objectives of case study in nursing

How to Present a Nursing Case Study

What Is a Case Study in Nursing?

A nursing case study is an in-depth examination of a situation that a nurse encounters in her daily practice. The case study offers a safe way for the nurse to apply theoretical and actual knowledge to an actual or potential patient scenario. She can employ her decision-making skills, use critical thinking to analyze the situation, and develop cognitive reasoning abilities without harming a patient. Nursing case studies are commonly used in undergraduate nursing programs, graduate schools offering a master’s of science degree in nursing (MSN), and orientation programs for new graduate nurses. They may be presented in written form, online, or live in a classroom setting.

Choose a topic. According to Sigma Theta Tau International, the topic should be focused, based in reality, and relevant. It should demonstrate current best practices that are supported by nursing research. The nurse may choose to discuss a situation from his past experience, or delve into something in his current job.

Write objectives. There should be at least three learning objectives, or outcomes, that identify what the learner will gain from completing the case study. Learning objectives are written as clear, measurable behaviors, such as “Identify five risk factors for falls in older adults.”

Write an introduction. This should be a one- or two-paragraph overview that describes the patient, the situation, and circumstances relevant to that situation. The introduction can also include a little about the patient’s history leading up to the situation.

Integrate more history and background. The next 1 to 2 paragraphs provide the learner with in-depth information to analyze the situation, such as lab values, diagnostic study results, findings from the nurse’s assessment of the patient, and a more detailed patient history.

Formulate questions. Nursing case studies are interactive scenarios that stimulate analysis and critical thinking. The questions typically require the learner to use the nursing process (assessment, nursing diagnosis, planning, intervention, and evaluation) and to anticipate what will happen next in the situation.

Give feedback. According to Sigma Theta Tau, the nursing case study provides the learner with two types of feedback: informational and reinforcing. Informational feedback lets the learner know if she has answered questions correctly, and gives her an idea of how she is progressing through the patient scenario. Reinforcing feedback gives the learner additional information about her responses to the questions. If she answers the question correctly, she’ll be given the rationale behind her right answer. If she gives the wrong answer, reinforcing feedback lets her know why that answer is wrong.

Provide references. It’s important to point the learner toward additional learning opportunities in print or on the web.

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• Sigma Theta Tau International

Sandy Keefe, M.S.N., R.N., has been a freelance writer for over five years. Her articles have appeared in numerous health-related magazines, including "Advance for Nurses" and "Advance for Long-Term Care Management." She has written short stories in anthologies such as "A Cup of Comfort for Parents of Children with Special Needs."

Health Case Studies

(29 reviews)

Glynda Rees, British Columbia Institute of Technology

Rob Kruger, British Columbia Institute of Technology

Janet Morrison, British Columbia Institute of Technology

Copyright Year: 2017

Publisher: BCcampus

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Jessica Sellars, Medical assistant office instructor, Blue Mountain Community College on 10/11/23

This is a book of compiled and very well organized patient case studies. The author has broken it up by disease patient was experiencing and even the healthcare roles that took place in this patients care. There is a well thought out direction and... read more

Comprehensiveness rating: 5 see less

This is a book of compiled and very well organized patient case studies. The author has broken it up by disease patient was experiencing and even the healthcare roles that took place in this patients care. There is a well thought out direction and plan. There is an appendix to refer to as well if you are needing to find something specific quickly. I have been looking for something like this to help my students have a base to do their project on. This is the most comprehensive version I have found on the subject.

Content Accuracy rating: 5

This is a book compiled of medical case studies. It is very accurate and can be used to learn from great care and mistakes.

Relevance/Longevity rating: 5

This material is very relevant in this context. It also has plenty of individual case studies to utilize in many ways in all sorts of medical courses. This is a very useful textbook and it will continue to be useful for a very long time as you can still learn from each study even if medicine changes through out the years.

Clarity rating: 5

The author put a lot of thought into the ease of accessibility and reading level of the target audience. There is even a "how to use this resource" section which could be extremely useful to students.

Consistency rating: 5

The text follows a very consistent format throughout the book.

Modularity rating: 5

Each case study is individual broken up and in a group of similar case studies. This makes it extremely easy to utilize.

Organization/Structure/Flow rating: 5

The book is very organized and the appendix is through. It flows seamlessly through each case study.

Interface rating: 5

I had no issues navigating this book, It was clearly labeled and very easy to move around in.

Grammatical Errors rating: 5

I did not catch any grammar errors as I was going through the book

Cultural Relevance rating: 5

This is a challenging question for any medical textbook. It is very culturally relevant to those in medical or medical office degrees.

I have been looking for something like this for years. I am so happy to have finally found it.

Reviewed by Cindy Sun, Assistant Professor, Marshall University on 1/7/23

Interestingly, this is not a case of ‘you get what you pay for’. Instead, not only are the case studies organized in a fashion for ease of use through a detailed table of contents, the authors have included more support for both faculty and... read more

Interestingly, this is not a case of ‘you get what you pay for’. Instead, not only are the case studies organized in a fashion for ease of use through a detailed table of contents, the authors have included more support for both faculty and students. For faculty, the introduction section titled ‘How to use this resource’ and individual notes to educators before each case study contain application tips. An appendix overview lists key elements as issues / concepts, scenario context, and healthcare roles for each case study. For students, learning objectives are presented at the beginning of each case study to provide a framework of expectations.

The content is presented accurately and realistic.

The case studies read similar to ‘A Day In the Life of…’ with detailed intraprofessional communications similar to what would be overheard in patient care areas. The authors present not only the view of the patient care nurse, but also weave interprofessional vantage points through each case study by including patient interaction with individual professionals such as radiology, physician, etc.

In addition to objective assessment findings, the authors integrate standard orders for each diagnosis including medications, treatments, and tests allowing the student to incorporate pathophysiology components to their assessments.

Each case study is arranged in the same framework for consistency and ease of use.

This compilation of eight healthcare case studies focusing on new onset and exacerbation of prevalent diagnoses, such as heart failure, deep vein thrombosis, cancer, and chronic obstructive pulmonary disease advancing to pneumonia.

Each case study has a photo of the ‘patient’. Simple as this may seem, it gives an immediate mental image for the student to focus.

Interface rating: 4

As noted by previous reviewers, most of the links do not connect active web pages. This may be due to the multiple options for accessing this resource (pdf download, pdf electronic, web view, etc.).

Grammatical Errors rating: 4

A minor weakness that faculty will probably need to address prior to use is regarding specific term usages differences between Commonwealth countries and United States, such as lung sound descriptors as ‘quiet’ in place of ‘diminished’ and ‘puffers’ in place of ‘inhalers’.

The authors have provided a multicultural, multigenerational approach in selection of patient characteristics representing a snapshot of today’s patient population. Additionally, one case study focusing on heart failure is about a middle-aged adult, contrasting to the average aged patient the students would normally see during clinical rotations. This option provides opportunities for students to expand their knowledge on risk factors extending beyond age.

This resource is applicable to nursing students learning to care for patients with the specific disease processes presented in each case study or for the leadership students focusing on intraprofessional communication. Educators can assign as a supplement to clinical experiences or as an in-class application of knowledge.

Reviewed by Stephanie Sideras, Assistant Professor, University of Portland on 8/15/22

The eight case studies included in this text addressed high frequency health alterations that all nurses need to be able to manage competently. While diabetes was not highlighted directly, it was included as a potential comorbidity. The five... read more

The eight case studies included in this text addressed high frequency health alterations that all nurses need to be able to manage competently. While diabetes was not highlighted directly, it was included as a potential comorbidity. The five overarching learning objectives pulled from the Institute of Medicine core competencies will clearly resonate with any faculty familiar with Quality and Safety Education for Nurses curriculum.

The presentation of symptoms, treatments and management of the health alterations was accurate. Dialogue between the the interprofessional team was realistic. At times the formatting of lab results was confusing as they reflected reference ranges specific to the Canadian healthcare system but these occurrences were minimal and could be easily adapted.

The focus for learning from these case studies was communication - patient centered communication and interprofessional team communication. Specific details, such as drug dosing, was minimized, which increases longevity and allows for easy individualization of the case data.

While some vocabulary was specific to the Canadian healthcare system, overall the narrative was extremely engaging and easy to follow. Subjective case data from patient or provider were formatted in italics and identified as 'thoughts'. Objective and behavioral case data were smoothly integrated into the narrative.

The consistency of formatting across the eight cases was remarkable. Specific learning objectives are identified for each case and these remain consistent across the range of cases, varying only in the focus for the goals for each different health alterations. Each case begins with presentation of essential patient background and the progress across the trajectory of illness as the patient moves from location to location encountering different healthcare professionals. Many of the characters (the triage nurse in the Emergency Department, the phlebotomist) are consistent across the case situations. These consistencies facilitate both application of a variety of teaching methods and student engagement with the situated learning approach.

Case data is presented by location and begins with the patient's first encounter with the healthcare system. This allows for an examination of how specific trajectories of illness are manifested and how care management needs to be prioritized at different stages. This approach supports discussions of care transitions and the complexity of the associated interprofessional communication.

The text is well organized. The case that has two levels of complexity is clearly identified

The internal links between the table of contents and case specific locations work consistently. In the EPUB and the Digital PDF the external hyperlinks are inconsistently valid.

The grammatical errors were minimal and did not detract from readability

Cultural diversity is present across the cases in factors including race, ethnicity, socioeconomic status, family dynamics and sexual orientation.

The level of detail included in these cases supports a teaching approach to address all three spectrums of learning - knowledge, skills and attitudes - necessary for the development of competent practice. I also appreciate the inclusion of specific assessment instruments that would facilitate a discussion of evidence based practice. I will enjoy using these case to promote clinical reasoning discussions of data that is noticed and interpreted with the resulting prioritizes that are set followed by reflections that result from learner choices.

Reviewed by Chris Roman, Associate Professor, Butler University on 5/19/22

It would be extremely difficult for a book of clinical cases to comprehensively cover all of medicine, and this text does not try. Rather, it provides cases related to common medical problems and introduces them in a way that allows for various... read more

Comprehensiveness rating: 4 see less

It would be extremely difficult for a book of clinical cases to comprehensively cover all of medicine, and this text does not try. Rather, it provides cases related to common medical problems and introduces them in a way that allows for various learning strategies to be employed to leverage the cases for deeper student learning and application.

The narrative form of the cases is less subject to issues of accuracy than a more content-based book would be. That said, the cases are realistic and reasonable, avoiding being too mundane or too extreme.

These cases are narrative and do not include many specific mentions of drugs, dosages, or other aspects of clinical care that may grow/evolve as guidelines change. For this reason, the cases should be “evergreen” and can be modified to suit different types of learners.

Clarity rating: 4

The text is written in very accessible language and avoids heavy use of technical language. Depending on the level of learner, this might even be too simplistic and omit some details that would be needed for physicians, pharmacists, and others to make nuanced care decisions.

The format is very consistent with clear labeling at transition points.

The authors point out in the introductory materials that this text is designed to be used in a modular fashion. Further, they have built in opportunities to customize each cases, such as giving dates of birth at “19xx” to allow for adjustments based on instructional objectives, etc.

The organization is very easy to follow.

I did not identify any issues in navigating the text.

The text contains no grammatical errors, though the language is a little stiff/unrealistic in some cases.

Cases involve patients and members of the care team that are of varying ages, genders, and racial/ethnic backgrounds

Reviewed by Trina Larery, Assistant Professor, Pittsburg State University on 4/5/22

The book covers common scenarios, providing allied health students insight into common health issues. The information in the book is thorough and easily modified if needed to include other scenarios not listed. The material was easy to understand... read more

The book covers common scenarios, providing allied health students insight into common health issues. The information in the book is thorough and easily modified if needed to include other scenarios not listed. The material was easy to understand and apply to the classroom. The E-reader format included hyperlinks that bring the students to subsequent clinical studies.

Content Accuracy rating: 4

The treatments were explained and rationales were given, which can be very helpful to facilitate effective learning for a nursing student or novice nurse. The case studies were accurate in explanation. The DVT case study incorrectly identifies the location of the clot in the popliteal artery instead of in the vein.

The content is relevant to a variety of different types of health care providers and due to the general nature of the cases, will remain relevant over time. Updates should be made annually to the hyperlinks and to assure current standard of practice is still being met.

Clear, simple and easy to read.

Consistent with healthcare terminology and framework throughout all eight case studies.

The text is modular. Cases can be used individually within a unit on the given disease process or relevant sections of a case could be used to illustrate a specific point providing great flexibility. The appendix is helpful in locating content specific to a certain diagnosis or a certain type of health care provider.

The book is well organized, presenting in a logical clear fashion. The appendix allows the student to move about the case study without difficulty.

The interface is easy and simple to navigate. Some links to external sources might need to be updated regularly since those links are subject to change based on current guidelines. A few hyperlinks had "page not found".

Few grammatical errors were noted in text.

The case studies include people of different ethnicities, socioeconomic status, ages, and genders to make this a very useful book.

I enjoyed reading the text. It was interesting and relevant to today's nursing student. There are roughly 25 broken online links or "pages not found", care needs to be taken to update at least annually and assure links are valid and utilizing the most up to date information.

Reviewed by Benjamin Silverberg, Associate Professor/Clinician, West Virginia University on 3/24/22

The appendix reviews the "key roles" and medical venues found in all 8 cases, but is fairly spartan on medical content. The table of contents at the beginning only lists the cases and locations of care. It can be a little tricky to figure out what... read more

Comprehensiveness rating: 3 see less

The appendix reviews the "key roles" and medical venues found in all 8 cases, but is fairly spartan on medical content. The table of contents at the beginning only lists the cases and locations of care. It can be a little tricky to figure out what is going on where, especially since each case is largely conversation-based. Since this presents 8 cases (really 7 with one being expanded upon), there are many medical topics (and venues) that are not included. It's impossible to include every kind of situation, but I'd love to see inclusion of sexual health, renal pathology, substance abuse, etc.

Though there are differences in how care can be delivered based on personal style, changing guidelines, available supplies, etc, the medical accuracy seems to be high. I did not detect bias or industry influence.

Relevance/Longevity rating: 4

Medications are generally listed as generics, with at least current dosing recommendations. The text gives a picture of what care looks like currently, but will be a little challenging to update based on new guidelines (ie, it can be hard to find the exact page in which a medication is dosed/prescribed). Even if the text were to be a little out of date, an instructor can use that to point out what has changed (and why).

Clear text, usually with definitions of medical slang or higher-tier vocabulary. Minimal jargon and there are instances where the "characters" are sorting out the meaning as well, making it accessible for new learners, too.

