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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" 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, "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,


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

-- Tim van Gelder

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

-- Robert Ennis

Levels of Critical Thinking 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.

Stages of Critical Thinking

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

Components of the Critical Thinking

 The eight components that have been identified as part of the critical thinking process

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
 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 explanation 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
 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

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 ―logic‖ 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


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.

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.


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.
Models of critical thinking

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
 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.

Techniques of critical thinking

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

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.

Benefits of critical thinking

 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?

Use of critical thinking skills in nursing:

 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


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.
Stages of Decision making:

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 decision-
making 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

Principles of decision making:

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
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


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 is proposed by David Welsh in his book 'Decisions,

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

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

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.

Techniques and Tools 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
 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

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.

Types of Decision Making

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 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.

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)


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.


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.


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 the
results 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.


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


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 night 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


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.


Such decisions are put on hold till the decision–makers feel that the time is right. A go-ahead
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.


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

Two are autocratic (A1 and A2), two are consultative (C1 and C2) and one is Group based

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

C2: Leader shares problems with followers as a group, listens to ideas and then decides

G2: Leader shares problems with followers as a group and then seeks and accepts consensus

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


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

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


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.

Factors Affecting the Decision-Making Process

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