Case Study Research Methodology in Nursing Research

The cognitive processes employed by undergraduate nursing OSCE assessors: A qualitative research study

OBJECTIVES

The Objective Structured Clinical Examination (OSCE) is an assessment format commonly used to assess undergraduate nursing students. However, in spite of its prominence, relatively little research has been conducted into how OSCE assessors form judgements about student performances, and whether divergent processes of judgement formation have the potential to negatively impact the inter-rater reliability (IRR) of awarded scores. This qualitative study aimed to uncover the cognitive processes which assessors employ when assessing OSCE performances.

DESIGN, SETTING, PARTICIPANTS

In order to investigate this, a convenience, purposive sample of 12 assessors watched four videos of students completing single-station OSCEs: two videos of blood pressure measurement, and two of naso-gastric tube insertion.

METHODS

Assessors were asked to "think aloud" while watching the videos, and also participated in a semi-structured interview about their assessment practices.

RESULTS

Thematic analysis of the qualitative data revealed three themes: observation, processing, and integration. Within each theme, a number of sub-themes were identified, which explain the cognitive mechanisms used by assessors when watching, judging and grading student performances.

CONCLUSIONS

Notably, the presence of these mechanisms was not uniform across the sample, indicating that assessors utilise different approaches when viewing and interpreting the same performances. This has the potential to threaten the IRR of awarded scores, and thus the validity of decisions made on the basis of those scores.

In-service education in trauma care for intensive care unit nurses: An exploratory multiple case study

AIM

This study explores the perceptions of intensive care units (ICUs) nurses with different educational backgrounds regarding their abilities in trauma care and the in-service education they receive to support it.

BACKGROUND

The advanced care of patients with traumatic injuries in ICU environments requires skilled and knowledgeable nurses, who need continuing and in-service education to provide the best care. Therefore, it is essential to understand the competencies and educational support these nurses may need in the ICUs to ensure safe and effective care delivery.

DESIGN

An exploratory multiple case study design was used, comprising three hospitals located in two different regions of Saudi Arabia.

METHODS

The study was conducted between October 2021 and March 2022. A total of forty ICU clinical staff, twelve managers, nine leaders and seven clinical educators participated in semi-structured interviews, which were complemented by a review of available documents on the trauma care in-service education syllabi, competencies and protocols. Interview data were analysed according to the Framework analysis approach, while documents were reviewed using qualitative content analysis.

FINDINGS

The data analysis revealed two interrelated categories relevant to trauma care: (i) care practice and (ii) education practice. The trauma care practice category highlighted the limited competencies and education in trauma care, as well as the perceived challenges and educational needs of nurses. The education practice category described the staff learning behaviours, supervision practices and in-service education systems in the participants' settings.

CONCLUSIONS

The study concludes that there is a lack of trauma care education at the examined sites. It suggests the need for further research to develop a theoretical foundation for trauma care education that can meet ICU nurses' educational needs while this being feasible to implement in the specific ICU context and practice.

Evaluating Public Participation in a Deliberative Dialogue: A Single Case Study

BACKGROUND

Deliberative dialogues (DDs) are used in policy-making and healthcare research to enhance knowledge exchange and research implementation strategies. They allow organized dissemination and integration of relevant research, contextual considerations, and input from diverse stakeholder perspectives. Despite recent interest in involving patient and public perspectives in the design and development of healthcare services, DDs typically involve only professional stakeholders. A DD took place in May 2019 that aimed to improve the social environment (eg, safety, social inclusion) and decrease social isolation in a rent-geared-to-income housing complex in a large urban community. Tenants of the housing complex, public health, primary care, and social service providers participated. This study aimed to determine how including community tenants impacted the planning and execution of a DD, including adjustments made to the traditional DD model to improve accessibility.

METHODS

A Core Working Group (CWG) and Steering Committee coordinated with researchers to plan the DD, purposefully recruit participants, and determine appropriate accommodations for tenants. A single mixed-methods case study was used to evaluate the DD process. Meeting minutes, field notes, and researchers' observations were collected throughout all stages. Stakeholders' contributions to and perception of the DD were assessed using participant observation, survey responses, and focus groups (FGs).

RESULTS

34 participants attended the DD and 28 (82%) completed the survey. All stakeholder groups rated the overall DD experience positively and valued tenants' involvement. The tenants heavily influenced the planning and DD process, including decisions about key DD features. Suggestions to improve the experience for tenants were identified.

CONCLUSION

These findings demonstrate the viability of and provide recommendations for DDs involving public participants. Like previous DDs, participants found the use of engaged facilitators, issue briefs, and off-the-record deliberations useful. Similarly, professional stakeholders did not highly value consensus as an output, although it was highly valued among tenants, as was actionability.

Communication of Code Status Escalation for Nurses and Physicians in the Intensive Care Unit: A Case Study

BACKGROUND

Interprofessional teams working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient's code status can help clinicians to understand the appropriate life support measures to deliver to patients in this setting. Members of the interprofessional team, such as physicians and nurses, can experience challenges related to communication when the code status is unclear.

PURPOSE

The purpose of this study was to explore how nurses and physicians in the ICU experience communication of code status escalations.

METHODS

A qualitative case study approach was used. Participants were physicians and nurses, working in the medical-surgical ICU of a large, urban academic hospital. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. Data were analyzed using qualitative content analysis.

RESULTS

Thematic findings include: (1) engaging in an interprofessional discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the patient story. The study findings also provide contextual information about participants' experiences of code status communication during the first wave (February 2020 to May 2020) of the COVID-19 pandemic.

CONCLUSIONS

The results of this study could inform standard communication frameworks or practices related to dissemination of code status decisions among members of the ICU team.

How do nurses use the early warning score in their practice? A case study from an acute medical unit

AIMS AND OBJECTIVES

This study aimed to describe how nurses use the early warning score (EWS) in an acute medical ward and their compliance with the EWS and explore their views and experiences of the EWS.

BACKGROUND

early warning score systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence. Improvement strategies including education and training and electronic devices have assisted in compliance with the system.

DESIGN

A holistic single descriptive case study design was used.

METHODS

Data triangulation was used including non-participant observation, semi-structured interviews with nurses and document analysis. Nurses were observed using EWS and were subsequently interviewed. Data analysis was guided by systematic text condensation (STC), an approach underpinned by Giorgi's phenomenological method, where meaning units and themes are identified. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines.

RESULTS

Three themes with associated meaning units were found. Protocol Adherence vs. Clinical Judgement addresses nurses' knowledge, skill and experience and patient assessment. Parameter Adjustment and Escalation included parameters not being adjusted or reviewed, junior doctors not being authorised to set parameters and escalation. The final theme Culture highlighted a task-driven approach and deficient communication processes.

CONCLUSION

This study highlights the need for ongoing training, behavioural change and a cultural shift by healthcare professionals and organisations to ensure adherence with EWS escalation protocols.

RELEVANCE TO CLINICAL PRACTICE

Improvements in education and training into recognition, management and communication of a deteriorating patient are required. Also, a cultural shift is needed to improve compliance and adherence with EWS practice. The potential use of electronic data should be explored.