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What Is Problem-Solving Therapy?

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long. 

Key Components

There are two major components that make up the problem-solving therapy framework:

• Applying a positive problem-solving orientation to your life
• Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

• Knowing how to identify a problem
• Defining the problem in a helpful way
• Trying to understand the problem more deeply
• Setting goals related to the problem
• Generating alternative, creative solutions to the problem
• Choosing the best course of action
• Implementing the choice you have made
• Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

• Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
• Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
• Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
• Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

• Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
• Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
• Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

• Chronic stress due to accumulating minor issues
• Complications associated with traumatic brain injury (TBI)
• Emotional distress
• Post-traumatic stress disorder (PTSD)
• Problems associated with a chronic disease like cancer, heart disease, or diabetes
• Self-harm and feelings of hopelessness
• Substance use
• Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

• Death of a loved one
• Dissatisfaction at work
• Everyday life stressors
• Family problems
• Financial difficulties
• Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

• Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
• Confidence that you can handle problems that you face
• Having a systematic approach on how to deal with life's problems
• Having a toolbox of strategies to solve the issues you face
• Increased confidence to find creative solutions
• Knowing how to identify which barriers will impede your progress
• Knowing how to manage emotions when they arise
• Reduced avoidance and increased action-taking
• The ability to accept life problems that can't be solved
• The ability to make effective decisions
• The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in: 

• Older adults
• People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials .  Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) .  Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study .  Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Why Is Problem-solving an Important Skill to Address Mental Health?

Problems that we cannot solve take a toll on our mental well-being . When we can’t get rid of a problem, it stresses us out. We lose sleep. We couldn’t even eat properly. That’s when our physical and mental health starts to decline . We feel stressed by the simplest of things. A small problem can lead to a bigger problem when left unsolved. We end up feeling depressed and hopeless because there seems to be no way out of the problem.

But when you learn how to solve your problems efficiently, you can also remove the stressors in your life. You will begin to learn how to cope with these problems, and you will soon find out that it’s easier to face them than run away from them. After all, no matter what you do, your problems are going to hound you.

What if the problems are not easily fixed?

There are problems, of course, that will be hard to address. Marriage problems are on the top of that list. Whenever you deal with issues in your personal relationship, you sometimes feel like there is no way out. No matter where you look, there will be consequences from your actions. There is, however, one particular step that you need to take when the matters get too serious—you have to call an  attorney from a family law firm . The attorney will guide you through the process of solving your marital problems.

Sometimes, you don’t even have to deal with the problem on your own. It’s through legal means. While the solution is complicated and expensive, what’s important is there is a way to solve the issue legally. Even problems in your workplace can be solved through legal means, so make sure you’re aware of your rights at work and at home.

Better functioning, improved productivity

When you can deal with the challenges that you face in your personal and professional life, you will be more productive at work. Stress will not weigh you down. You will also be better at dealing with your personal relationships when you have fewer problems and issues to think about. A problem-free life? Is that possible? Not really possible, but problems can be better managed.

Closer relationships with family, friends, and co-workers

People who cannot deal with problems often find themselves isolated from their family, friends, and co-workers. They become moody because of the stress of running away from their problems. But you can enjoy your relationships better when you have the skills to solve your problems, from small ones to complicated ones. You will become a better version of yourself, someone who can forge lasting relations with other people, even with your co-workers.

Higher Self-esteem

When you are confident with your ability to handle your problems, that will translate into everything you do. You will be more confident at work and in your personal relationships. You’re going to be more outgoing, too. This will improve not only your self-esteem but your social skills, too. You will be confident among your peers. That will create a positive impact on your mental health because your problem-solving skills will arm you with the tools you need to socialize, build camaraderie in the workplace, and improve your well-being.

Higher Life Satisfaction

Aren’t you more satisfied with life when you are free from worries? People tend to wallow in their sorrow when they don’t have any idea how to deal with their problems. However, once you have a “formula” of how to manage the issues that you face at work and home, then you will also have a better understanding of what makes you happy. Although you cannot always avoid situations that might lead to even bigger problems (since that is no way to live your life), you can arm yourself with the skills you need to be happier and more fulfilled.

Problems create stress in your life when you have no idea how to deal with them. Most people wouldn’t know how to solve or even face their problems. That’s normal because who really has a Ph.D. in problem-solving? But as you go through life and face challenges left and right, you need to find a “formula” that works for you. What is it that works for you? Do you need time to think, or are you the kind of person who acts immediately? Do you find it more satisfying when you face a problem head-on or when you take time off at first before dealing with it?

About The Author

Maria Santos

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How Therapy Works: The Importance of Skill Building

We can only do well what we know how to do well..

Posted February 9, 2021 | Reviewed by Abigail Fagan

Imagine yourself a therapist. The client across from you is a young man with a fear of driving. Once in his car, he experiences disorienting panic, which causes him much distress and limits his ability to enjoy his life. Your background assessment has shown that he is not physically handicapped (i.e., blind, deaf) or mentally handicapped (i.e., low intelligence ; psychosis ). What would you guess is the source of his problem? What questions would you ask him in order to figure it out?

Perhaps you’d start by inquiring about his personality traits. Is he an anxious, neurotic person, lacking in overall confidence ? If so, that could help explain things. His fear of driving is but one manifestation for his overall personality style.

Perhaps you’d inquire too about the condition of his car, or the road conditions where he lives. If his car is old and unreliable, or if he lives in a shattered war zone, then that may explain his fear.

Perhaps you’d want to inquire about his life history. Did he experience or witness a car accident as a child, thus developing a lifelong aversion? Was he involved in a recent accident, after which the symptoms emerged?

Perhaps you’d inquire too about his relationships with his parents. Perhaps his abusive father was a truck driver, and the client’s fear of driving manifests his unconscious resentment of his father.

All the above are good questions, and may yield important data. But the most important question you’d want to ask first is altogether different, simpler, and potentially more useful: Is he a good driver?

Owing much to the legacy of Sigmund Freud and his followers, therapy in the popular imagination is often viewed as a deep dive into the dark, convoluted mysteries of the unconscious, unearthing clients' traumatic experiences, tangled relationships histories, and personality quirks.

In the real world, however, clients’ difficulties often relate more to skill deficits than to deep, obscure, or complicated motives. Most meaningful life projects—relationship, work, love, sex , parenting , health, money—require a measure of skill. At the end of the day, we can only do what we know how to do, and we do it only as well as we know how.

Your personality traits, environmental conditions, and past experiences are important, and a big reason why is that they often relate to your skill level. But these are not one and the same and should not be confused. Traits are behavioral tendencies. Skills are behavioral abilities. Environmental conditions and early experiences create (and limit) opportunities for skill development, but they are not sufficient to produce skill. Having a piano at home is not the same thing as knowing how to play the piano.

Still, our traits, circumstances, and early experiences may help us to develop some skills over others. An extraverted person, who grew up in a socially open and safe environment will likely end up with better social skills than an introverted, isolated, timid individual.

Alas, the fact that your personality, circumstances, and early experiences have conspired to deprive you of certain life skills doesn’t render those skills less important; quite the opposite, in fact. Money doesn’t cease to matter because you were born poor. It matters more.

To wit: If I’m an introverted child growing up with timid parents and used to being ignored at school, then my self-assertion skills will remain underdeveloped. Such underdevelopment may underlie my current problems in finding intimacy and advancing at work. The solution is not to rage against my history or try to alter my biological makeup, but to acquire the missing skill.

Skill acquisition is effortful and may often require us to bump up against our temperamental tendencies, our experience, or our environmental conditions. If you’re an inhibited, introverted individual by personality, then you are less inclined to put yourself in situations of social interaction. This may over time lead to deteriorated social skills, and thus higher social anxiety and more social avoidance—a self-perpetuating vicious cycle.

To gain adequate skill, you’ll need to reverse the cycle, accept the discomfort, and move counter to your tendency. This is difficult, but worthwhile, because, as the work of psychologist Gilbert Gottlieb has shown, just as biological temperament may drive behavior, so behavior may drive biology. To evolve teeth, a species has to start biting first. Likewise, over time, skills may evolve into traits (if what you learned how to do becomes what you tend to do), re-shaping character , affecting experience (doing something well feels different than doing it poorly or not at all) and environmental conditions (improved skills lead to improved circumstances: social, financial, occupational etc.).

Once we agree that skills are important for mental health, the question arises: what are the most important mental health skills? A new article in Psychological Science attempts to answer this question. In the piece, authors Christopher Soto of Colby College and colleagues argue that in addition to the effects of personality, experience, intelligence, etc., “success in life is influenced by … social, emotional, and behavioral skills (SEB skills): a person’s capacities to maintain social relationships, regulate emotions, and manage goal- and learning-directed behaviors.” Summarizing a large body of research on such skills, they go on to propose “an integrative model that defines SEB skills as capacities (what someone is capable of doing) rather than personality traits (what someone tends to do).”

Noting that personality traits and skills are often correlated, the authors then organize these life skills by five major domains that parallel the Big Five personality traits, as follows:

Social Engagement skills (linked to the personality trait of extraversion ): Capacities used to actively engage with other people, including leadership (asserting one’s views and speak in a group) and conversational skill (initiating and maintaining social interactions)

Cooperation Skills (linked to agreeableness ): Capacities used to maintain positive social relationships, including perspective-taking (understanding other people’s thoughts and feelings) and social warmth (evoking positive social responses from other people).

Self Management Skills (linked to conscientiousness ): Capacities used to effectively pursue goals and complete tasks, including goal regulation: (setting clear and ambitious goals), and task management (working persistently to complete tasks and achieve goals).

Emotional Resilience Skills (parallel to low Neuroticism ): Capacities used to regulate emotions and moods, including stress regulation (regulating stress, anxiety , and fear), and anger management (regulating anger and irritation).

