Didactic Case Study

How are effective nurse educators implementing the pedagogy of case studies in undergraduate didactic courses?

The implementation strategies of case studies by the faculty yielded two primary patterns: (a) Formal Implementation (FI), and (b) Informal Implementation (II) of case studies. The FI of case studies produced two subcategories: (a) the use of Formal Implementation Inside the Classroom (FIIC) and (b) the use of Formal Implementation of case studies Outside the Classroom (FIOC). The pattern of FI case studies indicates that the case studies were preplanned and were in written format. The students had access to the cases before class or were given them during class either via a PowerPoint® slide or on a separate sheet of paper. The pattern II of case studies is meant to reflect the impromptu use of case studies that were delivered verbally during class time. They were not written down in any form. These informal case studies were often a reflection of personal clinical experiences of the nurse educators. See Table 2 for culminating themes, and Tables 3 and ​4 for examples of emerging patterns that ultimately lead to designated themes for both FI and II case study presentations. See Table 5 for a comparison of the two guiding theoretical frameworks and the developed themes for research question two.

Examples of formal implementation of case studies inside the classroom

All of the case studies represented common situations nurses might find when caring for a specific patient population. Amy utilized cases within the classroom by presenting a situation and then having the students carry out the case with impromptu role playing. For instance, one of her cases involved the students interviewing an expectant mother regarding illicit drug use before and during her pregnancy. Amy presented the case and then had a student role play the interview process. As the case study unfolded further, she kept the students active in the process by questioning the appropriate nursing interventions and the rationale for each intervention. Betty and Dana used an even more formal methodology. Students brought case studies into class and then, as a group, responded to prearranged questions. Dana sometimes had the students break into small groups to work through a case; she then had the class come back together as a whole and each group discussed their responses.

Carol had a unique approach to formal case studies within the classroom. Within Carol’s syllabus, the session was represented by “case-study day.” Students were told to bring their reference books and laptops to class. No other information was provided. The class started with Carol having her students break-up into groups. She handed out a case study to each of the student groups. She advised the students there would be no lecture, only a series of case studies that the students were going to analyze and present to the class. Carol termed this case study approach a form of problem-based learning.

One example of a case involved a Hispanic male who did not speak English, lived 70 miles away from the nearest hospital, and had to depend on family members for transportation. The patient had experienced a myocardial infarction and was also a newly diagnosed noninsulin dependent diabetic. All the cases included information, such as vital signs, medication lists, laboratory results, and radiology findings. Each group had a different case to present. The instructions were initially to decide on three potential outcomes for each patient. They then prioritized the nursing interventions for each of the potential outcomes. Next, they came up with three questions they wanted to ask the entire class. Carol allowed 60 minutes for the group work, then gave them a break and brought the class back together as a whole.

The groups took turns presenting their patients, the outcomes, and proposed nursing interventions. They led discussions regarding the three questions they asked the class, which were a mixture of thought-provoking questions and factual questions specific to nursing care. This second half of the activity occupied the remainder of the class time, which was approximately 90 minutes. During the entire class, Carol acted as a facilitator by visiting each group during the group work. Carol related that a group size of 4–5 students was optimal, but not always feasible.

Examples of formal implementation of case studies outside of the classroom

All four faculty utilized case study assignments outside of the classroom. Some of the case studies were assigned with grades given, and some were formative. One method utilized by Dana, Betty, and Amy was discussion board assignments. Case studies were posted on the course management system, Blackboard®. The discussion board responses from the students were monitored for participation points by the instructor. Carol utilized outside of the classroom assignments in a slightly different manner. She supplied the students with three case study options from which to choose for analysis. Students took the case studies home and worked on them. She gave each student a template of how the case should be presented. Carol encouraged study groups to work on the case studies at home, but required individual submission of case analysis.

Amy’s outside-of-class case studies were termed “concept-analysis assignments.” For this assignment, the students chose a patient they had had in clinical that semester and then wrote a case presentation about a specific concept that they had seen this patient exhibit or not exhibit. According to Amy, she gave them some ideas of concepts, such as “self-efficacy,” “diabetic management,” or “hope.” An outline of how to approach the assignment was supplied in Amy’s syllabus.

Examples of informal implementation of case studies

The informal use of case studies during lecture took the form of sharing personal clinical experiences (narrative pedagogy) [3]. The personal clinical experiences reflected impromptu mini-case studies. Each of the four participants responded that they used personal experiences liberally within their lectures to present specific concepts. Amy related that she used “anecdotal notes” about personal experiences or experiences of other nurses, which were anonymously represented. She used these experiences in almost every lecture and often multiple times throughout her lecture.

Betty stated, “It just happens. I’m an oncology nurse and I have lots of stories.” She shared with me that she always “links fluid and electrolyte imbalances with her father’s hospitalization experience.” Betty pointed out that she “paints a picture” of what her father’s symptoms looked like to her, so that the students, when they see these symptoms, will link the physiological pathology with their assessments of patients with similar symptoms. Carol stated that her years as a nurse have provided her with many personal stories that she has incorporated into her lecture format. She further explained that it is not only the physiological aspects of her mini-cases that she included in her stories but also “the emotional components of them as well.” Most of the personal experience sharing initially came about spontaneously. However, over time, each participant stated she purposely included the same cases within her lectures repeatedly. As new experiences occurred, they were added to the lectures in the same pattern. The educators also stated they often used old experiences, from their early days as nurses, as examples of how far nursing has progressed. According to Dana, the sharing of real-life examples provided examples of how nursing care constantly changes; she used her old nursing stories to stress the importance of staying current with academic nursing journals and evidence-based practice.

