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Lessons learnt: examining the use of case study methodology for nursing research in the context of palliative care

Paula brogan.

School of Communication and Media, University of Ulster, Northern Ireland, UK

Felicity Hasson

Institute of Nursing Research, University of Ulster, Northern Ireland, UK

An empirical social research approach, facilitating in-depth exploration of complex, contemporary contextualised phenomena, case study research has been used internationally in healthcare studies across clinical settings, to explore systems and processes of care delivery. In the United Kingdom, case study methods have been championed by nurse researchers, particularly in the context of community nursing and palliative care provision, where its applicability is well established. Yet, dogged by conceptual confusion, case study remains largely underutilised as a research approach.

Drawing on examples from nursing and palliative care studies, this paper clarifies case study research, identifies key concepts and considers lessons learned about its potential for nursing research within the unique and complex palliative and end of life context.

A case study approach offers nurse researchers the opportunity for in-depth, contextualised understanding of the systems and processes which influence their role in palliative care delivery across settings. However, philosophical and conceptual understandings are needed and further training in case study methodology is required to enable researchers to articulate and conduct case study.

Introduction

An empirical social research approach, facilitating in-depth exploration of a contemporary phenomenon ( Yin, 2009 ), case study research has been used internationally in healthcare studies ( Anthony and Jack, 2009 ) to explore systems of palliative care ( Lalor et al., 2013 ), diverse contexts for palliative care delivery ( Sussman et al., 2011 ), roles of professional groups such as pharmacy ( O’Connor et al., 2011 ), the impact of services such as complementary therapy ( Maddalena et al., 2010 ) and nursing (Kaasalainen et al., 2013). In the United Kingdom, case study methods have been championed by nurse researchers ( Payne et al., 2006 ), particularly in the context of community nursing and palliative care provision ( Kennedy, 2005 ; Walshe et al., 2004 , 2008 ) and its applicability to palliative and end-of-life care research is established ( Goodman et al., 2012 ). Suited to the study of complex processes ( Walshe, 2011 ), case study methodology is embedded in professional guidance on the development of complex interventions ( Medical Research Council, 2008 ). Yet, case study is dogged by conceptual confusion (Flyvberg, 2006), and, despite sporadic use, remains underutilised as a research approach in healthcare settings ( Froggatt et al., 2003 ).

Illustrated by examples from nursing and palliative care studies, this paper aims to clarify conceptual understanding and identify key lessons for its application within these unique and complex contexts and, more broadly, for nursing research.

Origins and definitions

French sociologist Frederic Le Play (1806–1882) is associated with the origin of the case study approach ( Hamel et al., 1993 ). Using a purposive sample of working class families and fieldwork methods of observation and individual interview, he sought a contextualised and in-depth understanding of their individual experiences. Each family case study uncovered the unique experience of that family, but each additional family studied was another ‘ case of the lived experience’ of working class families in mid-18th century France. Thereby, Le Play used the lens of individual experience ( Yin, 2013 ) to build comparisons across families and enrich overall understanding of that complex society.

This early glimpse of the case study approach showed it to be a straightforward ‘field investigation’ ( Hamel et al., 1993 ); epistemologically pragmatic as it generated knowledge through data drawn from diverse sources, such as family members, and used the best available data collection methods then, to inform a holistic and contextualised understanding of how people operated within a complex social system ( Stake, 1995 ).

However, defining case study has become increasingly challenging since its expansion into North America in the 1800s ( Platt, 1992 ), and its use across a range of disciplines such as politics ( Gerring, 2004 ), social science ( George and Bennett, 2005 ), education ( Merriam, 1998 ) and healthcare ( Yin, 2013 ). Variously characterised as a case report, data collection method and methodology ( Anthony and Jack, 2009 ), the development of case histories as illustrations in health and social care and in education ( Merriam, 1998 ) has contributed to further confusion for researchers and readers of case study research ( Gomm et al., 2000 ). Critiques of case study note that it lacks a single definition, such that a plethora of discipline dependant interpretations ( Simons, 2009 ) and loose use of the term case study ( Tight, 2010 ) have contributed to confusion and undermined case study credibility. However, Simons ( 2009 , p. 63) advises researchers that case study must be seen within the complex nexus of political, methodological and epistemological convictions that constitute the field of enquiry, and variations of these may be glimpsed in Table 1 as definitions from four eminent and frequently cited case study authors illustrate philosophical and discipline-influenced differences in emphasis. Consequently, the case study definition selected, with its underpinning ontology and epistemology has important implications for the coherent outworking of the overall research design. It is therefore notable that many of the palliative care case studies contained in Table 2 fail to identify any such definition and this may have implications for interpretation of the quality of studies.

Definitions of case study by four key authors, showing the variation in meaning and interpretation.

Examples of Case Studies (CS) conducted in palliative care contexts.

Case study as a philosophy for the epistemology of knowledge generation

Although frequently linked to naturalistic inquiry ( Lincoln and Guba, 1986 ), interpretative/constructivist philosophy and qualitative methodology ( Stake, 1995 ), case study is not in fact bound to any single research paradigm ( Creswell, 2013 ). It is philosophically pragmatic, such that the case study design should reflect the ontological positions and epistemological considerations of the researchers and their topic of interest ( Luck et al., 2006 ). In practice, this means that case study research may pragmatically employ both qualitative and quantitative methods independently or together in order to respond to the research objectives ( Cooper et al., 2012 ; Simons, 1987 ; Stake, 2006 ). So whilst Table 2 shows that qualitative case studies are common in palliative care, epistemological variation is evident and reflects the study topic, purpose and context of the research. For example, Maddalena et al. (2010) used in-depth interview and discourse analysis to understand individual patient meaning-making; Brogan et al. (2017) used focus groups and thematic analysis as part of an embedded element of a multiple case study, to contrast the diverse perspectives of multi-disciplinary healthcare practitioners on end-of-life decision-making; Sussman et al. (2011) incorporated survey data into a mixed methods multiple case study which explored health system characteristics and quality of care delivery for cancer patients across four regions of Canada. Consequently, it is useful to ‘conceptualise (case study) as an approach to research rather than a methodology in its own right’ ( Rosenberg and Yates, 2007 , p. 448), so that a non-standardised approach exists and the case study design, its boundaries, numbers of cases and methods are guided by the stated underpinning ontological perspectives of the researcher and their topic of interest. The study then flexibly adopts the best methods to gain an in-depth, holistic and contextualised understanding of the phenomenon of interest – the latter objectives being at the core of any definition of case study research.

Key case study concepts and lessons for practice

When considering the utility of a case study approach, research conducted in complex palliative care contexts offers several insights into how central concepts translate to practice.

Contextualised understanding

Drawing on the definitions in Table 1 , Stake emphasised the particularity and intrinsic value of each individual case ( Stake, 1995 ), to emphasise the usefulness of multiple cases to increase insight ( Stake, 2006 ), analyse patterns ( Gerring, 2004 ; George and Bennett, 2005 ) and develop causal hypotheses ( Yin, 2013 ). Yet, whatever the purpose, all case studies are concerned with the crucial relationship between a phenomenon and the environment in which it has occurred. In practice therefore, case study researchers must be concerned with understanding the background systems, structures and processes that influence and interact with the phenomenon under study. This capacity for contextualised and holistic understanding is underpinned by use of multiple data collection methods, such as observation, interview and document review, used simultaneously or sequentially ( Stake, 2006 ; Scholz and Tietje, 2002 ), to mine multiple sources of data, such as participant experience ( Brogan et al., 2017 ; Kaasalainen et al., 2012 ), documents (Lalor et al., 2003) service evaluations ( Walshe et al., 2008 ), and diaries ( Skilbeck and Seymour, 2002 ). This is exemplified in a study by Walshe et al. (2011) , who investigated referral decisions made by community palliative care nurses in the UK, by capturing interview data on the self-reported perspectives of healthcare professionals, in combination with observed team meetings in which decisions were influenced, and review of the written referral policies, protocols and palliative healthcare strategies specific to those decisions. This comprehensive and complex data enabled comparison of decisional processes and their influencing factors both within and across three Primary Care Trusts, thus providing a contemporaneous understanding of the complex relationship between individual nurse's referral decisions and the impact of the organisational and professional systems that underpinned them. Enhancing rigor, such methodological triangulation importantly contributed to the richness of data analysis and the development of assertions which might be drawn from the findings ( Cooper et al., 2012 ; Stake, 2006 ).

Process-focused

Flexible data collection methods, linked to the research purpose, enables case study researchers to gather both historical and real-time data in a variety of ways. For example, Kennedy’s longitudinal case study ( Kennedy, 2002 ) observed snapshots of the initial and follow-up assessment conducted by 11 district nurses over the subsequent 12 months, enabling an exploration of the outcome and impact of their decision-making, demonstrating the usefulness of case study to understand complex roles and processes which are fluid and elusive ( Yin, 2013 ), or otherwise difficult to capture, particularly in the intimate interpersonal contexts where nursing happens.

