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.
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