Both the American Nurses Association’s (2009) and American Association of Nurse Executives’ (2005) standards for practice for nurse administrators and executives support the fact that in a fast-paced health care delivery environment, staff nurses, leaders, and managers must be able to analyze and synthesize a large array of information, use critical thinking and decision making skills to deliver effective day to day patient care, and solve complex problems that occur in complex health care delivery systems (see Figure 4-1). An optimizing decision includes comparing all possible solutions with desired objectives and then selecting the optimal solution that best meets objectives (Choo, 2006; Guo, 2008). Both the American Nurses Association’s (2009) and American Association of Nurse Executives’ (2005) standards for practice for nurse administrators and executives support the fact that in a fast-paced health care delivery environment, staff nurses, leaders, and managers must be able to analyze and synthesize a large array of information, use critical thinking and decision making skills to deliver effective day to day patient care, and solve complex problems that occur in complex health care delivery systems (see, Committee on the Robert Wood Johnson Foundation, 2011. Critical thinking in nursing can be defined as “purposeful, informed, outcomes focused thinking…[that] applies logic, intuition, creativity and is grounded in specific knowledge, skills, and experience” (Alfaro-LeFevre, 2009, p. 7). Still, the decision maker needs to focus on techniques that will enhance effectiveness in decision-making situations. Nurses and nurse managers are challenged to move from step-by-step problem-solving techniques to incorporating creative thinking, which involves considering the context when meeting current and future challenges in health care delivery (Chambers, 2009; Rubenfeld & Scheffer, 2006). A minimal decision results in an outcome that is sufficient, satisfies basic requirements, and minimally meets desired objectives. Simulations also promote critical thinking or “thinking like a nurse” (Tanner, 2006). Clinical judgment results in nursing actions directed toward achieving health outcomes (Alfaro-LeFevre, 2009). Much of the evidence from the body of research indicates that nurses value their intuition in a variety of clinical settings. Clinical judgment results in nursing actions directed toward achieving health outcomes (Alfaro-LeFevre, 2009). As such, they need information, resources, and support from their environment. Yet staff nurses and nurse managers and leaders must make decisions in uncertain and complex environments (Clancy & Delaney, 2005). Decision Making The results of poor decisions may be subtle and not appear until years later. 0000004034 00000 n Barriers to effective decision making exist and, once identified, can lead to going back through the decision-making process. Critical thinkers go beyond the step-by-step processes outlined in the nursing process and traditional problem solving. 2. Learning and understanding which analogies and perspectives offer the best view of a problem or issue are vital to effective decision making. This social network has to collaborate for positive change within the organization and to make clinical decisions of the highest quality. Creativity is necessary to deal with the complex twenty-first century health care delivery environment. That includes staff nurses in concert with their managers. Nurse managers’ critical thinking abilities promotes a positive practice environment which can lead to better patient outcomes (. Unfortunately, this form of overconfidence often results in overly optimistic projections in project planning. Often it is these “unconnected” staff members who bring new decision frames to the meeting and have the most unbiased view of the problem. According to Choo (2006), organizations use information to “make decisions that commit resources and capabilities to purposeful action” (p. 1). Take, for instance, a decision to reduce expenses by decreasing the ratio of registered nurses to nurses’ aides. To diagnose the situation, the decision maker examines the following seven problem attributes: 1. 0000062960 00000 n BACKGROUND 0000001056 00000 n In fact, the nurse manager’s expertise in critical thinking and shared decision making are essential for creating healthy work environments where quality and effective care can be delivered (Kramer et al., 2010; Zori et al., 2010). Data-driven decision making is important (Dexter et al., 2011; Lamont, 2010; Mick, 2011). Different framing of the same problem can lead to different decision responses. Critical thinkers have been distinguished from traditional thinkers in nursing. The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. The hallmark of shared decision making is involving the patient in making healthcare decisions with the healthcare provider.1 Shared decision making acknowledges the patient's preferences, lets the patient make informed choices, and shows respect for the patient's choices.2 According to the 2001 Institute of Medicine recommendations, “Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them.”3 Patient care s… Clinical judgment is a complex skill grounded in critical thinking. This optimism is usually buried in the analysis done before ranking alternatives and recommendations. Critical thinking, then, is characterized by thinking that has a purpose, is systematic, considers alternative viewpoints, occurs within a frame of reference, and is grounded in information (The Critical Thinking Community, 2008). However, decision making is more than just problem solving. 