Author: Anne McGrorty, MSN, RN, CPNP
Title: Assistant Professor
Institution: La Salle University
Coauthors: Kristine Ellis, MSN, RN
Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration
Skills or Simulation Laboratories
- Implement Joint Commission safety standards in the care of an acutely ill pediatric patient.
- Use situational, background, assessment, and recommendations (SBAR) during the patient transfer.
- Provide safe nursing care to the newly admitted pediatric patient with multiple health care needs.
- Demonstrate evidence-based safe care for the pediatric patient receiving IV therapy and medications.
- Calculate accurate medication doses based on the pediatric patient’s weight.
- Perform a systematic physical assessment on a simulated, acutely ill, pediatric patient.
- Differentiate developmentally appropriate and inappropriate responses to nursing care.
- Analyze pediatric laboratory values and their influence on patient care decisions.
- Demonstrate professional behaviors during the simulation.
- Recognize the importance of family-centered care.
- Demonstrate adherence to infection control standards when performing nursing care.
- Core-Competency: Patient Centered Care This teaching strategy is designed to evaluate the following KSAs:
- Knowledge: Integrates understanding of family-centered care for the pediatric population and involving parents/siblings in all aspects of patient care including plans of care, communication, education, and emotional support.
- Attitude: Encourages parental involvement in patient care Recognizes the need for emotional support of family members.
- Skills: Acknowledges family as a part of patient care and outcomes through effective communication and evaluation of parental involvement and knowledge of care.
- Core-Competency: Safety This teaching strategy is designed to evaluate the following KSAs:
- Knowledge: Describes the nurse’s role in providing safe, effective patient care and the impact of Joint Commission standards on nursing care.
- Attitude: Seeks to provide safe patient care and educate the patient and family about safety throughout the hospital stay.
- Skills: Implements Joint Commission standards of safe patient care through the use of medication reconciliation, communication, error reporting, patient identifiers, medication safe doses, abbreviations, SBAR technique during patient transfer, and the five rights of medication administration.
- Core Competency: Team and Collaboration This teaching strategy is designed to evaluate the following KSAs:
- Knowledge: Recognizes the importance of effective communication among different healthcare providers (nurse to nurse, nurse to physician).
- Attitude: Identifies the importance of effective communication with physicians and other members of the healthcare team to ensure patient safety and positive outcomes.
- Skills: Gives report for a patient using SBAR technique. Communicates safety threats to physicians who prescribed medication orders.
- Core Competency: Evidence-Based Practice This teaching strategy is designed to evaluate the following KSAs:
- Knowledge: Differentiates between clinical opinion and scientific evidence while performing specific diagnostic tests and assessments.
- Attitude: Values continuous improvement in the clinical setting.
- Skills: Identifies potential medical errors and possible conflicts with other health care providers.
This pediatric simulation and unfolding case study takes place in the Nursing Learning Resource Center and is scheduled early in the Nursing Care of Children and Adolescents course. It stands as an immersion day experience that is comprehensive and interactive. The simulation and unfolding case study is aimed at promoting creative and critical thinking. It specifies the learning objectives, equipment, and an unfolding case study of an ill infant. Students demonstrate skills using Sim-baby. Patient data are presented as the situation progresses. Questions are posed to encourage decision making.
The material for the Pediatric Simulation and Unfolding Case Study is included in the document found in File 1.
Anecdotal reports noted by students indicate that they enjoyed the first version of the Pediatric Simulation and Unfolding Case Study. The material presented here is a thorough revision of that teaching strategy.
Using Case Studies to Teach
Why Use Cases?
Many students are more inductive than deductive reasoners, which means that they learn better from examples than from logical development starting with basic principles. The use of case studies can therefore be a very effective classroom technique.
Case studies are have long been used in business schools, law schools, medical schools and the social sciences, but they can be used in any discipline when instructors want students to explore how what they have learned applies to real world situations. Cases come in many formats, from a simple “What would you do in this situation?” question to a detailed description of a situation with accompanying data to analyze. Whether to use a simple scenario-type case or a complex detailed one depends on your course objectives.
