Unit 7 Problem Solving Critical Thinking Creativity and Decision Making

Unit Seven
Problem solving, Critical

thinking, Creativity, and
Decision making
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Learning objectives
At the end of this unit, the learner will be able to;
1.Define problem solving, creativity, critical thinking
and decision making
2.Discuss critical thinking and problem solving.
3.Describe importance of critical thinking for
nurses.
4.List the five steps in the decision making process.
5.Describe at least six techniques to increase
creativity.
6.Identify at least two decision making tools.
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Problem Solving
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Problem Solving
 If you have a
problem at work,
it is a good idea
to sort things
out.
 This is called
problem solving.
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Problem Solving…
 Basic intellectual process that has been
refined and systemized for the various
challenges people face.
 Problem solving which involves a decision
making steps focused on trying to an
immediate problems which can be viewed
as a gap between “what is?” and “what
should be?”
 Problem makes leader better, not bitter
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Problem Solving…
If you think you have a problem at
work, there are a number of ways to
sort things out …
•Talk to the person you are having a problem
with.
•Talk to your supervisor to help you sort out
the problem.
•Have a meeting with all the people who can
help you sort out the problem.
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Problem Solving…
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Why is it important to solve
problems at work?
• People can get cross.
• Work does not get done.
• People are unhappy at work.
• Accidents can happen.
• Contracts can be lost.
• People leave work.
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Some Do’s of problem solving
 Do say what the problem is for you.
 Do listen to what the problem is for
the other person.
 Do attack the problem, not the
person.
 Do look for solutions that suit you
both.
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Some Don’ts of problem
solving
 Don’t call people mean names.
 Don’t put people down.
 Don’t be angry or aggressive.
 Don’t stop listening.
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Approaches of problem
solving
 Trial and Error
 Intuition
 Nursing Process
 Scientific method/Research process
 Modified Scientific Method
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Problem Solving Steps
1. Define The Problem
2. Analyze The Problem
3. Generate Possible Solutions
4. Select The Best Solution
5. Plan For Implementation
6. Implement And Evaluate The
Solution
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Step One : Define The
Problem
 Identify the problem
 Develop an accurate problem statement
 Comparison against others
 Monitor for weak signals
 Comparison of current performance with
objectives or past performance
 Checklists
 Inverse brainstorming
 Listing complaints
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Step Two: Analyze The
Problem
 Don’t rush to a wrong
solution.
 Highly critical step.
 Common mistake to
immediately begin
generating solutions.
 Must identify and
eliminate root causes
of problem.
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Step Two: Analyze The
Problem…
Diagnostic Tools
Brainstorming
Flow Diagrams
Cause and Effect
Diagrams
Pareto Charts
Check Sheets
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Step Three : Generate
Alternative Solutions
How to Develop Alternatives:
Look at the data. What does it tell you?
– Data will lead to some ideas
– Data may not lead to best idea
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Alternative Solutions…
 Question each aspect of situation.
– What is the job to be done?
– Why is the job to be done?
– Who should do the job?
– Where should the job be done?
– When should the job be done?
– How should the job be done?
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 Apply creativity to the situation.
– Making new ways
– Rearranging old ways
– Form novel and useful ideas
 Use all idea sources available.
– The worker involved.
– In-house experts.
– Written material
– Outside experts
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 Apply some appropriate action
– Eliminate (part, reason, job, activity)
– Combine (parts, forms, jobs, functions)
– Rearrange (sequence, location)
– Simplify (foolproof, make obvious,
provide interlocks, remove steps,
reduce physical effort)
 Brainstorm for alternative solutions.
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Step Four : Select A Solution
 Refer back to original problem
statement. Consider:
– Safety
– Cost
– Product performance
– Better management information
– Improved Technology
– Time
– Quality
– Appearance
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Step Four : Select A
Solution…
 Some questions to ask:
– Will this completely resolve the problem?
– Will this only satisfy part of the problem?
– Will this prevent future occurrences?
– Will this have little or no impact on the
problem?
– Do we have the authority to implement?
– Do we have the necessary resources?
– How long will it take to implement?
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Step Five : Plan and
Implement Solution
Steps to ensure successful
implementation:
Work the most powerful forces
Prepare an action plan:
– What will be done?
– How will it be done?
– Where will it be done?
– Who will do it?
– When will it be done?
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Step Five : Plan and
Implement Solution…
 Develop a tracking system:
– Identify milestones or events
