1. UNIVERSITY OF THE SOUTHERN CARIBBEAN
P.O. BOX 175, PORT-OF-SPAIN
TRINIDAD AND TOBAGO
Assignment 6.2
Instructor: Mr. Val Tobias
COURSE: NURS331
CRITICAL THINKING & DECISION MAKING (CTDM) By:
Members of Group two (2)
Compilation of group assignments
Group members include:
1.Cornibert, Kelly-Ann (Group leader)
2. Dyett-Crooks,Leah
3. Dubay- Ramrattan, Jaya
4. Deterville, Eliah
5. Dumar, Jacqueline
6.Rachael, Constantine

2. Group work
Decide on a topic of interest among group members. Applying the ‗ten (10) Steps to Teaching Others‘ from the reading for this unit,
in Alfaro-LeFevre‘s book, develop a teaching plan.
Topic of interest:
Stress management in amongst registered nurses at the Victoria Hospital.
Expected outcomes:
At the end of this teaching plan workers will be able to:
1) Define stress.
2) Identify factors which may influence stress at the work place.
3) Identify signs and symptoms of work related stress.
4) Identify strategies to deal with the stress factors identified.
5) Identify coping mechanisms to deal with work related stress
• Assess patient‘s knowledge of stress management by utilizing the following questions:
o What do you know about stress and its management among nurses?

3. o What have you been told about stress management in nursing?
o How have you managed stress in the past?
o What stress management strategies have you utilized recently to help relieve your WRS?
o How will you say you manifest WR stress?
o In your estimation, what do you consider as the triggers?
o What situation triggers your greatest stress levels?
o Of all the coping measures you have tried, which one seems to be the best to relieve your stress?
o You have c/o WRS, how is it affecting you and your family?
o When highly stressed, and in your attempt to cope with stress, are there attending problems that you have difficulty
handling?
This assists in understanding the nurse‘s areas that are of greatest concerns to be identified and addressed.

4. o Question the learner‘s preferred learning styles. The method by which the learner prefers to be taught is evaluated it
may be doing, observing, listening or reading. Ask the nurse the following questions, these questions have been
adopted from the AHEC Clear Health Communication Program, Ohio State University(2007):
 What‘s your preferred method of learning? For example, Reading? Listening? Doing?
 Reflect on the last time that you learned a new skill, operated new equipment, or learnt a new hobby). In
what way did you learn it? What was the best way for you?
 Observe and note if the nurse explain things in intellectual or tangible terms.
o Identify barriers to learning:
 Are there any problems that would prevent you from learning at this time? (within one, two, four weeks, etc)
(Lieb, 1991).
 Do you think that the stipulated time for the teaching session is sufficient facilitate a comprehensive
understanding of stress management? (Lieb, 1991).
 Are you confident enough to implement the various strategies taught to cope with stressful situations in your
life (Lieb, 1991)?
 Do you have sufficient information about opportunities to learn about stress management to make changes in
your life (Lieb, 1991)?

5.  Do you experience scheduling problems when using stress management techniques (Lieb, 1991)?
 Do you lack of motivation to utilize effective stress management techniques (Lieb, 1991)?
 Are there institutional policies that hinder you from utilizing effective stress management techniques (Lieb,
1991)?
Ensure that the learner is encouraged to engage in the teaching session: Please feel comfortable to ask questions, seek
clarifications on all information about stress management that is being offered. Also this teaching session continuously centers
on your preferred stressful areas thus appropriate stress management techniques will be discussed with you.
Provide support
Everyone experiences factors which contribute to stress at the work place, you can now identify them and we will discuss ways
to manage stressful situations. Here are some coping mechanisms for stressful situations according to the Mayo Clinic (2013):
 Scale back. Reduce on your obligations when probable. Evaluate your daily, weekly and monthly schedule and find
meetings, activities, dinners or chores that you can cut back on or delegate to someone else.
 Prepare. Prepare for meetings or trips, scheduling your time better, and setting realistic goals for tasks both big and
small in advance to reduce stress. An unaccounted situation causes stress to build up.
 Reach out. Make or renew connections with others. Surrounding yourself with supportive family, friends, co-workers,
or clergy and God fearing spiritual persons have a major positive effect on your mental well-being and your ability to

