Critical Thinking

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CRITICAL THINKING I. INTRODUCTION You assist an evil system most effectively by obeying its orders and decrees. An evil system never deserves such allegiance. Allegiance to it means partaking of the evil. A good person will resist an evil system with his or her whole soul. --Mahatma Gandhi Critical thinking is the disciplined, intellectual process of applying skilful reasoning as a guide to belief or action. In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip). Critical thinking when developed in the practitioner includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgments and safe decision-making. II. MEANING:

"Critical" as used in the expression "critical thinking" connotes the importance or centrality of the thinking to an issue, question or problem of concern. "Critical" in this context does not mean "disapproval" or "negative." There are many positive and useful uses of critical thinking, for example formulating a workable solution to a complex personal problem. III. DEFINITION:

Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. National Council for Excellence in Critical Thinking,1987

"Critical thinking in nursing practice is a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns.


Critical thinking is the skillful application of a repertoire of validated general techniques for deciding the level of confidence you should have in a proposition in the light of the available evidence. -- Tim van Gelder

Critical thinking is reasonable, reflective thinking that is focused on deciding what to believe or do.

-- Robert Ennis



The eight components that have been identified as part of the critical thinking process include: 1. Perception 2. Assumption 3. Emotion 4. Language 5. Argument 6. Fallacy 7. Logic 8. Problem Solving 1. Perception: Perception refers to the way we receive and translate our experiences – how and what we think about them. For some, plain yogurt is delicious, while for others it is disgusting. For the most part, perception is a learned process. Eg: In the workplace, one employee will perceive a co-worker to be a constructive decision-maker, while at the same time, another sees the same employee as an adversarial roadblock to progress. 2. Assumptions: Trying to identify the assumptions that underlie the ideas, beliefs, values, and actions that others and we take for granted is central to critical thinking. Assumptions are those taken-for-granted values, common-sense ideas, and stereotypical notions about human nature and social organization that underlie our thoughts and actions. Assumptions are not always bad. For example, when you buy a new car, you assume that it will run without problems for a while. When you go to sleep at night, you assume that your alarm will wake you up in the morning.

Remember, assumptions depend on the notion that some ideas are so obvious and so taken for granted that they don‗t need to be explained. Yet, in many cases, insisting on an exp lanation reveals that we may need more factual evidence in order to develop well-supported viewpoints and to come to sound decisions. The problem with assumptions is that they make us feel comfortable without present beliefs and keep us from thinking about alternatives.

3.Emotion: Emotions/feelings are an important aspect of the human experience. They are a critical part of what separates humans from machines and the lower animals. They are part of everything we do and everything we think. Emotions can affect and inspire thought, stated William James, but they can also destroy it. We all have personal barriers enculturation, ego defenses, self-concept, biases, etc.—shaped by our exposure to culture and genetic forces. But to the critical thinker, personal barriers are not walls, merely hurdles. Critical thinkers don‗t ignore or deny emotions; as with other forces of influence on our thinking, they accept and manage them.

4.Language: Some say that language is the landscape of the mind. Others say that language is the software of our brain. Whatever the metaphor, it is clear that thinking cannot be separated from language. Furthermore, for the multitude that define thinking itself as ―expressed thought,‖ language carries the content and structures the form of the entire thinking process.

5.Argument: Many people think that arguing means fighting or quarreling. In the context of critical thinking, however, this definition does not fit. An argument is simply a claim, used to persuade others, that something is (or is not) true and should (or should not) be done. When someone gives reasons for believing something hoping that another person will come to the same conclusion by considering those reasons the discourse is geared toward persuasion. An argument contains three basic elements: an issue, one or more reasons called premises in logic, and one or more conclusions. Arguments can be valid or invalid, based on how they are structured. Arguments are not true or false only premises and conclusions are true or false. The goal of a critical thinker is to develop sound arguments that have both validity (are structured properly) and true premises. When we have a validly structured argument with true premises, we have a


sound argument. In sound arguments the conclusion must be true and therein lies the beauty and usefulness of logic.

6.Fallacy: Since we use language for the three primary purposes of informing, explaining, and persuading, we must be careful how we use it. We must make every effort to apply sound reasoning, particularly when language is used to persuade. To be sound, reasoning must satisfy three conditions: 1. it must be valid (structured properly); 2. the premises must be true; and 3. all relevant information must be included. If the reasoning fails to satisfy any of these three criteria, it is said to be fallacious. A fallacy, then, is an incorrect pattern of reasoning. Remember, finding a fallacy in your own or someone else‗s reasoning does not mean that the conclusion is false. It means only that the conclusion has not been sufficiently supported because one or more of the above three conditions were not satisfied. Fallacies can be committed through any of our communication methods, especially in the print, visual, and sound media.

7.Logic: Traditionally, philosophy has distinguished between two methods of reasoning: deductive logic and inductive logic. In logic, moving from observations to conclusions is called induction. Moving from conclusions to predictions that something will follow, given a set of circumstances and then verifying the prediction is called deduction. Inductive reasoning is characterized by reasoning from diverse facts, probability, generalizations, hypotheses, and analogies, leading to inductive strength. Deductive reasoning is characterized by reasoning from known facts, certainty, syllogisms, validity, and truth of premises, leading to sound arguments and conclusions 8.Problem Solving: Solving ―logical problems is like solving any problem that we encounter or identify in life. The following general model for problem solving is suggested: 1. Read and heed the problem. What is it telling you? What is it asking? Define terms that you do not understand.


