Dynamics of
Care in Society
Professional Decision Making
& Problem Solving
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Impact our decision making & problem solving
skills.
There can be several interpretations of the same
information.
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What do you see???
GOOD or EVIL
Is this woman old...or young?
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The "illusion" is that this is just a picture of coffee beans; but it is not.
Can you find a man's face among the beans?
Some say that if you find the man in 3 seconds or less, the right half of your brain may
be more well developed than most.
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What you read
vs
what you see
A skull?
Or
a woman looking
into a vanity mirror?
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How many
horses can
you find in
this picture?
Most people
can find
5…some
experts say
there are 7
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Errors in Perception:
 Pretending to know…
deceiving yourself and others about what you know.
 Resistance to change…
opposing new ideas, because they are unfamiliar or
uncomfortable.
 Either/Or Thinking…
taking only extreme positions for or against, seeing
only black or white.
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• Objective 1 –
Define critical thinking & discuss reasons why
this is an essential skill for all health
professionals.
Critical Thinking Definition
The process by which we detect &
analyze assumptions underlying our
actions, decisions and judgments in our
personal and professional roles. It is an
essential skill for all health professionals.
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•Objective 2…
Identify and define underlying
assumptions &/or problems regarding
an issue, idea or phenomenon.
•Objective 3…
choose appropriate methods of inquiry
and or problem solving for addressing the
issue, idea or phenomenon.
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 Features of Critical Thinking in Health
Care
 Purposeful & results-oriented
 Based on principles of:
Health care practice
 Scientific method
 Evidence-based
 Guided by professional standards & ethics codes
 Self-correcting through constant reevaluation

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When Critical Thinking We…
•Differentiate between facts & opinions….
Facts are realities be able you can provide
a source for your information.
Opinions are beliefs & judgments
•Form opinions with great care &
are willing to revise even cherished
opinions, whenever they prove to be in error.
If you are unsure if it is fact or opinion…treat it
as opinion.
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Why is critical thinking important?????
•Forces the development & evaluation of your
thinking skills.
•Allows you to probe beneath the surface.
•Discovers the structure of your thoughts.
•Develops critical listening skills.
•Suspends judgment until there is enough sufficient
evidence is found.
•Allows you to explore opposing viewpoints.
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Exercise #2
 Mrs. Riley, a 45-year old wife and mother, has
just returned to your nursing unit from the
recovery room after a gastric resection for a
malignant stomach tumor. She has orders for
respiratory care, pain medication, continuous
gastric suction, incision monitoring, and NPO
status. Eight hours postoperatively she develops
sudden dyspnea and decreasing oxygen
saturations. On each of the 5 components of
critical thinking, write down what could be going
on with your patient.
Mrs. Riley
 Exploring: what could be causing this
woman to be so suddenly dyspneic and
hypoxic?
Mrs. Riley
 Exploring: what could be causing this
woman to be so suddenly dyspneic and
hypoxic?
 Pneumothorax
 Hemothorax
 Pneumonia
 Pleural Effusions
 Atelectasis
 Electrolyte Disorders
Mrs. Riley
 Analyzing: what other information can I
gather to help me narrow down the possible
causes of her dyspnea/hypoxia?
Mrs. Riley
 Analyzing: what other information can I
gather to help me narrow down the possible
causes of her dyspnea/hypoxia?
 Breath Sounds
 ABG
 Blood Chemistry
 After listening to her breath sounds, you
determine that breath sounds are absent on
the left side.
Mrs. Riley
 Prioritizing/Deciding: is this change significant
to this patient, and do I need to even look
further? This also includes the decision that is
made whether to inform the physician of the
change in their patient’s status. What would you
say?
Mrs. Riley
 Prioritizing/Deciding: is this change significant
to this patient, and do I need to even look
further? This also includes the decision that is
made whether to inform the physician of the
change in their patient’s status. What would you
say?
 Any significant change in a patient’s respiratory
status should be reported to the patient’s
physician right away.
Mrs. Riley
 Evaluating: after reporting the alteration to the
patient’s Physician, he orders the following:
 STAT ABG & STAT Portable CXR
 Equipment for chest tube insertion to be at
bedside STAT
 When the chest x-ray comes back, there is a
large pneumothorax on the left, as well as diffuse
atelectasis. Anesthesia is called to place a chest
tube STAT. Your analysis was right on target!