Overall, the style is consistent between cases - largely broken up into scenes and driven by conversation rather than descriptions of what is happening.

There are 8 (well, again, 7) cases which can be reviewed in any order. Case #2 builds upon #1, which is intentional and a good idea, though personally I would have preferred one case to have different possible outcomes or even a recurrence of illness. Each scene within a case is reasonably short.

Organization/Structure/Flow rating: 4

These cases are modular and don't really build on concepts throughout. As previously stated, case #2 builds upon #1, but beyond that, there is no progression. (To be sure, the authors suggest using case #1 for newer learners and #2 for more advanced ones.) The text would benefit from thematic grouping, a longer introduction and debriefing for each case (there are learning objectives but no real context in medical education nor questions to reflect on what was just read), and progressively-increasing difficulty in medical complexity, ethics, etc.

I used the PDF version and had no interface issues. There are minimal photographs and charts. Some words are marked in blue but those did not seem to be hyperlinked anywhere.

No noticeable errors in grammar, spelling, or formatting were noted.

I appreciate that some diversity of age and ethnicity were offered, but this could be improved. There were Canadian Indian and First Nations patients, for example, as well as other characters with implied diversity, but there didn't seem to be any mention of gender diverse or non-heterosexual people, or disabilities. The cases tried to paint family scenes (the first patient's dog was fairly prominently mentioned) to humanize them. Including more cases would allow for more opportunities to include sex/gender minorities, (hidden) disabilities, etc.

The text (originally from 2017) could use an update. It could be used in conjunction with other Open Texts, as a compliment to other coursework, or purely by itself. The focus is meant to be on improving communication, but there are only 3 short pages at the beginning of the text considering those issues (which are really just learning objectives). In addition to adding more cases and further diversity, I personally would love to see more discussion before and after the case to guide readers (and/or instructors). I also wonder if some of the ambiguity could be improved by suggesting possible health outcomes - this kind of counterfactual comparison isn't possible in real life and could be really interesting in a text. Addition of comprehension/discussion questions would also be worthwhile.

Reviewed by Danielle Peterson, Assistant Professor, University of Saint Francis on 12/31/21

This text provides readers with 8 case studies which include both chronic and acute healthcare issues. Although not comprehensive in regard to types of healthcare conditions, it provides a thorough look at the communication between healthcare... read more

This text provides readers with 8 case studies which include both chronic and acute healthcare issues. Although not comprehensive in regard to types of healthcare conditions, it provides a thorough look at the communication between healthcare workers in acute hospital settings. The cases are primarily set in the inpatient hospital setting, so the bulk of the clinical information is basic emergency care and inpatient protocol: vitals, breathing, medication management, etc. The text provides a table of contents at opening of the text and a handy appendix at the conclusion of the text that outlines each case’s issue(s), scenario, and healthcare roles. No index or glossary present.

Although easy to update, it should be noted that the cases are taking place in a Canadian healthcare system. Terms may be unfamiliar to some students including “province,” “operating theatre,” “physio/physiotherapy,” and “porter.” Units of measurement used include Celsius and meters. Also, the issue of managed care, health insurance coverage, and length of stay is missing for American students. These are primary issues that dictate much of the healthcare system in the US and a primary job function of social workers, nurse case managers, and medical professionals in general. However, instructors that wish to add this to the case studies could do so easily.

The focus of this text is on healthcare communication which makes it less likely to become obsolete. Much of the clinical information is stable healthcare practice that has been standard of care for quite some time. Nevertheless, given the nature of text, updates would be easy to make. Hyperlinks should be updated to the most relevant and trustworthy sources and checked frequently for effectiveness.

The spacing that was used to note change of speaker made for ease of reading. Although unembellished and plain, I expect students to find this format easy to digest and interesting, especially since the script is appropriately balanced with ‘human’ qualities like the current TV shows and songs, the use of humor, and nonverbal cues.

A welcome characteristic of this text is its consistency. Each case is presented in a similar fashion and the roles of the healthcare team are ‘played’ by the same character in each of the scenarios. This allows students to see how healthcare providers prioritize cases and juggle the needs of multiple patients at once. Across scenarios, there was inconsistency in when clinical terms were hyperlinked.

The text is easily divisible into smaller reading sections. However, since the nature of the text is script-narrative format, if significant reorganization occurs, one will need to make sure that the communication of the script still makes sense.

The text is straightforward and presented in a consistent fashion: learning objectives, case history, a script of what happened before the patient enters the healthcare setting, and a script of what happens once the patient arrives at the healthcare setting. The authors use the term, “ideal interactions,” and I would agree that these cases are in large part, ‘best case scenarios.’ Due to this, the case studies are well organized, clear, logical, and predictable. However, depending on the level of student, instructors may want to introduce complications that are typical in the hospital setting.

The interface is pleasing and straightforward. With exception to the case summary and learning objectives, the cases are in narrative, script format. Each case study supplies a photo of the ‘patient’ and one of the case studies includes a link to a 3-minute video that introduces the reader to the patient/case. One of the highlights of this text is the use of hyperlinks to various clinical practices (ABG, vital signs, transfer of patient). Unfortunately, a majority of the links are broken. However, since this is an open text, instructors can update the links to their preference.

Although not free from grammatical errors, those that were noticed were minimal and did not detract from reading.

Cultural Relevance rating: 4

Cultural diversity is visible throughout the patients used in the case studies and includes factors such as age, race, socioeconomic status, family dynamics, and sexual orientation. A moderate level of diversity is noted in the healthcare team with some stereotypes: social workers being female, doctors primarily male.

As a social work instructor, I was grateful to find a text that incorporates this important healthcare role. I would have liked to have seen more content related to advance directives, mediating decision making between the patient and care team, emotional and practical support related to initial diagnosis and discharge planning, and provision of support to colleagues, all typical roles of a medical social worker. I also found it interesting that even though social work was included in multiple scenarios, the role was only introduced on the learning objectives page for the oncology case.

Reviewed by Crystal Wynn, Associate Professor, Virginia State University on 7/21/21

The text covers a variety of chronic diseases within the cases; however, not all of the common disease states were included within the text. More chronic diseases need to be included such as diabetes, cancer, and renal failure. Not all allied... read more

The text covers a variety of chronic diseases within the cases; however, not all of the common disease states were included within the text. More chronic diseases need to be included such as diabetes, cancer, and renal failure. Not all allied health care team members are represented within the case study. Key terms appear throughout the case study textbook and readers are able to click on a hyperlink which directs them to the definition and an explanation of the key term.

Content is accurate, error-free and unbiased.

The content is up-to-date, but not in a way that will quickly make the text obsolete within a short period of time. The text is written and/or arranged in such a way that necessary updates will be relatively easy and straightforward to implement.

The text is written in lucid, accessible prose, and provides adequate context for any jargon/technical terminology used

The text is internally consistent in terms of terminology and framework.

The text is easily and readily divisible into smaller reading sections that can be assigned at different points within the course. Each case can be divided into a chronic disease state unit, which will allow the reader to focus on one section at a time.

Organization/Structure/Flow rating: 3

The topics in the text are presented in a logical manner. Each case provides an excessive amount of language that provides a description of the case. The cases in this text reads more like a novel versus a clinical textbook. The learning objectives listed within each case should be in the form of questions or activities that could be provided as resources for instructors and teachers.

Interface rating: 3

There are several hyperlinks embedded within the textbook that are not functional.

The text contains no grammatical errors.

Cultural Relevance rating: 3

The text is not culturally insensitive or offensive in any way. More examples of cultural inclusiveness is needed throughout the textbook. The cases should be indicative of individuals from a variety of races and ethnicities.

Reviewed by Rebecca Hillary, Biology Instructor, Portland Community College on 6/15/21

This textbook consists of a collection of clinical case studies that can be applicable to a wide range of learning environments from supplementing an undergraduate Anatomy and Physiology Course, to including as part of a Medical or other health... read more

This textbook consists of a collection of clinical case studies that can be applicable to a wide range of learning environments from supplementing an undergraduate Anatomy and Physiology Course, to including as part of a Medical or other health care program. I read the textbook in E-reader format and this includes hyperlinks that bring the students to subsequent clinical study if the book is being used in a clinical classroom. This book is significantly more comprehensive in its approach from other case studies I have read because it provides a bird’s eye view of the many clinicians, technicians, and hospital staff working with one patient. The book also provides real time measurements for patients that change as they travel throughout the hospital until time of discharge.

Each case gave an accurate sense of the chaos that would be present in an emergency situation and show how the conditions affect the practitioners as well as the patients. The reader gets an accurate big picture--a feel for each practitioner’s point of view as well as the point of view of the patient and the patient’s family as the clock ticks down and the patients are subjected to a number of procedures. The clinical information contained in this textbook is all in hyperlinks containing references to clinical skills open text sources or medical websites. I did find one broken link on an external medical resource.

The diseases presented are relevant and will remain so. Some of the links are directly related to the Canadian Medical system so they may not be applicable to those living in other regions. Clinical links may change over time but the text itself will remain relevant.

Each case study clearly presents clinical data as is it recorded in real time.

Each case study provides the point of view of several practitioners and the patient over several days. While each of the case studies covers different pathology they all follow this same format, several points of view and data points, over a number of days.

The case studies are divided by days and this was easy to navigate as a reader. It would be easy to assign one case study per body system in an Anatomy and Physiology course, or to divide them up into small segments for small in class teaching moments.

The topics are presented in an organized way showing clinical data over time and each case presents a large number of view points. For example, in the first case study, the patient is experiencing difficulty breathing. We follow her through several days from her entrance to the emergency room. We meet her X Ray Technicians, Doctor, Nurses, Medical Assistant, Porter, Physiotherapist, Respiratory therapist, and the Lab Technicians running her tests during her stay. Each practitioner paints the overall clinical picture to the reader.

I found the text easy to navigate. There were not any figures included in the text, only clinical data organized in charts. The figures were all accessible via hyperlink. Some figures within the textbook illustrating patient scans could have been helpful but I did not have trouble navigating the links to visualize the scans.

I did not see any grammatical errors in the text.

The patients in the text are a variety of ages and have a variety of family arrangements but there is not much diversity among the patients. Our seven patients in the eight case studies are mostly white and all cis gendered.

Some of the case studies, for example the heart failure study, show clinical data before and after drug treatments so the students can get a feel for mechanism in physiological action. I also liked that the case studies included diet and lifestyle advice for the patients rather than solely emphasizing these pharmacological interventions. Overall, I enjoyed reading through these case studies and I plan to utilize them in my Anatomy and Physiology courses.

Reviewed by Richard Tarpey, Assistant Professor, Middle Tennessee State University on 5/11/21

As a case study book, there is no index or glossary. However, medical and technical terms provide a useful link to definitions and explanations that will prove useful to students unfamiliar with the terms. The information provided is appropriate... read more

As a case study book, there is no index or glossary. However, medical and technical terms provide a useful link to definitions and explanations that will prove useful to students unfamiliar with the terms. The information provided is appropriate for entry-level health care students. The book includes important health problems, but I would like to see coverage of at least one more chronic/lifestyle issue such as diabetes. The book covers adult issues only.

Content is accurate without bias

The content of the book is relevant and up-to-date. It addresses conditions that are prevalent in today's population among adults. There are no pediatric cases, but this does not significantly detract from the usefulness of the text. The format of the book lends to easy updating of data or information.

The book is written with clarity and is easy to read. The writing style is accessible and technical terminology is explained with links to more information.

Consistency is present. Lack of consistency is typically a problem with case study texts, but this book is consistent with presentation, format, and terminology throughout each of the eight cases.

The book has high modularity. Each of the case studies can be used independently from the others providing flexibility. Additionally, each case study can be partitioned for specific learning objectives based on the learning objectives of the course or module.

The book is well organized, presenting students conceptually with differing patient flow patterns through a hospital. The patient information provided at the beginning of each case is a wonderful mechanism for providing personal context for the students as they consider the issues. Many case studies focus on the problem and the organization without students getting a patient's perspective. The patient perspective is well represented in these cases.

The navigation through the cases is good. There are some terminology and procedure hyperlinks within the cases that do not work when accessed. This is troubling if you intend to use the text for entry-level health care students since many of these links are critical for a full understanding of the case.

There are some non-US variants of spelling and a few grammatical errors, but these do not detract from the content of the messages of each case.

The book is inclusive of differing backgrounds and perspectives. No insensitive or offensive references were found.

I like this text for its application flexibility. The book is useful for non-clinical healthcare management students to introduce various healthcare-related concepts and terminology. The content is also helpful for the identification of healthcare administration managerial issues for students to consider. The book has many applications.

Reviewed by Paula Baldwin, Associate Professor/Communication Studies, Western Oregon University on 5/10/21

The different case studies fall on a range, from crisis care to chronic illness care. read more

The different case studies fall on a range, from crisis care to chronic illness care.

The contents seems to be written as they occurred to represent the most complete picture of each medical event's occurence.

These case studies are from the Canadian medical system, but that does not interfere with it's applicability.

It is written for a medical audience, so the terminology is mostly formal and technical.

Some cases are shorter than others and some go in more depth, but it is not problematic.

The eight separate case studies is the perfect size for a class in the quarter system. You could combine this with other texts, videos or learning modalities, or use it alone.

As this is a case studies book, there is not a need for a logical progression in presentation of topics.

No problems in terms of interface.

I have not seen any grammatical errors.

I did not see anything that was culturally insensitive.

I used this in a Health Communication class and it has been extraordinarily successful. My studies are analyzing the messaging for the good, the bad, and the questionable. The case studies are widely varied and it gives the class insights into hospital experiences, both front and back stage, that they would not normally be able to examine. I believe that because it is based real-life medical incidents, my students are finding the material highly engaging.

Reviewed by Marlena Isaac, Instructor, Aiken Technical College on 4/23/21

This text is great to walk through patient care with entry level healthcare students. The students are able to take in the information, digest it, then provide suggestions to how they would facilitate patient healing. Then when they are faced with... read more

This text is great to walk through patient care with entry level healthcare students. The students are able to take in the information, digest it, then provide suggestions to how they would facilitate patient healing. Then when they are faced with a situation in clinical they are not surprised and now how to move through it effectively.

The case studies provided accurate information that relates to the named disease.

It is relevant to health care studies and the development of critical thinking.

Cases are straightforward with great clinical information.

Clinical information is provided concisely.

Appropriate for clinical case study.

Presented to facilitate information gathering.

Takes a while to navigate in the browser.

Cultural Relevance rating: 1

Text lacks adequate representation of minorities.

