maternal child nursing case study

Nursing Case Study for Maternal Newborn

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Luisa, 25 years old, is a 37-week pregnant patient who presents to triage with abdominal and back pain. She says she thinks she is in labor because her contractions are regular and about 10 minutes apart. Her electronic health record indicates she is G3 P1 A1 and she is followed by a local obstetrics and gynecology office. She states she thinks she may be in labor but “has not seen any fluid.”

What does G3P1A1 mean in regard to this patient?

• Gravida 3 (number of pregnancies), P 1 (number of live or stillbirths) A 1 (number of abortions [induced] or fetal demises before 20 weeks’ gestation). So, Luisa could have 3 pregnancies and no live children (due to stillbirth) or 1 live child. She may have had an abortion or a miscarriage. Note: if A is 0 it may be omitted.

What does the triage nurse understand labor to be in a pregnant woman?

• Labor is defined as regular and painful uterine contractions that cause progressive dilation and effacement of the cervix. Normal labor results in descent and eventual expulsion of the fetus. Interpreting labor progress depends on the stage and phase:
• First stage: The time from onset of labor (i.e., when contractions started to occur regularly every three to five minutes for more than an hour) to complete cervical dilation (noted when first identified on physical examination)
• Phases: The first stage consists of a latent phase and an active phase. The latent phase is characterized by gradual cervical change, and the active phase is characterized by more rapid cervical change.
• Second stage: The time from complete cervical dilation to fetal expulsion.
• Third stage: The time between fetal expulsion and placental expulsion.
• Lack of fluid indicates that the rupture of the membranes (amniotic sac) has not occurred yet

Vital signs are as follows: BP 150/94 mmHg SpO2 98% on room air HR 91 bpm and regular Pain 2/10 at rest, 8/10 when she reports a contraction RR 12 bpm at rest, 24 bpm when she reports what she thinks is a contraction Temp 36.8°C

Which vital sign is most concerning to the nurse? What should they do regarding this vital sign?

• This blood pressure may indicate pre-eclampsia (“Preeclampsia refers to the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria after 20 weeks of gestation or postpartum in a previously normotensive woman”).
• (Hypertension denotes a rise in systolic blood pressure of 30 mmHg or more and a rise in diastolic blood pressure of 15 mmHg or more from baseline)
• The end-organ dysfunction is evaluated by looking at certain criteria: proteinuria, platelet count, serum creatinine, liver transaminases, pulmonary edema, new-onset and persistent headache unresponsive to analgesics, visual symptoms.”

The nurse decides to take the patient’s blood pressure manually which gives a reading of 130/82. Therefore, the patient is admitted to the labor and delivery unit.

SBAR report is given and Luisa’s admission for labor is started. She is placed in a convertible birthing bed with a fetal monitor attached to her abdomen.

What is the monitor called? What is it for?

•  “Tocodynamometry provides contraction frequency and approximate duration of labor contractions” and measures both fetal heart rate and maternal contractions. It is placed externally to watch both mother and baby as labor progresses.” There are also internal devices that can be placed on the fetus within the mother to monitor fetal heart rate.

Luisa progresses through an uneventful labor with her significant other at the bedside. She does not want any pain control and eventually delivers her newborn son, to be named after his father, Santiago.

At the time of birth, how would staff evaluate Santiago?

• “Staff asks three questions. The answers are used to determine whether the newborn is admitted to the normal nursery (neonatal level of care 1) or requires a higher level of care (neonatal level of care 2, 3, or 4)
• Is the newborn’s GA ≥35 weeks?
• Does the newborn have good muscle tone?
• Is the newborn breathing or crying?”

They determine Santiago is healthy enough to be placed on his mother’s chest to promote bonding and encourage breastfeeding. The staff takes him from his mother after a few minutes and she asks why.

What are staff doing when they remove Santiago at 5 minutes old?

• Checking an Apgar score (“Apgar score — The Apgar scores at one and five minutes of age provide an accepted, universally used method to assess the status of the newborn infant immediately after birth. Although data from a population-based study reported that lower Apgar scores of 7, 8, and 9 versus 10 were associated with higher neonatal mortality and morbidity, the Apgar score should not be used to predict individual neonatal outcomes as it is not an accurate prognostic tool The following signs are given values of 0, 1, or 2, and added to compute the Apgar score. Scores may be determined using the Apgar score calculator.
• Respiratory effort
• Muscle tone
• Reflex irritability
• Approximately 90 percent of neonates have Apgar scores of 7 to 10 and generally require no further intervention. These neonates usually have all of the following characteristics and can be admitted to the level 1 newborn nursery for routine care:
• Gestational age (GA) ≥35 weeks
• Spontaneous breathing or crying
• Good muscle tone
• Also, they record length, weight, head and chest circumference.

Santiago weighs 3550 grams and is 50.6 cm long. Luisa and Santiago, Sr. ask what that is in pounds and inches so they can tell family and post on social media.

How does the staff respond to this?

• A size chart may be available for staff to convert from metric to English measure and electronic health records may convert these values. But it is key that nursing staff knows how to convert mathematically.
• 50.6 cm/2.54cm per in = 19.9 inches (long)
• 3550 gm x .0022 gm/lb = 7.8 lbs or 7 lbs 12.8 oz. Alternatively, the nurse can convert gm to kg (3550 gm = 3.55 kg) then 3.55 kg x 2.2 lb/kg = 7.8 lbs (the 10th place is multiplied by 16 oz to convert to ounces i.e., 0.8 x 16 = 12.8)

Luisa and Santiago (referred to as a “mother-baby couplet”) are moved from the labor & delivery unit to the postpartum care unit as per protocol. The staff takes the newborn to the nursery for an evaluation. Luisa wants to know what they are looking for and if her son is healthy.

How should the nurse respond?

• Staff frequently (per protocol) assess a postpartum mother for possible complications. A good acronym for this assessment is BUBBLE which is essentially a focused head-to-toe (working from top to bottom) assessment.
• B – breasts (tenderness, size, shape, etc.) U – uterus (is it firm, boggy? This is done by feeling the fundus and massaging if necessary. This is to help assess for a serious postpartum complication – maternal hemorrhage) B – bladder (is mom voiding? Is there distension or difficulty urinating? This is also a good time to discuss self-peri-care) B – bowel (is mom constipated? She may need a stool softener to ease discomfort) L – lochia (quality, quantity of postpartum bleeding). You could also add an “L” for legs to check for swelling, Homan’s sign, etc. E – episiotomy (if this was done, it should be assessed for bleeding or hematoma. Use the REEDA acronym to remember what to look for {Redness, edema, ecchymosis, discharge, approximation)

While the infant is being evaluated in the nursery, postpartum staff come in and assess Luisa. She wants to know why they keep feeling her abdomen and asking her about bleeding. She says, “I thought everything went OK. Why are you always checking on me?”

What is the best answer for Luisa?

• “By pressing on your abdomen, we are assessing your fundus to ensure that the uterine muscle is properly contracting, which prevents bleeding. Similarly, we are evaluating how much you are bleeding to verify that there are no complications after delivering your baby.”

The mother-baby couplet is set to be discharged home after a few days. It turns out that Luisa has no living children as her first pregnancy ended in stillbirth and her second was a miscarriage. She holds Santiago and is tearful as staff prepares to educate her for going home. She says, “I am so afraid I will hurt him or not do stuff right. Why do I keep crying? This is overwhelming.”

Should the nurse address this? What may help the transition from a postpartum unit to home?

• Explain that hormonal changes (for mother) are to be expected at this time but reassure her that discharge criteria have been met. Maybe explain, “In the United States, because of concerns that early discharge could adversely affect maternal and infant health outcomes, both state and federal governments passed postpartum discharge laws in the late 1990s (Newborns’ and Mothers’ Health Protection Act [NMHPA]) to prevent extremely short hospital stays. In general, these laws require insurance plans to cover postpartum stays of up to 48 hours for infants born by vaginal deliveries (96 for c-sections). The impact of legislation ensuring insurance coverage for a minimum of 48 hours has increased the LOHS of newborn infants and their mothers and appears to have decreased neonatal readmission rates and emergency department visits.” Also, providing resources for education and follow-up will help ease anxiety. Always be prepared with whatever resources the facility and/or OB/GYN practice provides. There may be support numbers or websites available and those should be provided to the mother as appropriate.

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View the full transcript, nursing case studies.

This nursing case study course is designed to help nursing students build critical thinking.  Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process.  To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy  to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs.  If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding.  In the end, that is what nursing case studies are all about – growing in your clinical judgement.

Nursing Case Studies Introduction

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Respiratory nursing case studies.

