Additional Learning Exercises and Applications

LEARNING EXERCISE

1.4

Assessing Personal Decision Making A S S I G N M E N T:

Write a two- to three-page response to one of the following prompts:

A. Identify a poor decision that you recently made because of faulty data gathering. Have you ever made a poor decision because necessary information was intentionally or

unintentionally withheld from you?

B. Describe the two best decisions that you have made in your life and the two worst. What factors assisted you in making the wise decisions? What elements of critical thinking went awry in your poor decision making? How would you evaluate your decision-making ability?

C. Examine the process that you used in your decision to become a nurse. Would you describe it as fitting a profile of the economic man or the administrative man?

D. Do you typically use a problem-solving or decision-making model to solve problems? Have you ever used an intuitive model? Think of a critical decision that you have made in the last year. Describe what theoretical model, if any, you used to assist you in the process. Did you enlist the help of other experts in solving the problem?

LEARNING EXERCISE

1.5

Sharing Workload

Y

ou are a staff nurse on a small telemetry unit. The unit is staffed at a ratio of one nurse for every four patients, and the charge nurse is counted in this staffing because there is a full-time unit secretary and monitor technician to assist at the desk. The charge nurse is responsible for making the daily staffing assignments. Although you recognize that the charge nurse needs to reduce her patient care assignment to

have time to perform the charge nurse duties, you have grown increasingly frustrated that she normally assigns herself only one patient, if any, and these patients always have the lowest acuity level on the floor.

This has placed a disproportionate burden on the other nurses, who often feel the assignment they are being given may be unsafe. The charge nurse is your immediate supervisor. She has not generally been

responsive to concerns expressed by the staff to her about this problem.

A S S I G N M E N T:

Decide what the problem is in this scenario and who owns it. Identify at least five alternatives for action and select which one you believe will have the greatest likelihood of successful

implementation. How did differences in power and status influence the alternatives you identified?

What outcomes must be achieved for you to feel that the choice you made was a good one?

LEARNING EXERCISE

1.6

Considering Critical Elements in decision Making

Y

ou are a college senior and president of your student nursing organization. You are on the committee to select a slate of officers for the next academic year. Several of the current officers will be graduating, and you want the new slate of officers to be committed to the organization. Some of the brightest members of the junior class involved in the organization are not well liked by some of your friends in the organization.

A S S I G N M E N T:

Looking at the critical elements in decision making, compile a list of the most important points to consider in making the decision for selecting a slate of officers. What must you guard against, and how should you approach the data gathering to solve this problem?

LEARNING EXERCISE

1.7

Examining the Decision-Making Process

Y

ou have been a staff nurse for the 3 years since your graduation from nursing school. There is a nursing shortage in your area, and there are many openings at other facilities. In addition, you have been offered a charge nurse position by your present employer. Last, you have always wanted to do community health nursing and know that this is also a possibility. You are self-aware enough to know that it is time for a change, but which change, and how should you make the decision?

A S S I G N M E N T:

Examine both the individual aspects of decision making and the critical elements in making decisions. Make a plan including a goal, a list of information, and data that you need to gather and areas where you may be vulnerable to poor decision making. Examine the consequences of each alternative available to you. After you have done this, as an individual, form a small group and share your decision-making planning with members of your group. How was your decision making like others in the group, and how was it different?

LEARNING EXERCISE

1.8

Decision Making and Risk Taking

Y

ou are a new graduate nurse just finishing your 3-month probation period at your first job in acute care nursing. You have been working closely with a preceptor; however, he has been gradually transitioning you to more independent practice. You now have your own patient care assignment and have been giving medications independently for several weeks. Today, your assignment included an elderly confused patient with severe coronary disease. Her medications include antihypertensives, antiarrhythmics, and beta- blockers. It was a very busy morning, and you have barely had a moment to reorganize and collect your thoughts.