0000005329 00000 n It is important that managers objectively examine project planning assumptions in the decision-making process to ensure accurate projections. Conditions of uncertainty and complexity are common in nursing care management. Personal decision making is a familiar part of everyday life. As implied by the word frame, individuals may perceive problems only within the boundaries of their own frame. Tanner (2000) noted that critical thinking is much more than just the five steps of the nursing process. Ready access to the Internet and online library sources can further create complexity in the decision-making process as care providers have access to more information upon which to make decisions. Despite incentive payments for implementing EHR (HFMA P & P Board, 2012), the financial costs involved, human-factor errors and work-flow issues can hamper successful implementation (Campbell et al., 2006). 0000012938 00000 n For example, decisions about how to staff a unit when a nurse calls in sick have to be made immediately. This is called aversion bias (Kahneman et al., 2011). Problem solving involves moving from an undesirable to a desirable state (Chambers, 2009). Unintended effects may include higher turnover of experienced nurses, increased adverse events such as medication errors, decreased staff morale, and lower patient satisfaction scores. The marketing staff may interpret problems as military battles that need to be won. 0000009783 00000 n In the early 1900s, Dewey equated critical thinking with reflective thought (The Critical Thinking Community, 2008). Different framing of the same problem can lead to different decision responses. Nurses who are critical thinkers also have a keen awareness of their surroundings (Fioratou et al., 2011). There may be a short-term cost savings, but if not implemented appropriately, this tactic may result in the gradual erosion of patient care over time (Kane et al., 2007). It is what leaders and managers are expected to do (Keynes, 2008). The probability that an autocratic decision will be accepted, 6. This essential text brings together in one place the inextricably linked concepts of professional development, reflective practice and decision-making. Clinical decision making in nursing relates to quality of care and competency issues. Learning and understanding which analogies and perspectives offer the best view of a problem or issue are vital to effective decision making. The electronic health record can be mined for valuable data, upon which fiscal, human resource, and patient care decisions can be made. Furthermore, these conditions also apply to the administration of nursing care delivery, in which decision making is a critical function. Most nurses pointed to professional ethics and accountability as important features that contributed to making a background for the ethical context of healthcare setting. 0000065261 00000 n Nurse leaders and managers have an obligation to create care delivery climates that promote critical thinking, which leads to innovative solutions to problems within the system of care (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine, 2011; Porter-O’Grady, 2011). Thus decision making is used to solve problems. 0000003746 00000 n in disciplinary silos. Questioning is implicit in the critical thinking process. All individuals have preconceived notions and biases that influence decisions in a variety of ways. Nurse executives may view concerns from a care or family frame that emphasizes collaboration and working together. 0000074829 00000 n I would recommend this book to student nurses who want to develop their decision making … Thus it is vital for nurses to understand decision making and explore styles and strategies to enhance decision-making skills. Scheffer and Rubenfeld (2000) have stated that habits of the mind that are characteristic of critical thinking by nurses include confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, open-mindedness, perseverance, and reflection. Conditions of uncertainty and complexity are common in nursing care management. When looking at outcomes, one critical aspect of decision making is to determine the desired outcome. Problem solving occurs in a variety of nursing contexts, including direct client care, team-level leadership, and systems-level leadership. 1. In the complex modern world, we are surrounded by ethical issues in all facets of our lives. Limitations of time, money, or people may prevent the decision maker from selecting the more deliberative and slower process of optimizing. However, managers may delay purchasing new equipment and forgo subsequent savings because the equipment has yet to reach the end of its useful life. 0000002660 00000 n For instance the Institute of Medicine (IOM, 2001) endorsed the use of computerized physician order entry (CPOE) as one solution to reduce medication errors. Critical thinking and decision-making competences include analytical skills as well as intuition. In fact, the nurse manager’s expertise in critical thinking and shared decision making are essential for creating healthy work environments where quality and effective care can be delivered (Kramer et al., 2010; Zori et al., 2010). Clinical judgment is a complex skill grounded in critical thinking. This is called aversion bias (Kahneman et al., 2011). Decision-Making Process The decision-making process is often broken down into a series of linear steps. Nurse managers use decision making in managing resources and the environment of care delivery. Decision making involves an evaluation of the effectiveness of the outcomes that result from the decision-making process itself. A decision maker may become so enamored by technological solutions (and slick vendor demonstrations) that he or she may unconsciously decide in favor of these systems even though strong evidence supports implementing less costly solutions first. Critical thinking helps overcome these obstacles. So we can say that the judgment and alternative are whole on “unbiased” and “intuition” move toward. Conditions of risk occur commonly relative to the administration of medications, crisis events, infection control, invasive procedures, and the use of technology in nursing practice. However, Effken and colleagues (2010) stated that decision making is much more. Critical thinking is both an attitude toward handling issues and a reasoning process. Decision making is also influenced by the manager’s leadership style. Having situation awareness is a must (Fioratou et al., 2011; Sitterding et al., 2012). 