Analytic frame

Palliative care studies reviewed frequently report the use of thematic analysis. However, whilst this approach is certainly useful to process data generated in qualitative case studies, the approach to analysis must be congruent with the research design and reflect the purpose of the research and methods used. Moreover, beyond decisions about use of thematic analysis or descriptive statistics etc., in case study, important decisions must be made about the analytic frame of the research. Gerring’s definition (2004) set out the analytic frame in which the cases studied might be understood, explaining that each unit of analysis (or case), sheds light on other units (or cases). Thus defined, an individual case offers intrinsically valuable information about a phenomenon ( Stake, 1995 ) and the purposeful selection of cases is central to case study design. This is because, viewed from a certain angle, each case is also a case of something else, such that the findings have broader implications ( Gerring, 2004 ; Simons, 2009 , 1987 ; Yin, 2013 ). In practice, this means that the case and what it is a case of, must be clearly identified and well defined at the outset of a study, since this has implications for the relevance of findings. This can be seen in a study by O’Connor et al., (2011) , who considered the perceived role of community pharmacists in palliative care teams in Australia. Each unique case included multi-disciplinary healthcare team members, such as pharmacists, doctors and nurses working in localities, whose perspectives were sought. Each locality group was a case of community pharmacy provision in palliative care settings in Australia, and findings had implications for the planning of community services overall. So, insight development was possible at an individual, group and organisational level, and inferences were made directly in relation to the parameters of that case study.

The addition of several carefully selected cases, as in multiple case studies, offers the opportunity to analyse data gained within and across cases ( Stake, 2006 ). Case selection may be made in order to explore similarities and contrasting perspectives ( Brogan et al., 2017 ), understand the various impacts of geographical differences ( Sussman et al., 2011 ), and different organisational influences ( Walshe et al., 2008 ). However, whilst repetition of data across cases may reinforce propositions made at the outset of a study, the purpose of increasing the number of cases in case study research is primarily about increasing insight development into the complexity of a phenomenon ( Stake, 2006 ). Since case study is the study of a boundaried phenomenon ( Yin, 2013 ), establishing the analytic frame then underpins the selection criteria for potentially useful cases. Such clarification is essential since it provides the lens through which to focus research ( Gerring, 2004 ; Scholz and Tietje, 2002 ; Stake, 2006 ) and permits key decisions to be made about data which may be included and that which is not applicable.

However, significantly, this information is rarely articulated within published case studies in palliative care. This is an important issue for the quality of case study research, since description of the process of refining case study parameters, establishing clear boundaries of the case, articulating propositions based on existing literature, identifying the sources of data (people, records, policies, etc.) and the ways in which data would be captured, establishes clarity and underpins a rigorous, systematic and comprehensive process ( Gibbert et al., 2008 ), which can usefully contribute to practice and policy development ( George and Bennett, 2005 ).

Shaped by organisational systems, intimate settings and significant life stage contexts, the interconnection between context and participant experience of palliative care is one example of a process of healthcare provision that is often complex, subtle and elusive ( Walshe et al., 2011 ). Case studies conducted in these swiftly changing contexts illustrate several characteristics of case study research, which make it an appropriate methodological option for nurse researchers, providing the opportunity for in-depth, contextualised understanding of the systems and processes which influence their role in palliative care delivery across settings ( Walshe et al., 2004 ) and many others who seek a contextualised, contemporaneous understanding of any complex role or process ( Yin, 2013 ; Simons, 2009 ). This fieldwork-based approach has the potential to achieve depth and breadth of insight through the pragmatic, but carefully planned and articulated, use of multiple methods of data collection in order to answer the research question ( Stake, 2006 ) when analysed systematically within a frame determined at the outset by the definition of the case and its boundaries ( Gerring, 2004 ). Yet, the methodological flexibility that is advantageous in complex contexts, may be misunderstood ( Hammersley, 2012 ), particularly where terminology is unclear ( Lather, 1996 ) or where description of the systematic and rigorous application of the approach is missing from the report ( Morrow, 2005 ). Taken as an example of one area of healthcare research, evidence suggests that palliative care studies that deal meaningfully with underpinning philosophical perspectives for their selected case study approach, or which articulate coherent links between the defined case, its boundaries and the analytical frame are rare. The impact of such omissions may be the perpetuation of confusion and out-dated perceptions about the personality and quality of case study research ( King et al., 1994 ), with implications for its wider adoption by nurses in healthcare research. Further training in case study methodology is required to promote philosophical and conceptual understanding, and to enable researchers to fully articulate, conduct and report case study, to underpin its credibility, relevance and future use ( Hammersley et al., 2000 ; Stake and Turnbull, 1982).

Key points for policy, practice and/or research

• Case study is well suited to nursing research in palliative care contexts, where in-depth understanding of participant experience, complex systems and processes of care within changing contexts is needed.
• Not bound to any single paradigm, nor defined by any methodology, case study’s pragmatism and flexibility makes it useful for studies in palliative care.
• Training is needed in the underpinning philosophical and conceptual basis of case study methodology, in order to articulate, conduct and report credible case study research, and take advantage of the opportunities it offers for the conduct of palliative and end-of-life care research.

Paula Brogan is a Lecturer in counselling and communication in the School of Communication and Media, and was recently appointed as Faculty Partnership Manager, University of Ulster. Dual qualified as a Registered Nurse with specialism in District Nursing and as a Counsellor/couple psychotherapist (Reg MBACPaccred), she has over 30 years’ clinical practice experience in community palliative care nursing and the provision of psychological care to patients and families dealing with palliative and chronic illness. Having worked across statutory, voluntary and private sectors, her PhD focused on multi-disciplinary decision-making at the end of life with patients and families in the community setting. Currently secretary of the Palliative Care Research Forum for Northern Ireland (PCRFNI), Paula’s ongoing research interests include communication and co-constructed decision-making in palliative and chronic illness, and the psychological support of individuals, couples, patient-family groups and multi-disciplinary staff responding to challenges of advanced progressive illness.

Felicity Hasson is a Senior Lecturer in the Institute of Nursing Research at the University of Ulster with 20 years’ experience in research. A social researcher by background, she has extensive experience and knowledge of qualitative, quantitative and mixed method research and has been involved in numerous research studies in palliative and end-of-life care. She completed her MSc in 1996 and her PhD from University of Ulster in 2012. Felicity sits on the Council of Partners for the All Ireland Institute of Hospice and the Palliative Care Palliative Care Research Network (PCRN) and is an executive board member for the UK Palliative Care Research Society. She holds an editorial board position on Futures and Foresight Science. Felicity has an established publication track recorded and successful history of grant applications. Her research interests include nurse and assistant workforce, workforce training, palliative care and chronic illness (malignant and non-malignant with patients, families and multi-disciplinary health care professionals) and public awareness of palliative care and end of life issues.

Sonja McIlfatrick is a Professor in Nursing and Palliative Care and has recently been appointed as the Head of School of Nursing at University of Ulster. She is an experienced clinical academic with experience in nursing and palliative care practice, education and research. She previously worked as the Head of Research for the All Ireland Institute of Hospice and Palliative Care (2011-2014) and led the establishment of the All Ireland Palliative Care Research Network (PCRN) and is the current Chair of the Strategic Scientific Committee for the PCRN (AIIHPC). Sonja is an Executive Board member for the UK, Palliative Care Research Society and is member of the Research Scientific Advisory Committee for Marie Curie, UK. Sonja holds an Editorial Board position on the International Journal of Palliative Nursing and Journal of Research in Nursing. Professor McIlfatrick has published widely in academic and professional journals focused on palliative care research and has a successful history of grant acquisition. Sonja has a keen interest in doctoral education and is the current President of the International Network of Doctoral Education in Nursing (INDEN). Her research interests include, palliative care in chronic illness, decision making at end of life; public awareness of palliative care and psychosocial support for family caregivers affected by advanced disease.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics statement

Ethical permission was not required for this paper.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Nursing Case Study Analysis [10 Examples & How-To Guides]

• Wilson Logan
• August 6, 2022
• blog , Nursing Topics and Ideas

What is a case study analysis?

A case study analysis is a detailed examination of a specific real-world situation or event. It is typically used in business or nursing school to help students learn how to analyze complex problems and make decisions based on limited information.

Preparing a good case study analysis is not an easy task and requires a lot of time and effort. This article provides some tips on how to write a case study analysis that will help you get the most out of your research and provide a solid foundation for your writing.(Nursing Case Study Analysis)

Nursing Case Study Analysis

Nurses are constantly faced with decisions that have to be made in a timely and effective manner. Often, these decisions are based on the available information, which may be limited.

In order to make the best possible decisions, nurses need to be able to analyze and interpret data. Nursing case studies are an important tool that can help nurses improve their decision-making skills.

10 Nursing Case Study Analysis Examples

How to write case study analysis in nursing.

A case study analysis requires you to investigate a nursing scenario, examine the alternative solutions, and propose the most effective solution using supporting evidence.(Nursing Case Study Analysis)

Nurses have to constantly make decisions that affect the lives of their patients. In order to ensure that these decisions are made correctly, nurses need to have strong problem-solving and critical-thinking skills. Case studies are an excellent way for nurses to hone these skills.