2. Identify the unknown(s). It is helpful to name these with a symbol. Math uses a letter known as a variable, but any symbol will do. 3. Identify the known‗s. Write down all the information that the problem tells you. Even if you just repeat the givens in the problem, list them. 4. Start to identify the relationships between the known and the unknowns. This is the critical and creative part of solving a problem. Create a visual aid like a diagram, sketch, table, etc., that allows you to ―see‖ the relationships. 5. Use the relationships identified in step (4) to generate a problem-solving strategy. 6. Apply the strategy and solve. 7. If something doesn‗t seem to work, repeat steps 1-6. The secret to problem solving is continuing to try and learning something new on each successive iteration. The solution will ultimately be reached.



 Stage One: We Begin as Unreflective Thinkers. We all begin as largely unreflective thinkers, fundamentally unaware of the determining role that thinking is playing in our lives. We don‗t realize, at this stage, the many ways that problems in thinking are causing problems in our lives. We unconsciously think of ourselves as the source of truth. We assume our own beliefs to be true. We unreflectively take in many absurd beliefs merely because they are believed by those around us. We have no intellectual standards worthy of the name. Wish fulfillment plays a significant role in what we believe.  Stage Two: We Reach the Second Stage When We Are Faced with The Challenge Of Recognizing the Low Level at Which We and Most Humans Function as Thinkers. For example, we are capable of making false assumptions, using erroneous information, or jumping to unjustifiable conclusions. This knowledge of our fallibility as thinkers is connected to the emerging awareness that somehow we must learn to routinely identify, analyze, and assess our thinking.


 Stage Three: We Reach the Third Stage When We Accept the Challenge and Begin to Explicitly Develop Our Thinking Having actively decided to take up the challenge to grow and develop as thinkers, we become "beginning" thinkers, i.e., thinkers beginning to take thinking seriously.  Stage Four: We Reach the Fourth Stage When We Begin to Develop A Systematic Approach to Improving Our Ability to Think. At this stage, we now know that simply wanting to change is not enough, nor is episodic and irregular "practice." We recognize now the need for real commitment, for some regular and consistent way to build improvement of thinking into the fabric of our lives.  Stage Five: We Reach the Fifth Stage When We Have Established Good Habits of Thought Across the Domains of Our Lives. We know that we are reaching the stage we call the Advanced Thinker stage when we find that our regimen for rational living is paying off in significant ways. We are now routinely identifying problems in our thinking, and are working successfully to deal with those problems rationally. We have successfully identified the significant domains in our lives in which we need to improve (e.g. professional, parenting, husband, wife, consumer, etc.), and are making significant progress in all or most of them  Stage Six: We Reach the Sixth Stage When We Intuitively Think Critically at a Habitually High Level Across all the Significant Domains of Our Lives. The sixth stage of development, the Master Thinker Stage, is best described in the third person, since it is not clear that any humans living in this age of irrationality qualify as "master" thinkers. It may be that the degree of deep social conditioning that all of us experience renders it unlikely that any of us living today are "master" thinkers. Nevertheless, the concept is a useful one, for it sets out what we are striving for and is, in principle, a stage that some humans might reach.



According To Bloom Bloom identified six thinking levels: 1. Knowledge (knowing things)

2. Comprehension (understanding things) 3. Application (being apply to apply knowledge in the real world) 4. Analysis (ability to pull things apart intellectually) 5. Synthesis (ability to see through the clutter to the core issues) 6. Evaluation (the ability to make good judgments)

Levels 4, 5 and 6 are the most important one for mid and higher levels of management.



a. Debate: it involve enquiry, advocacy, and reasoned judgment on a proposition. A person or group may debate or argue the pros and cons of a proposition in coming to a reasoned judgment. b. Individual decision: an individual may debate a proposition in his or her mind using problem solving or decision making process. When consent or cooperation of others is needed, the individual may use group discussion, persuasion, propend, coercions or a combination of this method c. Group discussion: five conditions for reaching decision through group discussion are group members agree that a problem exist, have comparable standard of value, have comparable purposes, are willing to accept consensus of the group, and relatively few in number d. Persuasion: it is communication to influence the acts, beliefs, attitude, and value of others by reasoning, urging or inducement. Debate and advertising are two forms of communication which intent is to persuade e. Propend: it can be good or bad; it is multiple media communication designed to persuade or influence a mass audience. f. Coercion: threat or use of force is coercions. An example of coercions is brainwashing in which subjects are completely controlled physically controlled for a indefinite period of time. g. Combination of method: Some situation requires a combination of foregoing communication techniques to reach a decision.

VIII. PROCESS OF CRITICAL THINKING The critical thinking process, as described by Wolcott and Lynch , includes four steps. Students generally begin their critical thinking at step one and, with practice, progress to step 2 and up the ladder.

