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Six Caps Case Study

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Six Caps Case Study

University of Phoenix

Undergraduate Nursing Studies

Introduction In the words of Albert Einstein, “the world we have created is a product of our thinking; it cannot be changed without changing our thinking.” Today more and more nurses have to change their thinking process to ensure clients receive quality care. Therefore, clinical judgments cannot be based on speculation but on outcome, directed thinking. As the client health status changes, the nurse must be able recognize, assess, and evaluate all the presenting information to make an outcome decision that is best for the client and client’s family. To make appropriate decisions require nurses to put on their thinking caps. Edward de Bono’s six thinking caps integrates knowledge, comprehension, application, analysis, and evaluation allowing the nurse to make quality, outcome based decision. The purpose of this paper will focus on a case study using six thinking caps to critically analyze and make clinical decisions in promoting client safety and quality care.
White Cap Thinking Looking at the case study with the White, Ms. Marianne first presented with a severe headache. The nurse uses her knowledge base about hemorrhagic stroke to decide what additional information is needed. Since information cannot be obtained from the patient, the nurse ask the patient’s family questions about the patient’s health problems, family health problems, medical history, medication regimen and dietary habits. Lunney (2003) states “the nurse uses information seeking to collaborate with the client’s family on what is the diagnosis, to consider whether collaboration is also needed with another health care provider” ( para 23). The nurse empathetic attitude tells her that the client may have had other predisposing factors. She may have been non compliant with her medication and dietary regimen. She may have been suffering with headaches for awhile.
Red Cap Thinking Using the red cap, the nurse looks at the “decision with intuition, gut, reaction, and emotion.” The nurse also tries to think “how people will react emotionally and try to understand the intuitive responses of people who do not fully know your reasoning (mind tools, 2009). According to the case study, Ms. Marianne spouse wants the medical staff to “try everything. The children believe that their mother would not want to undergo surgery if her prognosis is poor: she will be kept alive with poor quality of life, which they agree is the likely outcome.” Applying the red cap, the nurse knows that the prognosis of hemorrhagic stroke may be fatal. People who have a hemorrhagic stroke usually die within a few days. However, if Ms Marianne survives she may have lost some brain function. The nurse can assume that the husband does not want to lose his spouse; they were probably married for many years since they have grown adult children. In regards to the children the nurse can safely presume that their mother may have had a very active life and visualizing their mother as a dependent person is something they believe she would not like or want. Ms. Marianne has no advance directive or no health care proxy therefore her significant other, her husband, would make all the decision about her care unless he appoints someone else.

Black Cap Thinking According to DeBono’s theory “Black cap thinking helps to make your plans tougher and more resilient. It can also help you to spot fatal flaws and risks before you embark on a course of action. Black cap thinking is one of real benefits. Many successful people get so use to thinking positively that they often cannot see the problem in advance leaving them under prepared for difficulties.” Applying black cap thinking to the case study, Ms Marianne spouse presently is not thinking of the responsibility of taking care of his spouse for a prolong indefinitely period of time. If Ms. Marianne has surgery, she maybe disabled secondary to brain damage. The after effects of the surgery can place client at risk of developing respiratory, neurological, musculoskeletal and elimination disorders. The black cap enables the nurse to think of the various complications that can arise by embarking on the course of surgery.
Yellow Cap Thinking “The yellow hat helps you to think positively. It is the optimistic viewpoint that helps you to see all the benefits of the decision and the value in it, and spot the opportunities that arise from it. Yellow Hat thinking helps you to keep going when everything looks gloomy and difficult” (De Bono). Ms. Marinna spouse can look forward to his wife communicating her needs adequately, no contractures, continent of urine , breathing independently, no infections, independence with personal care, compensating for her sensory deficits, and walks without assistive device. The nurse would educate the patient and family about risk factors for stroke and how they can be avoided. She should also provide information on stroke prevention and suggest a nutritionist for dietary consultation
Green Cap Thinking Green hat thinking indicates growth or creativity. Individuals try to find alternative solutions to the problem. If Ms. Marianne survives her stroke and has lost of brain function, her family may consider providing 24 hour care at home to help them cope with the change in their family. The medical staff should encourage the family to seek counseling, provide them information about stroke, peer groups and stroke clubs her long term treatment may include occupational, physical and speech therapies.
Blue Cap Thinking Blue hat thinking focuses on control. It utilizes all of the other thinking hats to avoid arguments or disagreements. In the case study, Ms. Marianne’s husband appears to have his mind made up as to the course of treatment she should receive. If the client is returning home with her spouse, the family should be thought the relationship of her medical history to her hemorrhagic stroke. She should be given information of home care, outpatient and inpatient therapy. On the other hand, the patient may need long term placement. The nurse can reassure the family that all the patient needs will be met while at the facility. The nurse knows that the patient dietary regimen will be adhere to, her medication will be given as ordered, precautions to prevent another recurrence will be maintained.

According to Lunney, “development of critical thinking abilities for diagnostic accuracy is important because accurate interpretation of patient’s data is a challenging task that requires high levels of thinking abilities and intelligence.” Critical thinking is goal oriented. Before a course of treatment is implemented all the information and family input should be assessed and evaluated. Therefore all personal prejudices, problems, experiences, biases and emotional factors should be harness in order for the nurse to focus on the patient and family’s needs. The nurse must be open minded, honest, objective, confident, and courageous to be able to think critically.

References Hoch, D. (2008 September 16) Re: Hemorrhagic Stroke: MedlinePlus Medical Encyclopedia. Retrieved from

Heaslip, P (1993) Re: Critical Thinking: To Think Like A Nurse. Retrieved from

Six Thinking Hats - Decision Making Techniques from Mind Tools - 6. (1995 – 2006) Retrieved from

Daly, W. M. (1998, August). Critical thinking as an outcome of nursing education. What is it? Why is it important to nursing practice? Journal of Advanced Nursing, 28(2), 323.

Lunney, M. (2003, July-September). Critical thinking and accuracy of nurses' diagnoses. International Journal of Nursing Terminologies and Classifications, 14(3), 96.

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