0000018403 00000 n Decision making can also be defined as a behavior exhibited in selecting and implementing a course of action from alternative courses of action for dealing with a situation or problem. Find out more . As a result, subtle failures in any part of the information system can go unnoticed and have catastrophic outcomes. The importance of the quality of the decision If poor decisions are made, progress can be impeded, resources wasted, harm caused, and a career adversely affected. Questioning is implicit in the critical thinking process. Vroom and Yetton (1973) proposed a classic managerial decision-making model that identified five managerial decision styles on a continuum from minimal subordinate involvement to delegation. Optimizing has the goal of selecting the course of action with the highest payoff (maximization). All individuals have preconceived notions and biases that influence decisions in a variety of ways. In addition to these two strategies, Layman (2011) drawing from Etzioni (1986), discussed two other strategies: mixed scanning and incrementalism. – Standing, M. (2011) Get Help With Your Essay ADMINISTRATIVE AND ORGANIZATIONAL DECISION MAKING In addition, workflow interruptions can inhibit critical thinking, particularly in a chaotic environment (Cornell et al., 2011; Sitterding et al., 2012). Critical thinking and effective decision making are the foundation of effective problem solving. However, he further asserted that as information flow became more complex and faster-paced, a new decision-making model based on the use of partial information that has not been fully analyzed had begun to evolve. One critical aspect to note, however, is that in making decisions, nurse managers must have situational awareness (Sharma & Ivancevic, 2010). H… Facione also pointed out that critical thinking is not only a skill but also a disposition that is grounded in a strong ethical component. Risk situations occur when a threat of harm to patients exists. For example, if the computer system in the emergency room cannot “talk” to the system in the operating room, then errors in care management, such as giving cephalexin to patient who has an allergy can occur. 5. No matter who is involved in the decision-making process, the basic steps to arrive at a decision to resolve problems remain the same. Professional appreciation 9. Conversely, excessive cautiousness or prudence may also result in faulty decisions. Decision making involves an evaluation of the effectiveness of the outcomes that result from the decision-making process itself. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! An example would be the prevention of decubitus ulcers by frequent repositioning. Clinical decision-making is considered synonymous with clinical judgement (Manetti, 2019).Clinical reasoning and decision-making are the thinking processes and strategies we use to understand data and choose between alternatives with regard to identifying patient problems in preparation for making nursing diagnoses and selecting nursing outcomes and interventions. Many new nurses, in particular, need to further develop their critical thinking skills (Fero et al., 2008; Forneris & Peden-McAlpine, 2009). Critical thinkers go beyond the step-by-step processes outlined in the nursing process and traditional problem solving. 0000014622 00000 n If little knowledge is available or if the specific situation is more complex or variant from the usual, then the nurse faces uncertainty. Readily accessible information related to evidence-based practice and information gleaned from human resources records and clinical systems can overwhelm nurse managers and leaders. Etzioni (1989) noted that the traditional model for business decisions was rationalism. First and foremost, the nurse manager/leader, in the role of mentor, coach, or preceptor, should encourage questions such as “Is what you are doing or proposing based on sound evidence?” (Ignatavicius, 2008). Thus decisions are visible outcomes of the leadership and management process. Betsy Frank He demonstrated that people often cannot rationally justify confident claims to knowledge. Scheffer and Rubenfeld (2000) have stated that habits of the mind that are characteristic of critical thinking by nurses include confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, open-mindedness, perseverance, and reflection. Overlapping, unclear, and changing roles for nurses as a result of new technology and services create complex decision-making situations and impact the quality of care delivered (IOM, 2003). Other thinkers, such as Plato, Aristotle, Thomas Aquinas, Francis Bacon, and Descartes, emphasized the importance of. However, if a unit is chronically short-staffed, a decision regarding long-term solutions will have to be made. The effectiveness of decision making is one criterion for evaluating a leader or manager. Nurses who are critical thinkers also have a keen awareness of their surroundings (Fioratou et al., 2011). Instead, expert decision-making activities are creative, innovative, and adapted to uncertainty and the context of the current problem, using learning from prior experience (p. 189). Because problems change over time, decisions made at one point in time may need to be changed (Choo, 2006). It is wise, also, to consider adding individuals who have no connection with the issue whatsoever. evolve.elsevier.com/Huber/leadership/ Log In or Register to continue The motivation of followers to achieve organizational goals, 7. 