Nursing administrative strategies

1. Critical thinking and
Decision Making skills
By /MahmoudShaqria
‫شقريه‬ ‫محمد‬ ‫محمود‬

2. Out lines
 The definition of Critical thinking
 Critical thinking can be divided into three core skills
 Someone with critical thinking skills can
 The Skills We Need for Critical Thinking
 List of Critical Thinking Skills
 Critical thinking process
 Fast and Effective Critical Thinking Strategies
 Six Cognitive Skills Used in Critical Thinking
 Why do we need to think critically
 How do nurse's accomplish this?

3.  Definitions of decision making
 Ethical decision making
 Types of decisions
 Characteristics of Decisions:
 Factors affecting decision making
 Decision making tools:-
 Decision-Making Process
 Decision Making Technique
 Barriers of Decision Making:

4.  Critical elements in Decision Making
 Improving Decision Making skills:-
 Qualities of a successful decision maker:-
 A model of the successful decision maker:
 Ethical Decision Making Approaches
 Problem Solving vs Decision Making
 Nursing Process as method of Decision making & problem solving.
 Critical Elements in Problem Solving and Critical Thinking
 Individuals Variations in Decision making
 Role of nursing manager in ethical decision making
 Example of clinical decision making:

5.  The definition of Critical thinking
 Is the objective analysis of facts to form a judgment.
 Unbiased analysis or evaluation of factual evidence.
 sometimes referred to as reflective thinking, is related to
evaluation and has a broader scope than decision making and
problem solving.
 “Critical thinking is the ability for person to use her/his
intelligence, knowledge, and skills to question and carefully
explore the situation to arrive at thoughtful conclusion based
on evidenced and reason.

6.  Critical thinking can be divided into three core skills:
 Curiosity is the desire to learn more information and
as well as being open to new ideas.
 Skepticism involves having a healthy questioning
attitude about new information that you are exposed
to and not blindly believing everything everyone tells
you.
 Humility is the ability to admit that your opinions and
ideas are wrong when faced with new convincing
evidence that states otherwise.

7. Someone with critical thinking skills can:
 Understand the links between ideas.
 Determine the importance and relevance of arguments and
ideas.
 Recognize build and appraise arguments.
 Identify inconsistencies and errors in reasoning.
 Approach problems in a consistent and systematic way.
 Reflect on the justification of their own assumptions, beliefs
and values.

8.  The Skills We Need for Critical Thinking
 Critically are varied and include observation, analysis,
reflection, evaluation, inference, explanation, and decision
making. Specifically we need to be able to:
 Think about a topic or issue in an objective and critical way.
 Identify the different arguments there are in relation to a
particular issue.
 Evaluate a point of view to determine how strong or valid it is.
 Recognize any weaknesses or negative points that there are in
the evidence or argument.
 Provide structured reasoning and support for an argument that
we wish to make.

9. List of Critical Thinking Skills
 Analysis
 Clarification
 Evaluation
 Explanation
 Inference
 Interpretation
 Judgment
 Objectivity
 Problem Solving
 Reasoning

10. Critical thinking process: (steps)
 Step 1: Knowledge
 Identifies the argument or the problem that needs to be
solved.
 The questions in this stage should be open-ended to allow the
chance to discuss and explore main reasons.
 Two main questions need to be addressed: What is the
problem? And why do we need to solve it?

11. Step 2: Comprehension
 To understand the situation and the facts aligned with it.
 The data is collected about the problem using any of the
research methods that can be adopted depending on the
problem.

12. Step 3: Application
 Mind maps can be used to analyze the situation, build a relation between it
and the core problem, and determine the best way to move forward
Step 4: Analyze
 One of the commonly used tools that can be deployed to analyze the problem
and the circumstances around it is the cause effect diagram, which divides the
problem from its causes and aims to identify the different causes and based on
their type and impact on the problem.

13.  Step 5: Synthesis
 One of the tools that contribute choosing the problem solution is
the SWOT analysis that tends to identify the solution’s strength,
weakness, opportunity, and threats.
 Step 6: Take Action
 These steps should be translated into a plan of action that ensures
that the decided resolution is well achieved and integrated between
all the involved bodies.

14. 1.Fast and Effective Critical Thinking Strategies
1. Use the right tools
2. Give them slack
3. Involve them in reverse engineering
4. Teach students how to prioritize
5. Switch their perspective
6. Let students collaborate
7. Take breaks

15. Six Cognitive Skills Used in Critical Thinking
Interpretation: involve clarifying the meaning.
Analysis: understanding data
Evaluation: determine the outcomes
Inference: draw the conclusion
Explanation: justify actions based on data
Self-regulation: examine one professional practice.

16. Why do we need to think critically?
Need to make accurate and appropriate clinical decisions
Need to solve problems and find solutions
Need to plan care for each unique client and client problem
Need to seek knowledge and use it to make clinical decisions and problem solve
Need to be able to think creatively when planning care for clients
Critical Thinking involve
Reflecting upon the meaning of the statement.
Examining the offered evidences.
Developing a judgment about facts.