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Maternal-Child Nursing Test Success : an Unfolding Case Study Review

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• MATERNAL-CHILD NURSING TEST SUCCESS: AN UNFOLDING CASE STUDY REVIEW; Half Title Page; Authors' Page; Title Page; Copyright; Dedication; Contents; Preface; Acknowledgments; Half Title Page;
• Chapter 1: NCLEX-RN®: Preparation Tips and How We Really Feel; A Guide FOR Students BY Students; What We Like to Call Our "Introduction"; Study Skills and Habits; Preparing for NCLEX-RN®; YOUR PLAN: Two to Three Months Before the Exam; Four to Six Weeks Before the Exam; One Week Before the Exam; Anchors and Lifesavers; Leading Up to Test Day; Test Day; References;
• Chapter 2: Newborn Nursing Care.
• Case Study 1 Jasmine and RiverAnswers;
• Chapter 3: Postpartum Care; Case Study 2 Jolene; Case Study 3 Paula; Answers;
• Chapter 4: Infertility, Preconception, Conception, and Preterm Labor; Case Study 4 Isabella and Christopher; Answers; Reference;
• Chapter 5: Hyperemesis Gravidarum (HG); Case Study 5 Tamiko; Answers;
• Chapter 6: Sexually Transmitted Infections; Case Study 6 Sonia; Answers;
• Chapter 7: Labor and Delivery; Case Study 7 Karen; Answers;
• Chapter 8: First Trimester Bleeding and Previa; Case 8 Chelsea; Answers;
• Chapter 9: Ectopic Pregnancy; Case Study 9 Bonita; Answers.
• Chapter 10: Hydatidiform Mole (Gestational Trophoblastic Disease or GTD)Case Study 10 Lauren; Answers;
• Chapter 11: Incompetent Cervix, Abruption, and DIC; Case Study 1 Lillian; Answers;
• Chapter 12: Gestational Hypertension and HELLP; Case 12 La-Neisha; Answers; Reference;
• Chapter 13: Gestational Diabetes (GD); Case Study 13 Margaret; Answers;
• Chapter 14: ABO Incompatibility; Case Study 14 Regina; Answers;
• Chapter 15: Rupture of the Membranes (ROM); Case 15 Savannah; Answers;
• Chapter 16: Preterm Labor (PTL); Case 16 Bonnie; Answers;
• Chapter 17: Cardiac Disease; Case Study 17 Maggie; Answers.
• Chapter 18: AsthmaCase Study 18 Rachel; Answers;
• Chapter 19: Sickle Cell Anemia; Case Study 19 Maria; Answers;
• Chapter 20: Human Immunodeficiency Virus (HIV); Case Study 20 Kendall; Answers;
• Chapter 21: Preterm Infant Care; Case Study 21 Preterm Multiples; Answers; References;
• Chapter 22: Retinopathy of Prematurity and Bronchopulmonary Dysplasia (BPD); Case Study 22 Robert; Answers;
• Chapter 23: Anemia and Polycythemia; Case Study 23 Twin-to-Twin Transfusion Syndrome (TTTS); Answers;
• Chapter 24: Transient Tachypnea of the Newborn (TTN); Case Study 24 Aaron; Answers.
• Chapter 25: Meconium Aspiration Syndrome (MAS)Case Study 25 Benjamin; Answers;
• Chapter 26: Periventricular-Interventicular Hemorrhage; Case Study 26 Jason; Answers;
• Chapter 27: Neonatal Abstinence Syndrome (NAS); Case Study 27 Michael; Answers;
• Chapter 28: Inborn Errors of Metabolism; Case Study 28 Frances; Answers; References; Index.

Sara’s Case Study: Maternal and Child Nursing

The case study.

An indigenous child, Sara aged four, has been admitted after fainting at the Early Childhood Centre (ECC) she attends for three hours, in the morning. She spends the afternoon in the crèche adjacent to the ECC. The child’s aunty comes to the clinic some hours after Sara’s admission and tells you that Sara is always difficult, and naughty, and is probably fainting for attention. Sara weighs 8.5kgs, height is 92 cm, her baby teeth are complete but have some cavities, and she is toilet trained. She was breast fed until her mother left home when Sara was four months old, and was then bottle fed. Her immunizations are incomplete.

Her teacher states that Sara has not eaten much today, and is not interacting well with the other children. On examination, Sara is slightly dirty, her hair is dry, dull and unkempt but she is dressed appropriately for the season. Her skin turgor is poor and there is evidence of pallor around the mouth and fingernails. Her pulse is thready and 120BPM, her temperature is 37.5 degrees Celsius and she has a history of low-grade fever, lack of appetite, myalgia and headache. Sara had scabies about six weeks ago, which was not treated.

Immediate Nursing Care Required by Sara

Sara’s immediate nursing care is multifaceted. First and foremost, she needs medical care for the scabies she suffered from six months ago and for which she was not treated. This would protect her from secondary infections and complications. Second, Sara needs nursing care to enhance her physical health. Her numerous symptoms such as fainting spells, under weight, poor skin turgor, poor appetite, myalgia, headache, cavities and history of fever are all manifestations of a health condition.

A thorough examination should thus be performed on her to establish the cause for the symptoms and appropriate medical measure should be taken to rectify her problem. Third, Sara is in dire need of the vaccinations she missed. The vaccinations will improve her immune system and protect her from serious incapacitating illnesses such as polio which can easily be prevented by vaccinations.

Psychological Nursing Care Required by Sara

The psychological growth and development of a child begins at home through attachment and bonding with his/her immediate family members. The first role model for any child is normally the mother. This process starts when the child is conceived and is strengthened through breastfeeding. The child later becomes attached to the other family members including the father and siblings. It is important to note that the type of relationship the family develops with the child affects the type of relationship the child will have with other members of the community including his/her peers. A child who grows up in a warm and secure family environment is more likely to grow into a happy and secure adult with high self-esteem.

On the other hand, a child who grows up in a family environment that is full of conflicts and violence is more likely to become a violent adult. Indeed, many of the social problems experienced in the society such as violence, substance abuse and psychological illnesses such as depression have a foundation in poor psychological growth of children (Luby, 2006, p. 6).

In the case of Sara, her poor psychological growth is manifested through her inability to cope with her peers, naughtiness and difficult to handle. The reason for this is obvious. Sara was only able to spend her first four months with her mother who later abandoned her. As a result, Sara did not have the opportunity to experience attachment and bonding with her mother. Since then she has been living with her relatives who seem to lack adequate time and attention for her. Therefore, Sara does not know what it means to grow up in a warm and secure environment. The nurse in charge of Sara can help her by involving her relatives in creating a warm and secure environment for Sara to grow up in. this would go a long way in addressing her psychosocial problems and in enhancing her psychological growth (Zeanah, 2009).

Social Nursing Care Required by Sara

By the time a child enters kindergarten he/she ought to have developed a vita set of social skills that will assist him to have healthy experiences in the school environment as well as in future. The social skills encompass cooperation, sharing, kindness, generosity, display of affection, conversation, expression of feelings, being helpful to others and making friends. Children at this age display strong emotions and tend to have mood swings. The children have a vivid imagination as well as real fears. At this age, children should have learned to control their feelings and should be in a position to name them instead of acting on them.

It is an age during which the development of identity is crucial in that they are able to recognize that they are boys or girls and the family, community or culture they belong to. It is thus important for parents to encourage and assist the children to develop the social and emotional skills that are useful for their children. Such children thrive on one-to-one communication with a parent. Such interactive communications help the children to learn how to express their feelings and ideas. Moreover, the communication nurtures not only emotional and moral growth in the children but also self-esteem and cognitive development (Zeanah, 2009).

Preschool children also have real fears as a result of their vivid imaginations. These fears may lead to numerous emotions and therefore parents ought to confirm the feeling or emotion and then hold a discussion with child about the options available for addressing the emotion (Ricci & Kyle, 2008, p. 836). In the case of Sara, the development of such crucial social skills may be hindered by several reasons. The chief reason is the fact that she lives with her relatives rather than her biological parents. Sara’s relatives may lack adequate time and affection to nurture Sara’s social skills. There may be lack of intensive interpersonal communication between Sara and her guardians which is manifested by the assertion made by her aunt that Sara is always difficult, naughty and striving for attention.

Children at this age also need to interact with friends. Learning how to make and keep a friend is a crucial part of social development. Friends may be in the child’s neighbourhood or in the child’s day care centre. Having friends not only helps a child develop social skills but also skills in solving conflicts because conflicts will inevitable occur. A child’s social flexibility is also manifested by this age. A child who is adaptable is able to deal with external stimuli pretty well rather than avoid it. When parents are aware of the children’s task orientation, social flexibility and reactivity, they are in a better position to help the children develop effective social and emotional skills (Ricci & Kyle, 2008, p. 836).

Sara’s inability to interact well with her peers is as a result of poor social skills. The nurse in charge of Sara should discuss with Sara’s guardians about the importance of nurturing crucial social and emotional skills in Sara which would help her in the future. This would entail holding numerous teaching and counselling sessions with Sara’s guardians and encouraging them to pay attention to her and treat her as if she were their own biological child. The social skills Sara learns at home will help her in having healthy and useful interactions with her peers at the day care centre.

Physical Nursing Care Required by Sara

Sara has several manifestations of poor physical health. One of these manifestations is the scabies she suffered from six months ago and which was left untreated. Scabies originates from itch mites that impregnate in the epidermis. Scabies often lead to secondary infections due to the scratching of the lesions. Sara can be treated using medications such as oral antihistamines. It is important to note that the compliance of the patient with the medications is important in preventing the transmission of the scabies to other members of the family. But since Sara is a young child, the compliance with the medications is the responsibility of her guardians. The nurse in charge of Sara should also be in a position to identify signs and symptoms that indicate potential secondary infections (White, 2004, p. 1665).

The most effective nursing care for the scabies involves a holistic health promotion and management strategy which promotes healing, teaching, prevention of secondary infections, and prevention of further transmission of the condition. The nurses should teach the patient and her guardians the infectious nature of scabies and that it is transmitted through close contact not only with the contaminated patient but also through sharing of personal items such as combs towels and beddings with the infected patient.

The patient and her guardians should also be taught how to identify the signs and symptoms of secondary infections related to scabies and to seek medical attention immediately. Most importantly, the nurses should educate the family on how to prevent secondary infections through maintenance of hygiene, isolation, disinfection and sterilization of rooms and personal items (Billings, 2008, p. 192).

Sara’s poor physical health is also manifested by the other symptoms such as low weight. Normal and healthy children who are in the same age bracket with Sara weigh between 13.6 to 15.6 kg and are 70 to 91 cm tall (Rosdahl & Kowalski, 2007, p. 104). This, couple with other symptoms such as lack of appetite, dry and dull hair, poor skin turgor, pallor around the mouth and fingernails, thready pulse, 120BPM, high temperatures, history of low-grade fever, myalgia and headache show that there is something physically wrong with Sara and she could be suffering from a serious illness. The evaluation of Sara’s physical health is thus important to determine what could be wrong with her.

