Nursing Education and Decision Case Method What Is the Decision Case Method?
The decision case method is a teaching strategy that uses open-ended cases to develop decision-making skills and critical thinking in nursing students. Unlike traditional case studies that provide both the situation and its resolution, decision cases present real-world scenarios without predetermined solutions. These cases are drawn from actual clinical practice, described in detail to capture the complexity, ambiguity, and sometimes messy nature of healthcare settings. The specifics of each case — such as the setting, the practitioners involved, the background of the situation, and the unfolding scenario — are presented authentically, with any identifying information suitably camouflaged.
This teaching method differs significantly from conventional lectures or theory-based content delivery. Instead of providing information directly, educators using the decision case method employ the Socratic approach, which fosters in-depth discussions and encourages the application of analytical and critical thinking skills (Wolfer, Freeman, & Rhodes, 2001). Students are prompted to place themselves in the position of the decision-maker (Leenders, Mauffette-Leenders, & Erskine, 2001), thereby facing the challenges encountered in actual practice. By immersing themselves in real-life scenarios that demand decision-making, students gain valuable experience that can be directly applied in their future nursing careers.
Implementation of the Decision Case Method in Nursing
Preparing students for the myriad challenges they will encounter in real-world practice is a top priority for nursing education. Merely mastering theoretical content is not sufficient; graduates must learn to think like nurses and make complex decisions in dynamic and high-stakes situations. The decision case method brings clinical experience into the classroom and provides a safe environment to explore various situations, decisions, and potential outcomes. This teaching and learning approach promotes evidence-based nursing by encouraging students to apply research and theoretical knowledge to actual clinical scenarios (McSherry & Proctor-Childs, 2001).
Through this method, students do not solely learn from the professor or a single clinical preceptor but from one another, as multiple perspectives and approaches are explored. The decision case method offers several potential benefits, including the development of critical thinking and judgment skills, the practice of making real-life decisions, the transition from passive to active learning, the integration of knowledge rather than mere memorization, experiencing the realities of clinical topics, and fostering an interactive and stimulating classroom environment that engages students (Delpier, 2006).
Additionally, McSherry and Proctor-Childs (2001) highlight several benefits specific to nursing education, such as promoting multi-professional collaboration, involving patients and caregivers in providing real-life healthcare experiences, developing research awareness skills within the context of practice, and acquiring or consolidating clinical skills in a safe environment. By engaging with decision cases, students can move away from a binary framework of right and wrong, towards a more nuanced framework that involves analyzing and evaluating the complexities of situations (Perry, 1999). The use of narrative and visual aids further enhances the retention of concepts, details, and facts (Moon & Fowler, 2008; Sandstrom, 2006).
Impact on Nursing Education
The decision case method aligns with the recommendations outlined in several landmark reports on nursing education. For instance, “The Future of Nursing: Leading Change, Advancing Health” by the Institute of Medicine (2011) calls for radical changes in nursing education, including moving away from highly structured curricula focused on content memorization towards approaches that encourage the application of content in various contexts. Similarly, “Educating Nurses: A Call for Radical Transformation” by the Carnegie Foundation for the Advancement of Teaching (Benner, Sutphen, Leonard, & Day, 2010) echoes this call for transformation in nursing education.
The decision case method offers a practical mechanism for bridging the gap between knowledge and practice as recommended by these reports. It fosters evidence-based nursing practice by allowing students to apply research and theoretical frameworks to real-world clinical situations (McSherry & Proctor-Childs, 2001). While case studies have been a long-standing component of nursing education, they have traditionally been used to illustrate or emphasize certain points rather than serving as a core instructional method (Harrison, 2012).
The decision case method was developed at Harvard Business School in the early 20th century to provide education grounded in real-world scenarios. Later, in the 1970s, problem-based learning was developed as a curriculum modality at McMaster University Medical School, designed to enhance critical thinking by applying content to clinical dilemmas and practice settings (Williams & Beattie, 2007). Although decision case method teaching has been praised for its ability to link content and theory to practice, it also presents certain challenges. Both students and educators must adapt to and embrace the risks associated with adopting a new approach to teaching and learning.
Students accustomed to the traditional lecture and memorization methods may feel unprepared for or resistant to an approach that encourages creative and independent thought. Therefore, the classroom environment must promote open communication, intellectual curiosity, and a sense of security that assures students their contributions will be respected and valued.
Outcomes of Decision Case Methods
The success of the decision case method relies heavily on both the instructor’s commitment to this pedagogical approach and the availability of suitable decision cases. Instructors who use the decision case method must shift from the traditional role of an authoritative source of information to that of a facilitator of learning. This shift requires a combination of questioning, listening, and responding techniques to guide discussions toward defined learning objectives. While this transition may initially feel like navigating “uncharted waters,” with time, instructors often find that this approach becomes more comfortable and that the learning outcomes justify the initial discomfort and risks associated with trying a new method.
One of the greatest challenges of using the decision case method is the development or procurement of appropriate cases. The process of identifying cases from practitioners, conducting interviews, documenting details, and writing comprehensive narratives can be labor-intensive and may require specific writing skills. However, these challenges can be mitigated by collaborative efforts. For example, educators could work together as a team, with each member assuming specific responsibilities in the case development process.
Additionally, involving students in the case development process — such as recruiting cases from practicing nurses, assisting with interviews, and reviewing the final narratives for accuracy — can provide them with a deeper understanding of actual practice scenarios (Head & Bays, 2010). Groups of faculty members could also collaborate to create a shared repository of cases for teaching specific course content, which could be made available to other educational institutions.
Conclusion
The decision case method offers a dynamic and effective way to enhance nursing education by developing critical thinking, decision-making, and analytical skills in students. By immersing students in real-life scenarios that demand problem-solving and decision-making, this method bridges the gap between theoretical knowledge and clinical practice. Furthermore, it encourages evidence-based practice by providing opportunities for students to apply research and theoretical frameworks to actual clinical situations.
While there are challenges associated with implementing the decision case method, such as resistance from students accustomed to traditional teaching methods and the difficulty in sourcing or developing suitable cases, these challenges can be overcome through collaboration, creativity, and a commitment to innovation in nursing education. The decision case method aligns with contemporary calls for transformation in nursing education, providing a valuable approach to preparing students for the complexities and demands of real-world practice. As nursing education continues to evolve, the decision case method is likely to play an increasingly important role in shaping the next generation of competent and confident nursing professionals.