6. cope with stress. Go to church services as the assembling together is good for your spiritual and mental wellbeing and
volunteer your services in your church and community.
 Take up a hobby. The time spent engaging in enjoyable activities soothes and calms your restless mind. Attempt
exploring nature, sewing, reading, gardening, crafts, tinkering with electronics, fishing, carpentry, music — things that
you don't get competitive or more stressed out about.
 Relax. Physical activity, meditation, yoga, massage and other relaxation techniques can help you manage stress. The
goal here is to center your attention on calming and relaxing your mind and body thus freeing your thoughts from
stressful thoughts.
 Get enough sleep. Your immune system is weakened when it does not receive sufficient sleep thus you feel more
irritable and less focused. Most people need seven to eight hours of sleep a day.
 Get professional help. If whatever method(s) you have deemed appropriate to reduce your stress levels does not
alleviate it, consult your doctor for appropriate referrals. Chronic, uncontrolled stress can lead to a variety of potentially
serious health problems, including depression and pain.
Conducive environment
The teaching session will take place in the nurse‘s lounge at 10:00am on Monday 20th
May, 2013. This location is conducive,
as it is located in a quiet area of the hospital. The time chosen is convenient for persons coming from home and those who
worked the night shift which ended at 7am, where they are able to rest before attending the teaching session, allowing the

7. learners to be comfortable and rested. However if persons are not able to attend the session at the abovementioned time
different more appropriate arrangements can be made. There will be two (2) booths in the conference rooms to complete the
session before the teaching commences.
Illustrations
In the teaching session, there will be use of two assessment tests, diagrams, discussions through use of scenarios, pamphlets
and simulations and this will enhance comprehension as we cater for all individuals present who learn through theory and
visual aids.
Mental images
Various comparisons and representations are utilized to explain terms, concepts, prescribed regimens to the learner. Individuals
understand concepts more clearly when they are taught using terms, words, situations that are personalized to their everyday
experiences.
Triggers
For increased compliance, remembering and understanding of the concepts being taught it is effective to utilize words that
persons are familiar with.
Keep it simple

8. The information provided during the teaching session will be given in simple terms for the benefits of every individual
understanding.
Learners responses
Learners are given time to ask questions to clarify misconceptions during the teaching session.
Summary
A summary of all key points in the teaching plan will be repeated. A handout will be given to allow learners to review and
refresh their memory.
Topic: Stress management in the work environment
Date and time: 20th
May, 2013, 10AM
Location: Nurses lounge, Victoria Hospital
Objectives / expected
outcomes
Data / Information provided to learners Aids used for
illustration
Evaluation
1) By the end of 15
- 20 minutes
learners will be
According to Davis (2001), stress is any physical,
physiological or psychological force that disturbs the body‘s
equilibrium.
Factors that influence stress includes:
At the beginning
of teaching
session, learners
By the end of 20
minutes learners
define stress as events

9. able to define
stress and
identify factors
which may
influence stress
at the work
place.
Being Overworked
Most obvious stress factor where one has too much work to
do, insufficient time to perform it (Aynilists, 2013).
Being Underworked
An individual don‘t wants to be caught doing nothing and
being paid on the company‘s time. This is particularly hard if
you have no control over your workflow (Aynilists, 2013).
Job Security
Layoffs are made with little hiring. Not having job security
can be seriously magnified (Aynilists, 2013).
Progression
No one wants to remain in the same position, on the same pay
for an extended period of time, but many careers are currently
stifled by a market where little hiring or promotion is being
done. Even though you may have a job, not being able to get
to your next level can make you feel bored and trapped, which
can be stressful (Aynilists, 2013).
Having the Wrong Job
Having a job that you have insufficient skills or experience to
handle, you‘re going to feel like you‘re sinking. When you
can‘t ask for training or help because you don‘t want to admit
you‘re not right for it, the stress increases (Aynilists, 2013).
will be given
handout ―WHERE
ARE YOU NOW‖
for assessment and
questioning.
A Skit acted out
by presenters
which indentified
the different stress
factors in which
the learners had to
spot / identify
them from the skit
and personal
experiences.
which lead to
negative effects on
one‘s body. The
learners identify
different stress
factors, namely:
Job security
Being
overworked
Being
stagnant, not
being
promoted
Poor work
environment
Poor

