IDENTIFYING THE PROBLEMS OF SPECIFY UNITS AND DEVELOP A PLAN OF ACTION BY PROBLEM SOLVING APPROACH

Submitted by: IInd year MSc Nursing

PROBLEM SOLVING INTRODUCTION Problem solving is a mental process and is part of the larger problem process that includes problem finding and problem shaping. Considered the most complex of all intellectual functions, problem solving has been defined as higher-order cognitive process that requires the modulation and control of more routine or fundamental skills. Problem solving occurs when an organism or an artificial intelligence system needs to move from a given state to a desired goal state. DEFINITION A nurse mangers most effective leadership skill is problem solving ability. A problem is a situation for which an individual has no ready response in her or his behavioral repertoire. An optimist might see a problem as a poorly defined opportunity for improvement in a situation. Although a problem is a provocative situation for which a person has no ready response, the problems solution need not consist of wholly new knowledge, skills, or attitudes. Often, an effective problem solution is merely a new combination of existing ideas and abilities. Or At this point, one may be wondering about the relationship between decision-making and problem-solving. The first step in decision-making was to identify the problem. But problemsolving can involve the making of several decisions. The best way to define the relationship between the two is to define the steps of problem-solving. PRINCIPLES OF PROBLEM SOLVING Problem solving like other managerial activities is facilitated by proper organization. In organizing subordinates, problem-solving efforts, a manager should observe the following principles: To resolve problems affecting organizational efficiency, the manager should separate large problems from small ones, use policy to solve the smaller problems, and conserve managerial time for solving major problems.

The manager should delegate smaller problems to subordinates and teach them to solve these by applying existing agency rules. In resolving operational problems, the manager should consult internal and external experts, so that solutions will be based on current knowledge. Problem solutions are most effective when the manager approaches problems in relaxed fashion and refuses to solve problems under stress. It is impossible to anticipate all eventualities or to expect 100 percent accuracy in diagnosing and resolving problems. Therefore, it is unwise to agonize over selecting a solution.

To conserve time, a nurse manager should ensure that job descriptions and personnel-evaluation forms specify employees responsibilities for problem-solving. The manager should be explicit in assigning problem-solving responsibility to particular employees and prepare detailed agendas for problem-solving meetings. The manager should show appreciation for unacceptable, as well as acceptable, ideas generated during employees search for a problem solution. An official format should be used in presenting and reviewing proposed solutions to ensure that all employees proposals receive equal consideration. A manager can enhance staff nurses problem solving by teaching them multiple problemsolving techniques. Adults learn best through immediate application and experimentation with newly acquired information. Therefore problem-solving instruction should include in-basket exercises, where nurses are given information about real-life nursing problems, which they must solve by using existing resources. When problem-solving instruction is given in groups, coworkers can serve as a reference source while the nurse learns new techniques; and the primary work group can be strengthened for problem-solving in quality circles. Inaccurate problem definition is the principal cause for poor problem-solving. Teaching nurses to follow a step-by-step problem-solving process will improve solution quality, even for employees incapable of analytical or creative thought. To maximize the transfer of training, the managertrainer should call attention to the type of solution that solves the problem in each in-basket vignette and discuss probable effects of using the same solution for a problem on the nursing unit.

CHARACTERISTICS OF SKILLFUL PROBLEM-SOLVING In decentralizing authority for clinical decisions, a manager should delegate the responsibility to the most capable nurses. Creative solutions are generated by nurses with clinical expertise, understanding of the problems long-range effects and skill in symbolic expression. Highly creative persons are characterized by their wide range of interests and their knowledge of several subjects. Persons with research skills are inclined to be politically liberal, cognitively complex, and reflective. Nurses use different approaches to problem-solving. Some prefer a serial approach, in which they tackle problems in sequence, completely resolving one before turning to the next. Others survey all existing problems, rank them by importance, and solve one at a time in order of priority. Still, others group problems according to the resources needed to investigate and remedy each, then solve a group of related problems simultaneously. Creative persons become intrigued by related problems during investigation of the primary problem and, so redesign the search to branch in several directions and work on several problems at once, each at a different stage of resolution. IDENTIFY THE PROBLEMS OF SPECIFY UNITS A. Psychological problems: 1. Moving from Novice to Expert One of the challenges for beginning nurses is pressure to function as an expert without adequate knowledge and skills. Janice (2004) identified six different roles which nurses perform while they move from the sate of being a Novice to Expert. The helping role The teaching-coaching function The diagnostic and monitoring function Effective management of rapidly changing situation

Administering and monitoring therapeutic interventions and regimens Monitoring and ensuring the quality of health care practice and organizational work-role competencies.

