DECISION MAKING - JOURNAL PRESENTATION

Reference : NNT March 2008 Mrs. Prema. P

PrincipalNavodaya College of Nursing

MRS. SNEHA PRAKASHFINAL YEAR M.SC (N) NAVODAYA COLLEGE OF NURSINGRAICHUR

Objectives

To introduce the topic

To define decision making

To list out the levels of decision

To explain briefly the approaches to decision making

To describe the process of decision making

To mention the decision making styles

To describe the decision making situations and techniques applied in each situations

To list out the two step process in decision making

To describe the criteria for implementation

Introduction

• Decision making is the cognitive process leading to the selection of a course of action among variations

• It is a psychological construct• It begins when we need to do something• It is both managerial and organizational process

Definitions

• Decision making is a position or opinion or judgement reached after consideration and choosing between alternative courses of action using cognitive processes such as memory, thinking and evaluation.

• The process of selecting from several choices, products or ideas and taking action.

• Decision making is the process of choosing the best from the alternative solutions under a given set of circumstances

Cont

• The process of mapping likely consequences of decisions, working out the importance of individual factors and choosing the best course of action to take.

• Decision making is a conscious human process involving both individual and social phenomenon based upon factual and value premises which concludes with a choice of behavioural activity.

DECISION LEVELS

DECISION LEVELS

Operational

Tactical

Strategic

STRATEGIC •Highest level•Concerns general directions, long term goals, philosophies and values

TACTICAL •Support strategic decisions•Medium range, medium significance, with moderate consequences

OPERATIONAL•Everyday decisions, used to support tactical decisions•Short term, short range and usually low cost

Approaches

Intuitive – emotional approach

• Decisions are influenced by the inner feeling of the decision maker

• Takes number of alternative into consideration

Rational – analytical approach

• Decisions are made depending upon the rationale

• Chooses the alternative that produces the maximum gain

Cont

Satisfying approach

• Decisions are made when an acceptable alternative has been found

Political – behavioural approach

• All people and the organization is considered in making decision

• Decisions are made through mutual consultation among all the people

Process

Identify and define the problem

Identify the decision to be made

Gather relevant information

Identify alternatives

Weigh evidence

Choose among alternatives

Take action

Review decision and consequences

Decision Making Styles

A1 : solve the problem or make the decision by using information available at that time

C1 : share the problem with relevant individual, getting their ideas without bringing them together in group

A2 : obtained the necessary information from subordinates without their knowledge and then decide the solution

C2 : share the problem with the subordinates as a group, collectively obtaining their ideas and suggestions

Decision Making Situation & Techniques Applied in Each Situation

• In groups• In one’s personal life• In health care• In business and management• In clinical nursing practice

Decision making groups

TECHNIQUES • Unanimity

Requires every one to agree on a given course of action

• Majority

Requires support from more than 50% of the members of the group

• Range voting

Allows a group to select one option from a set. The option with highest average is chosen.

Cont • Consensus

Requires the majority to approve the given course of action and the minority to go along with the course of action.

• Gathering

Involves all participants acknowledging each other’s opinion and tends towards a problem solving approach in which as many opinions as possible can be satisfied

• Sub-committee

Involves assigning responsibility for evaluation of a decision to a subset of a larger group

Cont

• Plurality

The largest block in a group decides, even if it falls short of a majority

• Dictatorship

One individual determines the course of action

• Participatory

Each actor would have a say in decisions directly proportionate to the degree that particular decision affected by him or her

Decision Making in one’s Personal life

• Listing the advantages and disadvantages of each

option, and then taking a decision.

• Flipping a coin

• Accepting the first option that seems to achieve

the desired result

• Prayer, astrology, tarot cards

• Acquiesce to a person in authority or an expert

Decision making in health care

In the health care field, the steps of making a decision is BRAND which includes :

• Benefits of the action• Risk in the action• Alternatives to the prospective action• Nothing • Decision

Decision Making in Business and Management• SWOT analysis

evaluation by the decision making individual or organization of Strengths, Weakness, Opportunities and Threats with respect to desired end state or objective.

• Analytic hierarchy

procedure for multi level goal hierarchy

• Buyer decision process

transaction before, during and after a purchase.

• Cost-benefit analysis

process of weighing the total expected costs vs. the total expected benefits

Cont

• Control ethics

a decision making framework that balances the tensions of accountability and best 1 outcome

• Decision trees

- Programme Evaluation and Review Technique (PERT)

- critical path analysis

- critical chain analysis

• Force field analysis

analyzing forces that either drive or hinder movement toward a goal

Cont

• Pareto analysis

selection of a limited number of tasks that produce significant over all effect

• Robust decision

making the best possible choice when information is incomplete, uncertain, evolving and inconsistent

• Satisfying

the tendency to select the first option that meets a given need

• Scenario analysis

process of analyzing possible future events

Decision Making in Clinical Nursing Practice

• Nursing is a self regulated and competency based profession where in registered nurses are accountable for their own practice at all times

• Professional nursing practice must be sensitive, relevant and responsive to the needs of the individual client

• The quality of practice help the nurse to achieve the goal and have a direct impact on the ability to provide competent and professional care

Principles

• The practice of nurses must meet the legislative requirements and standards relevant to the profession

• Nurses should see at no time, client safety or well being be compromised as a result of changes to nursing practice

• Nurses are responsible for their own level of competence and require additional experience and education to attain and maintain competence

• Health care agency should support competent nurses to provide a quality outcome for the client

• Health care agencies are responsible for ensuring that resources are available for determining if a new procedure is reasonable

Two Step Process in Decision Making in Nursing Practice

• STEP I

Is the new procedure reasonable, appropriate and consistent with the current professional practice of nursing.

1. the risks or possible complications and benefits to the client of performing the new procedure and the consequences of not performing the procedure.

2. The appropriateness of performing the new procedure in the particular setting for the specific clients or group of clients

3. The opportunity to acquire the knowledge and skill to safely perform the procedure, including the management of potential complications

Cont

• STEP 2

If the procedure is determine to be appropriate, reasonable and consistent with current professional practice proceed to implementation.

Criteria for Implementation

• There must be a written policy identifying the newly introduced procedure including conditions or restrictions on implementation.

• There must an educational programme of theory and clinical practice to allow the nurse to attain competence in performing the new procedure

• There must be some form of competency assessment at the completion of educational programme.

Cont

• Agencies must determine what is reasonable with respect to maintenance of competence.

• The agency ensures appropriate resources are available during implementation.

• The agencies ensures that there are mechanisms for reviewing and recording the achievement and maintenance of competence.

Thank You