The term “problem solving” is often used synony-mously with decision making, but the processes are not the same. Decision making may or may not involve a problem but always involves selecting one action from several alternatives. Problem solving involves diagnosing or identifying a problem and solving it and includes making decisions along the way (Sullivan & Decker, 2001). In other words, problem solving is broader in scope than decision making in that it may include making many deci-sions in order to resolve the problem (Fig. 10-4). But problem solving is also more narrow in scope than decision making in that decisions are made about many different issues, not just about problems.
Enhancing Your Critical Thinking, Decision Making, and Problem Solving 161
Box 10-2
Decision-Making Tips
■ Do not make decisions that are not yours to make, and do not waste your time making decisions that do not have to be made.
■ Not making a decision is a decision; it is a decision to not take action.
■ When making a decision, a choice is made from options. A choice is not being made between right and wrong.
■ Avoid snap decisions. Move quickly on the reversible ones and slowly on the nonreversible ones.
■ Make decisions on paper. Make notes, and keep ideas visible so all the relevant information can be viewed
■ Be sure to choose what is right, not who is right.
■ Make decisions as you go along. Do not let them accumulate.
■ Consider those affected by a decision. Whenever feasible, get people involved to increase their commitment.
■ To be effective, a manager must have the luxury of having the right to be wrong.
■ Once the decision has been made, do not look back.
Never regret a decision; it was the right thing to do at the time.
■ As part of the decision-making process, always consider how it will be implemented.
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The problem-solving process can take some time to define the problem and its scope and the goal for problem solving. Problem solving should be a group process, involving all individuals or groups affected by the problem. Problems can also be viewed as opportunities to make change and improve out-comes. Start the investigation with who, what, when, where, why, and how. Either or both of the following techniques present effective ways to explore all aspects of the problem and obtain feed-back about the decisions that are made along the way.
BRAINSTORMING TECHNIQUE
Using the basic brainstorming technique to solve problems can be a very powerful strategy. This is a group process using a strong facilitator who can control the discussion while allowing each individ-ual the freedom to meet and express ideas without threat of ridicule or sanction. The purpose of the meeting must be clear to everyone involved, and the facilitator has the task of keeping everyone focused on that purpose. Deciding how much time will be allowed to brainstorm is critical, and the facilitator or leader should be prepared with ideas to get the process started and keep it moving. Frequent clari-fication and summary will help keep the discussion on track, and the outcomes should be apparent and flow logically from the discussion. The process begins with defining and agreeing on the objective and continuing as follows:
■ Brainstorm ideas and suggestions with an agreed upon time limit.
■ Categorize/condense/combine/refine.
■ Assess/analyze effects or results.
■ Prioritize options/rank-list as appropriate.
■ Agree on action and period.
■ Control and monitor follow-up.
SEVEN HAT TECHNIQUE
A parallel thinking technique introduced by deBono (1985) can enhance problem solving.
DeBono identified six thinking hats, with each col-ored hat representing a different viewpoint. This deliberate method encourages a group to think along similar lines at the same time so that personal egos do not interfere in the creation of facts, infor-mation, or solutions. Each individual in the group is expected to take a particular position or “wear a dif-ferent color hat.” Individuals may be asked to change hats and review the issues from a different perspective.
■ Blue Hat thinking provides a formal structure to the thinking at all times. One person, usu-ally the group facilitator, wears this hat. The blue hat is responsible for focusing the ing at all times and keeping the various think-ing hats trained on the correct tasks. One suggested sequence, controlled at all times by the blue hat, is to start with the white hat, fol-lowed by the red, yellow, green, and black hats.
■ White Hat thinking deals with figures and facts in an objective or neutral way. Individual opin-ion is excluded. It provides an opportunity to move back down the abstraction ladder to the data, or lowest-rung, level. An example of white hat thinking is “There are RNs and UAPs in all nursing departments.” It would be unacceptable to say “I think all nursing depart-ments should consist of RNs and UAPs.”
■ Red Hat thinking involves emotion and is not rational. It is based on feelings and intuitions that can be positive or negative. The key to red hat thinking is that explanations are unneces-sary. The red hat puts positive and negative feelings out in the open so they do not lurk in the background and cloud the thinking 162 Skills for Being an Effective Leader
Decisions
Solution Problem
Critical Thinking
FIGURE 10-4 Decision model.
10Jones Leadership(F)-ch 10 1/14/07 3:40 PM Page 162
process. The red hat acknowledges the fact that feelings can shape perceptions.
■ Yellow Hat thinking is visionary. It is about constructive thinking and making things hap-pen. Here, alternatives are discussed and may be speculative in nature. “Long shots” are included because they expand the thinking and provide the opportunity to clarify other ideas. Ideas do not have to be new or unique;
yellow hat thinking is concerned about finding effective ways to accomplish the task.
■ Green Hat thinking involves the creation of new ideas or thinking about things in different ways. This hat legitimizes the wild and crazy ideas. It involves movement in a forward direc-tion. Here, the fact that that there is more than one right answer to a problem is acknowl-edged.
■ Black Hat thinking is logical and negative, never emotional. This hat does not consider arguments for or against, only negative state-ments that are based on reason and logic. Facts produced in the white hat thinking can be chal-lenged when wearing the black hat. Statements take the form of “I am concerned about” and
“Can you help me with this concern?”