2. Reality shock One problem confronted by the new graduates is the seeming impossibility of delivering quality care within the constraints of the system as it exists. The person undergoing such stress is less able to perceive the entire situation and to problems effectively. 3. Burnout Burnout is a form of chronic stress related to ones job. It can be identified by feelings of hopelessness and powerlessness, and is accompanied by a decreased ability to function both on the job and in personal life. Burnout is more frequent in nurses who work in particularly stressful areas of nursing. It also occurs when staffing is inadequate or interpersonal relationships are strained. The main causes for burnout are conflict between ideals and reality, practicing nursing in areas that have high mortality rates, inadequate staffing, staying overtime, skipping breaks and lunch and running throughout the shift. 4. Discrimination Discrimination relates to treating other differently based on stereotypes about groups of people. Discrimination may occur regarding racial or ethnic background, gender or sex, sexual orientation and/ or age. Men in nursing have expressed concern about sex discrimination. They are not allowed to care for women clients, or restrictions are placed on them in terms of obtaining consent from each client. Female nurses care for men clients in all situations. This has been accepted because women are commonly seen in nursing and the public associates mothering role with nursing. 5. Mandatory overtime Mandatory overtime is another way that hospitals deal with poor staffing. It creates a loss of control for the nurse over the ability to schedule non-work activities, including essential family

functions. This also puts safe patient care at risk because of nurses fatigue and subsequent loss of ability to concentrate and make good decisions. 6. Floating Nurses are sometimes required to float from the area in which they normally practice to another nursing unit. It reduces nurses competence also affects quality nursing care. B. Physical problems: 1. Harassment and violence Violence includes a range of behavior from verbal abuse, threats and unwanted sexual attacks to physical assault and at the extreme, homicide. According to OSHA, two thirds of non-fatal workplace assaults happen in health and social services facilities, the majority of these are assaults by clients on nursing staff, and more in psychiatric mental health setting than in other settings. The WHO has identified violence as a worldwide problem, which threatens the effective delivery of health care (WHO 2002). Both men and women may be the objects of sexual harassment. Sexual harassment is a concern in nursing. Harassers in the health care workplace may be clients, coworkers, or physicians. The most dangerous settings for violence are psychiatric units and nursing homes, where patients are often confused, disoriented or suffering from mental ailments as well as emergency rooms, where long waits for care can anger patients, and the people with them. 2. Infection as an Occupational hazard Transmission of infection is a major concern for the nurses when caring for infected clients. The higher danger for nurses lies in those clients who have not been diagnosed as having an infection and for whom specific infection-control measures have therefore not been prescribed. 3. Needle stick injuries Needle stick injuries especially those with large-bore needles (e.g. bone-marrow aspiration needles) continue to be the most frequent source of infection transmission.

4. Hazardous chemical agents Nurses working in operation rooms should seek information regarding anaesthetic gases that can increase the risk of foetal malformation and spontaneous abortion in pregnant women who are exposed to them on a regular basis. Chemotherapeutic agents used in the treatment of cancer are extremely toxic and nurses who work in setting where such agents are prepared and administered should seek additional education regarding their administration, not only in relation to the clients safety but also personal safety. Contact with any medication, especially antibiotics, during preparation and administration may cause the nurse to develop sensitivity leading to hand-rash for example. Some medications are absorbed through the skin and may produce an undesirable effect. Cleansing agents and disinfectants used in the hospital may also be hazardous if used improperly. 5. Back injuries Nursing includes providing direct care to incapacitated individuals; hence back injuries are a common occupational hazard. 6. Bioterrorism Most biological attacks will be covert, meaning that there will be no warning. Therefore, it is important that nurses should know and understand what bioterrorism is and how to identify a potential event because health care workers in hospitals and clinics may have the first opportunity to recognize the covert event. An alert nurse can save lives, including her own. Anthrax, botulism, plague and smallpox are considered the four top agents for potential bioterrorism because plague and smallpox can be disseminated to a population via airborne release.

STEPS IN THE PROCESS

The steps of the problem-solving process are the same as the steps of the nursing process and the decision-making process: assess and analyse, plan, implement and evaluate. Assessment includes systematic collection, organization and analysis of data related to a specific problem or need. It involves logical fact-finding, questioning all sources and differentiating between objective facts and subjective feelings, opinions and assumptions. Knowledge and experience guide the data collection and analysis of data. Before the process goes any further assessment should also determine whether a commitment exists to implement a decision or an action. Making certain that there is no readily apparent solution also saves the time of all the people who may become involved in problemsolving. Once the problem is identified, it must be determined whether it requires other than routine handling- that is, whether it is a rare or unique situation rather than a recurrent one. This leads to the second step of problem-solving planning.

