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Case Study For Nurses

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

Researchers describe how case studies examine complex phenomena in the natural setting to increase understanding of them.3 4 Indeed, Sandelowski5 suggests using case studies in research means that the holistic nature of nursing care can be addressed. Furthermore, when describing the steps undertaken while using a case study approach, this method of research allows the researcher to take a complex and broad topic, or phenomenon, and narrow it down into a manageable research question(s). By collecting qualitative or quantitative datasets about the phenomenon, the researcher gains a more in-depth insight into the phenomenon than would be obtained using only one type of data. This is illustrated in the examples provided at the end of this paper.

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

Method

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:

  1. Observational data to gain a picture about actual pain management practices.

  2. Questionnaire data about nurses’ knowledge about paediatric pain management practices and how well they felt they managed pain in children.

  3. Questionnaire data about how critical nurses perceived pain management tasks to be.

These datasets were analysed separately and then compared7–9 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 practices9; 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:

  1. Review of documentation related to the NPLC model (media, annual reports, research articles, grey literature and regulatory legislation).

  2. 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.

  3. 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

Conclusion

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.

References

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Records 1 to 55 of 55

A Case of Iron Deficiency Anemia
“Dolores Welborn,” a 28-year-old attorney, is pregnant with her first child. Lately she has been tiring easily and is often short of breath. She has also had periods of light-headedness, cramping in her legs, and a sore tongue. Students rea...


A Case of Medication Error
This case study begins with a real news article about a six-month-old baby who died from an overdose of medication administered by hospital staff. The infant was diagnosed with pneumonia and given an intravenous dose of the antibiotic azithromycin, the...


A Case of Pharyngitis
Seven-year-old “Jason Hornbuckle” has been complaining for the past 12 hours of pain when he swallows.  He also has a headache and has vomited twice.  His mother decides to take him to the pediatrician.  Students read a brief...


A Case of Thrombocytopenia
“Carolyn Jones” is a 40-year-old professor of economics. The past week she has felt tried and weak. The past few days she has noticed small, red dots on her skin and gums.  Even more upsetting, she cut herself while making dinner and t...


A Case of X-linked Agammaglobulinemia
Though a normal, full-term baby at birth, starting at about 10 months of age “Billy DeWitt” has suffered a series of infections, including sinusitis, otitis media, and pneumonia. Students read a brief clinical history of the patient and a d...


A Case Study Involving Influenza and the Influenza Vaccine
This interrupted case study presents a discussion about the benefits of the influenza vaccine between Mary, a nursing student, and her coworker, Karen. Karen is not convinced by Mary’s arguments in favor of vaccination, and she counters with seve...


A Difficult Pregnancy
This case study, about a developmentally disabled, 30-weeks-pregnant 19-year-old, presents some of the patient management issues that health care workers face. The case is used in a graduate level seminar for family nurse practitioner students going th...


A Metabolic Storm
This "clicker" case presents the true story of a 20-year-old athlete who developed a life threatening reaction to anesthesia during a simple elective surgical procedure. His response was unexpected, but not unusual for individuals who possess an inheri...


A Pain in the Gut
This interrupted case study in gastric physiology follows the story of Frank, a businessman under a lot of stress who has a car accident while driving home from work one night. Frank has low blood insulin levels and high blood sugar levels that his doc...


A Yellow-Bellied Lawyer?
This interrupted case study tells the story of Michael, a Harvard law graduate with a stressful job and a seemingly heavy drinking problem. Students are provided with background information, medical history, and lab results in order to guide them towar...


All or Nothing
In this interrupted case study, students pose as an intern of a neuromuscular/skeletal specialist and discover how sarin and myasthenia gravis influence muscle function. Students are given background information about the patients and their situations,...


Amber's Secret
This problem-based case focuses on the female menstrual cycle and early stages of pregnancy of an unwed teenager. Working in small groups, students identify the learning issues for each part of the story and research answers to their questions. They ar...


Asthma Attack!
This interrupted case study follows the progress of a pediatric patient who experiences an acute asthma exacerbation brought on by an environmental trigger.  Students completing the case will synthesize their understanding of respiratory system an...


Black and Blue with Love
In this directed case study students follow a nurse practitioner and work with a diagnostics team to determine what is wrong with Tristan, an infant who comes to the clinic with multiple bruises. Students are given background and patient history, and a...


Born for Recovery: The Effects of Maternal Methadone Use on Neonates
This interrupted case study presents the story of "Jane Paul," a 27-year-old pregnant woman excited by the prospect of bringing a new life into the world. Jane had been using heroin for the past seven years, but when she learns she is pregnant, she goe...