Identify the problem, the relevant information and all uncertainties Step;1 about the problem. This include awareness that there is more than one correct solution. Explore interpretations and connections. this includes recognize one‘s Step; 2 own bias, articulating the reasoning associated with alternative points of view, and organizing information in meaningful ways. Prioritize alternatives and communicate connections. this includes Step; 3 thorough analysis, developing the guidelines used for prioritizing factors, and defending the solution option chosen. Integrate monitor and Step; 4 refine strategies for re- addressing the

problem. this includes acknowledging limitations of chosen solution and developing an ongoing process for generating and using new information.



Benjamin Bloom's Model of Critical Thinking Perhaps most familiar to educators is "BLOOM'S taxonomy." Benjamin Bloom describes the major areas in the cognitive domain. The taxonomy begins by defining  knowledge as the remembering of previously learned material. Knowledge, according to Benjamin Bloom, represents the lowest level of learning outcomes in the cognitive domain.  comprehension, the ability to grasp the meaning of material and goes just beyond the knowledge level. Comprehension is the lowest level of understanding.

 Application is the next area in the hierarchy and refers to the ability to use learned material in new and concrete principles and theories. Application requires a higher level of understanding than comprehension.  Aanalysis, the next area of the taxonomy, the learning outcomes require an understanding of both the content and the structural form of material.  synthesis, which refers to the ability to put parts together to form a new whole. Learning outcomes at this level stress creative behaviors with a major emphasis on the formulation of new patterns or structures.  evaluation. Evaluation is concerned with the ability to judge the value of material for a given purpose. The judgments are to be based on definite criteria. Learning outcomes in this area are the highest in the cognitive hierarchy because they incorporate or contain elements of knowledge, comprehension, application, analysis, and synthesis. In addition, they contain conscious value judgments based on clearly defined criteria. The activity of inventing encourages the four highest levels of learning--application, analysis, synthesis, and evaluation--in addition to knowledge and comprehension.


Structural model Jeffrey Ellis A simple structural model proposed by Jeffrey Ellis illustrates the structural relationships between major components of critical thinking. It is based on defining critical thinking as a set of four sets: CT = { {S}, {H}, {V}, {R} } where {S} is a set of cognitive skills, {H} is a set of characteristic habits or attitudes, {V} is a set of values/commitments, and {R} is a set of relationships among the various elements in {S}, {H}, and {V}. The set of cognitive skills {S} include fundamental reasoning abilities such as analysis, synthesis, logic, evaluation, interpretation, and so on. The characteristic habits/attitudes {H} are the acquired behavior patterns that distinguish a critical thinker from a non-critical thinker. These are approximately equivalent to what Richard Paul has called the valuable intellectual traits of a critical thinker: intellectual humility, intellectual courage, intellectual empathy, intellectual integrity, intellectual perseverance, faith in reason, and fair-mindedness . The set of values/commitments, for a critical thinker, has but one element: a commitment to the truth, or in cases where the truth is unknowable, a commitment to the most defensible opinion. The relationships {R} between the elements in this model are shown graphically (see figure to right). Values/commitments provide the foundation for critical thinking. It is the commitment to searching for the truth that motivates the need for intellectual humility, empathy, and the various other critical thinking traits, and these traits in turn regulate the way in which cognitive skills are applied to form opinions, make decisions, and solve problems.



Here are 16 basic techniques of critical thinking. 1. Clarify. State one point at a time. Elaborate. Give examples. Ask others to clarify or give examples. If you‗re not sure what you‗re talking about, you can‗t address it. 2. Be accurate. Check your facts. 3. Be precise.

Be precise, so you are able to check accuracy. Avoid generalizations, euphemisms, and other ambiguity. 4. Be relevant. Stick to the main point. Pay attention to how each idea is connected to the main idea. 5. Know your purpose. What are you trying to accomplish? What‗s the most important thing here? Distinguish your purpose from related purposes. 6. Identify assumptions. All thinking is based on assumptions, however basic. 7. Check your emotions. Emotions only confuse critical thinking. Notice how your emotions may be pushing your thinking in a certain direction. 8. Empathize. Try to see things from your opponent‗s perspective. Imagine how they feel. Imagine how you sound to them. Sympathize with the logic, emotion, and experience of their perspective. 9. Know your own ignorance. Each person knows less than 0.0001% of the available knowledge in the world. Even if you know more about relevant issues than your opponent, you still might be wrong. Educate yourself as much as possible, but still: be humble. 10. Be independent. Think critically about important issues for yourself. Don‗t believe everything you read. Don‗t conform to the priorities, values, and perspectives of others. 11. Think through implications. Consider the consequences of your viewpoint. 12. Know your own biases. Your biases muddle your thinking. Notice how they might be pushing your thought toward a particular end, regardless of the logical steps it took to get there. 13. Suspend judgment. Critical thinking should produce judgments, not the other way around. Don‗t make a decision and then use critical thinking to back it up. If anything, use the method of science: take a guess about how things are and then try to disprove it.

14. Consider the opposition. Listen to other viewpoints in their own words. Seriously consider their most persuasive arguments. Don‗t dismiss them. 15. Recognize cultural assumptions. People from different times and cultures thought much differently than you do. In fact, your ideas might have arrived only in the last 50 years of human history! Why is your perspective better than that of everyone else in the world today and throughout history? 16. Be fair, not selfish. Each person‗s most basic bias is for themselves.



