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What Is a Case Study?
When you’re performing research as part of your job or for a school assignment, you’ll probably come across case studies that help you to learn more about the topic at hand. But what is a case study and why are they helpful? Read on to learn all about case studies.
Deep Dive into a Topic
At face value, a case study is a deep dive into a topic. Case studies can be found in many fields, particularly across the social sciences and medicine. When you conduct a case study, you create a body of research based on an inquiry and related data from analysis of a group, individual or controlled research environment.
As a researcher, you can benefit from the analysis of case studies similar to inquiries you’re currently studying. Researchers often rely on case studies to answer questions that basic information and standard diagnostics cannot address.
Study a Pattern
One of the main objectives of a case study is to find a pattern that answers whatever the initial inquiry seeks to find. This might be a question about why college students are prone to certain eating habits or what mental health problems afflict house fire survivors. The researcher then collects data, either through observation or data research, and starts connecting the dots to find underlying behaviors or impacts of the sample group’s behavior.
Gather Evidence
During the study period, the researcher gathers evidence to back the observed patterns and future claims that’ll be derived from the data. Since case studies are usually presented in the professional environment, it’s not enough to simply have a theory and observational notes to back up a claim. Instead, the researcher must provide evidence to support the body of study and the resulting conclusions.
Present Findings
As the study progresses, the researcher develops a solid case to present to peers or a governing body. Case study presentation is important because it legitimizes the body of research and opens the findings to a broader analysis that may end up drawing a conclusion that’s more true to the data than what one or two researchers might establish. The presentation might be formal or casual, depending on the case study itself.
Draw Conclusions
Once the body of research is established, it’s time to draw conclusions from the case study. As with all social sciences studies, conclusions from one researcher shouldn’t necessarily be taken as gospel, but they’re helpful for advancing the body of knowledge in a given field. For that purpose, they’re an invaluable way of gathering new material and presenting ideas that others in the field can learn from and expand upon.
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- v.7; Jan-Dec 2021
Case Study Analysis as an Effective Teaching Strategy: Perceptions of Undergraduate Nursing Students From a Middle Eastern Country
Vidya seshan.
1 Maternal and Child Health Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman
Gerald Amandu Matua
2 Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman
Divya Raghavan
Judie arulappan, iman al hashmi, erna judith roach, sheeba elizebath sunderraj, emi john prince.
3 Griffith University, Nathan Campus, Queensland 4111
Background: Case study analysis is an active, problem-based, student-centered, teacher-facilitated teaching strategy preferred in undergraduate programs as they help the students in developing critical thinking skills. Objective: It determined the effectiveness of case study analysis as an effective teacher-facilitated strategy in an undergraduate nursing program. Methodology: A descriptive qualitative research design using focus group discussion method guided the study. The sample included undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018. The researcher used a purposive sampling technique and a total of 22 students participated in the study, through five (5) focus groups, with each focus group comprising between four to six nursing students. Results: In total, nine subthemes emerged from the three themes. The themes were “Knowledge development”, “Critical thinking and Problem solving”, and “Communication and Collaboration”. Regarding “Knowledge development”, the students perceived case study analysis method as contributing toward deeper understanding of the course content thereby helping to reduce the gap between theory and practice especially during clinical placement. The “Enhanced critical thinking ability” on the other hand implies that case study analysis increased student's ability to think critically and aroused problem-solving interest in the learners. The “Communication and Collaboration” theme implies that case study analysis allowed students to share their views, opinions, and experiences with others and this enabled them to communicate better with others and to respect other's ideas which further enhanced their team building capacities. Conclusion: This method is effective for imparting professional knowledge and skills in undergraduate nursing education and it results in deeper level of learning and helps in the application of theoretical knowledge into clinical practice. It also broadened students’ perspectives, improved their cooperation capacity and their communication with each other. Finally, it enhanced student's judgment and critical thinking skills which is key for their success.
Introduction/Background
Recently, educators started to advocate for teaching modalities that not only transfer knowledge ( Shirani Bidabadi et al., 2016 ), but also foster critical and higher-order thinking and student-centered learning ( Wang & Farmer, 2008 ; Onweh & Akpan, 2014). Therefore, educators need to utilize proven teaching strategies to produce positive outcomes for learners (Onweh & Akpan, 2014). Informed by this view point, a teaching strategy is considered effective if it results in purposeful learning ( Centra, 1993 ; Sajjad, 2010 ) and allows the teacher to create situations that promote appropriate learning (Braskamp & Ory, 1994) to achieve the desired outcome ( Hodges et al., 2020 ). Since teaching methods impact student learning significantly, educators need to continuously test the effectives of their teaching strategies to ensure desired learning outcomes for their students given today's dynamic learning environments ( Farashahi & Tajeddin, 2018 ).
In this study, the researchers sought to study the effectiveness of case study analysis as an active, problem-based, student-centered, teacher-facilitated strategy in a baccalaureate-nursing program. This choice of teaching method is supported by the fact that nowadays, active teaching-learning is preferred in undergraduate programs because, they not only make students more powerful actors in professional life ( Bean, 2011 ; Yang et al., 2013 ), but they actually help learners to develop critical thinking skills ( Clarke, 2010 ). In fact, students who undergo such teaching approaches usually become more resourceful in integrating theory with practice, especially as they solve their case scenarios ( Chen et al., 2019 ; Farashahi & Tajeddin, 2018 ; Savery, 2019 ).
Review of Literature
As a pedagogical strategy, case studies allow the learner to integrate theory with real-life situations as they devise solutions to the carefully designed scenarios ( Farashahi & Tajeddin, 2018 ; Hermens & Clarke, 2009). Another important known observation is that case-study-based teaching exposes students to different cases, decision contexts and the environment to experience teamwork and interpersonal relations as “they learn by doing” thus benefiting from possibilities that traditional lectures hardly create ( Farashahi & Tajeddin, 2018 ; Garrison & Kanuka, 2004 ).
Another merit associated with case study method of teaching is the fact that students can apply and test their perspectives and knowledge in line with the tenets of Kolb et al.'s (2014) “experiential learning model”. This model advocates for the use of practical experience as the source of one's learning and development. Proponents of case study-based teaching note that unlike passive lectures where student input is limited, case studies allow them to draw from their own experience leading to the development of higher-order thinking and retention of knowledge.
Case scenario-based teaching also encourages learners to engage in reflective practice as they cooperate with others to solve the cases and share views during case scenario analysis and presentation ( MsDade, 1995 ).
This method results in “idea marriage” as learners articulate their views about the case scenario. This “idea marriage” phenomenon occurs through knowledge transfer from one situation to another as learners analyze scenarios, compare notes with each other, and develop multiple perspectives of the case scenario. In fact, recent evidence shows that authentic case-scenarios help learners to acquire problem solving and collaborative capabilities, including the ability to express their own views firmly and respectfully, which is vital for future success in both professional and personal lives ( Eronen et al., 2019 ; Yajima & Takahashi, 2017 ). In recognition of this higher education trend toward student-focused learning, educators are now increasingly expected to incorporate different strategies in their teaching.
This study demonstrated that when well implemented, educators can use active learning strategies like case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. This study is significant because the findings will help educators in the country and in the region to incorporate active learning strategies such as case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. Besides, most studies on the case study method in nursing literature mostly employ quantitative methods. The shortage of published research on the case study method in the Arabian Gulf region and the scanty use of qualitative methods further justify why we adopted the focus group method for inquiry.
A descriptive qualitative research design using focus group discussion method guided the study. The authors chose this method because it is not only inexpensive, flexible, stimulating but it is also known to help with information recall and results in rich data ( Matua et al., 2014 ; Streubert & Carpenter, 2011 ). Furthermore, as evidenced in the literature, the focus group discussion method is often used when there is a need to gain an in-depth understanding of poorly understood phenomena as the case in our study. The choice of this method is further supported by the scarcity of published research related to the use of case study analysis as a teaching strategy in the Middle Eastern region, thereby further justifying the need for an exploratory research approach for our study.
As a recommended strategy, the researchers generated data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and cased-based teaching approaches. The focus group interviews allowed the study participants to express their experiences and perspectives in their own words. In addition, the investigators integrated participants’ self-reported experiences with their own observations and this enhanced the study findings ( Morgan & Bottorff, 2010 ; Nyumba et al., 2018 ; Parker & Tritter, 2006 ).
Eligibility Criteria
In order to be eligible to participate in the study, the participants had to:
- be a baccalaureate nursing student in College of Nursing, Sultan Qaboos University
- register for Maternity Nursing Course in 2017 and 2018.
- attend all the Case Study Analysis sessions in the courses before the study.
- show a willingness to participate in the study voluntarily and share their views freely.
The population included the undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018.
The researcher used a purposive sampling technique to choose participants who were capable of actively participating and discussing their views in the focus group interviews. This technique enabled the researchers to select participants who could provide rich information and insights about case study analysis method as an effective teaching strategy. The final study sample included baccalaureate nursing students who agreed to participate in the study by signing a written informed consent. In total, twenty-two (22) students participated in the study, through five focus groups, with each focus group comprising between four and six students. The number of participants was determined by the stage at which data saturation was reached. The point of data saturation is when no new information emerges from additional participants interviewed ( Saunders et al., 2018 ).Focus group interviews were stopped once data saturation was achieved. Qualitative research design with focus group discussion allowed the researchers to generate data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and case-based teaching approaches. The focus group interviews allowed the study participants to express their perspectives in their own words. In addition, the investigators enhanced the study findings by integrating participants’ self-reported experiences with the researchers’ own observations and notes during the study.
The study took place at College of Nursing; Sultan Qaboos University, Oman's premier public university, in Muscat. This is the only setting chosen for the study. The participants are the students who were enrolled in Maternal Health Nursing course during 2017 and 2018. The interviews occurred in the teaching rooms after official class hours. Students who did not participate in the study learnt the course content using the traditional lecture based method.
Ethical Considerations
Permission to conduct the study was granted by the College Research and Ethics Committee (XXXX). Prior to the interviews, each participant was informed about the purpose, benefits as well as the risks associated with participating in the study and clarifications were made by the principal researcher. After completing this ethical requirement, each student who accepted to participate in the study proceeded to sign an informed consent form signifying that their participation in the focus group interview was entirely voluntary and based on free will.
The anonymity of study participants and confidentiality of their data was upheld throughout the focus group interviews and during data analysis. To enhance confidentiality and anonymity of the data, each participant was assigned a unique code number which was used throughout data analysis and reporting phases. To further assure the confidentiality of the research data and anonymity of the participants, all research-related data were kept safe, under lock and key and through digital password protection, with unhindered access only available to the research team.
Research Intervention
In Fall 2017 and Spring 2018 semesters, as a method of teaching Maternal Health Nursing course, all students participated in two group-based case study analysis exercises which were implemented in the 7 th and 13 th weeks. This was done after the students were introduced to the case study method using a sample case study prior to the study. The instructor explained to the students how to solve the sample problem, including how to accomplish the role-specific competencies in the courses through case study analysis. In both weeks, each group consisting of six to seven students was assigned to different case scenarios to analyze and work on, after which they presented their collective solution to the case scenarios to the larger class of 40 students. The case scenarios used in both weeks were peer-reviewed by the researchers prior to the study.
Pilot Study
A group of three students participated as a pilot group for the study. However, the students who participated in the pilot study were not included in the final study as is general the principle with qualitative inquiry because of possible prior exposure “contamination”. The purpose of piloting was to gather data to provide guidance for a substantive study focusing on testing the data collection procedure, the interview process including the sequence and number of questions and probes and recording equipment efficacy. After the pilot phase, the lessons learned from the pilot were incorporated to ensure smooth operations during the actual focus group interview ( Malmqvist et al., 2019 .
