Case Studies as a Signature Pedagogy in Nursing

Dr. Frances Kalu, Teaching and Learning Specialist and Carnelle Symes, RN, MScN, Nursing Instructor, University of Calgary in Qatar

As a practice-based discipline, nursing education combines pure and applied science; as such, bridging the gap between theory and practice is key to student learning. In his seminal work, Shulman (2005) describes signature pedagogies within professions as discipline-specific approaches to teaching that educate novices to think, perform and act within their disciplinary frameworks. Clinical rotation and simulation are two of the signature pedagogical approaches used in nursing. Both approaches enable students to learn from nursing practitioners—at the bedside in the case of clinical rotations, and in simulation labs where practice can take place in safe environments (Long et al., 2012). However, in an age where knowledge changes rapidly, with information contained in textbooks and lectures quickly becoming obsolete and patients becoming less likely to spend as much time in acute care settings (Long et al., 2012; Schulman, 2005), health science disciplines are looking at different signature pedagogies for educating students. In nursing, narrative pedagogies and problem-based learning approaches have been identified as techniques that engage students to think critically and empathetically while excising clinical judgement (Long et al., 2012). There are many problem-based pedagogical approaches, including the use of case studies.

Popil (citing Leenders et al., 2001) notes that case studies describe actual or hypothetical situations that commonly include challenges, problems or opportunities requiring resolutions and decisions. Used in the classroom, they create opportunities for students to think critically, analyzing and synthesizing knowledge to bridge the gap between theory and practice. As problem-based learning environments provide opportunities for students to learn while resolving real life problems (Jonassen, 2011), case studies enable students to think within their disciplinary contexts while developing habits of mind (a tenet of signature pedagogy) (Shulman, 2005).

In the nursing profession, we often use case studies to instruct our students both in the clinical environment and in the classroom. Our Spring 2018 Teaching and Learning in Nursing Education Book Club at the University of Calgary in Qatar (UCQ) introduced us to a variety of case studies that can be used to enhance students’ understanding of content. These case study types include Quickies, Preclass, Interspersed, Continuing and Unfolding (Herrman, 2016). The author explains that the various types of cases studies can be used for diverse class sizes depending on class outcome goals.

One of the authors has used all of the various case study forms noted by Herrman (2016). The sections below contain brief definitions of the case study types  and explanations of how the author applied them in Nursing Inquiry, taught during the Spring 2018 semester for the Bachelor of Nursing, Regular Track (BNRT) students, and in Nursing Scholarship, taught during the Winter 2018 for the Bachelor of Nursing, Post Diploma (PDBN) students.

Quickie Case Study

This type of case study is usually very short and generally consists of an introduction to a patient and relevant clinical situations. It can be used to introduce topics, to transition from one topic to another or to demonstrate links between content. I used the quickie case study approach with case descriptions I’d used for test questions. I frequently give students in-class multiple choice questions using a classroom response system such as Socrative. These questions commonly provide case study components for context. Here is an example: You are a nurse working with an interdisciplinary team to provide care to a patient. During patient rounds you hear several members of the team make derogatory remarks about the patient due to their nationality. What patterns of knowing might you experience during this interaction: Empiric, Personal, Ethical, Aesthetic or Emancipatory? (You may choose more than one).

Preclass Case Study

This approach provides students with a case study before class. This is very useful for classes that need to cover more content than time permits. Although I did not use this case study typein the aforementioned classes, I have used it in clinical and lab courses. Most recently, I used it this fall for Consolidated Practicum II, a course for students who were in clinical rotation at the Heart Hospital in Qatar. This helped facilitate learning and prepare the students for the clinical placement area by familiarizing them with the types of diseases, medications and treatments they would encounter.

Interspersed Case Study

This type of case study helps break up lessons and reinforce difficult concepts. It sometimes involves mini-cases. I used this approach in N207 and N411 to reinforce the idea that a single report or journal article may be informative but may not be/should not be enough to change professional practice. The levels of pre-appraised evidence (Dicenso, Bayley & Haynes, 2009) can be confusing for students to understand, so I turned to the case study of the Lancet article stating that autism may be caused by the MMR vaccine. This article has since been proven inaccurate and retracted, but it has managed to do a lot of damage from a public health perspective, with some individuals now refusing to vaccinate their children. I expected students to identify that this article falls at the base of the evidence period (level 1) and should therefore not be used as definitive proof, and that it should not be generalized without further investigation.

Continuing Case Study

A continuing case study is discussed multiple times throughout a class period to reinforce a variety of linked concepts. It can be continually developed as new content is presented. Hermann (2016, p. 59) asserts that this case study type brings a ‘human element,’ as students get to know a client and develop a holistic picture of the situation. I like to use an example in my class of a patient I had who was sedated and therefore unable to state who his family members were. In this case study, there was a conflict between the patient’s parents and a person who claimed to be the patient’s common-law partner. I provided more details to the students as they learned more about the concepts of reflection in difficult situations, models of reflection and ethical dilemmas in nursing. This occurred over the course of one class period. Continuing case studies can be used for topics in which the contents are layered and increasing in complexity. They can also be used to review concepts before examinations or tests.

Unfolding Case Study

This approach helps develop and introduce key components that will be covered in several lectures, or perhaps over the entire term, as students learn about the different components required for care. For N207 and N411, I used the same case study about conflict between patient families throughout the course. I first used this study to discuss reflection, and again in the classes where we covered patterns of knowing, specifically how to identify patterns of knowing when reviewing the nurse’s role and evidence-based practice (EBP), and when searching for literature to guide our practice. This case moved through the process of evidence-based practice and promoted greater understanding. We did not spend time each class trying to reorient students to the case, leaving time instead to provide examples that supported their understanding of the content.

Problem-based learning environments allow students to learn while resolving problems (Jonassen, 2011). Nurses spend time problem-solving various issues related to clients. Case studies enable students to acquire and apply knowledge while critically resolving problems that could be encountered in real-life situations. This is an effective teaching tool that could be seen as a signature pedagogy in nursing education. It has been used successfully in many courses at the University of Calgary in Qatar, allowing students to deepen their learning.

References

Dicenso, A., Bayley, L., & Haynes, B.R. (2009). Accessing preapproaised evidence: fine-tuning the 5S model into a 6S model. American College of Physicians, 151(3), 2-3.

Herrman, J.W. (2016). Creative teaching strategies for the nurse educator (2nd ed.). Philadelphia: FA Davis Company.

Jonassen, D. H. (2011). Learning to solve problems: A handbook for designing problem-solving learning environment. New York, NY: Routledge.

Leenders, M. R., Maufette-Leenders, L.A. & Erskine, J.A. (2001). Writing cases. London, Ontario: Richard Ivey School of Business Publishing.

Long, L. T., Breikreuz, K. R., Diaz, D. A., McNulty, J. J., Engler, A. J., Polifroni, C. & Telford, J. C. (2012). Competence and care: Signature pedagogies in nursing education. In N.L Chick, A. Haynie, & R. A. Gurung (Eds.), Exploring more signature pedagogies: Approaches to teaching disciplinary habits of the mind (pp. 171 -187). Sterling, Virginia: Stylus Publishing.

Schulman, L. S. (2005). Signature pedagogies in the professions. Daedalus, 134 (3), 52 – 59.

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