– Assign completion dates
– Identify reporting systems
 Design evaluation procedures
 Implement the procedures
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Step Six : Evaluate The
Solution
 Measure results using procedures
established during implementation
 Use data gathering:
– Check sheets
– Control charts
– Time studies
– Pareto analysis
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Problem Solving Strategies
 Do it yourself
 Influence others
 Assign someone
 Do nothing
 Combine knowledge
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Problem Solving Strategies…
 Do it yourself
– The problem solver should evaluate
his/her capabilities and expertise and
determine whether this is the preferred
option
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 Influence Others
– Allow the person owning the problem to
solve it
– Eg. Conflict between 2 employees: The
nurse manager may bring the parties
together to discuss their issues
• Interpersonal skills may be used to
assist in conflict resolution, but the
employees would be allowed to work
out their own solution.
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 Assign someone –
– Delegation is the “transferring to a
competent individual the authority
to perform a selected nursing task
in a selected situation.”
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 Do Nothing
– Often a problem will subside on its own
– The problem solver should recognize
when a problem has the potential to
resolve by itself and should consider
making a conscious effort not to
intervene
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 Combine knowledge
– Consultation, collaboration with an
expert
– Talking through the situation
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Pitfalls in Problem-Solving
– Failure to clearly identify the real
problem
– Failure to eliminate preconceived ideas
in the identification of solutions
– Failure to communicate
– Failure to follow up
– Failure to use appropriate resources
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Critical thinking
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Critical thinking
 Successful Intelligence depends on 3
thinking skills:
practical
analytical THINKING
SKILLS
creative
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Critical thinking…
 Critical: means requiring careful
judgment.
 Thinking: means to have an opinion, to
reflect on or ponder, to call to mind or
remember to devise a plan, to form a
mental picture of (image), to reason
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 Analytical thinking, purposeful, goal-
directed thinking process that strives to
problem solve patient care issues through
the use of clinical reasoning.
 Combines logic, intuition, and creativity
 Essential to nursing practice
 It is manifested when ever a nurse ask
“why?”, “ what?”, and “how?”.
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THINKING Vs CRITICAL THINKING
Criticalthinking is controlled, purposeful &
more likely to lead to obvious beneficial
results
Thinking is basically any mental activity;
can be aimless & uncontrolled; it may serve
a purpose, but we often aren’t aware of its
benefits; we might not even remember our
thoughts at all
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 No matter which definition you
choose, critical thinking involves the
use of several concepts, including:
exploring, analyzing, prioritizing,
explaining, deciding, and evaluating
to identify solutions and determine a
course of action to solve patient care
problems.
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NURSING CRITICAL
PROCESS THINKING
Assessment Exploring
Diagnosis Analyzing
Planning Prioritizing/decision
making
Implementation Prioritizing and
deciding
Evaluation Evaluating
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o It is important for manager to assess their
staff members to think critically and
enhance their knowledge and skill
through;
o Staff development programs
o Coaching
o Role modeling
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 Critical thinking is
important for;
 Problem solving
 Creativity
 Decision making
 Clinical judgment
 Critical thinking
is the concept
that link all the
above mentioned
concepts.
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WHAT IS CRITICAL THINKING
IN NURSING?
 Purposeful, goal-directed thinking aiming
to make judgments based on evidence
rather than conjecture.
 It is based on principles of science & the
scientific method & develops strategies
that maximize human potential &
compensates for problems caused by
human nature.
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Why do we need to think
critically?
 To make accurate and appropriate clinical
decisions
 To solve problems and find solutions
 To plan care for each unique client and
client problem
 To seek knowledge and use it to make
clinical decisions and problem solve
 To be able to think creatively when
planning care for clients
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CHARACTERISTICS OF CRITICAL
THINKING
 It is rational & reflective.
 It involves healthy, constructive
skepticism.
 It is autonomous.
 It includes creative thinking.
 It is fair thinking.
 It focuses on what to believe & do.
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A Path to Critical/Analytical
Thinking
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Components of Critical
Thinking
 Interpretation
 Analysis
 Inference
 Explanation
 Evaluation
 Self-regulation
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Aspects of Critical Thinking
 To develop into an expert critical
thinker the nurse needs to use:
– REFLECTION: purposefully thinking
back /recalling. Requires honest review
– LANGUAGE: precise & clear resulting in
