🎩 Six Thinking Hats for Nursing Clinical Judgment

Teaching nursing clinical judgment means moving students beyond memorization and into the highest levels of Bloom's taxonomy (analyzing, evaluating, and creating). That's easier said than done, especially when students are still building their foundational knowledge. What exactly are they supposed to "create" at this stage?

Here's a helpful reframe: we're not asking them to create something from nothing. We're training their brains to create a desired patient outcome, and then use clinical assessment and nursing interventions to get there. That's clinical judgment.

And with the right classroom activity, we can make that kind of thinking feel natural, even for students who are just finding their footing.

Educational consultant Patti Drapeau (2014) discusses 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

The activity I want to share allows students to demonstrate creative thinking. It is called the Six Thinking Hats and it was developed by Edward de Bono in 1985. 

Using this in your classroom or clinical setting can help students practice decision-making, develop nursing clinical judgment, and incorporate creative thinking when approaching a problem. The activity guides students through various viewpoints and creates a decision-making tree in their minds that they can reference when faced with tough decisions requiring a creative solution.

Next, assign students to the different hat roles.

• 🧢 BLUE HAT - The blue hat is the leader, responsible for keeping the group focused, organizing the team's thoughts, and providing a synopsis of the group's work at the end of the activity.
• 📚 WHITE HAT - 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 regarding blood product administration.
• 🥰 RED HAT - 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.
• 🎨 GREEN HAT - The green hat is creative, thinks outside the box, and looks for an alternative, atypical solution to solve the problem.  
• 🤝🏽 YELLOW HAT - 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?
• 🎩 BLACK HAT - The black hat is a pessimist and looks for potential negative impacts of the decision. Their job is to identify why the decision would not work and help the group eliminate or change aspects of the plan in light of negative consequences.

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.

Finally, give the students time to reflect on the activity afterward. You can lead the debriefing session with these prompts:

• Compare the student's initial reaction, as written, 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?

For beginner students, a safety case study could be an excellent way to introduce the six thinking hats. 

For example, the scenario could be a confused, combative patient at risk for falls. Assign the students to the different hat roles, then brainstorm which fall-prevention 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 how to prioritize care. In addition, instructors could utilize this activity in community clinicals or public health areas where resources are scarce.  

In addition, the six thinking hats can be translated 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.  

You could easily modify this for online synchronous learning by using breakout rooms and assigning roles to students within each room. 

If you are teaching online asynchronously, assign six students to a discussion board and ask them to write the viewpoint of their assigned hat within the thread.

Students can take on more than one hat role if your groups do not divide evenly into groups of 6.

Consider other professional situations or current events that new graduate nurses will encounter. These may include hospital systems lacking PPE, burnout and mandatory overtime, nurses' engagement in professional councils, and workplace violence.  

The Six Thinking Hats for nursing clinical judgment 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.

Finally, debrief the activity by asking students to compare their initial reaction with their final response after considering the problem from multiple angles.

The Six Thinking Hats is one of those rare activities that feels like a discussion but quietly does some of the heaviest lifting in your classroom. It will help you to engage students at the top of Bloom's taxonomy without them realizing they've left their comfort zone. Here are three things to remember as you bring it into your teaching: