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  1. Unit 5 DECISION – MAKING IN NURSING

  2. Dr. Atef J Ismail Decision – Making In Nursing The process of selecting one action from alternatives Decision making is the learned & scientific problem solving process. Managers spend much time making decisions and solving problems, especially non routine situations

  3. Dr. Atef J Ismail Decision Making Process 1) Identify the problem: defining the problem. What is wrong? Where is improvement needed? begins when the nurse manager perceives a gap between what is actually happening and what should be happening. The nurse manager can identify the problem by analyzing situation.

  4. Dr. Atef J Ismail What is the desirable situation? What are the presenting symptoms? What are the discrepancies? Who is involved? When? Where ? How? * Develop Feasible hypotheses, and elimination of hypotheses that fail to conform to the facts. Feasible hypotheses should be further tested for causal validity. By analyzing available information, manager should begin exploring possible solutions

  5. Dr. Atef J Ismail 2) Explore alternatives: If situation is not covered by policy, manager must draw on his education and experience, but it may be inadequate. more experienced manager had more alternatives to be suggested for solving a variety of problems. Health care is changing rapidly manager should learn how others are solving similar problems. This can be done through continuing education, professional meetings, review of the literature, and brainstorming with staff.

  6. Dr. Atef J Ismail 3) Choose most desirable alternative: One alternative is not always clearly superior to all others. Manager must try to balance multiple factors such as pt safety, staff acceptance, morale, public acceptance, cost, and risk of failure. * The following questions may be asked: Will this decision accomplish the stated objectives? (yes or no) Dose it maximize effectiveness and efficiency? use available resources before seeking outside assistance. Can the decision be implemented? If not, it will not solve the problem

  7. Dr. Atef J Ismail 4) Implement decision: The manager will need to communicate the decision to appropriate staff smoothly to win the cooperation 5) Evaluate results: Evaluate the results of the chosen alternative. Be alert: solutions to old problems sometimes create new problems, so you need additional decisions.

  8. Dr. Atef J Ismail Creativity In Decision Making The ability to develop and implement new and better solution The creativity has four stages. 1) Preparation: Acquiring information to understand the situation. through observation and extensive use of libraries for data collection, make notes on reading. 2) Incubation stage: Is a period for ponderingthe situation. Repetition of the same thoughts. No new ideas or interpretations. Reexamine the situation and review the data collected.

  9. Dr. Atef J Ismail 3) Illumination (insight): Is the discovery of solution may be during performance of another task. 4) Verification: Experimentation of solution (succeeded or failed). Ethical Decision Making Ethics: Moral philosophy. Science of judging the relationship of means to ends, and the art of controlling means so they will serve human ends. It Involves conflict, choice, and conscience

  10. Dr. Atef J Ismail **Why ethics became a greater dimension in management decision making 2000s? A . Increasing technology, and regulatory pressures. B . Competitiveness among health care providers . C . Nursing shortages, and reduced fiscal resources & spiraling costs of supplies and salaries. D . The public’s increasing distrust of the health care delivery system and its institution.

  11. Dr. Atef J Ismail Ethical Dilemmas Choose decision between two equally desirable or undesirable alternatives values, beliefs, and personal philosophy play a major role in the ethical decision making. If no right or wrong answer exists? Or if both answers are right or wrong?

  12. Dr. Atef J Ismail Characteristics of ethical dilemma: 1 ) problem cannot be solved using only empirical data. 2) problem must be so perplexing that deciding what facts and data need to be usedin making the decision is difficult. 3) The result of the problem must affect more than the immediate situation there should be far-reaching effects .

  13. Dr. Atef J Ismail Ethical Problem Solving And Decision Making. systematic ethical decision making and problem solving: - reduces personal bias - facilitates better decision - making - managers feel more comfortable about decisions they have made If problem solving approach is used: - gathering data is adequate alternatives are analyzed manager feels that the best possible decision was made at specific time and available information regardless of the outcome.