10. Blame culture
In the workplace people adapt to cultures, if someone cannot
confess to errors there are implausible to progress and learn.
If no one can acknowledge the error, blaming becomes
common, producing an environment of fear and lack of trust
that is actually stressful to deal with in the workplace in every
day basis. (Aynilists, 2013).
Bad Management
A lack of strong and effective management can leave a team
directionless, and individuals in a state of disorganized
confusion that is very stressful. Conversely, over-management
and micromanagement are claustrophobically stressful for
employees and leave no room for creativity or growth
(Aynilists, 2013).
Bullying by co-workers
Unfortunately, workplaces can bear a striking similarity to
playgrounds when the pressure is on and bullying by a
colleague or manager can make life very difficult taking their
problems and worries out on their team or colleagues
(Aynilists, 2013).
No Support Network
management
Generally the learners
voiced that having a
substantial amount of
work with little time
to complete it is one
of the most stressful
factors in the work
environment.

11. Workplaces with weak, or non-existent, human resources
structures, and a lack of proper procedures for making
complaints or dealing with problems, mean that employees are
left to handle situations on their own. This can cause a huge
amount of stress and a sense of fear and isolation (Aynilists,
2013).
Poor Working Environment
Companies may not have procedures in place for regular
health and safety. Poor work environment would consist of
old or broken equipment, poor lighting, uncomfortable
furniture, excessively high levels of noise can make for an
extremely stressful working environment (Aynilists, 2013).
2) By the end of
10-15 minutes
learns will
identify signs
and symptoms
of work related
stress.
An individual who is experiencing work related stress may
experience the following:
Feelings of anxiety, irritability, depression, loss of
interest at work, insomnia (inability to sleep), trouble
concentrating, social withdrawal, loss of sex drive, use
of alcohol or drugs to cope with stress factors (Segal,
Smith & Robinson, 2012).
Active discussion
between learners
and presenters.
By the end of 5
minutes learners
identify the following
signs of work related
stress:
Anxiety, depression,
use if alcohol and
drugs.

12. 3) By the end of 10
minutes learners
will identify
strategies to
deal with the
stress factors
identified
Escape
Remove self physically and mentally from the stressful
situation. This can be done by: going for a walk, listening to
music, meditation (Stress Management Workshop Handout).
Physical relaxation
This will assist in decreasing cortisol levels which leads to
stress, increasing confidence. This can be accomplished by:
jogging, yoga, sporting activities, dancing, swimming (Stress
Management Workshop Handout).
Self care
To increase energy levels one should care for self. This is
done through adequate sleep, balanced diet, drinking sufficient
water, reduce intake of caffeine, sugary foods, alcohol,
nicotine, recreational drugs (Stress Management Workshop
Handout).
Use of pictures
(see below).
Handouts given at
end of teaching
session. Multi
sessions may be
needed, and
scheduled at the
end of this
teaching session.
By the end of 10
minutes the learners
identify the following
as ways to deal with
the stress factors
identified earlier:
escape, physical
relaxation, self care,
time management,
having a support
network. Some
voiced that having
participating in these
activities occasionally
will act as
prophylaxis to stress

13. Time management
Much pressure is caused by feeling you have too many
demands and too little time. Sometimes individuals
procrastinate. This can be reduced if individuals prioritize, do
not procrastinate, and do not cut out sleep. Cut down on social
time when necessary, during long periods of work take a 5
minute break and move around (Stress Management
Workshop Handout).
Build a support network
Find individuals and support groups where you can talk to
vent (Stress Management Workshop Handout).
management.
Near the end of
teaching a summary
of the valid points
will be re-enforced.
Learners will be
asked questions to
evaluate their
understanding and
amount of
information retained.
A handout will be
given to learners at
the end of teaching

