White hat- purely facts
 Green hat- creative thinking
 Blue hat- the big picture. All the viewpoints.
 Risk analysis
 Fishbone / cause and effect diagram
 Cost-benefit analysis – evaluating quantitatively whether to follow a course of action.
Add up the value of the benefits of a course of action and subtract the costs associated
with it.
 Timelines
 Flow charts
 DECISION MAKING

Decision making is about deciding what action to take, it usually involves choices between
options. The object of problem solving is usually a solution, answer or conclusion. The
outcome of creative thinking is new ideas.

It is a critical step in the problem-solving process. Most of the time decision making is a
subset of a problem-solving nature, such decision about scheduling, choosing an equipment
or other matters that do not involve problem solving as a deliberate process.

Decision making is process of choosing a solution based on your judgement, situation, facts,
knowledge or a combination of available data. The goal is to avoid potential difficulties.
Identifying opportunity is an important part of decision-making process.

Process of evaluating and choosing among available alternatives and implementing solutions.

The term decision making is used inconsistently and often interchangeably with problem
solving. Although the two processes appear similar and may depend on one another, they are
not synonymous.

Decision making and problem solving can be found in human brains or technical brains i.e.
computers. Both skills require critical thinking, which is high-level cognitive process and
both can be improved with practice.

In simple terms it is: -

 Making a judgement
 Choosing an option
 Making choices between alternative

DECISION MAKING SITUATION

• Personal decision making – familiar part of everyday life.

• Clinical decision making – relates to quality of care and competency issues.

• Organizational decision making – is choosing option directed toward the resolution of

organizational problems and the achievement of organizational goals.

LEVELS OF DECISIONS
 1. Strategic decision – decision made by top executives that a crucial to operations for
long-range planning

• Are strategic because they define and focus on major, long term goals.

2. Administrative decisions – middle managers make most administrative decisions. They

resolve unusual problems and develop techniques to improve functioning.

3. Operational decision – these are the routine decisions that relate to day-to-day events.
Middle and first line managers make most of the operational decisions.

DECISION MAKING CONDITION

Managers make decisions both as individual and in groups that occur in an organizational
context. The condition surrounding decision making can vary and change dramatically. It is
essentially for the manager to consider the total system, realizing that whatever solutions are
created will succeed only if they are compatible with other parts of the system. Within the
organization, decisions are made under conditions of certainty, risk or uncertainty.

o Decision making under certainty – A condition under which taking a decision

involves reasonable degree of certainty about its result, what are the opportunities and
what conditions accompany this decision.

An example of this could be setting a budget for a project. The manager has access to
the resources and data needed to make an accurate forecast of the budget and the final
cost of the project.

When the nurse manager knows all the possibilities or alternatives and the conditions
surrounding each alternative, a state of certainty is said to exist. Suppose a nurse
manager in a unit with acutely ill patients wants to decrease the number of
venipunctures a patient experienced when an IV started, as well as reduce the costs
resulting from failed venipuncture. 3 alternatives exist: -
1) Establishment of an IV team on all shifts to minimize attempts and reduce
costs.
2) Establish a reciprocal relationship with anesthesia department to start IV when
nurses experience difficulty.
3) Set a standard of wo insertion attempts per nurse per patient.
The manager knows the alternatives (IV team, anesthesia department and standards) and
the condition associated with each (reduced costs, assistance with starting IVs, minimum
attempts and some cost reduction).

Therefore a condition of strong certainty is said to exist and the decision can be made
with full knowledge of what the payoff probably will be.

o Decision making under risk – A condition in which the availability of the various
opportunities and associated with each of them the potential benefits and costs are
known with some estimated probability.

Importantly here is the ability to predict by the manager, the potential results of the
actions. Managers should skilfully use own individual qualities such as intuition, and
capitalize on the experience of the past. Risk condition is accompanied by the average
level of confusion and moderate risk of taking the wrong decision. Scientists link this
type of condition with gambling. In management, risky decision is being made
knowing the opponent cards, at least in a substantial part of it. On the other hand, it is
not known what effects can bring decision preferring either party.

An example of this could be investing in a new product line. The manager has access
to the resources and data needed to make an educated guess as to the success of the
product, but there is no guarantee of success.

o Decision making under uncertainty- A condition in which decision maker does not
know all the choices, as well as risks associated with each of them and possible
consequences.

