Healthcare in general, and nursing in particular, has become more complex and sophisticated due to scientific advances and new insights into best practice nursing techniques. The competency level expected of new nursing graduates is correspondingly higher. Patients are living longer. More complex conditions are being understood and treated. There is greater use of technology, both in immediate care and in research and problem-solving. To meet these new challenges, nursing educators must adopt new methods in order to ensure their students absorb as much information as possible.
When the amount of complex information that must be taught increases to the degree that it has over the last few decades, the danger is that students will not be able to take it all in. New circumstances demand new methods. The traditional approach, based around lengthy lectures to which students listen passively, augmented by essay writing based on textbook study, is insufficient. Although lectures and textbooks will always be a part of higher education, the use of case studies is one of several additional methods that can be used to improve the effective absorption of knowledge.
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Case-based learning
Case studies are employed in the scientific teaching method known as case-based learning (CBL) which has been increasingly employed in nursing education over the past few years. Students are invited to analyze actual clinical nursing cases and to discuss why the actions taken were correct, what alternative courses of action might have been more effective, and why. This exercises the students’ critical thinking faculties in a real-world situation and prepares them for the kinds of judgments they will be expected to make in their working lives.
Case-based learning is often described as a form of guided inquiry where students seek out solutions through a combination of their own knowledge and the requirements of the scenario presented to them. In doing this, the students develop greater powers of self-reflection as well as critical reflection, and they develop skills including those associated with scientific inquiry.
One advantage of case-based learning is that it is student-centered yet teacher-facilitated. It is based on the active analysis of real problems and, as a form of active learning, it helps students to develop the practical skills and sense of confidence that they’ll need in order to progress in their careers. Studies suggest that case-based learning is one of the best ways to integrate theory with practice in nursing education.
Critical thinking
While nursing requires a great deal of clinical knowledge and fact-based understanding, it is not a field that can be taught by rote. Every patient a nurse sees in the course of their career will be different, and while identifying symptoms and categorizing conditions are an important part of the nursing role, so is knowing how to make individual assessments based on the unique circumstances of each patient. The main skill required to achieve this is critical thinking.
Critical thinking enables a nurse to think through each individual case objectively based on the combination of factors that are present, identifying the issues that need to be addressed and deciding on the best methods to address them. One of the most effective ways to instill critical thinking skills in nursing students is through the use of case studies in the teaching process.
Problem-solving and collaboration
In the classroom, students look at case studies and suggest their own solutions to the problems presented to them. This forces them to think on their feet, using the knowledge they’ve previously absorbed on the course but applying it to a real-world situation rather than just regurgitating information on demand. It’s an opportunity to see how different approaches and theories ‘play out’ when tested against circumstances of the kind that any nurse may easily encounter.
Testing these theories in a classroom environment also emphasizes the advantages of teamwork and collaboration. Students can compare ideas, share opinions and work together on analyzing a case and brainstorming a solution. At the same time, they will observe how the context of each individual case affects the choice of solutions. ‘Learning by doing’ is considered to be more effective in developing and retaining practical knowledge and capabilities than the passive experience of listening to a lecture or reading a textbook.
Another positive aspect of case-based learning is that students learn how to articulate their own views in a way that is most likely to contribute to a positive decision while also discovering the value of multiple perspectives. What may seem obvious to one student may not be noticed by others in the class, and, in fact, a student who is sure of a solution may have overlooked a crucial factor in the case that other students may notice. Developing effective problem-solving skills requires the ability to integrate different perspectives, and this is something that can be provided by case-based learning.
Deeper understanding
Case studies are equally valuable when students are learning remotely, including those taking MSN to DNP programs online. A Doctor of Nursing Practice (DNP) is the highest level of nursing qualification, and Wilkes University offers an accelerated course that lets applicants complete their DNP in just six terms, or less than two years, while still meeting their professional obligations. Students who use case-study analysis typically find they have a deeper understanding of the material compared to that which they gain from merely memorizing the contents of a lecture.
Using case studies prepares students for the clinical placement aspect of their course, where they may find themselves working in situations similar to those they have recently analyzed. The use of real-life case studies can also demonstrate how a medical situation never occurs in isolation, and how problems must be treated as part of a flow of patient care. In this way, case-based learning improves patient management planning by, for instance, focusing on the allocation of resources and encouraging awareness of competing pressures.