Data Collection
The focus group interviews took place after the target population was exposed to case study analysis method in Maternal Health Nursing course during the Fall 2017 and Spring 2018 semesters. Before data collection began, the research team pilot tested the focus group interview guide to ensure that all the guide questions were clear and well understood by study participants.
In total, five (5) focus groups participated in the study, with each group comprising between four and six students. The focus group interviews lasted between 60 and 90 min. In addition to the interview guide questions, participants’ responses to unanswered questions were elicited using prompts to facilitate information flow whenever required. As a best practice, all the interviews were audio-recorded in addition to extensive field notes taken by one of the researchers. The focus group interviews continued until data saturation occurred in all the five (5) focus groups.
Credibility
In this study, participant's descriptions were digitally audio recorded to ensure that no information was lost. In order to ensure that the results are accurate, verbatim transcriptions of the audio recordings were done supported by interview notes. Furthermore, interpretations of the researcher were verified and supported with existing literature with oversight from the research team.
Transferability
The researcher provided a detailed description about the study settings, participants, sampling technique, and the process of data collection and analyses. The researcher used verbatim quotes from various participants to aid the transferability of the results.
Dependability
The researcher ensured that the research process is clearly documented, traceable, and logical to achieve dependability of the research findings. Furthermore, the researcher transparently described the research steps, procedures and process from the start of the research project to the reporting of the findings.
Confirmability
In this study, confirmability of the study findings was achieved through the researcher's efforts to make the findings credible, dependable, and transferable.
Data Analysis
Data were analyzed manually after the lead researcher integrated the verbatim transcriptions with the extensive field notes to form the final data set. Data were analyzed thematically under three thematic areas of a) knowledge development; b) critical thinking and problem solving; and (c) communication and collaboration, which are linked to the study objectives. The researchers used the Six (6) steps approach to conduct a trustworthy thematic analysis: (1) familiarization with the research data, (2) generating initial codes, (3) searching for themes, (4) reviewing the themes, (5) defining and naming themes, (6) writing the report ( Nowell et al., 2017 ).
The analysis process started with each team member individually reading and re-reading the transcripts several times and then identifying meaning units linked to the three thematic areas. The co-authors then discussed in-depth the various meaning units linked to the thematic statements until consensus was reached and final themes emerged based on the study objectives.
A total of 22 undergraduate third-year baccalaureate nursing students who were enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018 participated in the study, through five focus groups, with each group comprising four to six students. Of these, 59% were females and 41% were males. In total, nine subthemes emerged from the three themes. Under knowledge development, emerged the subthemes, “ deepened understanding of content ; “ reduced gap between theory and practice” and “ improved test-taking ability ”. While under Critical thinking and problem solving, emerged the subthemes, “ enhanced critical thinking ability ” and “ heightened curiosity”. The third thematic area of communication and collaboration yielded, “ improved communication ability ”; “ enhanced team-building capacity ”; “ effective collaboration” and “ improved presentation skills ”, details of which are summarized in Table 1 .
Table 1.
Objective Linked Themes and Student Perceptions of Outcome Case Study Analysis.
Theme 1: Knowledge Development
In terms of knowledge development, students expressed delight at the inclusion of case study analysis as a method during their regular theory class. The first subtheme related to knowledge development that supports the adoption of the case study approach is its perceived benefit of ‘ deepened understanding of content ’ by the students as vividly described by this participant:
“ I was able to perform well in the in-course exams as this teaching method enhanced my understanding of the content rather than memorizing ” (FGD#3).
The second subtheme related to knowledge development was informed by participants’ observation that teaching them using case study analysis method ‘ reduced the gap between theory and practice’. This participant's claim stem from the realization that, a case study scenario his group analyzed in the previous week helped him and his colleagues to competently deal with a similar situation during clinical placement the following week, as articulated below:
“ You see when I was caring for mothers in antenatal unit, I could understand the condition better and could plan her care well because me and my group already analyzed a similar situation in class last week which the teacher gave us, this made our work easier in the ward”. (FGD#7).
Another student added that:
“ It was useful as what is taught in the theory class could be applied to the clinical cases.”
This ‘theory-practice’ connection was particularly useful in helping students to better understand how to manage patients with different health conditions. Interestingly, the students reported that they were more likely to link a correct nursing care plan to patients whose conditions were close to the case study scenarios they had already studied in class as herein affirmed:
“ …when in the hospital I felt I could perceive the treatment modality and plan for [a particular] nursing care well when I [had] discussed with my team members and referred the textbook resource while performing case study discussion”. (FGD#17).
In a similar way, another student added:
“…I could relate with the condition I have seen in the clinical area. So this has given me a chance to recall the condition and relate the theory to practice”. (FGD#2) .
The other subtheme closely related to case study scenarios as helping to deepen participant's understanding of the course content, is the notion that this teaching strategy also resulted in ‘ improved test taking-ability’ as this participant's verbatim statement confirms:
“ I could answer the questions related to the cases discussed [much] better during in-course exams. Also [the case scenarios] helped me a great deal to critically think and answer my exam papers” (FGD#11).
Theme 2: Critical Thinking and Problem Solving
In this subtheme, students found the case study analysis as an excellent method to learn disease conditions in the two courses. This perceived success with the case study approach is associated with the method's ability to ‘ enhance students’ critical thinking ability’ as this student declares:
“ This method of teaching increased my ability to think critically as the cases are the situations, where we need to think to solve the situation”. (FGD#5)
This enhanced critical thinking ability attributed to case study scenario analysis was also manifested during patient care where students felt it allowed them to experience a “ flow of patient care” leading to better patient management planning as would typically occur during case scenario analysis. In support of this finding, a participant mentioned that:
“ …I could easily connect the flow of patient care provided and hence was able to plan for [his] management as often required during case study discussion” (FGD#12)
Another subtheme linked with this theme is the “ heightened curiosity” associated with the case scenario discussions. It was clear from the findings that the cases aroused curiosity in the mind of the students. This heightened interest meant that during class discussion, baccalaureate nursing students became active learners, eager to discover the next set of action as herein affirmed:
“… from the beginning of discussion with the group, I was eager to find the answer to questions presented and wanted to learn the best way for patient management” (FGD#14)
Theme 3: Communication and Collaboration
In terms of its impact on student communication, the subtheme revealed that case study analysis resulted in “ improved communication ability” among the nursing students . This enhanced ability of students to exchange ideas with each other may be attributed to the close interaction required to discuss and solve their assigned case scenarios as described by the participant below:
“ as [case study analysis] was done in the way of group discussion, I felt me and my friends communicated more within the group as we discussed our condition. We also learnt from each other, and we became better with time.” (FGD#21).
