Dynamics of Care in Society Professional Decision Making & Problem Solving

1. Dynamics of Care in Society Professional Decision Making & Problem Solving

2. Perceptions & Interpretations Impact our decision making & problem solving skills. There can be several interpretations of the same information.

3. What do you see??? GOOD or EVIL Is this woman old...or young?

4. 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.

5. Whatyouread vs whatyousee A skull? Or a woman looking into a vanity mirror?

6. How many horses can you find in this picture? Most people can find 5…some experts say there are 7

7. 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. Affects Perception

8. 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.

9. 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.

11. 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

12. When Critical Thinking We… • Differentiate between facts & opinions…. Facts are realities be able you can providea 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.

13. 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.

14. Mrs. Riley • 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.

15. Mrs. Riley • Component 1Exploring: what could be causing this woman to be so suddenly dyspneic and hypoxic?

16. Mrs. Riley • Exploring: what could be causing this woman to be so suddenly dyspneic and hypoxic? • Pneumothorax • Hemothorax • Pneumonia • Pleural Effusions • Atelectasis • Electrolyte Disorders

17. Mrs. Riley • Component 2 • Analyzing: what other information can I gather to help me narrow down the possible causes of her dyspnea/hypoxia?

18. 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.

19. Mrs. Riley • Component 3 Prioritizing/Deciding: is this change significant to this patient, and do I need to even look further? Should I inform the physician of the change in their patient’s status?

20. Mrs. Riley • Prioritizing/Deciding: is this change significant to this patient, and do I need to even look further? Should I inform the physician of the change in their patient’s statusAny significant change in a patient’s respiratory status should be reported to the patient’s physician right away.

21. Mrs. Riley • Component 4 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!

22. 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?

24. 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.

25. 5 Step Problem Solving • Identify the problem • Gather information & identify possible solutions • Select the best option • Implement the solution • Evaluate the results

27. Similar idea : Six steps to making an effective decision: • Create a constructive environment. • Generate good alternatives. • Explore these alternatives. • Choose the best alternative. • Check your decision. • Communicate your decision, and take action.

28. Strategies for improving problem solving & decision making: • 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.

29. 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.

30. 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.

31. 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.

32. 4. Flowcharting a map that shows all the steps in a process.

33. 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

34. 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

35. 10. Decision Making Trees see handout • Look at Choices • Consider Factors of Influence(roots, trunk) • Suggest Appropriate Alternatives (lg. branches) • Consider Risks of choosing alternatives (sm. branches) • Choose Action to be taken • Critique Action

36. Decision Making Trees

37. 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.

38. Activity: 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 Getting rid of all dogs Electronic fencing Animal Control a Leash Law (home) to pick up strays Effectiveness Feasibility Cost Feasibility Sustainability Political Acceptability Social Will Unintended consequences Intervention Rating

40. 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.) )

41. 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.

42. Three Parts of Learning Information • Reception: taking in information without knowing what it means • Perception: giving meaning to information • 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

43. Let’s Share What is your best study tip???

44. 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

45. Study Skills • Form a study groupCommitted 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 Illustrations

46. STOP HERE

47. 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 Getting rid of all dogs Electronic fencing Animal Control a Leash Law (home) 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?

48. 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?

49. 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. There were 50 rabbits in year one.

50. 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.