Chapter 1: Decision Making, Problem Solving, and Critical Thinking: Requisites for Successful
Leadership and Management
Decision making: complex, cognitive process of choosing a particular course of action; the
thought process of selecting a logical choice from available options
Problem Solving: part of decision making; systematic process focusing on analyzing a difficult
situation involving higher-order reasoning and evaluation
Critical Thinking: the mental process of actively and skillfully conceptualizing, applying,
analyzing, synthesizing, and evaluating information to reach an answer or conclusion
Clinical Reasoning: integrating and applying different types of knowledge to weigh evidence,
critically think about arguments, and reflect upon the process used to arrive at diagnosis
Characteristics of a Critical Thinker
Open to new ideas Flexible Creative
Intuitive Empathetic Insightful
Energetic Caring Willing to take action
Analytic Observant Outcome directed
Persistent Risk taker Willing to change
Assertive Resourceful Knowledgeable
Communicator Out-of-the-box thinker Circular thinking
Vicarious Learning to Increase Problem-Solving & Decision Making Skills
o Case studies: provide stories that impart learning
o Simulations: provide opportunities for learning with no risk to patients or organizational
performance
o Problem-based learning (PBL): provides opportunities for learners to address and learn
from authentic problems vicariously
Theoretical Approaches to Problem Solving & Decision Making
o Heuristics: allows them to solve problems more quickly and to build upon experiences
they have gained in their lives; uses trial-and-error methods or a rule-of-thumb approach
to problem solving, rather than set rules
Traditional Problem-Solving Process Managerial Decision-Making Model
Identify the problem Determine the decision & desired outcomes
Gather data to identify the causes & consequences Research & identify the options
of the problem
Explore alternative solutions Compare & contrast these options & their
consequences
Evaluate each alternative Make a decision
Select an appropriate solution Implement an action
Implement the solution Evaluate the results
Evaluate results
Strategies for the New Nurse to Promote Evidence-Based Best Practice
o Keep abreast of the evidence
o Use multiple sources of evidence
o Use evidence to support clinical interventions and teaching strategies
o Find established sources of evidence
, o Implement and evaluate nationally sanctioned clinical practice guidelines
o Question and challenge nursing traditions
o Dispel myths and traditions not supported by evidence
o Collaborate with other nurses locally and globally
o Interact with other disciplines to bring nursing evidence to the table
Brain Hemisphere Dominance & Thinking Styles
o Left-brain thinkers: typically better at processing language, logic, numbers, and
sequential ordering; do well in mathematics, reading, planning, & organizing
o Right-brain thinkers: excel at nonverbal ideation and holistic synthesizing; better at
handling images, music, colors, & patterns
o Upper left-brain dominance: analytic thinkers who like working with factual data &
numbers; deal with problems in a logical & rational way
o Lower left-brain dominance: highly organized & detail oriented; prefer a stable work
environment & value safety & security over risk taking
o Upper right-brain dominance: big picture thinkers who look for hidden possibilities &
are futuristic in their thinking; frequently rely on intuition to solve problems & are
willing to take risks to seek new solutions to problems
o Lower right-brain dominance: experience facts & problem solve in a more emotional
way; sympathetic, kinesthetic, & empathetic, & focus more on interpersonal aspects of
decision making
Decision Making in Organizations
o Powerful people in organizations are more likely to have decisions made that are
congruent with their own preferences & values
o Economic Man vs. Administrative Man
Economic Administrative
Make decisions in a rational manner Makes decisions that are good enough
Has complete knowledge of the problem or Because complete knowledge is not possible,
decision situation knowledge is fragmented
Has a complete list of possible alternatives Because consequences of alternatives occur
in the future, they are impossible to predict
accurately
Has rational system of ordering preference of Usually chooses from among few
alternatives alternatives, not all possible ones
Selects the decision that will maximize The final choice is satisfying rather than
utility maximizing
Decision Making Tools
o Decision grid: allows one to visually examine the alternatives & to compare each against
the same criteria
o Payoff tables: have a cost-profit-volume relationship & are helpful when quantitative
information is available; one must determine probability & use historical data