  14. Dr. Atef J Ismail The MORAL Decision - Making Model: Crisham (1985) M.— Massage the dilemma. Collect data about the ethical problem. O.— Outline options. Identify & analyze alternatives and consequences of each. R.— Review criteria and resolve. Weigh the option's effect in the decision A. — Affirm position and act. Develop implementation strategy L.— Look back. Evaluate the decision making.

  15. Dr. Atef J Ismail Ethical Frameworks For Decision Making Not solve ethical problem, but assist manager in clarifying personal values and beliefs 1) Utilitarianism: - Make a decision based upon providing the greatest good for the greatest number of people Ex. : using travel budget money to send many staff to local workshops rather than sending one or two individuals to attend a national conference.

  16. Dr. Atef J Ismail 2) Duty -based reasoning: - some decisions must be made because there is a duty to do what is right 3) Rights based reasoning: - “Rights are deferent from needs, wants, or desires”. 4) The intuitionist framework : -decision maker reviews each ethical problem on a case-by case basis comparing the relative weights of goals duties and rights. determined primarily by intuition. - What the decision maker feels is right for the particular- situation Disadvantages are subjectivity and bias.

  17. Dr. Atef J Ismail Models For Ethical Relationships: 1) 1- The priestly model: The manager is paternalistic and make decisions without considering other’s values. ‘Autocratic leadership may use the priestly model” 2) The engineering model: Suggests that one person presents facts to another and sets aside his own ethics to do what the either wants. “Staff working for line authority may be an example of this model”

  18. Dr. Atef J Ismail Models For Ethical Relationships.. Cont. 3) The contractual model: Contract that identifies general obligations and benefits for two or more people. “deals with morals of both parties and is appropriate for superior-subordinate relationships . 4) The collegial model: Individual's share mutual and reach decisions through discussion and consensus. (build teams and minimize conflict). To make an ethical decision one must consider what is intended to be a means and an end. If a major evil is intended either as a means or an end, it is unethical decision.

  19. Dr. Atef J Ismail Selec1ing Decision Making Styles 1- Continuum of participation: Members of a group or organization Participate in decision making. The extent of participation depend on organizational philosophy, managerial style. - Agencies allow greater participation are democratic in nature, & those discourage participation are autocratic **Tannenbaun and Schmidt: developed the continuum of leadership and participationrelated to the degree of authority used by the leaderand the freedom of subordinates in decisions. The extreme left characterize the manager who maintains a high degree of control, whereas the right characterize the leader who releases a high degree of control.

  20. Dr. Atef J Ismail 2 3 4 5 6 7 Use of authority by manager Area of freedom for subordinates Manager Makes Decision And Announces It Manager sells Decision Manager Presents Ideas And Invites Question Manager Presents Tentative Decision Subject To Change Manager Presents Problem Gets Suggestion Makes Decision Manager Defines Limits Asks Group To make Decision Manager Permits Subordinates To function Within Limits Defined By superior

  21. Dr. Atef J Ismail A manager can be autocratic or democratic in decision making depends on the following factors: How important is the quality of the decision? Does the manager have sufficient information to make a good decision? If not, others should be involved in the decision Is acceptance of the decision critical for its implementation from subordinates? - Subordinates should be included in decision making if they share organizational goals and are not in conflict with preferred solution.

  22. Dr. Atef J Ismail 2- Vroom and yetton normative mode: They address decision making as a social process and emphasize how managers do rather than should behave in their normative model. Identified the 5 decision making methods: A = autocratic C = Consultative G = Group I = First variant II = Second variant

  23. Dr. Atef J Ismail They have identified five decision making methods or styles: AI- You solve the problem or make the decision alone, using information available to you at that time. AII- You obtain the necessary information from your subordinates, and make a decision. The role of your subordinates in making the decision is providingthenecessary information to you, rather than generating or evaluating alternative solutions. CI- You share the problem with relevant subordinated individually. - Getting their ideas and suggestions, - Then you make the decision that may or may not reflect your subordinates’ influence

  24. Dr. Atef J Ismail CII- You share the problem with your subordinates as group obtaining their ideas and suggestions. Then you make the decision that may or may not reflect your subordinate's influence . GII- (group decision making) -You share a problem with your subordinates as a group - Together you generate and evaluate alternatives & reach agreement (consensus) on a solution. Your role is much like that of chairman. - Don't try to influence the group to adopt ‘your” solution , & willing to accept and implement group supported solution.