This would require the nurse to obtain Sara’s health history and to carry out physical and development assessment. However, since Sara is a young child, this achievement would necessitate cooperation from her guardians. In assessing Sara’s weight and height, caution should be taken because she is an indigenous child and her physical structure may thus not conform to the standards which are usually based on Caucasian children (Littleton & Engebretson, 2002).

The nurse should also evaluate Sara’s general appearance, for instance, does she generally appear to be happy and content with life or does she seem sad and withdrawn? Such signs are crucial because they symbolize a deeper problem than it appears. For instance, Sara looks dirty and her hair is unkempt. This may mean that she does not receive proper and adequate care and attention at home. This is a great possibility because she does not live with her mother and instead lives with her extended family members who may not provide her with adequate attention because of the lack of maternal love. The nurse should thus engage Sara’s relatives in the care of Sara by encouraging and advising them on the importance of giving adequate care to Sara (Pillitteri, 2009, p. 863).

One of the most important physical nursing care needs of pre-schoolers like Sara is nutrition. The general appearances of Sara such as dry and dull hair and poor skin turgor are manifestations of poor nutrition. This situation is worsened by the fact that Sara did not receive exclusive breastfeeding for six months because her mother abandoned her at the age of four months. Exclusive breastfeeding of a child for six months is important for the growth, development and general health of a child. To make up for this and to improve Sara’s health, the nurse should advise Sara’s guardians on improving her nutrition through diet and supplements where necessary (Stanfield & Hui, 2009, p. 140).

Pre-schoolers like Sara are not old enough to differentiate between good and bad nutrition. Moreover, at this stage, children are good at imitating what others are doing including what others are eating at home. It is thus the responsibility of her guardians to ensure that Sara gets the appropriate nutrition by changing their diet and eating habits for her sake. Because children at the age of four have great needs for calories (due to their energetic nature), Sara should be fed on foods that will meet her caloric needs. The nurse in charge of Sara should discuss her nutritional needs not only with her guardians but also the day care centre which Sara attends during the day.

Sara’s physical health condition is also poor because she has not received all the immunizations a child is supposed to receive. As a result, she is at high risk of infections and grave illnesses which can easily be avoided by vaccinations. The nurse should therefore ensure that Sara gets the vaccinations she missed so as to protect her from serious illnesses. The nurse should also take into consideration Sara’s dental cavities. Just because her primary teeth will fall out someday does not mean that she should not receive dental care. If not treated, the cavities will go on to affect her permanent teeth. The nurse should therefore ensure that Sara receives dental care and that her guardians are part of this care by limiting her access to sweet things and providing her with nutritious foods (Lyebote, 1990, p. 44).

Planning for Sara’s Discharge and the Support Required by Her Extended Family

Planning for the child’s discharge and care at home begins early in the hospital setting. Nurses and other health team members must assess the levels of understanding of the child and family and their abilities to learn about the child’s condition and the care necessary after the child goes home. Giving medications, using special equipment, and enforcing necessary restrictions must be discussed with the person who will be the primary caregiver and with one other person, if possible.

It is necessary to provider specific, written instructions for reference at home. The nurse must be certain that the caregiver can understand the written materials too. If the treatment necessary at home appears too complex for the caregiver to manage, it may be helpful to arrange for a visiting nurse to assist for a period after the child is sent home (Jones & Jones, 2004).

Shortly before the child is discharged, a conference may be arranged to review information and procedures with which the family caregivers must become familiar. Questions and concerns must be dealt with honestly, and a resource such as a telephone number the caregiver can call should be offered for questions that arise after discharge. The return home may ne a difficult period of adjustment for the entire family. The preschool child may be aloof at first, followed by a period of clinging, demanding behaviour. The family may be advised to encourage positive behaviour and avoid making the child the centre of attention because of the illness. Discipline should be firm, loving, and consistent. The child may express feelings verbally or in play activities. The family may be reassured that this is not unusual (Hatfield, 2007, p. 70).

Summary and Conclusion

Sara is a 4-year-old girl from an indigenous community. She is an epitome of a child with poor physical, social and psychological growth and development. This is mainly due to the fact that her mother left her at the tender age of four months and is now being taken care of by her relatives. Sara’s poor physical health is a result of the lack of adequate exclusive breastfeeding and incomplete immunizations. She portrays a child with poor social skills through her inability to interact well with her peers at the day care centre.

This may result from the experience she is having at home. Without adequate time and attention, Sara’s relatives have failed to provide her with an environment that nurtures, stimulates and develops her social skills. This is evident from her aunt’s seemingly obvious irritation with her fainting spells claiming that Sara is only looking for attention. As a young child, Sara lacked the opportunity to become attached to and bond with her mother because her mother left her at the age of four months.

This experience, together with the lack of a caring and loving environment at home, has affected her psychological growth and development. Sara is thus vulnerable to psychological disorder if no action will be taken soon. The nursing care provided to Sara should thus be holistic by addressing her physical, social, and psychological well-being. Moreover, it should involve her guardians so as to ensure that it is a continuous and life-long process.

Reference List

Billings, D., 2008. Lippincott’s Content Review for NCLEX-RN. New York: Lippincott Williams & Wilkins.

Hatfield, N., 2007. Broadribb’s Introductory Paediatric Nursing. New York: Lippincott Williams & Wilkins.

Jones, S. & Jones, M., 2004. Great expectations: your all-in-one response for pregnancy and childbirth. London: Sterling Publisher Company.

Littleton, L. & Engebretson, J., 2002. Maternal, neonatal, and women’s health nursing . Thousand Oaks, CA: Cengage Learning.

Luby, J., 2006. Handbook of preschool mental health: development, disorders, and treatment. Spring Street, NY: Guilford Press.

Lyebote, F., 1990. A Guide to School Certificate ENGLISH. New York: Barnes & Noble.

Pillitteri, A., 2009. Maternal and child health nursing: Care of the childbearing and childrearing family. 6 th ed. New York: Lippincott Williams & Wilkins.

Ricci, S. & Kyle, T., 2008. Maternity and Paediatric Nursing . New York: Lippincott Williams & Wilkins.

Rosdahl, C. & Kowalski, M., 2007. Textbook of basic nursing. New York: Lippincott Williams & Wilkins.

Stanfield, P. & Hui, Y., 2009. Nutrition and Diet Therapy: Self-Instructional Approaches. Chicago: Jones & Bartlett Learning.

White, L., 2004. Foundations of Nursing . Thousand Oaks, CA: Cengage Learning.

Zeanah, C., 2009. Handbook of infant mental health . Spring Street, NY: Guilford Press.

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Based on a philosophy of active learning, this innovative and refreshing study aid is designed to help students learn the fundamentals of maternal-child nursing through unfolding case studies. Nursing content is woven into vivid case vignettes that evolve over time, thus engaging students and helping them develop critical thinking and clinical decision-making skills. The text also serves as a comprehensive workbook for students preparing for the NCLEX-RN®. It is the only maternal-child nursing review text to integrate content with practice and professional responsibilities to foster an engrossing real-world learning experience.

The case vignettes are based on actual cases and incorporate all core content topics (assessment, planning, intervention, and evaluation of patient care) for maternal-child nursing and NCLEX-RN® success. The book includes multiple choice, matching, true/false and calculation questions, each related to the unfolding clinical situation. Exercise answers with rationale appear at the end of each chapter. References at the end of the book facilitate self-remediation. Nurse-educators will also find this resource helpful for simulation experiences, classroom cases, group projects, and clinical conferences.

• Reviews maternal-child nursing core content for course learning and test review prep, as well as for NCLEX-RN® success
• Uses unfolding, real-life case vignettes to integrate core content with practice and professional responsibilities
• Covers all types of NCLEX-style questions for greater test familiarity
• Incorporates online resources for use in clinical settings
• Develops critical thinking skills to help students "think like a nurse"
• ISBN-13 978-0826141569
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• Publication date June 24, 2011
• Language English
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From the back cover, about the author.

Ruth A. Wittmann-Price, PhD, RN, CNS, CNE, CNEcl, CHSE, ANEF, FAAN Dean of Thomas Edison State University School of Nursing National League for Nursing's Academy of Nursing Education Fellow American Academy of Nursing Fellow Professor and Chair of Undergraduate Nursing Thomas Jefferson College of Nursing Center City, Philadelphia

Frances H. Cornelius, PhD, MSN, RN-BC, CNE Assistant Dean, Teaching Learning and Engagement Clinical Professor College of Nursing and Health Professions Drexel University Philadelphia, Pennsylvania

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• ASIN ‏ : ‎ B00I8VSV86
• Publisher ‏ : ‎ Springer Publishing Company; 1st edition (June 24, 2011)
• Publication date ‏ : ‎ June 24, 2011
• Language ‏ : ‎ English
• File size ‏ : ‎ 3933 KB
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• Print length ‏ : ‎ 820 pages
• #137 in Pediatric & Neonatal Nursing (Kindle Store)
• #222 in Maternity & Women's Health Nursing
• #457 in Nursing Reviews & Study Guides (Kindle Store)

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• Open access
• Published: 26 March 2024

The effect of “typical case discussion and scenario simulation” on the critical thinking of midwifery students: Evidence from China

• Yuji Wang 1   na1 ,
• Yijuan Peng 1   na1 &
• Yan Huang 1  

BMC Medical Education volume  24 , Article number:  340 ( 2024 ) Cite this article

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Assessment ability lies at the core of midwives’ capacity to judge and treat clinical problems effectively. Influenced by the traditional teaching method of “teacher-led and content-based”, that teachers involve imparting a large amount of knowledge to students and students lack active thinking and active practice, the clinical assessment ability of midwifery students in China is mostly at a medium or low level. Improving clinical assessment ability of midwifery students, especially critical thinking, is highly important in practical midwifery education. Therefore, we implemented a new teaching program, “typical case discussion and scenario simulation”, in the Midwifery Health Assessment course. Guided by typical cases, students were organized to actively participate in typical case discussions and to promote active thinking and were encouraged to practice actively through scenario simulation. In this study, we aimed to evaluate the effect of this strategy on the critical thinking ability of midwifery students.