The next subtheme further augments the notion that case study analysis activities helped to “ enhance team-building capacity” of students as this participant affirmatively narrates:
“ students have the opportunity to meet face to face to share their views, opinion, and their experience, as this build on the way they can communicate with each other and respect each other's opinions and enhance team-building”. (FGD#19).
Another subtheme revealed from the findings show that the small groups in which the case analysis occurs allowed the learners to have deeper and more focused conversations with one another, resulting in “ an effective collaboration between students” as herein declared:
“ We could collaborate effectively as we further went into a deep conversation on the case to solve”. (FGD#16).
Similarly, another student noted that:
“ …discussion of case scenarios helped us to prepare better for clinical postings and simulation lab experience” (FGD#5) .
A fourth subtheme related to communication found that students also identified that case study analysis resulted in “ improved presentation skills”. This is attributed in part to the preparation students have to go through as part of their routine case study discussion activities, which include organizing their presentations and justifying and integrating their ideas. Besides readying themselves for case presentations, the advice, motivation, and encouragement such students receive from their faculty members and colleagues makes them better presenters as confirmed below:
“ …teachers gave us enough time to prepare, hence I was able to present in front of the class regarding the finding from our group.” (FGD#16).
In this study, the researches explored learner's perspectives on how one of the active teaching strategies, case study analysis method impacted their knowledge development, critical thinking, and problem solving as well as communication and collaboration ability.
Knowledge Development
In terms of knowledge development, the nursing students perceived case study analysis as contributing toward: (a) deeper understanding of content, (b) reducing gap between theory and practice, and (c) improving test-taking ability. Deeper learning” implies better grasping and retention of course content. It may also imply a deeper understanding of course content combined with learner's ability to apply that understanding to new problems including grasping core competencies expected in future practice situations (Rickles et al., 2019; Rittle-Johnson et al., 2020 ). Deeper learning therefore occurs due to the disequilibrium created by the case scenario, which is usually different from what the learner already knows ( Hattie, 2017 ). Hence, by “forcing” students to compare and discuss various options in the quest to solve the “imbalance” embedded in case scenarios, students dig deeper in their current understanding of a given content including its application to the broader context ( Manalo, 2019 ). This movement to a deeper level of understanding arises from carefully crafted case scenarios that instructors use to stimulate learning in the desired area (Nottingham, 2017; Rittle-Johnson et al., 2020 ). The present study demonstrated that indeed such carefully crafted case study scenarios did encourage students to engage more deeply with course content. This finding supports the call by educators to adopt case study as an effective strategy.
Another finding that case study analysis method helps in “ reducing the gap between theory and practice ” implies that the method helps students to maintain a proper balance between theory and practice, where they can see how theoretical knowledge has direct practical application in the clinical area. Ajani and Moez (2011) argue that to enable students to link theory and practice effectively, nurse educators should introduce them to different aspects of knowledge and practice as with case study analysis. This dual exposure ensures that students are proficient in theory and clinical skills. This finding further amplifies the call for educators to adequately prepare students to match the demands and realities of modern clinical environments ( Hickey, 2010 ). This expectation can be met by ensuring that student's knowledge and skills that are congruent with hospital requirements ( Factor et al., 2017 ) through adoption of case study analysis method which allows integration of clinical knowledge in classroom discussion on regular basis.
The third finding, related to “improved test taking ability”, implies that case study analysis helped them to perform better in their examination, noting that their experience of going through case scenario analysis helped them to answer similar cases discussed in class much better during examinations. Martinez-Rodrigo et al. (2017) report similar findings in a study conducted among Spanish electrical engineering students who were introduced to problem-based cooperative learning strategies, which is similar to case study analysis method. Analysis of student's results showed that their grades and pass rates increased considerably compared to previous years where traditional lecture-based method was used. Similar results were reported by Bonney (2015) in an even earlier study conducted among biology students in Kings Borough community college students, in New York, United States. When student's performance in examination questions covered by case studies was compared with class-room discussions, and text-book reading, case study analysis approach was significantly more effective compared to traditional methods in aiding students’ performance in their examinations. This finding therefore further demonstrates that case study analysis method indeed improves student's test taking ability.
Critical Thinking and Problem Solving
In terms of critical thinking and problem-solving ability, the use of case study analysis resulted in two subthemes: (a) enhanced critical thinking ability and (b) heightened learner curiosity. The “ enhanced critical thinking ability” implies that case analysis increased student's ability to think critically as they navigated through the case scenarios. This observation agrees with the findings of an earlier questionnaire-based study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh, that showed 81% of respondents agree that case study analysis develops critical thinking ability and enables students to do better problem analysis ( Muhiuddin & Jahan, 2006 ). This observation agrees with the findings of an earlier study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh. The study showed that 81% of respondents agreed that case study analysis facilitated the development of critical thinking ability in the learners and enabled the students to perform better with problem analysis ( Muhiuddin & Jahan, 2006 ).
