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According to Gilson (2010), a case study approach is a particular useful research methodology that is normally employed in case of obtaining in-depth appreciation on the topic of interest. This topic may vary from issues, events or phenomena of interest, which are researched on their natural real-life context. The multi-facet exploration of complex issues in their real-life settings using a variety of data sources as contributed by a case-study approach has made it to be a well-recognized method, especially in the field of business, law, policy, and health services. In the latter, when a case-study is qualitatively applied correctly, it normally becomes a valuable method for the field of health science research. Moreover, it helps in developing theories, evaluating programs, and more significantly developing of medical interventions (Gilson, 2010).
Gilson (2010) notes that a case-study approach to research ensures that issues under study are not only explored through one lens, but rather through a variety of lenses that effectively allow for multiple facets of the event to be revealed and understood. According to the author, a case study approach is usually considered when focusing on a study in trying to answer how and why questions. It can also be used when a researcher is not in a position to manipulate the behavior of those involved or when covering contextual conditions that are believed to be essential for the phenomenon under the study. Additionally, a case study approached can be used when there is no clear boundary distinction between a phenomenon and context.
For instance, a case-study approach has been used in studying the decision making processes of nursing students in trying to determine the type of decisions they make and factors that influence such decisions. Having such a case-study is essential as it entails the main components of which the study was chosen. This paper, thus analyzes the findings of two case studies on nursing student’s decision making process. It also evaluates the approach, validity, and conclusions of the same two case studies related to the topic. Moreover, the article proposes ways of addressing challenges associated with case-study approached based on the topic under study.
Analyzing Findings of Case-Studies
As pointed out by Gilson (2010), the main objective of carrying out analysis of case studies is to generate findings of relevance, which are beyond individual cases. This research methodology as the writer acknowledges seems to be appropriate, especially when investigating a large variety of factors and relationships, of which there is no basic laws to determine such interactions. In this respect, analyzing cases studies helps in developing a comprehensive model that describes the pattern of student nurses’ decision making behaviors. In so doing, researchers are able to develop sharper awareness of the special problems associated with nursing decisions, thereby gaining a variety of insights, which are essential in improving nursing students’ decision making processes.
Garrett (2009), in his article, presents important case study findings that are essential in determining the factors that influence the decision making of these students. The research findings projected in this case study is essential, because it explains, describes, and more so explores events of the undergraduate nursing student’s perceptions of clinical decision-making skills. Through his findings, nursing students at times demonstrate a complicated theoretical conceptualization of clinical decisions they normally make. This is due to the fact that nursing students normally tend to focus on the impact of their decision and the value of the concrete clinical experience rather than recognizing the value of cognitive skills that is essential in decision making process (Garrett, 2009). Significantly, nursing students at times do not apply decision-making theories into their practices. This results into negative perception towards nursing.
Based on Garrett findings, a case study approach has phenomenological nature. This has enabled researchers to utilize non-experimental approach. This makes the use of the cross-sectional description designed for a specific study, thereby helping in countering manipulative aspects associated with large data sources use in investigation. According to him, case study approach has appealed more to nursing students not to link their level of clinical knowledge and experience with the level of skills they have for decision-making. However, rather, they should link their clinical decision making ability with their cognitive ability.
Through such findings, policy makers are enriched with inductive logics that not only help them in investigating the validity of the research findings, but rather restructure nursing programs in order to enhance student’s cognitive ability. As Garrett (2009) asserts, students normally identifies the patient as the focal point for their clinical decision-making. In so doing, they reflect the same on their personal concerns, which in turn points out to the quality of care as the main factor influencing their clinical decision-making.
On the other hand, Baxter (2008) article findings present a contextual nature for which a case study is designed. Through his findings, the case study was chosen because it involves case of decision making that could not be considered without the context of the School of Nursing. According to him, understanding the clinical decision made by nursing students can effectively be understood by interactively knowing the clinical and classroom settings under which nursing studies are incorporated. Therefore, it would be imperatively impossible to have true picture of nursing student decision making if the context within which it occurs has not been considered.
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To Baxter (2008), the inability of nursing student’s to make insightful decisions that demonstrate their cognitive ability is affected by the policy, nursing program, and professional environment. Since such environmental settings has strong evidence practices that enhances their decision making process. Therefore, he points out the weakness of case study research in providing systematic measures that can effectively help in devising standardized classroom nursing environment as have been the cause of such inequities.
Evaluating the Approach, Validity, and Conclusion of the Case Studies
The two above highlighted case studies have incorporated element of cases study approaches in validating their findings and conclusions. In his case study, Garrett (2009) uses non-experimental approach in utilizing a cross-sectional descriptive design that was used in coming up with inclusive and decisive findings and conclusions. This helps in understanding the factors that influence nursing student’s decision making. According to the author, non-experimental approach helps in emphasizing the unit of analysis that is essential for validating and projecting case study findings. He believes that considering the question to address in research study requires first determining what the case is. This helps in determining what unit of analysis (case) can be devised. This is essential as it helps in validating the findings captured in the case study research.
