Case Scenario Utilization in Nursing Education
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What is Case
Scenarios in Learning
A case scenario is a comprehensive analysis learning during
instruction of course material (Rowles, 2012). Case scenarios encourage
critical thinking through application of theory and didactic content to real
or simulated life situations. The term case scenario is used interchangeably
with case study, case problem case report, and research case. Attributes of
case scenarios may be exemplified through social drama and role play
methodologies that incorporate theatrical presentation of classroom theory.
Case Scenario In Nursing Education
Development of critical thinking and clinical reasoning is
essential to the education of nurses. Clinical reasoning encompasses reflection
(Benner, Sutphen, Leonard, & Day, 2010) and ability to use critical
thinking skills to accommodate the ever changing nature of clinical environments
(Rowles, 2012) Throughout history, nurse educators have relied on clinical
rotations to provide experiential learning for students; However, clinical
learning opportunities vary depending on care needs of patients and available
clinical sites.
Considering the impact of multiple variables on clinical
learning, there is a call for nursing education to be transformed through the
use of active teaching and learning strategies, one of which is the case
scenario, many students learn through inductive rather than deductive reasoning
they learn better from examples, and benefit from applying what they have
learned in the classroom to real world situations.
Case scenarios, written from
rich clinical experiences, may be used as an adjunct to a mini lecture or
customized to assist students with applying course specific theory to real life
in an active learning environment.Multiple case scenarios incorporated in a
classroom setting allow smaller groups of students to identify similarities and
differences among cases. Well designed cases should illustrate critical
concepts in a nonthreatening environment to ensure active student
participation.
Engagement in case study discussion promotes development of
analytical and problem-solving skills and improves students’ decision making
abilities in complex situations. Comprehension of concepts may be reinforced by
pairing the case with a reading assignment and/or through utilization of
concept maps, chalkboards, and electronic resources.
Use of a framework to foster development of clinical
reasoning promotes integration and application of theory to practice in the
clinical setting. The concept of case-based reasoning (CBR), born of research
in the 1980s, suggested that individuals not only organize different types of
knowledge through identifying schema like knowledge structures, they also
simultaneously make inferences determined by those knowledge structures
(Kolodner, 2 006 ).
Researchers’ observations further indicated that there are
processes that allow a reasoner to reason on the basis of previous experiences.
Considering these findings, the use of a framework based on principles of CBR
has potential for designing learning environments, including adult education,
K-12 classrooms, and undergraduate education.
In CBR, a case includes a setting, actors and actor’s
goals, sequence of events, expected results, and explanations that link
outcomes to goals and means; Intelligent behavior is determined by a person’s
ability to identify significant features of a new situation and apply previous
experiences to solve problems (Kolodner, 2006).
Although reflection on learning
has been linked to more complex thinking, particularly in the practice
dimension of clinical reasoning, students must actively engage with the
theoretical, psycho-motor, and effective content inherent in nursing to
transform information into their own knowledge (Rowles, 2012).
Focused
reflection to reason on the basis of previous experiences and critical thinking
to find answers they will not find in a book. Use of a holistic nursing
knowledge base allows nurses to think through patient situations and provide
individualized evidence-based care as opposed to following a routine procedure.
Nurses engage in meta cognition (reflective thinking), a self-communication
process, before, during, and after performance of a task or skill (Rowles,
2012). Metacognition and critical thinking, when combined, have been described
as the thinking required in nursing (Kuiper & Pesut, 2004). Participation in
a case study discussion promotes formulation of varied and unique ideas at both
the individual and collaborative levels, thus broadening the knowledge
integration perspective (Linn, 2006).
Implementation of Case Scenario In Nursing Education
Learning involves a relatively permanent change in cognition
that results from experience and directly influences behavior. Active learning
strategies such as case scenarios that prepare students for challenges of the
health care environment are supported by the American Association of Colleges
of Nursing (AACN, 2009). Benner et al. (2010) support radical transformation in
learning, whereby educators promote clinic like experiences that inspire
students to apply knowledge and practice thinking to changing situations to
improve patient health outcomes.
According to Benner’s theory, students’
perceptual awareness of emerging clinical problems closely parallels their
level of clinical competence (Larew, Lessans, Spunt, Foster, & Covington,
2006). Case scenarios can be written for simulated learning opportunities, designed
to emphasize various nursing concepts, and used in collaborative education
environments at multiple levels of learning (Hannah & Oliver, 2011). This
evidence-based teaching methodology promotes exchange of ideas between
information and practice, and assists students with identifying “practice
evidence” on which they can base care of clients in the future.
Benefits to use Case Scenario In Nursing Education
Nurse educators have a professional responsibility to
incorporate established standards and clearly articulated student learning and
program outcomes consistent with contemporary practice in the educational
preparation of students (Accreditation Commission for Education of Nurses
(ACEN), 2013). Benner et al. (2010) and the National League for Nursing (2005)
recognize the need to transform knowledge by designing nursing curricula that
mirror contemporary health care trends, thus preparing graduates to perform
effectively in the health care arena.
The nurse educator facilitates learning
by modeling critical and reflective thinking Use of case-based scenarios
promotes the cognitive, psycho motor, and effective development of nursing
students. Case scenarios stimulate critical thinking, may be presented in more
practical context, can be used in a safe environment without threat to a patient
(Rowles, 2012), and have potential to simulate real life situations,
particularly among an aging population with multiple organ disease and
disabilities.