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When managers confront complex problems, their attitudes toward problem solving affect their behavior. The problem-solving attitudes of over 100 women and men who manage six hospitals are analyzed.
Interpersonal problem-solving skills of 17 mildly mentally retarded and two groups of nonretarded subjects (Ns = 30) matched on mental age (MA) and chronological age (CA) were assessed, utilizing a series of hypothetical problem-solving situations. Results indicated similarities between mentally retarded subjects and MA-matched nonretarded subjects both in types and number of strategies produced. Nonretarded CA-matched subjects, on the other hand, exhibited a wider range of problem-solving strategies and increased use of strategies thought to reflect higher levels of social understanding.
A collaborative problem-solving system committed to the interests of those involved complies with the teachings of the total quality management movement in health care. Deming espoused that any quality system must become an integral part of routine activities. A process that is used consistently in dealing with problems, issues, or conflicts provides a mechanism for accomplishing total quality improvement. The collaborative problem-solving process described here results in quality decision-making. This model incorporates Ishikawa's cause-and-effect (fishbone) diagram, Moore's key causes of conflict, and the steps of the University of North Dakota Conflict Resolution Center's collaborative problem solving model.
Hospitalized psychiatric patients frequently have deficits in their problem-solving abilities. An inpatient problem-solving group provides a therapeutic experience in which patients learn and apply the problem-solving process to practical and interpersonal difficulties they are presently experiencing. Two problem-solving group models, derived from cognitive-behavior theory, are suggested to accommodate diverse levels of inpatient functioning. Implications for nursing practice and recommendations are addressed.
OBJECTIVE: To determine whether, in the treatment of major depression in primary care, a brief psychological treatment (problem solving) was (a) as effective as antidepressant drugs and more effective than placebo; (b) feasible in practice; and (c) acceptable to patients. DESIGN: Randomised controlled trial of problem solving treatment, amitriptyline plus standard clinical management, and drug placebo plus standard clinical management. Each treatment was delivered in six sessions over 12 weeks. SETTING: Primary care in Oxfordshire. SUBJECTS: 91 patients in primary care who had major depression. MAIN OUTCOME MEASURES: Observer and self reported measures of severity of depression, self reported measure of social outcome, and observer measure of psychological symptoms at six and 12 weeks; self reported measure of patient satisfaction at 12 weeks. Numbers of patients recovered at six and 12 weeks. RESULTS: At six and 12 weeks the difference in score on the Hamilton rating scale for depression between problem solving and placebo treatments was significant (5.3 (95% confidence interval 1.6 to 9.0) and 4.7 (0.4 to 9.0) respectively), but the difference between problem solving and amitriptyline was not significant (1.8 (-1.8 to 5.5) and 0.9 (-3.3 to 5.2) respectively). At 12 weeks 60% (18/30) of patients given problem solving treatment had recovered on the Hamilton scale compared with 52% (16/31) given amitriptyline and 27% (8/30) given placebo. Patients were satisfied with problem solving treatment; all patients who completed treatment (28/30) rated the treatment as helpful or very helpful. The six sessions of problem solving treatment totalled a mean therapy time of 3 1/2 hours. CONCLUSIONS: As a treatment for major depression in primary care, problem solving treatment is effective, feasible, and acceptable to patients.
An organized radiologic problem-solving system is presented for developing improved view box exercises for students and residents. It is based on six components: (1) problem sensing, (2) problem hypothesizing, (3) problem searching and definition, (4) problem identification, (5) resolution, and (6) verification. Since all examinations by the practicing radiologist involve these components, worthwhile simulated clinical management games should also incorporate them. A simulated radiologic exercise should be a valid measurement of the resident's ability to manage a wide range of clinical situations and techniques and should improve problem-solving strategies. Use of simulated clinical cases eliminates risk to patients during the educational process.
OBJECTIVE: To determine whether expert problem-solving strategies can be identified within a large number of student performances of complex medical diagnostic simulations. METHODS: Self-organizing artificial neural networks were trained to categorize the performances of infectious disease subspecialists on six computer-based clinical diagnostic simulation that used the sequence of diagnostic tests requested as the input data. Six hundred seventy-six student solutions to these problems were presented to these trained neural networks to determine which, if any, of the student solutions represented those of the experts. RESULTS: For each simulation, the expert performances clustered around one dominant output neurode, indicating that there were common problem-specific features associated with the experts' problem-solving performances. When the performances of students who also made correct problem diagnoses were tested on these expert-trained neural networks, 17% were classified as representing expert strategies, indicating that expert performance was a somewhat rare and inconsistent occurrence among the students. CONCLUSIONS: The ability to identify a small number of expert-like strategies within a large body of student performances may provide an opportunity to study the dynamics of complex learning at both individual and population levels as well as the emergence of medical diagnostic expertise.
