Objectives

Define problem solving and decision making. Use a problem solving method of decision making appropriately

Problem Solving
Is a basic life skill, identifying a problem and then taking steps to resolve it

are matter of common sense Obtaining information that clarifies the nature of the problem and suggests possible solutions
The mental Activity of identifying a problem (unsatisfactory state) and finding

a reasonable solution to it. This requires decision making; it may or may not require use of critical thinking

Methods of Problem-solving

Brainstorming: (especially among groups of people) suggesting a large

number of solutions or ideas and combining and developing them until an optimum is found
Trial-and-error: testing possible solutions until the right one is found Research process: employing existing ideas or adapting existing solutions to

similar problems

Intuition the understanding or learning of things without the conscious use of reasoning Scientific method is a sequence or collection of processes that are considered characteristic of scientific investigation and the acquisition of new scientific knowledge based upon physical evidence.

Problem-Solving Process

Identify and Select the Problem (assessment). Gather and analyze data (outcome identification). Generate alternatives and select an action (planning). Implement the selected action (implementation).

Evaluate the action (evaluation).

Nursing Process

A systematic, creative approach to thinking and doing that nurses use to obtain, categorize, and analyze patient data and to plan actions to meet patient needs. This type of problem solving process requires the use of decision making, clinical judgment and a variety of critical thinking.

Decision making the process of establishing criteria by which alternative courses of action are developed and selected
A critical thinking process for choosing the best actions to meet goal.

The process of choosing the best action to take the action most likely to produce the desired outcome. It involves deliberation, judgment and choice. Decisions must be made whenever there are mutually exclusive choices, but not necessary problems. Nurses must make decisions and assist clients to make decisions. When faced with several client need at the same time, the nurse must prioritize and decide which clients to assist first. The nurse may;

Look at the advantages and disadvantages of each option Apply Maslows hierarchy of needs

Consider which task can be delegated to others Use another priority setting framework

Decision Making Process

Identify the purpose - Identify why a decision is needed and what need to be

determined
Set the criteria 3 questions must be answered:

o What is the desired outcome? o What needs to be preserved? o What needs to be avoided?
Weight the criteria sets priorities/ranks/activities/services in order of

importance from least to most important as they relate the specific situation
Seek alternatives identifies all possible ways to meet the criteria. In clinical

situations, the alternatives may be selected from range of nursing interventions or client care strategies.
Examine alternatives the nurse analyzes the alternatives to ensure that there

is an objective rationale in relation to the established criteria for choosing one strategy over another.
Project - the nurse applies creative thinking and skepticism to determine what

go wrong as a result of a decision and develops plans to prevent, minimize, or over any problems,
Implement the decision plan is placed into action Evaluate the outcome the nurse determines the effectives of the plan and

whether the initial purpose was achieved.

Decision making used in situations that do not involve problem solving, the nurse make:
Value decisions e.g. to keep client information confidential Time management decisions e.g. taking clean linens to the clients room at

the same time as the medication in order to save steps

Scheduling decisions e.g. to bathe the client before visiting hours

 Priority decisions e.g. which interventions are most urgent and which can be

delegated. Frequently Asked Questions

How is critical thinking related to the problem-solving and decision-making processes?

Critical thinking includes both problem solving and decision making.

In problem solving, problems are identified, information is gathered, a specific problem is named, a plan for solving the problem is developed, the plan is put into action, and results of the plan are evaluated. Decision making is the consideration and selection of interventions from a repertoire of actions that facilitate the achievement of a desired outcome.

What is the relationship between the problem-solving process and the nursing process?
The nursing process is a specific type of problem-solving method, used by

nurses and applied to client care.

What is the difference between a goal and an expected outcome?

Goals are broad statements that describe an intended or desired change in the

clients behavior. Expected outcomes are specific objectives related to the goals. They are used to evaluate nursing interventions, so they should be measurable, achievable within a certain time limit, and realistic.

What are the reasons why goals are not met or are only partially met? When goals are not met or are only partially met, the reasons may be that (1) the initial assessment data may have been incomplete, (2) the goals and expected outcomes may not have been realistic, (3) the time frame may have been too optimistic, or (4) the goals and/or nursing interventions may not have been appropriate for the client.

1. A co-worker asserts: "men always seem to exaggerate pain," the nurse who is thinking critically might ask:
a. "Where did you read that?" b. "Who told you that?" c. "What evidence do you have for that?" d. "How many male patients have you had?"

Rationale: The importance of critical thinking is valued in nursing. Skills to hone critical thinking can be obtained through education and experience. Answers a, b, and d are merely asking for further information. 2. When a 4-year old child refuses to take a medication in pill form because it is "too big and it hurts when I swallow," the nurse demonstrates critical thinking by:
a. Asking the mother how she gets him to cooperate b. Allowing the child to skip a dose this one time and documenting the reason

why
c. Asking the nurse-manager what to do d. Checking with the pharmacy to see if the medication can be dispensed in

liquid form

Rationale: Part of critical thinking is being creative in approaches to difficult situations. Asking the mother how she gets him to cooperate may be helpful, but is not using critical thinking. It is never correct for the nurse to allow the child to skip a dose. Asking the nurse-manager what to do may be helpful, but it is not critical thinking. 3. In the decision making process, after the nurse sets and weights the criteria and examines alternatives but before implementing the plan, the nurse should? a. Reexamine the purpose for making the decision

b. Consult the client and family members to determine their view of the criteria c. Identify and consider various means for reaching the outcomes d. Determine the logical course of action should intervening problem arise
Rationale: It is

important to project what problems might interfere with the plan and have responses to those problems in mind. The purpose for the decision should have been clear enough at the outset as to not require reexamination at this point. Clients and families should be consulted early in the purpose setting and criteria setting steps. Considering various means for reaching the outcomes is the same as examining alternatives.

4. When an elderly client brings up the possibility of entering a nursing home, the nurse who is critically thinking may ask:
a. "Who suggested a nursing home to you?" b. "Why are you considering a nursing home?" c. "Which nursing home are you considering?" d. "What is bothering you?"

Rationale: The nurse who is using critical thinking is able to suspend judgment and individualize care. The nurse is assuming the individual is planning for the future. In Answer a, the nurse is assuming that someone else is trying to plan for the client's future residence. In Answer c, the nurse is assuming that a decision already has been made. In answer d, the client may not be bothered by anything, and the nurse is making an assumption.

5. A client who is in pain refuses to be repositioned. In making a decision about what to do, what should the nurse consider first?
a. Why a decision is needed b. When a decision is needed c. Who actually gets to make the decision

d. What are the alternatives

Rationale: Decision making requires the nurse to select the best action to meet a desired goal. When a decision is needed comes after determining why a decision is needed. Who actually makes the decision is important, but not the first thing to consider. What the alternatives are comes after determining why a decision is needed, who makes the decision, and when a decision is needed.

6. After examining her client's abdomen and finding it firm and round, even though the client says it doesn't hurt, the nurse says to a colleague, "I think something is going on here; I am going to check the latest assessment." This nurse is using:
a. Deductive reasoning b. Intuition c. Trial and error d. Modified scientific method

Rationale: Intuition is the "gut feeling" one has without the conscious use of reasoning. Deductive reasoning is reasoning from the general to the specific. Trial and error is a problem-solving process that requires trying one or more approaches until one works. Modified scientific method is a logical, systematic approach to problem solving that the nurse is not using in this case.

Are you at your best?

5 6 points: Youre Excellent Critical Thinker

Congratulations! Keep up the good work!

THANK YOU!!!