Writing a nursing case study analysis is not as difficult as it may first seem. Follow these steps and you will be well on your way to writing a successful case study analysis.(Nursing Case Study Analysis)

• Read the case study carefully. As you read, take note of any key facts or information that could be important for your analysis.
• Once you have finished reading the case study, identify the main problem or issue that needs to be addressed.
• Brainstorm possible solutions to the problem or issue . Try to come up with a few different options.
• Choose the best solution based on the information in the case study and your own clinical experience.
• Write up your analysis in a clear and concise manner. Be sure to support your chosen solution with evidence from the case study and your own professional experience .

Here’s How To Write A Nursing Case Study

How do you analyze a case study in nursing?

A nursing case study is an in-depth examination of a single individual. It is usually used to identify new areas of knowledge or to validate existing knowledge.

When analyzing a nursing case study, it is important to consider the following elements:

• The patient’s medical history. This includes any prior illnesses, treatments, and medications.
• The patient’s current condition. This includes symptoms, vital signs, and laboratory results.
• The nurse’s observations. This includes the nurse’s notes on the patient’s condition and behavior.
• The patient’s family and social history. This includes information on the patient’s family, friends, and social support network.(Nursing Case Study Analysis)
• The patient’s response to treatment. This includes any changes in the patient’s condition or symptoms after receiving treatment.

How nursing practitioners can analyze Patient’s Cases

As a nurse practitioner, you will often be asked to provide a case analysis for your patients. This can be a daunting task, but there are some key elements that you should always include in your analysis.

• The first element is the patient history. This should include any relevant medical history, as well as any personal information that may be pertinent to the case.
• The second element is the physical examination. This should include a thorough examination of the patient, including any relevant test results.(Nursing Case Study Analysis)
• The third element is the diagnosis. This is where you will provide your assessment of the patient’s condition and identify any potential problems.
• The fourth element is the treatment plan. This is where you will outline the course of treatment that you recommend for the patient.
• The fifth and final element is the prognosis. This is where you will provide your assessment of the likely outcome of the case, based on the information that you have gathered.

Steps of writing nursing case study analysis

Furthermore; there are different ways to approach writing a nursing case study analysis, but there are generally three main steps that need to be followed.

• First, you will need to perform a thorough analysis of the case study. This means looking at all aspects of the case and trying to identify any key issues or problems.(Nursing Case Study Analysis)
• Once you have done this, you will need to develop a hypothesis or research question that you can test.
• Finally, you will need to write up your findings in a clear and concise manner.

Assuming that you have been given the task of writing a case study analysis, there are a few key steps that you will need to take in order to ensure that your document is well-written and informative.

• Make sure that you understand all of the information presented in the case study , and take note of any key points or details that you think may be important.
• What points do you want to make in your analysis?
• What evidence will you use to support these points?
• Once you have a good idea of what you want to say in your analysis, start organizing your thoughts and putting them into a coherent structure.(Nursing Case Study Analysis)
• Once you have a rough outline of your case study analysis , start filling in the details. Flesh out your arguments and provide evidence to support them. In addition, make sure to address any counterarguments that could be made against your points.
• Finally, conclude your analysis by summarizing your main points and providing any recommendations or suggestions for further action .

Nursing Case study Analysis Format and Structure

When it comes to writing a case study analysis, there is no one-size-fits-all approach. However, there is a general format and structure that you can follow to ensure your analysis is well-organized and flows smoothly. Here are the basics:

A nursing case study is a detailed study of a patient that is encountered by a nurse. The purpose of the case study is to provide a comprehensive view of the patient’s health condition and history. Nurse practitioners use case studies to enhance their ability to care for patients by providing them with a more complete picture of the patient’s health . Nurse practitioners may use different formats for their nursing case studies. However, all case studies should include certain key elements. These key elements include:

• Patient information – This section should include basic demographic information about the patient, such as age, gender, race/ethnicity, and chief complaint
• Medical history – This section should detail the patient’s past medical history, including any chronic conditions, medications, allergies, and surgeries.(Nursing Case Study Analysis)
• Family history – This section should detail the patient’s family medical history, including any chronic conditions or genetic diseases that may be relevant to the patient’s current condition.
• Social history – This section should detail the patient’s social circumstances, such as employment status, living situation, and alcohol/drug use.
• Review of symptoms –A physical examination will help you to identify any physical abnormalities that may be causing or contributing to the patient’s condition.
• Diagnostic testing – Diagnostic testing may be necessary in order to confirm or rule out a diagnosis . Common tests used in case analysis include blood work, imaging tests, and biopsies.
• Treatment options – Once a diagnosis has been made, you will need to consider treatment options. Treatment options will vary depending on the diagnosis and the severity of the condition.(Nursing Case Study Analysis)
• The prognosis (Evaluation and outcomes) – After considering all of the above factors, you will be able to give the patient a prognosis. The prognosis is an educated guess as to how the condition will progress.

When writing a nursing case study, nurse practitioners should use a clear and concise format. The format should be easy to follow and understand. Nurse practitioners should also include all of the key elements in their nursing case studies.

As a nurse practitioner, you will be required to conduct case analyses on patients in order to make treatment decisions. There are key elements that you will need to take into consideration when conducting a case analysis. These elements include the patient’s history, physical examination, laboratory data, and imaging studies.(Nursing Case Study Analysis)

By taking into consideration all of these elements, you will be able to develop a comprehensive picture of the patient’s condition. This will allow you to make an informed decision about the best course of treatment.

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• More On the 6 Components of the Ongoing Case Study

Nursing Career Guide

A Deep Dive into the Six Components of the NCLEX-NGN Ongoing Case Studies

Need help understanding the six components of the Ongoing Case Studies that are part of NCLEX-NGN? We’re here to walk you through each of them so you can feel confident when you sit for your examination.

The Ongoing Case Studies are designed to simulate an actual case that you might encounter in a clinical setting. Rather than simply test the knowledge that you acquired in nursing school—which is also important—the case study progresses from your first interaction with a client through your evaluation of the outcomes.

We told you about the reasoning behind NCLEX-NGN and the implementation of the Clinical Judgment Measurement Model . And we provided a brief description of the six components that you’ll be asked to analyze, using your cognitive skills—not just the “perfect world” situations that textbooks provide.

Recognize cues

The nurse reviews all client findings and determines which data are relevant and important, focusing on cues (findings or assessments) that are of IMMEDIATE CONCERN.

You consider every bit of information in the initial scenario, including things like medical-social history, mental status, developmental stage, diagnosis, and current symptoms. No two clients are the same, so what is abnormal for one client may be acceptable for another. For example, an O2 saturation of 90% means hypoxia for most people but is in the normal range for a client with COPD.

The question: What matters most?

Tips for recognizing cues:.

• This is only the first step—do not interpret or analyze yet. Don’t try to figure out what the findings could mean or what you, as the nurse, will do. Simply sort through all the data and look for items that are normal/usual, abnormal but expected (not relevant), or abnormal but unexpected (relevant).
• When you decide that a finding is abnormal or unexpected, look at the client and the scenario. If it’s expected (as with the O2 saturation of 90% for a client with COPD) then it’s probably not relevant.
• Are MOST important
• Of IMMEDIATE concern
• REQUIRE follow-up.
• Even if a client finding is relevant, it may not be a priority. Example: A client presents to the ED with crushing chest pain; the client also has diabetes. Diabetes is an abnormal finding, so it’s relevant, but NOT the priority in this scenario.

Analyze Cues

With relevant cues sorted out, now the nurse can begin to interpret what the cues can mean. By analyzing the factors in the clinical scenario, you can start to fit them into the case. Now you will think about what is happening and possible complications for the client.

Now you analyze the cues that you have recognized; this will be the basis for the rest of the Ongoing Case Study as you begin to plan and prioritize the client’s needs and how you will meet them. To do this, you’ll require knowledge of health conditions and how they relate to the client’s current situation. You will also have to know about diagnostic tests and what the results can indicate.

The question: What does it mean?

Tips for analyzing cues:.

• Go back to the relevant cues you found in Recognize Cues.
• Link the cues to possible client conditions that match with your findings and cues.
• All client findings are important but concentrate on those that are not normal or not expected. These are the findings to analyze.
• Determine if the findings tell what is happening to the client: Do they support or oppose any conditions?
• Decide if you need more information to make an accurate analysis or understand the clinical situation.

Prioritize Hypotheses

Now the nurse is ready to make predictions (hypotheses) in order to prioritize client needs. You’ve looked at all the data and considered all the possibilities for what the client is experiencing. It’s time to rank the hypotheses according to their urgency, as well as the risks that the client faces.

You look for all explanations and decide which ones are most likely, as well as those that are least likely. As you prioritize, you will use your cognitive skills to decide which problems or issues require IMMEDIATE attention and which ones can be postponed for the moment.

The question: Where do I start?

Tips for prioritizing hypotheses:.

