1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 21 Decision Making

3. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Apply effective decision making to clinical situations incorporating critical thinking and problem solving. Apply a decision-making model to a nursing clinical problem. Facilitate group decision making using various techniques. Identify limitations to effective decision making. Apply technology, as appropriate, to decision making. Examine the nurse's role in patient decision making. Examine strategies to improve decision making and build self-confidence.

4. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company4 Critical Thinking  Rapid changes in the health care environment not only have expanded the decision-making role of the nurse but also have demanded that the results of decisions be effective.  Critical thinking is essential when making decisions and solving problems.

5. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company5 Critical Thinking  A good critical thinker: Examines decisions from all sides and takes into account varying points of view Generates new ideas and alternatives when making decisions Asks “why” questions about a situation in order to arrive at the best decision

6. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company6 Reflective Thinking  Reflective thinking is watching or observing oneself as one performs a task or makes a decision about a certain situation.  The reflective self watches the active self as it engages in activities, acting as an observer and offering suggestions about the activities engaged in.  Reflection upon a situation or problem after a decision has been made allows the individual to evaluate the decision.

7. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company7 Problem Solving  Problem solving is an active process that starts with a problem and ends with a solution.  The problem-solving process consists of the following steps: Identify the problem (assessment, diagnosis). Gather and analyze data (outcome identification). Generate alternatives and select an action (planning). Implement the selected action (implementation). Evaluate the action (evaluation).

8. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company8 Decision Making  Decision making is a “behavior exhibited in making a selection and implementing a course of action from alternatives.”  Decision making is not necessarily related to solving a problem; however, the steps in decision making are similar to those in problem solving.

9. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company9 Problem Solving and Decision Making: Tools for Viewing Choices  Decision grid  PERT chart  Decision tree  Gantt chart

10. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company10 Group Decision Making  Group decision making may be necessary in some situations.  People affected by a decision often will be involved in the decision.  People with information or resources that contribute to the decision may be involved.

11. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company11 Group Decision Making: Advantages and Disadvantages  Advantages: A group can generate more ideas, thus allowing for more choices and an increased chance of higher quality outcomes. When members participate in the decision-making process, the decision is more likely to be accepted. Groups may be used as a medium for communication.

12. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company12 Group Decision Making: Advantages and Disadvantages  Disadvantages: Time-consuming Can be wasteful and unproductive if not managed effectively Can be costly Can generate conflict

13. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company13 Techniques of Group Decision Making  Nominal group technique Group members write ideas, without discussion. Each idea is presented with advantages and disadvantages. Group discusses, clarifies, and evaluates ideas. Group votes privately on ideas.  Delphi group technique There is no face-to-face meeting. Questionnaires are distributed to groups. Responses are summarized & disseminated to group members. The process is repeated until the group reaches consensus.

14. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company14 Consensus Strategy  Consensus means that everyone in the group can live with and fully support the decision regardless of whether they totally agree.  This strategy should be reserved for important decisions that require strong support from participants who will implement them.

15. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company15 Consensus Strategy  Consensus decision making is best used under these conditions: All members of the team are affected by the decision. Implementation of the solution requires coordination among team members. The decision is critical, requiring full commitment by team members.

16. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company16 Groupthink  In groupthink, the goal is for everyone to be in 100% agreement.  Groupthink hinders creativity, and usually leads to inferior decisions.  To avoid groupthink: Appoint group members to roles that evaluate how the group decision making occurs. Encourage all group members to think independently and verbalize their individual ideas. Allow the group time to gather further data and reflect on data already collected.

17. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company17 Limitations to Effective Decision Making  Bias and preconceived ideas  Inflexible values  Not gathering/analyzing enough information  Protecting the status quo  Making decisions to justify previous decisions  Ignoring evidence that does not support predetermined ideas  Presenting the issue in a biased manner  Inaccurately presenting alternatives

18. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company18 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.

19. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company19 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.  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.

20. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company20 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.  Keep notes and other information for reference.

21. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company21 Strategies to Improve Decision Making  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.  Do not put off decision making out of fear.