Thinking Critically Making Decisions Solving Problems

Critical Thinking
A process of examining underlying assumptions Interpreting and evaluating arguments Imagining and exploring alternatives Developing reflective criticisms for the purpose of reaching a reasoned, justifiable conclusion.

Critical Thinking Model

l ac i ti r C n i hT gn ik

 Analyzing Evaluating

Reasoning

Problem Problem Solving Solving Decision Decision Making Making

New Ideas

Critical Thinking

Left

Right

Creative Thinking

Critical Thinking
What it IS Reasonable, reflective thinking focused on what to believe or do (Ennis & Milman, 1985) The propensity to engage in an activity with reflective skepticism (McPeck, 1990) Purposeful goal directed thinking (Halpern, 1989) The art of thinking about thinking while thinking to make thinking better (Paul & Heaslip, 1995) Purposeful, self-regulatory judgment (Facione, 1990)

What it is NOT Common sense Spontaneous responses Regular or normal thinking Being critical or judgmental Disorganized Task-oriented Working in isolation Being competitive Inability to communicate with others Lack of concern with motives, facts, underlying reasons Emotion-driven

The Nursing Process

Critical Thinking Skills Observing Distinguishing relevant from irrelevant data Distinguishing important from unimportant data Validating data Organizing data Categorizing data Finding patterns and relationships Making inferences Stating the problem Suspending judgment Generalizing Transferring knowledge from one situation to another Developing evaluative criteria Hypothesizing Applying knowledge Testing hypothesis Deciding whether hypotheses are correct Making criterion-based evaluation

Assessment

Diagnosis

Planning

Implementation

Evaluation

Characteristics of an Expert Critical Thinker

Outcome-directed Open to new ideas Flexible Willing to change Innovative Creative Analytical Communicator Assertive
D.D. Ignatavicius, 2001

Persistent Caring Energetic Risk-taker Knowledgeable Resourceful Observant Intuitive out of the box thinker

Creativity
essential part of the critical thinking process ability to develop and implement new and better solutions.

The Creative Process

Information gathering Unconscious work going on Solutions emerge

Solutions Evaluated

Decision Making

Decision Making
can be regarded as the mental processes (cognitive process) resulting in the selection of a course of action among several alternatives. Every decision making process produces a final choice. The output can be an action or an opinion of choice.

Decision Making
a process whereby appropriate alternatives are weighed and one is ultimately selected may or may not involve a problem always involves selecting one of several alternatives

Problem Solving
a process whereby a dilemma is identified and corrected involves diagnosing a problem and solving it may not entail on deciding one correct solution

Types of Decisions
1. Routine decisions 2. Adaptive decisions 3. Innovative decisions

Routine Decisions
The type of decisions made: when problems are relatively well defined and common when established rules, policies and procedures can be used to solve them Are more often made by first-level managers than by top administrators Ex: Medication errors (managers actions are guided by policy and report form)

Adaptive decisions
type of decisions made when problems and alternative solutions are somewhat unusual and only partially understood.

Innovative decisions
Type of decisions made when problems are unusual and unclear and creative, novel solutions are necessary.

Decision Making Conditions

1. Decision Making under Certainty

When nurse managers know the alternatives and the conditions surrounding each alternative. Ex: a nurse manager in the unit wants to decrease the number of venipunctures a patient experiences when an IV is started, as well as reduce costs resulting from failed venipunctures.

Decision Making Conditions

2. Decision Making under Uncertainty - the individual or group making the decision does not know all the alternatives, risks or the consequences of each option. - inevitable because of the complex and dynamic nature of health care organizations. -successful decisions are dependent on human judgment (Mc Connell,2000)

3. Decision Making under Risk - availability of each alternative, potential successes, and costs are all associated with probability estimates. Probability is the likelihood that an event will or will not occur.
100% - if something certain is to happen 0% - if it is certain not to happen 50% - if there is a 50-50 chance

Decision Making Conditions

A. Probability Analysis- a calculation of the

Determining the Probabilities:

expected risk made to accurately determine the probabilities of each alternative. B. Objective Probability- the likelihood that an event will or will not occur based on the facts and reliable information. C. Subjective Probability- the likelihood that an event will or will not occur based on a managers personal judgment and beliefs.

