Chapter 1

Decision Making, Problem

Solving, and Critical Thinking:
Requisites for Successful
Leadership and Management

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Decision Making, Problem Solving, Critical

Thinking, and Clinical Reasoning
Decision Making: complex, cognitive process of choosing
a particular course of action; the thought process of
selecting a logical choice from available options
Problem Solving: part of decision making; systematic
process focusing on analyzing a difficult situation
involving higher-order reasoning and evaluation

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Decision Making, Problem Solving, Critical

Thinking, and Clinical Reasoning(cont.)
Critical Thinking: the mental process of actively and
skillfully conceptualizing, applying, analyzing,
synthesizing, and evaluating information to reach an
answer or conclusion
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 diagnosis

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Characteristics of a Critical Thinker

Insight
Intuition
Empathy
Willingness to take action

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Successful Decision Makers

Self-aware
Courageous
Sensitive
Energetic
Creative

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Which is a characteristic of a successful decision maker?
A. Impulsiveness
B. Courage
C. Decisiveness
D. Whimsy

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
B. Courage
Rationale: A successful decision maker should be willing to take
risks

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Marquis-Huston Critical-Thinking Teaching

Model

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Feedback Mechanism of the Nursing

Process

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Experiential Learning
Provides mock life experiences to learn from
Allows learners to apply leadership and
management theory
Promotes whole-brain thinking and improved
problem-solving skills

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Vicarious Learning to Enhance

Decision-Making Skills

Case studies: provide stories that impart learning

Simulations: provide opportunities for learning with

no risk to patients or organizational performance

Problem-based learning (PBL): provides opportunities

for learners to address and learn from authentic
problems vicariously

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Critical Elements in Problem Solving

and Decision Making

State a clear objective

Gather data carefully

Take the time necessary

Use an evidence-based approach

Generate many alternatives

Think logically

Choose and act decisively

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Which is NOT a factor in solving a problem successfully?
A. Using an evidence-based approach
B. Doing all work independently
C. Stating a clear objective
D. Watching for faulty logic

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
B. Doing all work independently
Rationale: It is important to use group process in some
way to increase solutions

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Questions Asked in Data Gathering

What is the setting?
What is the problem?
Where is it a problem?
When is it a problem?
Who is affected by the problem?
What is happening?
Why is it happening? What are the causes of the problem? Can I
prioritize the causes?
What are the basic underlying issues? Areas of conflict?
What are the consequences of the problem? Which of these are
most serious?
Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Questions Asked in Analyzing Solutions

What factors can you influence? How can you accentuate

the positive factors and minimize the negative factors?

What are the financial, political, time, and resource

implications of each possible solution?

What are the weighting factors?

What is the best solution?

What are the means of evaluation?

What are the consequences of each alternative?

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Problem-Solving versus Decision-Making

Models
Managerial DecisionMaking Model

The Traditional ProblemSolving Process

Identify the problem

Gather data to identify the

causes and consequences of
the problem

Determine the decision and

the desired outcome (set
objectives)

Research and identify options

Compare and contrast these

options and their
consequences

Explore alternative solutions

Evaluate each alternative

Select appropriate solution

Implement solution

Make a decision

Evaluate results

Implement an action plan

Evaluate results

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
What is the first step in managerial decision-making model?
A. Identify the problem
B. Evaluate alternatives
C. Gather data
D. Set objectives

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
D. Set objectives
Rationale: While the traditional model begins with
identifying the problem, in managerial decisionmaking model one approaches the issue by first
deciding on the objectives

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process: A Problem-Solving

and Decision-Making Model

Assess

Diagnose

Plan

Implement

Evaluate

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Strategies for New Nurses to

PromoteEvidence-Based Practice
Keep abreast of the evidence
Use multiple sources of evidence
Use evidence to support clinical interventions and
teaching strategies
Find established sources of evidence
Implement and evaluate nationally sanctioned clinical
practice guidelines
Question and challenge nursing traditions

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Strategies for New Nurses to Promote

Evidence-Based Practice(cont.)
Dispel myths and traditions not supported by
evidence
Collaborate with other nurses locally and globally
Interact with other disciplines to bring nursing
evidence to the table

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Tell whether the following statement is True or False:
New nurses should question and challenge nursing traditions.
A. True
B. False

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
A. True
Rationale: New nurses should question and challenge nursing
traditions and promote a spirit of risk-taking in order to best
utilize evidence-based practice

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Successful Decision Maker

Understands:
Gender
Personal individual values
Life experience
Preferences
Willingness to take risks
Brain hemisphere dominance
Predominant thinking style
Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Decision-Making Tools
Decision grids
Payoff tables
Decision trees
Consequence tables
Logic models
Program evaluation and review technique

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Example of a Decision Tree

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Economic Man versus Administrative Man

Copyright 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins