Running head: CASE STUDIES IN NURSING EDUCATION

Case Studies in Nursing Education

Makaela Giannini

Youngstown State University

NURS 4832L

December 2021
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Case Studies in Nursing Education

Fostering critical thinking skills and clinical judgment is an essential component of

nursing education. According to Papathanasiou, Kleisiaris, Fradelos, Kakou, and Kourkouta

(2014), “critical thinking is defined as the mental process of actively and skillfully perception,

analysis, synthesis, and evaluation of collected information through observation, experience and

communication that leads to a decision for action” (pg. 283). Developing and eventually refining

critical thinking skills allows nurses to assess accordingly, dissect findings, make decisions,

prioritize, and problem-solve. Clinical judgment, on the other hand, is a decision formed based

upon nursing knowledge, objective and subjective data, detailed assessments, and attention to the

patient’s complaints. Clinical reasoning is the rationale for the clinical judgment decisions; it is

usually based upon evidence-based practice, patient status, assessment findings, and nursing

knowledge.

Although critical thinking skills and clinical judgment are best developed through hands-

on patient care, they should be developed through a variety of learning tools to foster a well-

rounded, integrative education. Educational activities that engage students in a challenging

manner will aid in the development of needed nursing skills. Additionally, preparation for entry

into professional nursing practice is enhanced using these educational tools. Unfolding nursing

case studies is one method that has proven to successfully simulate real-life clinical scenarios.

These scenarios are based upon situations the nursing students could possibly encounter in future

clinical practice. This improves their ability to respond appropriately based upon their

knowledge from the case study. Unfolding case studies provide an alternative teaching strategy

to ultimately enhance learning and engage students.

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What is a Case Study?

A case study is a tool used in education to build necessary skills. Beale and Twycross

(2017) defined case studies 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” (pg. 7). Case studies may be based upon “an individual patient or a practice

situation or [an] approach that illuminates much wider practice issues and concerns” (Price,

2017, pg. 35).

In nursing case studies, complex clinical situations are explained using relevant context

and details. The writer can also include information such as patient preferences, values, and

beliefs to integrate the psychosocial, emotional, and developmental aspects of nursing care. The

case study can be tailored to meet student learning objectives and promote certain skills or

knowledge. The writer then asks a series of questions based upon principles of patient-centered

care, safety, and the nursing process.

Purpose of Case Studies in Nursing Education

Case studies are incorporated into nursing education to provide necessary nursing skills.

Evidence-based studies supports the use of unfolding case studies in nursing education to ensure

quality patient care; using case studies as a developmental tool allows nursing students to delve

deeper and build an understanding of nursing scenarios, promoting improved patient outcomes

and experiences.

Parallels the Nursing Process

Nursing education specifically utilizes unfolding case studies, meaning the case studies

are written in increments, mirroring the process of actual nursing practice. These step-by-step

scenarios pose open-ended questions for readers to answer throughout the case. The author
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creates these questions are based upon patient care, nursing interventions, safety, prioritization,

and other essential skills. This simulates the process of professional nursing care and aids

students’ development of critical thinking skills and clinical judgment. These studies are written

to follow the nursing process, making unfolding case studies one of the most realistic teaching

strategies that can be used to foster nursing knowledge. They ultimately provide a medium to

improve patient care and ensure optimal outcomes in a consistent and systemic manner, without

practicing on actual patients.

Simulation of Clinical Scenarios

Students are given a case study containing a patient’s medical history, complaints,

symptoms, and other data relevant to the nursing process. As students gain experience, patient

information such as psychosocial history, financial status, emotional wellbeing, and overall

values can also be added to create a more realistic nursing scenario. The students follow along as

the case study unfolds with a series of questions. The goal for nursing students is to accurately

assess, diagnose, and provide appropriate nursing interventions for the patient. It should be

considered that in practice, diagnosis is not within the nurse’s scope of practice; however, nurses

are still expected to recognize signs and symptoms of disease and medical conditions to advocate

for patients and ultimately improve patient outcomes.

Identify Areas of Strengths and Weaknesses

Following completion of the case study, nursing instructors spend time debriefing the

scenario with students. During this step, nursing students are asked to identify gaps in

knowledge, evaluate their success, discuss what was learned, and explore how this scenario will

improve the care of their future patients. This opportunity allows students to reflect upon their

ability to adequately provide nursing care and predict future patient needs or complications. This
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refines clinical judgment, facilitates the growth of critical thinking skills, and encourages

students to identify aspects of the case they were successful in and areas that needed

improvement. As students experience more case studies, they begin to understand the power of

forethought to prevent poor patient outcomes.

Writing a Case Study

Case studies should always include context, a description of the case, and evidence

pertinent to the case. If the case is based upon a true patient scenario, they can also include a

component discussing issues and insight related to the case. Providing adequate information is

essential to successfully facilitating the learning process provided through case studies. As

previously stated, nursing utilizes unfolding case study scenarios, meaning the information is

provided in staggered amounts, with intermittent questions.

Context

Context is important to case studies because “the circumstances in which care was

delivered has a fundamental influence on the care itself” (Price, 2017, pg. 38). Background

information such as the patient’s gender, age, and location of the incident are essential to include.

