10Jones Leadership(F)-ch 10 1/14/07 3:40 PM Page 163 Enhancing Your Critical Thinking, Decision Making, and Problem Solving ■ ■ ■ 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 happen 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 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 direction Here, the fact that that there is more than one right answer to a problem is acknowledged Black Hat thinking is logical and negative, never emotional This hat does not consider arguments for or against, only negative statements that are based on reason and logic Facts produced in the white hat thinking can be challenged 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 scientific 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, clarification, and basic support Decision making and problem solving are not synonymous Decision making involves identifying and selecting a course of action from several alternatives 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 identifying the problem, gathering and analyzing 163 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 defibrillators 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 Use the pre–decision making process to analyze this issue How soon does a decision need to be made? Determine when the agency will be accepting patients for home care who have external defibrillators 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 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 When the nurse manager of a busy rehabilitation 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 The manager of a unit was concerned about the plans for unit renovations In an effort to be sure 10Jones Leadership(F)-ch 10 164 1/14/07 3:40 PM Page 164 Skills for Being an Effective Leader 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 S Adams read the notice about the new intravenous pumps that had been purchased for the unit She reviewed the information and instructions 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 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 Using Wheeler’s decision-making model with concentric circles is useful only if: A One applies the model exactly as it is presented 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 represent the situation 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 regular collection and the process for emergency or STAT laboratory testing The policy and procedure 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 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 medications on the unit? A Status quo B Framing C Expert D Prudence All nurses were advised to register any additional 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 There were many new nurses working on the unit, and many of them were from other countries The manager became aware of many difficulties that seemed to be arising from this cultural diversity She decided to get the staff together to talk about the differences and commonalities and decide on a plan to educate every one working on the unit about the different 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 vacation days and began to schedule these days for them Many nurses became very upset with this, and finally one nurse said that the problem 10Jones Leadership(F)-ch 10 1/14/07 3:40 PM Page 165 Enhancing Your Critical Thinking, Decision Making, and Problem Solving 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 REFERENCES Anderson, K (2004a) More of the most common decisionmaking mistakes people make Accessed August 31, 2004, at www.pertinent.com/articles/communications/KareCom Anderson, K (2004b) How we sometimes fool ourselves when making decisions: Part I Accessed August 31, 2004, atwww pertinent.com/articles/communications/KareCom1.asp Broome, B.J., DeTurk, S., Kristjansdottir, E.S, et al (2002) Giving voice to diversity: An interactive approach to conflict management and decision-making in culturally diverse work environments Journal of Business and Management, 8, 239–264 deBono, E (1985) Six Thinking Hats Boston: Little, Brown & Co Decision Making Tips (2001) Liraz Publishing Co http://www.LIRAZ.com/tdecision.htm Fralic, M.F., & Denby, C.B (2000) Retooling the nurse executive for the 21st century practice: Decision support systems Nursing Administration Quarterly, 24(2), 19–28 Lowy, A., & Hood, P (2004) The Power of the ϫ Matrix San Francisco: Jossey-Bass Marketing Teacher, (n.d.) S.W.O.T Analysis http://www marketingteacher.com/index.html McNichol, E (2002) Thinking outside the box: Encouraging flexible thinking for problems and decisions Nursing Management (London), 9(4), 19–22 Sullivan, E.J., & Decker, P.J (2001) Problem solving and decision making Effective leadership and management in nursing (5th ed.) Upper Saddle River, NJ: Prentice Hall Thompson, C (1999) A conceptual treadmill: The need for “middle ground” in clinical decision making theory in nursing Journal of Advance Nursing, 30, 1222–1229 Wheeler, R (2000) Being proactive, not reactive In Fay L Bower (Ed.) Nurses taking the lead: Personal qualities of effective leadership Philadelphia: W.B Saunders 165 BIBLIOGRAPHY Benner, P (1984) From novice to expert: Excellence and power in clinical nursing practice Reading, MA: Addison Wesley Bruhn, J.G (2004) Leaders who create change and those who manage it: How leaders limit success The Health Care Manager, 23, 132–140 Carlson, R (1997) Don’t Sweat the Small Stuff and It’s All Small Stuff New York: Hyperion Press Clancy, R.R (2003) The art of decision-making Journal of Nursing Administration, 33, 343–349 Fraser, K.D., & Strang, V (2004) Decision-making and nurse case management: A philosophical perspective Advances in Nursing Science, 27, 32–43 Green, C (2000) Critical thinking in nursing, Upper Saddle River, N J: Prentice Hall Health Janis, I.L., & Mann, L (1977) Decision making: A psychological analysis of conflict, choice, and commitment New York: Macmillan Johnson, L.J (1990) The influence of assumptions on effective decision-making Journal of Nursing Administration, 20(4), 35–39 Kay, S (1998) How employees process information Supervision, 59(12), 6–7 Kikuchi, J.F., & Simmons, H (1999) Practical nursing judgment: A moderate realist conception Scholarly Inquiry for Nursing Practice, 13, 43–55 Lindner, K (2004) Crunch Time: steps to Making the Right Life Decisions When It Counts New York: Gotham Books Accessed March 31, 2005, at http://www.msnbc.com/id/ 6766123/ McGraw, P.C (2000) Life strategies New York: Hyperion Press Peterson, T.O., & Lunsford, D.A (1998) Parallel thinking: A technique for group interaction and problem solving Journal of Management Education, 22, 537–554 Rausch, E (1999) Management/leadership decision guidelines: Critical ingredients for competitiveness Competitiveness Review, 9(2), 19–27 Smith, G.F (2003) Beyond critical thinking and decision making: Teaching business students how to think Journal of Management Education, 27(1), 24–51 Tucker-Ladd, C.E (2002) Decision-making and problemsolving Psychological Self-Help Online book: Mental Health Net http://mentalhelp.net/psyhelp/chap13/chap13o.htm Wheeler, J (2001) Thinking your way to successful problemsolving Nursing Times, 97(37), 36–37 10Jones Leadership(F)-ch 10 1/14/07 3:40 PM Page 166 This page has been left intentionally blank 11Jones Leadership(F)-ch 11 1/14/07 3:42 PM Page 167 chapter 11 Nurses Leading Change DEBRA A MORGAN, EDD, RN JEWETT G JOHNSON, NSN, RN DEBORAH R GARRISON, PHD, RN CHAPTER MOTIVATION “Nothing is permanent but change.” Heraclitus (c 500 BC) CHAPTER MOTIVES ■ ■ ■ ■ ■ Apply change theories to clinical situations Identify strategies to overcome barriers to change Discuss the role of the change agent Identify common characteristics among various change theories Use various change theories as frameworks for initiating change 167 ... for problems and decisions Nursing Management (London), 9(4), 19–22 Sullivan, E.J., & Decker, P.J (2001) Problem solving and decision making Effective leadership and management in nursing (5th... to diversity: An interactive approach to conflict management and decision-making in culturally diverse work environments Journal of Business and Management, 8, 239–264 deBono, E (1985) Six Thinking... information and instructions 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