Unit 7-problem Solving, Critical Thinking, Creativity, And Decision Making.ppt 1i5n5z

Unit Seven Problem solving, Critical thinking, Creativity, and Decision making 1

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. 4

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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 5

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. 8

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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. 9

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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. 2. 3. 4. 5. 6.

Define The Problem Analyze The Problem Generate Possible Solutions Select The Best Solution Plan For Implementation Implement And Evaluate The Solution 12

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 13

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. 14

Step Two: Analyze The Problem… Diagnostic Tools Brainstorming Flow Diagrams Cause and Effect Diagrams Pareto Charts Check Sheets 15

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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Step Three : Generate 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? 17

Step Three : Generate Alternative Solutions… 

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 18

Step Three : Generate Alternative Solutions…  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. 19

Step Four : Select A Solution  Refer

back to original problem statement. Consider: – – – – – – – –

Safety Cost Product performance Better management information Improved Technology Time Quality Appearance 20

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? 21

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? 22

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 24

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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Problem Solving Strategies…  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. 27

Problem Solving Strategies…  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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Problem Solving Strategies…  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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Problem Solving Strategies…  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 THINKING SKILLS SKILLS creative 33

Critical thinking…  Critical:

means requiring careful judgment.  Thinking: means to have an opinion, to reflect on or ponder, to call to mind or to devise a plan, to form a mental picture of (image), to reason

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Critical thinking…  Analytical

thinking, purposeful, goaldirected 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?”. 35

Critical thinking… THINKING Vs CRITICAL THINKING Critical

thinking 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 our thoughts at all 36

Critical thinking…  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. 37

Critical thinking…

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Critical thinking… o

It is important for manager to assess their staff 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… 

Critical thinking is important for;  Problem solving  Creativity  Decision making  Clinical judgment  Critical thinking is the concept that link all the above mentioned concepts. 40

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. 41

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 42

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. 43

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 46

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. 47

Critical Thinking Competencies  General

critical thinking competencies used by many disciplines, in many everyday situations. – Scientific method – Problem solving – Decision making 48

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 50

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 51

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 critical thinking 52

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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Attitude/skills of critical thinkers...  Good

communicators.  Empathetic.  Open-minded.  Independent thinkers.  Curious & insightful.  Humble.  Proactive. 54

Attitude/skills of critical thinkers...  Honest

with themselves & others, itting 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. 55

Standards for Critical Thinking  Universal

Intellectual Standards for Critical Thinking: – – – – – –

Clarity Accuracy Precision Depth Breadth Logic, applied to clinical reasoning 56

Standards for Critical Thinking…  Intellectual

Standards– 14 intellectual standards (Paul,1993) Nurses use these when using the nursing process: 1. 2. 3. 4. 5. 6.

Confidence 7. Perseverance Independence 8. Creativity Fairness 9. Curiosity Responsibility10. Integrity Risk taking 11. Humility Discipline 57

Standards for Critical 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 58

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  ion,

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 63

Characteristics of Creative People

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Creativity Enhancers       

Focus on intrinsic motivation Creativity goals Developmental ive supervision Healthy competition Participative decision making Autonomy

       

Hire creative people Enriched, complex jobs Provide resources Clear organizational goals Instructions to be creative Recognize and reward creativity Encourage risk taking No punishment for failure

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Creativity Enhancers…   

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Workforce diversity Internal and external interaction Diverse teams skilled at working together ive climate

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Organizational culture that promotes innovation Flexible, flat structures Close interaction and relationships with customers 66

How Can Organizations Foster Creativity?

Hire creative & diverse workforce

Provide resources esp. time

Design complex & challenging jobs

Set clear org. goals

“Be Creative!”

Set creativity goals

Use diverse teams

Recognize & reward creativity

Create the right org. culture 67

Management Style and Creativity  Encourage

risk taking  Provide autonomy  Encourage productivity- “sweat equity”  ive supervision, climate, and work group  Participative leadership 68

Organization Design and Creativity Flexible Flat Structures That promote Internal & External Interaction

Close With Customers 69

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 70

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 71

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 ing 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. 74

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). 75

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. 76

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 ed by rationale  Failure to evaluate effectiveness of nursing actions 77

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. 79

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, welldefined goal is to be achieved Problem is clear and unambiguous

All alternatives and consequences are known

Preferences are clear

Preferences are constant and stable

Rational Decision Making

Final choice will maximize payoff

No time or cost constraints exist 81

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 82

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 85

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. 86

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. 87

Decision Making Process… Feasible hypotheses should be further tested for causal validity.  By analyzing available information, manager should begin exploring possible solutions. 

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Decision Making Process… 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. 89

Decision Making Process… 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. 90

Decision Making Process… 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: 91

Decision Making Process… 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 92

Decision Making Process… Step 4: Implement decision 

The manager will need to communicate the decision to appropriate staff smoothly to win the cooperation.

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Decision Making Process… 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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Decision making models… 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. 97

Decision making models… 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. 98

Decision making models… 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. 99

Decision making models… 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 noncritical, urgent, immediate answer were needed within a short period of time. 100

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. 2.

3.

The importance of the decision quality to the institutional success. The degree to which the manager process the information and skills to decision. The degree to which the followers have the necessary information to generate a quality decision. 102

Decision making style… 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

Decision making style…  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. 104

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. 105

Types of decisions...  On

the basis of these, there are three classifications: 1. Ends -Means 2. istrative-Operational 3. Programmed-Non-programmed

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Types of decisions... 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. 107

Types of decisions... 2. istrative-Operational • istrative: 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. 108

Types of decisions... 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 nonroutine. This can be used in emergency/urgent situation. 109

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. 2.

3. 4.

Relying on tradition: based on past decision making May appeal to authority: based on suggestions from an expert/a higher level management Prior reasoning: based on assumption Logical decision making: is a rational, intelligent and systematic approach 111

Factors Influencing Decision Making 1. Decision makers attribute • Knowledge, experience, and judgment • Perception and personality • Values and philosophy

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Factors Influencing Decision Making… 2. The Situation • Urgency of solution and time pressures • Magnitude and importance • Structure and uncertainty and risk • Cost benefit 113

Factors Influencing Decision Making… 3. Environmental Constraints • External • Internal

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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 115

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? 117

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' it to your superior. 118

Barriers to Effect DecisionMaking 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

Barriers to Effect DecisionMaking… 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.

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Barriers to Effect DecisionMaking… 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.

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Use of Technology in Decision Making  Technology

can , 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.

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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.

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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  Anchoring  Immediate gratification

 Representation  Availability

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