A total of 104 midwifery students in grades 16–19 at the West China School of Nursing, Sichuan University, were included as participants through convenience sampling. All the students completed the Midwifery Health Assessment course in the third year of university. Students in grades 16 and 17 were assigned to the control group, which received routine teaching in the Midwifery Health Assessment, while students in grades 18 and 19 were assigned to the experimental group, for which the “typical case discussion and scenario simulation” teaching mode was employed. The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) and Midwifery Health Assessment Course Satisfaction Questionnaire were administered after the intervention.

After the intervention, the critical thinking ability of the experimental group was greater than that of the control group (284.81 ± 27.98 and 300.94 ± 31.67, p  = 0.008). Furthermore, the experimental group exhibited higher scores on the four dimensions of Open-Mindedness (40.56 ± 5.60 and 43.59 ± 4.90, p  = 0.005), Analyticity (42.83 ± 5.17 and 45.42 ± 5.72, p  = 0.020), Systematicity (38.79 ± 4.70 and 41.88 ± 6.11, p  = 0.006), and Critical Thinking Self-Confidence (41.35 ± 5.92 and 43.83 ± 5.89, p  = 0.039) than did the control group. The course satisfaction exhibited by the experimental group was greater than that exhibited by the control group (84.81 ± 8.49 and 90.19 ± 8.41, p  = 0.002).

The “typical case discussion and scenario simulation” class mode can improve the critical thinking ability of midwifery students and enhance their curriculum satisfaction. This approach carries a certain degree of promotional significance in medical education.

Typical case discussion and scenario simulation can improve midwifery students’ critical thinking ability.

Typical case discussion and scenario simulation can enhance students’ learning interest and guide students to learn independently.

Midwifery students were satisfied with the new teaching mode.

Peer Review reports

Maternal and neonatal health are important indicators to measure of the level of development of a country’s economy, culture and health care. The positive impact of quality midwifery education on maternal and newborn health is acknowledged in the publication framework for action strengthening quality midwifery education issued by the World Health Organization (WHO) [ 1 ]. Extensive evidence has shown that skilled midwifery care is crucial for reducing preventable maternal and neonatal mortality [ 2 , 3 , 4 ]. Clinical practice features high requirements for the clinical thinking ability of midwives, which refers to the process by which medical personnel analyze and integrate data with professional medical knowledge in the context of diagnosis and treatment as well as discover and solve problems through logical reasoning [ 5 ]. Critical thinking is a thoughtful process that is purposeful, disciplined, and self-directed and that aims to improve decisions and subsequent actions [ 6 ]. In 1986, the American Association of Colleges of Nursing formulated the “Higher Education Standards for Nursing Specialty”, which emphasize the fact that critical thinking is the primary core competence that nursing graduates should possess [ 7 ]. Many studies have shown that critical thinking can help nurses detect, analyze and solve problems creatively in clinical work and is a key factor in their ability to make correct clinical decisions [ 8 , 9 , 10 ].

However, the traditional teaching method used for midwifery students in China is “teacher-led and content-based”, and it involves efficiently and conveniently imparting a large amount of knowledge to students over a short period. Students have long failed to engage in active thinking and active practice, and the cultivation of critical thinking has long been ignored [ 5 ]. As a result, the critical thinking ability of midwifery students in China is mostly at a medium or low level [ 5 ]. Therefore, it is necessary to develop a new teaching mode to improve the critical thinking ability of midwifery students.

In 2014, Professor Xuexin Zhang of Fudan University, Shanghai, China, proposed a novel teaching method: the divided class mode. The basic idea of this approach is to divide the class time into two parts. The teachers explain the theoretical knowledge in the first lesson, and the students discuss that knowledge in the second lesson. This approach emphasizes the guiding role of teachers and encourages and empowers students to take responsibility for their studies [ 11 ]. Research has shown that the divided class mode can improve students’ enthusiasm and initiative as well as teaching effectiveness [ 12 ].

The problem-originated clinical medical curriculum mode of teaching was first established at McMaster University in Canada in 1965. This model is based on typical clinical cases and a problem-oriented heuristic teaching model [ 13 ]. The process of teaching used in this approach is guided by typical cases with the goal of helping students combine theoretical knowledge and practical skills. This approach can enhance the enthusiasm and initiative of students by establishing an active learning atmosphere. Students are encouraged to discuss and analyze typical cases to promote their ability to digest and absorb theoretical knowledge. Research has shown that the problem-originated clinical medical curriculum teaching mode can enhance students’ confidence and improve their autonomous learning and exploration ability. Scenario simulation teaching can provide students with real scenarios, allowing them to practice and apply their knowledge in a safe environment [ 14 ], which can effectively improve their knowledge and clinical skills and enhance their self-confidence [ 15 , 16 ].

Based on the teaching concept of divided classes, our research team established a new teaching model of “typical case discussion and scenario simulation”. Half of the class time is allocated for students to discuss typical cases and carry out scenario simulations to promote their active thinking and active practice. The Midwifery Health Assessment is the final professional core course that midwifery students must take in our school before clinical practice. All students must complete the course in Grade 3. Teaching this course is important for cultivating the critical thinking and clinical assessment ability of midwifery students. Therefore, our team adopted the new teaching mode of "typical case discussion and scenario simulation" in the teaching of this course. This study explored the teaching mode’s ability to improve the critical thinking ability of midwifery students.

Study design

The study employed a semiexperimental design.

Participants

A convenience sample of 104 third-year midwifery students who were enrolled in the Midwifery Health Assessment course volunteered to participate in this research at a large public university in Sichuan Province from February 2019 to June 2022 (grades 16 to 19). All the students completed the course in the third year of university. Students in grades 16 and 17 were assigned to the control group, which received the traditional teaching mode. Students in grades 18 and 19 were assigned to the experimental group, in which context the “typical case discussion and scenario simulation” class mode was used. The exclusion criteria for midwifery students were as follows: (1) dropped out of school during the study, (2) took continuous leave from school for more than two weeks, or (3) were unable to complete the questionnaire. The elimination criterion for midwifery students was that all the items were answered in the same way. No significant differences in students’ scores in their previous professional courses (Midwifery) were observed between the two groups. Textbooks, teachers, and teaching hours were the same for both groups.

Development of the “typical case discussion and scenario simulation” class mode

This study is based on the implementation of the new century higher education teaching reform project at Sichuan University. With the support of Sichuan University, we first established a “typical case discussion and scenario simulation” class mode team. The author of this paper was the head of the teaching reform project and served as a consultant, and the first author is responsible for supervising the implementation of the project. Second, the teaching team discussed and developed a standard process for the “typical case discussion and scenario simulation” class mode. Third, the entire team received intensive training in the standard process for the “typical case discussion and scenario simulation” class mode.

Implementation of the “typical case discussion and scenario simulation” class mode

Phase i (before class).

Before class, in accordance with the requirements for evaluating different periods of pregnancy, the teacher conceptualized typical cases and then discussed those cases with the teaching team and made any necessary modifications. After the completion of the discussion, the modified cases were released to the students through the class group. To ensure students’ interest, they were guided through the task of discovering and solving relevant problems using an autonomous learning approach.

Phase II (the first week)

Typical case discussion period. The Midwifery Health Assessment course was taught by 5 teachers and covered 5 health assessment periods, namely, the pregnancy preparation, pregnancy, delivery, puerperium and neonatal periods. The health assessment course focused on each period over 2 consecutive teaching weeks, and 2 lessons were taught per week. The first week focused on the discussion of typical cases. In the first lesson, teachers introduced typical cases, taught key knowledge or difficult evaluation content pertaining to the different periods, and explored the relevant knowledge framework. In the second lesson, teachers organized group discussions, case analyses and intergroup communications for the typical cases. They were also responsible for coordinating and encouraging students to participate actively in the discussion. After the discussion, teachers and students reviewed the definitions, treatments and evaluation points associated with the typical cases. The teachers also encouraged students to internalize knowledge by engaging in a process of summary and reflection to achieve the purpose of combining theory with practice.

Phase III (the second week)

Scenario simulation practice period. The second week focused on the scenario simulation practice period. In the first lesson, teachers reviewed the focus of assessment during the different periods and answered students’ questions. In the second lesson, students performed typical case assessment simulations in subgroups. After the simulation, the teachers commented on and summarized the students’ simulation evaluation and reviewed the evaluation points of typical cases to improve the students’ evaluation ability.

The organizational structure and implementation of the “typical case discussion and scenario simulation” class mode showed in Fig.  1 .

“Typical case discussion and scenario simulation” teaching mode diagram

A demographic questionnaire designed for this purpose was used to collect relevant information from participants, including age, gender, single-child status, family location, experience with typical case discussion or scenario simulation and scores in previous professional courses (Midwifery).