It is now 2:30 PM, and you are preparing your handoff report. When you review the patient’s 2:00 PM

vital signs, you note a significant rise in this patient’s blood pressure and heart rate. The patient, however, reports no distress. You remember that when you passed the morning medications, the patient was in the middle of her bath and asked that you just set the medications on the bedside table and that she would take them in a few minutes. You meant to return to see that she did but were sidetracked by a problem with another patient.

You now go to the patient’s room to see if she indeed did take the pills. The pill cup and pills are not where you left them, and a search of the wastebasket, patient bed, and bedside table yields nothing. The patient is too confused to be an accurate historian regarding whether she took the pills. No one on your patient care team noticed the pills.

At this point, you are not sure what you should do next. You are frustrated that you did not wait to give the medications in person but cannot change this now. You charted the medications as being given this morning when you left them at the bedside. You are reluctant to report this as a medication error because you are still on probation and you are not sure that the patient did not take the pills as she said she would.

Your probation period has not gone as smoothly as you would have liked anyway, and you are aware that reporting this incident will likely prolong your probation and that a copy of the error report will be placed in your personnel file. The patient’s physician is also frequently short-tempered and will likely be agitated when you report your uncertainty about whether the patient received her prescribed medications. The reality is that if you do nothing, it is likely that no one will ever know about the problem.

You do feel responsible, however, for the patient’s welfare. The physician might want to give additional doses of the medication if indeed the patient did not take the pills. In addition, the rise in heart rate and blood pressure has only just become apparent, and you realize that her heart rate and blood pressure could continue to deteriorate over the next shift. The patient is not due to receive the medications again until 9:00

PM tonight (b.i.d. every 12 hours).

A S S I G N M E N T:

Decide how you will proceed. Determine whether you will use a systematic problem-solving model, intuition, or both in making your choices. How did your values, preferences, life experiences, willingness to take risks, and individual ways of thinking influence your decision?

LEARNING EXERCISE

1.9

Determining a Need to Know

Y

ou are a nursing student. You are also HIV positive as a result of some high-risk behaviors you engaged in a decade ago. (It seems like a lifetime ago.) You are now in a committed, monogamous relationship, and your partner is aware of your HIV status. You have experienced relatively few side effects from the antiretroviral drugs you take, and you appear to be healthy. You have not shared your sexual preferences, past history, or HIV status with any of your classmates, primarily because you do not feel that it is their business and because you fear being ostracized in the local community, which is fairly conservative.

Today, in the clinical setting, one of the students accidentally stuck herself with a needle right before she injected it into a patient. Laboratory follow-up was ordered to ensure that the patient was not exposed to any blood-borne disease from the student. Tonight, for the first time, you recognize that no matter how careful you are, there is at least a small risk that you could inadvertently expose patients to your bodily fluids and thus to some risk.

A S S I G N M E N T:

Decide what you will do. Is there a need to share your HIV status with the school? With future employers? With patients? What determines whether there is “a need to tell” and a “need to know”? What objective weighted most heavily in your decision?

LEARNING EXERCISE

1.10

Using a Flowchart for Project Management

T

hink of a project that you are working on; it could be a dance, a picnic, remodeling your bathroom, or a semester schedule of activities in a class.

A S S I G N M E N T:

Draw a flowchart, inserting at the bottom the date that activities for the event are to be completed.

Working backward, insert critical tasks and their completion dates. Refer to your flowchart throughout the project to see if you are staying on target.

LEARNING EXERCISE

1.11

Making A Decision About Your First Job (Marquis & Huston, 2012)

Y

ou are about to graduate from a local community college with an associate degree in nursing. Your instructor suggests that a good fit between the new graduate’s skills and abilities and their first job is very important for how they will feel about nursing in the future. Some of your classmates have already made up

their mind about the job they want, and they are holding out for a position in pediatrics or the emergency room even if it means they need to relocate. You are unsure what job best fits you, although you most enjoyed your obstetrical rotation; however, your local hospitals rarely hire new graduates directly into the obstetrical unit. So far, you have been interviewed by two local hospitals and have been offered a job in each. One is for working the evening shift on a surgical unit and the other is working day shift in an oncology unit. You are sure you could find other offers if you relocated, but you are not sure you want to relocate at the present time. You have 1 week to make up your mind and let the personnel department know if you want to accept either of the positions you have been offered. How will you decide?