Innovation Skills ( openness to experience ): Capacities used to engage with novel ideas and experiences, including abstract thinking (engaging with abstract ideas) and artistic skill (creating and appreciating art).

The authors argue that while many SEB skills likely relate to personality traits and measured intelligence, they remain distinct enough to capture unique information.

A focus on skills is also useful because we cannot yet control our genes , early experience, and early environment, and we often have limited ability to control our current circumstances. Our skill level, however, is to a considerable extent under our control. We can get better at stuff, and one place in which to do this is in therapy.

Indeed, much evidence has accumulated in recent decades to show that life skills of the kind discussed by the authors can and do improve with therapy, as clients learn how to regulate emotions, set appropriate goals , manage stress , interact usefully with others , increase empathy , and appreciate abstraction .

Thus, the goal of therapy—and the hard work of it—is often for clients to find which important life skills are underdeveloped, and to develop them adequately.

Often, the way to eliminate your fear of driving is to become a better driver.

Noam Shpancer, Ph.D., is a professor of psychology at Otterbein University and a practicing clinical psychologist in Columbus, Ohio.

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Problem solving self-help guide

Work through a self-help guide for problem solving based on Cognitive Behavioural Therapy (CBT).

Navigate self-help guide

1. introduction, 2. identifying problems, 3. types of problem - activity 1, 4. recognising there's a problem, 5. barriers to problem-solving, 6. activity 2 – writing your problem list, 7. activity 3 - focusing on one problem, 8. activity 4 - pros and cons, 9. choosing a solution, 10. plan your chosen solution - activity 5, 11. how did it go, 12. next steps.

Section 1 of 12

Urgent help

This self-help guide is intended for people with mild-to-moderate mental health issues.

If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

For an emergency ambulance phone 999.

This self-help guide is intended for people with mild-to-moderate symptoms of depression.

It’s easy to feel overwhelmed by problems, particularly if you’re experiencing mental health difficulties. This guide:

• provides step-by-step advice on how to solve problems
• gives you a set of skills to help manage problems in the future

This guide is based on Cognitive Behavioural Therapy (CBT). CBT helps you to examine how you think about your life, and challenge negative automatic thoughts to free yourself from unhelpful thought and behaviour patterns.

How to use the problem solving self-help guide

Working through this guide can take around 30 to 40 minutes, but you should feel free to work at your own pace.

Work through the guide on your device, using the “Next” button to move forward and use the “Previous” button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

If you’d like to save the guide and return to it later, you’ll need to save it as a PDF on your device before you leave the page. You can then continue filling it out on the PDF. We don’t use a login feature on our mental health self-help guides for privacy reasons.

If you’d like to print the guide at any time, you’ll find an option to save and print the whole guide, including the parts you have added, in each section.

Section 2 of 12

When you solve a problem, it increases your confidence and makes you feel more able to solve problems in future. When you feel overwhelmed, it’s easy to forget that you already have the ability to solve problems – it’s how you’ve coped with life so far. This guide is designed to help you tap into that ability and boost your confidence.

Finding the hidden problem

Sometimes you can’t tell what the problem that’s affecting you most actually is – you might feel stuck and unable to think of anything that would help.

Here are 2 examples of hidden problems:

Work was becoming stressful for Paul after a new computer system was put in place. He’d been confident at work before, but was now finding it hard to get out of bed to go into the office. All his colleagues seemed to be managing fine, but Paul was making lots of mistakes. When his boss asked how he was doing, Paul felt like he had to say he was fine, as he was worried about being sacked. At home, his girlfriend had noticed a change in his mood – he wasn’t keen to go out or do anything they used to enjoy.

Mandy was a single parent. She looked after her sister’s child as well as her own 12-year-old daughter, Lizzie. She also cared for her elderly mum, who was unwell. Mandy found it difficult to find time for herself, and always felt like her house was a mess and cleaning was never done. She found herself becoming irritable, especially when people asked her to do things or asked her what was wrong. Mandy was angry that no one seemed to understand how busy she was.

From these examples, you may be able to see how sometimes problems can become overwhelming and hard to identify, while at other times you can see them clearly. In this guide you’ll continue to work on identifying your own problems, and work out a series of steps to solve them.

Section 3 of 12

There are a large number of different types of problem. Have a look at this list and see which type – or types – your problem could be.

• relationships – for example, difficulties getting along with your partner/spouse, falling out of touch with friends, or feeling alone and isolated
• money – for example, struggling to manage bills or afford different expenses, increasing debts,  or feeling pressure to spend money you can’t afford
• lifestyle issues – for example, drinking too much alcohol, not eating healthily, not having time for your interests, or not having time to keep in touch with friends and loved ones
• work/education – for example, trouble doing well at work or meeting deadlines
• addiction issues – for example alcohol, drugs, or gambling
• managing health – for example, organising GP and dentist appointments, or getting enough exercise
• illness or disability – for example, dealing with a chronic illness or having a disability
• family responsibilities – for example, being there for family commitments, organising childcare, helping with lots of requests from family, or being a carer

Use the boxes below to type any problems you might experience that fall under these categories.

Section 4 of 12

Paul’s girlfriend helped him talk about his job more. He explained that he hated his job because he couldn’t get used to the new computer system and was always worried about making a mistake. Paul told her he felt like he had to stay late at work to avoid falling behind, and that meant he was too tired to go out when he got home.

Paul recognised he was so unhappy at work because he was terrified he’d make a mistake with the new computer system. He also recognised that trying to cope by staying late at work was causing another problem – he was too tired to do the things he enjoyed when he got home. This was making him more unhappy.

Mandy didn’t want to let anyone know how she was feeling, but one Saturday her sister asked if Mandy could drop her child off at a birthday party for her. Mandy lost her temper, and was shocked by how angry and upset she felt. Once she calmed down, she decided it was time to sit down and think about what was really going on.

Mandy recognised that all the different tasks she had to do for other people, and all the demands on her time, were making her feel frustrated and irritable. They were also making it hard to fit everything in. Mandy recognised that she found it hard to say no to other people. This left her feeling angry when she ended up with very little time to do her own tasks, or take time for herself to do things she enjoyed.

Think about your own situation. You’ve reached a point where you need to take action, which is why you’re completing this guide. Where do you think would be a good place to start?

Section 5 of 12

Sometimes it feels like it’s impossible to even start solving your problems, but that’s not the case. Here are some common challenges.

Avoiding the problem

Paul had been avoiding bringing up the difficulties he was having with his girlfriend or his boss, because he didn’t want anyone to criticise him or think he wasn’t good enough at his job. This meant his boss didn’t know what the problem was when he noticed Paul taking longer with his tasks, and he didn’t know how to help. It also meant Paul’s girlfriend didn’t know why he wasn’t interested in activities in the evening anymore.

Mandy had been avoiding thinking about her problems, as she didn’t feel she had enough time. Instead, she was concentrating on everything she had to do every day, so she felt like she was coping. This meant she had little time for herself and other people didn’t realise she was finding it hard to cope.

Take a few minutes to think about whether you’ve been avoiding thinking about what your problem is. The next part of this guide will give you the chance to write out a list of your problems.

Feeling like you have too many problems

Writing a list of your problems helps to break your difficulties down so you can deal with one at a time. It also helps you to feel less overwhelmed.

You know what the problems are, but not the solutions

It’s okay if you don’t know the solutions just now. This approach gives you a structure you can use to find possible solutions that are realistic for you. It’s important to be patient with yourself – you don’t have to have all the answers straight away.

"Everything's fine in my life – I don't know why I feel like this."

Sometimes you can’t always identify what the problem is – to a stranger, it might seem like your life is perfect. But problems can include how you feel about yourself and your life too.

Do you ever do any of these things?

• put yourself down – think negative thoughts about yourself
• think negatively – always worry about what might go wrong rather than think about what might go right
• feel like everything has to be perfect – set yourself unrealistically high standards, so nothing you do ever feels “good enough”

These thinking problems can also be tackled by the methods in this guide.

If you can’t think of any problems that could explain while you feel this way, even after working through this guide, you should consider looking at  the other mental health self-help guides on NHS inform  if you haven’t already. You could also make an appointment with your GP to discuss things further. You can find a local GP using  Scotland’s Service Directory .

Section 6 of 12

The next step is writing out a list of your problems. You can either:

• use the boxes below, and save and download the list to your device at the end of this guide
• download a sh eet to your device

Please note:  If you decide to download a sheet to fill in, the text you add to that sheet will only be saved to your device. If you use an iPhone, the only way to edit the problem list is by using a PDF app on your device.

Here are some tips to make writing your problem list easier:

• Remember there are no wrong answers   – even the small things, over time, can grow into big issues. Nothing you write in this list is too small.
• Think about what’s really important to you – often when we’re struggling with things that seem small, it’s because we’re having trouble with areas of life that really matter to us.
• Talking   – try to talk to someone you know well and trust. If there isn’t anyone you feel comfortable discussing your issues with, you could call a service like  Breathing Space .
• If you need to, take a little time   – get away from the situation to allow yourself time to put things into perspective. Why not make yourself a cup of tea, or go for a walk? It’s often easier to see what the problem is when you’re not in the middle of it.

Section 7 of 12

The goal of writing a problem list is to pick one problem to work on at a time. After writing your problem list, the next step is to select the one you want to work on first.

Which one you choose is up to you but we suggest starting with the one that looks the easiest, or least distressing, to solve. You could also choose the one that you feel is the most important.

The next step is coming up with ideas for solving that problem.

Mandy chose the problem “not having enough time to relax”. While getting her ideas down, she came up with the following list, to help her find the time to do this.