We have too much information. Critical thinking helps you focus on what matters.  We have too many options. Critical thinking helps you do what matters.  Millions of scam artists want to steal your time and money. You can use critical thinking to defeat them.  Critical thinking helps you avoid false beliefs. Do you believe something because you read it somewhere? Because your family or government or culture told you so? Because it makes you feel good? Because you ―just believe‖ it?  If so, you probably have many false beliefs. Critical thinking can help you avoid those. Who knows? It might even help you form some truebeliefs.  But we probably already agree that critical thinking is good. How do we do it?



Nurses use knowledge from other subjects and fields. Nurses deal with change in stressful environments. Nurses make important decisions. Nurses provide care according to nursing process


Choose always the way that seems the best, however rough it may be. Custom will soon render it easy and agreeable. -Pythagoras I. DEFINITION

Decision making can be regarded as the mental processes (cognitive process) resulting in the selection of a course of action among several alternatives. –Wikipedia

Decision making is the process of selecting one course of action from alternatives.



1. Purpose-Driven. People need a reason to participate in the process. 2. Inclusive, Not Exclusive. All parties with a significant interest in the issues should be involved in the collaborative process. 3. Educational. The process relies on mutual education of all participants. 4. Voluntary. The parties who are affected or interested participate voluntarily. 5. Self-Designed. All parties have an equal opportunity to participate in designing the collaborative process. The process must be explainable and designed to meet the circumstances and needs of the situation. 6. Flexible. Flexibility should be designed into the process to accommodate changing issues, data needs, political environment, and programmatic constraints such as ptime and meeting arrangements. 7. Egalitarian. All parties have equal access to relevant information and the opportunity to participate effectively throughout the process.

8. Respectful. Acceptance of the diverse values, interests, and knowledge of the parties involved in the collaborative process is essential. 9. Accountable. The participants are accountable both to their constituencies and to the processthat they have agreed to establish. 10. Time Limited. Realistic deadlines are necessary throughout the process. 11. Achievable. Commitments made to achieve the agreement(s) and effective monitoring are essential.



Developed by B. Aubrey Fisher, there are four stages that should be involved in all group decision making. These stages, or sometimes called phases, are important for the decisionmaking process to begin Orientation stage- This phase is where members meet for the first time and start to get to know each other. Conflict stage- Once group members become familiar with each other, disputes, little fights and arguments occur. Group members eventually work it out. Emergence stage- The group begins to clear up ambigiuity in opinions is talked about. Reinforcement stage- Members finally make a decision, while justifying themselves that it was the right decision. IV. STEPS IN DECISION MAKING

The decision making task can be divided into 7 steps which are stated in order of sequence are as 1. Establishing goal and objectives 2. Making the diagnosis 3. Analyzing the problem 4. Searching alternative solution 5. Selecting the best possible solution

6. Putting the decision into effect 7. Following up the decision 1. Establishing goal and objectives: goal and objectives can be set prior to beginning the general process. They will answer the question, what do we want the outcome or results of this decision to be? When new products or services are the outcome, goals and objectives are established first and problems or decision are then forecast. 2. Making the diagnosis: the first step is to determine what the real problem is. If the problem is not ascertained correctly at the beginning, money and effort spent on the decision making will be a waste. The original situation will not come under control. But new problem will start from this incorrect appraisal of the situation. The diagnosis should not be merely based on one or more visible symptoms but it should be diagnosed after the whole situation. 3. Analyzing the problem: The problem should be analysed to find out adequate background information and data relating to the situation. This analysis may provide the manager with some revealing circumstances that will help him to gain an insight into the problem. A thorough information search include knowledge of organizational policy, prior personal experience or training or the experience of others. From the information gathered, the facts should be identified and separated so as to provide the solid foundation for making sound decision. 4. Searching alternative solution: after analysing the problem, attempts are made to find alternative solutions to the problems comparing the potential solutions to the desired outcome to available resources. Establishing goals with measurable objectives helps to focus the search the alternatives. This search for alternatives forces the manager to see things from many view points and to study cases from their proper perspectives. When comparing potential alternatives, one should certainly consider the cost, time required and available, and the capabilities of those who will be involved in implementating a decision. 5. Selecting best possible solution: the selection of one best course of action, out of several alternatives developed, requires an ability to draw distinction between tangible and intangible factors as well as facts and guesses. Four criteria suggested by Drucker for choosing the best possible solution are as  Proportion of risk to the expected gain


 Relevance between the economy of effort and the possibility of results  The time consideration that meet the needs of the situation  The limitation of resources 6. Putting the decision into effect: even the best decision may become inoperative due to the opposition of employees. The decision can only be made effective through the action of the people. To overcome the resistance or opposition in the employees, managers must make necessary preparations for putting the decision into effect. Three important things related to preparation of this are  Communication of decision  Securing employees acceptance  Timing of decision 7. Follow up the decision for evaluation: inspite of all efforts, the decision taken may not be accurate mainly because of two reasons:  Some amount of guesswork becomes inevitable in almost every decision. Because of the cost and time involved in analyzing the problem.  Wrong decision also arise from the limited capacity of the manager itself



The 9 step decision making model Step 1 - Identify your objective What is it you wish to achieve? Step 2 - Do a preliminary survey of your options Besides the most obvious choices available to you, what other kinds of options can you think of? Step 3 - Identify the implicated values What values are at stake here? If it's an easy or unimportant decision you may not necessarily do this step. But if the decision has a major impact on your wealth, your health or self-respect, then it's useful to be aware of it.