17. How do nurse's accomplish this?
Learns to be flexible in clinical decision making
Reflect on past experiences and previous knowledge
Listen to others point of view
Identify the nature of the problem
Select the best solution for improving client’s health

18. Definitions of decision making;
*Decision making is a cognitive process consisting of sequential steps that
can be analyzed and refined.
*It is the last step in the process by which an individual chooses one
alternative from several to achieve a desired objective.
*It described as the process of converting information into action.
*It is defined as a choice among alternative where the outcome is uncertain

19. Ethical decision making:-
 decision making can be hard enough but when we have to consider
ethics and decision making we can tie our selves up so tight that some
times we stop decision making entirely.
 We are often faced with situations which require sound Ethical decision
making ability

20. 1.Types of decisions
Management decision are of three types:
*Strategic:- are those made by top executives that commit valuable agency resources to achieve major ,
long term goals.
*Administrative Decisions:-are those made by mid level managers to solve unusual
problems and develop methods for improving agency function.
* Operational decisions:-are routine decisions governing day to day events that have
been delegated to first level managers and are made according to pre established rules and regulations.

21. Management decision may be :-
 Programmed:- Are decision needed in problem situations where it is immediately
apparent what information is needed and where the information can be obtained.
 Non programmed decisions:- are novel , unstructured, creative decisions that are
made to solve problems for which no well defined strategies are available.
1. Characteristics of Decisions:-
2. Mental process
3. Choice of alternatives
4. Uncertainty of results( Decision is predictive for future)
5. Affected by feeling
6. Resolve organizational conflicts& personal conflicts

22. Factors affecting decision making:-
A- Internal factors;-
Includes variables such as , decision makers physical and emotional
state, personal characteristics, cultural, social and past experience.
B- External factors:-
Including, environmental condition, time.

23.  Decision trees:-
 Decision tree developed because the decision is tied
between the outcome of other events.
 It compare the cost of hiring regular staff to the cost of
hiring temporary employee.

24. 2- Consequence tables:
Consequence table demonstrates how various alternatives create different
consequences.
It lists the objectives for solving a problem down side of the table and rates how
each alternatives would meet the desired objectives.
For example. Consider this problem. The number of patient falls has exceeded
the benchmarks rate for two consecutive quarters,. After a period of analysis,
the following alternatives were selected as solutions:-
1- Provide educational program to instruct staff on how to prevent falls.
2- Implement a night check to ensure that patients have side rails up and beds in
low position.
3- implement a policy requiring soft restrains orders in all confused patients.

25. Alternative 3Alternative 2Alternative 1
Objectives for problem
solving
XXX
1- Reduces the number of
falls
XXX
2- Meets regularly
standards
XX3- Is cost effective
X
4- Fits present policy
guidelines
Decision score

26. Decision-Making Process
1-Identify the Ethical Problem
The decision maker must be able to determine:
• If there is a possible violation of an important ethical principle, societal law,
or organizational standard or policy
• If there are potential consequences that should be sought or avoided that
emanate from an action being considered to resolve the problem.
2-Collect Relevant Information
The decision maker should seek to gather as much information as possible about
which rights are being forsaken and to what degree.
• A consequential focus would prompt the decision maker to attempt to measure
the type, degree, and amount of harm being inflicted or that will be inflicted
on others

27. 3- Evaluate the Information
Once the information has been collected, the decision maker must apply some type
of standard or assessment criterion to evaluate the situation.
• The decision maker might use one of the predominant ethics theories—
utilitarianism, rights, or justice.
4- Consider Alternatives
The decision maker needs to generate a set of possible action alternatives, such as:
• confronting another person’s actions,
• seeking a higher authority,
• stepping in and changing the direction of what is happening

28. 5- Make a Decision
The decision maker should seek the action alternative that is supported by the evaluation
criteria used in Step 3.
• A decision maker selects a course of action that is supported by all the ethics theories or
other evaluation criteria used in the decision- making process.
6-Act or Implement
The decision maker, if truly seeking to resolve the problem being considered, must take
action.
• Once the action alternatives have been identified in Step 4 and the optimal response is
selected in Step 5, the action is taken in Step 6

29. 7- Review the Action
Once the action has been taken and the results are known, the decision maker should
review the consequences of the action.
• If the optimal resolution to the problem is not achieved, the decision maker may need
to modify the actions being taken or return to the beginning of the decision-making
process

30. Decision Making Technique
There are several techniques to help managers to make high quality
decisions.
1- Brain storming
2- Nominal grouping , by which group members identify and prioritize
goals under non threaten conditions.
3- Delphi technique:- the formal procedure for obtaining the consensus of
a number of experts through the use of a series of questionnaires.
The procedure is similar to nominal grouping, but participants don't
meet

31. 4- Decision tree:- Used to break a goal , problem or idea, into a
manageable tasks or action steps
5- Fish bone or cause and effect chart:- used to help in
identifying the multiple causes of any final result, outcome
or problem, also called a fish bone because of its appearance

32.  Barriers of Decision Making:
1- Inadequate fact finding ( Decision should be based on accurate information,).
2- Time constrains (Pressures of time, resources and priorities render the decision-
making more complex, It is not always possible to obtain all the necessary facts ,
This produces a degree of uncertainty, especially when multiple alternatives are
identified).
3- Poor Communication ( Communicating the decision to appropriate individuals as
essential as following up to determine if results are as expected.
4- Failing to systematically follow the steps of decision- making process will likely
result in unanticipated results.
5- Individuals resistance to change and risk of new idea.