Reviewed by Kim Garcia, Lecturer III, University of Texas Rio Grande Valley on 11/16/20

The book has 8 case studies, so obviously does not cover the whole of medicine, but the cases provided are descriptive and well developed. Cases are presented at different levels of difficulty, making the cases appropriate for students at... read more

The book has 8 case studies, so obviously does not cover the whole of medicine, but the cases provided are descriptive and well developed. Cases are presented at different levels of difficulty, making the cases appropriate for students at different levels of clinical knowledge. The human element of both patient and health care provider is well captured. The cases are presented with a focus on interprofessional interaction and collaboration, more so than teaching medical content.

Content is accurate and un-biased. No errors noted. Most diagnostic and treatment information is general so it will remain relevant over time. The content of these cases is more appropriate for teaching interprofessional collaboration and less so for teaching the medical care for each diagnosis.

The content is relevant to a variety of different types of health care providers (nurses, radiologic technicians, medical laboratory personnel, etc) and due to the general nature of the cases, will remain relevant over time.

Easy to read. Clear headings are provided for sections of each case study and these section headings clearly tell when time has passed or setting has changed. Enough description is provided to help set the scene for each part of the case. Much of the text is written in the form of dialogue involving patient, family and health care providers, making it easy to adapt for role play. Medical jargon is limited and links for medical terms are provided to other resources that expound on medical terms used.

The text is consistent in structure of each case. Learning objectives are provided. Cases generally start with the patient at home and move with the patient through admission, testing and treatment, using a variety of healthcare services and encountering a variety of personnel.

The text is modular. Cases could be used individually within a unit on the given disease process or relevant sections of a case could be used to illustrate a specific point. The appendix is helpful in locating content specific to a certain diagnosis or a certain type of health care provider.

Each case follows a patient in a logical, chronologic fashion. A clear table of contents and appendix are provided which allows the user to quickly locate desired content. It would be helpful if the items in the table of contents and appendix were linked to the corresponding section of the text.

The hyperlinks to content outside this book work, however using the back arrow on your browser returns you to the front page of the book instead of to the point at which you left the text. I would prefer it if the hyperlinks opened in a new window or tab so closing that window or tab would leave you back where you left the text.

No grammatical errors were noted.

The text is culturally inclusive and appropriate. Characters, both patients and care givers are of a variety of races, ethnicities, ages and backgrounds.

I enjoyed reading the cases and reviewing this text. I can think of several ways in which I will use this content.

Reviewed by Raihan Khan, Instructor/Assistant Professor, James Madison University on 11/3/20

The book contains several important health issues, however still missing some chronic health issues that the students should learn before they join the workforce, such as diabetes-related health issues suffered by the patients. read more

The book contains several important health issues, however still missing some chronic health issues that the students should learn before they join the workforce, such as diabetes-related health issues suffered by the patients.

The health information contained in the textbook is mostly accurate.

I think the book is written focusing on the current culture and health issues faced by the patients. To keep the book relevant in the future, the contexts especially the culture/lifestyle/health care modalities, etc. would need to be updated regularly.

The language is pretty simple, clear, and easy to read.

There is no complaint about consistency. One of the main issues of writing a book, consistency was well managed by the authors.

The book is easy to explore based on how easy the setup is. Students can browse to the specific section that they want to read without much hassle of finding the correct information.

The organization is simple but effective. The authors organized the book based on what can happen in a patient's life and what possible scenarios students should learn about the disease. From that perspective, the book does a good job.

The interface is easy and simple to navigate. Some links to external sources might need to be updated regularly since those links are subject to change that is beyond the author's control. It's frustrating for the reader when the external link shows no information.

The book is free of any major language and grammatical errors.

The book might do a little better in cultural competency. e.g. Last name Singh is mainly for Sikh people. In the text Harj and Priya Singh are Muslim. the authors can consult colleagues who are more familiar with those cultures and revise some cultural aspects of the cases mentioned in the book.

The book is a nice addition to the open textbook world. Hope to see more health issues covered by the book.

Reviewed by Ryan Sheryl, Assistant Professor, California State University, Dominguez Hills on 7/16/20

This text contains 8 medical case studies that reflect best practices at the time of publication. The text identifies 5 overarching learning objectives: interprofessional collaboration, client centered care, evidence-based practice, quality... read more

This text contains 8 medical case studies that reflect best practices at the time of publication. The text identifies 5 overarching learning objectives: interprofessional collaboration, client centered care, evidence-based practice, quality improvement, and informatics. While the case studies do not cover all medical conditions or bodily systems, the book is thorough in conveying details of various patients and medical team members in a hospital environment. Rather than an index or glossary at the end of the text, it contains links to outside websites for more information on medical tests and terms referenced in the cases.

The content provided is reflective of best practices in patient care, interdisciplinary collaboration, and communication at the time of publication. It is specifically accurate for the context of hospitals in Canada. The links provided throughout the text have the potential to supplement with up-to-date descriptions and definitions, however, many of them are broken (see notes in Interface section).

The content of the case studies reflects the increasingly complex landscape of healthcare, including a variety of conditions, ages, and personal situations of the clients and care providers. The text will require frequent updating due to the rapidly changing landscape of society and best practices in client care. For example, a future version may include inclusive practices with transgender clients, or address ways medical racism implicitly impacts client care (see notes in Cultural Relevance section).

The text is written clearly and presents thorough, realistic details about working and being treated in an acute hospital context.

The text is very straightforward. It is consistent in its structure and flow. It uses consistent terminology and follows a structured framework throughout.

Being a series of 8 separate case studies, this text is easily and readily divisible into smaller sections. The text was designed to be taken apart and used piece by piece in order to serve various learning contexts. The parts of each case study can also be used independently of each other to facilitate problem solving.

The topics in the case studies are presented clearly. The structure of each of the case studies proceeds in a similar fashion. All of the cases are set within the same hospital so the hospital personnel and service providers reappear across the cases, giving a textured portrayal of the experiences of the various service providers. The cases can be used individually, or one service provider can be studied across the various studies.

The text is very straightforward, without complex charts or images that could become distorted. Many of the embedded links are broken and require updating. The links that do work are a very useful way to define and expand upon medical terms used in the case studies.

Grammatical errors are minimal and do not distract from the flow of the text. In one instance the last name Singh is spelled Sing, and one patient named Fred in the text is referred to as Frank in the appendix.

The cases all show examples of health care personnel providing compassionate, client-centered care, and there is no overt discrimination portrayed. Two of the clients are in same-sex marriages and these are shown positively. It is notable, however, that the two cases presenting people of color contain more negative characteristics than the other six cases portraying Caucasian people. The people of color are the only two examples of clients who smoke regularly. In addition, the Indian client drinks and is overweight, while the First Nations client is the only one in the text to have a terminal diagnosis. The Indian client is identified as being Punjabi and attending a mosque, although there are only 2% Muslims in the Punjab province of India. Also, the last name Singh generally indicates a person who is a Hindu or Sikh, not Muslim.

Reviewed by Monica LeJeune, RN Instructor, LSUE on 4/24/20

Has comprehensive unfolding case studies that guide the reader to recognize and manage the scenario presented. Assists in critical thinking process. read more

Has comprehensive unfolding case studies that guide the reader to recognize and manage the scenario presented. Assists in critical thinking process.

Accurately presents health scenarios with real life assessment techniques and patient outcomes.

Relevant to nursing practice.

Clearly written and easily understood.

Consistent with healthcare terminology and framework

Has a good reading flow.

Topics presented in logical fashion

Easy to read.

No grammatical errors noted.

Text is not culturally insensitive or offensive.

Good book to have to teach nursing students.

Reviewed by april jarrell, associate professor, J. Sargeant Reynolds Community College on 1/7/20

The text is a great case study tool that is appropriate for nursing school instructors to use in aiding students to learn the nursing process. read more

The text is a great case study tool that is appropriate for nursing school instructors to use in aiding students to learn the nursing process.

The content is accurate and evidence based. There is no bias noted

The content in the text is relevant, up to date for nursing students. It will be easy to update content as needed because the framework allows for addition to the content.

The text is clear and easy to understand.

Framework and terminology is consistent throughout the text; the case study is a continual and takes the student on a journey with the patient. Great for learning!

The case studies can be easily divided into smaller sections to allow for discussions, and weekly studies.

The text and content progress in a logical, clear fashion allowing for progression of learning.

No interface issues noted with this text.

No grammatical errors noted in the text.

No racial or culture insensitivity were noted in the text.

I would recommend this text be used in nursing schools. The use of case studies are helpful for students to learn and practice the nursing process.

Reviewed by Lisa Underwood, Practical Nursing Instructor, NTCC on 12/3/19

The text provides eight comprehensive case studies that showcase the different viewpoints of the many roles involved in patient care. It encompasses the most common seen diagnoses seen across healthcare today. Each case study comes with its own... read more

The text provides eight comprehensive case studies that showcase the different viewpoints of the many roles involved in patient care. It encompasses the most common seen diagnoses seen across healthcare today. Each case study comes with its own set of learning objectives that can be tweaked to fit several allied health courses. Although the case studies are designed around the Canadian Healthcare System, they are quite easily adaptable to fit most any modern, developed healthcare system.

Content Accuracy rating: 3

Overall, the text is quite accurate. There is one significant error that needs to be addressed. It is located in the DVT case study. In the study, a popliteal artery clot is mislabeled as a DVT. DVTs are located in veins, not in arteries. That said, the case study on the whole is quite good. This case study could be used as a learning tool in the classroom for discussion purposes or as a way to test student understanding of DVTs, on example might be, "Can they spot the error?"

At this time, all of the case studies within the text are current. Healthcare is an ever evolving field that rests on the best evidence based practice. Keeping that in mind, educators can easily adapt the studies as the newest evidence emerges and changes practice in healthcare.

All of the case studies are well written and easy to understand. The text includes several hyperlinks and it also highlights certain medical terminology to prompt readers as a way to enhance their learning experience.

Across the text, the language, style, and format of the case studies are completely consistent.

The text is divided into eight separate case studies. Each case study may be used independently of the others. All case studies are further broken down as the focus patient passes through each aspect of their healthcare system. The text's modularity makes it possible to use a case study as individual work, group projects, class discussions, homework or in a simulation lab.

The case studies and the diagnoses that they cover are presented in such a way that educators and allied health students can easily follow and comprehend.

The book in itself is free of any image distortion and it prints nicely. The text is offered in a variety of digital formats. As noted in the above reviews, some of the hyperlinks have navigational issues. When the reader attempts to access them, a "page not found" message is received.

There were minimal grammatical errors. Some of which may be traced back to the differences in our spelling.

The text is culturally relevant in that it includes patients from many different backgrounds and ethnicities. This allows educators and students to explore cultural relevance and sensitivity needs across all areas in healthcare. I do not believe that the text was in any way insensitive or offensive to the reader.

By using the case studies, it may be possible to have an open dialogue about the differences noted in healthcare systems. Students will have the ability to compare and contrast the Canadian healthcare system with their own. I also firmly believe that by using these case studies, students can improve their critical thinking skills. These case studies help them to "put it all together".

Reviewed by Melanie McGrath, Associate Professor, TRAILS on 11/29/19

The text covered some of the most common conditions seen by healthcare providers in a hospital setting, which forms a solid general base for the discussions based on each case. read more

The text covered some of the most common conditions seen by healthcare providers in a hospital setting, which forms a solid general base for the discussions based on each case.

I saw no areas of inaccuracy

As in all healthcare texts, treatments and/or tests will change frequently. However, everything is currently up-to-date thus it should be a good reference for several years.

Each case is written so that any level of healthcare student would understand. Hyperlinks in the text is also very helpful.

All of the cases are written in a similar fashion.

Although not structured as a typical text, each case is easily assigned as a stand-alone.

Each case is organized clearly in an appropriate manner.

I did not see any issues.

I did not see any grammatical errors

The text seemed appropriately inclusive. There are no pediatric cases and no cases of intellectually-impaired patients, but those types of cases introduce more advanced problem-solving which perhaps exceed the scope of the text. May be a good addition to the text.

I found this text to be an excellent resource for healthcare students in a variety of fields. It would be best utilized in inter professional courses to help guide discussion.

Reviewed by Lynne Umbarger, Clinical Assistant Professor, Occupational Therapy, Emory and Henry College on 11/26/19

While the book does not cover every scenario, the ones in the book are quite common and troublesome for inexperienced allied health students. The information in the book is thorough enough, and I have found the cases easy to modify for educational... read more

While the book does not cover every scenario, the ones in the book are quite common and troublesome for inexperienced allied health students. The information in the book is thorough enough, and I have found the cases easy to modify for educational purposes. The material was easily understood by the students but challenging enough for classroom discussion. There are no mentions in the book about occupational therapy, but it is easy enough to add a couple words and make inclusion simple.

Very nice lab values are provided in the case study, making it more realistic for students.

These case studies focus on commonly encountered diagnoses for allied health and nursing students. They are comprehensive, realistic, and easily understood. The only difference is that the hospital in one case allows the patient's dog to visit in the room (highly unusual in US hospitals).

The material is easily understood by allied health students. The cases have links to additional learning materials for concepts that may be less familiar or should be explored further in a particular health field.

The language used in the book is consistent between cases. The framework is the same with each case which makes it easier to locate areas that would be of interest to a particular allied health profession.

The case studies are comprehensive but well-organized. They are short enough to be useful for class discussion or a full-blown assignment. The students seem to understand the material and have not expressed that any concepts or details were missing.

Each case is set up like the other cases. There are learning objectives at the beginning of each case to facilitate using the case, and it is easy enough to pull out material to develop useful activities and assignments.

There is a quick chart in the Appendix to allow the reader to determine the professions involved in each case as well as the pertinent settings and diagnoses for each case study. The contents are easy to access even while reading the book.

As a person who attends carefully to grammar, I found no errors in all of the material I read in this book.

There are a greater number of people of different ethnicities, socioeconomic status, ages, and genders to make this a very useful book. With each case, I could easily picture the person in the case. This book appears to be Canadian and more inclusive than most American books.

I was able to use this book the first time I accessed it to develop a classroom activity for first-year occupational therapy students and a more comprehensive activity for second-year students. I really appreciate the links to a multitude of terminology and medical lab values/issues for each case. I will keep using this book.

Reviewed by Cindy Krentz, Assistant Professor, Metropolitan State University of Denver on 6/15/19

The book covers eight case studies of common inpatient or emergency department scenarios. I appreciated that they had written out the learning objectives. I liked that the patient was described before the case was started, giving some... read more

The book covers eight case studies of common inpatient or emergency department scenarios. I appreciated that they had written out the learning objectives. I liked that the patient was described before the case was started, giving some understanding of the patient's background. I think it could benefit from having a glossary. I liked how the authors included the vital signs in an easily readable bar. I would have liked to see the labs also highlighted like this. I also felt that it would have been good written in a 'what would you do next?' type of case study.