Greater engagement
Students become more engaged with their own learning when presented with real cases to study. These are often the lessons that are most eagerly anticipated and that stimulate student curiosity to the fullest extent, making the students more active learners. In turn, this enthusiasm and engagement leads to greater retention of information and more independent thinking on the subject, so that ideas are developed rather than just being mentally filed away.
Case study analysis can also function as a team-building exercise, encouraging the class members to work together to find solutions to the problems presented to them. Classes may be divided into smaller groups for the purpose of working on a case, allowing for more in-depth discussion. Typically, they then have to present their findings to the rest of the class and the teacher. This develops oral communication skills and the ability to explain and justify their methods and conclusions. Receiving immediate constructive feedback from teachers and peers will further improve their presentation skills.
Storytelling
One of the great advantages of using case studies is that this method involves storytelling. Our brains are naturally wired to respond to narrative, characters, and other story elements, and to try to solve the problems presented in the narrative. Student responses to case-based learning can be compared to the way we respond to ‘whodunit’ detective fiction, in that otherwise less active parts of the brain are activated leading to an enjoyable engagement with the material that stimulates further inquiry.
In fact, scientists have found that listening to stories triggers the release of the hormone oxytocin, increasing our sensitivity to social cues. We become more empathetic, compassionate and kind through hearing and identifying with the stories of others.
In a teaching context, storytelling makes learning enjoyable in much the same way as the gamification methods that are becoming increasingly popular in education. However, stories have a further advantage over games in potentially providing a point of identification for students while also leaving room for them to interpret and expand on the material presented. Stories generate meaning, which anchors us in the world and our communities and motivates us to learn. In terms of education, this can mean the difference between dry facts and theory in a medical textbook, disconnected from actual experience and a situation in which one is emotionally engaged.
Role play
The use of role play is a way to keep students active and engaged in their own learning. For instance, after a case is presented, students may be asked to role-play both the patient from the case and a nurse interviewing them. Other students may be encouraged to ask further questions of both participants.
Sometimes, students may be given all the relevant information on a case upfront and be asked to suggest a number of possible outcomes based on that information. They might then be expected to plan nursing interventions appropriate to each outcome. A discussion could follow where the students explain their methodology and the whole class explores other options.
In other cases, information might initially be withheld in order to encourage the students to ask the right questions that will uncover the full facts. It is up to the teacher to choose the method they feel is most appropriate to the class and the lessons being taught.
Combining methods
In a nursing class, students may be presented with a description of a patient exhibiting certain symptoms. The students are able to ask questions and later propose tests in order to arrive at a diagnosis. From there, they can proceed to outline a treatment plan. The interactive nature of this example shows how storytelling can be combined with role-play so that game elements are included alongside narrative, further stimulating engagement.
Students looking at large-scale public health solutions may be given an epidemic case to study and be expected to work back through the evidence to identify ‘patient zero.’ As well as proposing methods to contain and eventually eliminate the epidemic, in this scenario, students may also suggest ways in which the epidemic could have been prevented in the first place.
Case studies promote analysis, synthesis and evaluation of the facts rather than merely their accumulation. The actual cases may be brought to the class by the teacher or by students as part of their assignment. They may be real or scripted but should represent the kinds of situations that a nurse may expect to encounter in the field.
Other contexts
In remote learning situations, case studies can be posted online and analyzed either in real-time virtual classes or via online discussion boards. Teachers might use ChatGPT in teaching and learning to help create case studies. Case studies may also be presented by lecturers in the form of anecdotes based on their own personal experiences as nurses or the experiences of their colleagues. These can then be expanded on with discussion points if necessary.
Sometimes, these cases may be used as examples of how nursing has progressed in the intervening years since the original incident took place. On other occasions, the lecturer may use case studies to show how a complex diagnosis can be arrived at or how a procedure may be undertaken. In a lecture context, the purpose of a case study is to retain the interest of the listeners and also to enhance understanding of the points being made.
The contribution of case studies to nursing education
The use of case studies is just one teaching method that can be used to make nursing education more effective. Just as healthcare and the nursing profession are becoming more sophisticated and demanding, so is nursing education. Teachers are required to familiarize themselves with the latest techniques and to shake up the structure of their classes when appropriate.
By promoting active learning, case studies have been shown to both increase the retention of information by students and foster critical thinking skills that are essential in today’s nursing environment. Passive teaching methods, such as lectures or textbook-based study, are not always effective in developing critical thinking as students may simply repeat what they’ve been told in order to pass examinations. By using case studies, teachers can bridge the gap between theory and practice, bringing students closer to the true experience of nursing and so preparing them more fully for their working lives.