All Good Things…
■ Critical thinking is the process that guides sci-entific reasoning, the nursing process, problem solving, and decision making.
■ Critical thinking involves the use of the cognitive process, which includes divergent thinking, reasoning, reflection, creativity, clar-ification, and basic support.
■ Decision making and problem solving are not synonymous.
■ Decision making involves identifying and selecting a course of action from several alter-natives.
■ Problem solving requires identifying a problem and finding a solution.
■ There are many decision-making models, which are derived from theories to guide the process.
■ There are two types of decisions: routine and innovative.
■ The problem-solving process involves identify-ing the problem, gatheridentify-ing and analyzidentify-ing
information, developing and implementing the solutions, and evaluating the outcomes.
Let’s Talk
The coordinator of a home care team has been informed by administration that the team must begin to care for patients who have external defib-rillators in the home. The nursing staff is not familiar with this technology. The team leader must decide who to assign to care for these patients.
1.Use the pre–decision making process to analyze this issue.
2.How soon does a decision need to be made?
Determine when the agency will be accepting patients for home care who have external defibrillators.
3.Who has the power to make the decision?
Obviously, the administration made the decision about accepting this type of patient. Determine if you will be able to decide when and how many of these patients are accepted for home care.
4.What are the controllable and uncontrollable factors? After gathering this information, you will be able to determine what you can control.
You can then move on to decide how best to prepare the nurses to care for these patients.
NCLEX Questions
1. When the nurse manager of a busy rehabilita-tion unit decided the best way to reward staff was to give a monetary bonus rather than time off, many of the staff became upset and went to administration with complaints. This manager skipped which step of the critical thinking process?
A. Obtaining a majority consensus of all of the staff.
B. Considering the context and meaning of the issues to each individual.
C. Not asking the staff how much money would be considered an adequate reward.
D. Identifying assumptions underlying the issue.
2. The manager of a unit was concerned about the plans for unit renovations. In an effort to be sure
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the renovations would be “nurse-friendly” he asked the staff to make a wish list of everything they would like moved or fixed on the existing unit. This is an example of which part of the decision-making process?
A. Assessment/data collection.
B. Planning.
C. Data interpretation.
D. Generating hypotheses.
3. S. Adams read the notice about the new intra-venous pumps that had been purchased for the unit. She reviewed the information and instruc-tions for use and compared them with the pumps they had been using. She listed all the similarities in her mind and decided these new pumps were not really very different and might be easier to use than the old pumps. She is an example of which kind of individual?
A. Chaotic thinker.
B. Innovative thinker.
C. Negative thinker.
D. Adaptive thinker.
4. A good decision maker is one who:
A. Uses various models to guide the process based on the situation.
B. Adopts one model and uses it to guide all decision making.
C. Does not use any models because they are not at all useful.
D. Develops a model each time a decision needs to be made.
5. Using Wheeler’s decision-making model with concentric circles is useful only if:
A. One applies the model exactly as it is pre-sented in the textbook.
B. One can absolutely predict the outcomes in any given situation.
C. Everyone understands the model.
D. The labels are changed in the circles to repre-sent the situation.
6. J. Strong, manager of an orthopedic unit, drafted a policy to be used in his department to define the process to have laboratory tests completed on his unit. This policy included the times of regu-lar collection and the process for emergency or STAT laboratory testing. The policy and proce-dure were never followed because:
A. The policy was too complicated and included too much information.
B. The policy and procedure made decisions for another department.
C. The staff did not believe it was necessary to follow any procedure.
D. None of the above.
7. Amazing fell into what trap when she decided that all staff would be required to pick up all medications from the pharmacy for their patients because the unit secretary brought the medications from a different unit, which caused a half-hour delay in administering med-ications on the unit?
A. Status quo.
B. Framing.
C. Expert.
D. Prudence.
8. All nurses were advised to register any addi-tional vehicles they might drive to work with security. JJ could not decide which other car to register so he did not register any additional automobiles with security. When his primary car was in the shop, he could not park in the employee area and had to pay visitors’ parking fees. This was what kind of decision making?
A. Not making a decision results in a decision being made for you.
B. Making a decision that is not yours to make.
C. Relying on too much expert opinion.
D. Innovative decision making.
9. There were many new nurses working on the unit, and many of them were from other coun-tries. The manager became aware of many dif-ficulties that seemed to be arising from this cultural diversity. She decided to get the staff together to talk about the differences and com-monalities and decide on a plan to educate every one working on the unit about the differ-ent cultures. This is an example of what kind of problem-solving technique?
A. Seven hats.
B. Pros and cons.
C. Brainstorming.
D. Concentric circles.
10. When confronted with the controversy and apparent poor morale of the 3-11 p.m. staff, the manager decided the staff needed to take vaca-tion days and began to schedule these days for them. Many nurses became very upset with this, and finally one nurse said that the problem 164 Skills for Being an Effective Leader
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was not the schedule but the difficulties the nurses were having with the charge nurse with the patient assignments. This is an example of what kind of error in problem solving?
A. Not using a problem-solving model.
B. Poor evaluation of outcomes.
C. Not considering several alternatives.
D. Incorrect problem identification.
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