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Decision Making, Problem Solving,
Critical Thinking & Clinical
Reasoning
Definitions
Decision making is a complex, cognitive process
often defined as choosing a particular course of
action
Problem solving is part of decision making. A
systematic process that focuses on analyzing a
difficult situation. Problem solving always includes a
decision-making step
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Critical Thinking(reflective thinking): is a
mental process of actively and skillfully
conceptualizing, applying, analyzing,
synthesizing, and evaluating information
to reach an answer or conclusion. It
involves both cognitive and affective
components
Clinical Reasoning: Integrating and
applying different types of knowledge to
weigh evidence, critically think about
arguments and reflect upon the process
used to arrive at a diagnosis. It uses both
knowledge and experience to make
decisions at the point of service.
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Vicarious learning to increase PS
and DM skills
Case studies
Simulation
Problem-based learning
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Theoretical Approaches to PS &DM
Most individuals rely on discrete, often
unconscious processes known as heuristics:
(use trial and error or rule-of- thumb) quick
PS
A structured approach The best way to make
quality decisions: prevents trial and error,
focus on alternatives and increases clinical
reasoning. (apply theoretical models)
1. Identify the
problem
7. Evaluate the
2. Gather data
results
[Link]
Problem-
Solving Process
6. Implement the 3. Explore
solution. alternatives
Weakness
The amount of time
needed for proper
5. Select the
implementation. appropriate
4. Evaluate the
alternatives
Lack of an initial solution
objective-setting step.
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1. Determine
decision & set
objectives
6. Evaluate results 2. Identify options
2. Managerial Decision-
Making Models
3. Compare
5. Implement
options &
action plan
consequences
4. Make a decision
Eliminates the weakness of the traditional model by adding a
goal-setting step
3. The Nursing Process
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Theoretical Approaches to PS & DM
Decision-Making Process Simplified Nursing Process
Identify the decision Assess
Collect data
Identify criteria for decision Plan
Identify alternatives
Choose alternative
Implement alternative Implement
Evaluate steps in decision Evaluate
State problem
Evaluate and Collect info &
prevent
occurrence analyze problem
[Link] ethical PS model
Develop Develop,
strategies to analyze
implement alternatives
Select, justify
alternative
• Requires the identification of strategies to prevent problem
recurrence
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[Link] DM model
Is a rapid, automatic process of recognizing familiar
problems instantly and using experience to identify
solutions
Use of gut feeling to take appropriate action that
impact outcomes
Should be
founded on scientific knowledge
Used in conjunction with evidence-based practice
Used when time is limited or systematic DM is not possible
Critical Elements in PS and DM
Define Objectives Clearly
Gather Data Carefully
Setting, problem (what and where, when), who is
affected, what is happening, underlying issues,
consequences…
Take the time necessary
Use an evidence-based approach
Generate Many Alternatives
At least two
↑ Number of people working on the problem.
Brainstorming
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Think Logically
Draw inferences from information
People think illogically in 3 ways:
Overgeneralizing: A has a characteristic
>> all As are the same
Affirming the consequences: B is good then
A is bad
Arguing from analogy: A is present in B
then A & B are alike
Choose and Act Decisively
Individual Variations In D M
Gender
o Men & women have different structures and wiring in the
brains and use brains differently: Parts of frontal lobe, limbic
cortex and white matter are larger in women. Grey matter is
larger in men
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Values
consciously or subconsciously values influence
perception, information gathering, processing and
final outcome address or ignore problems
Life Experience
e.g. ↑ life experience → ↑ alternatives.
Good or bad previous decisions affect future
decisions.
Autonomy more experience for DM
Individual Preference
Preferring one alternative over another due to:
Individual risks such as physical, economic, and
emotional risks, and time and energy expenditures.
Brain Hemisphere Dominance and Thinking Style
Analytical thinker: linear, left-brain thinkers (think
Systematically)
Intuitive thinker: creative,, right-brain thinkers (think
intuitively)
Organization needs all types of thinkers
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Overcoming Individual Vulnerability
in Decision Making
Values
Values clarification decreases confusion, through
understanding their personal beliefs and feelings
Life experience
Use available resources, Involve other people, Analyze
decisions
Individual Preference
self-awareness, honesty, and risk taking
Individual Ways of Thinking
Use both types of thinkers, use group process, talking
management problems over with others, and developing
whole-brain thinking
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Qualities of Successful Decision Makers:
Courage
Sensitivity
Energy
Creativity
Decision Making in Organizations
Effect of Organizational Power on Decision
Making
Decisions of powerful people in organizations
→ congruent with their own preferences and
values.
People having little power in organizations →
consider the preference of the powerful.
The powerful also can inhibit the preferences
of the less powerful.
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Decision Making in Organizations
Rational and Administrative Decision Making
Economic Man (Rational)
Administrative Man
Economic Man (Rational) Administrative Man
Very rational decisions. Decisions that are good
Complete knowledge of the enough.
problem or decision Knowledge is always
situation.
fragmented.
Complete list of possible
alternatives. Impossible to predict all
Rational system of ordering
alternatives accurately.
preference of alternatives. Usually chooses from
Selects the decision that will among a few alternatives.
maximize utility function The final choice is
“satisficing” rather than
maximizing.
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Decision Making Tools
Decision Grid
Allows one to visually examine the alternatives and compare
each against the same criteria.
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Decision Making Tools
Payoff Tables
Have a cost – profit relationships and the probabilities of
certain outcomes using current information and historical
data.
Decision Trees
Is a graphic method that can help managers visualize the
alternatives available, outcomes, information needs for a
specific problem over time.
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Decision Making Tools
Consequence Tables
List the objectives for solving a problem down one side of a
table and rates how each alternative would meet the desired
objective.
Objectives for problem Alternative 1 Alternative 2 Alternative 3
solving
1. Reduce the number of falls X X X
2. Meets regulatory standards X X X
3. Is cost effective X X
4. Fits present policy guidelines X
Decision Score
Decision Making Tools
Logic Models
Schematic or picture of how program is
intended to operate. Schematic includes
resources, processes, and desired outcomes
and depicts exactly what the relationships are
between the three components.
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Decision Making Tools
Program Evaluation and Review Technique
(PERT)
A flowchart that predicts when events and
activities must take place if a final event is to
occur.
Network system model for planning and
control under uncertain conditions.
See figure 1-5
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Pitfalls in Using Decision Making Tools
Confirmation Bias: is a tendency to affirm
one’s initial impression and preferences as
other alternatives are evaluated.
Individuals past influence current decisions
Biases can be reduced by using correct
decision making style and involving others
when appropriate.
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