Garrett (2009) asserts that the quest for a unit of analysis (case) enabled him in having constructive and comprehensive findings that made it possible to validate the same. While the case of Garrett (2009) study is “The decision making process of nursing student on their final year of adult nursing studies,” he develops a research question of “How do nursing students at their final year of nursing studies decide to have clinical decision about patient care? What factors influence their decisions?” This formed the basis from which he developed hypothesis in order to research and validate his findings.
Baxter (2008), on the other hand, uses exploratory and explanatory approach in analyzing the unparalleled data that was collected from thirty three- second year and thirty one-third year nursing student in a diploma nursing school. In justifying their findings and conclusion, he uses questionnaires to progressively focus and develop assertions on how nursing students view clinical decision making as constituted by their classroom environment. Through enhanced participant observation and participation coupled with document analysis of literature review, the research provided findings that illustrated the influence of classroom setting on student’s decision making process.
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Reasons and Challenges of Using Case-Study Approach
There are two main reasons for conducting a case-study approach with a sample population. First, it entails sufficiently use of large sample size in order to reduce the chances of discovery failure. Second, it helps in obtaining sufficient findings that are essential in providing ethical reasoning that does not expose the subject under study to potential harmful treatment without initiating knowledge advancement. The above aspects, therefore, helps in determining and understanding factors that influence nursing students’ decision-making towards patient care.
However, conducting case-study research with a sample population can normally encounter challenges. These challenges associated with sample population are based on the characterization of the population number and the selection of subject under examination. Having under-size nursing student population normally limits the influence of outliers or extreme observation. Additionally, an under-size population can be a waste of resources, thereby not providing useful results. As pointed out by Gilson (2010), under-size sample in case-study is not capable of effectively producing useful results that help in exploring the issue under the study. This is due to the fact that under-size sample size normally results into ethical reasoning that exposes the subject to potential harmful treatment without initiating knowledge advancement due to its lack of full representation.
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Nevertheless, this can be addressed by incorporating a large sample size in the case-study. This would broaden the possibility of getting a variety of data and forms of which would help in better understanding the issue being studied. Additionally, snowball sampling employed in order to identify the otherwise unknown users of clinical decisions that are made by nursing students. In so doing, it offers comprehensive characteristic of unknown population, which influences student’s decision making.
Similarly, case-study approach just like other research methodologies has both advantages and disadvantages. Case-study approach helps in setting insightful grounds for the future studies. This is due to the fact that it provides a great amount of description and details concerning a particular case, which can be used as reference in future (Gilson, 2010). Its descriptive, explanatory, and inclusive nature helps in avoiding problems associated with statistical analysis. Therefore, it explores theories that are introduced when using empirical methods and are the root cause of such statistical problems.
On the other hand, case-study approach is disadvantageous, because it does not enhance researcher control over events under study. Gilson (2010) asserts that case-study approach often limits researchers’ control over certain variables and events under study. This means that the researcher might not be able to draw definite causal-effect conclusion. Additionally, case-study approach contains the element of biasness, especially in data collection and interpretation. This is based on the fact that only a single person gathers and analyzes the information, which is essential in understanding the issue under discussion.
Just like other research methodologies, case-study should be done in an ethical manner. In this respect, informed consent is an ethical code that might be involved in case-study approach. Marshall & Batten (2009) believe that using informational meetings, detailed letters of consent, or even offering transcript review of interview do not provide participant with full understanding of the purpose and potential consequences of conducting a case study. However, this can be addressed by making the process to be more reciprocal and collaborative. By this, it means that researchers and research participants must work together in not only shaping the concept of the research, but its definition as well. In our case, nursing student must be involved interactively in the research in order to be well-informed.
In summary, the proposed study’s target population should range between thirty five to one hundred nursing students. The research goal is to use this target sample population sufficiently and particularly to produce a range of possible data of nursing student’s perception regarding clinical decision-making process. In achieving this goal, a set of questions are devised such as:
1) How do nursing students at their final year of nursing studies decide to have clinical decision about patient care?
2) Why does a classroom setting affects nursing student’s decision-making?
3) How do nursing student’s decisions depict their cognitive ability?
In finding answers to the above questions, both the exploratory and explanatory case study approaches are engaged. This is to provide expected values that explain the causal links in nursing program intervention with its effect on students’ decision-making. Additionally, the approach explores those situations where little is known about nursing program intervention or classroom setting and its potential influence on students’ decision outcomes.
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In conclusion, a case-study approach is an essential research methodology, which helps in understanding the complex issues surrounding nursing students’ decision-making. It set out interactive research process that helps in obtaining sufficient information that links participants’ perceptions towards the issue under study. Therefore, it is important to consider the ethical codes in research in order not to breach informant consent of the participant of which may interfere with the validity of the research being conducted.
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