The Anticipation Thinking Exercise is a simple modification to an existing case study that will quickly transform your lesson into a nursing flipped classroom.

Imagine you are sitting down for a beautiful brunch.  You have a nice hot cup of coffee, but over the next 15 minutes of sipping and chatting, your cup is empty. 

You make a side-eye at the waiter.  No response.  You raise your hand timidly like you are in grade school to get their attention. They walk right by you.  You finally say “excuse me” nice and loud, and you finally have their attention and get some hot coffee.  Too bad you are already a bit annoyed. This example of the waiter, although simplistic, is NOT how we want our students to approach patient care.  We do not want the patients to have to wave their “red flag” assessment findings in the face of our students and new nurses to anticipate the patient’s needs.  Instead, we want them to catch the side-eye glances, and the subtle hand raises.  We want them to take notice of these as abnormal and anticipate what is coming next. 

Anticipation is an essential skill for a nurse.  It involves the nurse being acutely aware of what potential complications could arise and intervening early.  It is linked to caring, advocacy, trust, and the development of the nurse-patient relationship.  It can allow the nurse to prepare for what the untrained eye would call an unexpected event.  It can move care along in a timely manner. So can we teach anticipation?

This Anticipated Thinking activity is a way to build anticipation skills with students in a nursing flipped classroom.  

Kristen Swanson’s Theory of Caring includes five caring processes and includes the need for the nurse to anticipate. The five elements of caring are Maintaining Belief, Knowing, Being With, Doing For, and Enabling. This Anticipated Thinking activity focuses on the “doing for” care process, which is described as doing something for someone how they would do it for themselves if they were able and includes anticipating patient needs. When the healthcare provider uses the “doing for” care process, the patient will feel safe and comforted.

How-To Setup the Anticipated Thinking Activity

This one is an excellent activity to jazz up an existing case study that you already use in class.  While similar to an unfolding case study, the questions in this activity focus directly on anticipation and ask students to predict possible outcomes.  If you are looking for a relevant, ready-to-go case study, check out KeithRN’s clinical reasoning case studies.

First, the instructor would designate stopping points in the case study text (we are using a post-op hip replacement scenario here).  At each stopping point, the instructor poses anticipation questions and has students write a short care plan in which they will hypothesize what will happen next.  In addition, you can have students must find evidence, either in their notes or textbook, that supports their hypothesis.

It is helpful to develop a framework to guide students through this nursing flipped classroom activity. Here, I have given each stopping point its’ own page. Also, the information in the case study is somewhat limited, giving it a variety of possible outcomes as opposed to only one “correct” answer.  This intentional omission of information allows students to predict and practice anticipation. Below is the first stopping point of this exercise.

The care planning worksheet is where students will write a simple, prioritized, anticipated patient problem and interventions based on the information that is currently available.  This page is excellent to have as part of debriefing at the end of the activity as it will allow students to compare their initial and final thoughts. Below is an example of the care planning page.

If you are building this activity from an exisiting case study, questions that promote anticipation include:

What complications are likely to occur?

Which lab values will be elevated?  Which will be decreased?

Which diagnostic tests may be ordered?

Which medication may be ordered?

What assessment data will the provider want to know?

What teaching would the patient need?

In the example, I specifically use the word “anticipate” in many of the questions.  This direct wording will help students begin to think into the future when looking at patient assessment findings.  The instructor can further facilitate this thinking through careful questioning.  For example, if a student anticipates that the patient will have a decreased hemoglobin, the instructor can ask the student to describe the next step.  If they answer blood transfusion, great!  But they should also anticipate a type/screen, the time it takes the blood bank to prepare the product, the blood tubing and saline that they will need to get ready, and the co-worker they will need at the bedside to hang the blood product.  If students can begin to anticipate all of these steps, they can start to prepare before the blood arrives and ultimately administer the transfusion sooner! Below are the second and third stopping points:

You can access the entire template for this activity HERE.

How to Debrief the Anticipated Thinking Nursing Flipped Classroom Activity

This activity translates into an excellent large group discussion and debriefing.  Options for a structured debriefing session include:

  1. Students review their care planning worksheet and compare their first stopping point to subsequent stopping points. Discuss how more information changed their priorities.
  2. Students share any similar work or clinical experiences.
  3. Students describe they used evidence in their notes or textbook to support their anticipation.  
  4. Students create and write out the next stopping point, including either worsening or improving patient assessment data.

In Conclusion . . .

This anticipation thinking exercise is an excellent tool to use in nursing flipped classroom.  We want our students to be able to anticipate patient needs without waving their red flags obnoxiously in front of students. Educators can use this with an already existing case study simply by creating stopping points within the storyline and asking students to predict what will happen next. 

  1. Use an existing case study and designate stopping points throughout the text.
  2. Give students a framework to predict and anticipate what will happen.
  3. Debrief the scenario by comparing initital predictions to subsequent prioritiy patient problems.

This activity quickly adapts to any theory lesson using the template provided below 👇🏽 with directed questions and a care planning page to guide student thinking.  Finally, once the activity is complete, a debriefing session will help students compare their initial and final thoughts, connect the case study to practice, and allow further application by creating an additional stopping point.

You can access the entire template for this activity HERE.

Did you know we have a community?

Head over to the ACTIVE LEARNING STRATEGIES FOR NURSE EDUCATORS Facebook group for more ideas and inspiration!

Martha Johnson is the charge nurse over at BreakoutRN

Martha Johnson MSN, RN, CEN

Charge nurse over at BreakoutRN with a focus on helping other nursing educators transition from lecture to active learning.  She believes it does not have to be hard or overwhelming, just take it one activity at a time 💜

Looking for more inspiration and active learning techniques?

Subscribe to get exclusive BONUS content and our latest updates through email.

    We won't send you spam. Unsubscribe at any time.
    Copyright 2020 - BreakoutRN