In this condition most of today's serious decision are being made. The dynamics of
economic life determines the managers to decide without knowing all alternatives, as
well as knowledge of the risks associated with the known alternatives. Such situation
is associated with a very high probability of erroneous decision, which could trigger a
counterproductive effects. First of all, in order to reduce the risk: managers should
collect as much relevant information, and then try to make rational and logical choice.
Intuition, correct judgement and experience are in such conditions, the priority,
although you should not forget about other methods that may help to decide.
 An example of this could be a decision to enter a new market. The manager has no
data or resources to accurately predict the success or failure of the venture, and must
make a decision based on their judgement.

Most of the decision in an organization taking under conditions of uncertainty and

risk. The individual or group making the decision, does not know all the alternatives,
attendant risk or likely of each option. Uncertainty and risk are inevitable because of
the complex and dynamic nature of health organization. Successful decisions are
depending on human judgement. Greater the amount of reliable information, the more
likely the manager will make a good decision. Hence the manager should make sure
that the right information is available.

GENERAL GUIDELINES FOR DECISION MAKING

Using a systematic, comprehensive approach to decision making will aid in consistently

arriving at decisions with positive outcomes.

 Always consider the time element that will be involved in reaching the decision.
Some decisions must be made in seconds, whereas others may require weeks of
deliberation.
 Use the full period of time you have available for the process. Do not rush yourself,
but at the same time, do not act slowly.
 Always be clear about the situation. Gather as much information as possible and
continue to add to it, if the situation will allow.
  Stay current with regards to the knowledge of nursing, patient care and the patient
care environment.

DECISION MAKING PROCESS

Using a step-by-step decision making process can help us to make more deliberate,
thoughtful decisions by organizing relevant information and defining alternatives. This
approach increases the chances that we will choose the most satisfying alternative possible.

1. Identify problem
2. Gather data
3. Analyze data
4. Established goals and outcomes
5. Choose alternatives
6. Implement chosen alternatives/ make decision
7. Evaluate the decision outcomes
1) Identify the problem:- before making a decision we must possess as complete and
accurate understanding of situation as is possible. The first step is very important, try
to clearly define the nature of the problem.
2) Gather data:- collect some pertinent information before moving to the next steps,
what information is needed, the best sources of information and how to get it. This
steps involves both internal and external “work”. Some information is internal i.e.
you’ll seek it through a process of self-assessment. Other information is external-
you’ll find it online, in books, from other people and from other sources.
Keep in mind, you can become bogged down by too much information and that might
only complicate the process.
3) Analyze the data:- through the process of analysis, we examine and study our data to
determine whether it is adequate. We develop assumption from data, make inferences
and draw conclusion. All of these intellectual activities are necessary parts of making
sound decisions and should not be rushed if the situation will allow time for serious
deliberation.
4) Establish goals and outcomes: - it involves recognizing the discrepancy between the
current situation and an ideal situation and establishing a goal or outcome that will
bring the situation as close too ideal as it is possible.
 Goals may be both short and long term. This is a deliberate process by which we
mentally weigh or try to determine how well the approach will work. We will also
want to consider such things as how much time it will take, whether needed resources
are available or whether obstacles exist to implementing the action.
5) Choose alternatives:- alternatives are also known as strategies. It involves to
determine which course of action will be the best to solve the problem. Therefore a
person should develops as many advantages and disadvantages for each course of
action as possible. Then they must objectively and logically analyze the advantages
and disadvantages of each one against one another.
Hopefully, you’ve identified and clarified what decision needs to be made, gathered
all relevant information, and developed and considered the potential paths to take.
You should be prepared to choose form alternatives.
Sources for alternatives: -
a. Textbooks, libraries and informational resources – as a decision maker one
should think about referring, reviewing a textbook. This would definitely and
undoubtedly provide you direction that which approaches to use, why and
under which circumstances each should be considered. If one feels that he or
she needs a broader view the literature review should include several
textbooks.
b. Policy and procedure manuals – hospitals policy and procedure manuals are
also the best source that provide a particular facility that has developed for
working with risk management aspects of patient care.
c. Experienced colleagues – a third valuable resource can be found in our
experienced colleagues.
6) Implement chosen alternatives/ make decision:- Here is the part of the decision-
making process where you actually make the decision. The logical step is to take
action or implement the alternatives that we have chosen. In management role it is
possible that we will not be the person responsible for carrying out the action, it may
be implemented by the staff nurse or another health worker. However, the leader or
the decision maker will still be accountable for the outcome.
To ensure the desired outcomes it is important that the plan be skilfully
communicated to others and they are adequately trained to carry out the actions.
7) Evaluation of decision outcomes :- evaluation is the final step in the decision
making process. We will compare the actual outcomes to the goals or outcome criteria
 that were developed originally. We will know that the decision-making process was
effective when the current situation matches the desired outcomes. In managerial role
we may also wish to evaluate other factors involved in implementing the decision
such as the use of time, energy, the impact on staff.

Take an honest look back at your decision. Did you solve the problem? Did you
answer the question? Did you meet your goals?

If so, take note of what worked for future reference. If not, learn from your mistakes
as you begin the decision-making process again.

Since decision making process is a thought process, it is both rational and intuitive.
Our intuition is that aspect of mind that tells us what is right or wrong. However we
should never make a mistake while making decision, totally guided by emotions or
intuitions and immediately do “what we fell right”.

DECISION MAKING STYLES

Decision making can be grouped into 4 main styles. The four styles are directive style,
analytic style, conceptual style and behavioral style. Although no one fits completely into
just one style category the have characteristics that fit into one or two styles. Each style deals
with processing the information on which the decision is based differently.

Knowing your decision-making style can make you a better leader. While decision-making is
important for everyone, leaders or manager must be especially mindful of their approach, as
many of their choices affect others.

If you’re a leader (or hope to be one in the future), learning to adjust your style to each
situation is an excellent step toward making better decision.

1. Directive decision-making:- Directive decision-makers prefer a high level of

structure and make decisions based on technical outcomes. When considering
possible courses of action, they focus on their own knowledge: their gut feeling, past
experiences, and whether the existing procedures fit the outcomes they’re considering.

Use the directive style when:-

o You have to make a quick decision

 o There are limited options
o There aren’t any complicated ethical issues to tease out
o You’re in a stable situation with predictable cause-and-effect results

Advantages of directive decision-making:-

o This method is fast, as directive decision-makers don’t usually seek extra data or
consider external input
o The process is low-effort, which reduces decision fatigue
o This method maintains momentum rather than miring the company in endless
discussion
o The decision-maker doesn’t seek feedback, so there are few overt conflicts to deal
with
o The simplicity of the decision makes it easy to evaluate after the fact (e.g., did sales
increase after this marketing campaign: yes/no)
o Accountability for the final decision is clear

Disadvantages of directive decision-making:

o This method’s lack of consultation process can alienate stakeholders

o Solutions may be unrealistic because the decision-maker is disconnected from on-the-
ground realities
o This method can lead to autocratic “my-way-or-the-highway” thinking
o Outcomes tend to be conventional
o Due to the lack of external input, the decision-maker may base solutions on
incomplete information
o The decision-maker runs the risk of oversimplifying complex situations
2. Analytic decision-making:- Analytic decision-makers prefer a low level of structure
and make decisions based on technical outcomes. They collect large volumes of data
from different sources, then pore over the data to evaluate every solution before
settling on one.

Use the analytical style when:

o You want to examine multiple options in detail before deciding

o There’s a lot of relevant data available
 o There’s enough time to think things through
o You need to do some digging to understand the relationships between cause and effect

Advantages of analytic decision-making:

o It’s detail-oriented, so analytic decision-makers notice things others might not

o The high volume of information involved makes predictions more accurate
o The decision-maker goes in with few biases and preconceptions
o It considers unconventional options

Disadvantages of analytic decision-making:

o It consumes time and energy

o Managing so much information can be stressful for the decision-maker
o It relies on the existence of relevant data collected in similar situations
o It can lead to analysis paralysis
o It’s a risk-averse approach
3. Behavioural decision-making:- Behavioural decision-makers prefer a high level of
structure and make socially oriented decisions. They map out a few courses of action,
seek feedback from various sources, and try to build a consensus regarding the best
path. Leaders with this approach tend to favour a consultative management style.