• Book Lizzie into an after-school club, like drama or dancing
• Ask a friend or neighbour to watch Lizzie one evening a week
• Forget about housework for the next 3 years
• Ask Lizzie to help with some of the household chores
• Find a gym with a class Lizzie could do and go together
• Ask my sister for help with some of the things I have to do
• Get more confident about saying “no” to doing things when I’m busy

Getting all your ideas out

Use the solution sheet below to start writing out possible solutions to the problem you’ve chosen. The idea is to think up as many ways as possible of solving it, not come up with the perfect answer right away.

It’s important to write down every suggestion you think of, even if it seems unrealistic or ridiculous. The idea is to free up your creative thinking – thinking freely can help you consider things you normally wouldn’t.

You can include things you’re already doing to try and solve the problem.

You don’t have to fill out every line – if you can only come up with 2 or 3 solutions, that’s fine.

Ignore the part about pros and cons for now – this will be covered in the next section.

Download a solution sheet you can print or fill out on your device

Please note:  the text you add to the solution sheet will only be saved to your device. If you use an iPhone, the only way to edit the solution sheet is by using a PDF app on your device.

Section 8 of 12

The next step is thinking about the pros (good things) and cons (bad things) of each solution you thought of. Writing these down can help.

As an example, here’s the list Mandy came up with for her chosen problem.

Problem:  not having enough time to relax.

Write the pros and cons of each solution in the boxes on your solution sheet.

Section 9 of 12

Listing the pros and cons should’ve made it easier for you to decide what to do next. If not, try reading over the list again and thinking of some more pros and cons for each solution.

Are you having difficulty choosing a solution?

There are a few things that can make it harder for you to decide on a solution.

No solution seems good enough

There’s no such thing as a perfect solution – if there was, it’s likely you’d have solved the problem already. Are you setting your standards too high?

Your solution might not be perfect, but it doesn’t have to be perfect to start making things better.

You're scared to make the wrong choice

There’s always a bit of guessing involved in choosing a solution, as we can’t look into the future and see what’s going to happen.

With a lot of problems, it’s better to do something different than leave things the way they are. Even if things don’t turn out the way you’d hoped, it’s still a good chance to learn something and practice these problem-solving skills. In the next steps you’ll also review whether your solution helped – if not, you can follow the steps to try a different solution.

Two suggestions seem equally good

If you can’t choose which looks best, it might not matter very much which one you choose – they could both work equally well. Try one and see how it goes.

"The more I think about choosing a solution, the more I worry."

Getting caught up in worry can end up becoming a problem on its own. If you find yourself getting stressed out by trying to think of a solution, there are a couple of things you can do.

• do a relaxation exercise – you can find some  here
• distract yourself – do something different for a little while, like watching TV or reading a book
• decide to forget about the problem for a few hours or even a day – after you’ve had a break, you will feel better when you start thinking about it again
• it could be a good idea to look at your problem list and start with one that feels less overwhelming, where it’s easier think of possible solutions
• maybe a problem needs to be broken down more into simple steps to make it easier to think about solutions – for example, change “the house is a mess” to “the kitchen needs to be cleaned”

If you’re struggling to choose a solution and feel you’re getting caught up in worry, it might be worth visiting the  Depression  or  Anxiety  self-help guides on our site. If you’ve come to this guide from one of these, feel free to go back and work through it again if you think it’ll help.

We also have a lot of material on  coping with stress  that you might find helpful.

Section 10 of 12

It can be helpful to make a plan for the solution you’ve chosen. Once you lay out a step-by-step plan, taking action on your problem stops being a big task and becomes a number of smaller, more manageable tasks.

For example, Mandy decided to get more confident about saying no to things. You can see her action plan in the examples below.

Use the boxes below to write out your action plan step by step. You can save and download this at the end of the guide.

Or, if you prefer, you can download an action plan below to fill out on your device.

Download an action plan

Please note:  the text you add to the action plan PDF will only be saved to your device. If you use an iPhone, the only way to edit the action plan is by using a PDF app on your device.

Section 11 of 12

This is the time to reflect on how problem-solving went. Remember, even if your solution didn’t go the way you hoped, it’s important to keep using this approach until you feel confident.

1. The problem is solved

Well done! Your solution worked. Here are a couple of things to remember in future:

• You might not be aware that you’ve solved your problem until you realise you haven’t thought about it in a while – that’s fine, and shows that you don’t have to dwell on problems to solve them.
• It might be that things haven’t changed, or haven’t changed that much, but you’re now more able to deal with it.

2. The problem is slightly better

If the problem is slightly better, but not solved yet, there’s still a little more for you to do. There are a few things that could help:

• Keep doing what you’re doing – your problem could be solved if you continue with your current plan of action.
• Choose another solution from your list – have another look at your pros and cons list and see if another option could work better. Maybe a combination of two or more is the answer. You might even have another idea for a solution when you look at the list again.
• Choose another goal – have another look at your problem list and see if there is something else you could work on for a while.
• Choose a connected problem – if there’s another item on your problem list that could help solve the one you’re still working on, spend some time on that. You can return to the first problem later.

3. The problem isn’t better at all

If things aren’t any better, there are a few things you can do:

• Think about whether your plan has had time to work – things might get better if you keep going.
• Ask if anything at all is different – some things might be bad, but consider whether or not they were worse before you applied this problem-solving approach. The situation might have improved without you realising it.
• Try another option – go back over your solutions list, and the pros and cons, and see if a different solution works better.
• Check if you followed all the problem-solving steps correctly and, if needed, go back over some or all of the steps again.

If there still isn’t any improvement after you’ve done these things, don’t worry. If possible, discuss the problem with a person you trust, like a close friend or family member. You could also talk to someone anonymously using a service like  Breathing Space .

However it’s worked out, you should be proud of yourself for taking these steps. Keep using this problem-solving approach and it’ll get easier.

Section 12 of 12

Keep using the techniques from this guide – they’ll continue to help you. It’s important not to fall into old habits or forget how to use this problem-solving approach.

Remember that the problems you work on using these techniques don’t have to be big or life-changing – they can be day-to-day issues, or even decisions you need to make as part of work or study. The more you practice, the easier problem-solving will be.

Further help

If you’re feeling distressed, in a state of despair, suicidal or need emotional support you can phone NHS 24 on 111.

If you feel you need more help with your mental health, try speaking to your GP, or  search for mental health and wellbeing services in your area .

For information and advice when you’re feeling down, you can phone  Breathing Space  on 0800 83 85 87.

The Breathing Space phoneline is available:

• 24 hours at weekends (6pm Friday to 6am Monday)
• 6pm to 2am on weekdays (Monday to Thursday)

If you found this guide helpful and would like to do more work like this,  Living Life  offers a range of structured psychological interventions and therapies to improve mental health and wellbeing. This service is appointment-based and specifically for low mood, or mild/moderate depression or anxiety. Living Life are open Monday to Friday, from 1pm to 9pm, and you can phone them on 0800 328 9655 for an assessment appointment.

To learn more about coping with mental health issues,  visit our other mental health self-help guides on NHS inform .

For information that could help solve problems related to your health,  visit our Care, Support and Rights section .

To find services in your area that could help with a range of health and wellbeing issues, visit  Scotland’s Service Directory .

Section 1 of 17

This guide aims to help you:

• find out if you could have symptoms of depression
• understand more about depression
• find ways to manage or overcome depression

How to use the depression self-help guide

Work through the guide on your device, using the "Next" button to move forward and use the "Previous" button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

Last updated: 27 May 2021

Section 2 of 17

2. Symptoms of depression

Section 3 of 17

3. Symptoms of depression

Last updated: 4 March 2022

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Personal Growth

Building Mental Health Skills: Effective Interventions for a Stronger Mind

Mental health is essential to overall well-being, and developing a robust set of mental health skills can significantly affect how we cope with life's challenges. This article will explore various mental health skill-building interventions that can help you enhance emotional resilience, improve communication, and foster a healthier mindset.

Emotional Resilience Interventions

Emotional resilience refers to adapting to and recovering from adversity or challenging situations. Cultivating emotional resilience can lead to improved mental health and a greater sense of well-being. The following interventions can help you build emotional strength:

Cognitive Restructuring

Learn to identify and challenge negative thought patterns, replacing them with more balanced and positive perspectives. Practice reframing difficult situations to find the silver lining or growth opportunities.

Stress Management Techniques

Develop a toolbox of stress management strategies, such as deep breathing, progressive muscle relaxation, or mindfulness exercises. Implement these techniques regularly to build resilience and better manage stress.

Communication Skills Interventions

Effective communication is crucial for maintaining healthy relationships and navigating various social situations. Enhancing your communication skills can contribute to improved mental health and well-being. The following interventions can help you build stronger communication skills:

Active Listening

Practice active listening by giving your full attention to the speaker, making eye contact, and providing nonverbal feedback. Learn to withhold judgment and focus on understanding the other person's perspective.

Assertiveness Training

Develop assertiveness skills by expressing your feelings, needs, and opinions respectfully and confidently. Practice setting boundaries and saying "no" when necessary.

Mindfulness and Self-Awareness Interventions

Mindfulness and self-awareness are essential for understanding and managing our thoughts, feelings, and behaviors. Cultivating these skills can lead to improved mental health and emotional well-being. The following interventions can help you develop mindfulness and self-awareness:

Mindfulness Meditation

Practice mindfulness meditation by focusing on your breath, bodily sensations, or a specific object or mantra. Learn to observe your thoughts and feelings without judgment or attachment.

Engage in regular journaling to reflect on your thoughts, feelings, and experiences. Use journaling as a self-exploration tool and identify patterns or themes in your life.