In the study reported here, the authors assessed the use of efficient organization of knowledge and of problem-solving strategies to enhance medical students' clinical problem-solving skills. Thirty-five preclinical medical students were randomly assigned to a experimental or control group and given a knowledge base containing information on eight congenital heart diseases to learn. Information for the experimental group emphasized disease groupings (based on their similar clinical presentation), symptom-disease associations, and clinical problem-solving heuristics. The same information for the control group was presented in a textbook format that emphasized the pathophysiology of the diseases. The students then diagnosed three computerized diagnostic problems of varying difficulty while verbalizing their problem-solving strategies. The results showed that the experimental group acquired a higher ratio of diagnostic to nondiagnostic cues, mentioned the correct diagnosis sooner in their workups, and correctly diagnosed the most difficult case more often than the control group. These results provide support for revisions in the organization and presentation of information that are aimed at improving clinical problem-solving skills.
The study investigated problem solving ability in schizophrenia. Thirty DSM-IIIR schizophrenic patients and 27 matched normal controls were tested on the Three-Dimensional Computerised Tower of London Test (3-D CTL Test) (Morris et al., 1993). The patients took significantly more moves to solve a series of problems and solved significantly fewer problems in the predetermined minimum number of moves. The patients response times, as measured using a control version of the task (the 3-D CTL Control), were longer than those of the controls. However, when latencies were adjusted to take into account the slower responses overall, the patients planning times were not significantly increased. Inaccurate planning, as defined by taking more moves, did not correlate with either positive or negative symptoms, but the response times tended to be longer in patients who had more negative symptoms. The findings suggest that there is a deficit in problem solving activity in schizophrenia that may be associated with translating 'willed intentions' into action, independent of slower motor speed.
To examine the relationship between an inferred hemispheric style and problem-solving performance, 78 undergraduate students were classified as having preference of Left-, Integrated-, or Right-hemispheric style by scores on Your Style of Learning and Thinking. The Tower of Hanoi was used as a measure of problem solving. Number of moves, total time, and number of illegal moves to solve the Tower of Hanoi task were the dependent measures of problem-solving performance. Analysis of variance showed significant differences among the three inferred hemispheric-style groups on two of the three measures of problem solving. Further comparison indicated that students who scored as showing Left-hemispheric style reported more moves and a longer mean time to solve the task than did students scoring as Right-hemispheric style. No differences were observed among the three groups on the number of illegal moves.
Although a mother's perception of her competence in problem-solving issues of infant care may affect her sensitivity to her infant's cues, little is known about factors that contribute to this perception. This study explored the type of information on which maternal confidence is based and examined its relationship to perceived competence in problem-solving issues of infant care. The 49 mothers of healthy newborns who participated in this study were interviewed 30 and 90 days after the infant's birth to learn about sources of confidence or uncertainty. The interview protocol also included scaled items to assess perceived problem-solving competence. The infant's mood was most frequently reported as either a source of confidence or uncertainty at both 30 and 90 days. The infant's response to care as a source of confidence or uncertainty was positively related to perceived competence, suggesting that strengthening mothers' attention to this source of information about their performance may be clinically useful. Direct study of the type of information used to evaluate competence in problem-solving is recommended, since it may differ from the type of information on which mothers base their confidence in caring for their infants.
This study examined the impact of social problem-solving training on the behavior of five aggressive boys. Acquisition of problem-solving skills and changes in classroom behavior were evaluated using multiple-baseline designs within and across subjects. A generalization-programming procedure to promote the use of problem-solving skills in the natural environment was introduced across children in multiple-baseline fashion. Direct observation and behavior ratings were used to evaluate the treatment. Results indicated that each subject acquired the problem-solving skills at levels comparable to well-adjusted peers. Only one child showed behavioral improvement coincident with problem-solving skill acquisition. Three others showed moderate behavior change after the generalization-programming procedure was introduced. Only one child's gains on teacher ratings were maintained at the 6-month followup. The results suggest that cognitive-behavioral treatment of childrens' aggressive behavior may produce changes of limited magnitude and durability.