Chemical Eric Can't See
This autobiographical case study presents the story of Eric as he learns that he has a genetic eye disease, which progresses to the point that he becomes legally blind. The story is true and, in this respect, similar to another case by the same author ...


Cracking the Case
In this directed case study, students shadow Dr. Lee in diagnosing two patients with osteoporosis. The students are given patient history and an initial panel of test results, which they discuss in small groups. After diagnosis, they are asked specific...


Danielle's Difficulty
The incidence of Clostridium difficile infection (CDI), including severe infection, has increased in both institutional settings and the general community. This case study presents the story of an elderly woman who spent time in a hospital and...


Diagnosis of a Congenital Disorder
This progressive disclosure case study explores the medically-related issues of a female infant born with the congenital disorder Sirenomelia, more commonly known as "Mermaid Syndrome." The case starts with a high-risk mother participating in prenatal ...


Does a One-Size Drug Dose Fit All?
The purpose of this case study is to make students aware that some patients may require individualized drug dosing regimens based on a variety of patient variables. The central classroom activity consists of small group work in which students analyze a...


Emily and Dr. Haskins
This case study on clinical practice, preparation, and acumen follows the story of Emily, an intelligent, hard working, and motivated student who yet encounters difficulties in the clinical fieldwork component of her senior seminar. A follow-up section...


Family, Culture, Medicine
This four-part problem-based learning case examines cultural conflicts between Western medicine and non-Western traditional healing practices. Students consider notions of cultural relativism and ethnocentrism through the lens of social institutions, i...


Grandma's TUM-my Trouble
An elderly woman living independently with some help from her family is brought to the local emergency room because she is confused and vomiting. While her son suspects a stroke, a quick battery of laboratory tests indicates that her current probl...


Hyper-IgM Syndrome
Hyper-IgM syndrome is an X-linked genetic disorder more commonly affecting males than females. It is caused by the lack of heavy chain class-switching from IgM to other isotypes. Patients with hyper-IgM syndrome are susceptible to a variety of infectio...


I Heart Running: A Case Study on Tachycardia in Sam the Runner
"I Heart Running" is a case study in which students diagnose the cause of exercise-induced tachycardia in an otherwise healthy, 27-year-old female. The patient, Sam, is a long-distance runner and realizes that her exercising heart rate reaches over 200...


Living the Sweet Life
In this directed case study, students assist Dr. Gupta in his endocrinology clinic in diagnosing three patients having problems with blood glucose regulation. In Part I, students are given patient backgrounds and results from laboratory tests generated...


Lost in the Desert!
Students learn about the interconnectedness of the body, with a particular focus on the skin as one of the most important homeostatic organ systems, in this case study in which the protagonist sets out on a three-hour drive across the Arizona desert to...


Lost in the Desert! Hebrew Translation
In this directed case study, translated from the original English into Hebrew, students read about a man who sets out on a three-hour drive across the Arizona desert to meet his fiancee in California but never shows up at his final destination.  S...


Mary Keeper’s Aching Head
In this problem-based learning case, students read about a 41-year-old woman who is suffering from recurring headaches. Working in small groups, the students analyze a variety of information and then formulate a diagnosis. This case study was developed...


MDR Tuberculosis
In this case study on multi-drug resistant (MDR) tuberculosis, students consider ways in which to preserve health as a human right without subjecting already marginalized communities susceptible to the disease to further discrimination. Students learn ...


Morgan: A Case of Diabetes
This case teaches about the causes and effects of Type 2 diabetes by working through the various options available to a young Native American woman suffering from the disease. The case can be used in a variety of settings, including nutrition classroom...


Needles and Pins
This case, designed for medical students, dental students, and dental hygiene students, covers the steps involved in preventing and responding to accidental needle sticks in the clinical setting.  The case is particularly helpful for use with stud...


Pharmacogenetics: How Genetic Information Is Used to Treat Disease
In this clicker case, two teenagers are diagnosed with Acute Lymphoblastic Leukemia (ALL), a cancer of the bone marrow where there is an abnormal overproduction of lymphocyte precursors. The girls' reactions to treatment are very different, however, du...


Pharmacogenetics: Using Genetics to Treat Disease
This case study investigates the applications of genetics to medicine by exploring one of the first examples of a pharmacogenetic test to enter mainstream clinical practice. Pharmacogenetics examines how genetic variations in an individual correlate wi...


Properties of Gases: A Case Study of the Bends
In 2012, Mike Prickett, a world-renowned underwater cinematographer, was working on a commercial photo shoot in Tahiti when he witnessed a fellow diver sinking and drowning. While saving the drowning victim, Mike fell victim to decompression sickness (...