Use the behavioural style when:

o The decision will have a big impact on stakeholders’ lives

o There’s enough time to reach a consensus
o You’re looking for practical rather than creative solutions
o It’s important that team members feel included in the decision

Advantages of behavioral decision-making:-

o It incorporates diverse opinions and experiences

o The decision-maker remains humble and open to persuasion.
o People feel listened to and included in the decision process
o There’s collective ownership of the decision and more buy-in from stakeholders

Disadvantages of behavioral decision-making:-

 o It takes time to build a consensus
o The decision-maker needs to be able to resolve conflict satisfactorily rather than just
override it.
o The decision-maker can focus too much on keeping everyone happy.
4. Conceptual decision-making:- Conceptual decision-makers prefer a low level of
structure and make socially oriented decisions. Rather than providing stakeholders
with a predetermined set of possible outcomes (as in behavioral decision-making),
conceptual decision-makers set up brainstorming sessions with stakeholders to seek
and develop creative solutions.

Use the conceptual style when:-

o There’s an environment of psychological safety(people feel safe offering unusual or

half-formed ideas)
o A novel solution could lead to a significant breakthrough in how the company does
things
o You need to plan for the long term and prepare for uncertainty
o Your decision is ethically complex and will have a broad social impact
o You want to create a new option instead of choosing between existing ones

Advantages of conceptual decision-making:-

o It tackles problems at their root, avoiding short-term fixes

o It encourages creative problem-solving and “thinking outside the box”.
o The diversity of input can lead to unexpectedly innovative solutions
o It allows for calculated risks
o It prioritizes big-picture thinking, acknowledging that a solution’s effects may spread
beyond the company into the society
o It usually includes careful consideration of ethical issues

Disadvantages of conceptual decision-making:

o It’s time-consuming.
o It can be difficult to translate theory into practice.
o It can be hard to evaluate the results, as there are so many moving parts and impacts at
various levels.
 RISKS IN DECISION MAKING

o Only risk-takers are truly free. All decision of consequences involve risk.
o No such thing as permanent security.
o It is natural to be afraid when you risk.
o Separation anxiety is normal when you are out of your comfort zone.
o It is a necessary to have a clear purpose and a goal.
o Do it for the right reasons, when clam, thoughtful and non-emotional.
o Look pros, cons, probabilities, consequences and worst case scenarios.
o When possible, take one risk at a time.
o Use imaging and visualization
o Have a plan, a timetable with setting SMART goals.
o Dismiss extremely remote or unrealistic possibilities that are highly/extremely
improvable, avoid catastrophes whenever possible.
o Recognize the tradeoffs.

FACTORS AFFECTING DECISION MAKING

 Experience and knowledge

 Creative thinking

 Self concept

 Stress

 Interpersonal conflict

 Time available

 Managers personal ability

 Routine versus and non routine decision

 Risk associated with the decision

 Critical nature of work

 Written guidelines

 Organization attitude towards decision making

 Amount and kind of information available

 Degree of acceptance and support

HOW TO IMPROVE DECISION MAKING

1. Interpret data in more than one way.

2. Set criteria of success beforehand.

3. Ask other people

4. Lest your failure

5. Improve feedback by avoiding missing and confusing

6. Scrutinize the decision making process

7. 7. Change your way of deciding and reevaluate your time and learning from
experience

8. 8. Have group do decisions audits too

9. 9. Be rational

10. 10. Educate people so they know how to make appropriate decision

11. Seeking support of top management for decision making at the lowest possible level
e.g. decentralization

12. Successful manager stay informed about decision being made at different levels of the
organization after appropriately delegating these responsibilities.

13. The managers should deal with these decisions requiring their level of expertise(non
routine decisions), support implementation of decision and credit the decision maker.

14. Delegation of decision making (routine decision making) to subordinates to gain their
trust, loyalty and to raise their self-esteem.

15. Successful manager who is skilled in both decision making and problem solving
serves as a motivator and role model for others.

COMMON DECISION MAKING ERRORS AND BIASES

 Overconfidence – believing too much in our own ability to make good decisions.
  Self-serving
 Immediate gratification
 Anchoring effects
 Selective perception
 Confirmation bias – using only facts that support your decision.
 Framing
 Availability
 Representation
 Randomness
 Sunk costs

GROUP (PARTICIPATIVE) DECISION MAKING

Participative decision making means a group of individuals allowed to make decision rather
than a single individual. Group decision making can be particularly effective if the decision
will have an effect of employees making decision. The acceptance and commitment to the
decision can be greatly enhanced when those to be affected by the decision participate in it.