Problem-Solving and Decision-Making Interventions

Effective problem-solving and decision-making skills are crucial for navigating life's challenges and maintaining mental health. The following interventions can help you build these essential skills:

Problem-Solving Strategies

Learn and practice various problem-solving strategies, such as brainstorming, evaluating pros and cons, and breaking down larger problems into smaller, manageable steps. Develop a growth mindset by viewing challenges as opportunities for learning and growth.

Decision-Making Techniques

Use systematic decision-making techniques, such as weighted pros and cons lists, to objectively evaluate your options. Trust your intuition and consider rational and emotional factors when making decisions.

Self-Compassion and Empathy Interventions

Cultivating self-compassion and empathy can lead to a deeper understanding of ourselves and others, improving mental health and emotional well-being. The following interventions can help you develop self-compassion and empathy:

Self-Compassion Practices

Learn to treat yourself with kindness and understanding, especially during difficult times—practice self-compassion exercises, such as writing a letter to yourself or using self-compassionate language in your self-talk.

Empathy Development

Engage in activities that foster empathy, such as reading literature or watching films that provide insight into the experiences of others. Practice putting yourself in someone else's shoes and imagining their feelings and perspectives.

Goal Setting and Personal Growth Interventions

Setting goals and working towards personal growth can contribute to a sense of accomplishment, purpose, and overall mental health. The following interventions can help you set meaningful goals and continue to grow as an individual:

SMART Goal Setting

Develop clear and specific goals using the SMART (Specific, Measurable, Achievable, Relevant, Time-bound) framework. Break down larger goals into smaller, actionable steps to make them more manageable and achievable.

Self-Reflection and Personal Growth

Regularly reflect on your values, strengths, and areas for growth. Seek out new experiences and opportunities for learning to facilitate personal growth and self-improvement.

Creating a Supportive Environment

Surrounding yourself with a supportive environment is crucial for maintaining mental health and well-being. The following interventions can help you create a nurturing and uplifting atmosphere:

Building a Support Network

Develop strong relationships with friends, family, and community members who provide emotional support and encouragement. Seek social activities and join groups or clubs that align with your interests and values.

Cultivating a Positive Home Environment

Create a living space that promotes relaxation, comfort, and safety. Incorporate elements that reflect your personality and values, and ensure your home environment supports your mental health and well-being.

Final Thoughts

Building mental health skills is an ongoing journey that requires dedication, practice, and patience. Investing time and effort into developing these essential skills, you'll be better equipped to navigate life's challenges and maintain overall well-being. As you build your mental health skills, your emotional resilience, relationships, and sense of fulfillment will continue to grow and strengthen. Remember that progress may be gradual, and it's essential to be kind to yourself and seek support when needed.

Grouport Offers Online Group Therapy and Online DBT Skills Group

Grouport Therapy  provides online cognitive behavioral therapy (CBT) groups to assist individuals struggling with  anxiety ,  depression ,  PTSD, and trauma . Our online group therapy sessions teach members how to integrate CBT techniques into their daily lives. Incorporating these skill sets enables them to recognize triggers, counteract negative thought patterns, and adopt more positive behaviors to recover from and manage their symptoms.

Our licensed therapist leads weekly group sessions conducted remotely in the comfort of members' homes. According to participant feedback, 70% experienced significant improvements within 8 weeks.

You don't have to face these challenges alone.  Sign up for one of our courses  today and begin your journey towards meaningful, lasting change and renewed hope. Join our community and work together towards a brighter future.

Our CBT online group therapy sessions are for Florida, New York, and New Jersey residents due to licensing restrictions. If you are not a resident of either state, consider our  dialectical behavior therapy skills group . It is a therapist-instructor-led online group that will teach you strategic new skills to replace behaviors and emotions causing friction in your daily life and relationships.

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The Importance of Adherent Dialectical Behavior Therapy

The link between depression and weight gain, navigating unexplained sadness: understanding depression without a clear cause, get started with grouport today.

• Research article
• Open access
• Published: 07 October 2020

Impact of social problem-solving training on critical thinking and decision making of nursing students

• Soleiman Ahmady 1 &
• Sara Shahbazi   ORCID: orcid.org/0000-0001-8397-6233 2 , 3  

BMC Nursing volume  19 , Article number:  94 ( 2020 ) Cite this article

30k Accesses

25 Citations

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Metrics details

The complex health system and challenging patient care environment require experienced nurses, especially those with high cognitive skills such as problem-solving, decision- making and critical thinking. Therefore, this study investigated the impact of social problem-solving training on nursing students’ critical thinking and decision-making.

This study was quasi-experimental research and pre-test and post-test design and performed on 40 undergraduate/four-year students of nursing in Borujen Nursing School/Iran that was randomly divided into 2 groups; experimental ( n  = 20) and control (n = 20). Then, a social problem-solving course was held for the experimental group. A demographic questionnaire, social problem-solving inventory-revised, California critical thinking test, and decision-making questionnaire was used to collect the information. The reliability and validity of all of them were confirmed. Data analysis was performed using SPSS software and independent sampled T-test, paired T-test, square chi, and Pearson correlation coefficient.

The finding indicated that the social problem-solving course positively affected the student’ social problem-solving and decision-making and critical thinking skills after the instructional course in the experimental group ( P  < 0.05), but this result was not observed in the control group ( P  > 0.05).

Conclusions

The results showed that structured social problem-solving training could improve cognitive problem-solving, critical thinking, and decision-making skills. Considering this result, nursing education should be presented using new strategies and creative and different ways from traditional education methods. Cognitive skills training should be integrated in the nursing curriculum. Therefore, training cognitive skills such as problem- solving to nursing students is recommended.

Peer Review reports

Continuous monitoring and providing high-quality care to patients is one of the main tasks of nurses. Nurses’ roles are diverse and include care, educational, supportive, and interventional roles when dealing with patients’ clinical problems [ 1 , 2 ].

Providing professional nursing services requires the cognitive skills such as problem-solving, decision-making and critical thinking, and information synthesis [ 3 ].

Problem-solving is an essential skill in nursing. Improving this skill is very important for nurses because it is an intellectual process which requires the reflection and creative thinking [ 4 ].

Problem-solving skill means acquiring knowledge to reach a solution, and a person’s ability to use this knowledge to find a solution requires critical thinking. The promotion of these skills is considered a necessary condition for nurses’ performance in the nursing profession [ 5 , 6 ].

Managing the complexities and challenges of health systems requires competent nurses with high levels of critical thinking skills. A nurse’s critical thinking skills can affect patient safety because it enables nurses to correctly diagnose the patient’s initial problem and take the right action for the right reason [ 4 , 7 , 8 ].

Problem-solving and decision-making are complex and difficult processes for nurses, because they have to care for multiple patients with different problems in complex and unpredictable treatment environments [ 9 , 10 ].

Clinical decision making is an important element of professional nursing care; nurses’ ability to form effective clinical decisions is the most significant issue affecting the care standard. Nurses build 2 kinds of choices associated with the practice: patient care decisions that affect direct patient care and occupational decisions that affect the work context or teams [ 11 , 12 , 13 , 14 , 15 , 16 ].

The utilization of nursing process guarantees the provision of professional and effective care. The nursing process provides nurses with the chance to learn problem-solving skills through teamwork, health management, and patient care. Problem-solving is at the heart of nursing process which is why this skill underlies all nursing practices. Therefore, proper training of this skill in an undergraduate nursing program is essential [ 17 ].

Nursing students face unique problems which are specific to the clinical and therapeutic environment, causing a lot of stresses during clinical education. This stress can affect their problem- solving skills [ 18 , 19 , 20 , 21 ]. They need to promote their problem-solving and critical thinking skills to meet the complex needs of current healthcare settings and should be able to respond to changing circumstances and apply knowledge and skills in different clinical situations [ 22 ]. Institutions should provide this important opportunity for them.

Despite, the results of studies in nursing students show the weakness of their problem-solving skills, while in complex health environments and exposure to emerging diseases, nurses need to diagnose problems and solve them rapidly accurately. The teaching of these skills should begin in college and continue in health care environments [ 5 , 23 , 24 ].

It should not be forgotten that in addition to the problems caused by the patients’ disease, a large proportion of the problems facing nurses are related to the procedures of the natural life of their patients and their families, the majority of nurses with the rest of health team and the various roles defined for nurses [ 25 ].

Therefore, in addition to above- mentioned issues, other ability is required to deal with common problems in the working environment for nurses, the skill is “social problem solving”, because the term social problem-solving includes a method of problem-solving in the “natural context” or the “real world” [ 26 , 27 ]. In reviewing the existing research literature on the competencies and skills required by nursing students, what attracts a lot of attention is the weakness of basic skills and the lack of formal and systematic training of these skills in the nursing curriculum, it indicates a gap in this area [ 5 , 24 , 25 ]. In this regard, the researchers tried to reduce this significant gap by holding a formal problem-solving skills training course, emphasizing the common social issues in the real world of work. Therefore, this study was conducted to investigate the impact of social problem-solving skills training on nursing students’ critical thinking and decision-making.

Setting and sample

This quasi-experimental study with pretest and post-test design was performed on 40 undergraduate/four-year nursing students in Borujen nursing school in Shahrekord University of Medical Sciences. The periods of data collection were 4 months.

According to the fact that senior students of nursing have passed clinical training and internship programs, they have more familiarity with wards and treatment areas, patients and issues in treatment areas and also they have faced the problems which the nurses have with other health team personnel and patients and their families, they have been chosen for this study. Therefore, this study’s sampling method was based on the purpose, and the sample size was equal to the total population. The whole of four-year nursing students participated in this study and the sample size was 40 members. Participants was randomly divided in 2 groups; experimental ( n  = 20) and control (n = 20).

The inclusion criteria to take part in the present research were students’ willingness to take part, studying in the four-year nursing, not having the record of psychological sickness or using the related drugs (all based on their self-utterance).