o Consequence tables: demonstrate how various alternatives create different consequences
Leadership and Management
Decision making: complex, cognitive process of choosing a particular course of action; the
thought process of selecting a logical choice from available options
Problem Solving: part of decision making; systematic process focusing on analyzing a difficult
situation involving higher-order reasoning and evaluation
Critical Thinking: the mental process of actively and skillfully conceptualizing, applying,
analyzing, synthesizing, and evaluating information to reach an answer or conclusion
Clinical Reasoning: integrating and applying different types of knowledge to weigh evidence,
critically think about arguments, and reflect upon the process used to arrive at diagnosis
Characteristics of a Critical Thinker
Open to new ideas Flexible Creative
Intuitive Empathetic Insightful
Energetic Caring Willing to take action
Analytic Observant Outcome directed
Persistent Risk taker Willing to change
Assertive Resourceful Knowledgeable
Communicator Out-of-the-box thinker Circular thinking
Vicarious Learning to Increase Problem-Solving & Decision Making Skills
o Case studies: provide stories that impart learning
o Simulations: provide opportunities for learning with no risk to patients or organizational
performance
o Problem-based learning (PBL): provides opportunities for learners to address and learn
from authentic problems vicariously
Theoretical Approaches to Problem Solving & Decision Making
o Heuristics: allows them to solve problems more quickly and to build upon experiences
they have gained in their lives; uses trial-and-error methods or a rule-of-thumb approach
to problem solving, rather than set rules
Traditional Problem-Solving Process Managerial Decision-Making Model
Identify the problem Determine the decision & desired outcomes
Gather data to identify the causes & consequences Research & identify the options
of the problem
Explore alternative solutions Compare & contrast these options & their
consequences
Evaluate each alternative Make a decision
Select an appropriate solution Implement an action
Implement the solution Evaluate the results
Evaluate results
Strategies for the New Nurse to Promote Evidence-Based Best Practice
o Keep abreast of the evidence
o Use multiple sources of evidence
o Use evidence to support clinical interventions and teaching strategies
o Find established sources of evidence
, o Implement and evaluate nationally sanctioned clinical practice guidelines
o Question and challenge nursing traditions
o Dispel myths and traditions not supported by evidence
o Collaborate with other nurses locally and globally
o Interact with other disciplines to bring nursing evidence to the table
Brain Hemisphere Dominance & Thinking Styles
o Left-brain thinkers: typically better at processing language, logic, numbers, and
sequential ordering; do well in mathematics, reading, planning, & organizing
o Right-brain thinkers: excel at nonverbal ideation and holistic synthesizing; better at
handling images, music, colors, & patterns
o Upper left-brain dominance: analytic thinkers who like working with factual data &
numbers; deal with problems in a logical & rational way
o Lower left-brain dominance: highly organized & detail oriented; prefer a stable work
environment & value safety & security over risk taking
o Upper right-brain dominance: big picture thinkers who look for hidden possibilities &
are futuristic in their thinking; frequently rely on intuition to solve problems & are
willing to take risks to seek new solutions to problems
o Lower right-brain dominance: experience facts & problem solve in a more emotional
way; sympathetic, kinesthetic, & empathetic, & focus more on interpersonal aspects of
decision making
Decision Making in Organizations
o Powerful people in organizations are more likely to have decisions made that are
congruent with their own preferences & values
o Economic Man vs. Administrative Man
Economic Administrative
Make decisions in a rational manner Makes decisions that are good enough
Has complete knowledge of the problem or Because complete knowledge is not possible,
decision situation knowledge is fragmented
Has a complete list of possible alternatives Because consequences of alternatives occur
in the future, they are impossible to predict
accurately
Has rational system of ordering preference of Usually chooses from among few
alternatives alternatives, not all possible ones
Selects the decision that will maximize The final choice is satisfying rather than
utility maximizing
Decision Making Tools
o Decision grid: allows one to visually examine the alternatives & to compare each against
the same criteria
o Payoff tables: have a cost-profit-volume relationship & are helpful when quantitative
information is available; one must determine probability & use historical data
o Consequence tables: demonstrate how various alternatives create different consequences