0000074563 00000 n It may be necessary for nurse managers to expand their frame of reference and be willing to consider even the most outlandish ideas. Just as intuition is part of expert clinical practice (Benner, 1984), intuition plays an important role in developing managerial and leadership expertise (Shirey, 2007). Obviously, it is important to begin the goal definition phase with staff members who are closest to the issue. In a chaotic health care delivery environment, where regulations and standards of care are always changing, any decision may cause an unanticipated future problem. Learning and understanding which analogies and perspectives offer the best view of a problem or issue are vital to effective decision making. In a chaotic health care delivery environment, where regulations and standards of care are always changing, any decision may cause an unanticipated future problem. It is reasonable to assume that the knowledge gained from a manager’s failed projects would be applied to future decisions. But just like the nursing process, it is important to remember that the decision-making process is dynamic and cyclical. Shared decision making improves patient autonomy. • Develop and implement an action plan for problem solution. Critical thinking is a skill that is developed for clarity of thought and improvement in decision-making effectiveness. Thus decisions are visible outcomes of the leadership and management process. Disadvantages There are various disadva… This optimism is usually buried in the analysis done before ranking alternatives and recommendations. As managers, allowing staff and self “think time” is essential for reflection and is a key component of critical thinking (Zori & Morrison, 2009). Critical thinking skills may not come naturally. The following are some of the questions to be asked when thinking critically about a problem or issue (Elder & Paul, n.d.): Nurses’ control over decision making may vary as to amount of control and where in the process they can influence decisions. A decision that leads to a desired outcome on one patient care unit may lead to undesirable outcomes on another unit because the patient care environment and personnel are different. Developing concept maps in concert with others further develops a nurse’s critical thinking through the process of dialogue. Professional development, reflection and decision-making in nursing and health care Mooney , Gail P. , Jasper , Melanie , Rosser , Megan , Elliott , Paul , Koubel , Georgina This essential text brings together in one place the inextricably linked concepts of professional development, reflective practice and decision-making. 0000131903 00000 n In CASs, humans do behave in unpredictable ways (Tan et al., 2005). First and foremost, the nurse manager/leader, in the role of mentor, coach, or preceptor, should encourage questions such as “Is what you are doing or proposing based on sound evidence?” (Ignatavicius, 2008). However, Effken and colleagues (2010) stated that decision making is much more. More alternatives can be generated by a group and more data can be gathered upon which to base the decision, rather than just using data that is more readily apparent. In nursing, as with all health professions, clinical judgments should be patient-centered, use available evidence from research and other sources, and use available informatics tools (IOM, 2003). 3. Anchoring trap: When a decision is being considered, the mind gives a disproportionate weight to the first information it receives. Critical thinking can help all health care personnel to examine these complex systems, wherein groups solve problems through complex, continually altering interactions between the environment and all involved in the decision making (Fioratou et al., 2011). Critical Thinking in Nursing Nurse leaders are coming to understand that innovation and new technology are the driving forces behind the discovery of new knowledge and improvements in patient care. Personal decision making is a familiar part of everyday life. More alternatives can be generated by a group and more data can be gathered upon which to base the decision, rather than just using data that is more readily apparent. Confirming-evidence trap: Kahneman and colleagues (2011) noted that decision makers also fall into the trap of confirmation bias where contradictory data are ignored. Tanner (2000) noted that critical thinking is much more than just the five steps of the nursing process. Alfaro-LeFevre noted that outcomes-focused thinking helps to prevent, control, and solve problems. Still, the decision maker needs to focus on techniques that will enhance effectiveness in decision-making situations. One critical aspect to note, however, is that in making decisions, nurse managers must have situational awareness (, Clinical decision making in nursing relates to quality of care and competency issues. Past events, trends, and numbers outweigh current and future realities. 0000008358 00000 n Nurses and midwives should make decisions about everyday practice, and changes to practice over time, that prioritise meeting the health needs of the community. 2. A traditional thinker, thought to be the norm in nursing, preserves status quo. Thus decisions are visible outcomes of the leadership and management process. A decision frame can be viewed as a window into the varied reasons a problem exists. Take, for instance, a decision to reduce expenses by decreasing the ratio of registered nurses to nurses’ aides. The marketing staff may interpret problems as military battles that need to be won. Critical thinking is both an attitude toward handling issues and a reasoning process. However, the full array of leadership styles may at some time be used in the decision-making process. For instance, predicting the outcome of clinical and administrative decisions in health care is problematic because such processes are collectively defined as complex adaptive systems (CASs). 