Decision making is an integral part of the nursing process that is directly related to critical thinking and problem solving. This chapter explores the application of decision making in the clinical and management setting. It reviews the pros and cons of group decision making and the nurse’s role in patient decision making, plus strategies for improvement.

The author starts the discussion by defining critical thinking, which is the analysis of the way one thinks. It naturally fits within the steps toward problem solving and decision making.

Reflective thinking is a subset of critical thinking, allowing for self observation as one performs a task. There are two selvess involved, called the active self and reflective self. The active self is the part that is engaged in the act and the reflective self observes and makes suggestions. This reflective process allows for an individual to evaluate a situation after it occurs.

Problem solving is defined as a process that starts with identifying a problem and ends with a solution. This process uses five steps that similar to the nursing process: problem identification, data collection and analysis, alternatives, selection of action, implementation and evaluation of the action.

Decision making is defined as selecting and implementing action chosen from alternatives. It may be associated with a problem, but does not always focus on problems.

Clinical management applications are presented with sample tools to help in the process, including decision making grids for weighing options and PERT diagrams useful in determining the timing of decisions. Decision trees and Gantt charts are other tools highly effective in helping with making decisions and keeping committed to the plan and time line.

Group decision making is explored outlining group decision making questions and the advantages and disadvantages of groups participating in decisions. Suggested techniques are reviewed that separate multiple factors in the process which are applicable to many clinical settings, such as, nominal group technique, Delphi group technique. Consensus building is an effective strategy used to bring a group to a decision that all can live with and are willing to support regardless if all members agree. Lastly, groupthink is discussed., which interferes with appropriate decisions because members do not engage in divergent thinking, express creativity, or explore questions..