Mrs. Riley
 Once the chest tube was placed, Mrs. Riley had an
immediate improvement of her oxygen
saturations, and her dyspnea resolved. Now a new
set of critical thinking is demanded of you. How
does this chest tube change the care &
assessments you will provide for Mrs. Riley?
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Problem Solving vs. Decision Making
􀂃 Problem solving is a set of activities
designed to analyze a situation systematically
and generate, implement, and evaluate
solutions.
􀂃 Decision making is a mechanism for making
choices at each step of the problem-solving
process. It is part of problem solving.
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5 Step Problem Solving
1.Identify the problem
2.Gather information & identify
possible solutions
3.Select the best option
4.Implement the solution
5.Evaluate the results
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Similar idea : Six steps to making an effective decision:
1.Create a constructive environment.
2.Generate good alternatives.
3.Explore these alternatives.
4.Choose the best alternative.
5.Check your decision.
6.Communicate your decision, and take action.
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Strategies for improving problem solving
& decision making:
1.Brainstorming:
This technique is used to encourage participation
from each member of the team.
Brainstorming helps to break people out of the
typical mode of approaching things to produce new
and creative ideas.
It creates a climate of freedom and openness,
which encourages an increased quantity of ideas.
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2. Root Cause Analysis (AKA as the "Five
Why's.").
The objective of Root Cause Analysis is to find
the fundamental cause for a problem.
Simply ask "Why?" five times or more to really
get at the root of the problem.
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Using the 5 Whys, you go through the following steps to get to
the cause of the problem:
•Why is our patient, Mr. Sick upset? Because we did not
provide the test results when we said we would.
•Why were we unable to meet the agreed-upon timeline? One
new test ordered required more time before the results were
available.
•Why did it take so much longer? This is new test, and it had
to be sent to an outside lab.
•Why did we underestimate the time for the test results?
Because we were not aware of the new procedures.
•Why didn't we know this? Because we had not kept current
with policies & procedures for certain tests.
Conclusion…We clearly need to stay current and communicate
accurately about timelines for important patient information.
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3. Cause and Effect Diagrams.
This diagram is drawn to represent the relationship
between an effect (the problem) and its potential
causes. The diagram helps to sort-out and relate
the interactions among the factors affecting a
process.
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4. Flowcharting
a map that shows all the steps in a process.
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5. Think aloud… talk it through
6. Trial & Error…
explain, explain in a different way, use a visual,
pamphlet, interpreter , video…, ask open ended
questions, provide calm atmosphere, change
setting…
7. Use a problem solving group…
teams bring richness of thought, an ownership of
results and action when it comes to implementing
solution
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8. Scientific Problem Solving
Problem or question
Research
Hypothesis formulation
Experiment
Collect & analyse data
Form conclusion based on results
Communicate results
9. Intuitive Problem Solving
Based on inner prompting or instinct
No logical thinking
Identifying a solution to a problem based on its
similarity or dissimilarity to other problems
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10. Decision Making Trees
see handout
1. Look at Choices
2. Consider Factors of Influence
(roots, trunk)
3. Suggest Appropriate Alternatives
(lg. branches)
4. Consider Risks of choosing alternatives
(sm. branches)
5. Choose Action to be taken
6. Critique Action
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Decision Making Trees
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11. Decision Matrix: see activity
A Decision Matrix is useful when faced with making a difficult
decision. The options or alternatives are listed in the left-hand
column and the selection criteria is listed across the top row.
Each of the options are rated against the selection criteria to
arrive at the best logical decision.
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Decision Matrix
Activity:
: Example – Dog Bite Intervention
Suppose that these four interventions have been brainstormed to address the high
incidence of dog bites occurring in your tribal community. Using the decision
criteria in the first column, how would you rate each intervention. Rating is low,
moderate, or high. Answers will be different for each program and community. You
should be able to justify each rating you give.
Decision Criteria
Passage of
a Leash Law
Getting rid of all dogs
Electronic fencing
(home)
Animal Control
to pick up strays
Effectiveness
Feasibility
Cost Feasibility
Sustainability
Political Acceptability
Social Will
Unintended consequences
Intervention Rating
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12. Working backwards… see ex.
Ex. Leon wanted to know the age of a black bear at the zoo.