FACTORS RESULTING IN GOOD GROUP DECISION MAKING

o One should ascertain whether the group has adequate knowledge of the subject or
situation. Such knowledge can be used as strength in decision making process, if it’s
lack it may be the downfall.
o Adequate time for group decision making. Participative decision making is not
effective or appropriate for those problems which needs immediate attention or
solution.
o Sufficient maturity should be present among the participants to reverse the decision if
it found to be ineffective. A mature group is also composed of individuals who can
cooperate, tolerate conflicts, allow for individual differences, support diversity and
group process. The group should not be dominated by one or two individuals.
o Ascertain that the management will support the group’s decision.

TYPES OF GROUP DECISION MAKING

1. The task force – a task force is frequently used to address a single problem or
concern. A relatively inexpensive technique, it begins with the manager appointing a
group of individuals to work on the specific problem. They collect information,
 analyze it, outline alternatives, make a recommendation and send that
recommendation to the manager. They are then adjourned and do not reconvene
request to do so.

Advantages : - uses expertise of appointed members

Disadvantages :- members with dominant personalities may influence the group.

-may leave members dissatisfied because the group dissolve after making
recommendation.

2. Quality crises – it functions much like task forces, with the exception that the
membership is usually on a volunteer and membership may rotate. In some setting
quality, quality circles are ongoing groups of employees who are all parts of the same
department. Quality circles tend to bring together persons who are working in the
same area and have common concerns. They meet on regular basis to creatively
address day to day problems.

Advantages – uses experience of volunteer members who share common concerns.

Disadvantages –

- Time consuming
- Because of voluntary membership, may not get best input.
- Productivity relies on the ability of the group to work together effectively.
3. Brain storming – it is a way to gather as many feasible alternatives as possible. It
involves a group members meet together and generate many diverse ideas about
nature, cause, solution to a problem without consideration of their relative values. A
premium is placed on generating lots of ideas as quickly as possible and on coming up
with unusual ideas.
Most importantly the members do not critique ideas as they are proposed. Evaluation
takes place after all the ideas have been generated. Members are encouraged to
improve on each other’s ideas. The sessions are very enjoyable but are often
unsuccessful because members inevitably begin to critique ideas, meetings shift to
ordinary interacting group format. In its classical forms, brainstorming is a fairly
expensive process. Criticism of this approach are the high cost factor, time consumed
and the superficiality of many solutions.
 Advantages:- generates a larger number of creative approaches.
Disadvantages:-
- Focus is only on generating large number of solutions, quality may be lacking.
- Process can be stifled by premature critique of solution posed.
4. Nominal group technique – it involves seven to ten individuals selected by the
manager. The manager presents the problem to the group and each participant writes
down he or she sees as the best solution without discussing it with others. The leader
shares the ideas with the group and writes them on a chalk-board or flip chart. There
is no discussion until all ideas are written down. Then each solution is analyzed.
Participants are asked to rank the solutions privately and individually from most
acceptable. The solution that receives highest overall ranking is then presented as the
first alternative. This process allows for consideration of a number of approaches
without the member of the group being pressured toward a particular approach.

Advantages :-

- Allows for consideration of a large number of alternatives.

- Group members are not pressured toward a particular solution.

Disadvantages :-

- Time consuming
- Requires advance planning
- Members may not realize much satisfaction in the process.
5. Delphi method :- it is similar to nominal group technique. The manager gather
information about problem and outlines the solutions. All possible solutions are
shared with the participants who then select the best alternative. However, the
membership of the group is anonymous, with only the manager knowing whom he or
she has sent the information or questionnaires. The fact that participants do not meet
together prevents on person from influencing the decision of another. Because the
participants are never identified by name, they are free to approach the problem and
suggest solutions objectively without fears of being repercussion.

Advantages :-

- Generate many alternatives

 - Can involve a large number of participants because they do not have to come
together.
- Participants do not meet together, one can not influence another

Disadvantages :-

- Requires much time from start to finish.

- Requires advance planning
- Participants may have a low sense of accomplishment.
6. Consensus :- many people responsible for providing leadership to group like to make
decisions though the process of consensus. Reaching decisions though a consensus
requires that all participants accept and degree with the proposed solution. Most often
this requires that the original proposal or alternative be revised, a process that also
involves the group.

