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The Old School Tool Every Nurse Educator Must Continue to Use

By August 4, 2016 February 1st, 2019 2 Comments

As our society embraces technology that has since rendered the cassette tape, CD  and the last generation of cell phones obsolete, this trend can also influence the way that nursing is taught.

It is not enough to have a basic Sim-Man, but the highest fidelity of simulation manikins must be sought after even if they approach six figures in cost.

The latest in technology including clickers, computer based simulation, etc. have a potential bias to being the latest in technology and an improved way to teach.

Though technology can facilitate learning, nurse educators must evaluate and determine if these expensive tools are NICE to have or NEED to have based on their ability to develop nurse thinking and clinical practice skills.

In a recent review of the nursing literature, Popil (2011) identified one pedagogy that is LOW cost but HIGH in learning value because it promotes critical thinking.

This approach to teach any practice-based profession has been around for decades and can be considered old-school.

But this old-school tool still has the power to not only strengthen student learning but also transform nursing education!

What is this old-school tool?

Case studies.

Old School Pedagogy

in a recent survey of nurse educators, one of the greatest struggles that educators face in the classroom is a lack of engagement of students in the learning process.

As adult learners, students are looking for RELEVANCE and to be actively engaged in the learning process.

In a traditional content lecture where students are PASSIVE, student engagement begins to drop markedly after 20 minutes and 80% of knowledge is not retained after 24 hours.

Though there are many forms of active learning, case studies is one of the easiest and consistent ways to bring active learning to develop nurse thinking and breathe new life into this environment.

Active learning strategies have been shown to promote critical thinking (Popil, 2011). They require active involvement and the need to use problem-solving skills and decision-making in a nonthreatening environment.

A good case study does not give simple answers, but provokes student thinking and how to think professionally using what they have been taught in academia to resolve the clinical problem. Because they are based on real-life practice and scenarios this salience is a strength that can prepare students for clinical realities.

Content vs. Context

in order to transform nursing education, content must consistently be contextualized to the bedside. Content that does not have this hook is abstract which makes it more difficult for students to understand and realize the relevance of what is being taught (Benner, Sutphen, Leonard, & Day, 2010).

As a newer nurse educator, I recognized the need to contextualize my lecture content with case studies and not regurgitate the textbook. But not all case studies are created equal.

When I reviewed the case studies that were supplied by the textbook publisher, I observed two weaknesses that limited their effectiveness because they did not closely mirror clinical realities:

  • Emphasized application of CONTENT, but not a similar emphasis on the THINKING.
  • Answers for case studies were MULTIPLE CHOICE. In practice you either know what to do or NOT, you do not have the luxury of multiple choice. Therefore, this approach has limited effectiveness to assess student ability to apply and use knowledge.

Five Strengths of Case Studies

Popil’s review of the nursing literature on case studies revealed the following strengths of this practical pedagogy:

1. Facilitate active/experiential learning

Because case studies present a scenario with reflective questions, engagement and participation is not an option! Case studies utilized in the classroom can make it possible for educators to be that “guide on the side” instead of the “sage on the stage” and allow students to create, construct, and present what they have learned to one another and to the class.

2. Identify problems

A key component of clinical reasoning is the ability of the nurse to recognize what clinical data is relevant. What data is RELEVANT and a clinical RED FLAG as the history, current lab values, and most recent nursing assessment, vital signs etc are reviewed.

Once relevant clinical data is recognized, a potential problem or complication is also revealed.

The failure to recognize relevant data is the root of failure to rescue that results when a nurse fails to recognize a patient complication that needlessly progresses and can result in patient death as a result.

3. Experience clinical dilemmas

Nursing has clinical dilemmas that though infrequent, the nurse must know and be prepared to respond appropriately. How should the nurse respond when a physician or surgeon is uncivil or has alcohol on their breath?

What if the nurse is concerned when aggressive medical treatment is insisted by the family, but is NOT what the patient may have wanted or communicated.