14. session to allow for
review and to refresh
memory

17. Diagrams used to illustrate strategies for stress management.

18. References:
Aynilists, (2013) Top 10 causes of stress in the work place retrieved on 18/05/2013 from
http://allyouneedislists.com/world-business/online-business/top-10-causes-of-stress-in-the-
workplace/
Davis, F.A. (2001), Taber‘s Cyclopedic Medical Dictionary (20th
ed) F.A. Davis Company, Philadelphia, PA
19103.
How can you manage stress diagram retrieved on 18/05/2013 from http://stressmanage.net/wp-
content/uploads/2012/08/Stress-Management.jpg
Lieb, S. (1991) Adult learning principles. Retrieved May 31, 2013, from
http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/adults-2.htm.
Ohio State University,(2007); Clear health communication program Retrieved May 31, 2013, from
http://medicine.osu.edu/sitetool/sites/pdfs/ahecpublic/Learning_Assessment.pdf
Segal, J., Smith, M., Robinson, L., & Segal, R., (2012) stress at work retrieved on 18/05/2013 from
http://www.helpguide.org/mental/work_stress_management.htm
Student Counseling Service, Stress Management Workshop Handout retrieved on 18/05/2013 from
http://www2.lse.ac.uk/intranet/students/supportServices/Handout.pdf
Stress management diagram retrieved on 18/05/2013 from http://stressmanage.net/wp-
content/uploads/2012/08/Stress-Management-Tips.jpg
ASSIGNMENT 5.1
DEVELOPING A CTDM BUILDING BLOCK 3

19. Assignment 5.1
Use the same grouping that was used for the group assignment in Unit 4 to complete this assignment. Choose one of the decision
making models and processes that were found in your reading. By following the steps of the model or process, show how you will
ensure that the staff on the ward where you work comply with the directive given by the Nursing Administrator to have the nursing
process (patient classification, work load index, and nursing care plan) implemented and maintained in the hospital.
The Model chosen by the group is the DECIDE Model. This Model aids health care managers in making more quality decisions.
Decisions that will in due course, result in success in the clinical setting (Guo, 2008).
According to Guo, (2008), the DECIDE model is the acronym of 6 particular activities needed in the decision-making process, which
includes:
(1) D = Define the problem,
(2) E = Establish the criteria,
(3) C = Consider all the alternatives,

20. (4) I = Identify the best alternative,
(5) D = Develop and implement a plan of action,
(6) E = Evaluate and monitor the solution and feedback when necessary.
Define the problem:
Based on the situation given, the Nurses are not using the Nursing Process (patient classification, work load index, and nursing care
plan) to administer care. The problem stems from the Registered Nurses not complying with the Nursing Administrator willingness to
incorporate the use of the Nursing Process in the patient‘s care. It is important that the nursing process be utilized for superior quality
of care to be administered. If the Nursing Process is used, the care provider would have enhanced patient outcome, meet the patient‘s
needs holistically, improve their job satisfaction (Clement, 2007).
Establish the criteria
Utilization of the Nursing Process would;
Enhanced patients care outcome (Clement, 2007).
Any RN can follow up patient care (Clement, 2007).
Meets the needs of the patient, family and community (Clement, 2007)

21. Creates opportunities for patients to be directly involved in their care (Clement, 2007)
It provides job satisfaction for nurses, by allowing nurses to determine what interventions based on accurate identification of
the patients problems, hence preventing trial and error nursing. (Clement, 2007)
In having the staff utilize to nursing process in administering care, the quality of care administered to the patient is preserved and
achieved with this decision, therefore avoiding the inability to meet patients needs, job dissatisfaction for nurses (clement, 2007). The
effective use and implementation of the nursing process in health care delivery would ensure quality patient care across the life span.
C- Consider all the alternatives
Hold a ward meeting, asking the staff for their opinions, on how to achieve the goal of having nursing staff utilize the Nursing Process
in providing care.
Alternatives to meet the criteria above include:
Delegating staff to be responsible for the patient classification.
Use and ensure the nurse to patient ratio, according to patient classification (AACCN, 2013)
Hire more staff to facilitate nurse – patient ratio.
Train staff through workshops, on how to use the Nursing Process and it benefits.

