Critical thinking and decision making

17. Oct 2020

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Critical thinking and decision making

  1. Critical thinking and Decision Making skills By /MahmoudShaqria ‫شقريه‬ ‫محمد‬ ‫محمود‬
  2. Out lines  The definition of Critical thinking  Critical thinking can be divided into three core skills  Someone with critical thinking skills can  The Skills We Need for Critical Thinking  List of Critical Thinking Skills  Critical thinking process  Fast and Effective Critical Thinking Strategies  Six Cognitive Skills Used in Critical Thinking  Why do we need to think critically  How do nurse's accomplish this?
  3.  Definitions of decision making  Ethical decision making  Types of decisions  Characteristics of Decisions:  Factors affecting decision making  Decision making tools:-  Decision-Making Process  Decision Making Technique  Barriers of Decision Making:
  4.  Critical elements in Decision Making  Improving Decision Making skills:-  Qualities of a successful decision maker:-  A model of the successful decision maker:  Ethical Decision Making Approaches  Problem Solving vs Decision Making  Nursing Process as method of Decision making & problem solving.  Critical Elements in Problem Solving and Critical Thinking  Individuals Variations in Decision making  Role of nursing manager in ethical decision making  Example of clinical decision making:
  5.  The definition of Critical thinking  Is the objective analysis of facts to form a judgment.  Unbiased analysis or evaluation of factual evidence.  sometimes referred to as reflective thinking, is related to evaluation and has a broader scope than decision making and problem solving.  “Critical thinking is the ability for person to use her/his intelligence, knowledge, and skills to question and carefully explore the situation to arrive at thoughtful conclusion based on evidenced and reason.
  6.  Critical thinking can be divided into three core skills:  Curiosity is the desire to learn more information and as well as being open to new ideas.  Skepticism involves having a healthy questioning attitude about new information that you are exposed to and not blindly believing everything everyone tells you.  Humility is the ability to admit that your opinions and ideas are wrong when faced with new convincing evidence that states otherwise.
  7. Someone with critical thinking skills can:  Understand the links between ideas.  Determine the importance and relevance of arguments and ideas.  Recognize build and appraise arguments.  Identify inconsistencies and errors in reasoning.  Approach problems in a consistent and systematic way.  Reflect on the justification of their own assumptions, beliefs and values.
  8.  The Skills We Need for Critical Thinking  Critically are varied and include observation, analysis, reflection, evaluation, inference, explanation, and decision making. Specifically we need to be able to:  Think about a topic or issue in an objective and critical way.  Identify the different arguments there are in relation to a particular issue.  Evaluate a point of view to determine how strong or valid it is.  Recognize any weaknesses or negative points that there are in the evidence or argument.  Provide structured reasoning and support for an argument that we wish to make.
  9. List of Critical Thinking Skills  Analysis  Clarification  Evaluation  Explanation  Inference  Interpretation  Judgment  Objectivity  Problem Solving  Reasoning
  10. Critical thinking process: (steps)  Step 1: Knowledge  Identifies the argument or the problem that needs to be solved.  The questions in this stage should be open-ended to allow the chance to discuss and explore main reasons.  Two main questions need to be addressed: What is the problem? And why do we need to solve it?
  11. Step 2: Comprehension  To understand the situation and the facts aligned with it.  The data is collected about the problem using any of the research methods that can be adopted depending on the problem.
  12. Step 3: Application  Mind maps can be used to analyze the situation, build a relation between it and the core problem, and determine the best way to move forward Step 4: Analyze  One of the commonly used tools that can be deployed to analyze the problem and the circumstances around it is the cause effect diagram, which divides the problem from its causes and aims to identify the different causes and based on their type and impact on the problem.
  13.  Step 5: Synthesis  One of the tools that contribute choosing the problem solution is the SWOT analysis that tends to identify the solution’s strength, weakness, opportunity, and threats.  Step 6: Take Action  These steps should be translated into a plan of action that ensures that the decided resolution is well achieved and integrated between all the involved bodies.
  14. 1.Fast and Effective Critical Thinking Strategies 1. Use the right tools 2. Give them slack 3. Involve them in reverse engineering 4. Teach students how to prioritize 5. Switch their perspective 6. Let students collaborate 7. Take breaks
  15. Six Cognitive Skills Used in Critical Thinking Interpretation: involve clarifying the meaning. Analysis: understanding data Evaluation: determine the outcomes Inference: draw the conclusion Explanation: justify actions based on data Self-regulation: examine one professional practice.
  16. Why do we need to think critically? Need to make accurate and appropriate clinical decisions Need to solve problems and find solutions Need to plan care for each unique client and client problem Need to seek knowledge and use it to make clinical decisions and problem solve Need to be able to think creatively when planning care for clients Critical Thinking involve Reflecting upon the meaning of the statement. Examining the offered evidences. Developing a judgment about facts.