Advantages – it facilitate the implementation of a decision because it has already been

accepted and results in high quality decisions.

Disadvantages – it requires considerable time and all persons involved must be present
for the discussion.

7. Majority rule :- another approaches to decision making involves majority rule, which
accepts as the numbering approach that which is favoured by the majority of the
participants. It is system of decision making by which we elect president and other
public officials.
Majority rule means that some person wins and other loose that there is no complete
agreement among those affected. On occasion in such situations, certain group
member will form coalitions to support their position and block the action of the
group. This can be damaging to the position of the manager.

Advantages – saves time.

DECISION MAKING AND CRITICAL THINKING

Critical thinking is the process of examining underlying assumptions, interpretating and

evaluating arguments, imaging and exploring alternatives and developing a reflective
criticism for the purpose of reaching a reasoned conclusion that can be justified.
Critical thinking technique can be resolve problems rationally. Identifying, analysing and
questioning the evidence and implications of each problem stimulate and illuminate critical
thought process.

It is also an important component of decision making.

Using critical thinking:-

The critical thinking seems abstract unless it can be related to practical experiences. One way
to develop this process is to consider a series of questions when examining a specific problem
or making a decision. The following questions are suggested:

A. What are the underlying assumptions?

Underlying assumptions are unquestioned beliefs that influence an individual’s
reasoning. They are perception that may or may not be grounded in reality.
B. How is evidence interpreted? What is the content?
Interpretation of information also can be value-laden. Is the evidence presented
completely and clearly? Can the facts be sustained? Are the people presenting the
evidence using emotional or biased information? Are they any errors in reasoning?
C. How are the arguments to be evaluated?
Is there any objective evidence to support the arguments? Have all value preferences
been determined? Is there a good chance that the arguments will be accepted? Are
there enough people to support the decision?
D. What are possible alternative perspectives?
Using different basic assumptions and paradigms can help the critical thinker develop
several different views on an issue. For instance, a nurse manager who assumes that
high proportions of RN staffing are necessary to provide high quality patient care will
have different alternative solution to a managed budget cut than manager who is
committed to using assistive personnel.

CONCLUSION

Decision-making is making best choices among two or more alternatives

Problem solving and decision making are important skills for life. There are processes and
techniques to improve decision-making and the quality of decisions.
Decision-making is more natural to certain personalities, so these people should focus more
on improving the quality of their decisions.

Problems are not always clearly defined. Problems have to be formulated in a way which
enables people to make decisions about them.

Decision makers must have vast amounts of information in order to make use of the rational
comprehensive decision-making

REFERENCES

1. Fraser M. Conceptual Nursing in Practice: a research-based approach [Internet]. 1996

[cited 2018 Nov 15]. Available from: http://link.springer.com/openurl?genre book&isbn
978-1- 56593-418-4
2. Rumbold G. Ethics in nursing practice. 3rd ed. Edinburgh: New York: Bailliere Tindall;
1999. 275 р.
3. Hood LJ, Leddy S, Pepper JM, Leddy S. Leddy & Pepper's conceptual bases of
professional nursing. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2003, 591 p.
4. Ellis JR, Hartley CL.. Managing and coordinating nursing care, 4th ed. Philadelphia:
Lippincott Williams & Wilkins, 2005. 479 р.
5. Bastable S. Nurse as educator: principles of teaching for nursing practice 2nd edition,
Place of publication not identified: Jones & Bartlett; 2003.
6. Emerson RJ. Nursing education in the clinical setting. St. Louis, Mo.: Mosby Elsevier,
2007.
7. Ellis JR, Hartley CL.. Nursing in today's world: trends, issues & management. 8th ed.
Philadelphia: Lippincott Williams & Wilkins, 2004. 576 p
8. Elliott TE, Asche SE, O'Connor PJ, Dehmer SP, Ekstrom HL, Truitt AR, Chrenka EA,
Harry ML, Saman DM, Allen CI, Bianco JA, Freitag LA, Sperl-Hillen JM. Clinical
Decision Support with or without Shared Decision Making to Improve Preventive Cancer
Care: A Cluster-Randomized Trial. Med Decis Making. 2022 Aug;42(6):808-821. doi:
10.1177/0272989X221082083. Epub 2022 Feb 25. PMID: 35209775; PMCID:
PMC9283203.