clear message
– INTUITION: inner sensing that
something is so
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Levels of Critical Thinking
 Basic Critical Thinking: Thinking is
concrete and based on book, principles,
rules, policies (whatever they can read or
hear about).
 Complex Critical Thinking: the nurse rely
less and less on their resource people and
think before asking them, come up with
the answers themselves.
 Commitment: The nurse starts
anticipating patient needs independently.
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Critical Thinking
Competencies
 General critical thinking
competencies used by many
disciplines, in many everyday
situations.
– Scientific method
– Problem solving
– Decision making
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Critical Thinking
Competencies
 Specific critical thinking in clinical
situations used by physicians,
nurses, and other health care
professionals.
– Diagnostic reasoning/ Clinical inference
– Clinical decision making
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Critical Thinking
Competencies
 Specific critical thinking competency
used in nursing practice
 Nursing Process
– Assessment
– Analysis (Nursing Diagnosis)
– Planning
– Implementation
– Evaluation
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Critical Thinking Model
 The model helps to explain how nurses make
clinical judgments/ decisions in their clinical
practice that result in safe, effective, nursing
care. There are 5 components in this model of
critical thinking:
– Knowledge base
– Experience in nursing
– Critical thinking competencies
– Attitudes for critical thinking
– Standards for critical thinking
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Developing Critical Thinking
Attitudes/Skills/
 Not easy
 Not “either or”
 Self-assessment
 Tolerating dissonance and ambiguity
 Seeking situations where good
thinking practiced
 Creating environments that support
critical thinking
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Attitude/skills of critical
thinkers
They are:
Active thinkers.
Knowledgeable of their biases &
limitations.
Fair-minded.
Willing to exert a conscious effort to work
in a planful manner.
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thinkers...
 Good communicators.
 Empathetic.
 Open-minded.
 Independent thinkers.
 Curious & insightful.
 Humble.
 Proactive.
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thinkers...
 Honest with themselves & others, admitting
when their thinking may be flawed or
requires more thought.
 Organized & systematic in their approach.
 Flexible.
 Cognizant of rules of logic
 Realistic
 Team players.
 Creative & committed to excellence.
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Standards for Critical
Thinking
 Universal Intellectual Standards for
Critical Thinking:
– Clarity
– Accuracy
– Precision
– Depth
– Breadth
– Logic, applied to clinical reasoning
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Thinking…
 Intellectual Standards-
– 14 intellectual standards (Paul,1993) Nurses
use these when using the nursing process:
1. Confidence 7. Perseverance
2. Independence 8. Creativity
3. Fairness9. Curiosity
4. Responsibility10. Integrity
5. Risk taking 11. Humility
6. Discipline
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Thinking…
 Professional standards
– Sound ethical standards
• When critically thinking must have a sense of
their own values, beliefs, feelings and their
clients/ client’s family’s values, beliefs, feelings
– Scientifically based practice with standards
developed by experts
• Evidenced based practice
• Standards developed as a result of evidence
• These are minimum requirements that are
necessary to give quality effective care
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Creativity
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Innovation Vs Creativity
 Innovation is the
implementation of new ideas
at the individual, group or
organizational level.
 Creativity is the development
of ideas about products,
practices, services, or
procedures that are novel and
potentially useful to the
organization.
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What Does It Take
to Be Creative?
Time
Hard work
Mental energy
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Creativity needs
 Curiosity
 Flexibility
 Passion, inspiration
 Singleness (following direction)
 Looking ahead
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Components of creativity
 Cognitive thinking: capacity to work
with information and solve problems
 Approach to personal creativity
 Emotional & motivational
 Interpersonal relations: capacity to
participate in creativity process with
others
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Characteristics of Creative
People
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Creativity Enhancers
 Focus on intrinsic  Hire creative people
motivation  Enriched, complex jobs
 Creativity goals  Provide resources
 Developmental  Clear organizational goals
feedback  Instructions to be creative
 Supportive  Recognize and reward
supervision creativity
 Healthy competition  Encourage risk taking
 Participative  No punishment for failure
decision making
 Autonomy
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Creativity Enhancers…
 Workforce  Organizational
diversity culture that
 Internal and promotes
external innovation
interaction  Flexible, flat
 Diverse teams structures
skilled at working
together  Close interaction
 Supportive climate and relationships
with customers
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How Can Organizations Foster
Creativity?
Hire creative & Provide resources Design complex &
diverse workforce esp. time challenging jobs
Set clear “Be Creative!” Set creativity

