CASE STUDIES

Jaclyn Stratman, RN-BC, BSN

Clinical Nurse, Captain USAF

Nurs8082 Learning- Centered Teaching

April 2014

“The case study builds on learned material

that encourages students to more fully

understand the content being presented”

(Sprang, 2010)

“The most common type of case study is

problem based, which requires learners to

develop solutions to a given scenario”

(Snyder & McWilliam, 2003; Sprang, 2010)

“Similar to clinical practice, case studies are

often designed to be complex and ambiguous,

offering the learner an opportunity to build

critical-thinking and problem-solving abilities.”

(Plack & Santasier, 2004; Sprang 2010)

AUDIENCE

Case studies can be used in all levels of nursing,

medicine, law and business education.

Used in lecture-based or discussion-based

classes

Group size can include: trios, quads, or larger.

TIME

Case studies can vary in length of time

Time on task

Duration of groups

DETAIL

Simple VS complex

Solution VS identify

STUDENTS

Note taking

Personal shared experience

Resources

IMPLEMENTATION

Classroom

Clinical post conference

Simulation lab

VARIATION

Bullet cases

Mini cases (vignettes)

Continuous case

Sequential-interactive case

SCIENTIFIC EVIDENCE

Orlando’s Theory

Watson’s Theory of Human Caring

OBJECTIVE

The student will be able to correctly assess,

identify, and chart the postoperative patients

sedation level, with adhering to the ASPAN

standards and regulations

OBJECTIVE

The student will be able to appropriately

administer analgesics based on the pt GSC,

Aldrete score, and pain/comfort level

OBJECTIVE

The student will be able to effectively

maintain an airway

OBJECTIVE

The student will be able to recognize and

identify signs and symptoms of hemorrhagic

shock

OBJECTIVE

The student will be able to verbalize how

they feel about their ability and comfort level

on how to care for a critical postoperative

patient and the care that they would have

provided.

CASE OVERVIEW

Amanda Box is a 23 y/o female G1P1 who

gave birth to a healthy 6lb 7oz baby girl 6

days ago. She delivered vaginally. She called

the clinic utilizing the on call telephone

triage nurse..

CASE OVERVIEW

By the telephone triage report, Amada states

she has a fever, increased abdominal

cramping, and a foul vaginal odor. The nurse

requested that Amanda comes in

immediately to be seen by the provider.

CASE OVERVIEW

When Amanda arrives at the clinic, her VS:

HR 62, BP 110/56, R 14, T 101.7, O2 100%

RA

CASE OVERVIEW

After an examination by the physician, it is

determined that Amanda still has remains of the

placenta inside her. She is immediately rushed to

surgery for a dilation and curettage (D&C) of

the remaining placenta.

SCENARIO

You are the PACU nurse receiving Amanda

directly after surgery.

OR NURSE REPORT

“ She had a D&C of the placental remains. They

had to try four times to completely get all the

remains out, so it took a while. I placed a peri pad

on her and she wasn’t bleeding when I placed it. She

lost 800cc of blood. That’s it!”

PATIENT PRESENTATION

Amanda comes out awake and shows facial

grimacing. She is c/o nausea and the

anesthesiologist is holding an emesis basin

under her chin.

ANESTHESIOLOGIST REPORT

“ She had a total of 50mcg of Fentanyl, 0.4mg

of Dilaudid, 4mg of Zofran, some Propofol,

and Versed, 500mL of normal saline, a dose of

Doxycycline IV, and I think that is it!”

QUESTION 1

What is your first step after hooking

Amanda up to the monitors?

SITUATION CONTINUED

Amanda’s nausea and pain has subsided and she is

now resting comfortably and her VS are stable.

Another patient comes out of the OR and you help

“land the patient”. You left Amanda to sleep for 15

minutes, when you arrive back at her bedside she is

c/o continuous pain.

QUESTION 2

What is your next step?

SITUATION CONTINUED

Amanda is medicated per your mar and her pain

is not touched. You check her peri pad because

she states, “I feel wet down there”. Your

assessment reveals a soaked peri pad with bright

red blood.

QUESTION 3

When/would you notify the MD of

Amanda’s bleeding?

SITUATION CONTINUED

You notified the MD who is currently in

another OR case, and she tells you to just

keep monitoring Amanda, and does not

seem too concerned.

QUESTION 4

What signs and symptoms should you be

looking for in hemorrhagic shock?

SITUATION CONTINUED

10 minutes later Amanda states that she is “

Itching like crazy”, and you get a VORB to

give 25-50mg of Benadryl IV x1 now.

Amanda continues to c/o pain and feeling

wet.

QUESTION 5

What adverse signs and symptoms are

possible from the medications that Amanda

has received?

SITUATION CONTINUED

A few minutes later Amanda c/o having

difficulty breathing, she becomes tachycardic

HR 150 and her BP drops, BP 98/49.

QUESTION 6

What is your next step?

SITUATION CONTINUED

You call a Rapid Response and the

Anesthesiologist and several staff are by

your side to help. The Anesthesiologist starts

to give orders…

QUESTION 7

What are some orders the Anesthesiologist

would give?

SITUATION CONTINUED

The MD is now out of surgery and at the

patient’s bedside. At this time the MD decides

to take the patient back to the OR. The OR

team takes over and takes Amanda back to

surgery.

QUESTION 8

Was there anything that you could have done

to prevent Amanda from going back to

surgery?

QUESTION 9

What things would you consider to discuss

in a debrief?

SUMMARY

REFERENCES

Abdoli, S., & Safavi, S. S. (2010). Nursing students’ immediate responses to distressed clients based on Orlando’s theory. Iranian Journal of

Nursing and Midwifery Research, 15(4). pp. 178-184. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093185/

Academichelp.net. (n.d.) How to write a case study. Retrieved from http://academichelp.net/academic-assignments/write-case-study.html

Carnegie Mellon. (n.d.) Design & teach a course. Retrieved from

https://www.cmu.edu/teaching/designteach/teach/instructionalstrategies/casestudies.html

Delpier, T. (2006). Cases 101: Learning to teach with cases. Nursing Education Perspectives, 27(4). pp. 204-209. Retrieved from

http://web.b.ebscohost.com.proxy.libraries.uc.edu/ehost/pdfviewer/pdfviewer?sid=e7fb7606-547c-4156-b37a-

0e59b9de7ea2%40sessionmgr112&vid=2&hid=122

REFERENCES

Eisenhardt, K. M. (1989). Building theories from case study research. Academy of Management Review, 14(4). pp. 532-548. Retrieved from

http://www.buseco.monash.edu.au/mgt/research/acrew/eisenhardt.pdf

National League for Nursing. (n.d.). Faculty programs & resources. Retrieved from

http://www.nln.org/facultyprograms/facultyresources/aces/millie.htm

Nilson, L. B. (2010). The case method. Nilson, L. B. (Eds.), Teaching at its best: A research-based resource for college instructors (3rd ed, pp.181-185).

San Francisco, CA: Jossey-Bass.

Noel, D. L. (2010). Occupational health nursing practice through the human caring lens. American Association of Occupational Health Nurses

Journal, 60(3). pp. 97-103. doi: 10.3928/08910162-20091216-02

Sprang, S. (2010). Making the case using case studies for staff development. Journal for Nurses in Staff Development, 26(2). pp. E6-E10.

Retrieved from http://www.nursingcenter.com/lnc/static?pageid=1071277