Determining Probabilities
Probability Analysis 60% Filling shifts 100% Fixed wages 50% Filling shifts 70% Fixed wage

Agency A

Agency B

Conditions In Which Decisions Are Made

tainty
Objective Probabilities probabilities

Risk
Subjective

Uncert

Decision Making Process

Rational Decision Making Model

(a series of steps that managers take in an effort to make logical, well-grounded rational choices that maximize the achievement of objectives)
the rationality of the decision made

depends on the managers ability to use information and analysis and on his or her values, beliefs and objectives.

Rational (normative) Decision Making Model

Descriptive(bounded) Rationality Model

Developed by Simon in 1955 and supported by research in the 1990s (Simon, 1993).

Emphasizes the limitations of the rationality of the decision maker and the situation.

Descriptive(bounded) Rationality Model

The decision makers search for possible objectives or alternative solutions is limited because of time, energy and money. Managers frequently lack adequate information about problems and cannot control the conditions under which they operate. Managers often use satisficing strategy.

Satisficing
A decision making strategy whereby the individual chooses an alternative that is not ideal but either is good enough (suffices) under existing circumstances to meet minimum standards of acceptance or is the first acceptable alternative.

Political DecisionMaking Model

Describes the process in terms of the particular interests and objectives of powerful stakeholders, such as hospital boards, medical staff, corporate officers and regulatory body.

Steps in Decision Making

1. Identify the purpose 2. Set the criteria 3. Weight the criteria 4. Seek alternatives 5. Test alternatives 6. Troubleshoot 7. Evaluate the action

Decision-Making Techniques
Artificial intelligence computer technology that can diagnose problems and make limited decisions Expert systems computer programs that provide complex data processing, reasoning, and decision making

Decision-Making Techniques
Group Decision Making

Group Decision Making

Nominal Group Technique
(Delbecq, VandeVen, & Gustafson 1975)

a structure and precise method of eliciting written questions, ideas, and reactions from group members a group process in name only because no direct exchange occurs among members.

Group Decision Making

Nominal Group Technique consists of:
Silently generating ideas in writing Round-robin presentation by group members of their individual ideas in a terse phrase on a flip chart Discussion of each recorded idea for clarification and evaluation Voting individually on priority ideas, with the group solution being derived mathematically through rank ordering or rating using the groups decision rule.

Group Decision Making

Delphi Technique
judgment on a particular topic are systematically gathered from participants who do not meet face to face. - ideas collected through a carefully designed sequence of questionnaires - inputs of experts widely dispersed geographically -less expense

Group Decision Making

Statistical Aggregation
Does not require group meeting Individuals are polled regarding a specific problem Limited to problems for which quantifiable answer can be obtained No opportunity exists for group members to strengthen their interpersonal ties for the generative effect of group interaction

Group Decision Making

Group Decision Making

Brainstorming
Group members meet and generate diverse ideas about the nature, cause, definition, or solution to a problem Members do not critique ideas as they proposed. Evaluation takes place after all the ideas have been generated Members are encouraged to improve on each others ideas.

to problem solving and decision-making

Stumbling Blocks
Personality Many nurse managers are selected because of their expert clinical skills, not management skills resulting to various unproductive activities.

Stumbling Blocks
Rigidity (inflexible management style)
Nurse

manager has the tendency to look at new things in old ways and from established frame of reference (tunnel vision) A result from ineffective trialand-error problem solving, fear of risk taking, or inherent personality traits.

Stumbling Blocks
Preconceived Ideas
Effective nurse managers do not start out with the preconceived idea that one proposed course of action is right and all others wrong. Those who are certain that only their perception is accurate may never accept the final decision.

Problem Solving
A cognitive processing directed at achieving a goal where no solution method is obvious to the problem solver.

Problem Solving Methods

Trial and Error Method
A

method whereby one solution after another is tried until the problem is solved or appear to be improving. type of problem solving in which a theory is tested to enhance knowledge, understanding, or prediction

Experimentation
A

Problem Solving Methods

Trial and Error Method
A

method whereby one solution after another is tried until the problem is solved or appear to be improving. type of problem solving in which a theory is tested to enhance knowledge, understanding, or prediction

Experimentation
A

Problem Solving Methods

Past experience an individuals past
experience can determine how much risk she will take in present circumstances. The nature and frequency of the experience also contribute significantly to the effectiveness of the problemsolving method.