Step 4 - Assess the importance of the decision The importance of the decision will determine how much you invest in it in terms of time, energy and money. The importance is determined by examining the implicated values. You may also have to consider the context here as well, a different situation or environment can mean that a decision that is often not very important can become very significant. Step 5 - Budget your time and energy Having identified the main alternatives and the values, now decide on which time and energy to spend making the decision itself. More important decisions are given more time and energy. He suggests that busy people and nervous wrecks made worse decisions than other people. Step 6 - Choose a decision making strategy This step of the 9 step decision making model involves making another decision. The time and energy you plan to devote will affect the strategy you choose. And because the strategy you choose may profoundly affect your decision it's important to choose an appropriate one. Step 7 - Identify your options When you examine your options in more detail you may discover other options with different implicated values. He points out that occasionally you may have to go back to step three to five and make revisions. Step 8 - Evaluate your options This is where you compare the options available to you. Again he suggests that seeking advice from an expert is often easier than making the decision on your own. Step 9 - Make your choice - on time, on budget When you're finished doing the evaluation (only as much as it requires!), you make your choice. He notes that people may still have difficulty at this stage because they fear the consequences of making a bad decision. VI. TECHNIQUES OF DECISION MAKING

A. Judgmental technique B. Operational research technique C. Delphi technique D. decision tree

A. Judgemental technique: This is the oldest technique of decision making and is subjective in nature. As it is based on past experiences or intuition about future, it is frequently used for making routine decisions. It is cheap and can be quickly done. But it is hazardous as there is chance of taking a wrong decision. So this technique is rarely used in large capital comminments. C. Operational research technique:

It is the analysis of decision problem using scientific method to provide manager the need quantitative information in making decision. Steps of operational research are  Construction of a mathematical model that pin points the important factors in the situation.  Definition of criteria to be used for comparing the relative merits of various possible courses of action  Procuring empirical estimates of the numerical parameters in the model that specify the particular situation to which it is applied.  Carrying out through the mathematical process of finding and series of action which will give optimum solution

c. Delphi technique: The Delphi method is a systematic, interactive forecasting method which relies on a panel of experts. The experts answer questionnaires in two or more rounds. After each round, a facilitator provides an anonymous summary of the experts‘ forecasts from the previous round as well as the reasons they provided for their judgments. Thus, experts are encouraged to revise their earlier answers in light of the replies of other members of their panel. It is believed that during this process the range of the answers will decrease and the group will converge towards the "correct" answer. Finally, the process is stopped after a pre-defined stop criterion. Advantage is that it is free from another‘s influence and does not require physical presence which makes it appropriate for scattered group and limitation is that it is time consuming. D. Decision trees: A decision tree is a graphic method that can help the supervisor in visualizing the alternative available, outcomes, risks and information for a specific needs for a specific

problem over a period of time. It helps her to see the possible directions that action may take from each decision point and to evaluate the consequences of a series of decisions. The process begins with a primary decision having atleast two alternatives. Then the predicted outcome for each decision is considered, and the need for further decisions is contemplated.



Main types There are many types of decision making and these can be easily categorised into the following 4 groups:  Rational  Intuitive  Recognition primed decision making  The ultimate decision making model

Rational Rational decision making is the commonest of the types of decision making that is taught and learned when people consider that they want to improve their decision making. These are logical, sequential models where the emphasis is on listing many potential options and then working out which is the best. Often the pros and cons of each option are also listed and scored in order of importance.

Intuitive The second of the types of decision making are the intuitive models. The idea here is that there may be absolutely no reason or logic to the decision making process. Instead, there is an inner knowing, or intuition, or some kind of sense of what the right thing to do is. Recognition primed... Gather information from our environment in relation to the decision we want to make. Pick an option that work. We rehearse it mentally and if we still think it will work, we go ahead. If it does not work mentally, choose another option .If that seems to work, go with that one. Also points out that as get more experience, recognise more patterns, and make better choices more quickly. The ultimate... Firstly, before you even make a decision, you establish how and who you want to be. You obviously want to be in a good state so that you can make good decisions. But you also want to be true to yourself, and that means knowing who 'yourself' is.

(ACCORDING TO Ken Shah & Prof. Param J. Shah) Irreversible This are those type of decisions, which, if made once cannot be unmade. Whatever is decided would than have its repercussions for a long time to come. It commits one irrevocably when there is no other satisfactory option to the chosen course. A manager should never use it as an all-or-nothing instant escape from general indecision. Reversible This are the decisions that can be changed completely, either before, during or after the agreed action begins. Such types of decisions allows one to acknowledge a mistake early in the process rather than perpetuate it. It can be effectively used for changing circumstances where reversal is necessary. Experimental This types of decisions are not final until the first results appear and prove themselves to be satisfactory. It requires positive feedback before one can decide on a course of action. It is useful and effective when correct move is unclear but there is a clearity regarding general direction of action. Trial and Error In this type of decisions, knowledge is derived out of past mistakes. A certain course of action is selected and is tried out, if the results are positive, the action is carried further, if theresults appear negative, another course is adopted and so on and so forth a trial is made and

