1. NUR 425 Decision Making in Clinical Practice
Lecture 2:
Types and Models of
Decision-making

3. Well structured problem
Well-structured problems have a set number of possible solutions - solutions are either 100% right or 100% wrong. An example of a well-structured problem is a typical mathematical (2 + 2 = 4) question. This question has a definitive correct answer.

4. Ill structured problem
Problems may have many possible answers because they are complex and poorly defined. The "best" solutions to ill-defined problems depend on the priorities underlying the situation. What is "best" today may not be "best" tomorrow. Ill- structured problems, because they are more difficult to "solve," require the development of higher order thinking skills and the ability to construct a convincing argument for a particular solution as opposed to all other possible solutions.

5. Types of Decisions
A programmed decision is one that is fairly structured or recurs with some frequency (or both).
2. Non-programmed decisions, on the other hand, are relatively unstructured and occur much less often.

7. Models of Decisions

8. Decision-Making Model 2
Career Decision-Making Process
The career decision making process requires you to think carefully about your interests, talents, abilities and values. Usually what you are good at indicates your career interests.

9. Decision-Making Model 2
Steps Toward a Career Decision
STEP 1: DISCOVERING YOURSELF
What are my interests? Values? Skills? Personality preferences? Strengths?
What are careers that interest me?
What are college majors that I want to explore?
STEP 2: EXPLORING OPTIONS
What information or individuals can help me to explore my college or career options?
What classes or activities can help me to develop my strengths?
How can I learn more about informational interviews, job shadowing, internships, service learning, or student organizations to gain firsthand experience about a field?

10. Decision-Making Model 2
STEP 3: MAKING A DECISION
How much time and energy am I willing to invest to make a career decision?
Who is part of my support system to help me evaluate the pros and cons?
What are my top priorities to consider for this decision?
STEP 4: TAKING ACTION
How can I strengthen my readiness for success in a college major?
What is one goal that I have? How can I reach it? What action can I take now?
Which one of my talents can I develop through classes or outside activities?
STEP 5: EVALUATING THE DECISION
Is my decision a realistic option?
Is there anything preventing me from achieving this goal?
Who in my support system can assist me with achieving this goal?

11. Decision-Making Model 3

12. Decision-Making Model 3
Step 1: Identify the decision to be made. You realize that a decision must be made. You then go through an internal process of trying to define clearly the nature of the decision you must make. This first step is a very important one. Step 2: Gather relevant information. Most decisions require collecting pertinent information

13. Decision-Making Model 3
Step 3: Identify alternatives. Through the process of collecting information you will probably identify several possible paths of action, or alternatives. You may also use your imagination and information to construct new alternatives. In this step of the decision-making process, you will list all possible and desirable alternatives.

14. Decision-Making Model 3
Step 4: Weigh evidence. In this step, you draw on your information and emotions to imagine what it would be like if you carried out each of
the alternatives to the end.
Step 5: Choose among alternatives. Once you have weighed all the evidence, you are ready to select the alternative which seems to be best suited to you. You may even choose a combination of alternatives.

15. Decision-Making Model 3
Step 6: Take action. You now take some positive action which begins to implement the alternative you chose in Step 5. Step 7: Review decision and consequences. In the last step you experience the results of your decision and evaluate whether or not it has “solved” the need you identified in Step 1. If the decision has not resolved the identified need, you may repeat certain steps of the process in order to make a new decision. You may, for example, gather more detailed or somewhat different information or discover additional alternatives on which to base your decision.

16. Using Nursing Process
Have complete or “perfect” information about the situation. (COMPLETE HISTORY & PHYSICAL ASSESSMENT)
Distinguish perfectly between the problem and its symptoms. (GROUPING OF S/S – GATHERED FROM ASSESSMENT AND NURSING DIAGNOSIS)
Identify all criteria and accurately weigh all the criteria according to preferences. (PLANNING)
Know all alternatives and can assess each one against each criterion. (INTERVENTION & EVALUATION)

17. The Decision-Making Process
Define the problem.
Clarify your objectives.
Identify alternatives.
Analyze the consequences.
Make a choice.

22. Sample Consequence Matrix
Objective
Alternative
Cost efficient
Effect on quality of patient care
Hire 100% additional experienced nurse
Expensive
100% guaranteed
Hire 100% newly graduated nurse
Cheaper
May be problematic
Hire 50% experienced
And 50% newly graduated nurse
Balanced
Opportunity to have experienced care while mentoring new nurse

24. Intuitive Decision Making
Intuitive process involves more than cognitive skills to arrive at a decision. It involves attitudes, values, and a grasp of the whole, within the global picture (Tanner)
This process is developed through life experiences with similar situations.

25. How To Make Better Decisions
1. Increase Your Knowledge
Ask questions.
Get experience.
Use consultants.
Do your research.
Force yourself to recognize the facts when you see them (maintain your objectivity).

26. How To Make Better Decisions
2.Use Your Intuition
A cognitive process whereby a person instinctively makes a decision based on his or her accumulated knowledge and experience.
Bruner (1963) views intuition as "the intellectual technique of arriving at possible but tentative formulations without going through the analytical steps

27. How To Make Better Decisions
3.Weigh the Pros and Cons
Quantify realities by sizing up your options, and taking into consideration the relative importance of each of your objectives

28. How To Make Better Decisions
4.Don’t Overstress the Finality of Your Decision
Remember that few decisions are forever.
Knowing when to quit is sometimes the smartest thing a manager can do.
5. Make sure the timing is right.