what is the purpose of a case study in nursing

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• What is a case study?
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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

https://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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Delve into the intricacies of a nursing case study, a critical component in nursing education and practice. This comprehensive guide will establish a robust understanding of the construction, relevance, and application of these integral studies. You'll explore various formats, ethical implications, and practical examples, ultimately honing your skills in creating effective nursing case studies. With an in-depth analysis and step-by-step guidance, this guide is crucial for aspiring or seasoned nursing professionals looking to enhance their case study proficiency.

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What is a nursing case study?

What are the components of a nursing case study?

What is the importance of a nursing case study in clinical placement?

What is the nursing process for a case study?

What are the key components of a well-written nursing case study?

What is the purpose of writing a nursing case study?

What is the significance of nursing case study examples?

What are the major steps followed during a Nurse Practitioner case study analysis?

What essential points should be considered when analysing a delegation in nursing management case study?

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Understanding the Concept of a Nursing Case Study

Entering the field of nursing often requires more than simple rote learning. It demands an in-depth understanding of specific patient conditions, collaborative care planning, and the application of theoretical knowledge in practical scenarios. This is where a nursing case study plays a key role.

A nursing case study is a comprehensive examination of a patient's status, which comprises the gathering, assessment, and interpretation of data through various medical examinations and tests. This process allows healthcare professionals to make better-informed decisions about a patient's care plan and overall health management.

What is a Nursing Case Study: An Introduction

A Nursing Case Study is an in-depth examination of a patient case, wherein the nurse documents detailed information about the patient—everything from their initial history, diagnosis, to treatment—whilst also noting observations and reflecting on their nursing care.

A nursing case study typically includes sections for patient history, diagnosis, nursing assessment, treatment, and results. You will:

• Start by documenting a detailed patient history including previous medical conditions and lifestyle.
• Then, you'll progress to the diagnosis of the patient's condition.
• Next, perform a nursing assessment to identify potential health risks or complications.
• Formulate a treatment plan based on the assessment.
• And finally, evaluate the results of the treatment plan and adjust as necessary.

These comprehensive evaluations are critical in the field of nursing as they not only allow for appropriate patient care but also help guide future medical recommendations.

For example, consider a patient diagnosed with type 2 diabetes who complains of unexpected weight loss. A comprehensive nursing case study would involve recording the patient's current symptoms, medical history, conducting a nursing assessment to identify potential complications, and formulating a treatment plan. The results of this treatment would be regularly evaluated and adjusted to optimise the patient's health.

Importance and Relevance of a Nursing Case Study in Clinical Placement

A nursing case study plays an indispensable role in clinical placement . As you navigate your clinical experience :/p>

• You can use case studies as a reference tool in diagnosing, planning, implementing and evaluating patient care .
• Through case studies, you can also enhance your critical thinking and problem-solving skills.

Clinical placement refers to the practice-based learning experience that allows nursing students to apply their theoretical knowledge in a real-world clinic or hospital setting.

Such hands-on experience is essential to developing a solid understanding and mastery in nursing. A thorough nursing case study stands as a practical resource, providing valuable insights into complex patient conditions and providing a framework for delivering effective patient care. Furthermore, it also enables better comprehension of theoretical practice, thus bridging the gap between theory and application in nursing.

Exploring the Format of a Case Study in Nursing

It is crucial to understand the layout of a nursing case study. Having a solid grasp of the format will enable you to document all essential pieces of information about your patient care efficiently and thoroughly. Furthermore, clear structuring strongly supports effective communication within the healthcare team .

Remember, just like other academic papers, a nursing case study generally follows a logical flow that reflects the nursing process . This process includes five steps: Assessment, Diagnosis, Planning, Implementation and Evaluation; often abbreviated as ADPIE.

How to Write a Nursing Case Study: Step by Step Guide

When writing a nursing case study, it's vital to maintain a clear, structured and detail-oriented approach. Here, you will learn a standard step-by-step guide to creating your case study.

• Review the Patient History : Start by gathering all relevant details about the patient's medical history. Include specifics like past medical conditions, medication use, lifestyle factors and family history of diseases.
• Document Recent Health Assessments : Mention any recent diagnostic tests and their results, physical examination findings, and present complaints or conditions if any.
• Analyze Clinical Data : Analyze the data from the assessments and tests to identify any pertinent patterns or connections.
• Formulate Nursing Diagnoses : Based on your analysis, formulate nursing diagnoses . A nursing diagnosis can be described as a clinical judgement concerning a human response to health conditions.
• Develop a Comprehensive Care Plan : After diagnosis, establish a comprehensive care plan detailing the intended therapeutic interventions and expected outcomes. Remember, it's crucial to form SMART (Specific, Measurable, Achievable, Relevant, Time-bound) outcomes.
• Evaluate Progress : Lastly, evaluate the patient's progress towards the desired outcome and note any necessary changes to the care plan.