The zoo keeper told Leon that if he added 10 years to the age
of the bear and then doubled it, the bear would be 90 years
old. How old is the bear?
(Hint: Using the facts given, start with 90 years and work
backwards.)
Understanding the Problem
· Did the zoo keeper tell Leon the bear's age? (no)
· What was the last thing the zoo keeper did to the bear's
age? (He doubled it.)
· What was the first thing the zoo keeper did to the bear's
age? (He added 10.)
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Finding the Answer
Work Backwards
Start with 90, the final number given by zoo keeper.
Divide by 2 to get the number that was doubled—90
÷ 2 = 45.
Subtract 10 to get the age of the bear before 10
years was added—45 - 10 = 35
The bear was 35 years old.
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Three Parts of Learning Information
1. Reception: taking in information without knowing
what it means
2. Perception: giving meaning to information
3. Selection: recognizing information as important or
unimportant
Types of Memory
Working memory-stores & retrieves from short
term & long term memory
Short-term memory
Long-term memory
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Let’s Share
What is your best study tip???
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Study Skills
Say or write down everything you can remember
Try to recall events or information in a
different order
Read over daily notes
Recreate the learning environment or relive the
event
Make associations
(Acronyms: TEAM…Together Every one Achieves
More)
(Acrostics …ROYGBIV)
Flashcards
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Study Skills
 Form a study group
Committed
Contributing
Compatible
Considerate
Reading Strategies
Pay attention to bold & italicized print
Write main paragraph points in page margins or
a notebook
Read everything, including:
Tables
Graphs
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Illustrations
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PRACTICE
Name(s) ____________________________________________
Practice Problem Decision Matrix: Example – Dog Bite Intervention
Suppose that these four interventions have been brainstormed to address the high incidence of dog bites occurring in
your tribal community. Using the decision criteria in the first column, how would you rate each intervention. Rating is
low, moderate, or high. Answers will be different for each program and community. You should be able to justify each
rating you give.
Decision Criteria
Passage of
a Leash Law
Getting rid of all dogs
Electronic fencing
(home)
Animal Control
to pick up strays
Effectiveness
Feasibility
Cost Feasibility
Sustainability
Political Acceptability
Social Will
Unintended consequences
Intervention Rating
Practice problem- working backwards:
Rabbits multiply at an amazing rate.
In year 1 there are X rabbits.
The rabbit population doubles each year.
The forest is crowded in year 7 when there are 3200 rabbits.
How many rabbits were there in year one if the population doubles each year?
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Practice problem:
Rabbits multiply at an amazing rate.
In year 1 there are X rabbits.
The rabbit population doubles each year.
The forest is crowded in year 7 when there are 3200
rabbits.
How many rabbits were there in year one if the population
doubles each year?
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Practice answer:
Make a table and work
backward from year 7 when
there are 3200 rabbits. Since
population doubles each year,
working backward means
halving it.
Year
No. of Rabbits
7
3200
6
1600
5
4
3
2
800
400
200
100
1
50
There were 50 rabbits in year
one.
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Name __________________ Per ____ Date ___________
Activity: Select one of the topics below then follow step 1-3
•Should everyone applying for a marriage license be tested for AIDS?
•Do you favor a mandatory drug test for high school students?
Step 1 - State your position on the issue.
Explain what you’ve seen or learned that supports your thinking
Step 2 - Seek other views & evidence.
Briefly describe your findings, including references to your sources of information
Step 3 - Decide which view is most reasonable. If need be, revise your position from Step 1.
Explain any reasons for revising or not revising your original view.
Fair minded vs Unfair Minded
 Listen before reaching a conclusion
 No stereotyping
 Consider ideas before automatically rejecting or
accepting
Autonomy vs Conformity
 Think for yourself
 Analyze & evaluate beliefs & values
 Know when to question and when to conform
 Being open to necessary change or compromise
Perserverance vs Laziness
 Dedicated & determined to find a solution
 Research as needed
 Look for the BEST not the quickest or easiest
solution
 Be willing to “monitor and adjust” as necessary
Creativity vs Not
 Consider new solutions and ideas
•
•
Know the limits of your own knowledge
Ask for help, direction & support
Confidence vs Distrust
 Have faith in yourself…
your training, your knowledge
your abilities, your strengths
your self awareness, your limitations
•
•
Scrutinize your own knowledge & beliefs as you
would other
Research and be able to support your thinking