Intervention

At the beginning of study, all students completed the demographic information’ questionnaire. The study’s intervening variables were controlled between the two groups [such as age, marital status, work experience, training courses, psychological illness, psychiatric medication use and improving cognitive skills courses (critical thinking, problem- solving, and decision making in the last 6 months)]. Both groups were homogeneous in terms of demographic variables ( P  > 0.05). Decision making and critical thinking skills and social problem solving of participants in 2 groups was evaluated before and 1 month after the intervention.

All questionnaires were anonymous and had an identification code which carefully distributed by the researcher.

To control the transfer of information among the students of two groups, the classification list of students for internships, provided by the head of nursing department at the beginning of semester, was used.

Furthermore, the groups with the odd number of experimental group and the groups with the even number formed the control group and thus were less in contact with each other.

The importance of not transferring information among groups was fully described to the experimental group. They were asked not to provide any information about the course to the students of the control group.

Then, training a course of social problem-solving skills for the experimental group, given in a separate course and the period from the nursing curriculum and was held in 8 sessions during 2 months, using small group discussion, brainstorming, case-based discussion, and reaching the solution in small 4 member groups, taking results of the social problem-solving model as mentioned by D-zurilla and gold fried [ 26 ]. The instructor was an assistant professor of university and had a history of teaching problem-solving courses. This model’ stages are explained in Table  1 .

All training sessions were performed due to the model, and one step of the model was implemented in each session. In each session, the teacher stated the educational objectives and asked the students to share their experiences in dealing to various workplace problems, home and community due to the topic of session. Besides, in each session, a case-based scenario was presented and thoroughly analyzed, and students discussed it.

Instruments

In this study, the data were collected using demographic variables questionnaire and social problem- solving inventory – revised (SPSI-R) developed by D’zurilla and Nezu (2002) [ 26 ], California critical thinking skills test- form B (CCTST; 1994) [ 27 , 28 ] and decision-making questionnaire.

SPSI-R is a self - reporting tool with 52 questions ranging from a Likert scale (1: Absolutely not – 5: very much).

The minimum score maybe 25 and at a maximum of 125, therefore:

The score 25 and 50: weak social problem-solving skills.

The score 50–75: moderate social problem-solving skills.

The score higher of 75: strong social problem-solving skills.

The reliability assessed by repeated tests is between 0.68 and 0.91, and its alpha coefficient between 0.69 and 0.95 was reported [ 26 ]. The structural validity of questionnaire has also been confirmed. All validity analyses have confirmed SPSI as a social problem - solving scale.

In Iran, the alpha coefficient of 0.85 is measured for five factors, and the retest reliability coefficient was obtained 0.88. All of the narratives analyzes confirmed SPSI as a social problem- solving scale [ 29 ].

California critical thinking skills test- form B(CCTST; 1994): This test is a standard tool for assessing the basic skills of critical thinking at the high school and higher education levels (Facione & Facione, 1992, 1998) [ 27 ].

This tool has 34 multiple-choice questions which assessed analysis, inference, and argument evaluation. Facione and Facione (1993) reported that a KR-20 range of 0.65 to 0.75 for this tool is acceptable [ 27 ].

In Iran, the KR-20 for the total scale was 0.62. This coefficient is acceptable for questionnaires that measure the level of thinking ability of individuals.

After changing the English names of this questionnaire to Persian, its content validity was approved by the Board of Experts.

The subscale analysis of Persian version of CCTST showed a positive high level of correlation between total test score and the components (analysis, r = 0.61; evaluation, r = 0.71; inference, r = 0.88; inductive reasoning, r = 0.73; and deductive reasoning, r = 0.74) [ 28 ].

A decision-making questionnaire with 20 questions was used to measure decision-making skills. This questionnaire was made by a researcher and was prepared under the supervision of a professor with psychometric expertise. Five professors confirmed the face and content validity of this questionnaire. The reliability was obtained at 0.87 which confirmed for 30 students using the test-retest method at a time interval of 2 weeks. Each question had four levels and a score from 0.25 to 1. The minimum score of this questionnaire was 5, and the maximum score was 20 [ 30 ].

Statistical analysis

For analyzing the applied data, the SPSS Version 16, and descriptive statistics tests, independent sample T-test, paired T-test, Pearson correlation coefficient, and square chi were used. The significant level was taken P  < 0.05.

The average age of students was 21.7 ± 1.34, and the academic average total score was 16.32 ± 2.83. Other demographic characteristics are presented in Table  2 .

None of the students had a history of psychiatric illness or psychiatric drug use. Findings obtained from the chi-square test showed that there is not any significant difference between the two groups statistically in terms of demographic variables.

The mean scores in social decision making, critical thinking, and decision-making in whole samples before intervention showed no significant difference between the two groups statistically ( P  > 0.05), but showed a significant difference after the intervention ( P  < 0.05) (Table  3 ).

Scores in Table  4 showed a significant positive difference before and after intervention in the “experimental” group ( P  < 0.05), but this difference was not seen in the control group ( P  > 0.05).

Among the demographic variables, only a positive relationship was seen between marital status and decision-making skills (r = 0.72, P  < 0.05).

Also, the scores of critical thinking skill’ subgroups and social problem solving’ subgroups are presented in Tables  5 and 6 which showed a significant positive difference before and after intervention in the “experimental” group (P < 0.05), but this difference was not seen in the control group ( P  > 0.05).

In the present study conducted by some studies, problem-solving and critical thinking and decision-making scores of nursing students are moderate [ 5 , 24 , 31 ].

The results showed that problem-solving skills, critical thinking, and decision-making in nursing students were promoted through a social problem-solving training course. Unfortunately, no study has examined the effect of teaching social problem-solving skills on nursing students’ critical thinking and decision-making skills.

Altun (2018) believes that if the values of truth and human dignity are promoted in students, it will help them acquire problem-solving skills. Free discussion between students and faculty on value topics can lead to the development of students’ information processing in values. Developing self-awareness increases students’ impartiality and problem-solving ability [ 5 ]. The results of this study are consistent to the results of present study.

Erozkan (2017), in his study, reported there is a significant relationship between social problem solving and social self-efficacy and the sub-dimensions of social problem solving [ 32 ]. In the present study, social problem -solving skills training has improved problem -solving skills and its subdivisions.

The results of study by Moshirabadi (2015) showed that the mean score of total problem-solving skills was 89.52 ± 21.58 and this average was lower in fourth-year students than other students. He explained that education should improve students’ problem-solving skills. Because nursing students with advanced problem-solving skills are vital to today’s evolving society [ 22 ]. In the present study, the results showed students’ weakness in the skills in question, and holding a social problem-solving skills training course could increase the level of these skills.

Çinar (2010) reported midwives and nurses are expected to use problem-solving strategies and effective decision-making in their work, using rich basic knowledge.

These skills should be developed throughout one’s profession. The results of this study showed that academic education could increase problem-solving skills of nursing and midwifery students, and final year students have higher skill levels [ 23 ].

Bayani (2012) reported that the ability to solve social problems has a determining role in mental health. Problem-solving training can lead to a level upgrade of mental health and quality of life [ 33 ]; These results agree with the results obtained in our study.

Conducted by this study, Kocoglu (2016) reported nurses’ understanding of their problem-solving skills is moderate. Receiving advice and support from qualified nursing managers and educators can enhance this skill and positively impact their behavior [ 31 ].

Kashaninia (2015), in her study, reported teaching critical thinking skills can promote critical thinking and the application of rational decision-making styles by nurses.

One of the main components of sound performance in nursing is nurses’ ability to process information and make good decisions; these abilities themselves require critical thinking. Therefore, universities should envisage educational and supportive programs emphasizing critical thinking to cultivate their students’ professional competencies, decision-making, problem-solving, and self-efficacy [ 34 ].

The study results of Kirmizi (2015) also showed a moderate positive relationship between critical thinking and problem-solving skills [ 35 ].

Hong (2015) reported that using continuing PBL training promotes reflection and critical thinking in clinical nurses. Applying brainstorming in PBL increases the motivation to participate collaboratively and encourages teamwork. Learners become familiar with different perspectives on patients’ problems and gain a more comprehensive understanding. Achieving these competencies is the basis of clinical decision-making in nursing. The dynamic and ongoing involvement of clinical staff can bridge the gap between theory and practice [ 36 ].

Ancel (2016) emphasizes that structured and managed problem-solving training can increase students’ confidence in applying problem-solving skills and help them achieve self-confidence. He reported that nursing students want to be taught in more innovative ways than traditional teaching methods which cognitive skills training should be included in their curriculum. To this end, university faculties and lecturers should believe in the importance of strategies used in teaching and the richness of educational content offered to students [ 17 ].

The results of these recent studies are adjusted with the finding of recent research and emphasize the importance of structured teaching cognitive skills to nurses and nursing students.

Based on the results of this study on improving critical thinking and decision-making skills in the intervention group, researchers guess the reasons to achieve the results of study in the following cases:

In nursing internationally, problem-solving skills (PS) have been introduced as a key strategy for better patient care [ 17 ]. Problem-solving can be defined as a self-oriented cognitive-behavioral process used to identify or discover effective solutions to a special problem in everyday life. In particular, the application of this cognitive-behavioral methodology identifies a wide range of possible effective solutions to a particular problem and enhancement the likelihood of selecting the most effective solution from among the various options [ 27 ].

In social problem-solving theory, there is a difference among the concepts of problem-solving and solution implementation, because the concepts of these two processes are different, and in practice, they require different skills.

In the problem-solving process, we seek to find solutions to specific problems, while in the implementation of solution, the process of implementing those solutions in the real problematic situation is considered [ 25 , 26 ].

