1. Understanding the Maze of Non-Rational Thinking Dennis Ondrejka, Ph.D., R.N., COHN-S/CM Associate Professor, Denver School of Nursing goalquestinc@aol.com n This course challenges our traditional views that people are primarily logical. n If we are not logical or rational, what do we do? n We will evaluate the use of maturation models, advocacy models, bias, and principle methods used in Non-Rational PROBLEM SOLVING that can be used to address a host of complex occupational health nursing problems.

2. Objectives n 1. Develop an understanding of rational vs. non-rational (unstructured) thought that is tied to human behavior. n 2. Create an awareness of how one learns and develops a belief system for problem solving n 3. Examine the role of non-rational problem solving to address unstructured thought and behaviors.

3. Subjectives: Beyond the objective learning n S-1. Allow the participants to feel what it is like to use concrete rational thinking, and then to experience your feelings during periods of ambiguity and non-rational thinking. n S-2. Explore the human response to non- rational problem solving.

4. Rationalism, Associationism, Objectivism Started with Aristotle n You know because you can recreate objective reality of what you and others experience n You are able to determine the significant variables n You can make rational selections that will maximize your outcomes n Kantian, Aristonian, Tylerian,

5. Scientific Approach vs. Non-Rational Strategies n Decision Grids n Pay-off Tables n Decision Trees n Algorithms n Program Evaluation and Reviews n Mathematical Formulas n Statistical Inference n PERT, Gantt charts n The Human Factor n Hidden Agenda n Manipulation n Personal Bias n Self Serving Issues n Thinking filtered by emotion n Too Close to Home n Conscious thought

6. Solve the Problem 2 4 + X What is X? What assumptions must we make to answer this?

7. Solve the Problem n If A=3, and B=4, Find C n A+B=C n C = ____ Will A, B, or C always be the same regardless of the problem?

8. Solve the Problem n If we have jobs for those who can lift 30# from floor to hips, n and you are able to lift 30# from floor to hips, n Will you get the job? ____

9. Solve the Problem n We need someone who can do calculus, and is able to lift 30# from floor to hips. n I can do algebra 1, and can lift up to 50# over my head, n Will I get the job? ____

10. Solve the Problem n We need people who have good endurance, job flexible, good strength, and enjoy working as a team. n We only know this person wants the job, he/she works well with others, and does not need any accommodations. n Will we hire him/her? _____

11. Solve the Problem n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can perform his duties with one hand. n Staff nurses have no other roles on this unit. n Do you let Dennis come back to work?

12. Clinician Advocacy Scale by Dennis Ondrejka, Ph.D., R.N. (1995) c3 c2 c1 0 o1 o2 o3 Client Focused Organization Focused c3 = The client is always right. They understand themselves best. c2 = The client may need some discussion regarding options to make the best informed decision, or I may need to get additional information. c1 = I understand what the client wants and I will try to address that with other issues that may affect this decision. 0 = create a balance between client needs, and organization stewardship. o1 = I understand the client’s needs, but I need additional external support before I risk a liability to the company o2 = If I have difficulty believing the client, then I will try to curb abuses. o3 = Employees push everything on the company, and I see it as my role to protect the company against abuses.

13. Solve the Problem if you are a c3 n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can perform his duties with one hand. n Staff nurses have no other roles on this unit. n Do you let Dennis come back to work?

14. Solve the Problem if you are a o3 n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can perform his duties with one hand. n Staff nurses have no other roles on this unit. n Do you let Dennis come back to work?

15. Impacting your Non-Rational Problem Solving n Your choice of advocacy

16. Principle Centered Framing Model n 1. Plant safety comes first. n 2. The client is always right. n 3. First--Do no Harm. n 4. The doctor’s directions must be followed. n 5. Hold the person in the highest regard. n 6. The world is complex and full of paradox. We need to learn to live in it.

17. Solve the Problem if you Hold the Person in the Highest Regard n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can perform his duties with one hand. n Staff nurses have no other roles on this unit. n Do you let Dennis come back to work?

18. Principle Centered Framing Model n 1. Plant safety comes first. n 2. The client is always right. n 3. First--Do no Harm. n 4. The doctor’s directions must be followed. n 5. Hold the person in the highest regard. n 6. The world is complex and full of paradox. We need to learn to live in it.

19. Solve the Problem if Plant Safety is the Highest Priority n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can perform his duties with one hand. n Staff nurses have no other roles on this unit. n Do you let Dennis come back to work?