an error is occurred. Till the night combination this continues. It allows the manager to adopt and adjust plans continuously before the full and final commitment. It uses both, the positive and negative feedback before selecting one particular course of action. Made in Stages Here the decisions are made in steps until the whole action is completed. It allows close monitoring of risks as one accumulates the evidence of out- comes and obstacles at every stage. It permits feedback and further discussion before the next stage of the decision is made. Cautious It allows time for contingencies and problems that may crop up later at the time of implementation. The decision-makers hedge their best of efforts to adopt the right course. It helps to limit the risks that are inherent to decision- making. Although this may also limit the final gains. It allows one to scale down those projects which look too risky in the first instance. Conditional Such types of decisions can be altered if certain foreseen circumstances arise. It is an ‗either or‗ kind of decision with all options kept open. It prepares one to react if the competition makes a new move or if the game plan changes radically. It enables one to react quickly to the ever changing circumstances of competitive markets. Delayed Such decisions are put on hold till the decision–makers feel that the time is right. A goahead is given only when required elements are in place. It prevents one from making a decision at the wrong time or before all the facts are known. It may, at times result into forgoing of opportunities in the market that needs fast action. VIII. THEORIES OF DECISION MAKING 1. Marginal theory This theory stress on profit maximization .this theory focused on increases profit from the decision. It related to health care cost and patient outcome 2. Psychological theory The trust of this theory is on the maximization of customer satisfaction (patient). The manager acts as a administrative man rather than economic man 3. Mathematic theory This theory is based on the use of models. This is also known as operational research theory. The techniques generally used include linear programming. Theory of probability stimulation models etc


4. Classical decision theory  Views the decision maker as acting world of complete certain  Classical decision making faces a clearly defined problem. Knows all possible action alternative and their consequences  Choose the optimum alternative 5. Behavioural decision theory  Accepts a world with bounded rationality and views the decision maker as acting only in terms of what he/she perceive about a given situation  The behaviour decision maker faces a problem that is not clearly defined . has limited knowledge of possible action alternatives and their consequences

6. Statistical decision theory Several statistical tools and methods are available to organize evidence, evaluate risks, and aid in decision making. The risks of Type I and type II errors can be quantified (estimated probability, cost, expected value, etc.) and rational decision making is improved



 Vroan and yelton‟s normative model The Vroom-Yetton- model is a decision making tree that enables a leader to examine a situation and determine which style or level of involvement to engage. This model identifies five styles along a continuum ranging from autocratic to consultative to group-based. Two are autocratic (A1 and A2), two are consultative (C1 and C2) and one is Group based (G2). A1: Leader takes known information and then decides alone. A2: Leader gets information from followers, and then decides alone.


C1: Leader shares problem with followers individually, listens to ideas and then decides alone. C2: Leader shares problems with followers as a group, listens to ideas and then decides alone. G2: Leader shares problems with followers as a group and then seeks and accepts consensus agreement.  Bounded rationality model: is the notion that in decision making, rationality of individuals is limited by the information they have, the cognitive limitations of their minds, and the finite amount of time they have to make decisions. The process of bounded rationality involve 3 mechanism they are as Sequential attention to alternative: here person examine possible solutions of a problem systematically i.e. if first solution fails to work it is discarded and next solution is considered till he gets acceptable solution. Heuristics: it is a rule which guides the search for alternative into areas that have a high probability for yielding solution. Here the decision makers look for obvious solution or previous solution that worked in similar situation. Satisfying: Here the decision maker is looked as a satisfier where an alternative is satisfactory if there exist a set of criteria that describes minimally satisfactory alternative, alternative in question meets or exceeds all these criteria.  An Intuitive Decision Making Model Lets examine the intuitive decision making model. To make a decision intuitively the person or group just to go with the option that satisfies their emotional reactions to the alternatives. The advantages of this type of model is that it is quick and it helps ensure that it takes into account what you really care about. Because you have positive feelings about the decision you will be well motivated to carry it out. Intuitive decisions can have some serious drawbacks. You might not have fully considered all the alternatives and therefore have missed an even better solution. You might also have based the decision on inaccurate or incomplete information. Your prejudices might make you overrule the facts. For example, you might not hire the best qualified person because of sayprejudice in terms of age, sex, or race.


Intuitive decisions might be very difficult in a team decision situation because people have different intuitive perspectives.  An Ethical Decision-Making Model · Clarify. a. Determine precisely what must be decided. b. Formulate and devise the full range of alternatives. c. Eliminate patently impractical, illegal and improper alternatives. d. Force yourself to develop at least three ethically justifiable options. e. Examine each option to determine which ethical principles and values are involved. · Evaluate. a. If any of the options requires the sacrifice of any ethical principle, evaluate the facts and assumptions carefully. b. Distinguish solid facts from beliefs, desires, theories, suppositions, unsupported conclusions, opinions, and rationalizations. c. Consider the credibility of sources, especially when they are self-interested, ideological or biased. d. With regard to each alternative, carefully consider the benefits, burdens and risks to each stakeholder. · Decide. a. Make a judgment about what is not true and what consequences are most likely to occur. b. Evaluate the viable alternatives according to personal conscience. c. Prioritize the values so that you can choose which values to advance and which to subordinate. d. Determine who will be helped the most and harmed the least. e. Consider the worst case scenario.


f. Consider whether ethically questionable conduct can be avoided by changing goals or methods, or by getting consent. g. Apply three "ethics guides."
o o o

Are you treating others as you would want to be treated? Would you be comfortable if your reasoning and decision were to be publicized? Would you be comfortable if your children were observing you?