More recently, Suwono et al. (2017) found similar results in a quasi-experimental research conducted at a Malaysian university. The research findings showed that there was a significant difference in biological literacy and critical thinking skills between the students taught using socio-biological case-based learning and those taught using traditional lecture-based learning. The researchers concluded that case-based learning enhanced the biological literacy and critical thinking skills of the students. The current study adds to the existing pedagogical knowledge base that case study methodology can indeed help to deepen learner's critical thinking and problem solving ability.
The second subtheme related to “ heightened learner curiosity” seems to suggest that the case studies aroused problem-solving interest in learners. This observation agrees with two earlier studies by Tiwari et al. (2006) and Flanagan and McCausland (2007) who both reported that most students enjoyed case-based teaching. The authors add that the case study method also improved student's clinical reasoning, diagnostic interpretation of patient information as well as their ability to think logically when presented a challenge in the classroom and in the clinical area. Jackson and Ward (2012) similarly reported that first year engineering undergraduates experienced enhanced student motivation. The findings also revealed that the students venturing self-efficacy increased much like their awareness of the importance of key aspects of the course for their future careers. The authors conclude that the case-based method appears to motivate students to autonomously gather, analyze and present data to solve a given case. The researchers observed enhanced personal and collaborative efforts among the learners, including improved communication ability. Further still, learners were more willing to challenge conventional wisdom, and showed higher “softer” skills after exposure to case analysis based teaching method. These findings like that of the current study indicate that teaching using case based analysis approach indeed motivates students to engage more in their learning, there by resulting in deeper learning.
Communication and Collaboration
Case study analysis is also perceived to result in: (a) improved communication ability; (b) enhanced team -building capacity, (c) effective collaboration ability, and (d) enhanced presentation skills. The “ improved communication ability ” manifested in learners being better able to exchange ideas with peers, communicating their views more clearly and collaborating more effectively with their colleagues to address any challenges that arise. Fini et al. (2018) report comparable results in a study involving engineering students who were subjected to case scenario brainstorming activities about sustainability concepts and their implications in transportation engineering in selected courses. The results show that this intervention significantly improved student's communication skills besides their higher-order cognitive, self-efficacy and teamwork skills. The researchers concluded that involving students in brainstorming activities related to problem identification including their practical implications, is an effective teaching strategy. Similarly, a Korean study by Park and Choi (2018) that sought to analyze the effects of case-based communication training involving 112 sophomore nursing students concluded that case-based training program improved the students’ critical thinking ability and communication competence. This finding seems to support further the use of case based teaching as an effective teaching-learning strategy.
The “ enhanced team-building capacity” arose from the opportunity students had in sharing their views, opinions, and experiences where they learned to communicate with each other and respect each other's ideas which further enhance team building. Fini et al. (2018) similarly noted that increased teamwork levels were seen among their study respondents when the researchers subjected engineering students to case scenario based-brainstorming activities as occurs with case study analysis teaching. Likewise, Lairamore et al. (2013) report similar results in their study that showed that case study analysis method increased team work ability and readiness among students from five health disciplines in a US-based study.
The finding that case study analysis teaching method resulted in “ effective collaboration ability” among students manifested as students entered into deep conversation as they solved the case scenarios. Rezaee and Mosalanejad (2015) assert that such innovative learning strategies result in noticeable educational outcomes, such as greater satisfaction with and enjoyment of the learning process ( Wellmon et al., 2012 ). Further, positive attitudes toward learning and collaboration have been noted leading to deeper learning as students prepare for case discussions ( Rezaee & Mosalanejad, 2015 ). This results show that case study analysis can be utilized by educators to foster professional collaboration among their learners, which is one of the key expectations of new graduates today.
The finding associated with “improved presentation skills” is consistent with the results of a descriptive study in Saudi Arabia that compared case study and traditional lectures in the teaching of physiology course to undergraduate nursing students. The researchers found that case-based teaching improved student’ overall knowledge and performance in the course including facilitating the acquisition of skills compared to traditional lectures ( Majeed, 2014 ). Noblitt et al. (2010) report similar findings in their study that compares traditional presentation approach with the case study method for developing and improving student's oral communication skills. This finding extends our understanding that case study method improves learners’ presentation skills.
The study was limited to level third year nursing students belonging to only one college and the sample size, which might limit the transferability of the study findings to other settings.
Implications for Practice
These study findings add to the existing body of knowledge that places case study based teaching as a tested method that promotes perception learning where students’ senses are engaged as a result of the real-life and authentic clinical scenarios ( Malesela, 2009 ), resulting in deeper learning and achievement of long-lasting knowledge ( Fiscus, 2018 ). The students reported that case scenario discussions broadened their perspectives, improved their cooperation capacity and communication with each other. This teaching method, in turn, offers students an opportunity to enhance their judgment and critical thinking skills by applying theory into practice.
These skills are critically important because nurses need to have the necessary knowledge and skills to plan high quality care for their patients to achieve a speedy recovery. In order to attain this educational goal, nurse educators have to prepare students through different student- centered strategies. The findings of our study appear to show that when appropriately used, case-based teaching results in acquisition of disciplinary knowledge manifested by deepened understanding of course content, as well as reducing the gap between theory and practice and enhancing learner's test-taking-ability. The study also showed that cased based teaching enhanced learner's critical thinking ability and curiosity to seek and acquire a deeper knowledge. Finally, the study results indicate that case study analysis results in improved communication and enhanced team-building capacity, collaborative ability and improved oral communication and presentation skills. The study findings and related evidence from literature show that case study analysis is well- suited approach for imparting knowledge and skills in baccalaureate nursing education.
This study evaluated the usefulness of Case Study Analysis as a teaching strategy. We found that this method of teaching helps encourages deeper learning among students. For instructors, it provides the opportunity to tailor learning experiences for students to undertake in depth study in order to stimulate deeper understanding of the desired content. The researchers conclude that if the cases are carefully selected according to the level of the students, and are written realistically and creatively and the group discussions keep students well engaged, case study analysis method is more effective than other traditional lecture methods in facilitating deeper and transferable learning/skills acquisition in undergraduate courses.
Conflict of Interest: The authors declare no conflict of interest.