• This is the time to use your nursing education knowledge! You already have the information you need to think critically and prioritize.
• Prioritizing includes considering all factors, not just the client’s condition. Your plan will change depending on where it occurs (A physician’s office is different from an Emergency Department, which is different from an outpatient facility), as well as what resources are available. (Is your unit fully staffed? Do you have services such as Radiology and Respiratory Therapy? Are the client’s Medical Records available?)
• Look at your own level of knowledge and skills. A nurse with 5, 10, or 20 years of experience can handle more complex situations than a new graduate. Consider your expertise in performing tasks. You can’t plan for something you don’t yet know how to do.
• High/Top Priority: Life-threatening or can result in harm to the client
• Intermediate/Middle: Not an emergency/not life-threatening, but important. It may be serious but can wait while High Priorities are met.
• Low/Last Priority: Not directly related to the client’s current situation, is not urgent and can wait until High and Intermediate needs are met.
• ABCs: Always, always include Airway, Breathing, and Circulation in your prioritization. The exception: Cardiopulmonary resuscitation uses CAB: Circulation (compressions), Airway, and Breathing.
• Focus on the information you’re provided in the scenario. Everything you need to answer the test item is included. Don’t wish you had more data.

Generate Solutions

It’s time for the nurse to generate the plan of care and identify appropriate interventions that will lead to positive client outcomes. You’re now using your nursing knowledge and evidence-based practice to generate solutions based on the priorities you’ve established.

As you provide care for your clients, look at the plan of care that was created from the hypotheses and compare it to the client’s status. Determine if the interventions are still appropriate or if they need to be revised. Ask yourself if they will achieve the best outcomes for the client.

Question: What can I do?

Tips for generating solutions:.

• Identify the expected outcomes and determine if the established priorities will achieve those outcomes.
• Be prepared to see test items that ask about interventions based on your assessments, and any interventions that are nursing actions.
• Consider actions that are indications or contraindications.
• Think about the case study scenario and what potential risks and complications for the client.
• Identify contributing factors such as medications, sleep, infection, hydration, surroundings, and ability to communicate.

Take Action

Taking action means performing appropriate activities that benefit the client and lead to desired outcomes. Actions can include things like maintaining stability, improving a situation, preventing a complication, or recognizing and managing an emergency.

Choosing a nursing action is the equivalent of implementing nursing care. You’re meeting the client’s needs based on the priorities that you’ve established. You’re also demonstrating that you know what actions to take in the situation to keep the client safe and comfortable.

Question: What will I do?

Tips for taking action:.

• Expect to see many test items on nursing actions. Questions may be about nursing interventions or performing nursing skills.
• Pay attention to the information provided in the scenario. Every test item has everything you need to determine the correct (key) response.
• Always focus on the needs of your clients and what actions you will take to meet those needs.
• Before taking an action, pause to consider the scenario: What is happening with a client and what the priorities of care are.
• Decide if an action is appropriate and relevant for the client, based on their medical condition and the clinical setting.

Evaluate Outcomes

The nurse is constantly evaluating outcomes and modifying care to meet those goals. The nurse also communicates to the health care team, the client, and the client’s family regarding the plan of care.

Based on the evaluations, the nurse can continue the current plan of care or make revisions if it’s not effective or the goals have only been partially met. A plan of care doesn’t always proceed in a linear fashion and can require multiple adjustments to reach the desired outcomes.

Question: Did it help?

Tips for evaluating outcomes:.

• Focus on the expected outcomes and think if they were met or not. If not, try to decide what needs to be done in order to meet them.
• If outcomes were not met, or partially met, return to the first five steps and see if something was forgotten or misidentified. Examine if the expected outcomes were consistent with earlier assessments findings.
• You can be asked about specific findings, such as lab values, vital signs, or body systems. Remember that normal findings may not be relevant to the case study scenario.
• Look at client education to see if the client has understood your teaching or if more education is needed. If there is a lack of understanding, further follow-up is indicated.

Once you’re able to understand how the Unfolding Case Study progresses from noticing cues about the client’s situation, all the way to evaluating the interventions, the process will become familiar. The steps are logical and align with your knowledge from nursing school. Don’t be intimidated by the case studies. Practice taking them so you’re confident when you sit for your NCLEX.

About the Author

Winona Suzanne Ball

Nursing Adviser, RN | MHS, Governors State University, IL Full member of the American Nurses Association. Learn more

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How to write a Nursing Case Study Analysis Paper

Writing a nursing case study is not something most nursing students look forward to. This is because it is a somewhat difficult process that is often overwhelming for nursing students. Nevertheless, by reading this guide prepared by our best nursing students, you should be able to easily and quickly write a nursing case study that can get you an excellent grade.

How different is this guide from similar guides all over the internet? Very different!

This guide provides all the pieces of information that one would need to write an A-grade nursing case study. These include the format for a nursing case study, a step-by-step guide on how to write a nursing case study, and all the important tips to follow when writing a nursing case study.

This comprehensive guide was developed by the top nursing essay writers at NurseMyGrade, so you can trust that the information herein is a gem that will catapult your grades to the next level. Expect updates as we unravel further information about writing a nursing case study.

Now that you know you’ve discovered a gold mine, let’s get right into it.

What Is a Nursing Case Study?

A nursing case study is a real or imagined patient scenario designed to test the knowledge and skills of student nurses. Nursing case study assignments usually focus on testing knowledge and skills in areas of nursing study related to daily nursing practice.

As a nursing student, you must expect a nursing case study assignment at some point in college. The fact that you are reading this post means that point is now.

While there is no standard structure for writing a nursing case study assignment, there are some things or elements that must be present in your nursing assignment for your professor to consider it complete.

In the next section, you will discover these things that your instructor n expects in your nursing case study analysis.

The Nursing Case Study Template

• • Title page
• • Introduction
• • Case presentation (Patient info, history and medical condition)
• • Diagnosis/Nursing assessment
• • Intervention/Nursing care plan
• • Discussion and recommendations
• • Conclusion
• • References

The Structure of a Nursing Case Study Analysis

You now know what nursing professors expect in a nursing case study analysis. In this section, we will explain what exactly to include in each section of your nursing case study analysis to make it an excellent one.

1. Title page

The title page is important in all types of academic writing. You must include it when writing your nursing case study analysis or any other type of essay or paper. And you must include it in the format recommended by your college.

If your college has no specific title page format, use the title page format of the style requested in the assignment prompt. In nursing college, virtually all assignments are supposed to be written either in Harvard or APA format.

So, check your assignment prompt and create your title page correctly. The typical title page should include the topic of your paper, your name, the name of your professor, the course name, the date you are submitting the paper, and the name of your college.

2. Abstract

Most nursing professors require you to include an abstract in your nursing case study analysis. And even when you are not specifically required to write one, it is good to do so. Of course, you should consult with your professor before doing so.

When writing an abstract for your paper, make sure it is about 200 words long. The abstract should include a brief summary of the case study including all the important information in the patient presentation such as the history, the age, and the current diagnosis.

The summary should also include the nursing assessment, the current interventions, and recommendations.

3. Introduction

After writing the title page and the abstract, start writing the introduction. The introduction of a nursing case study analysis must briefly include the patient presentation, the patient’s current diagnosis and medication, and the recommendations. It must also include a strong thesis statement that shows what the paper is all about.

You shouldn’t just write an introduction for the sake of it. If you do so, your introduction will be bland. You need to put in good effort when writing your introduction. The best way to do this is to use your introduction to show you understand the case study perfectly and that you are going to analyze it right.

You can always write your introduction last. Many students do this because they believe writing an introduction last makes it more precise and accurate.

4. Case presentation

After introducing your nursing case study analysis, you should present the case. It is usually very easy to present a case. You simply need to paraphrase the patient scenario. When doing this, do not forget to include all the important details in the patient scenario including the description of the patient, patient history, complaints, medical history, family history, and so on.

In short, everything important in the patient scenario should be in your case presentation. The only thing you need to avoid when writing your case presentation is copying the patient scenario or case study word-for-word.

5. Diagnosis

After case presentation, you should explain the diagnosis. In other words, you should explain the condition, disease, or medical situation highlighted in the case presentation. For example, if the patient is a heavy smoker and he has COPD, it is at this point that you explain how COPD is linked to heavy smoking.

And when explaining the condition, go deep into the pathophysiology. Focus specifically on the patient’s risk factors. Make sure you get your explanation from recent nursing literature. And do not forget to cite all the literature you get your facts from.

In short, this section should explain the patient’s condition or suffering.

6. Intervention

After the diagnosis section, your nursing case study analysis should have an intervention section. This section is also known as the nursing care plan section. What you are supposed to do in this section is to present a nursing care plan for the patient presented in the patient scenario.

A good nursing care plan is one that details the patient’s chief complaints or critical problems. It then describes the causes for these problems using evidence from recent medical or nursing literature. It then details the potential intervention for each problem. Lastly, it includes goals and evaluation strategies for the measures.

Some nursing professors regard the intervention section (or nursing care plan section) as the most important part of a nursing case study. This is because this part details exactly how the student nurse will react to the patient scenario (which is exactly what the nursing professors want to know). So make sure you put in good effort when developing this section to get an excellent grade in this section.

7. Discussion and recommendations

The intervention section in a nursing case study is followed by a discussion and recommendations section. In this section, you are supposed to expound on the patient scenario, the diagnosis, and the nursing care plan. You are also supposed to expound on the potential outcomes if the care plan is followed properly. The rationale for the care plan or its important bits should also be explained in the discussion.