33.  Critical elements in Decision Making
1-lack of clear objectives
2-faulty data gathering
3-lack of self awareness
4-generating limited alternativesltlty
5-faulty logic
6-inability to choose and act

34. Improving Decision Making skills:-
1- Educating people (Subordinates) so they know how to make decision.
2- Support of top management for decision making at the lowest possible level.`
3- Establishing decision making checkpoints with appropriate time limits.
4- Using statistical analysis when possible to pinpoint problems for solutions.
5- Using new technologies to analyzing problems and identifying alternatives.

35. Qualities of a successful decision maker:-
1- Courage: courage is of particular importance and involves the willingness to
take risks.
2- Sensitivity: good decision makers seen to have some sort of antenna that
makes them particularly sensitive to situation and others.
3- Energy people: must have the energy
4- Creativity: successful decision makers tend to be creative thinkers they
develop new ways to solve problems

36. Ethical Decision Making Approaches:
1. Utilitarian Approach: –
Moral behavior produces the greatest good for the greatest number.
2. Individualism Approach: –
Acts are moral when they promote the individual’s best long-term interest, which
ultimately leads to the greater good.
3. Moral – Rights Approach:-
Decisions are those that best maintain the rights of those people affected by
them.
4. Justice approach: –
Moral Decisions must be based on standards of equity, fairness, impartiality

37. Problem solving and decision making
 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).

38. 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.

39. Critical Elements in Problem Solving and Critical
Thinking:
Define objective clearly
Gather data carefully
Use an evidence-Based approach
Generate many alternative
Think logically
Choose and act decisively.

40. Define objective clearly
Define the goals and objectives.
If a decision lacks a clear
objective or if an objectives is not consistence with the
organization philosophy, a poor quality
What is the setting? decision is likely.

41. Gather data carefully
What is the Problem?
Where is it a problem?
When is it a problem?
Who is affected by the problem?
Keep in mind that facts can be misleading if they are
taken out of the context.

42. Use an Evidence Based approach
Use outside resources such as:
textbook, periodicals, expert in the field, etc.
Evidence-Base practice: is the integration of the best
evidence available, nursing expertise, and the values and the
preference of the individual.
Generate many alternative
At least two choices in every decision.
Use Brain-Storming technique.
The greater the number of choices, the more opportunity to
reach the correct decision.

43. Think logically
People may think illogically in
three ways:
1. Over-generalizing (Ex,
Stereotyping)
2. Affirming the consequences
3. Arguing from analogy
Choose and act Decisively
Once you get into a decision you have to implement it withoutdelay.
A decision can be changed and
modified later.

44. Individuals Variations in Decision making
Gender
Values
Life Experience
Individual Preference
Individual way of thinking

45. Role of nursing manager in ethical decision
making
Respect the uniqueness and dignity of each person, self and others
-protect patient privacy
–Treat all you encounter with respect –patients, their family members and
significant others, co ‐workers
– Preserve your own self ‐ respect and dignity
• Prevent harm and removal of harmful conditions
– Intervene whenever a patient’s safety is at
– Promote a safe environment, both and psychologically
– Monitor the environment for safety hazards

46. • Act to remove harm or promote benefit
– Improve unsafe conditions
– Confront and report unsafe practices and errors
– Promote benefit by encouraging and assisting measures that promote
healing such as post ‐ surgical ambulation and deep breathing, and
measures
That prevents harm such as regular repositioning of patients at risk for
pressure sores.
These measures may be specifically ordered to be performed at specific
intervals, or it may be the healthcare professional’s responsibility to
Recognize the importance of these measures and carry them out.

47.  Treat individuals equally
–Extend equal respect and courtesy to all individuals you encounter.
Even when treated discourteously, respond in a manner that
effectively addresses the behavior without disrespecting the other
person promotes, advocates for, and strives to protect the health,
safety, and rights of the patient

48. Example of clinical decision making:
 The nurse identifies key cues when dealing with a patient who has
just returned to the ward after abdominal surgery and is looking pale
and feeling clammy (these cues have been clustered together and
interpreted as being meaningful).
 The nurse begins to create a tentative hypothesis or explanation
that the patient may be experiencing postoperative internal bleeding
and the nurse then wants to either refute this or accept it.
 The nurse will then seek and interpret other key cues of the
patient’s clinical
 Status – this may include the patient’s blood pressure, pulse,
temperature, pain

49.  Assessment, color, wound assessment and patient’s position –
before any diagnosis or decision is made.
 The hypothesis is then evaluated and if the patient is medically
 Stable with no signs and symptoms of bleeding then the
hypothesis is rejected. The nurse may then generate another
hypothesis that the patient may be in pain and so the information is
gathered to try to test another hypothesis
 Difference Between Problem Solving and Decision Making
 Categorized under Language | Difference Between Problem
Solving and Decision Making

50. Thank you…