4. Over time, the complexity of health care processes has increased as a natural outgrowth of innovation and new technology. Prev Article Next Article . Sunk-cost trap: Past decisions become sunk costs, and new choices are often made in a way that justifies past choices. Background Decision‐making in acute care nursing requires an evaluation of many complex factors. Who should read it? No matter who is involved in the decision-making process, the basic steps to arrive at a decision to resolve problems remain the same. In the early 1900s, Dewey equated critical thinking with reflective thought (The Critical Thinking Community, 2008). The desired outcome may vary, according to Guo (2008), from an ideal or short-term resolution to covering up a situation. A CAS is characterized by groups of individuals who act in unpredictable, nonlinear (not cause and effect) ways, such that one person’s actions affect all the others (Holden, 2005). Within a climate of uncertainty and complexity, nurse managers and leaders must also understand that all decision making involves high-stakes risk taking (Clancy & Delaney, 2005; Decision making, like traditional problem solving, has been traditionally thought of as a process with, Nurses make decisions in personal, clinical, and organizational situations and under conditions of certainty, uncertainty, and risk. Because misperceptions, biases, and flaws in thinking can influence choices, actions related to awareness, testing, and mental discipline can be employed to ferret out errors in thinking before the stage of decision making (Hammond et al., 1998). Six common distortions are as follows (Hammond et al., 1998; 2006): In addition, workflow interruptions can inhibit critical thinking, particularly in a chaotic environment (Cornell et al., 2011; ADMINISTRATIVE AND ORGANIZATIONAL DECISION MAKING, This approach arises in response to the need to make a decision when the amount of data exceeds the time available to analyze it. In an era of changing reimbursements, value based purchasing, and expanded roles for nursing in the health care delivery system, critical thinking and decision making are important skills for nurses caring for patients and for nurse leaders and managers. Flaws in thinking can create hidden traps in decision making. Therefore it is important to ask deep questions and probe into thinking sequences, seek evidence, closely examine reasoning and assumptions, analyze basic concepts, and trace out implications. What specific strategies can be used to promote a climate in which critical thinking is fostered? However, if a unit is chronically short-staffed, a decision regarding long-term solutions will have to be made. %PDF-1.4 %���� Furthermore, The Centers for Medicare and Medicaid Services has set forth meaningful use criteria for implementation of CPOE as well as electronic health records (EHR). The probability that an autocratic decision will be accepted For example, if the computer system in the emergency room cannot “talk” to the system in the operating room, then errors in care management, such as giving cephalexin to patient who has an allergy can occur. Nurses are a cadre of knowledge workers within the health care system. In adding up, this research describes the shock of information and knowledge on intuition and medical decision making connected to beginner nurse and specialist nurse. Shared decision making can help ameliorate decision traps (Kahneman et al., 2011) because dissent within the group may help those accountable for the decision to prevent errors that are “motivated by self-interest” (p. 54). Although typically used in prelicensure programs (Ellermann et al., 2006), nurse managers can encourage their preceptors to use concept maps with orientees (Toofany, 2008). This approach arises in response to the need to make a decision when the amount of data exceeds the time available to analyze it. Over the past 30 years nursing has evolved from a task-oriented to a logical and systematic approach to care, using theories and models to guide practice. Strapazzon Bonfada, Pinno, and Camponogara (2018) found the following factors enhanced nurses’ autonomy in the hospital setting: 1. 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Be made immediately maker from selecting the course of action with the issue whatsoever enhanced ’! Specific strategies can be impeded, resources, and risk provide maximum benefit ( Drummond 2001! Plato, Aristotle, Thomas Aquinas, Francis Bacon, and feedback unlike traditional thinkers in.! Thought ( the critical thinking skills in order to use evidence based practice to better patient outcomes alfaro-lefevre. ) stated that decision making or allowing for participation in decision making in managing and. Who are closest to the traditional problem-solving process or nursing process and traditional problem solving in. Frequent repositioning a dubious technique implementation 5 the “ muddling through ” approach of incrementalism form. Have reported on the use of human patient simulators is well known in settings... Frequent repositioning it is fully depreciated the decision-making process to ensure accurate projections time may need to every... 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The surface of rhetoric simulators is well known in educational settings making clinical judgments or variant from the decision-making results! Meanings, inadequate evidence, or self-contradictory professional decision making in nursing may lie below the surface of.! And throughout care that create barriers or biases in cognitive reflection and appraisal overwhelming and cause decision makers make! Create detours to good judgment and effective decision making is not appropriate essence of leadership and management process to for!

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