20. Impacting your Non-Rational Problem Solving n Your choice of advocacy n Principle based decisions

21. Biased Framing Model Judgments made through socially constructed learning n Profiling by race, religion, age, sexual orientation, & gender. n Subconscious blocks by the brain because there is no framework for it. n A primitive thought that was learned in childhood, and replayed as an adult. n A shadow attribute of self that cannot be accepted so it is projected unto others.

22. Solve the Problem if You Believe older workers have great work ethics and Dennis is “older” n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can perform his work with one hand. n Staff nurses don’t have any other role on this unit. n Do you let Dennis come back to work?

23. Solve the Problem if You Hold an Unconscious thought about injured workers who go back to work, seldom do all their work-They use it to their advantage n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can drive the fork lift with one hand. n Staff nurses don’t have any other roles on this unit. n Do you let Dennis come back to work?

24. Biased Framing Model n Profiling by race, religion, age, sexual orientation, & gender. (Blacks, Hispanics are …, Older workers are..., gays cannot …, women are …, He’s Jewish so...) n Subconscious blocks by the brain because there is no framework for it. (Dennis would work for free if he could just work. That is the way he is) n A primitive thought that was learned in childhood, and replayed as an adult. (all my buddies could manipulate their jobs anyway they wanted to, and people still do that) n A shadow attribute of self that cannot be accepted so it is projected unto others. (I hate work and I would do anything to get out of it, but that’s not me-as I am in denial, so I project it unto other’s)

25. Types of Framing Discussed n Advocacy Scale Framing n Principle Based Framing n Internal Biased Framing

26. Reflective Judgment Scale a model for maturation of thought n Pre-reflective n Transitional n Quasi-reflective n Reflective n Intersubjective reflectivity

27. Framing by Maturation of Thought n Pre-Reflective We can know with certainty. Knowledge is understood concretely as synonymous with facts. We either have knowledge immediately or get it from authorities. Justification is unnecessary because complex problems aren’t acknowledged. Called KISS Phase. (Archie Bunker)

28. Solve the Problem if You are Pre-Reflective and you don’t like Restrictions!!!! n Dennis wants to come back to work with a cast on his right arm and a restriction of “no use of right arm for 7 days.” n Dennis is a staff nurse and says he can perform his job with one hand. n Staff nurses don’t have any other roles on this unit. n Do you let Dennis come back to work?

29. Framing by Maturation of Thought n Transitional Knowledge is temporarily uncertain in some areas but certain in others. In time, we will know with certainty. Justification is impossible without certainty, thus, personal opinions are as valid as facts. Called Truth & Certainty Phase (Our middle school teacher mentor)

30. Framing by Maturation of Thought n Quasi-Reflective Knowledge is understood abstractly as involving uncertainty. Evidence is understood as relevant to a point of view, but knowledge and evidence can’t be clearly related. Can justify beliefs within a particular perspective: Called Skepticism or Relativism Phase. (Our freshman college mentor)

31. Framing by Maturation of Thought n Reflective Knowledge is the outcome of rational inquiry acting on evidence, which is often uncertain, incomplete, and inadequate. Reasonable judgments about the adequacy of arguments can be made based on an evaluation of evidence or an alignment with a conceptual framework. Called Critical Thinking Phase. ( Our university professor mentor)

32. Framing by Maturation of Thought n Intersubjective Reflectivity Knowledge is understood in multilevel complexity. Inquiry and evidence continues to be uncertain, incomplete, and inadequate, but it is important to correlate the adequacy of the argument to our best knowledge and still hold the ambiguity of the political nature of any phenomena.

33. Framing by Maturation of Thought n Intersubjective Reflectivity - cont. It allows for subjective, aesthetic, intuitive, and spiritual input as part of the layers of complexity. In relational understanding, it is critical to create clarity in the paradigm of the other person, maintain one’s own critical thinking, and live in the paradox that there are conflicting thoughts on most issues. Called Holistic Phase.

34. Reflective Judgment Scale n Pre-reflective: Would Archie Bunker let Dennis go back to work? Absolutely yes or absolutely no. n Transitional: I could let him go back to work if the doctor says its OK. (doctor does not know the hospital or his job, but we believe he/she is the expert)

35. Reflective Judgment Scale n Quasi-reflective: I think I need to discuss this with his doctor and see if he/she thinks it is still OK after we talk about the position. n Reflective: Lets evaluate him at the RTW center and have them simulate his ability to do this job. Then we can make a better decision. If that doesn’t work we will just have to decide.