The use of D’zurilla and Goldfride’s social problem-solving model was effective in achieving the study results because of its theoretical foundations and the usage of the principles of cognitive reinforcement skills. Social problem solving is considered an intellectual, logical, effort-based, and deliberate activity [ 26 , 32 ]; therefore, using this model can also affect other skills that need recognition.

In this study, problem-solving training from case studies and group discussion methods, brainstorming, and activity in small groups, was used.

There are significant educational achievements in using small- group learning strategies. The limited number of learners in each group increases the interaction between learners, instructors, and content. In this way, the teacher will be able to predict activities and apply techniques that will lead students to achieve high cognitive taxonomy levels. That is, confront students with assignments and activities that force them to use cognitive processes such as analysis, reasoning, evaluation, and criticism.

In small groups, students are given the opportunity to the enquiry, discuss differences of opinion, and come up with solutions. This method creates a comprehensive understanding of the subject for the student [ 36 ].

According to the results, social problem solving increases the nurses’ decision-making ability and critical thinking regarding identifying the patient’s needs and choosing the best nursing procedures. According to what was discussed, the implementation of this intervention in larger groups and in different levels of education by teaching other cognitive skills and examining their impact on other cognitive skills of nursing students, in the future, is recommended.

Social problem- solving training by affecting critical thinking skills and decision-making of nursing students increases patient safety. It improves the quality of care because patients’ needs are better identified and analyzed, and the best solutions are adopted to solve the problem.

In the end, the implementation of this intervention in larger groups in different levels of education by teaching other cognitive skills and examining their impact on other cognitive skills of nursing students in the future is recommended.

Study limitations

This study was performed on fourth-year nursing students, but the students of other levels should be studied during a cohort from the beginning to the end of course to monitor the cognitive skills improvement.

The promotion of high-level cognitive skills is one of the main goals of higher education. It is very necessary to adopt appropriate approaches to improve the level of thinking. According to this study results, the teachers and planners are expected to use effective approaches and models such as D’zurilla and Goldfride social problem solving to improve problem-solving, critical thinking, and decision-making skills. What has been confirmed in this study is that the routine training in the control group should, as it should, has not been able to improve the students’ critical thinking skills, and the traditional educational system needs to be transformed and reviewed to achieve this goal.

Availability of data and materials

The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.

Abbreviations

California critical thinking skills test

Social problem-solving inventory – revised

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Acknowledgments

This article results from research project No. 980 approved by the Research and Technology Department of Shahrekord University of Medical Sciences. We would like to appreciate to all personnel and students of the Borujen Nursing School. The efforts of all those who assisted us throughout this research.

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SA and SSH conceptualized the study, developed the proposal, coordinated the project, completed initial data entry and analysis, and wrote the report. SSH conducted the statistical analyses. SA and SSH assisted in writing and editing the final report. All authors read and approved the final manuscript.

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Ahmady, S., Shahbazi, S. Impact of social problem-solving training on critical thinking and decision making of nursing students. BMC Nurs 19 , 94 (2020). https://doi.org/10.1186/s12912-020-00487-x

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Communication Skills, Problem-Solving Ability, Understanding of Patients’ Conditions, and Nurse’s Perception of Professionalism among Clinical Nurses: A Structural Equation Model Analysis

This study was intended to confirm the structural relationship between clinical nurse communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. Due to changes in the healthcare environment, it is becoming difficult to meet the needs of patients, and it is becoming very important to improve the ability to perform professional nursing jobs to meet expectations. In this study method, structural model analysis was applied to identify factors influencing the perception of professionalism in nurses. The subjects of this study were 171 nurses working at general hospitals in city of Se, Ga, and Geu. Data analysis included frequency analysis, identification factor analysis, reliability analysis, measurement model analysis, model fit, and intervention effects. In the results of the study, nurse’s perception of professionalism was influenced by factors of communication skills and understanding of the patient’s condition, but not by their ability to solve problems. Understanding of patient’s condition had a mediating effect on communication skills and nursing awareness. Communication skills and understanding of the patient’s condition greatly influenced the nurse’s perception of professionalism. To improve the professionalism of clinical nurses, nursing managers need to emphasize communication skills and understanding of the patient’s condition. The purpose of this study was to provide a rationale for developing a program to improve job skills by strengthening the awareness of professional positions of clinical nurses to develop nursing quality of community.

1. Introduction

Changes in the environment related to climate and pollution are causing health problems and various diseases such as respiratory and circulatory problems, metabolic disorders, and chronic diseases. Moreover, access to modern healthcare facilities has created greater expectations among patients receiving personalized healthcare and high-quality healthcare. As the difficulty of satisfying the demands of patients increases, enhancing nursing capabilities has become increasingly important [ 1 ]. To improve this, hospitals are making efforts to change the internal and external environments so as to increase the number of nurses, reduce the length of hospital stays, and enable efficient nursing practice. Despite these efforts, the workloads of nurses and the demand for clinical nurses are continuously increasing [ 2 , 3 ]. As a result, nurses are developing negative attitudes and prejudices toward patients, as well as negative perceptions of professionalism. To address this, the cultivation and strengthening of nursing professionals’ capabilities is essential.

Nurses’ perception of professionalism is an important element influencing their ability to perform independent nursing, and a good perception of their profession results in a positive approach to solving patients’ problems [ 4 , 5 ]. In addition, the characteristics and abilities of individual nurses can influence the level of care and enable them to understand patients, solve problems, and provide holistic care, which is the ultimate goal of the nursing process [ 6 , 7 ]. Thus, patients expect nurses to not only have medical knowledge of the disease but to also be able to comprehensively assess the patient’s problems and be independent and creative in nursing [ 8 ]. This attitude can have a major impact on the quality of nursing services and can inspire pride in the nursing occupation and professional achievement. These findings can also be used by nurses to prevent burnout and maintain professionalism [ 9 , 10 ].

To respond to the increasing demands for diverse qualitative and quantitative nursing services and to strengthen the capabilities of nursing professionals, efforts have been made to move nursing education toward scientific and creative education. However, in point-of-care environments, not only are nurses prevented from making independent decisions regarding nursing, but also the diverse personal capabilities necessary for such independent behavior are not sufficiently developed [ 11 ]. Therefore, it is important to enhance clinical nurses’ perceptions of the nursing profession; maintain a balance of nursing capabilities; provide novel, high-quality nursing services; and identify assistive nursing education methods and obstructive environmental factors [ 10 ].

Communication skills involve a person’s ability to accurately understand (through both verbal and non-verbal indications) another person, and sufficiently deliver what the person desires [ 12 , 13 ]. Good communication skills are a primary requirement for providing professional nursing services because they enable an in-depth understanding of patients, solving of complicated problems, and reasonable and logical analysis of situations [ 14 , 15 , 16 ]. When effective communication takes place, nurses’ problem-solving abilities and perceived professionalism strengthen [ 17 , 18 ].

According to Park [ 19 ], nurses have difficulties in interpersonal relationships when social tension and interaction skills are low and communication is poor. In addition, these factors are negatively affected not only in the work of the nurse but also in the perception of the profession. Communication skills are associated with both the formation of relationships with patients and the ability to perform holistic nursing [ 20 ]. In order to improve and develop the overall nursing function of a clinical nurse like this, it is important to complement the relevant integrated nursing abilities [ 21 , 22 ].

Previous studies have investigated the importance of communication skills for nurses, and the relationships between nurses’ problem-solving ability and their understanding of the patients’ conditions. Nonetheless, data that can comprehensively explain the structural relationships between these qualities and how they affect the job perception of nurses remains insufficient.

Therefore, the present study aims to identify the structural model for the relationships between nurses’ communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. Additionally, the study provides basic data necessary for developing programs for improving nursing abilities.

The purpose of this study is to construct a theoretical model that explains the structural relationships among nurses’ communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. In addition, the study aimed to verify this model using empirical data.

2. Materials and Methods

2.1. study design.

To create and analyze the structural model for clinical nurses’ communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism, the theoretical relationships among the variables were developed based on related theories.

In this study, communication skills were set as the exogenous variables, whereas problem-solving ability, understanding of patients’ conditions, and perception of the nursing occupation were set as the endogenous variables. In addition, communication skills were set as the independent variables and nursing job perceptions as the dependent variable. This is because the ability of communication helps to maintain an intimate relationship with the patient and to assess the patient’s condition through each other’s relationship and to solve problems and develop correct understanding. Communication skills, problem-solving ability, and understanding of patients’ conditions were set as the parameters for determining causality. The research model is shown in Figure 1 .

Study model.

2.2. Study Participants

The structural equation model has less than 12 measurement variables. The sample size usually requires 200 to 400 participants [ 23 ]. A total of 250 participants were selected for the study. In line with ethical standards and practices, participants received a full explanation on the purpose of the study. They were briefed that the information collected would be used for research purposes only. Furthermore, they were informed that they could withdraw from the study at any time.

2.3. Data Collection Method

Data collection for this study was performed by two researchers unrelated to the hospital from April 20 to May 1, 2019. A questionnaire was used to collect data from clinical nurses working in five hospitals in Seoul, Gyeonggi, and Gangwon provinces. Of the 250 questionnaires disseminated, we received 225 completed returns. However, 54 were considered inaccurate, inconsistent, or unsatisfactory for coding purposes. Thus, 171 fully completed valid questionnaires comprised the final dataset for analysis.

2.4. Research Instruments

2.4.1. communication skills.

In this study, the communication skill instrument developed by Lee and Jang [ 24 ] was used. Its contents were modified and supplemented to clearly understand the communication skills of nurses. Our questionnaire comprised 20 questions with five questions each concerning “interpretation ability,” “self-reveal,” “leading communication,” and “understanding others’ perspectives.” The answers were rated on a five-point Likert scale ranging from 0 = “strongly disagree” to 4 = “strongly agree.” For this study, the Cronbach’s alpha value was 0.81.