org. goals goals
Use diverse Recognize & Create the right

teams reward creativity org. culture
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Management Style and
Creativity
 Encourage risk taking
 Provide autonomy
 Encourage productivity- “sweat
equity”
 Supportive supervision, climate, and
work group
 Participative leadership
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Organization Design
and Creativity
Flexible
Flat
Structures
That promote
Internal &
Close Contact
External
With Customers
Interaction
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Creativity Killers
 Excessive focus on extrinsic motivation
 Limits set by superiors
 Critical evaluation
 Close, controlling supervision
 Competition in a win-lose situation
 Control of decision making
 Control of information
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Creative Thinking Techniques
 Brainstorming Rules
– Expressiveness - Say whatever ideas come
to mind without focusing on constraints
– Non-evaluation - No criticism allowed; all
are valuable
– Quantity - Produce as many ideas as
possible
– Building - Expand on other
people’s ideas
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Creative Thinking Techniques…
 Brain writing
– Hybrid of both individual and group
brainstorming
– Produces more ideas than brainstorming
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Creative Thinking Techniques…
 Shift your perspective
 Take a risk
 Set the stage
 Be curious
 Be spontaneous
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Stages of the creative process
Wallas model
1.Preparation:- Define the problem, need, or
desire, and gather any information. Set up
criteria for verifying the solution's
acceptability.
2.Incubation:- Repetition of the same
thoughts. No new ideas or interpretations.
Reexamine the situation and review the data
collected. Last in minutes, weeks, even
years.
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Stages of the creative
process…
Wallas model…
3. Illumination/Insight/:- Seeing the
entire concept or entity all at once. Very
brief, involving a tremendous rush of
insights within a few minutes or hours.
4. Verification:- Experimentation of
solution (succeeded or failed).
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Forms of creativity
 Combinational: Unfamiliar combination
of familiar ideas.
 Exploratory: Exploration within an
established Conceptual space.
 Transformational: Arises from a
deliberate transformation of the
conceptual space.
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Barriers to Creative Thinking
 Resistance to change, rigid mind-set, practice
guided by tradition, habit, routines
 Stereotypical perceptions of clients
 Fear of making mistakes
 Unwillingness to take risks or look for alternative
strategies
 Decision making without sufficient data or
supported by rationale
 Failure to evaluate effectiveness of nursing
actions
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Decision Making
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Decision Making
 It is a purposeful and goal directed
effort that uses a systematic process
to choose among two or more options
to solve specific problem.
 Not all decision making begins with a
problem situation, instead the hallmark
of decision making is the identification
and selection of alternatives.
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Decision Making…
 Poor quality decision is likely if the
objectives are not clearly identified
or if they are inconsistent with the
value of an individual or
organization.
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Rational decision making
Single, well-
defined goal
is to be achieved
Problem is
All alternatives clear and
and consequences
are known
unambiguous
Rational
Decision
Final choice
Preferences Making will maximize
are clear
payoff
Preferences
No time or cost
are constant
constraints exist
and stable
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Characteristics of effective
decision making process
 Systematic, comprehensive way of
thinking.
 Predetermined consequences of
implemented decision.
 Much positive outcomes and fewer
negative consequences.
 Based on a “goal-oriented" analysis of the
situation
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Characteristics of the
decision
 Effective: Meets the pre-stablished
GOALS
 Realistic: Physically possible, fits
circumstances
 Feasible: Possible to carry out with
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WHAT ARE THE 3 CONDITIONS
IN DECISION MAKING?
 Freedom
 Rationality
 Voluntarity
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WHAT IS CLINICAL DECISION
MAKING COMPOSED OF?
 Cue
 Hypothesis
 Knowledge base
 Nursing intervention
 Search
 Assumption
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Decision Making Process
Step 1: Identify the problem
Defining the problem. What is wrong?
Where is improvement needed?
Begins when the nurse manager
perceives a gap between what is actually
happening and what should be
happening.
The nurse manager can identify the
problem by analyzing situation.
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Decision Making Process…
 What is the desirable situation?
 What are the presenting symptoms?
 What are the discrepancies?
 Who is involved?
 When? Where ? How?
 Develop Feasible hypotheses, and
elimination of hypotheses that fail to
conform to the facts.
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 Feasible hypotheses should be
further tested for causal validity.
 By analyzing available information,
manager should begin exploring
possible solutions.
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Step 2: Explore alternatives
 If situation is not covered by policy,
manager must draw on his education
and experience, but it may be
inadequate.
 More experienced manager had more
alternatives to be suggested for solving
a variety of problems.
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Step 2: Explore alternatives……
 Health care is changing rapidly
manager should learn how others are
solving similar problems.
 This can be done through continuing
education, professional meetings,
review of the literature, and
brainstorming with staff.
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Step 3: Choose most desirable
alternative
 One alternative is not always clearly
superior to all others.
 Manager must try to balance multiple
factors such as pt. safety, staff
acceptance, morale, public acceptance,
cost, and risk of failure. The following
questions may be asked:
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Step 3: Choose most desirable
alternative……
- Will this decision accomplish the
stated objectives? (yes or no)
- Dose it maximize effectiveness and
efficiency? use available resources
before seeking outside assistance.
- Can the decision be implemented?
If not, it will not solve the problem