The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) was developed by Peng et al. to evaluate the critical thinking ability of midwifery students [ 17 ]. The scale contains 70 items across a total of seven dimensions, namely, open-mindedness, truth-seeking, analytical ability, systematic ability, self-confidence in critical thinking, thirst for knowledge, and cognitive maturity. Each dimension is associated with 10 items, and each item is scored on a 6-point Likert scale, with 1 indicating “extremely agree” and 6 representing “extremely disagree”. The scale includes 30 positive items, which receive scores ranging from “extremely agree” to “extremely disagree” on a scale of 6 to 1, and 40 negative items, which receive scores ranging from “extremely agree” to “extremely disagree” on a scale of 1 to 6. A total score less than 210 indicates negative critical thinking ability, scores between 211 and 279 indicate an unclear meaning, scores of 280 or higher indicate positive critical thinking ability, and scores of 350 or higher indicate strong performance. The score range of each trait is 10–60 points; a score of 30 points or fewer indicates negative trait performance, scores between 31 and 39 points indicate that the trait meaning is incorrect, scores of 40 points or higher indicate positive trait performance, and scores of 50 points or higher indicate extremely positive trait performance. The Cronbach’s α coefficient of the scale was 0.90, thus indicating good content validity and structure. The higher an individual’s score on this measure is, the better that individual’s critical thinking ability.

The evaluation of teaching results was based on a questionnaire used to assess undergraduate course satisfaction, and the researchers deleted and modified items in the questionnaire to suit the context of the “typical case discussion and scenario simulation” teaching mode. Two rounds of discussion were held within the study group to form the final version of the Midwifery Health Assessment satisfaction questionnaire. The questionnaire evaluates the effect of teaching in terms of three dimensions, namely, curriculum content, curriculum teaching and curriculum evaluation. The questionnaire contains 21 items, each of which is scored on a 5-point Likert scale, with 1 indicating “extremely disagree” and 5 representing “extremely agree”. The higher the score is, the better the teaching effect.

Data collection and statistical analysis

We input the survey data into the “Wenjuanxing” platform ( https://www.wjx.cn/ ), which specializes in questionnaire services. At the beginning of the study, an electronic questionnaire was distributed to the students in the control group via student WeChat and QQ groups for data collection. After the intervention, an electronic questionnaire was distributed to the students in the experimental group for data collection in the final class of the Midwifery Health Assessment course. All the data were collected by the first author (Yuji Wang). When students had questions about the survey items, the first author (Yuji Wang) immediately explained the items in detail. To ensure the integrity of the questionnaire, the platform required all the items to be answered before submission.

Statistical Package for Social Sciences Version 26.0 (SPSS 26.0) software was used for data analysis. The Shapiro‒Wilk test was used to test the normality of the data. The measurement data are expressed as the mean ± standard deviation (X ± S), and an independent sample t test was used for comparisons among groups with a normal distribution. The data presented as the number of cases (%), and the chi-square test was performed. A P value < 0.05 indicated that a difference was statistically significant.

Ethical considerations

The study was funded by the New Century Teaching Reform Project of Sichuan University and passed the relevant ethical review. Oral informed consent was obtained from all individual participants in the study.

Characteristics of the participants

A total of 104 third-year midwifery students were enrolled from February 2019 to June 2022, and 98.1% (102/144) of these students completed the survey. Two invalid questionnaires that featured the same answers for each item were eliminated. A total of 100 participants were ultimately included in the analysis. Among the participants, 48 students were assigned to the control group, and 52 students were assigned to the experimental group. The age of the students ranged from 19 to 22 years, and the mean age of the control group was 20.50 years (SD = 0.61). The mean age of the experimental group was 20.63 years (SD = 0.65). Of the 100 students who participated in the study, the majority (96.0%) were women. No significant differences were observed between the intervention and control groups in terms of students’ demographic information (i.e., age, gender, status as an only child, or family location), experience with scenario simulation or typical case discussion and scores in previous Midwifery courses (Table  1 ).

Examining the differences in critical thinking ability between the two groups

The aim of this study was to evaluate the effect of the new teaching mode of “typical case discussion and scenario simulation” on improving the critical thinking ability of midwifery students. Independent sample t tests were used to examine the differences in critical thinking ability between the two groups (Table  2 ). The results showed that the total critical thinking scores obtained by the experimental group were greater than those obtained by the control group (284.81 ± 27.98 and 300.94 ± 31.67, p  = 0.008). The differences in four dimensions (Open-Mindedness (40.56 ± 5.60 and 43.59 ± 4.90, p  = 0.005), Analyticity (42.83 ± 5.17 and 45.42 ± 5.72, p  = 0.020), Systematicity (38.79 ± 4.70 and 41.88 ± 6.11, p  = 0.006), and Critical Thinking Self-Confidence (41.35 ± 5.92 and 43.83 ± 5.89, p  = 0.039)) were statistically significant.

Examining the differences in curriculum satisfaction between the two groups

To evaluate the effect of the new teaching mode of “the typical case discussion and scenario simulation” on the course satisfaction of midwifery students. Independent sample t tests were used to examine the differences in course satisfaction between the two groups (Table  3 ). The results showed that the curriculum satisfaction of the experimental group was greater than that of the control group (84.81 ± 8.49 and 90.19 ± 8.41, p  = 0.002). Independent sample t tests were used to examine the differences in the three dimensions of curriculum satisfaction between the two groups (Table  3 ). The results showed that the average scores of the intervention group on the three dimensions were significantly greater than those of the control group (curricular content: 20.83 ± 1.96 and 22.17 ± 2.23, p  = 0.002; curriculum teaching: 34.16 ± 3.89 and 36.59 ± 3.66, p  = 0.002; curriculum evaluation: 29.81 ± 3.27 and 31.42 ± 3.19, p  = 0.015).

Midwifery is practical and intensive work. To ensure maternal and child safety, midwives must make decisions and take action quickly. Therefore, midwives should have both critical thinking ability and clinical decision-making ability [ 18 ]. In addition, the Australian Nursing and Midwifery Accreditation Council (ANMAC) regulates the educational requirements for the programs required for registration as a midwife. According to these standards, education providers must incorporate learning activities into curricula to encourage the development and application of critical thinking and reflective practice [ 19 ]. Therefore, the challenge of cultivating the critical thinking ability of midwifery students is an urgent problem that must be solved. However, influenced by the traditional teaching method of “teacher-led and content-based”, the critical thinking ability of midwifery students in China is mostly at a medium or low level. In order to improve the critical thinking ability of midwifery students. Our research team has established a new teaching model, the “typical case discussion and scenario simulation” class model. And applied to the midwifery core curriculum Midwifery Health Assessment. This study aimed to investigate the implementation of a novel systematic and structured teaching model for midwifery students and to provide evidence regarding how to improve the critical thinking ability of midwives.

The results showed that the total CTDI-CV score obtained for the experimental group was greater than that obtained for the control group. These findings indicate that the “typical case discussion and scenario simulation” class mode had a positive effect on the cultivation of students’ critical thinking ability, a conclusion which is similar to the findings of Holdsworth et al. [ 20 ], Lapkin et al. [ 21 ] and Demirören M et al. [ 22 ]. We indicate the following reasons that may explain these results.The core aim of the typical case discussion teaching mode is to raise questions based on typical clinical cases and to provide heuristic teaching to students [ 23 ]. This approach emphasizes asking questions based on specific clinical cases, which enables students to engage in targeted learning. Moreover, scenario simulation allows students to attain certain inner experiences and emotions and actively participate in curriculum practice, which can enhance their ability to remember and understand knowledge [ 24 ]. Through the divided class mode, half of the class time was divided into the students. This method emphasizes the guiding role of teachers and encourages and empowers students to assume learning responsibilities. In addition, students can think, communicate and discuss actively [ 22 , 23 ]. Furthermore, this approach created opportunities for students to analyze and consider problems independently and give students sufficient time to internalize and absorb knowledge and deepen their understanding of relevant knowledge, which can increase their confidence in their ability to address such problems and improve their critical thinking ability [ 12 , 25 , 26 ].

In addition, the results showed that except for Truth-Seeking and Systematicity, the other five dimensions were all positive. These findings are similar to the results reported by Atakro et al.. and Sun et al. [ 27 , 28 ]. Through the intervention, the Systematicity scores became positive, suggesting that the new teaching mode can help students deal with problems in an organized and purposeful way. However, Truth-Seeking still did not become positive; this notion focuses on intellectual honesty, i.e., the disposition to be courageous when asking questions and to be honest and objective in the pursuit of knowledge even when the topics under investigation do not support one’s self-interest [ 29 ]. Studies have shown that this factor is related to the traditional teaching mode used [ 30 ]. The traditional teaching mode focuses on knowledge infusion, helps students remember the greatest possible amount of knowledge in a short time, and does not focus on guiding students to seek knowledge with sincerity and objectivity. Therefore, in future educational practice, we should focus on cultivating students’ ability to seek truth and engage in systematization.

Student evaluative feedback is an important way to test the effectiveness teaching mode. Therefore, understanding students’ evaluations of the effects of classroom teaching is key to promoting teaching reform and improving teaching quality. Therefore, we distributed a satisfaction questionnaire pertaining to the midwifery health assessment curriculum, which was based on the “typical case discussion and scenario simulation” class mode, with the goal of investigating curriculum satisfaction in terms of three dimensions (curriculum content, curriculum teaching and curriculum evaluation). The results showed that the satisfaction scores for each dimension increased significantly. This finding suggests that the new teaching method can enrich the teaching content, diversify the teaching mode and improve students’ curriculum evaluations.

In summary, the “typical case discussion and scenario simulation” class mode focuses on typical cases as its main content. Students’ understanding of this content is deepened through group discussion and scenario simulation. The subjectivity of students in curriculum learning should be accounted for. Students can be encouraged to detect, analyze and solve problems with the goal of improving their critical thinking ability. Moreover, this approach can also enhance curriculum satisfaction. It is recommended that these tools should be used continuously in future curriculum teaching.