2.4.2. Problem-Solving Ability

The tool developed by Lee [ 25 ] was used to measure the problem-solving ability of clinical nurses. The survey comprised 25 questions, with five questions each concerning “problem recognition,” “information-gathering,” “divergent thinking,” “planning power,” and “evaluation.” Items were scored on a five-point Likert scale ranging from 0 = “strongly disagree” to 4 = “strongly agree.” The internal consistency confidence value Cronbach’s alpha was 0.79.

2.4.3. Understanding Patients’ Condition

To measure nurses’ understanding of patients’ conditions, we developed 10 questions by revising and supplementing items from an existing understanding-measurement tool [ 26 ]. With a total of ten questions, we measured “diagnostic name,” “patient-treatment planning,” and “nursing intervention processes.” Items were scored using a five-point Likert scale ranging from 0 = “strongly disagree” to 4 = “strongly agree.” The internal consistency confidence value Cronbach’s alpha was 0.81.

2.4.4. Nurse’s Perception of Professionalism

Nurse’s perception of professionalism was measured using a tool developed by revising the 25 questions created by Kang et al. [ 1 ]. With a total of ten questions, we measured “vocation” and “autonomy.” Items were scored using a five-point Likert scale. The internal consistency confidence value Cronbach’s alpha was 0.81.

2.5. Data Analysis

To identify the relationships among the set variables, the data were computed statistically using the program included in IBM SPSS 24.0 and AMOS 23.0. (IBM Corp., Armonk, NY, USA). The analysis methods were as follows:

• Frequency analysis was conducted to identify the subjects’ demographic and general characteristics.
• The reliability of the questionnaire was verified using Cronbach’s α coefficients.
• Confirmatory factor analysis (CFA) was performed to verify the convergent validity of the selected measurement tool.
• The normality of the data was determined through analyzing the skewness and kurtosis of the measurement variables.
• The fitness of the model was verified using structural equation modeling (SEM).
• Bootstrapping was utilized to verify the mediating effect in the set study model, as well as the mediating effects of the nurses’ problem-solving ability and understanding of patients’ conditions.

3.1. Demographic Characteristics

The demographic and general characteristics of the study subjects are shown in Table 1 . Overall, 71 respondents were aged 25–29 years (41.5%), representing the most numerous age group. University graduates comprised 113 (66.1%) of the sample, while 50 (29.2%) held graduate degrees, with eight (4.7%) holding master’s degrees. Fifty-three respondents (31.0%) had over seven years of clinical experience, 43 (25.1%) had two to three years of experience, 42 (24.6%) had four to six years of experience, and 33 (19.3%) had less than two years of experience. Additionally, 121 respondents (70.8%) worked at secondary hospitals, while 50 (29.2%) worked at tertiary hospitals; 159 respondents (93.0%) reported that they were general nurses.

Participants’ general characteristics ( N = 171, %).

3.2. Technical Metrics of the Measurement Variables

The multivariate normality of the findings related to the factors of the latent variables was verified through standard deviations, skewness, and kurtosis. The present study meets the criteria for the skewness and kurtosis values mentioned by Hu and Bentler [ 27 ].

All sub-factors of the latent variables secured normality.

In this study, a normal distribution was obtained for each of the four sub-factors of communication skills, five sub-factors of problem-solving ability, three sub-factors for understanding the patient’s condition, and two sub-factors of the nurse’s perception of professionalism as shown in Table 2 .

Technical metrics of the measurement variables ( N = 171).

3.3. Correlations between the Measured Variables

The correlations between the measurement variables were analyzed using Pearson’s product–moment correlation coefficient analysis ( Table 3 ). The correlations among all individual measurement variables were found to show a positive correlation.

Correlations between the observed variables.

3.4. Confirmatory Factor Analysis of the Measurement Model

This study examined how well the measurement variables represented the latent variables in the measurement model. Each set path coefficient was evaluated using non-standardization factors, standardization factors, and standard errors. The path coefficients refer to the factor loadings in CFA. The standardization factors of the individual paths were shown to be at least 0.50 (except for vocation: 0.36), and the critical ratio (CR) was at least 1.96. This indicated that the measurement tool had good convergent validity ( Table 4 ).

Confirmatory factor analysis of the measurement model.

*** p < 0.001; CR: critical ratio.

3.5. Verification of the Structural Model

The structural model for relationships among clinical nurses’ communication skills, problem-solving ability, understanding of patients’ condition, and nurse’s perception of professionalism that would be suitable for predicting the influencing relationships was verified. Since the fitness index of the modified model was shown to be higher than that of the initial model, the final model for this study was set as shown in Figure 2 .

Final model. * χ 2 = 124.074 (df = 61, p <0.001), GFI(Goodness of Fit Index)= 0.90, RMSEA(Root Mean Square Error Approximation)=0.07, NFI(Normed Fit Index)=0.87, IFI(Incremental Fit Index)= 0.93, TLI(Tucker-Lewis Index)= 0.91, CFI(Comparative Fit Index)= 0.92.

3.6. Influencing Relationships between Variables of the Study Model

The standardization factors and CR values of the final model were examined to determine whether there were direct relationships between communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. The results are shown

For the relationship between communication ski in Table 5 .lls and problem-solving ability, the standardization factor was 0.85 and the CR value was 7.37; communication skills showed a statistically significant effect. Consequently. The relationship between communication skills and understanding of patients’ conditions also showed a statistically significant effect. Consequently, Hypothesis 1 was supported.

The relationships between the human effects of the measurement model.

* p < 0.05, *** p < 0.001; CR: critical ratio.

For the relationship between communication skills and nurse’s perception of professionalism, the standardization factor was 0.54, and the CR value was 2.02. Communication skills showed a statistically significant effect. Consequently. For the relationship between problem-solving ability and nurse’s perception of professionalism, the standardization factor was −0.056, and the CR value was −0.39. Problem-solving ability had no statistically significant effect. Consequently.

The relationship between nurses’ understanding of patients’ conditions and nurse’s perception of professionalism had a statistically significant effect. Consequently Figure 2 shows the influencing relationships between the study variables of the final study model, considering non-standardization and standardization factors of the relationships between the study variables.

3.7. Direct and Indirect Effects of the Variables

To grasp the significance of the mediating effect in the final study model, the direct and indirect effects of each variable were examined. To examine the mediating effect of the problem-solving ability and understanding of patients’ conditions variables, the bootstrapping method provided by the AMOS 23.0 program included in IBM was utilized. The results are shown in Table 6 .

Mediating effect analysis.

* p < 0.05, *** p < 0.001

The indirect effect of communication skills on nurse’s perception of professionalism through nurses’ understanding of patients’ conditions was statistically significant. That is, clinical nurses’ communication skills have an indirect positive effect on their nurse’s perception of professionalism, with nurses’ understanding of patients’ conditions acting as a parameter. We also found that the effect of communication skills on nurse’s perception of professionalism was statistically significant. Therefore, communication skills have a partially mediated effect on nurse’s perception of professionalism, with understanding of patients’ conditions acting as a parameter. However, communication skills were found to have no indirect positive effect on nurse’s perception of professionalism when problem-solving ability was set as a parameter.

4. Discussion

In this study, we developed and analyzed a hypothetical model regarding clinical nurses’ communication skills, problem-solving ability, and understanding of patients’ conditions, and how these factors influence their nurse’s perception of professionalism.

4.1. Effect of Communication Skills on Nurses’ Perception of Professionalism

Communication skills were found to have statistically significant effects on their relationship with nurses’ problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. Nurses’ communication skills not only affected their problem-solving ability but also their understanding of patients’ conditions and nurse’s perception of professionalism. Good communication among nurses can reduce uncomfortable situations and improve interactions with patients, which can consequently enhance problem-solving [ 28 ]. Supporting our findings, Ancel [ 17 ] reported that communication skills afford the maintenance of amicable cooperative relationships with patients across diverse medical classes, thereby enhancing the efficiency of nursing-related problem-solving.

Nurses’ communication is also closely related to their understanding of patients’ conditions, particularly regarding the treatment processes. Nurses frequently experience difficulties as a result of poor communication with not only patients and their family members but also other medical personnel. Further, poor delivery of explanations and questions affects nurses’ understanding of patients’ situations and problems, and patients can also feel concern regarding whether nurses accurately understand their problems [ 29 ]. Nurses frequently experience psychological abuse when communicating with patients and develop stress or discomfort [ 30 ]; this can lead to distrustful relationships with and inhibited understanding of patients [ 31 , 32 ]. Vermeir et al. [ 18 ] reported that scientific approaches are required to understand patients in-depth. To accurately understand both oneself and others, the most important method is successful communication. Such findings support the present study’s indication that nurses’ communication is a basic means of solving nursing problems, with both actions being interrelated.

Our finding that nurses’ communication skills are structurally related to their nurse’s perception of professionalism supports the findings of many previous studies. Regarding nurse’s perception of professionalism, Adams et al. [ 33 ] as well as Lee and Kim [ 34 ] explained that a good perception leads to higher-level capabilities, fostering high-level nursing of patients and the development of autonomous vocation. The above studies reported that, since nurses’ communication skills are related to their nurse’s perception of professionalism, communication skills should be considered a predictor of success. Further, McGlynn et al. [ 35 ] recommended positively reinforcing communication skills to improve nurse’s perception of professionalism. This supports the findings of the present study, indicating that communication and nursing professional perception are interrelated.