The book is very accurate in language, what tests would be prudent to run and in the day in the life of the hospital in all cases. One inaccuracy is that the authors called a popliteal artery clot a DVT. The rest of the DVT case study was great, though, but the one mistake should be changed.

The book is up to date for now, but as tests become obsolete and new equipment is routinely used, the book ( like any other health textbook) will need to be updated. It would be easy to change, however. All that would have to happen is that the authors go in and change out the test to whatever newer, evidence-based test is being utilized.

The text is written clearly and easy to understand from a student's perspective. There is not too much technical jargon, and it is pretty universal when used- for example DVT for Deep Vein Thrombosis.

The book is consistent in language and how it is broken down into case studies. The same format is used for highlighting vital signs throughout the different case studies. It's great that the reader does not have to read the book in a linear fashion. Each case study can be read without needing to read the others.

The text is broken down into eight case studies, and within the case studies is broken down into days. It is consistent and shows how the patient can pass through the different hospital departments (from the ER to the unit, to surgery, to home) in a realistic manner. The instructor could use one or more of the case studies as (s)he sees fit.

The topics are eight different case studies- and are presented very clearly and organized well. Each one is broken down into how the patient goes through the system. The text is easy to follow and logical.

The interface has some problems with the highlighted blue links. Some of them did not work and I got a 'page not found' message. That can be frustrating for the reader. I'm wondering if a glossary could be utilized (instead of the links) to explain what some of these links are supposed to explain.

I found two or three typos, I don't think they were grammatical errors. In one case I think the Canadian spelling and the United States spelling of the word are just different.

This is a very culturally competent book. In today's world, however, one more type of background that would merit delving into is the trans-gender, GLBTQI person. I was glad that there were no stereotypes.

I enjoyed reading the text. It was interesting and relevant to today's nursing student. Since we are becoming more interprofessional, I liked that we saw what the phlebotomist and other ancillary personnel (mostly different technicians) did. I think that it could become even more interdisciplinary so colleges and universities could have more interprofessional education- courses or simulations- with the addition of the nurse using social work, nutrition, or other professional health care majors.

Reviewed by Catherine J. Grott, Interim Director, Health Administration Program, TRAILS on 5/5/19

The book is comprehensive but is specifically written for healthcare workers practicing in Canada. The title of the book should reflect this. read more

The book is comprehensive but is specifically written for healthcare workers practicing in Canada. The title of the book should reflect this.

The book is accurate, however it has numerous broken online links.

Relevance/Longevity rating: 3

The content is very relevant, but some links are out-dated. For example, WHO Guidelines for Safe Surgery 2009 (p. 186) should be updated.

The book is written in clear and concise language. The side stories about the healthcare workers make the text interesting.

The book is consistent in terms of terminology and framework. Some terms that are emphasized in one case study are not emphasized (with online links) in the other case studies. All of the case studies should have the same words linked to online definitions.

Modularity rating: 3

The book can easily be parsed out if necessary. However, the way the case studies have been written, it's evident that different authors contributed singularly to each case study.

The organization and flow are good.

Interface rating: 1

There are numerous broken online links and "pages not found."

The grammar and punctuation are correct. There are two errors detected: p. 120 a space between the word "heart" and the comma; also a period is needed after Dr (p. 113).

I'm not quite sure that the social worker (p. 119) should comment that the patient and partner are "very normal people."

There are roughly 25 broken online links or "pages not found." The BC & Canadian Guidelines (p. 198) could also include a link to US guidelines to make the text more universal . The basilar crackles (p. 166) is very good. Text could be used compare US and Canadian healthcare. Text could be enhanced to teach "soft skills" and interdepartmental communication skills in healthcare.

Reviewed by Lindsey Henry, Practical Nursing Instructor, Fletcher on 5/1/19

I really appreciated how in the introduction, five learning objectives were identified for students. These objectives are paramount in nursing care and they are each spelled out for the learner. Each Case study also has its own learning... read more

I really appreciated how in the introduction, five learning objectives were identified for students. These objectives are paramount in nursing care and they are each spelled out for the learner. Each Case study also has its own learning objectives, which were effectively met in the readings.

As a seasoned nurse, I believe that the content regarding pathophysiology and treatments used in the case studies were accurate. I really appreciated how many of the treatments were also explained and rationales were given, which can be very helpful to facilitate effective learning for a nursing student or novice nurse.

The case studies are up to date and correlate with the current time period. They are easily understood.

I really loved how several important medical terms, including specific treatments were highlighted to alert the reader. Many interventions performed were also explained further, which is great to enhance learning for the nursing student or novice nurse. Also, with each scenario, a background and history of the patient is depicted, as well as the perspectives of the patient, patients family member, and the primary nurse. This really helps to give the reader a full picture of the day in the life of a nurse or a patient, and also better facilitates the learning process of the reader.

These case studies are consistent. They begin with report, the patient background or updates on subsequent days, and follow the patients all the way through discharge. Once again, I really appreciate how this book describes most if not all aspects of patient care on a day to day basis.

Each case study is separated into days. While they can be divided to be assigned at different points within the course, they also build on each other. They show trends in vital signs, what happens when a patient deteriorates, what happens when they get better and go home. Showing the entire process from ER admit to discharge is really helpful to enhance the students learning experience.

The topics are all presented very similarly and very clearly. The way that the scenarios are explained could even be understood by a non-nursing student as well. The case studies are very clear and very thorough.

The book is very easy to navigate, prints well on paper, and is not distorted or confusing.

I did not see any grammatical errors.

Each case study involves a different type of patient. These differences include race, gender, sexual orientation and medical backgrounds. I do not feel the text was offensive to the reader.

I teach practical nursing students and after reading this book, I am looking forward to implementing it in my classroom. Great read for nursing students!

Reviewed by Leah Jolly, Instructor, Clinical Coordinator, Oregon Institute of Technology on 4/10/19

Good variety of cases and pathologies covered. read more

Good variety of cases and pathologies covered.

Content Accuracy rating: 2

Some examples and scenarios are not completely accurate. For example in the DVT case, the sonographer found thrombus in the "popliteal artery", which according to the book indicated presence of DVT. However in DVT, thrombus is located in the vein, not the artery. The patient would also have much different symptoms if located in the artery. Perhaps some of these inaccuracies are just typos, but in real-life situations this simple mistake can make a world of difference in the patient's course of treatment and outcomes.

Good examples of interprofessional collaboration. If only it worked this way on an every day basis!

Clear and easy to read for those with knowledge of medical terminology.

Good consistency overall.

Broken up well.

Topics are clear and logical.

Would be nice to simply click through to the next page, rather than going through the table of contents each time.

Minor typos/grammatical errors.

No offensive or insensitive materials observed.

Reviewed by Alex Sargsyan, Doctor of Nursing Practice/Assistant Professor , East Tennessee State University on 10/8/18

Because of the case study character of the book it does not have index or glossary. However it has summary for each health case study outlining key elements discussed in each case study. read more

Because of the case study character of the book it does not have index or glossary. However it has summary for each health case study outlining key elements discussed in each case study.

Overall the book is accurately depicting the clinical environment. There are numerous references to external sites. While most of them are correct, some of them are not working. For example Homan’s test link is not working "404 error"

Book is relevant in its current version and can be used in undergraduate and graduate classes. That said, the longevity of the book may be limited because of the character of the clinical education. Clinical guidelines change constantly and it may require a major update of the content.

Cases are written very clearly and have realistic description of an inpatient setting.

The book is easy to read and consistent in the language in all eight cases.

The cases are very well written. Each case is subdivided into logical segments. The segments reflect different setting where the patient is being seen. There is a flow and transition between the settings.

Book has eight distinct cases. This is a great format for a book that presents distinct clinical issues. This will allow the students to have immersive experiences and gain better understanding of the healthcare environment.

Book is offered in many different formats. Besides the issues with the links mentioned above, overall navigation of the book content is very smooth.

Book is very well written and has no grammatical errors.

Book is culturally relevant. Patients in the case studies come different cultures and represent diverse ethnicities.

Reviewed by Justin Berry, Physical Therapist Assistant Program Director, Northland Community and Technical College, East Grand Forks, MN on 8/2/18

This text provides eight patient case studies from a variety of diagnoses, which can be utilized by healthcare students from multiple disciplines. The cases are comprehensive and can be helpful for students to determine professional roles,... read more

This text provides eight patient case studies from a variety of diagnoses, which can be utilized by healthcare students from multiple disciplines. The cases are comprehensive and can be helpful for students to determine professional roles, interprofessional roles, when to initiate communication with other healthcare practitioners due to a change in patient status, and treatment ideas. Some additional patient information, such as lab values, would have been beneficial to include.

Case study information is accurate and unbiased.

Content is up to date. The case studies are written in a way so that they will not be obsolete soon, even with changes in healthcare.

The case studies are well written, and can be utilized for a variety of classroom assignments, discussions, and projects. Some additional lab value information for each patient would have been a nice addition.

The case studies are consistently organized to make it easy for the reader to determine the framework.

The text is broken up into eight different case studies for various patient diagnoses. This design makes it highly modular, and would be easy to assign at different points of a course.

The flow of the topics are presented consistently in a logical manner. Each case study follows a patient chronologically, making it easy to determine changes in patient status and treatment options.

The text is free of interface issues, with no distortion of images or charts.

The text is not culturally insensitive or offensive in any way. Patients are represented from a variety of races, ethnicities, and backgrounds

This book would be a good addition for many different health programs.

Reviewed by Ann Bell-Pfeifer, Instructor/Program Director, Minnesota State Community and Technical College on 5/21/18

The book gives a comprehensive overview of many types of cases for patient conditions. Emergency Room patients may arrive with COPD, heart failure, sepsis, pneumonia, or as motor vehicle accident victims. It is directed towards nurses, medical... read more

The book gives a comprehensive overview of many types of cases for patient conditions. Emergency Room patients may arrive with COPD, heart failure, sepsis, pneumonia, or as motor vehicle accident victims. It is directed towards nurses, medical laboratory technologists, medical radiology technologists, and respiratory therapists and their roles in caring for patients. Most of the overview is accurate. One suggestion is to provide an embedded radiologist interpretation of the exams which are performed which lead to the patients diagnosis.

Overall the book is accurate. Would like to see updates related to the addition of direct radiography technology which is commonly used in the hospital setting.

Many aspects of medicine will remain constant. The case studies seem fairly accurate and may be relevant for up to 3 years. Since technology changes so quickly in medicine, the CT and x-ray components may need minor updates within a few years.

The book clarity is excellent.

The case stories are consistent with each scenario. It is easy to follow the structure and learn from the content.

The book is quite modular. It is easy to break it up into cases and utilize them individually and sequentially.

The cases are listed by disease process and follow a logical flow through each condition. They are easy to follow as they have the same format from the beginning to the end of each case.

The interface seems seamless. Hyperlinks are inserted which provide descriptions and references to medical procedures and in depth definitions.

The book is free of most grammatical errors. There is a place where a few words do not fit the sentence structure and could be a typo.

The book included all types of relationships and ethnic backgrounds. One type which could be added is a transgender patient.

I think the book was quite useful for a variety of health care professionals. The authors did an excellent job of integrating patient cases which could be applied to the health care setting. The stories seemed real and relevant. This book could be used to teach health care professionals about integrated care within the emergency department.

Reviewed by Shelley Wolfe, Assistant Professor, Winona State University on 5/21/18

This text is comprised of comprehensive, detailed case studies that provide the reader with multiple character views throughout a patient’s encounter with the health care system. The Table of Contents accurately reflected the content. It should... read more

This text is comprised of comprehensive, detailed case studies that provide the reader with multiple character views throughout a patient’s encounter with the health care system. The Table of Contents accurately reflected the content. It should be noted that the authors include a statement that conveys that this text is not like traditional textbooks and is not meant to be read in a linear fashion. This allows the educator more flexibility to use the text as a supplement to enhance learning opportunities.

The content of the text appears accurate and unbiased. The “five overarching learning objectives” provide a clear aim of the text and the educator is able to glean how these objectives are captured into each of the case studies. While written for the Canadian healthcare system, this text is easily adaptable to the American healthcare system.

Overall, the content is up-to-date and the case studies provide a variety of uses that promote longevity of the text. However, not all of the blue font links (if using the digital PDF version) were still in working order. I encountered links that led to error pages or outdated “page not found” websites. While the links can be helpful, continued maintenance of these links could prove time-consuming.

I found the text easy to read and understand. I enjoyed that the viewpoints of all the different roles (patient, nurse, lab personnel, etc.) were articulated well and allowed the reader to connect and gain appreciation of the entire healthcare team. Medical jargon was noted to be appropriate for the intended audience of this text.

The terminology and organization of this text is consistent.

The text is divided into 8 case studies that follow a similar organizational structure. The case studies can further be divided to focus on individual learning objectives. For example, the case studies could be looked at as a whole for discussing communication or could be broken down into segments to focus on disease risk factors.

The case studies in this text follow a similar organizational structure and are consistent in their presentation. The flow of individual case studies is excellent and sets the reader on a clear path. As noted previously, this text is not meant to be read in a linear fashion.

This text is available in many different forms. I chose to review the text in the digital PDF version in order to use the embedded links. I did not encounter significant interface issues and did not find any images or features that would distract or confuse a reader.

No significant grammatical errors were noted.

The case studies in this text included patients and healthcare workers from a variety of backgrounds. Educators and students will benefit from expanding the case studies to include discussions and other learning opportunities to help develop culturally-sensitive healthcare providers.

I found the case studies to be very detailed, yet written in a way in which they could be used in various manners. The authors note a variety of ways in which the case studies could be employed with students; however, I feel the authors could also include that the case studies could be used as a basis for simulated clinical experiences. The case studies in this text would be an excellent tool for developing interprofessional communication and collaboration skills in a variety healthcare students.

Reviewed by Darline Foltz, Assistant Professor, University of Cincinnati - Clermont College on 3/27/18

This book covers all areas listed in the Table of Contents. In addition to the detailed patient case studies, there is a helpful section of "How to Use this Resource". I would like to note that this resource "aligns with the open textbooks... read more

This book covers all areas listed in the Table of Contents. In addition to the detailed patient case studies, there is a helpful section of "How to Use this Resource". I would like to note that this resource "aligns with the open textbooks Clinical Procedures for Safer Patient Care and Anatomy and Physiology: OpenStax" as noted by the authors.

The book appears to be accurate. Although one of the learning outcomes is as follows: "Demonstrate an understanding of the Canadian healthcare delivery system.", I did not find anything that is ONLY specific to the Canadian healthcare delivery system other than some of the terminology, i.e. "porter" instead of "transporter" and a few french words. I found this to make the book more interesting for students rather than deter from it. These are patient case studies that are relevant in any country.