22. Motivate staff by recognizing them at staff meetings for good performance, give good appraisals when deserved.
Use of the Nursing Process.
Creation of suggestion boxes on various units
Engage nursing staff in weekly self reflection exercises and collegial dialogue on their experiences with the implementation of
the nursing process.
Formulate or revise admission forms to include forms for proper documentation of nursing care plans.
Use Maslow‘s hierarchy of needs to fulfill this goal allowing optimal patient care.
Use of most alternatives stated above should allow the use of the nursing process by Registered Nurses as an instrument used to
provide optimal care. Getting the staff actively involved will avoid staff resistance to the decision or change.
I - Identify the best alternatives.
At this phase the alternatives gained from the previous phase are reflected on, and the best are identified to be utilized. The best
alternative can be obtained through analyzing past experiences, intuition and research evidence (Guo, 2008).
"An alternative that satisfies all the criteria gets the highest rating (ie, a rating of a 10) and becomes the best alternative. This
approach, known as maximizing, develops the one best solution by comparing all the alternatives against all the criteria until one

23. solution emerges. The maximizing method leads to the one best solution, which is the only acceptable one" (Guo, 2008, (I = identify
the best alternative), para. 4).
The best alternative would include:
Training staff through workshops, on how to use the Nursing Process and it benefits towards quality patient care.
D- Develop and implement a plan of action.
Having workshops to train staff will require resources including personnel to do the training, a physical structure, equipments, cost.
The workshop will be held on the 8th
June, 2013 at 9am, in the Staff Lounge at the Victoria Hospital. The workshop will include what
is required of the manager and staff, the importance and benefits of using the nursing process as an instrument when providing care.
Goals such as by the end of one week, the manager will see improvement with the use of the nursing process and patient care will be
instituted. At the end of the week the manager reviews the notes to assess nursing care plan. A schedule will be made assigning staff
members days in which to do the patient classification, in order to determine the nursing resources needed to administer quality

24. nursing care. The manager is to ensure that this is done. These workshops will be held biannually to ensure staff stays on par and the
utilization of the nursing process as an instrument of care is maintained.
E- Evaluate and monitor the solution.
At this phase the plan is analyzed for defects. A meeting is held with staff who will voice concerns, queries and gains about the
change. Staff voice not having adequate time to do care plans due to the amount of work or number of patients providing care
for. Nursing care outcomes is evaluated through the use of data acquision (patient satisfaction tool, given to patients on discharge to
rate the care received), and questioning of inconsistencies allowing for revision of actions and goals.
In conclusion, decision making requires skills, knowledge, experience and understanding. The decision-making process and model
intends to assist managers improve their decision making to result in more effective decisions and become better equipped to act in
various situations that require decisions to be made. The DECIDE model is used in this scenario to help the manager make an
informed decision, with the assistance of staff, which will promote cooperation and implementation of the change. Monthly the
manager will monitor and evaluate the implementation of plan, whether principles are being followed, quality of care improved and
job satisfaction among staff is obtained, making the relevant changes where necessary (Guo, 2008).

25. References
American Association of Critical Care Nurses (2013), retrieved on 7/6/2013 from http://www.aacn.org/wd/practice/content/nurse-
staffing-ratio.pcms?menu=
Clement, I. (2007). Basic concepts on nursing procedures. Jaypee Brothers Publishers.
Guo, L., (2008); DECIDE: A decision making model for more effective decisions making by health care managers. The health care
managers, Volume 27 Number 2, p.118-127.