Thus, communication skills are important for nursing patients. They enable nurses to accurately understand patients’ problems, serve (by forming patient trust) an important function in the process of administering nursing interventions, and positively affect nurses’ perception of their profession. As such, each concept is important. However, nurses working in the clinic are critically aware of their professionalism. In order to reinforce this, communication skills are required, and the emphasis is placed on strengthening the nurses’ ability to solve problems as well as assess and understand patients. As a result, communication skills play an important role in helping nurses understand patients’ problems accurately, build patient trust in nursing interventions, and create structural relationships that have a positive impact on the perception of nursing occupations. Therefore, efforts to improve nurses’ communication skills not only improve their problem-solving abilities and understanding of patients’ conditions but also improve their nurse’s perception of professionalism. To maintain the professionalism of nurses, “competency development programs” would be helpful, thereby emphasizing the need for their application in nursing colleges and clinical practice.

4.2. Relationship between Nurses’ Problem-Solving Ability and Nurse’s Perception of Professionalism

We found clinical nurses’ problem-solving ability to have no positive effect on their perception of professionalism. This contrasts with previous studies, which reported that problem-solving ability is helpful for such perception of professionalism [ 36 ]. We also found that problem-solving ability does not affect nursing professional perception through a mediating effect.

The present findings indicate that the distinctiveness of the fields of nursing should not be overlooked. In nursing organizations that have a culture of discouraging diversity, when negative results are obtained from attempts to solve nursing problems, confusion regarding the identity of nursing professionals means perception of the profession is not reinforced; in many cases, the opposite perception is formed. Furthermore, for those in lower-level positions, nurse’s perception of professionalism is thought to be low because they cannot voice their opinions and have difficulties such as excessive workloads. Although few previous studies have directly examined this, Vermeir et al. [ 18 ] explained that, as the role expectation for nurses increases, factors for job turnover increase as a result of a sense of confusion regarding the nurses’ role and increases in stress. These findings indicate that factors that degrade nurses’ problem-solving ability induce skepticism regarding nursing and possibly career change, thereby supporting the findings of this study.

However, in the present study, positive results with low levels of relevancy in the structural model but high correlations were found. It is expected that, if nurses’ environmental conditions are improved and their nursing capabilities are developed so that they can solve nursing problems with confidence, their nursing professional perception will improve.

4.3. Relationship between Nurses’ Understanding of Patients’ Conditions and Nurse’s Perception of Professionalism

Our findings indicated that the relationship between nurses’ understanding of patients’ conditions and nurse’s perception of professionalism was statistically significant. This supports Nilsson et al. [ 21 ] and Philip et al. [ 29 ], who reported that, in the fields of nursing, when patients accurately understand nurses’ instructions or explanations and health information, they can participate in, independently adjust, and engage in creative decision-making related to self-nursing.

McGlynn et al. [ 35 ] suggested that understanding patient problems is an important element in resolving negative situations; meanwhile, Heo and Lim [ 37 ] indicated that clinical nurses provide high-quality nursing services and develop self-efficacy when they apply professional knowledge and a desire to understand patients’ problems. These study findings accord with our own findings.

The aforementioned findings suggest that the development and application of programs that can enhance nurses’ understanding of patients’ conditions should be emphasized, and that studies of various patient types, the characteristics of patients by age group and hospital areas, as well as the introduction of simulation education programs to improve nurses’ understanding of patients’ conditions should be continuously implemented.

5. Conclusions

This study aimed to verify the structural relationships between clinical nurses’ communication skills and their problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. We also aimed to identify, through a structural model, the mediating effects of nurses’ problem-solving ability and understanding of patients’ conditions in the relationship between communication skills and nurse’s perception of professionalism.

The findings of this study are as follows (all significance levels = 0.05). In the relationship between communication skills and problem-solving ability, the value of the standardization factor was 0.85 and the CR value was 7.37, indicating that communication skills had a statistically significant effect. In the relationship between nurses’ communication skills and understanding of patients’ conditions, the value of the standardization factor was 0.61 and the CR value was 6.35, indicating that communication skills had a statistically significant effect. In the relationship between communication skills and nurse’s perception of professionalism, the value of the standardization factor was 0.54 and the CR value was 2.02, indicating that communication skills had a statistically significant effect. However, in the relationship between problem-solving ability and nurse’s perception of professionalism, the value of the standardization factor was −0.05 and the CR value was −0.39, indicating that problem-solving ability has no statistically significant effect. Finally, in the relationship between nurses’ understanding of patients’ conditions and nurse’s perception of professionalism, the value of the standardization factor was 0.56, and the CR value was 2.14, indicating that nurses’ understanding of patients’ conditions has a statistically significant effect.

There are some limitations to this study. First, as we only examined nurses at secondary and tertiary university hospitals, our findings may not be generalizable to all clinical nurses. Replication studies examining a range of levels of medical institutions and associated workers are necessary. Second, the structural relationship between problem-solving ability and the nurse’s perception of professionalism turned out to be insignificant or mediated. Subsequent studies on the various approaches to revisit this structural relationship should be performed. Third, theories should be systematically developed to establish the values of the nursing profession, and additional studies are necessary to explore other variables.

Acknowledgments

We would like to thank the staff nurses who participated in the survey and took the time to complete the initial assessment.

Author Contributions

Conceptualization, A.Y.K. and I.O.S.; methodology, A.Y.K.; software, I.O.S.; validation, A.Y.K. and I.O.S.; formal analysis, A.Y.K. and I.O.S.; investigation, A.Y.K.; resources, A.Y.K.; data curation, A.Y.K.; writing—original draft preparation, A.Y.K.; writing—review and editing, A.Y.K. and I.O.S.; visualization, A.Y.K. and I.O.S.; supervision, I.O.S.; project administration, I.O.S. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Morning Carpool

21 Mental Shifts to Boost Problem-Solving Skills and Become More Strategic

Posted: February 10, 2024 | Last updated: February 10, 2024

Discover transformative mental shifts to supercharge your problem-solving skills. From embracing uncertainty to the power of daydreaming, prepare to change the way you tackle challenges forever!

Embrace Uncertainty

Accept that not all answers are immediately clear. Uncertainty can be a powerful motivator rather than a source of stress. By embracing the unknown, we open ourselves up to a broader range of possibilities and solutions.

Seek Diverse Perspectives

Look beyond your own experiences. Different perspectives can provide unique insights and spark innovative solutions. Engaging with people from various backgrounds allows you to see problems through a new lens and discover paths you might not have considered.

Simplify the Complex

Break down big problems into smaller, manageable parts. When faced with a complex issue, deconstruct it to understand its fundamental components. This approach makes the problem less daunting and easier to tackle, leading to clearer, more effective solutions.

Adopt a Growth Mindset

Believe in your ability to learn and grow. A growth mindset encourages resilience and the pursuit of knowledge. Challenges are just undiscovered opportunities with potential for personal and professional development.

Question Assumptions

Challenge the status quo. The barriers to solving a problem are often based on outdated or incorrect assumptions. By questioning the basis of your thinking, you can uncover new paths and innovative solutions.

Think in Reverse

Start with the desired outcome and work backward. This reverse-engineering approach forces you to think differently and can reveal insights you might have missed when approaching the problem linearly.

Embrace Failure as a Teacher

Learn from mistakes and change your perspective. Nobody likes to fail, but each failure provides valuable lessons that can guide future decisions and strategies. Failure isn’t the end but the beginning of understanding.

Harness the Power of Daydreaming

Let your mind wander. Sometimes, the best ideas come when you’re not actively trying to solve a problem. Allowing your mind to drift can lead to creative breakthroughs and unexpected solutions.

Practice Empathy

Understand others’ perspectives and needs. By putting yourself in someone else’s shoes, you can gain insights into the emotional and practical aspects of a problem, leading to more compassionate and effective solutions.

Set Clear Goals

Define what success looks like. Clear goals provide direction and focus, making identifying the steps needed to solve a problem easier. They also help measure progress and keep you motivated.

Stay Curious

Ask questions and seek knowledge. A curious mind is always looking for new information and ideas, which can lead to innovative problem-solving strategies. Curiosity is the engine of achievement.

Use Analogies

Draw parallels from different areas. Analogies can help clarify complex problems by relating them to something more familiar. This can simplify the problem-solving process and spark creative solutions.

Focus on the Process, Not Just the Outcome

Enjoy the journey of problem-solving. Focusing too much on the end result can lead to frustration and missed opportunities. By valuing the process, you can learn and adapt as you go, leading to more sustainable solutions.

Prioritize Effectively

Set deadlines for achieving your goals. Know what matters most. Not all aspects of a problem are equally important. By prioritizing the key factors, you can allocate your time and resources more effectively and achieve better results.

Build Resilience

Give yourself time to recover, then bounce back from setbacks. Resilience is crucial for problem-solving, as it allows you to keep going despite challenges and failures. Resilience turns problems into opportunities.

Cultivate Patience

Give solutions time to unfold. Sometimes, the best solutions emerge over time, and immediate answers aren’t always the best. Patience allows you to thoroughly explore options and make more considered decisions.

Practice Reflection

Don’t overlook the power of self-reflection. Take time to think about what you’ve learned. Reflecting on your experiences and the outcomes of your problem-solving efforts can provide valuable insights and improve future strategies.

Encourage Collaboration

Work with others to find solutions and share goals. Collaborating with a team can bring in a range of skills and perspectives that enhance the problem-solving process and lead to more effective solutions.

Visualize Success

Imagine the desired outcome. Visualization can be a powerful motivator to enhance your performance and guide your actions toward achieving your goals. Focusing on the end result in your mind’s eye can make it a reality.

Adapt and Evolve

Be willing to change your approach. The most effective problem-solvers are flexible and open to new methods and ideas. Adapting your strategy in response to new information or challenges can lead to better solutions.

Maintain a Positive Attitude

Stay optimistic and focused. A positive outlook can keep you motivated and open to new ideas. An optimistic mindset can also make the problem-solving process more enjoyable and less daunting.

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