  17. How do nurse's accomplish this? Learns to be flexible in clinical decision making Reflect on past experiences and previous knowledge Listen to others point of view Identify the nature of the problem Select the best solution for improving client’s health
  18. Definitions of decision making; *Decision making is a cognitive process consisting of sequential steps that can be analyzed and refined. *It is the last step in the process by which an individual chooses one alternative from several to achieve a desired objective. *It described as the process of converting information into action. *It is defined as a choice among alternative where the outcome is uncertain
  19. Ethical decision making:-  decision making can be hard enough but when we have to consider ethics and decision making we can tie our selves up so tight that some times we stop decision making entirely.  We are often faced with situations which require sound Ethical decision making ability
  20. 1.Types of decisions Management decision are of three types: *Strategic:- are those made by top executives that commit valuable agency resources to achieve major , long term goals. *Administrative Decisions:-are those made by mid level managers to solve unusual problems and develop methods for improving agency function. * Operational decisions:-are routine decisions governing day to day events that have been delegated to first level managers and are made according to pre established rules and regulations.
  21. Management decision may be :-  Programmed:- Are decision needed in problem situations where it is immediately apparent what information is needed and where the information can be obtained.  Non programmed decisions:- are novel , unstructured, creative decisions that are made to solve problems for which no well defined strategies are available. 1. Characteristics of Decisions:- 2. Mental process 3. Choice of alternatives 4. Uncertainty of results( Decision is predictive for future) 5. Affected by feeling 6. Resolve organizational conflicts& personal conflicts
  22. Factors affecting decision making:- A- Internal factors;- Includes variables such as , decision makers physical and emotional state, personal characteristics, cultural, social and past experience. B- External factors:- Including, environmental condition, time.
  23.  Decision trees:-  Decision tree developed because the decision is tied between the outcome of other events.  It compare the cost of hiring regular staff to the cost of hiring temporary employee.
  24. 2- Consequence tables: Consequence table demonstrates how various alternatives create different consequences. It lists the objectives for solving a problem down side of the table and rates how each alternatives would meet the desired objectives. For example. Consider this problem. The number of patient falls has exceeded the benchmarks rate for two consecutive quarters,. After a period of analysis, the following alternatives were selected as solutions:- 1- Provide educational program to instruct staff on how to prevent falls. 2- Implement a night check to ensure that patients have side rails up and beds in low position. 3- implement a policy requiring soft restrains orders in all confused patients.
  25. Alternative 3Alternative 2Alternative 1 Objectives for problem solving XXX 1- Reduces the number of falls XXX 2- Meets regularly standards XX3- Is cost effective X 4- Fits present policy guidelines Decision score
  26. Decision-Making Process 1-Identify the Ethical Problem The decision maker must be able to determine: • If there is a possible violation of an important ethical principle, societal law, or organizational standard or policy • If there are potential consequences that should be sought or avoided that emanate from an action being considered to resolve the problem. 2-Collect Relevant Information The decision maker should seek to gather as much information as possible about which rights are being forsaken and to what degree. • A consequential focus would prompt the decision maker to attempt to measure the type, degree, and amount of harm being inflicted or that will be inflicted on others
  27. 3- Evaluate the Information Once the information has been collected, the decision maker must apply some type of standard or assessment criterion to evaluate the situation. • The decision maker might use one of the predominant ethics theories— utilitarianism, rights, or justice. 4- Consider Alternatives The decision maker needs to generate a set of possible action alternatives, such as: • confronting another person’s actions, • seeking a higher authority, • stepping in and changing the direction of what is happening
  28. 5- Make a Decision The decision maker should seek the action alternative that is supported by the evaluation criteria used in Step 3. • A decision maker selects a course of action that is supported by all the ethics theories or other evaluation criteria used in the decision- making process. 6-Act or Implement The decision maker, if truly seeking to resolve the problem being considered, must take action. • Once the action alternatives have been identified in Step 4 and the optimal response is selected in Step 5, the action is taken in Step 6
  29. 7- Review the Action Once the action has been taken and the results are known, the decision maker should review the consequences of the action. • If the optimal resolution to the problem is not achieved, the decision maker may need to modify the actions being taken or return to the beginning of the decision-making process
  30. Decision Making Technique There are several techniques to help managers to make high quality decisions. 1- Brain storming 2- Nominal grouping , by which group members identify and prioritize goals under non threaten conditions. 3- Delphi technique:- the formal procedure for obtaining the consensus of a number of experts through the use of a series of questionnaires. The procedure is similar to nominal grouping, but participants don't meet
  31. 4- Decision tree:- Used to break a goal , problem or idea, into a manageable tasks or action steps 5- Fish bone or cause and effect chart:- used to help in identifying the multiple causes of any final result, outcome or problem, also called a fish bone because of its appearance
  32.  Barriers of Decision Making: 1- Inadequate fact finding ( Decision should be based on accurate information,). 2- Time constrains (Pressures of time, resources and priorities render the decision- making more complex, It is not always possible to obtain all the necessary facts , This produces a degree of uncertainty, especially when multiple alternatives are identified). 3- Poor Communication ( Communicating the decision to appropriate individuals as essential as following up to determine if results are as expected. 4- Failing to systematically follow the steps of decision- making process will likely result in unanticipated results. 5- Individuals resistance to change and risk of new idea.