ORCID iD: Judie Arulappan https://orcid.org/0000-0003-2788-2755
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A Case Study in Health Promotion Theory Application: (Problem, Significance, Solution, Barriers)
Diabetes Mellitus: Problem, Significance, And Magnitude (Including Nursing Implications)
Putting it all together: a case study approach, patient background information:, solution using the health promotion model.
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- Roberta Heale 1 ,
- Alison Twycross 2
- 1 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
- 2 School of Health and Social Care , London South Bank University , London , UK
- Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E2C6, Canada; rheale{at}laurentian.ca
http://dx.doi.org/10.1136/eb-2017-102845
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What is it?
Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research. 1 However, very simply… ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’. 1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables. 2
Often there are several similar cases to consider such as educational or social service programmes that are delivered from a number of locations. Although similar, they are complex and have unique features. In these circumstances, the evaluation of several, similar cases will provide a better answer to a research question than if only one case is examined, hence the multiple-case study. Stake asserts that the cases are grouped and viewed as one entity, called the quintain . 6 ‘We study what is similar and different about the cases to understand the quintain better’. 6
The steps when using case study methodology are the same as for other types of research. 6 The first step is defining the single case or identifying a group of similar cases that can then be incorporated into a multiple-case study. A search to determine what is known about the case(s) is typically conducted. This may include a review of the literature, grey literature, media, reports and more, which serves to establish a basic understanding of the cases and informs the development of research questions. Data in case studies are often, but not exclusively, qualitative in nature. In multiple-case studies, analysis within cases and across cases is conducted. Themes arise from the analyses and assertions about the cases as a whole, or the quintain, emerge. 6
Benefits and limitations of case studies
If a researcher wants to study a specific phenomenon arising from a particular entity, then a single-case study is warranted and will allow for a in-depth understanding of the single phenomenon and, as discussed above, would involve collecting several different types of data. This is illustrated in example 1 below.
Using a multiple-case research study allows for a more in-depth understanding of the cases as a unit, through comparison of similarities and differences of the individual cases embedded within the quintain. Evidence arising from multiple-case studies is often stronger and more reliable than from single-case research. Multiple-case studies allow for more comprehensive exploration of research questions and theory development. 6
Despite the advantages of case studies, there are limitations. The sheer volume of data is difficult to organise and data analysis and integration strategies need to be carefully thought through. There is also sometimes a temptation to veer away from the research focus. 2 Reporting of findings from multiple-case research studies is also challenging at times, 1 particularly in relation to the word limits for some journal papers.
Examples of case studies
Example 1: nurses’ paediatric pain management practices.
One of the authors of this paper (AT) has used a case study approach to explore nurses’ paediatric pain management practices. This involved collecting several datasets:
Observational data to gain a picture about actual pain management practices.
Questionnaire data about nurses’ knowledge about paediatric pain management practices and how well they felt they managed pain in children.
Questionnaire data about how critical nurses perceived pain management tasks to be.
These datasets were analysed separately and then compared 7–9 and demonstrated that nurses’ level of theoretical did not impact on the quality of their pain management practices. 7 Nor did individual nurse’s perceptions of how critical a task was effect the likelihood of them carrying out this task in practice. 8 There was also a difference in self-reported and observed practices 9 ; actual (observed) practices did not confirm to best practice guidelines, whereas self-reported practices tended to.
Example 2: quality of care for complex patients at Nurse Practitioner-Led Clinics (NPLCs)
The other author of this paper (RH) has conducted a multiple-case study to determine the quality of care for patients with complex clinical presentations in NPLCs in Ontario, Canada. 10 Five NPLCs served as individual cases that, together, represented the quatrain. Three types of data were collected including:
Review of documentation related to the NPLC model (media, annual reports, research articles, grey literature and regulatory legislation).
Interviews with nurse practitioners (NPs) practising at the five NPLCs to determine their perceptions of the impact of the NPLC model on the quality of care provided to patients with multimorbidity.
Chart audits conducted at the five NPLCs to determine the extent to which evidence-based guidelines were followed for patients with diabetes and at least one other chronic condition.
The three sources of data collected from the five NPLCs were analysed and themes arose related to the quality of care for complex patients at NPLCs. The multiple-case study confirmed that nurse practitioners are the primary care providers at the NPLCs, and this positively impacts the quality of care for patients with multimorbidity. Healthcare policy, such as lack of an increase in salary for NPs for 10 years, has resulted in issues in recruitment and retention of NPs at NPLCs. This, along with insufficient resources in the communities where NPLCs are located and high patient vulnerability at NPLCs, have a negative impact on the quality of care. 10
These examples illustrate how collecting data about a single case or multiple cases helps us to better understand the phenomenon in question. Case study methodology serves to provide a framework for evaluation and analysis of complex issues. It shines a light on the holistic nature of nursing practice and offers a perspective that informs improved patient care.
- Gustafsson J
- Calanzaro M
- Sandelowski M
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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The case study is a popular teaching strategy frequently used in academic settings. Currently, little evidence is found to support hospital-based educators using case studies to promote enhanced problem-solving, decision-making, and critical-thinking abilities. Department orientation and the improvement of patient outcomes are two examples of the use of case studies discussed in this article. Criteria for choosing and implementing an effective case study also are reviewed.
The case study is a popular teaching strategy frequently used in academic settings. As an active learning strategy, the case study builds on learned material that encourages students to more fully understand the content being presented. The most common type of case study is problem based, which requires learners to develop solutions to a given scenario ( Snyder & McWilliam, 2003 ). Similar to clinical practice, case studies are often designed to be complex and ambiguous, offering the learner an opportunity to build critical-thinking and problem-solving abilities ( Plack & Santasier, 2004 ).