Using one of the problem-solving models just presented, outline the steps you would take to ensure that your decision was based on a rational and well-thought-out process. Determine what you should do. What are the alternatives? What information should you gather? After you have made your decision, get together in a group (four to six people from your class) and share your decisions. Were they the same? How did you approach the problem solving differently from others in your group? Was a rational systematic problem- solving process used? Was a goal or objective identified? How did your personal values influence your decision? Did intuition play a part in your decision making?

LEARNING EXERCISE

1.12

Addressing a Communication Gap (Marquis & Huston, 2012)

Y

ou are a new graduate nurse just finishing your 3-month probation period at your first job in acute care nursing. Your usual assignment is to be a team leader for eight patients, with one licensed practical nurse (LPN)/licensed vocational nurse (LVN) and one nursing assistant on your team. Today, your assignment included an elderly confused patient. You requested, during work assignments with your team, that the nursing assistant pay particular attention to this patient’s intake and output as you feel he may need some intravenous fluids if his intake and output (I & O) remain poor. You asked the nursing assistant to notify you if there was significant change so you could notify the physician. It was a very busy day, and you have barely had a moment to reorganize and collect your thoughts.

It is now 2:30 PM, and you are preparing your end-of-shift report. When you review the patient’s 2:00 PM

intake and output sheet, you note a significant drop in intake and the total output for the shift is only 90 mL.

You meant to check the I & O sheet during the day but kept getting sidetracked by problems with other patients. However, you are also upset that the nursing assistant did not keep you informed of this condition.

You now go to the patient’s room and assess the patient and find his vital signs and other findings similar to this morning’s assessment. You check with the nursing assistant to make sure the I & O recorded for the day is accurate and you call the physician to obtain an order to begin intravenous fluids. When you ask the nursing assistant why she did not report the significant drop in output to you, she said, “I forgot.”

At this point, you are not sure what you should do next. You are frustrated that the nursing assistant did not report to you as you had requested. You are not sure what to do further about this situation. You feel you should handle this yourself and not go to the charge nurse. You are a new nurse and do not want to get started on the wrong foot by speaking too harshly to the nursing assistant, yet you feel this lack of following instructions cannot go unanswered. The reality is that if you do nothing, it is likely that no one else will ever know about the problem.

The doctor did not seem upset when you called him about the drop in output, he just ordered the fluids, but the need to start the intravenous line and give report caused you to work overtime. By the time you finished your shift, the nursing assistant had gone home and you are left to spend your evening at home pondering what, if anything, you should do to follow-up on this tomorrow.

A S S I G N M E N T:

Decide how you will proceed. Determine whether you will use a systematic problem-solving model, intuition, or both in making your choices. How did your values, preferences, life

experiences, willingness to take risks, and individual ways of thinking influence your decision?

LEARNING EXERCISE

1.13

Returning to school for a Bachelor of Science in Nursing Degree (Marquis & Huston, 2012)

Y

ou have been a registered nurse (RN) for 5 years. Right after high school, you became a licensed vocational nurse (LVN) and after 6 years decided to attend a local LVN to associate degree in nursing (ADN) program at a local community college. You have become increasingly interested in attending a baccalaureate university to complete requirements for your bachelor of science in nursing degree (BSN).

You are still undecided, some of your friends are urging you to do this, and others ask why you need the degree.

Not only must you make up your mind about pursuing this option but you also have two different local opportunities. The regional university is 60 miles away and would require significant amounts of driving if you did the on-campus program; however, the university’s school of nursing also offers an online course that would require only 4 full Saturdays of attendance each semester. Both options have pros and cons.

After making a payoff table, calculating chances for advancement and salary increase weighed against cost of your new degree, you decided that it made economic sense to get a BSN degree.