  33.  Critical elements in Decision Making 1-lack of clear objectives 2-faulty data gathering 3-lack of self awareness 4-generating limited alternativesltlty 5-faulty logic 6-inability to choose and act
  34. Improving Decision Making skills:- 1- Educating people (Subordinates) so they know how to make decision. 2- Support of top management for decision making at the lowest possible level.` 3- Establishing decision making checkpoints with appropriate time limits. 4- Using statistical analysis when possible to pinpoint problems for solutions. 5- Using new technologies to analyzing problems and identifying alternatives.
  35. Qualities of a successful decision maker:- 1- Courage: courage is of particular importance and involves the willingness to take risks. 2- Sensitivity: good decision makers seen to have some sort of antenna that makes them particularly sensitive to situation and others. 3- Energy people: must have the energy 4- Creativity: successful decision makers tend to be creative thinkers they develop new ways to solve problems
  36. Ethical Decision Making Approaches: 1. Utilitarian Approach: – Moral behavior produces the greatest good for the greatest number. 2. Individualism Approach: – Acts are moral when they promote the individual’s best long-term interest, which ultimately leads to the greater good. 3. Moral – Rights Approach:- Decisions are those that best maintain the rights of those people affected by them. 4. Justice approach: – Moral Decisions must be based on standards of equity, fairness, impartiality
  37. Problem solving and decision making  Problem solving is an active process that starts with a problem and ends with a solution.  The problem-solving process consists of the following steps: • Identify the problem (assessment, diagnosis). • Gather and analyze data (outcome identification). • Generate alternatives and select an action (planning). • Implement the selected action (implementation). • Evaluate the action (evaluation).
  38. Decision making is a “behavior exhibited in making a selection and implementing a course of action from alternatives.” Decision making is not necessarily related to solving a problem; however, the steps in decision making are similar to those in problem solving.
  39. Critical Elements in Problem Solving and Critical Thinking: Define objective clearly Gather data carefully Use an evidence-Based approach Generate many alternative Think logically Choose and act decisively.
  40. Define objective clearly Define the goals and objectives. If a decision lacks a clear objective or if an objectives is not consistence with the organization philosophy, a poor quality What is the setting? decision is likely.
  41. Gather data carefully What is the Problem? Where is it a problem? When is it a problem? Who is affected by the problem? Keep in mind that facts can be misleading if they are taken out of the context.
  42. Use an Evidence Based approach Use outside resources such as: textbook, periodicals, expert in the field, etc. Evidence-Base practice: is the integration of the best evidence available, nursing expertise, and the values and the preference of the individual. Generate many alternative At least two choices in every decision. Use Brain-Storming technique. The greater the number of choices, the more opportunity to reach the correct decision.
  43. Think logically People may think illogically in three ways: 1. Over-generalizing (Ex, Stereotyping) 2. Affirming the consequences 3. Arguing from analogy Choose and act Decisively Once you get into a decision you have to implement it withoutdelay. A decision can be changed and modified later.
  44. Individuals Variations in Decision making Gender Values Life Experience Individual Preference Individual way of thinking
  45. Role of nursing manager in ethical decision making Respect the uniqueness and dignity of each person, self and others -protect patient privacy –Treat all you encounter with respect –patients, their family members and significant others, co ‐workers – Preserve your own self ‐ respect and dignity • Prevent harm and removal of harmful conditions – Intervene whenever a patient’s safety is at – Promote a safe environment, both and psychologically – Monitor the environment for safety hazards
  46. • Act to remove harm or promote benefit – Improve unsafe conditions – Confront and report unsafe practices and errors – Promote benefit by encouraging and assisting measures that promote healing such as post ‐ surgical ambulation and deep breathing, and measures That prevents harm such as regular repositioning of patients at risk for pressure sores. These measures may be specifically ordered to be performed at specific intervals, or it may be the healthcare professional’s responsibility to Recognize the importance of these measures and carry them out.
  47.  Treat individuals equally –Extend equal respect and courtesy to all individuals you encounter. Even when treated discourteously, respond in a manner that effectively addresses the behavior without disrespecting the other person promotes, advocates for, and strives to protect the health, safety, and rights of the patient
  48. Example of clinical decision making:  The nurse identifies key cues when dealing with a patient who has just returned to the ward after abdominal surgery and is looking pale and feeling clammy (these cues have been clustered together and interpreted as being meaningful).  The nurse begins to create a tentative hypothesis or explanation that the patient may be experiencing postoperative internal bleeding and the nurse then wants to either refute this or accept it.  The nurse will then seek and interpret other key cues of the patient’s clinical  Status – this may include the patient’s blood pressure, pulse, temperature, pain
  49.  Assessment, color, wound assessment and patient’s position – before any diagnosis or decision is made.  The hypothesis is then evaluated and if the patient is medically  Stable with no signs and symptoms of bleeding then the hypothesis is rejected. The nurse may then generate another hypothesis that the patient may be in pain and so the information is gathered to try to test another hypothesis  Difference Between Problem Solving and Decision Making  Categorized under Language | Difference Between Problem Solving and Decision Making
  50. Thank you…