Please, keep in mind that the case study should follow a narrative approach, ensuring the information flows logically while maintaining patient confidentiality at all times.

An example could be a nursing case study for a patient with pneumonia . First, the patient's history is gathered, noting previous respiratory issues or any risk factors like smoking or occupational exposure. Next, the current clinical data would be documented, such as the results of a chest X-ray showing an infection in the lungs , together with vital signs and physical examination results. The data is then analyzed to arrive at a nursing diagnosis of impaired gas exchange related to alveolar consolidation, as evidenced by abnormal breath sounds and decreased oxygen saturation levels. The care plan would include interventions such as administering prescribed medications, oxygen therapy , and promoting good lung hygiene, with the expected outcome of improved respiratory function. Regular progress evaluations would be made, adjusting the plan as required.

Key Components of a Well-Written Nursing Case Study

The resultant quality of a case study depends on whether all key components are properly addressed. Here are some pivotal sections that should be present:

• Introduction : This provides a brief overview of the patient's demographic information and reason for admission.
• Patient History : The patient’s medical, surgical, and family history, including lifestyle factors.
• Physical Examination : Findings from the nurse's initial physical assessment of the patient, noting any abnormalities.
• Nursing Assessment : Identification of health issues or potential complications based on nursing theory.
• Nursing Diagnosis : Clinical judgement concerning a human response to health conditions.
• Nursing Interventions and Rationale : Explanation of the actions taken by the nurse to reach the planned outcomes, with a clear rationale behind each intervention.
• Expected Results and Actual Outcomes : Anticipation of results after interventions and comparison with actual outcomes. Adjustments to interventions may be made based on this comparison.

By giving due importance to each of these components, you ensure that the case study is comprehensive, accurate, and informative. This process aids in the ongoing optimisation of patient care, and shows the continual evidence-based practice in nursing.

Diving into Nursing Case Study Examples

An understanding of nursing case studies is significantly enhanced with the examination of practical examples. Analysis of these examples provides a real-life context to theories and practices, reinforcing their relevance and applicability. It is a great tool for learning by experience and expanding your knowledge in the field.

Reviewing nursing case study examples can spotlight the importance of thorough data collection, patient history compilation, diagnosis determination, and subsequent treatment provisioning. It permits you to appreciate the diversity of patient conditions, honing your skills in managing complex health situations effectively.

Nurse Practitioner Case Studies: Comprehensive Analysis

Nurse Practitioner case studies offer rich insights into the critical role nurse practitioners play within healthcare teams, particularly in primary care settings.

A Nurse Practitioner (NP) is a registered nurse with additional education and training in a particular area like family practice or paediatrics allowing them to examine, diagnose, and treat patients.

By looking into nurse practitioner case studies, you can expand your understanding of the advanced critical thinking, decision-making, and leadership skills exercised by NPs in diverse health scenarios. Here are the major steps that are typically followed during case analysis:

• First Step - Understanding the Patient's Details : The big picture of the patient's background, including their demographics, social, medical and personal history.
• Second Step - Identification of the Care Gaps : Identifying the issues in the existing care provision and areas of improvement for the Nurse Practitioner.
• Third Step - Formulation of a Healthcare Plan : The NP devises a robust patient-specific care plan detailing the required interventions.
• Fourth Step - Execution and Evaluation of the Plan : The plan is implemented, and the results are closely monitored for necessary changes.

Consider a Nurse Practitioner case study involving a 70-year-old female with a history of hypertension . The patient complaints of frequent headaches and tiredness. The NP begins by understanding the patient's overall health background, and then identifies the gaps in care—possibly inadequate control of hypertension. The NP formulates a plan that includes adjustment of antihypertensive drugs, lifestyle changes, and regular blood pressure monitoring . The execution of this plan is followed by a careful analysis of the patient's improvement in symptoms and hypertension control.

Delegation of Nursing Management Case Study: An Overview

Evaluating delegation in nursing management through case studies is an excellent way to understand its significance in nursing practice and learn the best principles for its application.

Delegation in nursing management refers to the process of assigning tasks to subordinates or team members in a way that maximises the efficiency and effectiveness of healthcare delivery.