This study has several limitations. First, the representativeness of the sample may be limited since the participants were recruited from specific universities in China. Second, we used historical controls, which are less effective than simultaneous controlled trials. Third, online self-report surveys are susceptible to response biases, although we included quality control measurements in the process of data collection. Fourth, we did not use the same critical thinking instrument, CTDI-CV, to investigate the critical thinking of the students in the experimental group or the control group before intervention but used professional course grades from the Midwifery for substitution comparison. This may not be a sufficient substitute. However, these comparisons could be helpful since those grades included some sort of evaluation of critical thinking. In light of these limitations, future multicenter simultaneous controlled studies should be conducted. Nonetheless, this study also has several strengths. First, no adjustment of teachers or change in learning materials occurred since the start of the midwifery health assessment, thus ensuring that the experimental and control groups featured the same teaching materials, teachers and teaching hours. In addition, to ensure the quality of the research, the first author of this paper participated in the entirety of the course teaching.

The “typical case discussion and scenario simulation” class mode can improve the critical thinking of midwifery students, which is helpful for ensuring maternal and child safety. Students are highly satisfied with the new teaching mode, and this approach has a certain degree of promotional significance. However, this approach also entails higher requirements for both teachers and students.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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The study was supported by Sichuan University’s New Century Education and Teaching Reform Project (SCU9316).

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Wang, Y., Peng, Y. & Huang, Y. The effect of “typical case discussion and scenario simulation” on the critical thinking of midwifery students: Evidence from China. BMC Med Educ 24 , 340 (2024). https://doi.org/10.1186/s12909-024-05127-5

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Case Study Analysis as an Effective Teaching Strategy: Perceptions of Undergraduate Nursing Students From a Middle Eastern Country

Vidya seshan.

1 Maternal and Child Health Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman

Gerald Amandu Matua

2 Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman

Divya Raghavan

Judie arulappan, iman al hashmi, erna judith roach, sheeba elizebath sunderraj, emi john prince.

3 Griffith University, Nathan Campus, Queensland 4111

Background: Case study analysis is an active, problem-based, student-centered, teacher-facilitated teaching strategy preferred in undergraduate programs as they help the students in developing critical thinking skills. Objective: It determined the effectiveness of case study analysis as an effective teacher-facilitated strategy in an undergraduate nursing program. Methodology: A descriptive qualitative research design using focus group discussion method guided the study. The sample included undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018. The researcher used a purposive sampling technique and a total of 22 students participated in the study, through five (5) focus groups, with each focus group comprising between four to six nursing students. Results: In total, nine subthemes emerged from the three themes. The themes were “Knowledge development”, “Critical thinking and Problem solving”, and “Communication and Collaboration”. Regarding “Knowledge development”, the students perceived case study analysis method as contributing toward deeper understanding of the course content thereby helping to reduce the gap between theory and practice especially during clinical placement. The “Enhanced critical thinking ability” on the other hand implies that case study analysis increased student's ability to think critically and aroused problem-solving interest in the learners. The “Communication and Collaboration” theme implies that case study analysis allowed students to share their views, opinions, and experiences with others and this enabled them to communicate better with others and to respect other's ideas which further enhanced their team building capacities. Conclusion: This method is effective for imparting professional knowledge and skills in undergraduate nursing education and it results in deeper level of learning and helps in the application of theoretical knowledge into clinical practice. It also broadened students’ perspectives, improved their cooperation capacity and their communication with each other. Finally, it enhanced student's judgment and critical thinking skills which is key for their success.

Introduction/Background

Recently, educators started to advocate for teaching modalities that not only transfer knowledge ( Shirani Bidabadi et al., 2016 ), but also foster critical and higher-order thinking and student-centered learning ( Wang & Farmer, 2008 ; Onweh & Akpan, 2014). Therefore, educators need to utilize proven teaching strategies to produce positive outcomes for learners (Onweh & Akpan, 2014). Informed by this view point, a teaching strategy is considered effective if it results in purposeful learning ( Centra, 1993 ; Sajjad, 2010 ) and allows the teacher to create situations that promote appropriate learning (Braskamp & Ory, 1994) to achieve the desired outcome ( Hodges et al., 2020 ). Since teaching methods impact student learning significantly, educators need to continuously test the effectives of their teaching strategies to ensure desired learning outcomes for their students given today's dynamic learning environments ( Farashahi & Tajeddin, 2018 ).

In this study, the researchers sought to study the effectiveness of case study analysis as an active, problem-based, student-centered, teacher-facilitated strategy in a baccalaureate-nursing program. This choice of teaching method is supported by the fact that nowadays, active teaching-learning is preferred in undergraduate programs because, they not only make students more powerful actors in professional life ( Bean, 2011 ; Yang et al., 2013 ), but they actually help learners to develop critical thinking skills ( Clarke, 2010 ). In fact, students who undergo such teaching approaches usually become more resourceful in integrating theory with practice, especially as they solve their case scenarios ( Chen et al., 2019 ; Farashahi & Tajeddin, 2018 ; Savery, 2019 ).

Review of Literature

As a pedagogical strategy, case studies allow the learner to integrate theory with real-life situations as they devise solutions to the carefully designed scenarios ( Farashahi & Tajeddin, 2018 ; Hermens & Clarke, 2009). Another important known observation is that case-study-based teaching exposes students to different cases, decision contexts and the environment to experience teamwork and interpersonal relations as “they learn by doing” thus benefiting from possibilities that traditional lectures hardly create ( Farashahi & Tajeddin, 2018 ; Garrison & Kanuka, 2004 ).

Another merit associated with case study method of teaching is the fact that students can apply and test their perspectives and knowledge in line with the tenets of Kolb et al.'s (2014) “experiential learning model”. This model advocates for the use of practical experience as the source of one's learning and development. Proponents of case study-based teaching note that unlike passive lectures where student input is limited, case studies allow them to draw from their own experience leading to the development of higher-order thinking and retention of knowledge.

Case scenario-based teaching also encourages learners to engage in reflective practice as they cooperate with others to solve the cases and share views during case scenario analysis and presentation ( MsDade, 1995 ).

This method results in “idea marriage” as learners articulate their views about the case scenario. This “idea marriage” phenomenon occurs through knowledge transfer from one situation to another as learners analyze scenarios, compare notes with each other, and develop multiple perspectives of the case scenario. In fact, recent evidence shows that authentic case-scenarios help learners to acquire problem solving and collaborative capabilities, including the ability to express their own views firmly and respectfully, which is vital for future success in both professional and personal lives ( Eronen et al., 2019 ; Yajima & Takahashi, 2017 ). In recognition of this higher education trend toward student-focused learning, educators are now increasingly expected to incorporate different strategies in their teaching.

This study demonstrated that when well implemented, educators can use active learning strategies like case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. This study is significant because the findings will help educators in the country and in the region to incorporate active learning strategies such as case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. Besides, most studies on the case study method in nursing literature mostly employ quantitative methods. The shortage of published research on the case study method in the Arabian Gulf region and the scanty use of qualitative methods further justify why we adopted the focus group method for inquiry.

A descriptive qualitative research design using focus group discussion method guided the study. The authors chose this method because it is not only inexpensive, flexible, stimulating but it is also known to help with information recall and results in rich data ( Matua et al., 2014 ; Streubert & Carpenter, 2011 ). Furthermore, as evidenced in the literature, the focus group discussion method is often used when there is a need to gain an in-depth understanding of poorly understood phenomena as the case in our study. The choice of this method is further supported by the scarcity of published research related to the use of case study analysis as a teaching strategy in the Middle Eastern region, thereby further justifying the need for an exploratory research approach for our study.

As a recommended strategy, the researchers generated data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and cased-based teaching approaches. The focus group interviews allowed the study participants to express their experiences and perspectives in their own words. In addition, the investigators integrated participants’ self-reported experiences with their own observations and this enhanced the study findings ( Morgan & Bottorff, 2010 ; Nyumba et al., 2018 ; Parker & Tritter, 2006 ).

Eligibility Criteria

In order to be eligible to participate in the study, the participants had to:

• be a baccalaureate nursing student in College of Nursing, Sultan Qaboos University
• register for Maternity Nursing Course in 2017 and 2018.
• attend all the Case Study Analysis sessions in the courses before the study.
• show a willingness to participate in the study voluntarily and share their views freely.

The population included the undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018.

The researcher used a purposive sampling technique to choose participants who were capable of actively participating and discussing their views in the focus group interviews. This technique enabled the researchers to select participants who could provide rich information and insights about case study analysis method as an effective teaching strategy. The final study sample included baccalaureate nursing students who agreed to participate in the study by signing a written informed consent. In total, twenty-two (22) students participated in the study, through five focus groups, with each focus group comprising between four and six students. The number of participants was determined by the stage at which data saturation was reached. The point of data saturation is when no new information emerges from additional participants interviewed ( Saunders et al., 2018 ).Focus group interviews were stopped once data saturation was achieved. Qualitative research design with focus group discussion allowed the researchers to generate data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and case-based teaching approaches. The focus group interviews allowed the study participants to express their perspectives in their own words. In addition, the investigators enhanced the study findings by integrating participants’ self-reported experiences with the researchers’ own observations and notes during the study.

The study took place at College of Nursing; Sultan Qaboos University, Oman's premier public university, in Muscat. This is the only setting chosen for the study. The participants are the students who were enrolled in Maternal Health Nursing course during 2017 and 2018. The interviews occurred in the teaching rooms after official class hours. Students who did not participate in the study learnt the course content using the traditional lecture based method.