Both nursing and health science literature discuss the benefits of using a case study to instruct students to think critically and develop problem-solving capabilities. Currently, much of the literature focuses on the impact of case study use on critical thinking and decision-making, not the method for choosing and implementing a case study. There is little evidence in the literature of hospital-based educators using case studies for staff development. Because this technique has worked in undergraduate curricula, integrating the case study in staff education could promote enhanced problem-solving, decision-making, and critical-thinking abilities in registered nurses.
The purpose of this article is to review the literature supporting the use of case studies as an effective teaching strategy that facilitates learning, improves critical thinking, and enhances decision-making. In this article, the author provides two examples supporting the use of case studies for staff development during department orientation and for improving patient outcomes. In addition, the author reviews the criteria for implementing an effective case study. Finally, the author provides a brief synopsis on evaluating the effectiveness of the case study.
REVIEW OF THE LITERATURE
The literature focused on a number of benefits supporting the use of the case study as a teaching strategy. By using active, learner-centered teaching strategies, instructors are able to influence the thoughts and behaviors of students that are vital to understanding the nursing process ( DeSanto-Madeya, 2007; Henning, Nielsen, & Hauschildt, 2006 ). As a result of learning through a case study method, many nursing students are given the tools to improve critical and reflective thinking ( Henning et al., 2006; Plack & Santasier, 2004; Snyder & McWilliam, 2003 ), decision-making ( Campbell, 2004 ), problem solving ( Henning et al., 2006; Snyder & McWilliam, 2003 ), and understanding of specific disease processes ( Sandstrom, 2006 ).
In an effort to move away from teacher-centered learning, the case study is a strategy designed to facilitate learner-centered pedagogy. One important aspect of case study use is to increase interactions among students and instructor, giving a team approach to solving the problem ( Henning et al., 2006 ). The guidance from the instructor is a critical component of successfully applying case studies in the curriculum. DeSanto-Madeya (2007) integrated Callista Roy's Adaptation Model into the organization of course curriculum and developed case studies to actively engage students in problem-solving activities. Using a case study to describe a process assisted students to synthesize and apply knowledge in conjunction with a theoretical nursing model. Functioning in the role of a mentor, the instructor facilitated the process of critical thinking by questioning, guiding, and refocusing students on problem resolution.
Another form of the learner-centered pedagogy is the unfolding or continuing case study method. Azzarello and Wood (2006) incorporated the unfolding case study into course content to present data in stages, thus allowing students to comprehend the important principles of the case before receiving additional information. Because not all information is available at one time, the process of using a building block style of case study mirrors actual nursing practice. To hone critical-thinking skills with this strategy, problems can be made increasingly complex to challenge thought processes, problem-solving abilities, and knowledge. Baumberger-Henry (2003) used a similar strategy by combining a continuing case study design with cooperative learning. This method was found to promote reflective and critical thinking by assisting students to integrate knowledge by reflecting on decisions and mentally practicing behaviors. In summary, the continuing case study method guided the learner in the process of methodically conforming data into meaningful information.
The development of clinical judgment through critical and reflective thinking skills is a major focus of many undergraduate programs. Delivering high-quality, efficient, customer-oriented care to patients requires the ability to quickly integrate information and think critically in the clinical setting ( Plack & Santasier, 2004 ). Case studies are used in the curriculum to provide a means for students to develop the tools necessary to think reflectively and critically about a problem. Using clinical-based problems encourages students to better understand thinking strategies, develop reasoning skills, and improve critical thinking ( Henning et al., 2006 ). The case study approach incorporates previously acquired knowledge with scenarios to assist in building critical and reflective thinking expertise ( Snyder & McWilliam, 2003 ). Plack and Santasier (2004) developed a model to teach reflection techniques that promoted the integration and application of previously learned information. The ability to assimilate knowledge into usable practice strategies promotes the process of critical thinking by combining the reflective process with the integration of information. The end result was the development of specific skills that enable the student to recognize and analyze various perspectives about a situation. In direct correlation, when improving critical thinking, decision-making and problem-solving skills are also enhanced.
One purpose of the case study is to depict realistic situations that can facilitate discussion and promote the decision-making skills of the learner. Case studies are beneficial in the clinical setting to enhance the application of previous knowledge, attain practical knowledge, and improve problem-solving skills ( Henning et al., 2006; Snyder & McWilliam, 2003 ). Campbell (2004) used case studies to stimulate critical thinking and decision-making through simulated patient experiences. The course design prompted students to cultivate behaviors that would improve critical-thinking and clinical decision-making skills. In this article, the case study method effectively generated independent thought and problem-solving capabilities by integrating theory and practice. After completing the curriculum, the student was then able to progress from a novice to an expert decision maker.
Case studies are also beneficial in assisting the learner to understand new or difficult material. Sandstrom (2006) incorporated Benner's model of novice to expert in a case study design to enhance student understanding of chronic diseases. Through the case study design, the facilitator was able to positively influence clinical practice by actively engaging students in the process of learning about a specific disease process. In essence, the case study allowed the instructor to build on the curriculum to mold the scenario to fit the learning needs of the student. As part of a course design, the case study can positively affect the ability to understand the nuances of a disease process.
CASE STUDY USE FOR STAFF DEVELOPMENT
Because the literature supports the use of case study methodology for instructing undergraduate students, it seems logical that the same tools be used to promote staff development efforts. There are two specific ways in which hospital-based educators can choose to use the case study method for teaching. During orientation, the case study can be used to instruct a new or experienced nurse on specific patient populations on that unit. Second, the case study method can encourage staff nurses to systematically review situations to improve patient outcomes.
The case study is an important tool in orienting new staff to a specific department in an acute care setting. Developing and using case studies during department orientation are beneficial for enhancing critical-thinking, decision-making, and problem-solving skills in new employees. The case study is a useful instrument in assessing the new employee's ability to make decisions appropriately and think critically. As students, curriculum is broad and general. Once entering the workforce, topics tend to be more specifically tailored to the patient population served by that department. Because there is generally a learning curve for understanding specific patient care issues on a unit, the case study can be used for experienced nurses transferring to a new department. The case study is used to provide basic instruction or enhance current knowledge about the medical conditions and disease-specific problems associated with the patient population of that department. The use of the case study can thus facilitate the development of critical-thinking and problem-solving skills necessary to positively affect the quality of care delivered to the patient ( Snyder & McWilliam, 2003 ).