Delegation is a crucial skill for every nurse, especially for those in leadership roles. It not only ensures smoother workflow but also empowers less experienced nurses, imparting skill development opportunities. The following points are important when analysing a delegation case study:

• Assessing the Situation : First, understand the precise patient care scenario and the workforce available.
• Identifying the Skills Required : After assessing the situation, identify the kind of skills needed for the delegated tasks.
• Assigning the Task : Delegate the task to the most competent and available person, considering their individual competencies and workload.
• Monitoring and Feedback : After delegation, it's crucial to supervise the task completion and provide constructive feedback to enhance performance in the future.

For instance, consider a case study highlighting delegation in a busy hospital setting. The nurse manager has to manage the care of 30 patients with only five nurses on duty. After assessing the situation and the individual abilities of the nurses, she assigns roles like medication administration , wound care , and patient education optimally. She then monitors the work and offers feedback after the shift, leading to efficient patient care despite the heavy workload.

Learning from these case studies equips you with efficient strategies for nursing management and ensures streamlined patient care. This knowledge acquisition is essential in modern healthcare settings to establish a patient-centred, coordinated approach.

Case Studies in Nursing Ethics

Examining case studies in nursing ethics is an invaluable way to explore the complex nature of ethical dilemmas in clinical settings. It allows you to conceptualise ethical concepts applied to patient care, while providing robust resources for learning and growth.

These case studies essentially offer an exploration into the intersection of healthcare, morality, philosophy, and social justice, which is represented in daily nursing practice.

Ethical Dilemmas in Nursing: Case Study Illustrations

An 'ethical dilemma' refers to situations where moral obligations conflict or where moral reasoning is not clear-cut. Nurses frequently encounter such dilemmas in their practice, making it crucial to understand how to approach these complex situations.

Ethical dilemma in nursing is a scenario where a decision must be made between two morally correct courses of action, but they are conflicting.

In nursing, the prime focus is always to provide the best possible care for a patient. However, ethical dilemmas arise when the right course of action is unclear, or when different beliefs and values clash. These situations can be stressful and deciding on the course of action can be challenging. Reviewing case study illustrations of ethical dilemmas can be a powerful teaching tool that facilitates a deeper understanding of these challenges.

Here are the most common ethical dilemmas that nurses face:

• Disclosure : How much information about the patient's health should be shared and with whom?
• Quality of Life : When a patient is suffering, what measures should be taken to maintain quality of life versus prolonging life itself?
• Professional Boundaries : How does a nurse maintain the right balance between being professional yet compassionate and empathetic?
• Cultural Differences : Treatment should be offered based on the patient's cultural beliefs, but what happens when these are in conflict with standard healthcare practices?
• End of Life Decisions : Addressing issues like euthanasia, Do Not Resuscitate orders and withdrawal or withholding of treatment.

It’s worth remembering that these issues often put a nurse’s professional duty against their personal beliefs, which further increases the complexity of managing them effectively.

For instance, consider a scenario where a patient’s religious beliefs prohibit blood transfusions, but they require one to survive. In carrying out the patient's wishes, the health provider might have to compromise the patient's wellbeing. Conversely, if the nurse ignores the patient's wishes to save their life, it can be considered a disregard for the patient's autonomy and beliefs. Thus, navigating this delicate balance may present an ethical dilemma.

Learning from Ethical Scenarios in Nursing Case Studies

Each ethical scenario in nursing case studies is a profound learning opportunity. Through exploring these intense and complex scenarios, you evolve as a nurse, honing your critical thinking, decision-making and reflection skills.

When analysing an ethical scenario, it's best to follow these steps:

• Identify the Dilemma : First, identify the ethical issue at hand and why it creates a dilemma.
• Understand the Context : Ascertain the involved parties, their beliefs or values, and how they relate to the situation.
• Evaluate the Options : Review the possible actions you could take, bearing in mind ethical guidelines and professional duties.
• Seek Advice : Consult with colleagues, mentors or your nursing governing body if in doubt. Asking for perspectives helps create a broader view of options.
• Make an Informed Decision : Based on all the information and advice, make a decision. Always keep the patient's best interest in focus.

Consider a case study where a patient refuses necessary treatment due to their religious beliefs. You first identify the ethical dilemma: respecting the patient's autonomous decision versus ensuring their wellbeing. The context includes the patient's health condition and their deeply-held religious belief. Possible options would be to respect the patient's choice, seek legal advice, discuss alternatives, or try to convince the patient or their family. Seeking advice from senior colleagues or the nurse manager may offer valuable insights into managing such situations. Finally, the decision should be taken considering all perspectives while maintaining the prime focus on the patient's wellbeing and rights.