Ethical Considerations

Permission to conduct the study was granted by the College Research and Ethics Committee (XXXX). Prior to the interviews, each participant was informed about the purpose, benefits as well as the risks associated with participating in the study and clarifications were made by the principal researcher. After completing this ethical requirement, each student who accepted to participate in the study proceeded to sign an informed consent form signifying that their participation in the focus group interview was entirely voluntary and based on free will.

The anonymity of study participants and confidentiality of their data was upheld throughout the focus group interviews and during data analysis. To enhance confidentiality and anonymity of the data, each participant was assigned a unique code number which was used throughout data analysis and reporting phases. To further assure the confidentiality of the research data and anonymity of the participants, all research-related data were kept safe, under lock and key and through digital password protection, with unhindered access only available to the research team.

Research Intervention

In Fall 2017 and Spring 2018 semesters, as a method of teaching Maternal Health Nursing course, all students participated in two group-based case study analysis exercises which were implemented in the 7 th and 13 th weeks. This was done after the students were introduced to the case study method using a sample case study prior to the study. The instructor explained to the students how to solve the sample problem, including how to accomplish the role-specific competencies in the courses through case study analysis. In both weeks, each group consisting of six to seven students was assigned to different case scenarios to analyze and work on, after which they presented their collective solution to the case scenarios to the larger class of 40 students. The case scenarios used in both weeks were peer-reviewed by the researchers prior to the study.

Pilot Study

A group of three students participated as a pilot group for the study. However, the students who participated in the pilot study were not included in the final study as is general the principle with qualitative inquiry because of possible prior exposure “contamination”. The purpose of piloting was to gather data to provide guidance for a substantive study focusing on testing the data collection procedure, the interview process including the sequence and number of questions and probes and recording equipment efficacy. After the pilot phase, the lessons learned from the pilot were incorporated to ensure smooth operations during the actual focus group interview ( Malmqvist et al., 2019 .

Data Collection

The focus group interviews took place after the target population was exposed to case study analysis method in Maternal Health Nursing course during the Fall 2017 and Spring 2018 semesters. Before data collection began, the research team pilot tested the focus group interview guide to ensure that all the guide questions were clear and well understood by study participants.

In total, five (5) focus groups participated in the study, with each group comprising between four and six students. The focus group interviews lasted between 60 and 90 min. In addition to the interview guide questions, participants’ responses to unanswered questions were elicited using prompts to facilitate information flow whenever required. As a best practice, all the interviews were audio-recorded in addition to extensive field notes taken by one of the researchers. The focus group interviews continued until data saturation occurred in all the five (5) focus groups.

Credibility

In this study, participant's descriptions were digitally audio recorded to ensure that no information was lost. In order to ensure that the results are accurate, verbatim transcriptions of the audio recordings were done supported by interview notes. Furthermore, interpretations of the researcher were verified and supported with existing literature with oversight from the research team.

Transferability

The researcher provided a detailed description about the study settings, participants, sampling technique, and the process of data collection and analyses. The researcher used verbatim quotes from various participants to aid the transferability of the results.

Dependability

The researcher ensured that the research process is clearly documented, traceable, and logical to achieve dependability of the research findings. Furthermore, the researcher transparently described the research steps, procedures and process from the start of the research project to the reporting of the findings.

Confirmability

In this study, confirmability of the study findings was achieved through the researcher's efforts to make the findings credible, dependable, and transferable.

Data Analysis

Data were analyzed manually after the lead researcher integrated the verbatim transcriptions with the extensive field notes to form the final data set. Data were analyzed thematically under three thematic areas of a) knowledge development; b) critical thinking and problem solving; and (c) communication and collaboration, which are linked to the study objectives. The researchers used the Six (6) steps approach to conduct a trustworthy thematic analysis: (1) familiarization with the research data, (2) generating initial codes, (3) searching for themes, (4) reviewing the themes, (5) defining and naming themes, (6) writing the report ( Nowell et al., 2017 ).

The analysis process started with each team member individually reading and re-reading the transcripts several times and then identifying meaning units linked to the three thematic areas. The co-authors then discussed in-depth the various meaning units linked to the thematic statements until consensus was reached and final themes emerged based on the study objectives.

A total of 22 undergraduate third-year baccalaureate nursing students who were enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018 participated in the study, through five focus groups, with each group comprising four to six students. Of these, 59% were females and 41% were males. In total, nine subthemes emerged from the three themes. Under knowledge development, emerged the subthemes, “ deepened understanding of content ; “ reduced gap between theory and practice” and “ improved test-taking ability ”. While under Critical thinking and problem solving, emerged the subthemes, “ enhanced critical thinking ability ” and “ heightened curiosity”. The third thematic area of communication and collaboration yielded, “ improved communication ability ”; “ enhanced team-building capacity ”; “ effective collaboration” and “ improved presentation skills ”, details of which are summarized in Table 1 .

Table 1.

Objective Linked Themes and Student Perceptions of Outcome Case Study Analysis.

Theme 1: Knowledge Development

In terms of knowledge development, students expressed delight at the inclusion of case study analysis as a method during their regular theory class. The first subtheme related to knowledge development that supports the adoption of the case study approach is its perceived benefit of ‘ deepened understanding of content ’ by the students as vividly described by this participant:

“ I was able to perform well in the in-course exams as this teaching method enhanced my understanding of the content rather than memorizing ” (FGD#3).

The second subtheme related to knowledge development was informed by participants’ observation that teaching them using case study analysis method ‘ reduced the gap between theory and practice’. This participant's claim stem from the realization that, a case study scenario his group analyzed in the previous week helped him and his colleagues to competently deal with a similar situation during clinical placement the following week, as articulated below:

“ You see when I was caring for mothers in antenatal unit, I could understand the condition better and could plan her care well because me and my group already analyzed a similar situation in class last week which the teacher gave us, this made our work easier in the ward”. (FGD#7).

Another student added that:

“ It was useful as what is taught in the theory class could be applied to the clinical cases.”

This ‘theory-practice’ connection was particularly useful in helping students to better understand how to manage patients with different health conditions. Interestingly, the students reported that they were more likely to link a correct nursing care plan to patients whose conditions were close to the case study scenarios they had already studied in class as herein affirmed:

“ …when in the hospital I felt I could perceive the treatment modality and plan for [a particular] nursing care well when I [had] discussed with my team members and referred the textbook resource while performing case study discussion”. (FGD#17).

In a similar way, another student added:

“…I could relate with the condition I have seen in the clinical area. So this has given me a chance to recall the condition and relate the theory to practice”. (FGD#2) .

The other subtheme closely related to case study scenarios as helping to deepen participant's understanding of the course content, is the notion that this teaching strategy also resulted in ‘ improved test taking-ability’ as this participant's verbatim statement confirms:

“ I could answer the questions related to the cases discussed [much] better during in-course exams. Also [the case scenarios] helped me a great deal to critically think and answer my exam papers” (FGD#11).

Theme 2: Critical Thinking and Problem Solving

In this subtheme, students found the case study analysis as an excellent method to learn disease conditions in the two courses. This perceived success with the case study approach is associated with the method's ability to ‘ enhance students’ critical thinking ability’ as this student declares:

“ This method of teaching increased my ability to think critically as the cases are the situations, where we need to think to solve the situation”. (FGD#5)

This enhanced critical thinking ability attributed to case study scenario analysis was also manifested during patient care where students felt it allowed them to experience a “ flow of patient care” leading to better patient management planning as would typically occur during case scenario analysis. In support of this finding, a participant mentioned that:

“ …I could easily connect the flow of patient care provided and hence was able to plan for [his] management as often required during case study discussion” (FGD#12)

Another subtheme linked with this theme is the “ heightened curiosity” associated with the case scenario discussions. It was clear from the findings that the cases aroused curiosity in the mind of the students. This heightened interest meant that during class discussion, baccalaureate nursing students became active learners, eager to discover the next set of action as herein affirmed:

“… from the beginning of discussion with the group, I was eager to find the answer to questions presented and wanted to learn the best way for patient management” (FGD#14)

Theme 3: Communication and Collaboration

In terms of its impact on student communication, the subtheme revealed that case study analysis resulted in “ improved communication ability” among the nursing students . This enhanced ability of students to exchange ideas with each other may be attributed to the close interaction required to discuss and solve their assigned case scenarios as described by the participant below:

“ as [case study analysis] was done in the way of group discussion, I felt me and my friends communicated more within the group as we discussed our condition. We also learnt from each other, and we became better with time.” (FGD#21).

The next subtheme further augments the notion that case study analysis activities helped to “ enhance team-building capacity” of students as this participant affirmatively narrates:

“ students have the opportunity to meet face to face to share their views, opinion, and their experience, as this build on the way they can communicate with each other and respect each other's opinions and enhance team-building”. (FGD#19).

Another subtheme revealed from the findings show that the small groups in which the case analysis occurs allowed the learners to have deeper and more focused conversations with one another, resulting in “ an effective collaboration between students” as herein declared:

“ We could collaborate effectively as we further went into a deep conversation on the case to solve”. (FGD#16).

Similarly, another student noted that:

“ …discussion of case scenarios helped us to prepare better for clinical postings and simulation lab experience” (FGD#5) .

A fourth subtheme related to communication found that students also identified that case study analysis resulted in “ improved presentation skills”. This is attributed in part to the preparation students have to go through as part of their routine case study discussion activities, which include organizing their presentations and justifying and integrating their ideas. Besides readying themselves for case presentations, the advice, motivation, and encouragement such students receive from their faculty members and colleagues makes them better presenters as confirmed below:

“ …teachers gave us enough time to prepare, hence I was able to present in front of the class regarding the finding from our group.” (FGD#16).

In this study, the researches explored learner's perspectives on how one of the active teaching strategies, case study analysis method impacted their knowledge development, critical thinking, and problem solving as well as communication and collaboration ability.