We present a control theory analysis of adolescents' attachment strategies in the Adult Attachment Interview (AAI). In Study 1, Q-sort prototypes for secure/anxious and deactivating/hyperactivating strategies were used to differentiate between Main and Goldwyn's AAI classifications. In Study 2, we examined how AAI strategies were associated with emotion regulation during mother-teen problem solving. 4 aspects of mother-teen problem solving (dysfunctional anger, support/validation, avoidance of problem solving, and maternal dominance) were used to predict teens' AAI strategies. Teens with secure strategies engaged in problem-solving discussions characterized by less dysfunctional anger and less avoidance of problem solving. In addition, attachment security showed a curvilinear relation with maternal dominance, indicating that secure teens maintained balanced assertiveness with their mothers. Teens with deactivating strategies engaged in problem-solving interactions characterized by higher levels of maternal dominance and dysfunctional anger. The contribution of attachment strategies to teens' autonomy and to transformations in mother-teen relationships is discussed.
OBJECTIVE: To study social problem-solving skills in psychiatrically defined aggressive boys, starting from Dodge's social information-processing model. METHOD: Videotaped stimuli of problematic social situations and questions were presented to elicit responses that indicate boys' social problem-solving skills (encoding and interpretation of social cues, generation of possible responses, evaluation of responses, self-efficacy evaluation, and response selection). Boys aged 7 to 12 years with oppositional defiant or conduct disorder (ODD/CD) (n = 48), attention-deficit hyperactivity disorder (ADHD) (n = 27), and both disorders (ODD/CD + ADHD) (n = 29) were involved as well as a normal control group (n = 37) and a psychiatric control group with internalizing disorders (n = 23). RESULTS: When compared with normal controls, boys with ADHD, with ODD/CD, and with ODD/CD + ADHD encoded fewer social cues and generated fewer responses. Boys with ODD/CD and with ODD/CD + ADHD moreover were more confident in their ability to enact an aggressive response than normal controls. When ODD/CD boys and ODD/CD + ADHD boys were given the opportunity to select a response from various types of responses shown, they selected an aggressive response more often than normal controls. Thus, in ADHD boys social problem-solving was affected only in encoding and in the generation of responses, whereas in ODD/CD and ODD/CD + ADHD boys social problem-solving was affected throughout the process. CONCLUSION: For the further study of social problem-solving in aggressive children, it is essential to differentiate between children with ADHD and children with ODD/CD and ODD/CD + ADHD.
The advent of the laparoscopic revolution and the wider applicability of laparoscopic procedures has caused surgeons to re-think the dynamics of intraoperative problem-solving. Problems of body habitus, previous surgery, exposure, bleeding, and anesthesia, as well as the problem cholangiogram, require new and innovative approaches, a practical approach to each of these common laparoscopic problems is presented.
A problem-solving method to provide appropriate clinical learning experiences was developed for physical therapy students enrolled in their first year of professional course work. Clinicians from selected facilities were asked to participate in a clinical rotation over a two-quarter period. Using a problem-solving format, each clinician was responsible for a two-hour presentation relating to a disease or disability. Each rotation was repeated weekly for seven different groups of 10 students. During the rotation, the clinician presented a patient with a particular disability or disease and worked with the students to identify patient problems, establish treatment goals, and discuss methods used to achieve the goals. The difficulties encountered with the clinical experiences and the positive aspects of the experiences are discussed.
Tests the efficacy of social problem-solving therapy for unipolar depression and examines the relative contribution of training in the problem-orientation component of the overall model. This process involves various beliefs, assumptions, appraisals, and expectations concerning life's problems and one's problem-solving ability. It is conceptually distinct from the remaining four problem-solving components that are specific goal-directed tasks. A dismantling research design, involving 39 depressed Ss, provides findings that indicate problem-solving to be an effective cognitive-behavioral treatment approach for depression, thereby extending previous research. Moreover, the results underscore the importance of including problem-orientation training.
The aim of this South African study was to obtain a measurement of the problem-solving ability of diplomates from a basic nursing programme with this skill included in its programme objectives. The problem-solving skills of diplomates from this programme were compared with those of first years to determine if there is an improvement in the problem-solving skills. A comparison was also made with a different basic programmes not claiming to teach problem-solving. The research design selected for this study was the ex post facto design. Data were collected using the Triple Jump Method which is an interview technique. The findings suggested that the level of the problem-solving skills of the comprehensive nursing programme diplomate is not satisfactory. There was, however, some improvement in the problem-solving ability from the first to the fourth year. The level of performance of the fourth years was slightly higher than that of the third years of the three-year nursing programme, who were used as the control group. Recommendations on selection teaching and evaluation of students, as well as further research, were made.