Revolt on the Tuberculosis Ward
Monique is a 30-year-old Haitian woman with advanced pulmonary tuberculosis who has been transferred from a tuberculosis sanatorium to a large general hospital in Port au Prince after developing a secondary infection with Bacteroides fragilis ...


Spirituality and Health Care
In this medical ethics case, a fourth-year medical student making hospital rounds with an attending physician and several residents is asked by a family member of a patient to pray with her.  The case allows medical students to explore issues rela...


Sunny Skies and a Lurking Microbe
Based on a true story, this case study chronicles the development of a wound infection that began as a minor cut that occurred while carrying out a typical household task (moving furniture).  Identifying the causative agent ultimately took three s...


Super Bug
Sam, a pre-med college student, routinely gets dialysis and develops a urinary tract infection. The infection is from a bacterium that the news media is calling a "superbug" from India. Sam does some internet searches to find out more information about...


The Case of the Crying Baby
The parents of a six-week-old baby girl know there is something seriously wrong with their child, but it takes a number of frustrating visits to the pediatrician before they finally get a correct diagnosis. Once they do, the parents must decide whether...


The Case of the Newborn Nightmare
Three newborns left in the care of "Dr. Mark Maddison" have developed a mysterious rash. Under increasing pressure from hospital administrators and distressed parents, the doctor must diagnose and treat the infants. Students are given discrete pieces o...


The Haemophilus Vaccine
This case study focuses on a young mother whose child attends a day care center where there has been an outbreak of bacterial meningitis. The case explores the need for health care workers to provide relevant medical information and advice to patients,...


The Heart of the Problem
This interrupted case study was developed for an undergraduate class in human cardiac physiology. The story follows a patient whose heart attack damaged a papillary muscle in the left ventricle of the heart. This caused valve dysfunction and mitral val...


The Medicinal Use of Marijuana
Whether marijuana should be legalized for medicinal purposes has been contested for decades. The claims, counter-claims, issues, and judgments in this high profile controversy make it an excellent candidate for “intimate debate.” While simi...


The Plan: Ethics and Physician Assisted Suicide
This case study on physician-assisted suicide is used in a medical ethics course. The case itself is a short article published in 1991 in the New England Journal of Medicine in which Dr. Timothy E. Quill described his care for a patient suffer...


The Unfortunate Nurse
Dengue (pronounced "deng-ee") is a viral disease transmitted by the bite of an infected mosquito, usually Aedes aegypti. It is common in tropical regions, especially Southeast Asia, India, South and Central America, and Mexico. There is conc...


Thyroid Troubles
In this interrupted case study, students shadow an endocrinologist as she tries to determine what is wrong with Angela Barber. Angela is a middle-aged woman presenting with symptoms suggestive of a thyroid issue. Students are given background informati...


To Tell the Truth
This case was developed to teach first-year medical students about medical ethics as they apply to patient communication. Students receive an introductory lecture covering the basics of giving bad news and then are asked to apply what they have learned...


Tragic Choices: Autism, Measles, and the MMR Vaccine
This case explores the purported connection between vaccines in general, and the MMR vaccine specifically, and autism. Students examine results from the 1998 Lancet article that ignited and still fuels the anti-vaccine movement; students are t...


Treating Ed
Ed is dying. How should his wishes for medical treatment be carried out? As the case unfolds, students explore the rights and responsibilities of doctors, patients, and patient representatives regarding difficult medical decisions. Specifically, studen...


Up All Night
In this clicker case, students are introduced to George, an undergraduate student who has been experiencing some odd symptoms. His roommate convinces him to see a physician who recognizes that George's symptoms are consistent with diabetes mellitus; bu...


Uretero What?
This case study follows a woman faced with a series of difficult medical decisions. Students apply systems-level physiology as they explore a pregnancy with medical complications and discuss situations involving life-changing decisions prompted by mode...


Wake-Up Call
The main character of this case is Denise, who we first meet in the early morning hours as she wakes up in a cold sweat, gasping for breath. But it is her husband, Jeremy, who has been diagnosed with heart disease, not her. What’s going on? In th...


Wearing on Her Nerves
This case study is designed to integrate important aspects of the nervous and muscular system portions of an anatomy and physiology course. Students follow the story of “Kathy,” whose symptoms involve both sensory and motor components of th...


When Drug Sales and Science Collide
When "Jeff," a fictionalized drug representative, is placed on the Vioxx® account in 2001, he finds himself pulled between sales and science as he struggles to reconcile three original documents: a Merck marketing pamphlet, a graph from a scientifi...