Republic of the Philippines

Visayas State University

VSU, Visca, Baybay, Leyte
College of Nursing

Course Title: Nursing 165 Nursing Care Management and Leadership

Topic: Decision Making Process
Preceptor: Ana Asumpta Novilla-Perez, R.N. M.A.N.
DMP – It is a process of selecting one action from alternatives or choices. (Tomey)

First Activity:
Organizational Chart – mention an organization/ hospital structure. People at all
levels in an organization must constantly make decisions and solve problems.
Nurses make good manager, good managers must make decisions and act on
them. The entire planning process involves manager in a continual series of
decision making situations and to what goals and opportunities to pursue.

Example of a programmed decision is to pay a newly hired employee since

organizations generally have an established salary scale for all positions.
- managers make use of policies, rules, or procedures
- handle customer complaints / patient’s complaints

Second Activity:
1.) State complaints of patients, get the data from the office of the Nursing
Service Department of DWUH and LPH.
e.g. Complaints of patients
- how did the nurse manager answered/ managed the complaints.
Non-programmed decisions, on the other hand, are made under new or unusual
conditions and require creative thinking.

Def. of Creative or
Critical Thinking – is the ability to question philosophically and exercise careful
judgment when evaluating a situation. (Tomey)

Box I Decision Making Process

I- Identify the problem and analyze the situation
E- Explore the alternative
C- Choose the most desirable alternative
I- Implement the decision
E- Evaluate the results

Example Problem for I.

 Two nurse may each complain about the intrusim of other into her work,
initially the problem may appear to be personality clash or power struggle,
however the cause maybe the manager’s failure to define the job responsibilities
of each nurse.

Questions to Answer:
1. What is wrong?
2. Where is improvement needed?

EXPLORE THE ALTERNATIVES

Using one’s experiences is probably the most common approach to solving
problems, but it maybe in adequate. Managers should look beyond their own
experiences and learn how others are solving similar problems. This can be done
by continuing education, professional meetings, review of literature,
correspondence, brainstorming.

CHOOSE THE MOST DESIRABLE ALTERNATIVE

Question: Who propose for alternatives?
One alternative is not always clearly superior to all others. Nurse Managers
must try to balance factors such as patient safety, staff acceptance, morale, public
acceptance, cost, risk of failure.
At this juncture, the following questions should be asked.
- Will this decision accomplish the stated objectives.
- If it does not, it should not be enforced be used?
- Can the decision be implemented?

IMPLEMENT THE DECISION

A decision that is not put into action is useless. The nurse manager should be
able to communicate the decision to appropriate staff associates in a manner that
does not arouse antagonism.
The decision and procedures for its implementation can be explained in an
effort to win the cooperation of those responsible for its implementation.
It is the role of the nurse manager to select the staff associate to implement
the decision and provide the direction to initiate action. You need to control the
environment so staff can function as planned. One of the decisions has been
implemented, it has to be evaluated.

EVALUATE THE RESULTS

Evaluate criteria may have to be developed like, audits, checklist, ratings
and ranking.

Third Activity:
A student is made to present his on views of his decision of enrolling at the
VSU, it was a decision you made 3 years ago? Why VSU? Do you think you are
closer to you goals, what happened along the way, what were the activities,
decisions that you have made.
ORGANIZATIONAL MODELS
A. RATIONAL – Based on the premise of common goals, technical competence
and sequential process to achieve goals when individual values are
consistent with organizational values.
a.1 feedback
a.2 strength deliberate method
a.3 weakness unrealistic expectations, lack of time narrow thought process.

B. POLITICAL MODEL – win-win situation

b.1 consensus
b.2 (strength)
1. changes are based on negotiations
2. can promote creative solutions with majority support that can be
implemented even if there are differences in viewpoints

C. COLLEGIAL MODEL – Involves full participation of a community of peers for

decision making, it is based on group consensus, mutual respect, adequate
time.
c.1 (strength) tends to support general welfare, when there is consensus;
implementation tends to go smoother than when there is consensus.

D. BUREAUCRATIC MODEL – Policies and procedures

d.1 (strength) operational efficiency based on history and tradition.

E. GARBAGE CAN MODEL – Based on the premiere of pure accident.

(weakness) Decisions are unplanned and coincidental based on multiple diffuse
values; implementation is incidental with no planning. Because there are no
goals or criteria for evaluating outcome, exercise maybe repeated.

F. CYBERNETIC MODEL
1. Needs assessment
2. Program implementation
3. Results assessment

Fourth Activity:
Students are made to explain the collage that they have made in the
organizational models.

ELEMENTS OF CRITICAL THINKING

A. Purpose or goal (SMART) clarity, significance, achievability
B. Question at Issue (to answer a question, one must understand what it
requires) or a central problem
- clarity, significance, relevance and answerability
C. Point of View – reasoning is improved when multiple Frame of Reference
relevant points of view are sought.
D. Empirical Dimension - reasoning is as sound as the evidence on which it is
based.
E. Conceptual Dimension – Concepts should be clear and deep
F. Assumptions – assumptions should be justifiable.
G. Implications and Consequences – all reasoning has implications and
consequences.
H. Inferences and Conclusions – reasoning is only as sound as the inferences it
makes and the conclusions to which it comes.
Question: How do you apply critical thinking while utilizing nursing process?
Group Decision Making
Advantages:
1. Wider range of knowledge
2. Participation allows the nurse to express her views and attempt to persuade
others, thereby increasing self expression, innovation and development.
Disadvantages: Format status

Task force - has a time limited assignment.

Committee is a group of people chosen to deal with a particular topic or
problem overtime; a committee may have advisory informational, coordinating,
or decision making responsibility.
e.g.
Staff committee serves as an advisory capacity
Line committee responsible for making decisions affecting subordinates
Formal committee – specific duties and authority
Informal committee – discussion
Adhoc committee – appointed to collect date, analyze it and make
recommendations

Advantages:
1. Group deliberation
2. Sharing
3. Unanimity of decisions helps increase the support and confidence of
subordinates
Disadvantages:
1. It is a group that is held responsible
2. A committee decision is slow, ponderous process
- please read on Committee functioning page 63 (Tomey)

Group think – people conform rather than challenge ideas.

Encoded: Ternura, Kristine Tinay