A S S I G N M E N T:

Now that you have decided to get your baccalaureate degree, you must decide between three alternatives: (a) attending a distant university 60 miles away, (b) attending your local university and enrolling in their on-campus program, or (c) enrolling as an online student. Make a decision grid for the three alternatives, weighting the same criteria for each, using such things as cost, travel, quality of campus life, reputation and quality of the university, and so on. Assign each of your criteria a weighted score for the value that you personally view it. What did your final grid

look like and what was your final decision?

LEARNING EXERCISE

1.14

How Good Are Your Decision-Making Skills? Quiz and Key Instructions:

For each statement, mark the box in the column that best describes you. Please answer questions as you actually are (rather than how you think you should be).

As you answered the questions, did you see some common themes? We based our quiz on six essential steps in the decision-making process:

1. Establishing a positive decision-making environment.

2. Generating potential solutions.

3. Evaluating the solutions.

4. Deciding.

5. Checking the decision.

6. Communicating and implementing.

If you are aware of these six basic elements and improve the way you structure them, this will help you develop a better overall decision-making system. Let us look at the six elements individually.

Establishing a Positive Decision-Making Environment (Statements 3, 7, 13, and 16)

If you have ever been in a meeting where people seem to be discussing different issues, then you have seen what happens when the decision-making environment has not been established. It is so important for everyone to understand the issue before preparing to make a decision. This includes agreeing on an objective, making sure the right issue is being discussed, and agreeing on a process to move the decision forward.

You also must address key interpersonal considerations at the very beginning. Have you included all the stakeholders? And do the people involved in the decision agree to respect one another and engage in an open and honest discussion? After all, if only the strongest opinions are heard, you risk not considering some of the best solutions available.

Generating Potential Solutions (Statements 4, 8, and 11)

Another important part of a good decision process is generating as many good alternatives as sensibly possible to consider. If you simply adopt the first solution you encounter, then you are probably missing a great many even better alternatives.

Evaluating Alternatives (Statements 1, 6, and 15)

The stage of exploring alternatives is often the most time-consuming part of the decision-making process.

This stage sometimes takes so long that a decision is never made! To make this step efficient, be clear about the factors you want to include in your analysis. There are three key factors to consider:

1. Risk—Most decisions involve some risk. However, you need to uncover and understand the risks to make the best choice possible.

2. Consequences—You cannot predict the implications of a decision with 100% accuracy. But you can be careful and systematic in the way that you identify and evaluate possible consequences.

3. Feasibility—Is the choice realistic and implementable? This factor is often ignored. You usually have to consider certain constraints when making a decision. As part of this evaluation stage, ensure that the alternative you have selected is significantly better than the status quo.

Deciding (Statements 5, 10, and 17)

Making the decision itself can be exciting and stressful. To help you deal with these emotions as

objectively as possible, use a structured approach to the decision. This means taking a look at what is most important in a good decision.

Take the time to think ahead and determine exactly what will make the decision “right.” This will significantly improve your decision accuracy.

Checking the Decision (Statements 2 and 9)

Remember that some things about a decision are not objective. The decision has to make sense on an intuitive, instinctive level as well. The entire process we have discussed so far has been based on the perspectives and experiences of all the people involved. Now, it is time to check the alternative you have chosen for validity and “making sense.”

If the decision is a significant one, it is also worth auditing it to make sure that your assumptions are correct, and that the logical structure you have used to make the decision is sound.

Communicating and Implementing (Statements 12, 14, and 18)

The last stage in the decision-making process involves communicating your choice and preparing to implement it. You can try to force your decision on others by demanding their acceptance. Or you can gain their acceptance by explaining how and why you reached your decision. For most decisions—particularly those that need participant buy-in before implementation—it is more effective to gather support by explaining your decision.

Have a plan for implementing your decision. People usually respond positively to a clear plan—one that tells them what to expect and what they need to do.

Source: Mind Tools Editorial Team. (1996–2015). How good is your decision-making? Retrieved October 11, 2015, from