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Step 4: Implement decision
 The manager will need to communicate
the decision to appropriate staff
smoothly to win the cooperation.
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Step 5: Evaluate results
 Evaluate the results of the chosen
alternative.
 Be alert: solutions to old problems
sometimes create new problems, so
you need additional decisions.
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Decision making models
 The decision method you used
depends on the following
circumstances.
Is the situation routine, predictable,
complex, and uncertain?
Is the goal of the decision to make a
decision conservatively (just good
enough) or optimally?
95
Decision making models…
 Based on the above assumption there
are four decision making model.
I. Normative or Prescriptive DM model
II. Descriptive/ Behavioral DM model
III.Satisfying/ Conservative DM model
IV.Optimal DM model
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I. Normative or Prescriptive DM model
 Used when the outcome is predictable,
the problem/situation is well structured.
 Information is objective.
 The decision is already prescribed.
Example: if one student get “F”, the
student should take the course again
by adding.
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II. Descriptive/ Behavioral DM model
 Used when the situation is complex,
unpredictable, and uncertain.
 You don’t know the outcome.
 Information is subjective and every
person define or interprets into
different direction.
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III. Satisfying/ Conservative DM model
 Used when information is gathered to
meet the minimum requirement for the
objective of decision.
 This model is appropriate when
critical, urgent, immediate answer
were needed within a short period of
time.
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IV. Optimal DM model
 The solutions/decisions are selected
based on optimal requirement for
objective decision.
 Appropriate in the situation that needs
time.
 This model is appropriate when non-
critical, urgent, immediate answer were
needed within a short period of time.
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Decision making style
 The situation and circumstances
should dictate which decision making
style is most appropriate.
 To select an appropriate decision
making style, the nurse manager
should look at the following decision
rules.
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Decision making style…
1. The importance of the decision quality
to the institutional success.
2. The degree to which the manager
process the information and skills to
decision.
3. The degree to which the followers
have the necessary information to
generate a quality decision.
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4. The degree to which the problem is
structured.
5. The importance of followers commitment.
6. The likelihood that an autocratic would be
accepted.
7. The strength of followers commitment to
institutional goals.
8. The likelihood of followers conflict over the
final decision.
103
 Based on the above mentioned rules
there are three DM styles. These are;
1. Autocratic
2. Democratic
3. Anarchic
Based the stated rules characterize them.
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Types of decisions
• Decisions made in the nursing service can
be categorized depending upon the
following criteria
How much time the manager spends in
making decision?
What proportion of the organization
must be involved in making decision?
The organization function/ the nursing
functions on which they focus.
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Types of decisions...
 Onthe basis of these, there are three
classifications:
1. Ends -Means
2. Administrative-Operational
3. Programmed-Non-programmed
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1. Ends-Means
Ends: deals with the determination of
desired individual or organizational
results to be achieved.
Means: decisions deal with strategic
or operational programmes, activities
that will accomplish desired results.
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2. Administrative-Operational
• Administrative: made by senior
management, which have significant
impact throughout the organization.
• Operational: are generally made by mid
level and first line managers and
address day to day operational
activities of a particular organizational.
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3. Programmed-Non-programmed
 Programmed:- these are repetitive and
routine in nature. Since they can be
programmed, procedures, rules and often
manuals are formulated to cover those
situations.
 Non-programmed:- unique and non-
routine. This can be used in
emergency/urgent situation.
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Conditions that initiate
decision making
These are;
1. Opportunity
2. Threat
3. Crisis