The content is up-to-date. Changes in medical science may occur, i.e. a different test, to treat a diagnosis that is included in one or more of the case studies, however, it would be easy and straightforward to implement these changes.

This book is written in lucid, accessible prose. The technical/medical terminology that is used is appropriate for medical and allied health professionals. Something that would improve this text would to provide a glossary of terms for the terms in blue font.

This book is consistent with current medical terminology

This text is easily divided into each of the 6 case studies. The case studies can be used singly according to the body system being addressed or studied.

Because this text is a collection of case studies, flow doesn't pertain, however the organization and structure of the case studies are excellent as they are clear and easy to read.

There are no distractions in this text that would distract or confuse the reader.

I did not identify any grammatical errors.

This text is not culturally insensitive or offensive in any way and uses patients and healthcare workers that are of a variety of races, ethnicities and backgrounds.

I believe that this text would not only be useful to students enrolled in healthcare professions involved in direct patient care but would also be useful to students in supporting healthcare disciplines such as health information technology and management, medical billing and coding, etc.

Table of Contents

• Introduction

Case Study #1: Chronic Obstructive Pulmonary Disease (COPD)

• Learning Objectives
• Patient: Erin Johns
• Emergency Room

Case Study #2: Pneumonia

• Day 0: Emergency Room
• Day 1: Emergency Room
• Day 1: Medical Ward
• Day 2: Medical Ward
• Day 3: Medical Ward
• Day 4: Medical Ward

Case Study #3: Unstable Angina (UA)

• Patient: Harj Singh

Case Study #4: Heart Failure (HF)

• Patient: Meryl Smith
• In the Supermarket
• Day 0: Medical Ward

Case Study #5: Motor Vehicle Collision (MVC)

• Patient: Aaron Knoll
• Crash Scene
• Operating Room
• Post Anaesthesia Care Unit (PACU)
• Surgical Ward

Case Study #6: Sepsis

• Patient: George Thomas
• Sleepy Hollow Care Facility

Case Study #7: Colon Cancer

• Patient: Fred Johnson
• Two Months Ago
• Pre-Surgery Admission

Case Study #8: Deep Vein Thrombosis (DVT)

• Patient: Jamie Douglas

Appendix: Overview About the Authors

Ancillary Material

About the book.

Health Case Studies is composed of eight separate health case studies. Each case study includes the patient narrative or story that models the best practice (at the time of publishing) in healthcare settings. Associated with each case is a set of specific learning objectives to support learning and facilitate educational strategies and evaluation.

The case studies can be used online in a learning management system, in a classroom discussion, in a printed course pack or as part of a textbook created by the instructor. This flexibility is intentional and allows the educator to choose how best to convey the concepts presented in each case to the learner.

Because these case studies were primarily developed for an electronic healthcare system, they are based predominantly in an acute healthcare setting. Educators can augment each case study to include primary healthcare settings, outpatient clinics, assisted living environments, and other contexts as relevant.

About the Contributors

Glynda Rees teaches at the British Columbia Institute of Technology (BCIT) in Vancouver, British Columbia. She completed her MSN at the University of British Columbia with a focus on education and health informatics, and her BSN at the University of Cape Town in South Africa. Glynda has many years of national and international clinical experience in critical care units in South Africa, the UK, and the USA. Her teaching background has focused on clinical education, problem-based learning, clinical techniques, and pharmacology.

Glynda‘s interests include the integration of health informatics in undergraduate education, open accessible education, and the impact of educational technologies on nursing students’ clinical judgment and decision making at the point of care to improve patient safety and quality of care.

Faculty member in the critical care nursing program at the British Columbia Institute of Technology (BCIT) since 2003, Rob has been a critical care nurse for over 25 years with 17 years practicing in a quaternary care intensive care unit. Rob is an experienced educator and supports student learning in the classroom, online, and in clinical areas. Rob’s Master of Education from Simon Fraser University is in educational technology and learning design. He is passionate about using technology to support learning for both faculty and students.

Part of Rob’s faculty position is dedicated to providing high fidelity simulation support for BCIT’s nursing specialties program along with championing innovative teaching and best practices for educational technology. He has championed the use of digital publishing and was the tech lead for Critical Care Nursing’s iPad Project which resulted in over 40 multi-touch interactive textbooks being created using Apple and other technologies.

Rob has successfully completed a number of specialist certifications in computer and network technologies. In 2015, he was awarded Apple Distinguished Educator for his innovation and passionate use of technology to support learning. In the past five years, he has presented and published abstracts on virtual simulation, high fidelity simulation, creating engaging classroom environments, and what the future holds for healthcare and education.

Janet Morrison is the Program Head of Occupational Health Nursing at the British Columbia Institute of Technology (BCIT) in Burnaby, British Columbia. She completed a PhD at Simon Fraser University, Faculty of Communication, Art and Technology, with a focus on health information technology. Her dissertation examined the effects of telehealth implementation in an occupational health nursing service. She has an MA in Adult Education from St. Francis Xavier University and an MA in Library and Information Studies from the University of British Columbia.

Janet’s research interests concern the intended and unintended impacts of health information technologies on healthcare students, faculty, and the healthcare workforce.

She is currently working with BCIT colleagues to study how an educational clinical information system can foster healthcare students’ perceptions of interprofessional roles.

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• Volume 21, Issue 1
• 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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Patients’ Lived Experiences During the Transplant and Cellular Therapy Journey pp 9–17 Cite as

Creating a Patient-Centered Case Study

• Jennifer Holl 5 ,
• Lisa Wesinger 6 ,
• Judi Gentes 7 ,
• Carissa Morton 8 &
• Jean Coffey 9  
• First Online: 25 August 2023

59 Accesses

Case studies provide an invaluable record of professional clinical practice and have been used in medicine since the late 1800s to describe both traditional and unusual presentations of specific disease pathologies. In medicine, case studies traditionally take a detached, objective approach to outlining the clinical course of a disease and its treatment. In keeping with the holistic approach to patient care found in nursing and using the theoretical foundations established in Jean Watson’s Theory of Human Caring as well as the Relationship-Based Care Model, this research team sought to revolutionize the case study paradigm and deconstruct the traditional case study approach, placing the patient, instead of the provider, at the center of the narrative. This new case study method intercalates the clinicians’ analysis of the case with the patient’s commentary. This chapter outlines the methods and theoretical underpinnings used to create a patient-centered case study and seeks to provide nurses with a creative alternative to the traditional, objective case study approach. Implications for future research include whether using patient-centered case studies, instead of traditional case studies, provide a valuable learning tool to educate nurses.

• Qualitative research
• Phenomenology
• Relationship-based care

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Holl, J., Wesinger, L., Gentes, J., Morton, C., Coffey, J. (2023). Creating a Patient-Centered Case Study. In: Coffey, J., Hill Jr., J.M., Long, T., McGrath, E.B. (eds) Patients’ Lived Experiences During the Transplant and Cellular Therapy Journey. Springer, Cham. https://doi.org/10.1007/978-3-031-25602-8_2

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Case Study Research: A Methodology for Nursing