With each ethical scenario analysed, you gain a deeper understanding of the ethical dimensions of nursing. This understanding fortifies your ability to provide effective, ethical patient care and to handle challenging situations in your nursing journey.

Tips and Techniques for an Effective Nursing Case Study

Nursing case studies are an integral part of nursing education and practice. They provide an in-depth insight into patient care, from diagnosis to treatment, through a practical approach. Understanding how to write them effectively is a vital skill for both nursing students and practicing nurses.

Improving Your Writing Skills for Nursing Case Studies

Improving your writing skills specifically for nursing case studies primarily means honing your ability to accurately document and articulate patient interactions, clinical symptoms, nursing interventions , and treatment results. It’s about refining your observational, analytic, and reporting skills.

Here's a list of techniques you can follow to enhance your case study writing skills :

• Understand the Format : Familiarise yourself with the structure and formatting of nursing case studies. Standard sections include patient history, diagnosis, nursing assessments, treatment, and evaluation.
• Be Clear and Precise : Use clear, precise language and mention facts accurately. Avoid unneeded jargon or long sentences.
• Consistent Clinical Terminology : Utilise the approved clinical language, acronyms, and terminology consistently for clarity and professionalism.
• Detail-Oriented Observation : Be observant about the smallest details related to a patient's symptoms, behaviours, reactions to interventions, and overall progress. Every tiny detail could be significant.
• Reflective Thinking : Develop your reflective thinking skills. Reflect on your nursing interventions: what has worked, what hasn't, and potential improvements.

Reflective thinking in nursing is a process where nurses analyse their clinical experiences to learn and improve their practices. It aids in transforming practical experiences into meaningful knowledge.

Suppose you are documenting a case study about a patient with diabetes suffering from recurring cases of hypoglycaemia. You'll need to provide a comprehensive patient history, precise details about their symptoms, and a clear description of your nursing interventions to prevent these episodes. Be sure to use consistent terminology and observe all related factors, like the patient's diet or emotional state, which could impact their sugar levels. The report should include regular evaluations of the patient's condition, and your reflections on the efficacy of your implemented care plan.

Do's and Don'ts in Writing a Nursing Case Study

To ensure you create compelling, informative, and accurate nursing case studies, here are some indispensable do's and don'ts to keep in mind:

Reflective writing in nursing case studies is a process where nurses consider their experiences, actions, feelings, and responses and analyse their impacts on patient outcomes . It includes assessing what was done well, what could be improved, and steps for future development.

If you have handled an incident of rapid patient deterioration in a clinical setting, instead of merely describing the event chronologically in the case study, engage in reflective writing. Discuss the nursing assessments undertaken, the intuitions you had, the quick decisions you made, and the outcomes you achieved. Reflect on your emotions, your learning, and the improvements you would implement in similar future scenarios.

Following these tips will, without a doubt, help you improve the quality of your nursing case studies, either for academic or professional purposes. Understanding the importance of each step, from precise patient details to reflective evaluations, is key to writing an effective nursing case study.

Nursing Case Study - Key takeaways

• A Nursing Case Study involves gathering patient history, analyzing clinical data, formulating nursing diagnoses, developing a comprehensive care plan, and evaluating progress.
• Nursing Case Study examples illuminate the process and importance of thorough data collection, patient history compilation, diagnosis determination, and subsequent treatment.
• The delegation of nursing management Case Study explores the efficient assignment of tasks within a nursing team, maximizing efficiency and effectiveness of healthcare delivery.
• Case studies in nursing ethics provide insight into ethical dilemmas in clinical settings and help to conceptualize ethical concepts applied to patient care.
• The format of a nursing case study typically includes an introduction, patient history, physical/nursing assessment, nursing diagnosis, nursing interventions and rationale, and expected/actual outcomes.

Flashcards in Nursing Case Study 30

A nursing case study is an in-depth examination of a patient's case, documenting detailed information about the patient's history, diagnosis, treatment, and reflecting on their nursing care.

A nursing case study includes patient history, diagnosis, nursing assessment, treatment formulation, and results evaluation.

A nursing case study provides valuable insights into patient conditions, serves as a practical resource, enhances critical thinking, and bridges the gap between theoretical knowledge and its application in patient care.

The nursing process for a case study includes five steps: Assessment, Diagnosis, Planning, Implementation, and Evaluation, often abbreviated as ADPIE.

The key components are Introduction, Patient History, Physical Examination, Nursing Assessment, Nursing Diagnosis, Nursing Interventions and Rationale, and Expected Results and Actual Outcomes.

A nursing case study is written to document all essential information about patient care efficiently and thoroughly. This clear structuring supports effective communication within the healthcare team.

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