Planning involves several phases. In nursing terms we determine priorities, set goals and measurable objectives, and plan interventions. Management literature essentially says the same thing: break the problem down into components and establish priorities; develop alternative courses of action; determine probable outcomes for each alternative; decide which course is best in relation to resources goals, risks, and the like; and decide on and make a plan of action with a time table for implementation.

When determining priorities, nurses should relate the problem to the corporate mission. Decisions involve choosing among alternative courses of action. They must have an acceptable effect on those directly involved, other areas affected, and the entire organization. Plans should include when and how to alter a course of action when undesired results occur.

The third step is implementation of the plan. The nurse should keep informed of the status of the process because it is unlikely that she or he will be directly involved. This is the one step in the process most likely to be delegated to subordinates. Implementation requires knowledge and skills appropriate to the specific alternatives selected.

Evaluation, the final step in problem-solving, includes determining how closely goals and objectives were met, the success or failure of actions taken in resolving the problem, and whether the plan should be terminated because the problem has been resolved or whether it should be continued, with or without modification.

Effective problem-solving requires that the practitioner be frequently at a high cognitive level: the level of abstract thinking.

APPROACHES TO PROBLEM SOLVING

Approaches to problem solving

Desired results

Management problems

Approaches

Routine Traditional S.O.P

Scientific Identify proposition Acquire prelim. Observation State tentative solutions

Decisional Define desired results Define problem Draw alternatives Evaluate alternatives

Creative Define problem Prepare for creativity Encourage ideas Permit innovation

Quantitative Define problem Construct a model Evaluate model Place needed constraints over use of methods.

Abide by superiors Order

Investigate propositions using current knowledge and experiments Classify data

Select best one Implement the best one Evaluate

Verify & evaluate

Implement the solution

Implement

Terminal solution

Tentative sol. to proposition Adjust and state soln. to proposition Implement Evaluate

There are five main approaches to problem solving 1. Routine 2. Scientific 3. Decisional 4. Creative 5. Quantitative These approaches are strategies for problem solving and any one approach may be suitable for the given situation. 1. Routine approach This approach deals with problem solving on traditional methods. a. What has always been in the past, when such situation occurred? If we do it now the same way we may succeed. b. There is Standard Operating Procedures (SOP) in many departments of the hospital. These SOPs tell that what should be in a particular situation. How is it done? Who does it? When will it be done? Step by step approach to deal with the problems. c. Another way of problem solving based on the traditional methods is, to have regards for the superior officers opinion and orders. Whatever they direct, instruct or order, presume that they are correct and follow it 100%. Such methods are of great value in medical care setting, like where the treatment of the patient is concerned. 2. Scientific approach The first step in this approach is to identify the problem. Second step is preliminary observation regarding the proposed scheme. Then we have to derive solutions to the problems. With the use of current knowledge and with controlled experiments investigate the proposition. The data so collected are classified and analyzed. On the basis of analysis a tentative solution is drawn. The solution so derived is implemented in that situation. After implementation it is evaluated for its relevance.

3. Decisional approach This is one of the most popular and also common approaches to deal with the problems. First of all we have to state as to what is the desired result. After making definition of the problem, various possible alternatives are sorted out then each alternative is evaluated from the point of view of its suitability and relevance. The best alternative is selected and implemented in the given situation. For any given situation several decisions can be made. 4. Creative approach First step is to define the problem and decisions makers study the information, people and facilities involved and concentrate on interactions and outputs from the inputs. Creativity and innovations of idea is given due consideration. This method uses the ability to develop new ideas and to implement them. The core theme is to create and apply new idea. It represents a new way of achieving the desired result without being prejudice. 5. Quantitative approach Problem solving is done by construction of mathematical models. First define the problem and construct a mathematical model and derive a solution from the model. Evaluate the model as well as the solution drawn from the model and implement the solution to solve the problem. The computer is of great help, when the mathematics is complex and the calculations are of large volume. Conclusion: In problem solving, the nurse obtains information that clarifies the nature of the problem and suggests possible solutions. The nurse then carefully evaluates the possible solutions and chooses the best one to implement. The situation is carefully monitored over time to ensure its initial and continued effectiveness. The nurse may also encounter a similar problem in a different client situation where an alternative solution is determined to be the most effective. Therefore problemsolving for one situation contributes to the nuress body of knowledge for problem solving in similar situations.