Nursing Education and Decision Case Method

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.