Many new nurses, in particular, need to further develop their critical thinking skills (Fero et al., 2008; Developing concept maps is another useful strategy to promote critical thinking. “Decision-making in nursing practice is influenced by evidence and also by individual values, client choice, theories, clinical judgment, ethics, legislation, regulation, health-care resources and practice environments” (CNA, p. 3). 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. 1. Shared decision making is a process by which nurses help patients make informed healthcare decisions. Log In or. Thus decisions are visible outcomes of the leadership and management process. Therefore using interprofessional teams for problem solving and decision making can be assumed to be more effective than working in disciplinary silos. Critical thinking is both an attitude toward handling issues and a reasoning process. Often it is these “unconnected” staff members who bring new decision frames to the meeting and have the most unbiased view of the problem. FIGURE 4-1 Differences and interactions among critical thinking, problem solving, and decision making. Evidence-based practice, evidence-based medicine, evidence-based nursing and evidence-informed decision-making began with Florence Nightingale in the 1850s during the Crimean War. 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. In the UK, for example, the Chief Nursing Officer recently outlined 10 key tasks for nurses as part of the National Health Services modernisation agenda and the breaking down of artificia… However, Effken and colleagues (2010) stated that decision making is much more. Evidence-based decision making is a prescriptive approach to making choices based on ideas of how research and theory can be used to improve decision making in regards to delivery and quality of patient care. Various decision-making models and strategies exist. Many new nurses, in particular, need to further develop their critical thinking skills (Fero et al., 2008; Forneris & Peden-McAlpine, 2009). Decision makers need to make every effort to forecast unanticipated consequences of their decisions. Barriers to effective decision making exist and, once identified, can lead to going back through the decision-making process. 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). According to Choo (2006), organizations use information to “make decisions that commit resources and capabilities to purposeful action” (p. 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). A traditional thinker, thought to be the norm in nursing, preserves status quo. However, Snowden and Boone (2007) cautioned that “best practice, by definition is past practice” (p. 71). One of the core competencies for all health professionals is working in interprofessional teams (Interprofessional Education Collaborative Expert Panel, 2011). DECISION-MAKING SITUATIONS Creativity is necessary to deal with the complex twenty-first century health care delivery environment. If the new equipment provides a higher level of quality at a lower cost, the sunk cost of the existing equipment is irrelevant to the decision-making process. • Establish desirable criteria for what you want to accomplish. In addition to these two strategies, Layman (2011) drawing from Etzioni (1986), discussed two other strategies: mixed scanning and incrementalism. 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). 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). Questioning is implicit in the critical thinking process. Personal decisions range from multiple small daily choices to time management and career or life choices. 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. Nurse executives may view concerns from a care or family frame that emphasizes collaboration and working together. Creativity is necessary to deal with the complex twenty-first century health care delivery environment. 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. Facione also pointed out that critical thinking is not only a skill but also a disposition that is grounded in a strong ethical component. In a chaotic health care delivery environment, where regulations and standards of care are always changing, any decision may cause an unanticipated future problem. 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. 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). Pulman and colleagues (2009) have reported on the use of simulators to promote critical thinking role development in inter-professional environments. Assignment 3: Ethical Decision Making in Personal Practice Experience Jessica Steffens ID# 3253187 Athabasca University NURS 250 Exploration of Professional Nursing Practice Tutor: Yvonne Moore December 11, 2016 Ethical Dilemma in Personal Practice Patient advocacy is an important nursing role and requires nurses to consider patients thoughts and feelings while ensuring their health care access… In any case, the processes are virtually the same, but their purposes may be slightly different. Is there another question that must be answered first? No matter who is involved in the decision-making process, the basic steps to arrive at a decision to resolve problems remain the same. 0000003133 00000 n Find out more . Thus it is vital for nurses to understand decision making and explore styles and strategies to enhance decision-making skills. Obviously, it is important to begin the goal definition phase with staff members who are closest to the issue. Simulators may also be useful in orienting new graduates to the acute care setting (Leigh, 2011). This optimism is usually buried in the analysis done before ranking alternatives and recommendations. Increasingly, however, they are being cast in the role of active decision makers in healthcare by policy makers and other members of the healthcare team. 0000095827 00000 n Confirming-evidence trap: Kahneman and colleagues (2011) noted that decision makers also fall into the trap of confirmation bias where contradictory data are ignored. Optimizing has the goal of selecting the course of action with the highest payoff (maximization). The electronic health record can be mined for valuable data, upon which fiscal, human resource, and patient care decisions can be made. 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). Hospital administrators may decide to add additional services to keep up with external forces. If problems require urgent action, then decisions must be made rapidly; if solutions do not need to be identified immediately, decision making can occur in a more deliberative way. Strapazzon Bonfada, Pinno, and Camponogara (2018) found the following factors enhanced nurses’ autonomy in the hospital setting: 1. No matter who is involved in the decision-making process, the basic steps to arrive at a decision to resolve problems remain the same. 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). @���q�)V<7=���L~_�^�+��^��@��Es(;U�8Pk��~q@��/���k �[���{Dׄ������}��xo��O��h�ɫ�w�D7��y����n�;W1h���v!�9,]~�C�ˬ)��0�����,�������tG>�M C��6Y��^������8��Z.��Κm������V��u8,��[��y��4���/nG9e���en�pt;GQ`�>�~pW�ε/�o��d�foČp��gD�f�ؘ�j���ܞ �=~B���gL i�����s�>�~]9��� �o; endstream endobj 99 0 obj <> endobj 100 0 obj <> endobj 101 0 obj <>stream Take, for instance, a decision to reduce expenses by decreasing the ratio of registered nurses to nurses’ aides. ��Z��(c2���Q�y��F֛܆�G�q��M/-�3��ۚ�e�it�#�����V0���e�zx.m������m� +�r���,�-fJ�FE�C��cֹ�7�=0�n�ʲ��_zG������K��S �$�,�c�$~X+����!LxlJpKZ+�wWDn~�3��t�m!e���bϧ�4�}�t��üۏ ���a���뗠K��h�lEذK ���A�������M����wz6cϘ�S(�^�>�;O����l�6�8x���:�1|�x��!�Fp Staff nurses and managers must use critical thinking skills in order to determine the appropriateness of implementing recommended practice protocols. • Consider all possible alternative choices that will accomplish the desired goal or criteria for problem solution. • Define the problem and determine why anything should be done about it and explore what could be happening. 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