· Implement. a. Develop a plan of how to implement the decision. b. Maximize the benefits and minimize the costs and risks. · Monitor and modify. a. Monitor the effects of decisions. b. Be prepared and willing to revise a plan, or take a different course of action. c. Adjust to new information.  Simon's Model of Decision Making Newell and Simon formulated a methodology for human information processing. This model is conceptual in nature and goes hand in hand with the working of a digital computer. Simmons decision-making model there are four phases 1) Intelligence phase 2) Design phase 3) Choice phase 4) Implementation phase

Initially the problem comes and we are in the intelligence phase thinking of the problem as it comes and then we try to find out what the solution to the given problem and then we move to design phase. In the design phase the way and method to solve the problem is thought and we actually try analyze the problem, we try to find the algorithms and the way that can actually solve the problem and hence we use the genetic algorithm to find

the solution to the given problem .After finding the method which is to be applied to the given problem we move to choice phase and here the actual work of finding the best algorithm come .Here we try to find the best algorithm from the given set of algorithm we have the option of choosing the algorithms such as "ACO" algorithm which is called the ant colony optimization algorithm or we have the choice of finding the algorithm such as Simulated annealing (SA) is a related global optimization technique that traverses the search space by testing random mutations on an individual solution. After deciding that genetic algorithm is the most suitable algorithm for the programming we move to the next step which is the implementation phase here the real implementation of the solution is done we implement the solution to the given problem by using the genetic algorithm according to the given problem.  Nursing process decision making model Problem identification. In the model this step defines the purpose, motivation and boundaries of the problem or opportunity. Resources (people, methods, technology, materials) are identified for future consultation or utilization. When problem identification is out of bounds or control, the nurse becomes swamped with data, which in turn diminishes the success of the decision or hinders the ability to complete the process. Assessment. This step alters information from the problem identification step to synthesize a structured approach to the problem. Specific data may be clarified or additional information requested. Potential conflicts in methods and outcomes are addressed. Controls are devised to guarantee that the focus of the decision making process remains correctly placed on the root problem or opportunity. When not managed in a planned methodology, conflict becomes subterranean and may surface as an unwelcomed outcome or as a challenge to the decision itself. Planning. This step provides an opportunity to stimulate creativity through the generation of ideas. The role of each individual is valued and appreciated as an important contribution of the team. Building teamwork fosters an atmosphere of group effort and

consensus. After ideas are generated, priorities are established based on factors such as goals and mission of the organization or individual; probability of success; resource intensity required; and probability of addressing the root cause of the problem. Too many ideas without reaching a consensus may be exhaustive and may cause communication problems in that the mission and goals of the organization or individual are not brought to bear on possible solutions, thus clouding the relationship between the activity and attention to the problem with the perceived outcome and benefit. Intervention. The purposes of this step are to produce stability and to increase productivity of the organization if the problem has been corrected. Support for the solution may require contributions by a few or by many individuals, groups, or departments. The service delivery system may be affected by the proposed changes and alternative solutions being tested. When a number of solutions are implemented in a short time frame, the work may be exhausting, depleting the energy of individuals and the organization, resulting in sickness rather than health. Evaluation. In this step a new paradigm or standards of practice may be established. Individual and organizational goals are evaluated based upon the achievement of problem resolution. Values of the organization or individual may change as the new methods become the accepted standards. Quality control measures are instituted to assure continued compliance with the new standards. Grieving may occur as the old ways are discarded. Individuals and organizations may be reluctant to terminate successful past practices, resulting in a rejection of the decision rather than acceptance.  Managerial decision making A major concern in management has been to understand and improve decision making. Various approaches have been proposed by psychologists, most based on a ―divide-and-conquer‖ strategy. There have been two approaches to management decision making (Huber, 1980). The first is concerned with development and application of normative decision rules based on formal logic derived from economics or statistics. The second involves descriptive accounts of how people actually go about making judgments, decisions, and choices.

Using both normative and descriptive approaches, there have been many successful applications of behavioral decision theory in management, business, and other settings. Decision making can usually be improved by breaking a problem into parts, working on the parts separately, and then combining them to make a final decision.