C HAPTER F OUR C ASE S TUDY R ESEARCH : A M ETHODOLOGY FOR N URSING Camille Cronin T his chapter presents a personal perspective on using case study research for both novice and prospective nurse researchers. My doctoral thesis, Workplace Learning—An Examination of Learning Landscapes (Cronin, 2012) provides a reference point and an example of case study research (CSR). This chapter, after describing the study briefly, focuses on the underlying philosophy, definitions, and justifications for using CSR and why I chose this method. The opportunity to reflect on my work, postdoctoral, is a pleasure and will provide others with insight into a valuable methodology for researching complex health care issues. A CASE STUDY For my doctoral research I chose to examine five students’ experiences of 15 health care placements as part of a health care program. As learning environments, these workplaces were explored through observations, interviews, and documents. This study reports on real-life context, which were examined over a 2-year period. This presented rich empirical data offering a pragmatic framework for investigating learning in the workplace. From carrying out this research, I presented a number of findings, which offered a useful framework to review the complexities that exist within the health care learning environment, how they interact with each other, and the possible impact they may have on learning in the workplace. This piece of work also highlighted the relationship the learner has with the learning environment and learning over time. The work examined the type of individual; their self-awareness; and their level of willingness to learn, which is seen as equally important in the learning environment. I concluded some very suggestive but realistic findings from this study proposing that the learning environment is unpredictable and that learning experiences are random. Through CSR, qualitative research methods were embraced in a rigorous and systematic manner. Each step of the research protocol was addressed. CSR can be both qualitative and rigorous. This study provided an example of a rigorous qualitative design in which CSR has been used to its full potential. The implications for nursing practice and for research in nursing are that real-life settings can be studied in a systematic and rigorous way and is certainly transferrable to other settings. A PHILOSOPHY OF PRACTICE I consider myself to be a learner at all times. There is always something more to discover, which is why life is so exciting and where my source of motivation lies. My interest in teaching has taken me through various paths and has always been a part of my role with colleagues, students, and patients. As a nurse, researcher, or manager, teaching and learning are essential prerequisites for these roles. My doctoral research is the culmination of various walks of my working life in nursing: practice, research, management, and education. With a number of experiences, this augmented the genesis of my work. A number of workplace visits and observations started to seam together. Although on a placement visit, I was observing a student and asked myself: Does this workplace affect practice? If so, how does this affect the students’ learning? How does each work environment affect the student? What about the other students and the other placements? How do these placements help students in their pathway toward becoming a nursing professional? How many students actually make it? Does this then have an impact on nursing recruitment? What about the other health care professions? Do these learners feel adequately prepared? So, this led to my decision to examine learning in the workplace focusing on health care settings. WHY CSR? Once it became clear what I was going to research, choosing CSR became straightforward (but getting to this point can take some time). It suited the practical nature of this study (and me which is actually very important to find a design that fits one’s own values and methods) and fitted very well with the variety of health care settings under investigation. CSR provides a practical and systematic way of collecting data in the naturalistic setting. This was very much a key issue as I wanted to be in each place of work collecting data. CSR assumes predetermined experience and knowledge and thus the literature review became a significant chapter in my thesis. Here, I could unload all my preconceptions and assimilate all I know from previous studies, practice, and pedagogy. The focus of this research study was to conduct an exploration of learning in health care workplaces. The research question was: How do students engage in learning in real-life settings? I ensured a number of objectives were set for data to be collected comprehensively, but in different ways:         To observe and report the learning context where every day face-to-face interactions of students take place in health care settings (hospitals, nursing homes, nurseries)         To examine critical learning incidents         To understand the different experiences and learning in the workplace Choosing the right research methodology is obviously very important for a dedicated piece of work over a number of years. Although attention is paid to what the research question is asking, one must ensure that both question and method will keep your interest sustained. This was very important to me, so I devoted a great amount of time deciding which philosophical and ethical approach to take. Fundamentally, the research question needed to be answered in the best possible way in order to understand and develop knowledge in this area. Personal philosophical beliefs were examined and how this world is constructed (a huge undertaking at the beginning of my thesis and I really did not know what it meant). But fundamentally I kept asking myself how students learn and engage in the workplace. However, the health care arena is complex; everyone is different and our expectations of each place differ. Are there patterns to learning or is it that we are individual and different? How does learning come together in this busy environment? Is it packaged differently to classroom learning? The workplace can be very different and yet in practice there is heavy reliance on this environment for learning. In practice-based disciplines, such as nursing, the importance of learning in the workplace provides up to half of the educational experience for students undertaking preregistration nurse education programs (Warne et al., 2010). Although objective knowledge can be gained from direct experience, what are we to learn in a health care environment–only facts? The purpose of science is to help people understand the world and their surroundings satisfying the natural curiosity of human beings through empirical data. Although this is possible, this study looks at people’s reality as represented through the eyes of the participants. Here, the importance of viewing the meaning of experience and behavior in context in its full complexity was the point of this study. CSR embraces this and the context becomes the focal point. With this in mind and as an educator, much of the ideas and theory on social constructivism have influenced my own epistemological and ontological stance often influencing ongoing personal and professional development. Social constructivism emphasizes the importance of culture and context in understanding what occurs in society and constructing knowledge based on this understanding (Kukla, 2000). This perspective is closely associated with many contemporary theories, most notably the developmental theories of Vygotsky (1978) and Bruner (1999), and Bandura’s (1989) social cognitive theory. Social constructivism is based on specific assumptions about reality, knowledge, and learning (Kukla, 2000). Here again, CSR embraces the reality where I wanted to collect my data. Constructivism is a theory of knowledge that argues that humans generate knowledge and meaning from an interaction between their experiences and their ideas (Piaget, 1950). Piaget suggests that through the processes of accommodation and assimilation, individuals construct new knowledge from their experiences. According to the theory, accommodation is the process of reframing one’s mental representation of the external world to fit new experiences. Accommodation can be understood as the mechanism by which failure leads to learning: When we act on the expectation that the world operates in one way and it violates our expectations, we often fail, but by accommodating this new experience and reframing our model of the way the world works, we learn from the experience of failure, or others’ failure (Rogoff, 1999). Piaget’s theory of constructivist learning has had wide-ranging impact on learning theory and teaching methods across disciplines. Constructivism is not a particular pedagogy; it is a theory that describes one way of how learning happens; regardless of whether learners are, for example, using their experiences to understand a lecture or follow the instructions to build a model house. In both cases, the theory of constructivism suggests that learners construct knowledge out of their experiences. However, constructivism is often associated with pedagogic approaches that promote learning by doing. In this research, constructivism provides a philosophical framework that has informed the thought process and research strategy for exploring learning environments in health care settings. How Did CSR Fit With My Exploration of Learning? However, in developing this philosophy further, social constructivism views each learner as a unique individual with unique needs and backgrounds, and is seen as complex and multidimensional (Wertsch, 1997). Moreover, social constructivism encourages the learner to arrive at their own version of the truth, which is influenced by their cultural background. This also stresses the importance of the nature of the learner’s social interaction with knowledgeable others. Without the social interaction with other more knowledgeable people (i.e., going to a work placement), it is impossible to acquire social meaning of important symbol systems and learn how to utilize them. From the social constructivist viewpoint, it is thus important to take into account the background and culture of the learner throughout the learning process, as this helps to shape the learner (Wertsch, 1997). Interestingly, Glasersfeld (1989) argues that the responsibility of learning should reside with the learner. This is where the philosophy of social constructivism overlaps into the workplace, emphasizing the importance of the learner being actively involved in the learning process with an element of responsibility. With learning, therefore, being an active social process, Vygotsky’s (1978) work strongly influences social constructivism, suggesting that knowledge is first constructed in a social context and is then appropriated by individuals viewing learning as an active process (Glasersfeld, 1989; Kukla, 2000). Furthermore, Vygotsky (1978) adds that the most significant moment in the social and practical elements of learning in intellectual development is when speech and practical activity, two previously independent lines of development, converge. Most social constructivist models stress the need for collaboration among learners, which is a contradiction to traditional approaches. One Vygotskian notion that has significant implications for peer collaboration is that of the zone of proximal development in which guidance or collaboration is given with more capable peers, and this contrasts with the fixed biological nature of Piaget’s stages of development. Through a process of “scaffolding” a learner can be extended beyond the limitations of physical maturation to the extent that the development process lags behind the learning process (Vygotsky, 1978). Finally, the social constructivist paradigm views the context in which the learning occurs as central to the learning itself (Kukla, 2000). Knowledge should not be divided into different subjects or compartments, but should be discovered as an integrated whole (Kukla, 2000). This also again underlines the importance of the context in which learning is presented. The world, in which the learner needs to operate, does not approach one in the form of different subjects, but as a complex myriad of facts, problems, dimensions, and perceptions (Wertsch, 1997). This is where Lave’s and Wenger’s (1991) notion of situated learning is directly relevant to learning, specifically those learners who have part of their curriculum taught in the workplace. This constructivist model of learning attempts to “invite learners to a community of practice” so that through authentic activity and social interaction a successful apprenticeship is formed with the learner. Meaningful learning occurs when individuals are engaged in social activities (Kukla, 2000). Instructional models based on the social constructivist perspective stress the need for collaboration among learners and with practitioners in the society (Lave & Wenger, 1991; Kukla, 2000). Lave and Wenger (1991) assert that a society’s practical knowledge is situated in relations among practitioners, their practice, and the social organization and political economy of communities of practice. For this reason, learning should involve such knowledge and practice (Gredler, 1997; Lave & Wenger, 1991). Therefore, this study investigated workplaces where students go to learn. The health care workplace is one example of a complex and unpredictable environment and there is an assumption that learning is “situated” and that there is an application of “appropriated” learning. This is where the methodology of choice, CSR, captured the reality of learning in real-life complex health care settings, the context in which learners (who are also complex beings) go to learn. In this way, CSR can examine complex situations that unfold multifaceted realities. Reality cannot be defined objectively, but subjectively; it is this interpretation of social reality that is important here. With this in mind the ontological stance takes precedence over the epistemological. Within the health care environment, the principles of the natural sciences are difficult to maintain; people cannot be treated as objects and measured objectively. Individual people are involved in the study sharing their views and experiences. Nonetheless, rigor and high-quality research must be applied in order to produce meaningful and pertinent research applicable to contemporary health care. In terms of epistemological influence over this piece of research, the researcher found strong overlaps with some of the methodologies available, namely, phenomenology, ethnography, and grounded theory. Although they do not directly relate to the ontological stance, there are strong influences and similarities among these philosophical methods of inquiry, which were scrutinized at length and were consequently discarded. A Brief Historical Perspective of CSR A case study approach is one of the most frequent research designs applied in social sciences (Burton, 2000). Despite its widespread use, it has changed over time and varies between disciplines and individual researchers (Creswell, 2009; Denzin & Lincoln, 2000; Yin, 2003b). Historically, there have been marked periods of intense use and periods of disuse. During the 1930s, particularly in America with high levels of immigration, poverty, and unemployment, it was associated with The University of Chicago Department of Sociology and, as an approach, it was strongly associated with the field of sociology, but during this time frame, other disciplines raised many questions about its scientific worth. Consequently, this led to a decline in the use of case study as a research methodology. The use of CSR in nursing has been similar to other disciplines, though its peak interest was in the 1960s followed by a rapid decline in its use (Burns & Groves, 1997). We are now seeing its revival, for example, with Newton, Billett, and Ockerby’s (2009) Australian-based case study of six students from a nursing cohort, and my study. Another example is Houghton, Murphy, Shaw, and Casey’s (2015) multiple case study exploring the role of the clinical skills laboratory in preparing students for the real world of practice. There has been some CSR in the further education (FE) sector, which shares some similarities with this area of exploration, namely, Colley et al. (2003) and Hodkinson and James (2003). Both these pieces of research resulted from a project “Transforming Learning Cultures in Further Education,” which aimed to deepen the understanding of the complexities of learning across the FE sector (Hodkinson & James 2003). It was a collaborative partnership among four universities and four FE colleges in England following level 3 programs in child care, health care, electronics, and telecommunications. All the sites had a substantial amount of work-based learning included throughout and data were generated from a cohort and followed for 2 years (Colley et al., 2003). Traditionally, quantitative researchers have argued that the CSR is anecdotal and nonscientific, dismissing the results and findings obtained by this method on the grounds that they lack validity and reliability. The controversy that surrounds its scientific nature is nothing new. Like others, Al Rubaie (2002) argues that the CSR is a completely legitimate method suited in both qualitative and quantitative dichotomies. In fact, Al Rubaie (2002) suggests that it is better suited to a holistic, democratic discipline dealing with the understanding and change of interwoven complexities associated with interpersonal processes that emerge and unfold within a wider social context. Hence, this is why this particular approach suits the complexities of the learning in the workplace. It is somewhat of a paradox because much of what we know about the empirical world is drawn from case studies, and many disciplines still continue to generate a large number of case studies. Yet, according to Gerring (2004) and Burton (2000), the case study is held in low regard or is just simply ignored. A case study might mean that its method is qualitative, with small numbers of participants; that the research may be ethnographic, clinical, participant–observation, or otherwise “in the field” (Yin 2009); the research that is carried out is characterized by process tracing (George and Bennett 2004), in which, as in an audit trail, the steps in the research can readily be followed; and the research can investigate a single case or single phenomenon. Interpretation of CSR has led to arguments resulting in no particular agreement. Although this may be the case, any researcher using CSR must ensure that each step of the research process is transparent. CASE STUDY RESEARCH Definition Defining case study remains problematic because it can constitute a design and a research method. The terms case study, case study method, and case method appear to be used interchangeably in the literature (Hamel, 1993; Yin, 2009). However, it is clear that CSR focuses on specific situations, providing a description of individual or multiple cases. In using this design, the researcher can investigate “everything” in that situation be it individuals, groups, activities, or a specific phenomenon. A distinguishing feature of case study is that although the number of cases may be small (or even one); the number of variables involved is large (Burns & Groves, 1997; Yin, 2009). To start with, I used a definition from Walsh et al. (2000): in-depth data analysis from systematic investigation over time. It describes basically what I summarized and particularly stressed that the “systematic” approach is to be taken. On further reading, Yin’s (2009) work on CSR became prominent in my reading. Yin’s (2003a) definition of a case study “is an empirical inquiry that investigates contemporary phenomena within its real-life context, especially when the boundaries between phenomena and context are not clearly evident” (p. 13). Yin (2009) argues that one of the most powerful uses of the method is to explain real-life, casual links. What this means is that the researcher can appreciate the subjective richness of individuals recounting their experiences in a particular context and the meanings embedded help guide practice. Yin developed his work further producing two research companion books (Yin, 2003a; 2003b), which provide rich and varied material. This has now been updated with a new fourth edition (Yin, 2009), which promotes CSR as a valid research tool. Many researchers quote Yin’s work and arguably it remains at the forefront of case study research. Advantages Gomm et al. (2007) identify three advantages to conducting CSR. First, case studies can take us to places where most of us would not have access or the opportunity to go. They provide enriched experiences of unique situations. Second, case studies allow us to look through the eyes of the researcher. Glesne and Peshkin (1992) recommended that researchers should be as unobtrusive as the wallpaper. In this instance, a poignant piece of reflection comes to mind (see Box 4.1 ). Although we do not in reality see through the researcher’s eyes, we in fact share the researcher’s perspective of the theoretical position in the study. Furthermore, by definition, theory simplifies our understanding of reality. Finally, the third reason why case studies may be preferable is that it is less likely to produce defensiveness and resistance to learning. It is more acceptable because the research reflects real life. All these issues raised bring together what case study is, and Hakim (1987) sums up how focused this CSR is like a spotlight on a unit of analysis. Thus the spotlight (or unit of analysis) is on a group of five learners participating in a 2-year study program in which the completion of work placements is compulsory.  

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Writing Tips

A comprehensive nursing case study writing guide.

Aug. 4, 2023 • 7 min read

Nursing Case Study Writing Step-By-Step Guide

Nursing case studies play a vital role in the education and training of aspiring nurses in the USA, UK, UAE, and Canada. These real-life scenarios provide students with a unique opportunity to apply theoretical knowledge to practical situations, enhancing their critical thinking, clinical reasoning, and decision-making skills. In this guide, we'll walk you through the essential steps to creating effective and insightful nursing case studies that meet the academic standards of these countries.

1. Choosing a Relevant Case

The foundation of a successful nursing case study is the selection of an appropriate case. Look for scenarios that align with your course's learning objectives and reflect the wide range of healthcare challenges that nurses may face. Select cases involving ethical quandaries, complex patient interactions, or situations requiring interdisciplinary collaboration.

2. Gathering Information

Thorough research is key to crafting a detailed and accurate nursing case study. Collect data from reputable sources such as medical journals, textbooks, and evidence-based practice guidelines. Ensure that the patient's medical history, current condition, and relevant clinical data are well-documented. Protect patient confidentiality by de-identifying information.

3. Setting the Stage

Introduce the case by providing basic details on the patient, the healthcare setting, and any other relevant information. Describe the patient's demographics, medical history, current symptoms, and reason for seeking medical help. This establishes the context for readers to comprehend the situation and its significance.

4. Clinical Assessment

Detail the nursing assessment process, including physical examinations, diagnostic tests, and the collection of subjective and objective data. Highlight the nurse's role in observing, interviewing, and evaluating the patient's condition. Discuss the data collected and its implications for the patient's care.

5. Diagnosis and Planning

Based on the assessment, outline the nursing diagnoses and collaborative problems. Clearly explain the rationale behind each diagnosis and present a well-reasoned plan of care. Discuss short-term and long-term goals, potential interventions, and the expected outcomes of nursing interventions.

6. Implementation and Evaluation

Describe how the nursing care plan was executed and the interventions that were implemented. Include details about the nurse's interactions with the patient, families, and other healthcare team members. Evaluate the effectiveness of the interventions, discussing any changes in the patient's condition, responses to treatment, and unexpected challenges.

7. Reflection and Learning

Encourage critical thinking by incorporating a reflection section. Invite students to analyze the case, consider alternative approaches, and reflect on what they have learned from the experience. Discuss the ethical, cultural, and emotional aspects of the case, promoting a holistic understanding of patient care.

8. References and Citations

Maintain academic integrity by properly citing all sources used in your case study. Follow the appropriate citation style (such as APA, MLA, or Chicago) as required by your institution.

Writing nursing case studies is an essential skill for nursing students in the USA, UK, and Canada. Through these case studies, students can bridge the gap between theory and practice, preparing them for the complex and dynamic healthcare environments they will encounter in their careers. By carefully selecting cases, conducting thorough research, and presenting well-structured and reflective analyses, nursing students can create case studies that not only meet academic standards but also contribute to their growth as competent and compassionate healthcare professionals.

Our platform has been giving quality services to our students from the very beginning, all thanks to our highly-trained and professional Nursing case study helpers, who complete every task with utmost sincerity and dedication by applying all their knowledge to your projects so that you can raise your head confidently while presenting in front of your class. TutorGenix has always been ranked as the Best Nursing Case Study help in the USA, the UK, Canada, and the UAE. Our Nursing project writers will complete your academic reports, essays, homework, and whatnot, so just order us and we will help with everything we’ve got. You will get instant solutions for nursing homeworks or any other subject homework you need help with, as we have 24/7 available tutors.

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Case Study #2: Pneumonia

Learning Objectives

Case 2 describes a patient’s experience of COPD exacerbation due to community acquired pneumonia. The patient in this case study has a complicated health history. The interprofessional collaboration is role modelled between nursing, medical radiology, medical laboratory, and health care workers in the emergency department.

Learners reviewing this case can consider how pneumonia affects COPD. Additionally this case offers opportunity for discussion on supporting families both in the Emergency Department and acute medicine areas. The interprofessional collaboration is ideal and offers opportunities for further discussion on why the collaboration works so well and what barriers would prevent ideal collaboration.

Note: The story told here is used in case 1 and case 2. The simpler version in case 1 can be used to teach novice students about health case studies. Case 2 reintroduces the patient from case 1 and expands her story with more details for more advanced study.

In this case, learners have an opportunity to:

• Review etiological factors (i.e., risk factors, prevalence, co­morbidities) associated with respiratory disease
• ‪Build knowledge related to the patient’s experience of respiratory insufficiency, including  COPD and pneumonia
• ‪Continue to develop comprehensive assessment and monitoring skills and abilities (e.g., relevant abnormal physical assessment findings, ABGs, lab, and diagnostic data)
• ‪Consider the links between evidence-based knowledge and practice in the care of patients with pneumonia (e.g., CAP guidelines)
• ‪Recommend interventions based on the risk factors, status, and progression of  pneumonia (e.g., antibiotic therapy, oxygen therapy)
• ‪Define the roles of health care professionals and the contributions they make to the healthcare team (or describe your own role and the roles of those in other professions)

Health Case Studies by BCIT is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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This online CNE nursing curriculum provides core knowledge of Oncology concepts, including an overview of cancer, diagnostic evaluation, goals of treatment, medications, chemotherapy administration, nutrition, cancer distress, ethics, genomics, effects of tobacco use, palliative care, content on disease sites, and survivorship. Many of the modules include case scenarios applicable to any practice setting. This content meets the criteria for the Commission on Cancer (CoC) Standard 4.2 Oncology Nursing Credentials.

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This online CNE nursing curriculum is designed for nurses caring for oncology patients throughout their cancer journey.

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Upon completion of this activity, participants should be able to:

• Describe the role of the nurse in caring for oncology patients.
• Identify treatment options for cancer care.
• Outline psychosocial factors associated with oncology care. 

Attendance at any Mayo Clinic course does not indicate or guarantee competence or proficiency in the skills, knowledge or performance of any care or procedure(s) which may be discussed or taught in this course. 

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Genomic testing and genomic medicine are both rapidly growing fields, and the American Nurses Association recognizes that all nurses have a role in delivering genetics/genomics services to patients and families. Clinical advances have resulted in the introduction of genomics into practices ranging from primary care to oncology to critical care. These courses are designed to provide nurses and health care staff with broad education in genomics and were specifically developed to translate genomic science into practice.

