Decision Making

decision making

• complex cognitive process of choosing a particular course of action

• the though process of selecting a logical choice from available options

problem solving

• part of decision making

• a systematic process focusing on analyzing a difficult situation involving higher order reasoning and evaluation

critical thinking

• mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer/conclusion

• its not about having the right answer but choosing the right process

• in nursing, critical thinking means questioning assumptions, assessing the evidence, and anticipating consequences

most important characteristics of a critical thinker

• insight

• intuition

• empathy

• willingness to take action

insight

allows leaders to see patterns other might miss

intuition

helps guide judgement when evidence is incomplete

empathy

ensures that decisions respect others perspective and willingness to act separate thinkers from leaders who hesitate

clinical reasoning

• integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at diagnosis

• ex: nurse notes subtle changes in a patients RR —> interprets data —> adjusts care accordingly thats clinical reasoning

qualities of successful decision makers

• self aware

• courageous

• sensitive

• energetic

• creative

self aware

helps leaders understand/recognize their biases

courageous

allows difficult decisions even when unpopular

sensitive

ensures awareness of team and patient needs/energy/creativity to inspire new solutions

causes of errors in decision making

• no clear objective/goal in decision making

• faulty data gathering or logic

• failure to use science, logic, and empirical evidence in making decisions

• not considering enough alternatives

• not assessing/ignoring the quality of decision making that is required

• lack of self-awareness

• too much time spent identifying the problem; not enough to gather adequate information, think logically, select from among many alternatives, and be aware of the influence of ones values, in final analysis one must ACT

• refusal to act

• using outcome only for evaluation

evaluating outcomes supeficially

it leads to a faulty decision

questions that should be 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?

right brain dominance

• right brain thinkers visualize the patterns

• associated with creativity, intuitive, and holistic thinkers

left brain thinkers

• left brain thinkers analyze data

• associated with logic, analytical, and detail oriented

heuristics

• rely on discrete, often unconscious processes 

• using a trial and error or rule of thumb approach to problem solving

• not optimal but provide more immediate solutions

• can speed decisions but over reliance may cause bias

traditional problem solving process

1. identify the problem

2. gather data to identify the causes and consequences of the problem

3. explore alternative solutions

4. evaluate each alternative

5. select the appropriate solution

6. implement the solution

7. evaluate the results

nursing process

1. assess

2. diagnose

3. plan

4. implement

5. evaluate

strategies to promote evidence-based best practice

• implement and evaluate nationally sanctioned clinical practice guidelines

• question and challenge nursing traditions and promote a spirit of risk taking

• dispel myths and traditions not supported by evidence

• collaborate with other nurses locally/globally

• interact with other disciplines to bring nursing evidence to the table

decision making tools

• decision grids

• decision trees

• consequence tables

decision grid

• allows one to visually examine the alternatives and compare each against the same criteria

• the same criteria are used to analyze each alternative

• this tool is useful when changing the method of managing care on a unit/selecting a candidate to hire from a large interview pool

• necessary to assign a number value to each criteria

• possible to weigh some criteria more heavily than others

decision trees

visualizes potential outcomes

consequence table

classifies trades offs on how various alternatives create different consequences