What should the nurse do? Case studies can be situated and contextualize these and other dilemmas so that students are well prepared to respond ethically and professionally when it happens after they graduate.

4. APPLY theory/USE knowledge

in order to be well prepared for a practice-based profession, students must not know enough to pass the test, but be able to USE and APPLY knowledge to the bedside.

Well developed case studies with salient scenarios can provide the opportunity to use what has been taught and apply to strengthen student learning.

Just as clinical educators use questions to assess student learning and knowledge, questions that emphasize the thinking of clinical reasoning can be integrated into a case study to evaluate student learning in the classroom.

This provides educators immediate evaluation and recognition of what was not “caught” so it can be addressed before the test!

5. Safe environment to practice

When high fidelity simulation is used in the skills lab, it may be only a matter of time before an adverse outcome or even patient death occurs if the student makes an incorrect clinical judgment,

Fortunately this is not a real person and essential takeaways that will strengthen student learning occur.

In the same way, consider a well-developed case study as low fidelity simulation because it represents salient clinical realities and provides an opportunity to bring this clinical context to the classroom.

In order to transform nursing education, clinical realities must be integrated into the classroom (Benner, Sutphen, Leonard, & Day, 2010). By consistently utilizing salient case studies in your classroom, you will  strengthen student learning and bring needed change and transformation!

In Closing

Case studies are effective teaching strategies that promote active learning and encourage the development of critical and clinical thinking skills.

Despite the overwhelming evidence regarding the effectiveness of case studies to prepare students for practice, case study pedagogy is not consistently implemented by educators.

Popil ends her article by stating, “I call out to educators today to use case studies more widely” (Popil, 2011, p. 207).

What about you?

Do you consistently use salient case studies in your classroom or clinical post-conference to strengthen the learning your students?

Embrace this practical pedagogy that has the power to strengthen student learning and bring new life into the classroom setting.

Though change is often difficult, do what is needed to do things differently to strengthen student learning.

Consistent use of case studies can help practically prepare students for a practice based profession!

What do you think?
How have you effectively implemented active learning in your classroom? What were your biggest barriers?
Comment below and let the conversation begin!

Want More?

TeachToTransfrom-sm (1)Two years ago I completed the rough draft of my manuscript tentatively titled “Teaching to Transform: Practical Strategies for Class and Clinical.” Todays blog was derived in part from my chapter on Transforming the Classroom.

I am on schedule to finalize my manuscript and publish by the end of the year just in time for Christmas and winter break! Stay tuned for details!

New OB Case Studies!

I just posted two OB topics that will put into practice the emphasis of todays blog!


  • Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
  • Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31, 204-207.

Join the discussion 2 Comments

  • Theresa L. wharton says:

    I reworked what was the traditional “GI lecture” into ‘nutrition and elimination’ and taught it with case studies this semester.
    I used my power points (which were full of clicker questions and ‘mini’ cases) into unfolding cases.

    First, I made a list of the ‘topics/conditions’ we used to cover. then I rewrote them as “What does the nurse need to know? Example a soft abdomen is good, a rigid abdomen is baadd. Or long term inflammation of an organ leads to scarring. Scarring leads to lack of function. Lack of function of organ x looks like a, b, and c.

    What I learned:
    1. I had them come with a vocabulary list already filled out. Ex – define fibrosis. I learned – make it longer – I had students who could not understand “gastric”.
    2. The big words do count. I created mock radiology reports using the terms I know are used. They struggled with these. Nurses must understand the significance of reading about opacities, effusions, etc…
    3. Include the names of surgeries in the look up list – ex- Gastric fundoplication. Next semester I am going to give some points for coming with definitions of the surgeries IN THEIR OWN WORDS.
    4. It takes students longer than you expect to finish a case study. OK – I knew this already, but plan time and one half for what you think it will take.

    • Keith Rischer says:

      What a great example of the creativity of nurse educators to strengthen student learning and also transform nursing education! Well done!

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