Experience and knowledge Experience and knowledge are two of the major factors affecting decision making. Decision making within practice disciplines, such as nursing, involves more than the application of theoretical knowledge. A deep understanding of the situation is required if treatment approaches are to address the experience of illness as it relates to a particular patient. This understanding evolves from knowledge and experience. Experience increases the cognitive resources available for interpretation of data, resulting in more accurate decision making. Creative thinking Problem solving involves organisation of new and previously learned information to form new responses to novel situations. The promotion of creative thinking through education calls for teachers to endorse the creative thinkers' self-worth, listen to them, challenge learners to develop new ideas and to question their taken-for-granted ideas, demonstrate critical thinking ability, encourage breadth of reading, invite learners to talk about what they think and feel, and to adopt a conversational approach Self Concept Perceptions of being less intelligent, less educated and less competent result in relinquished authority to those perceived as being better. Those with an internal locus of control believe in their ability to influence results, whereas, those possessing an external locus of control believe that events are contingent upon the actions of others. Locus of control refers to the extent to which a person believes they can control events and outcomes

Interpersonal Conflict


The stressors involved with interpersonal conflict constitute another barrier to decision making. Clinical decision making is a social activity involving health care team members and the patient. The social context in which the clinician functions impacts upon decision making Inadequate Staffing That it is stressful to work when staffing levels are inadequate for the tasks required would be disputed by few. Most nurses have frequently encountered circumstances when experienced staff are replaced with novices. This situation places stress on staff of all levels and influence the decision



 Only hearing and seeing what we want. Each individual has their own unique set of preferences or biases which blinker them to certain information. The best way to deal with this problem is to identify your preferences and biases whilst attempting to be open to the information around you.  Placing too great a reliance on the information you receive from others. Often we rely on certain individuals to provide support and guidance. This may be a suitable course of action in many cases. However, if the individual is not closely involved in the problem situation they may not have the necessary information or knowledge to help make the decision.  Placing too little emphasis on the information you receive from others. This issue can easily occur in a team situation. In many cases the team members are the people who are most closely involved in a problem situation and they often have the most pertinent information in relation to the problem. The best way to deal with this issue is to ensure that team members are involved in the decision making process.  Ignoring your intuition. On many occasions we are actually aware at a subconscious level of the correct course of action. Unfortunately, we often tend to ignore our intuition.


Today we have discussed about critical thinking, meaning and definition , components, stages, levels, methods, process, techniques, models, benefits and uses and regarding decision making ie, definition, principles, steps, 9 step decision making model, types, techniques , theories, models, factors affecting decision making.


Teaching Decision Making Skills to Student Nurses James Shanteau National Science Foundation and Margaret Grier, Joyce Johnson, and Eta Berner University of Illinois Medical Center Abstract This chapter describes the results of a project to teach decision making skills to student nurses. A special course was designed around three deficiencies observed in nurses' decision making: inappropriate information utilization, biased risk assessment, and suboptimal alternative evaluation. Student nurses skills in each of these areas were assessed before and after taking the course. Substantial improvement was observed in nurses' use and acquisition of information; after taking the course, the students' behavior approached that of expert nurses. In contrast, here was little improvement in assessment of probabilities; before and after the course, nurses showed conservatism by underestimating high probabilities and overestimating low probabilities. An improvement was observed in the ability to choose appropriate nursing actions; most of the improvement apparently was due to learning about the concept of utility maximization. These findings demonstrate, first, that there is a demonstrable need for a course to develop decision making skills and, second, that such a course can be effective in improving some decision skills of student nurses. Additional efforts are needed, however, on ways to teach probability and risk concepts more effectively Teaching Critical Thinking at the Community College.

AUTHOR: Robinson, Shawn PUBLICATION_DATE: 1996

ABSTRACT: Teaching critical thinking is what employers ask of educators and what teachers expect from their students. This paper attempts to reestablish the importance of critical thinking and how Valencia Community College's (Florida) critical thinking competency can be developed using several teaching models. A discussion is provided on the background of critical thinking, specifically where critical thinking skills come from. These skills have to be learned and finetuned with the assistance and guidance of an external entity. Competency I of a Valencia Community College graduate states that each graduate should be able to "think critically and make reasoned choices by acquiring, analyzing, synthesizing, and evaluating knowledge." Nine Valencia sub-competencies that can be used in the process of assessing and measuring critical thinking, include: (1) know what to observe and systematically make accurate observations; (2) represent observations in an appropriate pattern to show relationships; (3) recognize problems that need to be and can be solved; (4) use sequential and holistic approaches to problem solving; and (5) analyze information and ideas to make decisions. Some models of teaching that fit easily into the critical thinking competency are concept attainment, scientific inquiry, inquiry training, simulation, role playing, thinking inductively, advanced organizer, and synetics. This paper concludes with some activities instructors can use to develop critical thinking in the classroom. (VWC) CONCLUSION Critical thinking is a type of reasonable, reflective thinking that is aimed at deciding what to believe or what to do. It is a way of deciding whether a claim is always true, sometimes true, partly true, or false. Decision making can be regarded as the mental process resulting in the selection of a course of action among several alternative scenarios. Every decision making process produces a final choice.



1. Marquis B.L.,Hutson C.J . Leadership roles and management functions in nursing– Theory and application. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. 2. Douglass L M. The effective nurse- leader and manager. 5th ed. Mosby: St. Louis; 1996. 3. Morrison M. Professional skills for leadership. Mosby: US; 1993. 4. Ellis J R, Hartley C L. Managing and Co-ordinating nursing care. 3rd ed. Lippincott: Philadelphia;1995. 5. Basvanthappa BT. Nursing administration. New Delhi: Jaypee brothers; 2000. JOURNAL REFERENCE 1. Zori S, Morrison B. Critical thinking in nurse managers . Nurs Econ.2009 MarApr;27(2):75-9, 98.



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