CASE STUDY

A case study is an analysis of an incident or situation in which characters and relationships are
described, factual or hypothetical events transpire and problems need to be resolve or solved. (DeYoung,
Ed, Med, RN, 2003)
In nursing, case study method is a teaching strategy that enables students to apply fundamental
nursing concepts in a variety of situations. (Lippincott Williams & Wilkins, Inc., 2012)

The case method originated in Harvard Law School in 1870s (Wade,1999). It took
almost 100 years before case study is enjoyed much use in nursing.
Some people thought that Case Study is synonymous to Problem-based Learning (PBL) which is
an another form of a teaching strategy. In fact it is not the same but a significant variation from the
problem-based learning. The chief difference between PBL and the case study are summarized in the
diagram below.
CASE STUDY

PROBLEM-BASED LEARNING

May be used by individuals or group

Is conducted with small groups

The students already have most of the

background knowledge they need to apply to the
case

Students have little background knowledge of

the subject matter in the case

The cases are often long and detailed, and their

problems are fairly well defined.

The cases are usually brief and presenting

problems are ill structured

Case studies vary in length and detail, and can be used in a number of ways, depending on the
case itself and on the instructors goals.

They can be short (a few paragraphs) or long (e.g. 20+ pages).

They can be used in lecture-based or discussion-based classes.
They can be real, with all the detail drawn from actual people and circumstances, or simply
realistic.
They can provide all the relevant data students need to discuss and resolve the central issue, or
only some of it, requiring students to identify, and possibly fill in (via outside research), the
missing information.
They can require students to examine multiple aspects of a problem, or just a circumscribed
piece.
They can require students to propose a solution for the case or simply to identify the parameters
of the problem.

As an instructional strategy, case studies have a number of advantages:

Create the need to know.

Raise the level of critical thinking skills (application/synthesis/evaluation, not recall.

Enhance the listening/cooperative learning skills.

Prompt deeper diagnosis

Develop problem solving skills.

Help learners connect theory and practice

It safely exposes learners to real-world situations that they can encounter in the future.
Provide a vehicle for examining multiple points of view/hearing various voices.
Build partnership among learners and teacher.
Teach students not to take things literally.
Get you thinking and brainstorming.
Get students to be active, not passive.

What makes a GOOD CASE?

The incident entails difficult choices.

Is open-ended, allowing multiple interpretations and solutions.

Speaks to important aspects of your goals for your student learning.

Gets at issues that require or benefit collegial discussions,

Is related to the important curricular and pedagogical aims of the program.

The situation has stayed with you and wants to be told.

Steps on how to construct a case study for learners

1. Develop objectives: What do you want the participants to learn when they work through the case

study?
2. Select a situation: Choose a topic or a scenario that fits the objectives and content you want to

apply. Cases should be drawn from real life situations.

3. Develop the characters: the human factor in a case is very important in a practice profession.

Give enough details about the patient, family, health care providers so that the interpersonal
aspect of the case will be an integral part of it.
4. Develop the discussion questions: Questions should be designed to promote discussion. It is all

right to ask questions with factual answers, but most questions should require learners to apply
principles and generate a variety of possible interventions and outcomes.
5. Lead the group discussion: Explain to the class that except for factual questions, theres no one

right answer to a case. Many problems are so complex that they have a variety of resolutions
rather than a solution.
Keep the atmosphere of the class relaxed so participants will feel free to discuss their hypotheses
and not feel ashamed if they are on the wrong track.

CASE PRESENTATION
A case presentation is a formal communication between health care professionals (doctors,
pharmacists, nurses, therapists, nutritionist etc.) regarding a patient's clinical information. Essential parts
of a case presentation include:

Identification
Reason for consultation/admission

Chief complaints (CC) - what made patients seek medical attention.

History of present illness (HPI) - circumstances relating to chief complaints.

Past medical history (PMHx)

Past surgical history

Current medications

Allergies

Family history (FHx)

Social history (SocHx)

Physical examination (PE)

Laboratory results (Lab)

Other investigations (imaging, biopsy etc.)

Case summary and impression

Management plans

follow up in clinic or hospital

Adherence of the patient to treatment

success of the treatment or failure.

causes of success or failure.

Effective case presentation is also needed for communicating with other professionals in order to
provide more comprehensive care. An additional benefit in learning this skill is that more than most
things you can do, presenting clearly and to the point gives the impression of professional competence.
The length and completeness of a given presentation varies depending on the context. For
example, in a setting where each case is given only a few minutes' attention, the presentation should be
distilled to less than a minute or two, just enough to orient the people present as to the identity and key
features of the patient being described, along with the most relevant issues of the moment. In a setting
where a more leisurely review of the pathogenesis or course of treatment is indicated, a correspondingly
more comprehensive presentation is appropriate.
Recognize that your audience in most cases does not need to know "everything" about the client,
but rather is seeking to generate an internal picture of the situation being presented. Beware of "dumping"
all sorts of impressions and explanations and expecting your audience to be able to piece it all together--it
only overloads them. Ideally, imagine yourself in their role and recognize the basic facts that you need to
know just to become oriented to the problem.

The Purposes of a Case Presentation

Your presentation may involve any number of possible purposes: You may want some help in reevaluating the diagnosis or formulation of the problem or in developing a comprehensive treatment plan.
Perhaps your purpose is didactic, to demonstrate to students or colleagues some particularly
interesting diagnostic features, psychological dynamics, or therapeutic technique. Then you'll want to
focus on those facts which are relevant to your point and eliminate other information which might be
relevant to an exploration of other aspects of the case.

Beginning the Presentation

A key technique is to package three or four sentences at the very outset with three components:
purpose of the presentation, identifying data (ID), and chief complaint (CC). Although you should write
these as separate items when they are to be read, such as when following an official clinic or hospital
format, these three elements may be interwoven in oral presentation. For example, "John Doe is a sixyear-old boy who is being presented for a reconsideration of his diagnosis. He was transferred here from
Redland Hospital in Anytown, Texas, two months ago with a diagnosis of childhood schizophrenia, but
what we've been observing are behaviors such as excessive clinging, low frustration tolerance, retreat into
tearfulness and pouting, along with a clear ability to relate in an immature fashion to peers and staff."
The point is to orient the audience to what will be discussed. The purpose of the presentation can
be compressed into and mixed with some of the other elements. The identifying data contain a few fixed
and several variable components. The identified patient's full name, age, and sex are basic. (In large case
conferences, it may be judicious to simply use the patient's initials or the first name and the last initial. It's
not always necessary that everyone knows the patient's name.) Then, depending on the context and
purpose, include the following items if they're relevant:

Length of stay in the present treatment program

Total time in treatment for the present problem, including time spent at other clinics or
hospitals, and the number of admissions or re-admissions

Nature of the patient's course since beginning therapy with you, and/or beginning therapy
with other therapists or hospital admission (e.g. gradual progress, sudden relapse,
stagnation, deterioration, etc.)

Race, religion, social class, only if these factors have a definite bearing on the
formulation

PRESENTATION SKILLS

Bibliography

Books:
DeYoung, EdD, Med, RN, Sandra et al. , Teaching Strategies for Nurse Educators, 2003

Web:
http://www.cmu.edu/teaching/designteach/teach/instructionalstrategies/casestudies.
html
http://www.scientificjournals.org/journals2007/articles/1025.htm
http://www.cmu.edu/teaching/designteach/teach/instructionalstrategies/casestudies.
html