The discussion should be followed by recommendations. Recommendations usually everything important that can be done or changed to manage patient condition or prevent its reoccurrence. Basically, anything that enhances the patient’s well-being can be a recommendation. Just make sure your key recommendations are supported by evidence.

8. Conclusion

This is the second last section of a typical nursing case study. What you need here is to summarize the entire case study. Make sure your summary has at least the case presentation, the nursing assessment/diagnosis, the intervention, and the key recommendations.

At the very end of your conclusion, add a closing statement. The statement should wrap up the whole thing nicely. Try to make it as impressive as possible.

9. References

This is the last section of a nursing case study. No nursing case study is complete without a references section. You should make sure your case study has both in-text citations and a references page.

And you should make sure both are written as recommended in the assignment. The style section is usually Harvard or APA. Follow the recommended style to get a good grade in your essay.

Step-By-Step Guide to Writing a Nursing Case Study

You now know all the key sections you need to include in a nursing case study. You also know what exactly you need to do in each section. It is now time to know how exactly to write a nursing case study. The process detailed below should be easy to follow because you now know the typical structure of nursing case studies.

When given a nursing case study assignment, the first thing you need to do is to read. You need to read two pieces of information slowly and carefully.

First, you need to read the prompt itself slowly and carefully. This is important because the prompt will have important bits of information that you need to know, including the style, the format, the word count, and the number of references needed. All these bits of information are important to know to ensure what you are writing is the right thing.

Second, you need to read the patient scenario slowly and carefully. You should do this to understand it clearly so that you do not make any mistakes in your analysis.

• Create a rough outline

Failure to plan is a plan to fail. So do not fail to plan. In other words, do not fail to create an outline for your case study analysis. Use the template provided in this essay to create a rough outline for your nursing case study analysis.

Make sure your outline is as detailed as it can be at this stage. You can do light research to achieve this aim. However, this is not exactly necessary because this is just a rough outline.

• Conduct thorough research

After creating a rough outline, you should conduct thorough research. Your research should especially focus on providing a credible and evidence-based nursing assessment on the patient problem(s). The evidence you should use should only be from recent nursing or medical literature.

You will also need to conduct thorough research to come up with an effective intervention or nursing care plan. So when researching the patient’s problem and its diagnosis, you should also research the most suitable intervention or you should do it right after.

When conducting research, you should always note down your sources. So for every piece of information you find and what to use, you should have its reference.

After conducting thorough research, you should enhance your rough outline using the new pieces of information you have discovered. Make sure it is as comprehensive as possible.

• Write your nursing case study

At this stage, you simply need to follow your comprehensive outline to write your case study analysis. If you created a good outline, you should find it very easy to write your nursing case study analysis.

If you did not, you will find it difficult to write your nursing case study. Whenever you are stuck when writing your case study analysis paper, you should re-read the part of this article where we explain what to include in every section of your analysis. Doing so will help you know what exactly to write to continue with your essay. Writing a nursing case study analysis usually takes only a few hours.

• Reference your case study

After writing your case study, make sure you add all in-text citations if you had not added them already. And when adding them, you should make sure you follow the style/format recommended in the assignment prompt (usually APA or Harvard style).

After adding in-text citations exactly where they need to be and in the right format, add all the references you have used in a references page. And you should add them correctly as per the rules of the style you were asked to use.

Do not forget to organize your references alphabetically after you are done creating your references page.

• Thoroughly edit your case study

After STEP 5 above, you need to edit your case study. You should edit it slowly and carefully. Do this by proofreading it twice. Proofread it slowly each time to discover all the grammar, style, and punctuation errors. Remove all the errors you find.

After proofreading your essay twice, check it one more time to make sure every sentence is very easy to understand. This is what will transform your ordinary case study into an A-grade case study. Of course, it must also have all the standard sections expected in a case study.

Just to make sure your case study is absolutely perfect, check it one more time using a grammarly.com or a similar computer grammar checker. Doing this will help you catch and eliminate all the remaining errors in your work.

• Submit your case study analysis

After you are done proofreading and editing your case study analysis, it will be 100% ready for submission. Just convert it into the format it is required in and submit it.

Nursing Case Study Tips and Tricks

The guide above and other pieces of information in this article should help you to develop a good nursing case study analysis. The tips and tricks in this section should help you to ensure that your nursing case study analysis you create is an excellent one.

• Begin early

The moment you see a nursing case study assignment prompt, identify a date to start writing it and create your own deadline to beat before the deadline stated in the prompt.

If you do this and then start writing your case study analysis early before your deadline, you will have plenty of time to do excellent research, to develop an excellent paper, and to edit your final paper as thoroughly as you want to.

Most student nurses combine work and study. So if you decide to leave a nursing case study assignment until late to complete it, something could come up and you could end up failing to submit it or submitting a rushed case study analysis.

• Use the right terminology

When writing an essay or any other academic paper, you are always encouraged to use the simplest language possible to make your work easy to understand. However, this is not the case when writing a nursing case study analysis. While your work should certainly be easy to understand, you are required to use the right nursing terminology at every point where it is necessary. Failure to do this could water down your work or make it look less professional or convincing.

• Avoid copying and pasting

If you are a serious nursing student, you obviously know that copying and pasting is not allowed or tolerated in assignments. However, sometimes copying and pasting can seem okay in nursing case study. For example, it can seem okay to copy-paste the patient presentation. However, this is not okay. You are supposed to paraphrase the verbatim when presenting the patient presentation in your essay. You should also avoid copy pasting information or texts directly. Every fact or evidence you research and find should be paraphrased to appear in your work. And it should be cited correctly.

• Always ask for help if stuck

This is very important. Students are usually overwhelmed with academic work, especially a month or two to the end of the semester. If you are overwhelmed and you think you will not have the time to complete your nursing case study analysis or to submit a quality one, ask for help. Ask for help from an assignment help business like ours and you will soon have a paper ready that you can use as you please. If you choose to get help from us, you will get a well-researched, well-planned, well-developed, and fully edited nursing case study.

• Format your paper correctly

Many students forget to do proper formatting after they are done writing their nursing case study analyses. Before you submit your paper, make sure you format it correctly. If you do not format your paper correctly, you will lose marks because of poor formatting. If you feel you are not very confident with your APA or Harvard formatting skills, send your paper to us to get it correctly formatted and ready for submission.

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• Volume 21, Issue 1
• What is a case study?
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• Roberta Heale 1 ,
• Alison Twycross 2
• 1 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
• 2 School of Health and Social Care , London South Bank University , London , UK
• Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E2C6, Canada; rheale{at}laurentian.ca

https://doi.org/10.1136/eb-2017-102845

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What is it?

Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research. 1 However, very simply… ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’. 1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables. 2

Often there are several similar cases to consider such as educational or social service programmes that are delivered from a number of locations. Although similar, they are complex and have unique features. In these circumstances, the evaluation of several, similar cases will provide a better answer to a research question than if only one case is examined, hence the multiple-case study. Stake asserts that the cases are grouped and viewed as one entity, called the quintain . 6  ‘We study what is similar and different about the cases to understand the quintain better’. 6

The steps when using case study methodology are the same as for other types of research. 6 The first step is defining the single case or identifying a group of similar cases that can then be incorporated into a multiple-case study. A search to determine what is known about the case(s) is typically conducted. This may include a review of the literature, grey literature, media, reports and more, which serves to establish a basic understanding of the cases and informs the development of research questions. Data in case studies are often, but not exclusively, qualitative in nature. In multiple-case studies, analysis within cases and across cases is conducted. Themes arise from the analyses and assertions about the cases as a whole, or the quintain, emerge. 6

Benefits and limitations of case studies

If a researcher wants to study a specific phenomenon arising from a particular entity, then a single-case study is warranted and will allow for a in-depth understanding of the single phenomenon and, as discussed above, would involve collecting several different types of data. This is illustrated in example 1 below.

Using a multiple-case research study allows for a more in-depth understanding of the cases as a unit, through comparison of similarities and differences of the individual cases embedded within the quintain. Evidence arising from multiple-case studies is often stronger and more reliable than from single-case research. Multiple-case studies allow for more comprehensive exploration of research questions and theory development. 6

Despite the advantages of case studies, there are limitations. The sheer volume of data is difficult to organise and data analysis and integration strategies need to be carefully thought through. There is also sometimes a temptation to veer away from the research focus. 2 Reporting of findings from multiple-case research studies is also challenging at times, 1 particularly in relation to the word limits for some journal papers.

Examples of case studies

Example 1: nurses’ paediatric pain management practices.

One of the authors of this paper (AT) has used a case study approach to explore nurses’ paediatric pain management practices. This involved collecting several datasets:

Observational data to gain a picture about actual pain management practices.

Questionnaire data about nurses’ knowledge about paediatric pain management practices and how well they felt they managed pain in children.

Questionnaire data about how critical nurses perceived pain management tasks to be.