Most case assignments require students to answer an open-ended question or develop a solution to an open-ended problem with multiple potential solutions. Requirements can range from a one-paragraph answer to a fully developed group action plan, proposal or decision.
Common Case Elements
Most “full-blown” cases have these common elements:
- A decision-maker who is grappling with some question or problem that needs to be solved.
- A description of the problem’s context (a law, an industry, a family).
- Supporting data, which can range from data tables to links to URLs, quoted statements or testimony, supporting documents, images, video, or audio.
Case assignments can be done individually or in teams so that the students can brainstorm solutions and share the work load.
The following discussion of this topic incorporates material presented by Robb Dixon of the School of Management and Rob Schadt of the School of Public Health at CEIT workshops. Professor Dixon also provided some written comments that the discussion incorporates.
Advantages to the use of case studies in class
A major advantage of teaching with case studies is that the students are actively engaged in figuring out the principles by abstracting from the examples. This develops their skills in:
- Problem solving
- Analytical tools, quantitative and/or qualitative, depending on the case
- Decision making in complex situations
- Coping with ambiguities
Guidelines for using case studies in class
In the most straightforward application, the presentation of the case study establishes a framework for analysis. It is helpful if the statement of the case provides enough information for the students to figure out solutions and then to identify how to apply those solutions in other similar situations. Instructors may choose to use several cases so that students can identify both the similarities and differences among the cases.
Depending on the course objectives, the instructor may encourage students to follow a systematic approach to their analysis. For example:
- What is the issue?
- What is the goal of the analysis?
- What is the context of the problem?
- What key facts should be considered?
- What alternatives are available to the decision-maker?
- What would you recommend — and why?
An innovative approach to case analysis might be to have students role-play the part of the people involved in the case. This not only actively engages students, but forces them to really understand the perspectives of the case characters. Videos or even field trips showing the venue in which the case is situated can help students to visualize the situation that they need to analyze.
Case studies can be especially effective if they are paired with a reading assignment that introduces or explains a concept or analytical method that applies to the case. The amount of emphasis placed on the use of the reading during the case discussion depends on the complexity of the concept or method. If it is straightforward, the focus of the discussion can be placed on the use of the analytical results. If the method is more complex, the instructor may need to walk students through its application and the interpretation of the results.
Leading the Case Discussion and Evaluating Performance
Decision cases are more interesting than descriptive ones. In order to start the discussion in class, the instructor can start with an easy, noncontroversial question that all the students should be able to answer readily. However, some of the best case discussions start by forcing the students to take a stand. Some instructors will ask a student to do a formal “open” of the case, outlining his or her entire analysis. Others may choose to guide discussion with questions that move students from problem identification to solutions. A skilled instructor steers questions and discussion to keep the class on track and moving at a reasonable pace.
In order to motivate the students to complete the assignment before class as well as to stimulate attentiveness during the class, the instructor should grade the participation—quantity and especially quality—during the discussion of the case. This might be a simple check, check-plus, check-minus or zero. The instructor should involve as many students as possible. In order to engage all the students, the instructor can divide them into groups, give each group several minutes to discuss how to answer a question related to the case, and then ask a randomly selected person in each group to present the group’s answer and reasoning. Random selection can be accomplished through rolling of dice, shuffled index cards, each with one student’s name, a spinning wheel, etc.
Tips on the Penn State U. website: http://tlt.its.psu.edu/suggestions/cases/
If you are interested in using this technique in a science course, there is a good website on use of case studies in the sciences at the University of Buffalo.
Dunne, D. and Brooks, K. (2004) Teaching with Cases (Halifax, NS: Society for Teaching and Learning in Higher Education), ISBN 0-7703-8924-4 (Can be ordered at http://www.bookstore.uwo.ca/ at a cost of $15.00)