This course will be presented via a self-guided online interactive module.

Each online course included in this oncology nursing curriculum has been developed by experts in the specialty practice. 

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Roxanna M. Holper, MS, RN Nursing Education Specialist - Cancer Center Quality Program Instructor in Nursing, Mayo Clinic College of Medicine and Science Department of Nursing Mayo Clinic, Rochester, MN

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Horrocks S, Pollard K, Duncan L, et al. Measuring quality in community nursing: a mixed-methods study. Southampton (UK): NIHR Journals Library; 2018 Apr. (Health Services and Delivery Research, No. 6.18.)

Measuring quality in community nursing: a mixed-methods study.

Chapter 2 study objectives, design and methodology.

This chapter details the design and methodology of this mixed-methods study. The overall aims and objectives of the study are introduced below, followed by information about components of the study design and conduct. The chapter also includes information on how patient and public involvement contributed to and informed many aspects of both design and methodology; the process for gaining NHS ethics and research and development (R&D) approvals for the study; and a summary of deviations from the original protocol.

• Aims and objectives

The study aimed to investigate the selection, application and usefulness of quality measures in use for community nursing from April 2014 to June 2016 in order to identify how they are used and the factors that influence their usefulness in achieving their intended goals of ensuring high-quality care for patients.

The research questions developed for the study were:

• Which QIs are selected locally, regionally and nationally for community nursing?
• How are they selected and applied?
• What is their usefulness to patients, commissioners and community provider staff?

The associated study objectives were to:

• map QIs in use for community nursing
• identify the processes for the selection of QIs for community nursing at local, regional and national level
• clarify the processes for introducing and applying QIs into community nursing services and to explore how data are collected, analysed and quality assured
• explore the usefulness of indicators in terms of meeting priorities, assessing the quality of services, influencing commissioning decisions and bringing about changes in service delivery from the perspectives of patients, front-line teams and commissioners ( Figure 1 ).

Flow diagram of study methodology. a, Interviews will also explore selection; b, interviews will also explore selection and application.

A mixed-methods design in three phases was utilised, which comprised:

• phase 1 – a national cross-sectional survey of QI schemes
• phase 2 – an in-depth qualitative case study of the selection, application and usefulness of quality measures in use for community nursing in five study sites
• phase 3 – a series of stakeholder engagement workshops to validate and check the transferability of our findings.
• Mixed-methods design and conceptual framework

The study used a pragmatic mixed-methods design involving an integrative approach of ‘connecting’ quantitative and qualitative data rather than ‘merging’ or ‘embedding’. 60 Mixed methods were employed sequentially to provide both breadth (phase 1) and depth of description of QI use in community nursing (phase 2). Quantitative data were collected first to describe the range of QI and incentive schemes in use nationally in community nursing during 2014/15, and then to give a sample of providers from which to purposively select five sites for the case study. Case study research enables an in-depth exploration of contemporary events using a combination of qualitative data collection methods. Such methods include interviews, non-participant observation and documentary analysis. 61 , 62 One of the strengths of the case study approach is that it enables the triangulation of data, thus supporting the validity of the overall analysis. Our case study in multiple sites built on the survey findings by exploring in depth the relationship between policy directives on quality measurement and influences on local implementation. It enabled the identification and probing of the processes of selection and application of QI schemes and other quality measures currently used by community nurses, as well as an insight into the perceived effectiveness of such measures for the purpose of assessing service quality.

Individual and local factors can affect the success of national policy implementation, so an understanding of the interplay between these is fundamental in ensuring that any benefits from national initiatives, such as QI schemes, are obtained. To conceptualise our study, we used a framework originally developed by Franco et al. , 63 which had been utilised successfully in our earlier work. 32 This multilevel framework includes factors that influence individual behaviour and attitude, and incorporates organisational and wider health system contexts and relationships, helping explain the interplay between them. These contexts are all likely to have a bearing on which QIs get selected, as well as how they are applied in practice.

We ‘co-produced’ this project by working in partnership throughout the research process with patient and carer representatives, commissioners and community nurses, who were part of the larger study team. This included drawing on their expertise and knowledge when formulating the research question(s), scoping the literature, collecting and analysing data, and identifying the key messages, mediums and target audiences for dissemination. In a subsequent phase (phase 3), we held engagement events with commissioners, health-care practitioners, patients and carers in 10 locations nationally to check our analyses and interpretation of evidence to improve the dependability and transferability of our findings and also to support the development of good practice guidance (see Appendices 2 – 4 ).

The study provided a national snapshot of QI schemes applying to community nursing, followed by an investigation of the selection, application and implementation of QI schemes in five sites across England. Each case site comprised a dyad of a community nursing service provider contracted to provide NHS services and their associated CCG. At least one case study site was an independent provider. The included community nurses were registered nurses providing home-based nursing care to adults. A geographical spread of case sites and different types of community nursing provider enhanced the reach of the project and transferability of findings.

For clarity, the methodology of the national survey will be reported first, followed by the case study.

• Phase 1: national survey

Design and sampling

The original intention was to conduct an electronic cross-sectional survey of all 211 CCGs across England in order to identify their community nursing service providers and associated QI schemes. The first step was to identify potential respondents by using the CCG information and contact details available online from NHSE to identify departments and/or commissioners responsible for quality or commissioning community nursing services. It became clear quickly that the requisite information was generally not available online. Although using the telephone number given occasionally resulted in correctly identifying a potential respondent, this was a laborious and time-consuming approach. In April 2014, at the time of the survey, the CCGs were comparatively new organisations, having only recently been established after the implementation of the Health and Social Care Act 2012. 26 Often it was not easy for the local administrators answering the telephone to identify the correct personnel responsible for commissioning community nursing, and they frequently suggested that the researcher submit the questions through a Freedom of Information (FOI) request; this was therefore adopted as the main method of data collection.

Data collection

Once the appropriate avenue for submitting a FOI request to a CCG was identified, the following three questions were asked.

• Who commissions community nursing services for your CCG and what are their contact details?
• What QI scheme(s) covering community nursing services are being used for 2014/15?
• Which organisation provides your community nursing services and what is the nature of this provision, for example NHS, social enterprise, voluntary organisation or private?

Data comprising a mix of CQUINs, local QIs and KPIs were received in a variety of formats – electronic spreadsheets, word documents and copies of contracts – all with varying degrees of completeness. As the second phase of the project aimed to examine, in detail, the processes around quality measurement in community nursing, and as the aim of the current phase was to gain a broad national quality snapshot, it was decided to focus on CQUINs only for the analysis. CQUINs were also submitted in a format sufficiently consistent to allow a cross-organisation comparison, and allowed variation and local priorities to be identified nationally. All of the organisational details and CQUINs data were entered onto a Microsoft Excel ® (Microsoft Corporation, Redmond, WA, USA) spreadsheet, and were cleaned by checking for anomalies or inconsistencies across fields.

For each CQUIN, we recorded the NHS region and CCG area and, when supplied, the indicator name, its descriptor and the rationale for its use. The CQUINs were then categorised as ‘national’ (pertaining to the national indicator scheme) or ‘local’ (reflecting local needs and conditions), as defined by the NHSE CQUIN guidance. As the CQUINs documentation we received only rarely specified community nursing services in the title, it was necessary to identify which CQUINs applied to nursing. To identify and code community nursing CQUINs, three researchers with professional experience of either community nursing or commissioning, working in pairs, scrutinised the associated description and rationale to determine whether or not the CQUIN applied to nursing. At least one of the following criteria had to be met for this purpose:

• Community nurses are directly involved in gathering data about quality.
• Community nurses’ activities constitute an essential contribution to the achievement of the CQUIN.

There is significant variation in the configuration of community services, 11 which could affect the above coding. To be inclusive, when it was not possible to be certain whether or not the CQUIN applied to community nursing, the CQUINs were coded as ‘possible’ (e.g. if a CQUIN applied to a reablement service and it was not clear if the local service included a community nurse) or ‘definite’ (e.g. if it clearly related to community nursing service provision, or if such nurses collected data for the purposes of quality measurement).

Next, community nursing CQUINs were further coded by applying the following quality dimensions to each:

• patient safety, clinical effectiveness and patient experience, or a combination of these dimensions 23
• structure, that is, contributing to the underpinning service requirements (e.g. staff numbers, appropriate training, infrastructure, building and equipment); process, that is, activities carried out by staff in relation to service delivery; or outcome, that is, the assessment of the impact of health activities on patients. 19

Initial coding was conducted by one researcher, with a 10% sample recoded by a second researcher; any differences were resolved by discussion prior to completion of coding.

Since the national evaluation of CQUINs 25 had recommended the promotion of the use of a Pick List and evidence-based indicators, a final exercise investigated whether or not the community nursing CQUIN indicators had identifiable sources: indicator names, descriptors and rationales were searched for mention of particular documents (e.g. NHS Outcomes Framework) 27 and for particular organisations (e.g. NICE). Exact wording drawn from community indicators in the CQUINs Pick List (a database of evidence-based QIs for users of the CQUIN scheme), 24 was also used as a search term to identify any local CQUINs which had incorporated indicators from the Pick List. When a source was identifiable, the CQUIN was coded accordingly. Three researchers, two of whom had professional health-care backgrounds, collaborated to produce these coding schemes.

The resulting data were descriptively analysed using IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY, USA). The methods and emerging findings of the survey were made available on the project website.

The next section describes the design and methodology of the case study.

• Phase 2: case study

A case study is a preferred method for examining, in detail, contemporary events over which it is not possible or desirable to exert control. 61 , 62 It constitutes an in-depth exploration of a ‘bounded system’ (p. 61), 62 or ‘case’, over time, through the use of multiple data sources, rich in context and detail. The proposed case study was to explore in depth the processes in use for measuring quality in community nursing services in England. The aim was to collect data over the duration of the annual commissioning cycle, focusing on agreeing contracts and quality monitoring and evaluation in order to understand the processes involved. We also aimed to investigate the impact on front-line staff and patients and their carers of the application of quality measures in practice, and the perceptions of all participants of the usefulness of such measures for determining the quality of nursing. Following the Health and Social Care Act 2012 26 and the implementation of clinical commissioning organisations, and in discussion with the research management group, it was decided to explore whether or not the new organisational context might determine or help to explain any variations found across different sites. A multisite case study approach was therefore deemed appropriate and we recruited five case sites across the country.

Purposive sampling enables researchers to select sites on the basis of their potential to provide data on the contextual factors considered to be significant for the investigation. 64 In discussion with the research management group, a shortlist of 10 potential case sites was identified, from which seven were approached and five were recruited. Once identified as potential sites, both the commissioning and the provider organisation were approached separately, but concurrently, via the people named as responsible for commissioning and managing community nursing in the organisations. Each organisation was advised that it could not be used as a case site if the other organisation chose not to participate. The case sites were identified on the basis of the findings of the survey, selected using the following inclusion criteria:

• variation in geographical location across England
• range and number of QI schemes in operation across community nursing services
• range of provider organisation type (NHS and independent).

Although there is no consensus on the number of case sites to include in a multisite case study, five sites enabled depth of study, while also enabling sufficient cross-comparison to check for consistency. 65 One of three researchers was allocated to be the main contact for data collection within each site to enable trust to be established and an in-depth knowledge of the site to be developed. The nurse researcher visited all the sites in which front-line observations took place. This arrangement enabled sufficient depth of knowledge in relation to commissioning at each site and cross-case understanding of evidence relating to front-line staff, patients and informal carers.

Participant inclusion criteria

• National and regional quality leads from NHSE in a position to provide understanding about the influence of national and regional quality directives on local implementation of quality schemes.
• Commissioners and community service provider managers directly responsible for community nursing services and, in particular, agreeing and implementing QI schemes.
• Registered community nurses delivering nursing care to people aged ≥ 18 years in their own homes. This criterion included district nursing teams, integrated care teams, integrated community nursing teams, community matrons and community nurses for older people, who provide home-based care for adults with multiple and advanced long-term conditions requiring nursing and palliative care services. The service aims for these community nurses are to enable people with long-term or deteriorating conditions to live independently for as long as possible, reduce avoidable hospital admissions by timely nursing interventions and facilitate the discharge of patients not requiring hospital care.
• Patients (adults aged ≥ 18 years) or their carers receiving care from community nurses in their own homes were also recruited to the study for interview. Interpreters were available if required.

Participant exclusion criteria

• Community nurses providing children’s, mental health and learning disabilities nursing were excluded as joint commissioning arrangements often apply in relation to these services and these would have broadened the scope of the project significantly, causing a loss of focus.
• Patients were excluded from this study if they were aged < 18 years, in the final stages of terminal illness, or could not give informed consent (or, in the case of reduced mental capacity, consent could not be gained from their legal representative).

Case study sites

Each site comprised a CCG and a service provider. Community nursing services were provided by four NHS organisational types (community trusts, combined acute and community trusts or community foundation trusts) and one social enterprise. In all of the case sites, community nurses were located in geographically based teams of various configurations serving a number of general practices. They are accessed by a single point of entry system, whereby there is one centralised telephone number for referrers and other patients.

Pseudonyms have been used and any similarity with existing place names is unintentional. A summary of the characteristics of each case site is provided in Table 1 .

Demographic, CCG and provider details for each of the case study sites

Once permission was granted for the case study to be carried out, local senior managers (commissioners and providers) identified suitable meetings for the researchers to observe, as well as members of their organisation who could assist us in recruiting individuals from the requisite staff groups. With the assistance of administrative staff in the case study sites, potential participants were sent study information sheets so that they could decide whether or not to participate. The methods for recruiting service users to the study are explained below.

Observations, interviews and focus groups were the main methods of data collection. Semistructured interviews were used as they enable sufficient focus on the topic under investigation while allowing flexibility for the participants to introduce new ideas and experiences for study. These were audio-recorded and undertaken using purpose-designed interview schedules guided by the research questions and advice from members of the research management group. In particular, the patient reference group provided advice on the interview schedule designed for patients and carers. Four experienced researchers with varying backgrounds, including two with experience of professional practice in the NHS, collected data. The data collection methods used in each site are shown in Table 2 .

Methods of data collection in each site linked to research objective

One-to-one semistructured interviews were conducted with commissioners and provider managers. Observations of internal meetings or combined CCG/provider meetings (where QIs for community nursing were on the agenda) were also undertaken. Joint meetings between the commissioners and their service provider managers and internal quality meetings within the local service provider organisations were observed. The aim of the observations was to learn about the local priorities and contextual quality issues for commissioners and provider managers, and to understand the professional roles and relationship between staff in the different organisations. Interviews for commissioners and service providers covered the processes used for identifying suitable QIs and the policy-drivers underpinning their choices; perceived usefulness of QIs for service quality improvement; characteristics of effective schemes and perceptions of how well CQUIN schemes have worked for community nursing.