These datasets were analysed separately and then compared 7–9 and demonstrated that nurses’ level of theoretical did not impact on the quality of their pain management practices. 7 Nor did individual nurse’s perceptions of how critical a task was effect the likelihood of them carrying out this task in practice. 8 There was also a difference in self-reported and observed practices 9 ; actual (observed) practices did not confirm to best practice guidelines, whereas self-reported practices tended to.

Example 2: quality of care for complex patients at Nurse Practitioner-Led Clinics (NPLCs)

The other author of this paper (RH) has conducted a multiple-case study to determine the quality of care for patients with complex clinical presentations in NPLCs in Ontario, Canada. 10 Five NPLCs served as individual cases that, together, represented the quatrain. Three types of data were collected including:

Review of documentation related to the NPLC model (media, annual reports, research articles, grey literature and regulatory legislation).

Interviews with nurse practitioners (NPs) practising at the five NPLCs to determine their perceptions of the impact of the NPLC model on the quality of care provided to patients with multimorbidity.

Chart audits conducted at the five NPLCs to determine the extent to which evidence-based guidelines were followed for patients with diabetes and at least one other chronic condition.

The three sources of data collected from the five NPLCs were analysed and themes arose related to the quality of care for complex patients at NPLCs. The multiple-case study confirmed that nurse practitioners are the primary care providers at the NPLCs, and this positively impacts the quality of care for patients with multimorbidity. Healthcare policy, such as lack of an increase in salary for NPs for 10 years, has resulted in issues in recruitment and retention of NPs at NPLCs. This, along with insufficient resources in the communities where NPLCs are located and high patient vulnerability at NPLCs, have a negative impact on the quality of care. 10

These examples illustrate how collecting data about a single case or multiple cases helps us to better understand the phenomenon in question. Case study methodology serves to provide a framework for evaluation and analysis of complex issues. It shines a light on the holistic nature of nursing practice and offers a perspective that informs improved patient care.

• Gustafsson J
• Calanzaro M
• Sandelowski M

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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• Oncology Nursing Forum
• Number 6 / November 2015

Case Study Research Methodology in Nursing Research

Diane G. Cope

Through data collection methods using a holistic approach that focuses on variables in a natural setting, qualitative research methods seek to understand participants’ perceptions and interpretations. Common qualitative research methods include ethnography, phenomenology, grounded theory, and historic research. Another type of methodology that has a similar qualitative approach is case study research, which seeks to understand a phenomenon or case from multiple perspectives within a given real-world context.

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Through data collection methods using a holistic approach that focuses on variables in a natural setting, qualitative research methods seek to understand participants’ perceptions and interpretations. Common qualitative research methods include ethnography, phenomenology, grounded theory, and historic research. Another type of methodology that has a similar qualitative approach is case study research, which seeks to understand a phenomenon or case from multiple perspectives within a given real-world context (Taylor & Thomas-Gregory, 2015). Case study research has been described as a flexible but challenging methodology used in social science research. It has had the least attention and support among social science research methods, as a result of a lack of a well-defined protocol, and has had limited use in nursing research (Donnelly & Wiechula, 2012; Taylor & Thomas-Gregory, 2015; Yin, 2012, 2014). Three methodologists, Yin, Merriam, and Stake, have been credited as seminal authors who have provided procedures for case study research (Yazan, 2015). This article will describe and discuss case study research from the perspective of these three methodologists and explore the use of this methodology in nursing research.

The term case study is well known in the nursing profession as a teaching strategy to analyze a patient’s clinical case. Case study research is less employed and is defined similarly by all three methodologists as a research approach that focuses on one phenomenon, variable or set of variables, thing, or case occurring in a defined or bounded context of time and place to gain an understanding of the whole of the phenomenon under investigation (Merriam, 2009; Stake, 1995; Yin, 2014). The phenomenon or case can be a person, a group, an organization, or an event. The overall goal of case study research is to seek the “how” or “why” a phenomenon works, as opposed to other qualitative research approaches that seek to define the “what” of a phenomenon (Polit & Beck, 2012). Case study research usually requires detailed study during an extended period of time in an effort to obtain present and past experiences, situational factors, and interrelationships relevant to the phenomenon. Case study research has been viewed by some authors as a qualitative research methodology (Polit & Beck, 2012), and others view this type of research as flexible, using a mix of qualitative and quantitative evidence (Taylor & Thomas-Gregory, 2015; Yin, 2014).

Case Study Designs

Merriam, Stake, and Yin each have a differing perspective on case study design. Merriam (2009) purports a flexible design that allows researchers to make changes throughout the research process that is based on two or three research questions that construct and guide data collection. Stake’s (1995) design is based on a literature review that is the foundation of the research questions and theoretical framework but assumes that major changes may occur throughout the research as part of a process described as progressive focusing. Yin’s (2014) design is based on a sequence and includes several design options for the researcher. The selection of a case study design is based on the chosen theory and the case to be studied. The first decision is to determine whether the case study will use a single case or multiple cases. The use of a single case study is an appropriate design for certain circumstances, including when the case represents (a) a critical case to test theory, (b) an unusual or unique case, (c) a common case that can capture an understanding of usual circumstances, (d) a revelatory case that previously has been inaccessible, or (e) a longitudinal case (Yin, 2014).

A multiple case design is used when two or more cases are chosen to examine complementary components of the main research question (Yin, 2012). The multiple case design may be selected when the researcher is interested in examining conditions for similar findings that may be replicated or in examining conditions for contrasting cases. When choosing multiple cases, no formula exists to determine the number of cases needed, unlike power analysis to determine sample size (Small, 2009). In general, including more cases in a multiple case study will achieve greater confidence or certainty in a study’s findings. Conversely, the use of fewer cases will yield less confidence or certainty.

Single and multiple case studies can use holistic or embedded designs. A holistic design comprehensively examines a case or cases, and an embedded design also analyzes subunits associated with the case or cases.

Case study research is flexible and can use multiple sources of data. Yin’s (2014) methodology incorporates qualitative and quantitative data sources, and Merriam’s (2009) and Stake’s (1995) methodology exclusively use qualitative data sources. Multiple sources of evidence provide breadth in comprehending a case or cases and enhance confidence in the study findings. Common sources of evidence include direct observations of human behavior or physical environment, interviews, archival records, documents (e.g., newspaper articles, reports), participant observation, participant records, surveys, photographs, videos, or questionnaires.

Data analysis for case study research uses qualitative and quantitative data analysis methods, depending on the selected methodology, with the focus on describing the case or cases. Merriam’s (2009) data analysis is a process of consolidating, reducing, and interpreting procedures that occur simultaneously through data collection and analysis. Six analytic strategies are ethnographic analysis, narrative analysis, phenomenologic analysis, constant comparative method, content analysis, and analytic induction. Stake (1995) similarly employs data collection and analysis procedures through the use of two strategies—categorical aggregation and direct interpretation. Yin (2012) recommends initially categorizing the data then organizing the data by four techniques—pattern matching, explanation building, program logic models, and time–series analysis. Multiple case studies also would include an additional technique called cross-case synthesis to search for any repetition in the case. The final product of case study research is a narrative report that tells the story of the case and enables the reader to fully understand the case from the narrative (Taylor & Thomas-Gregory, 2015).

Methodologic Issues

An important aspect of case study research is ensuring study rigor similar to other qualitative studies. Strategies to ensure rigor include the maintenance of a diary or journal by the researcher to document personal feelings and reactions and minimize researcher bias, expert verification, an audit trail, use of thick descriptions, long-term observation, multisite designs, and member checking to ensure accuracy of findings by the participants (Taylor & Thomas-Gregory, 2015). Another methodologic issue is ensuring content validity. This can be achieved by the researcher’s final report that should include sufficient evidence and display a deep understanding of the case by the researcher.

Application of Case Study Design in Nursing Research

In this issue of Oncology Nursing Forum, Walker, Szanton, and Wenzel (2015) present their study exploring post-treatment normalcy using a multiple case design. The purpose of the study was to develop a better understanding of how adult survivors of early-stage breast and prostate cancers manage the work of recovery, which exemplifies the goal of case study research by asking “how” a phenomenon works. Multiple case study design was used through data collection that included self-reports, biweekly phone interviews, in-depth interviews, and written journals to evaluate existing theoretical knowledge and generate new theoretical knowledge about the process of managing recovery. The authors describe study rigor by illustrating expert validation and a constant comparative process of data analysis. From the data, the authors provide the reader with a detailed, narrative description of how adult survivors work toward normalcy that is engaging and tells the survivors’ story of life post-treatment.

Despite the lack of a well-defined protocol for case study research, Merriam, Stake, and Yin provide similar yet distinctive philosophies and procedures that researchers can use when embarking on a case study research project. Walker et al. (2015) provide an excellent exemplar of executing case study research in oncology through the investigation of the illness trajectory framework and how survivors work toward normalcy after treatment. Through this research approach, oncology nursing knowledge can benefit from a better understanding of the “how” and “why” of numerous phenomena that have implications for nursing practice and ultimately improve patient outcomes.

Donnelly, F., & Wiechula, R. (2012). Clinical placement and case study methodology: A complex affair. Nurse Education Today, 32, 873–877.

Merriam, S.B. (2009). Qualitative research: A guide to design and implementation. San Francisco, CA: Jossey-Bass.

Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams and Wilkins.

Small, M.L. (2009). How many cases do I need? On science and the logic of case selection in field-based research. Ethnography, 10, 5–38. doi:10.1177/1466138108099586

Stake, R.E. (1995). The art of case study research. Thousand Oaks, CA: Sage.

Taylor, R., & Thomas-Gregory, A. (2015). Case study research. Nursing Standard, 29(41), 36–40.

Walker, R., Szanton, S.L., & Wenzel, J. (2015). Working toward normalcy post-treatment: A qualitative study of older adult breast and prostate cancer survivors [Online exclusive]. Oncology Nursing Forum, 42, E358–E367. doi:10.1188/15.ONF.E358-E367

Yazan, B. (2015). Three approaches to case study methods in education: Yin, Merriam, and Stake. Qualitative Report, 20, 134–152.

Yin, R.K. (2012). Applications of case study research (3rd ed.). Thousand Oaks, CA: Sage.

Yin, R.K. (2014). Case study research: Design and methods (5th ed.). Thousand Oaks, CA: Sage.

About the Author(s)

Diane G. Cope, PhD, ARNP, BC, AOCNP®, is an oncology nurse practitioner at the Florida Cancer Specialists and Research Institute in Fort Myers. No financial relationships to disclose. Cope can be reached at [email protected] , with copy to editor at [email protected] .

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How to Write a Nursing Case Study [Examples, Format, & Tips]

✒️ case study topics for nursing students.

• 🩺️ The Basics
• 💉 Nursing Case Study: Writing Rules

📑 Nursing Case Study Format

📝 nursing case study examples.

• ⏱️ Tips on Quick Writing

🔗 References

A nursing case study is an in-depth analysis of the health situation of an individual patient.

The analysis is based on:

• medical history,
• other relevant criteria.

In most cases, you will be asked to diagnose to suggest the first aid measures. Alternatively, nurses can be asked to describe a patient in their practice and analyze the correctness of their actions. The purpose is to recreate a realistic hospital setting in the classroom and make students reflect on the treatment process from diagnosis to treatment.

• Anaphylactic shock in a teenager with peanut allergy.
• Non-compliant patient with diabetes: ways to improve adherence.
• Telehealth intervention for managing chronic disease.
• Communication strategies to address vaccine hesitancy in a rural community.
• Postpartum hemorrhage in a new mother: risk factors and interventions.
• Ways to improve recognition of dehydration in aging adults.
• The effective ways of maintaining work-life balance for nurses.
• Cultural competency in providing care to migrants and refugees.
• Why should every patient’s medical history remain confidential?
• The use of massage therapy in relieving pain.
• The challenges facing medicine in 2024.
• How does modern technology impact nursing?
• The significance of regular follow-up appointments with the healthcare provider.
• What are the primary treatments for postpartum depression?
• The use of steroids in cancer treatment.

🩺️ Nursing Case Study: What Is It About?

As a nursing student, you should understand that no two patients are the same. Each has a unique clinical record and condition. And although most nursing case study tasks will ask you to suggest a diagnosis or treatment, your focus should rest on the patient.

Busy nurses can sometimes see their patients in the framework of an illness to be treated or a procedure to be fulfilled. But you should do your best to remember that each patient is a living person with a complex set of needs, emotions, and preferences. A ready-made textbook answer is rarely the best solution for them. Moreover, it rarely helps to analyze a condition in isolation from the patient.

In a nursing case study, your task is to analyze a disorder or illness as a part of a specific medical situation. If you don’t do that, your case study becomes an essay (theoretical and generalized). It is the difference between the two assignment types.

Once again:

A case study in nursing emphasizes the particular patient’s condition. Meanwhile, a nursing essay will explore the disease, prevention methods, treatment, or possible consequences of the disease.

Even if the case is hypothetical, it should focus on the suggested reality. On the other hand, essays are usually literature-based. You are expected to do some reading for a case study too, but you should research and present the information within the context of the patient. In simple terms, a case study uses information in the actual application, and an essay uses it for the sake of generalized suggestions.

💉 How to Write a Nursing Case Study: 3 Key Rules

• Do the fieldwork. Before setting your hands to writing, you should collect all of the available materials: clinical notes, results of medical tests, x-rays, sickness records, etc. Use this information to draw a clear picture of the story. It is always helpful to ask yourself, “What is interesting or unusual about this patient’s condition?” In the course of writing, recall your answer from time to time not to get lost in words. It will help you to convey a definite and appropriate message.

• Stick to the facts. A nursing case study should be an accurate description of the actual situation. Restrain from speculating about the inherent mechanisms of the illness or the general treatment methodology. In fact, students are rarely prepared enough to discuss pathology and physiology. Leave this to reputable experts. The best result you can provide in a case study is an honest account of clinical events.
• Concentrate on the patients and their progress. Remember that a nursing case study is a story of a patient’s progress and not a narrative about their nurse. No matter how efficiently the medical specialist acted, it would be incorrect to add any praiseful remarks. The optimal way is to tell the story in its logical and time order and outline the result of treatment. In this case, the outcome will speak for itself.

Introduction

It is where you should tell the reader why this case is interesting . Place your study in a social or historical context. If, during your preliminary research, you found some similar cases, describe them briefly. If you had a hard time diagnosing the patient or your proposed treatment is complicated, mention it here. Don’t forget to cite the references to each of them!

The introduction should not exceed several paragraphs. The purpose is to explain why the reader will benefit from reading about the case.

Case Presentation

• Why did the patient seek medical help? (Describe the symptoms.)
• What is known about the patient? (Mention only the information that influenced your diagnosis. Otherwise, explain why some information is irrelevant to the diagnosis.)
• Stick to the narrative form. (Make it a story!)
• What are the variants for diagnosis? (Make a shortlist of possible disorders that fall under the patient’s symptoms. But make it specific: not just “pneumonia” but “bilateral pneumonia,” for example. Besides, this point is optional.)
• What were the results of your clinical examination? (If you saw the patient in person.)
• Explain the results of lab tests. (The words “positive” or “negative” are not always clear.)

Actions and Their Results

This section describes the care that has been provided and/or is planned. You can answer the following questions in narrative form . If some information is missing, skip the point:

• What preliminary actions have been taken? (Be specific: not just “wound care,” but “wound cleaning and dressing.”)
• How long has the patient been under care?
• Has the previous treatment given any visible result?
• Why was it suspended or finished?
• Why did the patient withdraw from treatment (if applicable)?
• How could you improve the patient’s condition if the result was negative?
• If the disease is incurable (like in the case of diabetes), which activities would stabilize the patient’s condition?
• If possible, include the patient’s reports of their own physical and mental health.

In this section, you should identify your questions about the case. It is impossible to answer all of them in one case study. Likewise, it is unreal to suggest all the relevant hypotheses explaining the patient’s condition. Your purpose is to show your critical thinking and observation skills. Finalize your conclusion by summarizing the lessons you learned from the nursing case study.

Whenever you directly or indirectly cite other sources or use data from them, add these books and documents to the references list. Follow the citation style assigned by your professor. Besides, 15 items are already too much. Try to make a list of up to 10. Using textbooks as references can be viewed as bad manners.

Include all the tables, photographs, x-rays, figures, and the journal of medication usage in this section. Unless required otherwise in the assignment, start each item from a new page, naming them “Appendix A,” “Appendix B…”.

Below you will find case study samples for various topics. Using them as a reference will improve your writing. If you need more ideas, you are welcome to use our free title-generating tool .

• Case study: healing and autonomy.
• Sara’s case study: maternal and child nursing.
• COPD medical diagnostics: case study.
• Care standards in healthcare institutions: case study.
• Acute bacterial prostatitis: case study analysis.
• Alzheimer disease: the patient case study.
• The treatment of foot ulcers in diabetic patients: case study.
• Hypertension: C.D’s case study.
• Myocardial infarction: cardiovascular case study.
• Major depressive disorder case.
• Case study of the patient with metabolic syndrome .
• Pulmonary analysis case study .
• Older adults isolation: Case study .
• The holistic care: Case study .
• Medical ethics: Case study .
• Patient diagnoses and treatment: Case study .
• Obesity case study: Mr. C .
• Nurse Joserine: Case study problems .
• Chronic stable angina: Case study .
• Fetal abnormality: Case study .
• Researching SOAP: Case study .
• Case study for a patient with hormonal disorders .
• Obesity in the elderly: The case study .
• “Walking the Tightrope”: A case study analysis .
• ARNP approach: Case study analysis .
• Case study on biomedical ethics in the Christian narrative .
• Thermal injury: Case study .
• Ethical dilemma in nursing: Case study .
• Asthma: A case study of the patient .
• Asthma discharge plan: Mini case study .
• Case study: An ethics of euthanasia .
• Case study: Head-to-toe assessment steps .
• Pain management strategies: Case study .
• Case study: Inflammatory bowel disease .
• Sleep deprivation and insomnia: The case study .
• The case study of a heart failure .
• Porphyria cutanea tarda: Disease case study .
• Case study: Hardy Hospital case summary .
• Obesity and its complications: Case study .
• Angina disease case study .
• Nursing ethics case study .
• Case study of a patient: Assessment and treatment plan .
• Cecile case study: Mrs. J .
• Nursing power in the emergency department: Case study .
• Heart failure case study: Mrs. J .
• Application of ethics in nursing: Case study .
• Sudden visual impairment: Case study .
• Epidemiology case study: Outbreak at Watersedge — Public health discovery game .
• Wellness of senior citizens: Case study .
• Healthcare organization evaluation: Case study of Banner Health .