Intuition - relies on past experience and trial and

error. Nurses wisdom, sensitivity and intuition are known to be valuable in solving problems.

Problem Solving Process

1. Define the problem

A descriptive statement of the state of affairs, not a judgment or conclusion.

Affinity map
A problem is acknowledged and a thoughtful question is raised to stimulate ideas. 2. Without talking among the group, ideas about the problem are generated and recorded on individual slips of paper or cards. 3. The group is asked to organize similar ideas into no more than six categories 4. The group facilitator names the categories, explains the rationale used for the naming process, and ensures agreement on category names.
1.

Affinity map
5. The group is allowed an opportunity to explain their thinking. In doing so, perceptions about the problem are discovered and consensus is built. There is no right or wrong answers; therefore, none of the ideas should be criticized. 6. The affinity map can be used to determine cause and effect relationships. The name of each category is written down in a circular format to create a diagram.

Problem Solving Process

2. Gather information a.)combination of facts and feelings b.)manager should obtain relevant , valid, accurate, and detailed descriptions from appropriate people or sources and put the information into writing. of c.)experience as source information

Problem Solving Process

3. Analyze the information:
Categorize information in order of reliability List information from most important to least important Set information into a time sequence Set up information in terms of cause and effect Classify information into categories: human factors, technical factors and policy factors Consider how long the situation has been going on

Problem Solving Process

4. Develop solutions
o should be written down

and plans made to immediately start developing the best of them o Develop alternative solutions and combine the best part of several solutions into a superior

Problem Solving Process

5. Make a decision o Select the most feasible and satisfactory and has the fewest undesirable consequences. o If there is change, those who will be affected should be informed

Problem Solving Process

6. Implement the decision zone of acceptance Clearly unacceptable Neutral Barely acceptable Fully acceptable

Problem Solving Process

7. Evaluate the solution
Are the results better or

worse than expected? What changes have contributed to its success? How can the solution continue to be used and to work?

Group Problem Solving

Advantages:
Groups

collectively possess greater knowledge and information than any single member and may access more strategies to solve a problem Groups can deal with more complex problems than a single individual Group members may have greater variety of training and experiences A group may generate more complete, accurate, and less biased information than one person.

Group Problem Solving

Disadvantages:
It takes time and resources and may involve conflict Can lead to the emergence of benign tyranny within the group Less informed/less confident members may allow stronger members to control group discussion and problem solving Can be affected by group think

Groupthink
A negative phenomenon occurring in highly cohesive, isolated groups in which group members come to think alike, which interferes with critical thinking. Suppresses open, freewheeling discussion Can result in erroneous and damaging situations

2 phenomena associated with groupthink

Premature concurrence seeking Misperceptions and illusions

Premature Concurrence Seeking

High pressure to conform Taboos against expressing dissent or criticizing ideas presented by the majority, leader or other powerful member Self-censorship of dissenting opinions Mind guards (group is protected from controversial information) Apparent unanimity, illusion that the group is in concurrence despite objections and concerns

Misperceptions & Illusions

A belief that the group is morally correct Rationalization of warnings and other forms of negative feedback Biased perceptions of the outgroup Collective rationalization of contradictory information

How to prevent groupthink

1. Promote open inquiry 2. Leader initially delay stating his 3. 4. 5. 6. 7. 8.

preference. Set up several independent work groups Discuss periodically groups deliberations Invite outside members who are not core members Assign role of devils advocate Warning signal from rival Second chance meeting
1.

Janis, 1982

Dialectical Inquiry
Use of formal debate format Formalizes conflict by allowing disagreement Encourages exploration of alternative solutions Reduces emotional aspects of conflict Can be used regardless of a managers feelings.

Risky shift
Phenomenon seen in groups in which riskier, more controversial decisions are made. Groups are more likely to support unusual or unpopular positions

When to use groups for problem solving

the problem is complex and unstructured time and deadlines allow for group decision group members share the organizations goals

When to use groups for problem solving

There is need for acceptance of the decision if it is to be implemented properly The process will not lead to unacceptable conflict

 Analyzing Evaluating

Reasoning

Problem Problem Solving Solving Decision Decision Making Making

New Ideas

Critical Thinking

Left

Right

Creative Thinking

Any Questions?