Case studies are also useful in the clinical setting to review specific positive or negative outcomes of patient care. A case study that highlights the positive actions that prevented an error from occurring or reaching a patient may be developed. More often, however, the case study is developed to help staff determine a series of problems that occurred because of process failures or human error. Whether the result is positive or negative, the process followed when caring for the patient helps determine the methods for improving patient outcomes. To affect patient outcomes, staff must reflect on the care that was provided to the patient and determine if that care was the most appropriate for the situation; the case study can be used for this purpose. Investigating the overall course and outcome of a specific patient scenario can enhance critical thinking and promote the development of new skills for decision-making. The use of a case study format to learn from particular patient experiences is beneficial to both novice and experienced nurses.
In staff development, there are two significant uses for the case study method that can be implemented for both novice and experienced nurses. Both of these areas require learners to develop an in-depth knowledge of specific areas of patient care. Ultimately, the staff nurse needs to be given the tools to provide safe, high-quality care. The case study method expands on previously learned material to make the nurse more effective at the bedside. As discussed, the literature supports using the case study to promote critical-thinking and decision-making skills. In addition, instructors in staff development need to understand how to choose, implement, and evaluate an effective case study for nursing staff development (see Table 1 ).
Before implementing any case study, the instructor must be able to choose or create an appropriate scenario to accomplish the learning objectives. First, establish the problem or disease process that would have the greatest benefit to the nursing staff in that department. Next, the case study chosen must be a relevant and realistic depiction of the patient problem ( Snyder & McWilliam, 2003 ). During department orientation, a general case study may be chosen from a variety of sources, but personal examples are often more beneficial to the learner because the smallest details are known by the facilitator (see Table 2 ). Content specific for department orientation may include scenarios based on potential safety issues, high-risk medications, or a particular patient population. For the purpose of improving patient outcomes, the case study should meticulously represent the overall patient experience. In this instance, the scenario is presented to learn from innovative treatments, new protocols, or errors that were made in the patient's course of treatment. The case study needs to contain sufficient information and be in a logical, sequential format ( Lane, 2007 ) to ensure that the employee can make the best possible decision for the patient. To fully understand the impact on patient care and prevent the situation from occurring again, it is imperative that the learner be provided with enough detail to adequately determine the process issue or error that produced the adverse outcome.
The most effective case studies are those that mirror actual nursing practice. As supported in the literature, it is more realistic to use a case study that builds on the information shared with the learner instead of presenting the entire case at one time ( Azzarello & Wood, 2006; Baumberger-Henry, 2003 ). By breaking down the scenario into multiple parts, similar to the unfolding case study, the staff nurse is able to review the critical decisions that may have been a contributing factor in the outcome. The case should have several possible solutions that require the nurse to make decisions and solve the problem based on the evidence. As with any case study, the scenario should be presented in a way that encourages personal reflection and in-depth questioning about the details of the situation. Because critical and reflective thinking about the problem is the goal, the instructor ought to take time to focus on various ways to resolve the issues.
In addition to choosing the most appropriate case study for the situation, the instructor should also consider the learning goals when determining how the case is to be resolved. Most often, during department orientation, it is best to encourage the employee to work individually to assess critical thinking and prioritizing. The cases generated for improving patient outcomes can be resolved as a team, similar to the patient care setting. In either situation, to facilitate further learning, group discussion is often the most beneficial method for analyzing the case study. Discussion provides an opportunity to examine information systematically while collaborating with peers in the decision-making process. Discussing the problem as a group promotes teamwork because learners work together in a manner similar to that in the clinical setting. In addition, a multidisciplinary group discussion regarding the outcome of a specific patient scenario may provide opportunities for determining the source of the problem and suggestions for improving future patient care.
After choosing a case study and putting it into practice, it is necessary to evaluate its effectiveness. The case can be deemed successful if it addresses the content and sparks in-depth discussion about the scenario. After any case is reviewed, the staff is asked to determine options for process improvements to influence future patient care. Staff nurses who completed the study should be asked if the goal of the case study personally enriched their critical-thinking skills and patient-centered knowledge. The responses should be used to guide future uses of the case study as a teaching tool.
Staff development is a continuous, ongoing process beginning with employee orientation and extending throughout the career of the nurse. In an effort to provide competent, well-prepared individuals to take care of patients, it is important to continuously expand critical-thinking and decision-making skills. Staff educators can use the case study method to promote problem-solving, decision-making, and critical-thinking abilities in registered nurses. Taking cues from the undergraduate literature, educators in staff development can adopt methods for providing learning opportunities for nurses. Incorporating case studies as a teaching strategy will help accomplish these goals.
The case study is an effective teaching strategy that is used to facilitate learning, improve critical-thinking, and enhance decision-making. Staff development educators charged with department orientation and improving patient outcomes can use the case study method to enhance the learning process. Future study should be done to encourage other uses of case studies to enrich staff education, such as in leadership or preceptor development programs.
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Unique Take on the Traditional Case Study: Allowing Students to “Choose Their Own Adventure” : Nurse Educator
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Unique Take on the Traditional Case Study: Allowing Students to “Choose Their Own Adventure”
Leggieri, Alyssa BSN, RN
By Alyssa Leggieri, BSN, RN, Registered Nurse, Emergency Room, Lankenau Medical Center, Wynnewood, Pennsylvania, [email protected] .
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When you’re performing research as part of your job or for a school assignment, you’ll probably come across case studies that help you to learn more about the topic at hand. But what is a case study and why are they helpful? Read on to lear...
Case studies are important because they help make something being discussed more realistic for both teachers and learners. Case studies help students to see that what they have learned is not purely theoretical but instead can serve to crea...
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