36. Reflective Judgment Scale n Intersubjective reflectivity: Lets talk to Dennis and see what is motivating him, and explore what is going on for him. Maybe we can determine what he can do, or he can help us understand how he believes he can do this work safely. Maybe we will need more medical information or change the unit to handle such situations.

37. Types of Framing Discussed n Advocacy Scale Framing n Principle Based Framing n Internal Biased Framing n Maturation of thought Framing n Re-educative Framing

38. Solve the Problem n These are Numbers 12379 n These are NOT Numbers 24689 n Which of these are Numbers 81672

39. Solve the Problem n These are Blueblockers 48036 n These are not Blueblockers X L KURP n Which of these are Blueblockers 3FKL79

40. Solve the Problem n These are the patterns of Galactics %&$14 These are not Galactic patterns MPLAZ n Which of these are Galactics M$5Y @

41. Solving Unstructured Problems n We know about ourselves in highly critical ways. We know our own biases, principles, advocacy, maturation of thought, and how we normally see the world to prevent subconscious framing.

42. Solving Unstructured Problems n We are making choices on framing before we seek to solve problems. (either with awareness or without being aware).

43. The Challenge n We don’t typically identify and then bracket our beliefs in order to work with others. We often think the client needs our opinion without any knowledge of their framing process.

44. The Challenge n We spend little time, if any, understanding our own framing which is often hidden in our lack of awareness or is found in the subconscious world.

45. The Challenge n It takes active & personal hard work to become really aware of self, and this has not been the priority focus of our professional training.

46. The Road Less Traveled n Begin by looking for your inconsistent patterns and then explore why it happened. n Look for patterns that other’s criticize or you dislike about yourself.

47. The Road Less Traveled n Choose one person per day to listen to, ask them questions, but never tell them what to do. See if they can choose for him/ herself. (Practice) n Look for your principles, beliefs, advocacy, and articulate what they are and why you have them. You can change them if you know them.

48. The Road Less Traveled n In conflict, seek to determine how the other person is framing the issue. Check for maturation of thought before you step in.

49. Study Bibliography Abrams, J. & Zweig, C. (1990). Meeting the shadow: The hidden power of the dark side of human nature. (eds.). Los Angeles: Jeremy P. Tarcher, Inc. Block, P. (1988). The empowered manager. San Francisco: Jossey-Bass Publishing. Cody, W. K. (1997, Winter). “Persistence in health patterns: The mystery of being human.” Nursing Science Quarterly,10 (4), pp. 152-153. Dayton, T. (1994). The drama within. Deerfield Beach, FL: Health Communications, Inc. Deci, E.L., & Flaste, R. (1995). Why we do what we do. New York: G.P. Putnam’s Sons. Downing, C. (1991). Mirrors of the self (ed). Los Angeles: Jeremy P. Tarcher, Inc. Gioiela, E. C. (1997, Winter). “Changing health patterns: An enduring puzzle. Nursing Science Quarterly,10 (4), p. 151. Kitchener, K.S. (1986). The reflective judgment model: Characteristics, evidence, and measurement. In R. A. Mines & K. S. Kitchener (Eds), Cognitive development in young adults. New York: Praeger. Kitchener, K. S. & King, P. M. (1981). Reflective judgment: Concepts of justification and their relationship to age and education. Journal of Applied Developmental Psychology, 2, 89-116. Kritek. P. B. (1994). Negotiating at uneven tables: Developing moral courage to resolving our conflicts. San Francisco: Jossey-Bass Publishing. Lynch, C. L. (May 20, 1998). Optimizing problem solving, critical thinking, and reflective judgment in adult learners. Workshop presented at Regis University, Denver Colorado. Presenter is at (502) 436-5839. Marquis, B. L., and Huston, C. J. (1994). Management decision making for nurses. Philadelphia: J. B. Lippincott Company. Mayer, R. E. (1992). Thinking, problem solving, cognition. New York: W. H. Freeman and Company. Moore, T. (1940). Care of the soul (1992 ed.). New York: Harper Collins. Napier, N.J. (1990). Recreating your self. New York: W. W. Norton & Company. Oakley, E. & Krug, D. (1991). Enlightened leadership. New York: Simon & Schuster. Parse, R. R. (1990). Health: A personal commitment. Nursing Science Quarterly,3, pp. 136-140. Pilkington, F. B. (1997, Winter). “Knowledge and evidence: Do they change patterns of health?” Nursing Science Quarterly,10 (4), pp. 156-157.