Knowledge Development

In terms of knowledge development, the nursing students perceived case study analysis as contributing toward: (a) deeper understanding of content, (b) reducing gap between theory and practice, and (c) improving test-taking ability. Deeper learning” implies better grasping and retention of course content. It may also imply a deeper understanding of course content combined with learner's ability to apply that understanding to new problems including grasping core competencies expected in future practice situations (Rickles et al., 2019; Rittle-Johnson et al., 2020 ). Deeper learning therefore occurs due to the disequilibrium created by the case scenario, which is usually different from what the learner already knows ( Hattie, 2017 ). Hence, by “forcing” students to compare and discuss various options in the quest to solve the “imbalance” embedded in case scenarios, students dig deeper in their current understanding of a given content including its application to the broader context ( Manalo, 2019 ). This movement to a deeper level of understanding arises from carefully crafted case scenarios that instructors use to stimulate learning in the desired area (Nottingham, 2017; Rittle-Johnson et al., 2020 ). The present study demonstrated that indeed such carefully crafted case study scenarios did encourage students to engage more deeply with course content. This finding supports the call by educators to adopt case study as an effective strategy.

Another finding that case study analysis method helps in “ reducing the gap between theory and practice ” implies that the method helps students to maintain a proper balance between theory and practice, where they can see how theoretical knowledge has direct practical application in the clinical area. Ajani and Moez (2011) argue that to enable students to link theory and practice effectively, nurse educators should introduce them to different aspects of knowledge and practice as with case study analysis. This dual exposure ensures that students are proficient in theory and clinical skills. This finding further amplifies the call for educators to adequately prepare students to match the demands and realities of modern clinical environments ( Hickey, 2010 ). This expectation can be met by ensuring that student's knowledge and skills that are congruent with hospital requirements ( Factor et al., 2017 ) through adoption of case study analysis method which allows integration of clinical knowledge in classroom discussion on regular basis.

The third finding, related to “improved test taking ability”, implies that case study analysis helped them to perform better in their examination, noting that their experience of going through case scenario analysis helped them to answer similar cases discussed in class much better during examinations. Martinez-Rodrigo et al. (2017) report similar findings in a study conducted among Spanish electrical engineering students who were introduced to problem-based cooperative learning strategies, which is similar to case study analysis method. Analysis of student's results showed that their grades and pass rates increased considerably compared to previous years where traditional lecture-based method was used. Similar results were reported by Bonney (2015) in an even earlier study conducted among biology students in Kings Borough community college students, in New York, United States. When student's performance in examination questions covered by case studies was compared with class-room discussions, and text-book reading, case study analysis approach was significantly more effective compared to traditional methods in aiding students’ performance in their examinations. This finding therefore further demonstrates that case study analysis method indeed improves student's test taking ability.

Critical Thinking and Problem Solving

In terms of critical thinking and problem-solving ability, the use of case study analysis resulted in two subthemes: (a) enhanced critical thinking ability and (b) heightened learner curiosity. The “ enhanced critical thinking ability” implies that case analysis increased student's ability to think critically as they navigated through the case scenarios. This observation agrees with the findings of an earlier questionnaire-based study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh, that showed 81% of respondents agree that case study analysis develops critical thinking ability and enables students to do better problem analysis ( Muhiuddin & Jahan, 2006 ). This observation agrees with the findings of an earlier study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh. The study showed that 81% of respondents agreed that case study analysis facilitated the development of critical thinking ability in the learners and enabled the students to perform better with problem analysis ( Muhiuddin & Jahan, 2006 ).

More recently, Suwono et al. (2017) found similar results in a quasi-experimental research conducted at a Malaysian university. The research findings showed that there was a significant difference in biological literacy and critical thinking skills between the students taught using socio-biological case-based learning and those taught using traditional lecture-based learning. The researchers concluded that case-based learning enhanced the biological literacy and critical thinking skills of the students. The current study adds to the existing pedagogical knowledge base that case study methodology can indeed help to deepen learner's critical thinking and problem solving ability.

The second subtheme related to “ heightened learner curiosity” seems to suggest that the case studies aroused problem-solving interest in learners. This observation agrees with two earlier studies by Tiwari et al. (2006) and Flanagan and McCausland (2007) who both reported that most students enjoyed case-based teaching. The authors add that the case study method also improved student's clinical reasoning, diagnostic interpretation of patient information as well as their ability to think logically when presented a challenge in the classroom and in the clinical area. Jackson and Ward (2012) similarly reported that first year engineering undergraduates experienced enhanced student motivation. The findings also revealed that the students venturing self-efficacy increased much like their awareness of the importance of key aspects of the course for their future careers. The authors conclude that the case-based method appears to motivate students to autonomously gather, analyze and present data to solve a given case. The researchers observed enhanced personal and collaborative efforts among the learners, including improved communication ability. Further still, learners were more willing to challenge conventional wisdom, and showed higher “softer” skills after exposure to case analysis based teaching method. These findings like that of the current study indicate that teaching using case based analysis approach indeed motivates students to engage more in their learning, there by resulting in deeper learning.

Communication and Collaboration

Case study analysis is also perceived to result in: (a) improved communication ability; (b) enhanced team -building capacity, (c) effective collaboration ability, and (d) enhanced presentation skills. The “ improved communication ability ” manifested in learners being better able to exchange ideas with peers, communicating their views more clearly and collaborating more effectively with their colleagues to address any challenges that arise. Fini et al. (2018) report comparable results in a study involving engineering students who were subjected to case scenario brainstorming activities about sustainability concepts and their implications in transportation engineering in selected courses. The results show that this intervention significantly improved student's communication skills besides their higher-order cognitive, self-efficacy and teamwork skills. The researchers concluded that involving students in brainstorming activities related to problem identification including their practical implications, is an effective teaching strategy. Similarly, a Korean study by Park and Choi (2018) that sought to analyze the effects of case-based communication training involving 112 sophomore nursing students concluded that case-based training program improved the students’ critical thinking ability and communication competence. This finding seems to support further the use of case based teaching as an effective teaching-learning strategy.

The “ enhanced team-building capacity” arose from the opportunity students had in sharing their views, opinions, and experiences where they learned to communicate with each other and respect each other's ideas which further enhance team building. Fini et al. (2018) similarly noted that increased teamwork levels were seen among their study respondents when the researchers subjected engineering students to case scenario based-brainstorming activities as occurs with case study analysis teaching. Likewise, Lairamore et al. (2013) report similar results in their study that showed that case study analysis method increased team work ability and readiness among students from five health disciplines in a US-based study.

The finding that case study analysis teaching method resulted in “ effective collaboration ability” among students manifested as students entered into deep conversation as they solved the case scenarios. Rezaee and Mosalanejad (2015) assert that such innovative learning strategies result in noticeable educational outcomes, such as greater satisfaction with and enjoyment of the learning process ( Wellmon et al., 2012 ). Further, positive attitudes toward learning and collaboration have been noted leading to deeper learning as students prepare for case discussions ( Rezaee & Mosalanejad, 2015 ). This results show that case study analysis can be utilized by educators to foster professional collaboration among their learners, which is one of the key expectations of new graduates today.

The finding associated with “improved presentation skills” is consistent with the results of a descriptive study in Saudi Arabia that compared case study and traditional lectures in the teaching of physiology course to undergraduate nursing students. The researchers found that case-based teaching improved student’ overall knowledge and performance in the course including facilitating the acquisition of skills compared to traditional lectures ( Majeed, 2014 ). Noblitt et al. (2010) report similar findings in their study that compares traditional presentation approach with the case study method for developing and improving student's oral communication skills. This finding extends our understanding that case study method improves learners’ presentation skills.

The study was limited to level third year nursing students belonging to only one college and the sample size, which might limit the transferability of the study findings to other settings.

Implications for Practice

These study findings add to the existing body of knowledge that places case study based teaching as a tested method that promotes perception learning where students’ senses are engaged as a result of the real-life and authentic clinical scenarios ( Malesela, 2009 ), resulting in deeper learning and achievement of long-lasting knowledge ( Fiscus, 2018 ). The students reported that case scenario discussions broadened their perspectives, improved their cooperation capacity and communication with each other. This teaching method, in turn, offers students an opportunity to enhance their judgment and critical thinking skills by applying theory into practice.

These skills are critically important because nurses need to have the necessary knowledge and skills to plan high quality care for their patients to achieve a speedy recovery. In order to attain this educational goal, nurse educators have to prepare students through different student- centered strategies. The findings of our study appear to show that when appropriately used, case-based teaching results in acquisition of disciplinary knowledge manifested by deepened understanding of course content, as well as reducing the gap between theory and practice and enhancing learner's test-taking-ability. The study also showed that cased based teaching enhanced learner's critical thinking ability and curiosity to seek and acquire a deeper knowledge. Finally, the study results indicate that case study analysis results in improved communication and enhanced team-building capacity, collaborative ability and improved oral communication and presentation skills. The study findings and related evidence from literature show that case study analysis is well- suited approach for imparting knowledge and skills in baccalaureate nursing education.

This study evaluated the usefulness of Case Study Analysis as a teaching strategy. We found that this method of teaching helps encourages deeper learning among students. For instructors, it provides the opportunity to tailor learning experiences for students to undertake in depth study in order to stimulate deeper understanding of the desired content. The researchers conclude that if the cases are carefully selected according to the level of the students, and are written realistically and creatively and the group discussions keep students well engaged, case study analysis method is more effective than other traditional lecture methods in facilitating deeper and transferable learning/skills acquisition in undergraduate courses.

Conflict of Interest: The authors declare no conflict of interest.

ORCID iD: Judie Arulappan https://orcid.org/0000-0003-2788-2755

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