Decision Case Method In Nursing Education
What Is Decision Case Method,Implementation of Decision Case Method in Nursing,Impact on Nursing Education,Outcomes of Decision Case Methods.
What Is Decision Case Method
The decision case method employs
open ended cases to stimulate and develop decision making skills and critical
thinking abilities in students. Decision cases depict actual situations taken
from practice; the setting, practitioners involved, known background related to
the situation, and the scenario are all described in rich detail. The facts are
not altered, although the identifying information is camouflaged. Rather than
depicting a situation and providing the outcome, decision cases realistically
portray the often messy, ambiguous reality of practice without providing
solutions.
When teaching with decision cases,
providing information and lecturing on theory or content is replaced by a
Socratic method, which facilitates in-depth discussion and encourages the use
of analytical, critical thinking skills ( Wolfer , Freeman, & Rhodes, 2001
) . The student is required to step figuratively into the position of the
decision maker ( Leenders , Mauffette Leenders , & Erskine, 2001) and
confront the challenges of practice. Students learn by actually placing
themselves in real life situations where decisions must be made.
Implementation of Decision Case Method in Nursing
Preparing students to meet the
multiple, unique challenges faced in actual practice should be a top priority
for nursing education. Mastering content is not enough graduates must be able
to think like nurses and make difficult decisions in complex, risky situations.Decision case method teaching
brings clinical experience into the classroom and provides a safe venue for
exploring numerous situations, solutions, and potential outcomes. This
teaching/learning approach promotes evidence-based nursing through the
application of research and theoretical learning to actual clinical experiences
( McSherry & Proctor Childs, 2001).
Students learn not only from the
professor or a single preceptor, but from each other as multiple viewpoints are
explored. Potential outcomes of teaching with cases include ( Delpier , 2006)
development of critical thinking and judgment skills; practice making real
decisions; active versus passive learning; learning integration rather than
mere memorization of content, experiencing the reality of clinical topics; and
creation of a stimulating interactive classroom in which students are engaged.
McSherry and Proctor Childs (2001)
note the following benefits specific to nursing education: promotion of
multi-professional collaboration and teaching: involvement of patients and
careers in providing real life experiences of health care provision;
development of research awareness skills in the context of practice; and
acquisition of or consolidation of clinical skills in a safe environment (
McSherry & Proctor Childs, 2001).
Use of decision cases can move students’
thinking from a dual framework of right versus wrong to a generalization
framework of analyzing and evaluating the complexities of a situation (Perry,
1999). Additionally, retention of concepts, details, and facts is enhanced via
the use of narrative and picture memory (Moon & Fowler, 2008; Sandstrom ,
2006).
Impact on Nursing Education
The Institute of Medicine report,
The Future of Nursing: Leading Change, Advancing Health, recommended radical
changes in nursing education, including the replacement of highly structured curriculum focused on content and memorization of facts with new approaches,
which encourage content application in a variety of attitudes (Committee on the
Future of Nursing, 2011).
This was echoed in the report of the Carnegie
Foundation for the Advancement of Teaching, Educating Nurses: A Call for
Radical Transformation (Benner, Sulphen , Leonard, & Day, 2010). Decision
case method teaching provides a mechanism for bridging the gap between
knowledge and practice as recommended by these reports. It encourages
evidence-based nursing practice by allowing students to apply research and
theory to clinical situations ( McSherry & Proctor-Childs, 2001).
Use of case studies in nursing
education has a long history, but cases have most often been used as points of
emphasis or examples rather than a means of instruction (Harrison, 2012). The
decision case method was developed at Harvard Business School in the first
decades of the 20th century as a method for providing students with education
based on reality. Also, problem based learning was developed as a curriculum
modality at McMaster University Medical School in the 1970s and evolved as a
method for promoting critical thinking by applying content to clinical dilemmas
and practice settings (Williams & Beattle, 2007 ) .
While decision case method teaching
has been touted as a means for linking content and theory to practice, there
are challenges involved in using this method. Both students and teachers must
make adjustments and take risks in employing a new method for teaching and
learning. Students accustomed to the lecture/memorization method of learning
may feel unprepared for or resistant to a new approach that encourages creative
thought. The classroom environment must support open communication and
intellectual curiosity, and students must feel secure in the knowledge that
their ideas will be supported.
Outcomes of Decision Case Methods
The success of the decision case
method depends on both the instructor’s commitment to this approach and the
availability of decision cases. When using the decision case teaching method,
instructors must surrender the role of the authority providing information and
become a facilitator of learning who skillfully uses a combination of
questioning, listening, and responding to direct the session toward defined
learning objectives. Initially, the instructor may feel that he or she is on
“uncharted waters,” but with time this approach will become
comfortable and the learning outcomes will justify the initial risks involved
in trying a new approach.
Perhaps the greatest challenge when
using this method is locating or developing suitable cases. The process of
recruiting cases from practitioners, interviewing and documenting details, and
writing the case is labor intensive, and some persons may not be skilled in
writing narrative accounts. These obstacles could be over- come by working in
collaboration with a team with each member assuming certain responsibilities in
the process.
Students could also be involved in the process of recruiting cases
from nurses in practice, assisting with interviews, and reviewing the developed
case to ensure accuracy, this would not only result in decision cases for use
in the curriculum but also in greater exposure of the students to actual
practice scenarios (Head & Bays, 2010). Groups of faculty members might
agree to work together on such efforts and share the cases developed. It is
also recommended that cases be published and shared by educational
institutions, thereby creating a repository of cases from which instructors can
select cases appropriate for teaching specific course content.