One-to-one semistructured interviews were conducted with nurse team leaders and an observation of team meetings was undertaken when the monitoring or application of QIs was on the agenda. Interview topics included perceptions of how front-line staff feed into the process of selection and implementation of QIs; systems for recording data; the extent to which selected indicators are under the control of the clinician; barriers to implementation; and benefits or service improvements deriving from indicator use.

Focus groups were conducted with front-line staff to explore their views and experiences of QIs being used for community nursing. In addition, front-line observations were undertaken by a community nurse-trained researcher to observe processes of QI data collection and recording during patient visits. Indicative topics for focus groups with front-line staff included awareness of current indicators; the extent to which staff feel able to influence or participate in selection of QIs; confidence in QIs as a reflection of service quality; extent to which staff are in control of factors that could influence achievement of particular QIs; how quality data are recorded; challenges for front-line teams in implementing indicators; and perceptions of impact on patient care. Front-line staff were recruited via their managers, or through newsletters to the organisation.

Table 3 details the number of participants contributing data in interviews and focus groups, and meetings observed in each case site.

Study participants in each case site: interviews, focus groups, meetings

Many of the data that inform quality measurement in community nursing are collected by front-line nurses themselves. Observation and shadowing of front-line staff was therefore undertaken to observe how data for QIs were documented during the course of delivering and recording patient care in the home. A researcher with a professional community nursing, albeit not district nursing, background (SH), undertook all the shadowing. The choice of using a registered nurse who was not a district nurse but had a community background was made to preserve the balance between ‘insider’ and ‘outsider’ status of the researcher to understand and identify with the front-line teams and preserve patient dignity, but also to maintain the professional distance that permits adequate observation and data collection. 66 Participating case sites identified members of nursing teams who were prepared to be shadowed and visits were arranged at times to suit the nurses, avoiding the winter pressures period. Handover meetings or safety briefings were also attended and the use of computer software for documenting activity and outcomes of care was observed. A contemporaneous diary was written and evidence from shadowing nursing staff in the home was recorded separately on purpose-designed observation schedules. In each case site, any key documents detailing the selection, monitoring and evaluation of quality measures in use for community nursing, such as CQUINs, NHS contract sections 4 and 6, and community dashboards, were requested. Table 4 shows the number of front-line nurses shadowed and the number of home visits made in each case site.

Front-line nurses involved in data collected through shadowing sessions

See Appendix 5 for interview, focus group and observation schedules used to collect data from commissioners, provider managers and front-line staff.

A combination of approaches was used to identify patient (patient and/or carers) participants. We aimed to conduct one-to-one semistructured interviews with people initially identified from the shadowing of front-line staff. This strategy had limited success owing to the age and infirmity of such patients and their carers. To ensure sufficient representation from patients and carers in the study, we supplemented one-to-one interviews with a locally derived focus group. Patient and carer interviews included questions about their perceptions and understanding of high-quality nursing care. The current QIs applying to community nursing were then explained and patients and carers were asked their views on these for assessing community nursing service quality. Any further areas that patients and carers felt were important indicators of nursing quality were noted.

See Appendix 6 for interview and focus group schedules used to collect data from patients and carers.

Data analysis

The case study generated multiple sources of qualitative data from the sites, including interviews with patients, local senior managers (commissioner and providers) with a role in quality implementation, community nursing team leaders, focus groups with front-line nurses, observations of front-line nursing staff and quality meetings, and documentation relating to the selection, application or monitoring of quality. Interview data were audio-recorded and transcribed verbatim, and contemporaneous notes were made during the observation of meetings and the shadowing of front-line staff. Data were anonymised and entered into NVivo 10 software (QSR International, Warrington, UK), or, in the case of front-line observations, into a Microsoft Excel ® spreadsheet to aid comparison.

Qualitative data analysis drew on constant comparison techniques by which analysis proceeded with and informed data collection, 67 with members of the research team liaising regularly to share their interpretations of findings from the case sites. Data were open coded initially to generate concepts that were then validated by comparison and discussion with members of the research team, whose composition reflected key audiences. Once the codes were agreed, these were used to construct a coding framework within NVivo and a team approach to coding proceeded, with each member of the team taking responsibility for coding a particular set of data across the sites [e.g. one member of the team coded all of the provider manager interviews (KP) and another coded all of the commissioner manager interviews (CP)]. All members of the team coded the meetings that they themselves had observed. Front-line team focus group data were analysed by one researcher (LD) and the service user interview, shadowing and observation data were analysed by the nurse researcher (SH). In this way, the research team gained a cross-site perspective. The individual coding databases were merged regularly into an NVivo master database to check progress and assess whether or not there were any differences in the way codes were being applied. The resulting codes were then further analysed to determine their attributes and dimensions, resulting in themes relating to selection, application and usefulness of QIs in the case study sites.

An adapted version of the five-level analysis theoretical framework developed by Franco et al. 63 was used to aid our interpretation of the interview and focus group data ( Figure 2 ). This framework was developed in previous work that examined the relationship between financial incentives and behaviour in a range of primary care and community settings in health care. 32 It is applicable to the selection and implementation of all types of QI schemes, not only those that include financial incentives. The framework assisted in enabling the matching of codes and emerging themes with potential contextual facilitators and barriers to use of quality measures in terms of meeting priorities, assessing service quality, influencing commissioning and bringing about changes in service delivery. To increase the rigour of the analysis, use of multiple sources of data provided opportunities for comparison and contrast across accounts. For example, patients’ views, expectations and experiences demonstrated an alternative perspective on the values driving selection and application of QIs by commissioners and health-care providers.

Framework used to aid analysis.

Documentary analysis was limited due to the relative paucity and incompleteness of documents supplied to the research team across the case sites. The standard NHS contract was analysed to assess the degree of content relating to quality of community nursing services. When it was possible to obtain documents containing information about QIs, these were analysed to identify which QIs were being used for contracting community nursing in 2015/16. Documents included quality reports, ‘dashboards’ and schedules 4 and 6 of the NHS contract from the case sites (see Chapter 4 ). The analysis compared how, or if, quality measures related to the professional standards set out in Vision and Strategy for Nursing, Midwives and Care Staff   3 and CQC quality criteria now being applied to community services. The documentary analysis was undertaken by a member of the research team who was actively working as a community nurse at the time of the study.

The next section describes the organisation of the stakeholder engagement events.

• Phase 3: stakeholder engagement

Evidence suggests that research is most effectively disseminated using multiple vehicles, ideally with face-to-face interaction. 68 Dissemination events were an integral part of the study design and were planned to start towards the final few months of the project. We planned to hold workshops across the country, both putting on special events ourselves and contributing to other organisations’ meetings and conferences in order to check the study’s emerging findings and develop our good practice guidance with a wider audience. These events were intended to include a mixed group of commissioners, service managers, front-line staff, patients and carers. Owing to the time constraints on NHS staff, these were timetabled to last either a morning or an afternoon, when possible, and attendees were able to hear about emerging findings from the study and discuss the good practice guidance.

Researchers contacted participating case sites and used personal and professional contacts and networks in different parts of the country to identify other organisations that might be interested and willing to assist in holding a workshop locally. Once a workshop was agreed in principle, a key local lead for community nursing was identified and asked to give an introduction to the day. An experienced facilitator with a commissioning background, a member of the core research team and one other member of the wider team involved in the project facilitated the workshops. To gain stakeholder feedback about some of the study findings as well as statements from the draft good practice guidance, a key activity during the workshop was to engage small delegate groups in a deliberative dialogue exercise. 69 These small group discussions were distinct from focus groups in so much as data were not collected with which to inform the study; rather they were designed to discuss our findings in relation to delegates’ own experiences. Each workshop produced feedback on emerging findings and draft good practice guidance. Nursing participants received certificates of attendances for professional revalidation purposes. Participants completed evaluation forms and facilitators reflected on each workshop, making adjustments to timing and materials in response to feedback (see Appendix 2 ).

• Projected outputs
• Development of a project website on which outputs based on emerging findings of the study have been published (www.QuICN.uk). As our NHS co-applicants stressed the importance of getting findings out early, we began to disseminate emerging findings via our website within 6 months of starting the project, with the analysis of the national QI database and publication of discussion papers ( www.quicn.uk ).
• Publications, including the full report, evidence summaries for participants and other stakeholders, peer-review journals, local NHS newsletters and A5 laminates, are in progress.
• Using the findings of our project we have developed good practice guidance (see Appendix 4 ) on how best commissioners and managers can approach the selection and application of appropriate quality measures for community nursing and their perceived usefulness from the patient and carer perspectives.
• Patient and public involvement

There has been substantial input from service users (patients, carers and/or members of the public) throughout the study. In earlier work to develop local QIs for community services in Bristol, a service user expressed concern that the administration and collection of data for QIs would distract community nurses from delivering patient-centred care. This individual was a co-applicant on the successful proposal and has been the co-lead on the user aspect of this study. As a former performance manager and member of the local community health forum, he contributed to designing the study and recruiting other lay people to become involved by sitting on the research management group and/or being part of a service user reference group (SURG) for the study. The SURG has contributed to the design of data collection tools for patients and carers, including an aide-memoire to assist researchers in covering topics thought by members to be important (see Appendix 6 ), the interpretation of findings and the content of the final report. SURG members have also been involved in the development and delivery of the stakeholder engagement workshops. In addition, a member of SURG was involved in interviewing and selecting research staff.

Patients and carers have attended workshops where emerging findings have been discussed and contributed to the interpretations of evidence and development of good practice guidance.

• Ethics and NHS permissions

We considered our project to be low risk (as it is not an intervention study and we were not recruiting patients unable to give informed consent for interviews). Therefore, on advice received from NHS ethics, we initially submitted via the proportionate review process. On their closer scrutiny, the project was deemed to involve risk as it involved the shadowing of front-line staff during patient visits, and the submission was, therefore, forwarded to the next full NHS ethics meeting. At this meeting, the proposal to include the shadowing of front-line staff was considered to be intrusive to patients. Moreover, the frailty of community nurse patients, some with fluctuating mental capacity to give informed consent for an observer to be present, led to the project then being referred to a specialist NHS Ethics Committee. Approval for the study was finally obtained in July 2014 (National Research Ethics Service Committee Yorkshire & The Humber – Leeds West 14/YH/1059). The process for shadowing front-line staff to observe documentation of quality data in the field (i.e. patients’ homes) required that nurses visiting patients a few days before the day of the observation visit took a study information sheet to patients in order to allow them to consider the nurses’ involvement in this aspect of the study. On the day of shadowing, the visiting nurse was consented to the study and went into the home alone to see the patient to ask if they would agree to a nurse researcher being present to observe their nurse for that visit. If they answered positively, the researcher was admitted. The researcher then obtained verbal permission from the patient to observe the nurse. Formal written consent to take part in the study was not required from patients themselves, as they were not study participants and no identifiable data were collected from or about them. We subsequently sought and received additional ethics permission to recruit patients to a focus group when we found that we were unable to recruit enough patients via front-line observation visits. These participants were recruited through the SURG.

We were unable to start NHS R&D permissions until we had identified potential case sites from the survey findings. Recruitment entailed initial contacts to both a community services provider and a commissioner from the local CCG, and approval to participate from both partners was required before an application for NHS permissions could be sought (this was sometimes a time-consuming process). Commissioning organisations were comparatively new and there were difficulties identifying the appropriate person within the organisation to give approval. Moreover, community nursing services provider organisations have a range of types (e.g. NHS community trust, combined acute and community organisations, independent or private), meaning that it was sometimes difficult to find the person who could take responsibility for signing up to the project. The NHS permissions process was lengthy and involved duplication and slight variation of requirements across the sites, where each application was considered separately. Owing to the multiplicity of data collection methods and range of participants in a mixed-methods study, there was a large amount of related paperwork for R&D departments to review. This created a lot of extra work for both the R&D departments and the research team. Overall, the administration involved in the permissions process was time-consuming for each organisation, and, on one occasion, having just achieved successful sign-off from R&D in one site, permission was suddenly withdrawn by the provider without explanation. One other case site took several months to obtain internal agreements, having initially expressed interest to the researcher, so we eventually withdrew and selected another site from the list in a similar area. We were eventually able to recruit and obtain permission for all 10 organisations constituting the five case sites, although we were late starting data collection in two sites.

• Deviation from the original protocol

Given the degree of organisational change and workforce pressures present during the course of this study, we were fortunate to have established good links with our case sites and to be allowed access to undertake data collection. However, the following small changes to the protocol had to be accepted.

The number of national and regional NHSE quality leads we interviewed was comparatively small. The interviews we conducted suggested that their strategic role with CCGs and current priorities tended towards the acute rather than the community sector and, although they were knowledgeable, their actual role in relation to quality process implementation in community settings appeared to be more limited. These interviews were, however, very useful for informing subsequent data collection in the case sites.

As explained earlier in this chapter, we took a pragmatic decision to alter our means of data collection for the national survey in response to the incompleteness of the CCG data available online at the time of the survey. We had planned to undertake an electronic survey, but the requisite e-mail addresses were not provided online owing to data protection, and the telephone numbers supplied usually went to a local administrative assistant who did not know to whom our enquiry should be directed. We were frequently asked to go through FOI channels to access the information we required, as these departments were set up to provide advice on a range of topics, so we used this as our main method of data collection. We also decided to focus our analysis on CQUIN data only for this part of the study, as only these data were provided in a form that was sufficiently comparable across organisations.

One case site did not allow us to shadow their front-line staff. As it had been hoped to recruit patients for interview from the shadowing exercise, this led to the provider organisation helping us with the identification of patients by offering us access to their local patient group, with limited success. There was considerable similarity in the findings from the four sites where front-line shadowing did take place, and evidence from the focus group of front-line staff that was held there confirmed that the same contextual pressures and views on quality measurement found in other sites pertained.

The supporting documentary analysis we had planned was constrained by the variation in the documents supplied to us by the case sites. We were able to compare CQUINs across the sites again, but, owing to the changes in the CQUIN schemes over time and current policy-drivers, the variation in what sites were doing nationally and locally had reduced. There may also have been some concerns in case sites at the potential sensitivity of documents being used.

• Cite this Page Horrocks S, Pollard K, Duncan L, et al. Measuring quality in community nursing: a mixed-methods study. Southampton (UK): NIHR Journals Library; 2018 Apr. (Health Services and Delivery Research, No. 6.18.) Chapter 2, Study objectives, design and methodology.
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• 2.1: Learning Objectives
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