Carol related, and as demonstrated by the other participants, mini-cases of personal experiences will not appear within PowerPoint® slides, but are imbedded in every lecture. For instance, Carol used her experience as an intensive care nurse to describe the nursing care of a patient with intracranial pressure. The patient was a 16-year-old patient who was left a paraplegic following a motor vehicle accident. She was discussing the purpose of intracranial monitoring and related a specific incident regarding utilizing the monometer at the appropriate height.

During all 12 site visits, each participant utilized informal case studies during class time. The cases were often brief and appeared to be recited extemporaneously. Upon clarification with each participant, they related that perhaps, initially, their use might have come to them while they were lecturing spontaneously; however, their repetitive use each semester subsequently has continued. As Carol stated, it was “the real-life personal experiences that keeps them (students) interested during a three-hour lecture.” According to the Amy, the students want to know about “real-life” nursing.

Research question 2

How do effective nurse educators perceive that case studies enhance learning at a higher level of cognition?

Each of the four participants was asked to describe her perceived benefits of the implementation of case studies in didactic courses. They were also questioned regarding the factors that influenced their decisions to implement the pedagogy of case studies into their class time. According to the participants, the students were asked to participate in the learning process when they used case studies. They have to “think,” according to Dana. She believed that the use of case studies has helped integrate the content within the didactic portion of nursing school and the clinical. Betty stated that case studies are “nursing in action.” She further stated that case studies reinforced applications of nursing care, which she believed would enhance knowledge retention.

Carol had a term for instructors who adhered to a traditional lecture format in their didactic course and never varied their pedagogies: the talking head. She explained that she had been trying to be more of a guide to learning in the classroom rather than the person simply standing at the front of the room doing all the talking. Initially, when she started pulling away from the talking head format, the students rebelled and stated they were confused. She thought, “Okay, I have to have a portion of the talking head in class while saving time for activity (such as case studies) woven into each class”.

Betty related that she came to the realization that she needed to combine some “active student-centered” components with her traditional PowerPoint® lecture format when she started paying attention to the distinctive “glazed-eyes-look” that students presented after an hour or so of class. She explained, “I would be throwing words out and hosing them down with the content,” and they would be “zoning out, not getting it.” Betty concurred with Carol that you cannot eliminate completely the traditional lecture format because students have a certain comfort level with this tradition; however, both are quick to defend the addition of an active-learning environment.

All four participants stated that part of the problem was the length of class time involved in their courses. All of them had class times that were 3 hours long, once a week. To keep the students active in the learning process, they stated they combined a learner-centered pedagogy and lecture with traditional PowerPoint® presentations on a routine basis. Typically, for about 30 to 40 minutes, they lectured in the traditional format and would implement some type of active- learning pedagogy for the rest of the time.

By David Myers, Stacie Nicole Smith, and May Shaer; 2010

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This case study, a collaborative project of the Getty Conservation Institute and the Jordanian Department of Antiquities, presents management of the archaeological site of Jarash, Jordan at a particular moment—between January and August 2007.

The publication has been designed as a didactic tool for use in academic programs, short courses, and workshops in heritage conservation, management, and planning. It is also relevant to educational and training programs in urban and regional planning, development studies, and dispute resolution.

It provides an opportunity for students and heritage professionals to learn about using a values-based process for decision making in heritage site management, including identifying stakeholders, eliciting their values and interests, writing a statement of significance, and considering stakeholder concerns in developing and selecting options for site conservation and management. It is also designed to provide an opportunity for learning about the application of consensus building strategies to heritage management.

The case study does not presume instructors or participants have any direct affiliation with or knowledge of the site of Jarash, or with the Kingdom of Jordan. It includes sufficient background information about the site and its context to complete the activities that it contains.

NOTE: A companion volume, Teaching Materials, is available to educators for download by registering online.

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Foreword, Preface, and Acknowledgments Pages i-x. (PDF, 11pp., 1.9MB)
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Introduction, Jarash in the Past and Today, The Management Context Pages 1-33. (PDF, 33pp., 4.4MB)
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Activities for Identifying & Dealing with Values and Stakeholders (Overview) Page 34. (PDF, 1p., 131KB)
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Activity 1: Identifying Values and Writing a Statement of Significance Pages 35-38. (PDF, 4pp., 221KB)
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Activity 2: Identifying Stakeholders and Their Values and Interests Pages 39-40. (PDF, 2pp., 168KB)
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Activity 3: Interviewing Stakeholders to Further Understand Their Interests and Positions Pages 41-42. (PDF, 2pp., 143KB)
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Activity 4: Developing Recommendations for a Site Management Plan Pages 43-58. (PDF, 16pp., 1.1MB)
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Appendixes, Glossary, References, and About the Authors. Pages 59-77. (PDF, 20pp., 676KB)
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How to Cite this Work
Myers, David, Stacie Nicole Smith, and May Shaer. 2010. A Didactic Case Study of Jarash Archaeological Site, Jordan: Stakeholders and Heritage Values in Site Management. Los Angeles, CA; Amman, Jordan: Getty Conservation Institute; Dept. of Antiquities, Hashemite Kingdom of Jordan. http://hdl.handle.net/10020/gci_pubs/jarash_case_study

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