The Six Thinking Hats Explores the Top of Bloom’s Pyramid
To teach nursing clinical judgment, we must explore the highest levels of Bloom's taxonomy in our classrooms.
Developing classroom activities for the highest level of Bloom's taxonomy is the most difficult. As we move away from the expectation of having students memorize our lecture content, it can be challenging to think of what they can "create" when we are still building their foundational nursing knowledge.
One helpful way to think of this is that we are helping them to create decision-making frameworks and use nursing clinical judgment. We are training their brain to "create" a desired patient outcome and then use their assessments and interventions to get there. We can ask them to think creatively in complex patient situations.
Connecting creative thinking to nursing education
Educational consultant Patti Drapeau (2014) reviewed the six criteria for students who are thinking creatively:
Express ideas that others haven't thought of
Choose their own way to demonstrate their understanding
Ask questions without fear of sounding silly
Enjoy open-ended assignments
Prefer to discuss ideas rather than facts
Like to try new ways to solve a problem rather than the accepted way
This activity, called the Six Thinking Hats, developed by Edward de Bono in 1985, can help students practice decision-making, develop nursing clinical judgment and incorporate creative thinking when looking at a problem. The activity guides students through various viewpoints and creates a decision-making tree in their brains that they can reference when faced with tough decisions that require a creative solution.
How to implement the Six Thinking Hats activity
Getting started with this activity is easy! You can download the template below.
Start with a problem
To start, give students a problem. For this example, students are presented with an ethical dilemma related to nursing practice.
Scenario: A new graduate nurse was hired into the float pool at your hospital. As a nurse in the oncology unit, you are assigned to orient the new nurse for the first four weeks.
During your first day, you review the protocol for a blood transfusion when she tells you that her religious beliefs will not allow her to administer blood products. As the shift goes on, she refuses to read the policy, will not go down to the blood bank to pick up the unit of blood, and is not in the room when you administer the blood.
As an oncology nurse on this unit, blood product administration is a regular occurrence and happens multiple times during a shift.
Ask students, "How should the nurse approach this issue?" Have students write down their initial, knee-jerk, instant reaction to compare to later. Then, they share their ideas and why they chose this initial response.
Have students analyze from a new viewpoint
Then, assign students the roles of the different hats.
🧙🏽♂️ The blue hat is the leader and is responsible for keeping the group focused, organizing the teams' thoughts, and giving a synopsis of the group's work at the end of the activity.
📚 The white hat is the researcher and looks at the available data. In this case, the white hat student may share facts about Jehovah's Witness beliefs around blood product administration.
👒 The red hat is a sensitive soul and brings up all the feelings that could result from a decision. These feelings can be happiness, sadness, anger, grief, or contempt. Anything that may arise.
👩🏽🎨The green hat is creative, thinks outside the box, and looks for an alternative, atypical solution to solve the problem.
🤝🏽The yellow hat is a peacekeeper and summarizes the benefits of the proposed idea. Does the solution benefit both parties? Would both sides be happy with the resolution?
🙅🏽♀️ The black hat is a pessimist and looks for potential negative impacts of the decision. Their job is to identify why it would not work and help the group eliminate or change aspects of the plan based on negative consequences.
Six Thinking Hats
Use this template to help describe the role of each hat
Once all of the students had had time to analyze the situation independently from the viewpoint of their hat color, the blue hat should lead the discussion giving each hat a few minutes to share their thoughts.
Give time for reflection
Give the students time to reflect on the activity afterward. Then lead the debriefing session.
Compare the student's initial, knee-jerk reaction that they wrote down to their group's final idea. How did looking at the topic through the six hats change your initial opinion?
How can analyzing a problem from different viewpoints help you confidently approach a situation?
What new ideas emerged? Did you come up with a satisfactory solution?
Variations of the six thinking hats to further develop nursing clinical judgment
In-Person Option
For beginner students, a safety case study could be an excellent way to introduce the six thinking hats. For example, the scenario may be a confused, combative patient at risk for falls. Assign the students the different hat roles and then brainstorm which fall precautions would be most effective.
Blue hat - Clearly defines the problem.
White hat - What information do you have about the patient? Especially related to fall risk?
Green hat - What creative ideas are out there for fall prevention?
Yellow hat - Would the proposed fall precautions be a good fit for the unit's staffing? How would the patient's family feel?
Black hat - What could go wrong with this plan? Is there additional staff, patient, or family education involved? Is the necessary equipment/staff available?
For advanced students, you could use the six thinking hats activity to explore ethical dilemmas, review medication errors, or discuss prioritizing care. In addition, instructors could utilize this activity in community clinicals or public health areas where resources are scarce.
Also, you can translate the idea of hats from color to interdisciplinary team member roles. For example, you could present a complex patient situation and have students put on the hat of a pharmacist, dietician, physical or occupational therapist, or case management nurse. Using the hats as interdisciplinary roles allows students to see the benefits of a team and how each specialty can enhance patient care outcomes.
Virtual Option
You could easily modify this for online learning by using breakout rooms and assigning roles to students within each room. Students can take on more than one hat role if your groups do not count out perfectly to 6.
Clinical Option
Consider other professional situations or current events that new graduate nurses will encounter. These may include hospital systems lacking PPE, addressing burnout and mandatory overtime, engaging nurses in professional councils, or workplace violence.
Start Building a Six Thinking Hats Activity
The Six Thinking Hats activity helps develop creative problem-solving and nursing clinical judgment. Start by choosing an existing case study, safety concern, or ethical dilemma that applies to the content in your class. Then, use the Six Thinking Hats diagram to assign a hat to each student and have them view the problem from this vantage point. Consider alternatives to the hats as well, such as interdisciplinary team members. You could also put on that blue hat yourself! Finally, debrief the activity by asking students to compare their initial reaction to their final response after looking at the problem from multiple angles.
Looking for additional ideas to create an active learning classroom?
Check out the other posts at the Idea Bank for more activities to help you step away from lecture with confidence in your classroom!