Additionally, the setting of the scenario, the circumstances, and conditions should be included.

These factors contribute small details that may seem to be unrelated to nursing, but they greatly

influence patient care and outcomes.

Description

Case studies should provide “detail [on] the patient, the patient’s perceived needs, and

how the nurse and others responded” (Price, 2017, pg. 39). Laboratory values, providers orders,

assessment data, vital signs, and other information that is relevant to the case should be included.
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Additionally, both subjective and objective data should be discussed to accurately simulate a

patient scenario.

Evidence

When students are debriefing the case study, educators should initiate discussion

regarding the reasoning behind their answers; this rationale is known as clinical reasoning.

Because open-ended questions are utilized in unfolding case studies, this is a great method to aid

development of clinical reasoning based upon what evidence-based practice the students have

learned.

Conclusion

In summary, case studies have proven to be a successful method in promoting

development of nursing students, critical thinking skills for all staff and consistent patient care to

all patients. Evidence-based practice has proven the overall impact case studies have had on

development of nursing skills and can provide improved patient outcomes overall. By utilizing

completion of unfolding case studies, nursing programs can effectively foster necessary

independence, critical thinking skills, and clinical judgment.

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References

Heale, R., & Twycross, A. (2018). What is a case study? Evidence Based Nursing, 21(1), 7–8.

https://doi.org/10.1136/eb-2017-102845

Hristova, T., Todorova, T., & Markova, M. (2021). Using case study method for forming clinical

thinking ability in nursing and Midwifery Education. TEM Journal, 10(1), 471–475.

https://doi.org/10.18421/tem101-59

Papathanasiou, I., Kleisiaris, C., Fradelos, E., Kakou, K., & Kourkouta, L. (2014). Critical

thinking: The development of an essential skill for nursing students. Acta Informatica

Medica, 22(4), 283–286. https://doi.org/10.5455/aim.2014.22.283-286

Price, B. (2017). How to write a reflective practice case study. Primary Health Care, 27(9), 35–

42. https://doi.org/10.7748/phc.2017.e1328
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Reye’s Syndrome Case Study

A 9-year-old female was last seen by the Emergency Department 4 days ago for complaints of a

sore throat and low-grade fever. She was diagnosed with a viral infection and her mother was

instructed to provide supportive care with acetaminophen, fluids, and popsicles. Today the

patient presents to the Emergency Department accompanied by her mother with complaints of

persistent vomiting. The vomiting began 24 hours ago, occurs multiple times an hour, and has

progressively worsened since it began. The mother states that the patient has been unusually

lethargic, and her behavior has been “different” since the vomiting began.

1. What is the most important actions for the nurse to take?

 Ensure patient is on side (risk of aspiration)

 Ensure patent airway

 Vitals

The patient is now turned on her side to prevent aspiration. All vitals were within normal limits

besides a slightly elevated temperature of 100.2 F. The last time the patient vomited was 15

minutes ago. The vomit was green and small in amount (65cc).

2. What assessments should the nurse prioritize?

 Focused abdominal, neuro assessments

 General head to toe assessment

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The abdomen was flat, symmetric, and non-distended, with active bowel sounds in all 4

quadrants. No guarding or tenderness noted. The patient is A&Ox4. Patient is lethargic and

wants to sleep. Speech and memory are intact. Bilateral sensation intact. Good muscle tone and

5+ strength. PERRLA, pupils 2+ bilaterally. Respirations are even, unlabored, with no

adventitious sounds. Capillary refill is < 3 seconds. S1, S2 auscultated.

3. What should the nurse expect providers to order at this time?

 Peripheral IV

 Labs

 POCT glucose

 Ondansetron

 Acetaminophen

4. What labs do you expect providers to order?

 CBC, CMP, PT/aPTT, ammonia, salicylates

The patient’s peripheral IV has been inserted successfully. She reports a decrease in nausea and

has not vomited following administration of ondansetron. Her temperature is 100.0 F after

receiving acetaminophen. She is resting with her eyes closed. Her labs show elevated WBCs,

elevated ammonia levels, and elevated liver enzymes. The patient’s glucose was also slightly

low, her PT/aPTT was prolonged, and she was positive for salicylates.

5. What questions should the nurse ask the mother at this time?
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 Did you give the patient any medication for her pain or fever after her last

hospital discharge?

The mother states that she did not have acetaminophen at home, so she gave her daughter aspirin

for the sore throat and fever.

6. What should the nurse suspect at this time?

 Reye’s Syndrome d/t positive salicylates (aspirin), elevated ammonia, elevated

liver enzymes, vomiting & lethargy

7. What does the nurse expect the child’s plan of care to include?

 ICU admission

 Continuous pulse ox & cardiopulmonary monitoring

 Frequent vitals

 Monitor ICP à elevated HOB to decrease pressure

 Monitor neuro, resp, & cardiac status

 Seizure precautions

 Strict I&O

 Monitor labs, glucose

 Medication administration (ondansetron for nausea, diuretics for excess fluid,

corticosteroids to reduce brain swelling, acetaminophen for fever)

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