4. Deviation
5. Improvement
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Ways of Decision Making
1. Relying on tradition: based on past
decision making
2. May appeal to authority: based on
suggestions from an expert/a higher
level management
3. Prior reasoning: based on assumption
4. Logical decision making: is a rational,
intelligent and systematic approach
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Factors Influencing Decision
Making
1. Decision makers attribute
• Knowledge, experience, and
judgment
• Perception and personality
• Values and philosophy
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Making…
2. The Situation
• Urgency of solution and time
pressures
• Magnitude and importance
• Structure and uncertainty and
risk
• Cost benefit
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Making…
3. Environmental Constraints
• External
• Internal
114
Decision Making Tools
There are many tools. The most common
are:
1. Probability theory:- is the likelihood that
an event or outcome will actually occur.
2. Decision tree:- are graphic decision
making tools used to evaluate decisions
containing a series of steps
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Deciding to decide
1. Is the problem easy to deal with?
– Tip: avoid being bogged down in
trivial details. Effective managers
reserve decision making techniques
for problems that require them.
2. Might the problem resolve itself.
– Tip: prioritize and rank problems in
order of importance.
116
Deciding to decide…
3. Is it my decision?
Tip: the closer to the origin of the problem
the decision is the better. Before
deciding ask the following questions:
 Does the issue affect other
departments?
 Will it have a major impact on the
superior's area of responsibility?
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Deciding to decide…
Does it need further information from
higher level?
Does it involve serious breach of my
department’s budget?
Is this problem outside my area of
responsibility or authority?
If the answer to any of these questions
is 'YES' pass it to your superior.
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Barriers to Effect Decision-
Making
1. Easy recall: the more easily can recall the
event, the more frequently they believe it
occur.
2. Easy search: not to put effort to seek
information from the appropriate sources.
3. Misconception of chance: Most people do
not understand the nature of random
events.
119
Making…
4. Confirmation gap/bias: bending
evidence to fit one’s beliefs.
5. Relaxed avoidance: the manager
decides not to decide or act after noting
that the consequences of inaction will
not be serious.
120
Making…
6. Defensive avoidance: Faced with a
problem and unable to find a good
solution based on past experience, this
manager seeks a way out.
7. Panic: the manager feels pressurized
not only by the problem but also time.
121
Use of Technology in Decision
Making
 Technology can support, but not take
over, the decision-making process.
 Clinical practitioners should evaluate
technology before adopting it.
 Other staff on which technology will
have an impact should have input into
decisions on its adoption.
122
The Nurse’s Role in Patient
Decision Making
 Patients are increasingly
knowledgeable about health care and
involved in treatment decisions.
 Nurses must be aware of patients’
rights in making decisions about
their treatments and must assist
patients in their decision making.
123
The Nurse’s Role in Patient
Decision Making…
 Nurses must recognize when
patients are lacking information and
implement teaching in such cases.
 Nurses may need to collaborate with
others to determine what information
has been shared with the patient and
family.
124
Strategies to Improve
Decision Making
 Make certain you have all necessary
information to make a proper
decision.
 Consider alternatives.
 Do not be afraid to revise a decision if
circumstances change.
 Anticipate questions and outcomes.
125
Strategies to Improve
Decision Making…
 Keep notes and other information for
reference.
 Consider the pros and cons of the
decision.
 Consider how your decision will
affect the people involved.
 Do not get caught up in unnecessary
details or issues.
126
Common Errors in Decision
Making
 Over-confidence  Framing
 Hindsight  Confirmation
 Self-serving  Selective
 Randomness perception
 Representation  Anchoring
 Availability  Immediate
gratification
127

Unit 7 Problem Solving Critical Thinking Creativity and Decision Making

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Unit 7 Problem Solving Critical Thinking Creativity and Decision Making

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Unit Seven

Problem solving, Critical

Set clear “Be Creative!” Set creativity

Use diverse Recognize & Create the right

If not, it will not solve the problem

Based the stated rules characterize them.

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