  25. Dr. Atef J Ismail Vroom's seven rules to determine which style is appropriate in a given situation:( 3 protect decision quality &4 protect acceptance 1) The information rule: - quality of the decision is important and the leader does not have enough information or experience to solve the problem (AI is eliminated ) 2)The goal congruence rule. Quality of the decision is important The subordinates do not share the organizational goals to be obtained in solving the problem (GII is eliminated)

  26. Dr. Atef J Ismail 3) The unstructured problem rule: quality of the decision is important, leader not have necessary information or experience to solve the problem by himself The problem is unstructured, i.e. he does not know exactly what information is needed and where it is located . involvement of subordinate's interaction with full knowledge of the problem to generate a high-quality solution (AI, AII, and CI are eliminated). 4) The acceptance rule. If the acceptance of the decision by subordinated is critical to effective implementation Not certain that an autocratic decision made by the leader would receive that acceptance. (AI and AII are eliminated)

  27. Dr. Atef J Ismail 5) The conflict rule: - If the acceptance of the decision is critical and autocratic decision is not certain to be accepted - subordinates are likely to be in conflict or disagreement with solution (AI, AII, and CI are eliminated)

  28. Dr. Atef J Ismail 6) The fairness rule: If the quality of decision is unimportant acceptance is critical and not certain to result from an autocratic decision. (AI, AII, CI, & CII are eliminated) 7) The acceptance priority rule: If acceptance is critical Not assured by an autocratic decision If subordinated can be trusted. (AI. AII. CI, and CII are eliminated)

  29. Dr. Atef J Ismail Outcomes that influence the effectiveness of decision 1. The quality of the decision . 2. Acceptance of the decision by the subordinates . 3. Available time needed to make the decision

  30. Dr. Atef J Ismail Managers can diagnose a situation quickly and accurately by answering following questions 1. Is there a quality requirement? 2. Do I have sufficient information to make a decision? 3. Is the problem structured? 4. Is acceptance of decision by subordinates critical? 5. If you have to make the decision by yourself, is It accepted by your subordinates? 6. Do subordinates share the organizational goals to be obtained in solving this problem? 7. Is conflict among subordinates likely in preferred solutions.

  31. Dr. Atef J Ismail Individuals as decision makers: Autocratic manager: Belief that others are not as competent as he/she - Try to make decision by himself Fears that others decisions may be more costly, less effective and affecting his power Everyone has different decision making style affected by values, life experiences, preferences, risks, and way of thinking People may perceive the same situation differently

  32. Dr. Atef J Ismail 1- Values and decision making: (decide mode of conduct) 2-Life experience and decision making. 3- perception (Individual preference) and decision making. 4- Individual ways of thinking and decision making. (decision is a thinking skill, and Individuals think differently) 5- Personality Group factors in decision making: It is unusual for an individual to do decision making process by himself. Commitment to the decision is important and increased by participation in the decision making process Individuals as decision makers: cont…

  33. Dr. Atef J Ismail The advantages of group participation in decision making: increase acceptance and enhanced cooperation in implementation Broader experiences, wider range of knowledge Time consuming to gather information and analyze it Allows the nurse to express his views and persuade others Sustain friendship

  34. Dr. Atef J Ismail Disadvantages of group participation in decision making Subordinate may influenced by his desire for group acceptance or be quite all the time of meeting Few people may be dominated the group Interested in an argument than in determining the best alternatives Consensus may not select the optimal alternative.

  35. Dr. Atef J Ismail THE END