⏱️ Bonus: Tips on Writing a Case Study in Record Time

Need to prepare a case study on nursing or in another field? Below you’ll find a collection fo tips that will help you do it as quickly as possible!

3 Shortcuts for a Quick Start

If you’re about to start writing a case study, you should check yourself if you’re not doing any of the following:

• spending too much time on selecting a topic;
• reading too much before selecting a topic;
• making conclusions too early – creating bias.

Instead of killing time doing the three useless things discussed above, consider these:

• Choose approach. Note that there are 2 major approaches to case studies: the analytical approach (investigating possible reasons without making any conclusions) and problem-oriented approach (focusing on a particular problem and investigating it).
• Skim some sources (DON’T READ THEM). Select several sources. Simply skim abstracts and conclusions.
• Start making notes early. Simply reading is ineffective unless you’re lucky to have a phenomenal memory. Always make notes of any useful arguments.

4 Shortcuts Not to Get Stuck in the Middle

Even if you kick started your case study, it’s too early to celebrate it. Consider the following traps in the middle of the project:

• Watch the structure. The classic logical structure is your formula of success. It will help you move from one point to another without the unnecessary procrastination:
• Respect the logic. Make your case study flow – make logical transitions between the different parts and make it consistent. Avoid changing your position throughout the paper.
• Be detail-oriented. Any trifle deserves attention when you write a case study.
• Avoid bias. Be sure that all your opinions are based on the specific arguments form the case study. Avoid pouring your biased views into the project.

3 Shortcuts for a Happy Ending

• Offer a realistic solution. College case study is a rehearsal of real-life situations. Take the responsibility for your suggestions.
• Keep your conclusion short. Avoid repeating the details and don’t include any new information.
• Consider creating a Power Point. If your task is not only writing a case study, but also presenting it – why not create PowerPoint slides to help you?

As the last step on your way to a perfect nursing case study, prepare the title page. Its format usually depends on the professor’s requirements. But if you know the citation style, our Title Page Maker is a perfect tool to apply the right formatting and accelerate the process. And if you have any know-how on how to write a medical case study, you are very welcome to share it with other students in the comments below.

❓ Nursing Case Study: FAQ

What is a case study in nursing.

A nursing case study explores the condition of a patient. It is based on previous clinical records, lab reports, and other medical and personal information. A case study focuses on the patient and describes the treatment that was (or should be) applied and its (expected) outcome.

How to Write a Nursing Case Study?

• Collect the bulk of data available about the patient.
• Read literature about the diagnosed condition.
• Focus on the individual patient and their symptoms.
• Describe the situation and outline its development in time.
• Analyze the actions of the medical personnel that have been done.
• Plan further treatment of the patient.

Why Are Case Studies Good for Nursing Students?

Nursing case studies offer you a priceless opportunity to gain experience of different patient conditions and cure methods without visiting the clinic. You can think about whether the proposed treatment was appropriate or wrong and suggest a better solution. And the best thing, your teacher will indicate your mistakes (and no patient will be hurt in the process).

Why Are Case Studies Important in Nursing?

• You learn to distinguish the relevant data and analyze it.
• You learn to ask the right questions.
• You learn to evaluate the severity of symptoms.
• You learn to make better diagnoses.
• You train your critical thinking in terms of treatment methods
• Case studies are in-class simulators of authentic atmosphere in a clinical ward.
• What is a case study? | Evidence-Based Nursing
• Case Studies – Johns Hopkins Medicine
• Case Study Research Design in Nursing
• Case study report for Nursing | Learning Lab – RMIT University
• Case Study or Nursing Care Study? – jstor

Research Paper Analysis: How to Analyze a Research Article + Example

Film analysis: example, format, and outline + topics & prompts.

How to Write a Case Study Paper for Nursing

A well-written case study paper for a nursing program requires some planning and consideration. All too often, students begin writing before they complete appropriate, preliminary steps. Ideally, before you start a paper, you should already have determined the focus and format of it. You will then follow this up with a fact-gathering step in which you will gather and collate the content of your paper. Finally, there is the construction/execution step in which you will write the paper in a standard format (such as the APA style) and edit it.

A nursing case study paper contains several sections that fall into three categories:

1. The status of the patient

• Demographic data
• Medical History
• Current diagnosis and treatment

2. The nursing assessment of the patient

• Vital signs and test results
• Nursing observations (i.e., range of motion, mental state)

3. Current Care Plan and Recommendations

• Details of the nursing care plan (including nursing goals and interventions)
• Evaluation of the current care plan
• Recommendations for changes in the current care plan

Patient Status

The first portion of the case study paper will talk about the patient — who they are, why they are being included in the study, their demographic data (i.e., age, race), the reason(s) they sought medical attention and the subsequent diagnosis. It will also discuss the role that nursing plays in the care of this patient.

Next, thoroughly discuss any disease process. Make sure you outline causes, symptoms, observations, and how preferred treatments can affect nursing care. Also, describe the history and progression of the disease. Some important questions for you to answer are: 1) What were the first indications that there was something wrong, and 2) What symptoms convinced the patient to seek help?

Nursing Assessment

When you are discussing the nursing assessment of the patient, describe the patientΓÇÖs problems in terms of nursing diagnoses. Be specific as to why you have identified a particular diagnosis. For example, is frequent urination causing an alteration in the patientΓÇÖs sleep patterns? The nursing diagnoses you identify in your assessment will help form the nursing care plan.

Current Care Plan and Recommendations for Improvement

Describe the nursing care plan and goals, and explain how the nursing care plan improves the quality of the patientΓÇÖs life. What positive changes does the nursing care plan hope to achieve in the patientΓÇÖs life? How will the care plan be executed? Who will be responsible for the delivery of the care plan? What measurable goals will they track to determine the success of the plan?

The final discussion should be your personal recommendations. Based on the current status of the patient, the diagnosis, prognosis, and the nursing care plan, what other actions do you recommend can be taken to improve the patientΓÇÖs chances of recovery? You must support your recommendations with authoritative sources and cite appropriately per APA style guidelines.

Creating a well-written nursing case study paper doesnΓÇÖt need to be a grueling challenge. It can be gratifying, and itΓÇÖs good practice for assessing patients while out in the field, too. Keep in mind that your instructor will not only grade you on the quality of the content of your paper but by how you apply the APA style, as well. If you find that you are spending too much time formatting your paper, consider using formatting software as a helpful tool to ensure accuracy, so you donΓÇÖt lose points on a well-written paper because of some formatting errors.

For more information about APA or MLA formats, contact us today.

David Plaut

David Plaut is the founder of Reference Point Software (RPS). RPS offers a complete suite of easy-to-use formatting template products featuring MLA and APA style templates, freeing up time to focus on substance while ensuring formatting accuracy. 

Reference Point Software is not associated with, endorsed by, or affiliated with the American Psychological Association (APA) or with the Modern Language Association (MLA).

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Main Tips On How To Write a Case Study Analysis

A nursing case study analysis is like an in-depth exploration. It acts as the lifeline connecting theoretical knowledge to its real-world implications, bridging the gap between understanding symptoms and improving the quality of patient care.

Why is a case study analysis so significant? Case studies are types of essays that breathe life into nursing principles, making them more than abstract concepts. They provide context, create connections, and highlight the real-world impact of nursing decisions. Furthermore, they foster empathy, allowing nursing professionals to perceive each patient as unique with distinctive healthcare needs. This comprehensive guide will serve as your roadmap for how to write a nursing case study analysis.

What is a Case Study Analysis in Nursing?

In the 5th century BC, the philosopher Lao-Tse (also Lao-tzu) wrote, “If you tell me, I will listen. If you show me, I will see. But if you let me experience, I will learn.” And so began one of the first active learning philosophies.

A nursing case study analysis is an immersive journey into a patient’s health scenario. It’s like a detective story, where the nurse or nursing student acts as the investigator, and the patient’s condition is the mystery waiting to be solved. Each patient’s story is unique and requires a thorough examination to extract useful insights. But what exactly does this process involve?

A nursing case study analysis begins with a comprehensive exploration of a patient’s health situation. This includes their health history, current symptoms, and previous treatments. This exploration phase involves collecting data from patient interviews, physical examinations, and diagnostic tests. Each data point could be the key to better understanding the patient’s condition.

The next step is to diagnose the issues. This involves understanding the complexities of the patient’s condition—the root causes, contributing factors, and potential risks. The nurse then moves on to planning and implementing interventions. This might involve developing a care plan, suggesting lifestyle modifications, or coordinating with other healthcare professionals for specialized care. These interventions aim to address the diagnosed issues and improve the patient’s health outcomes.

The nurse then moves on to planning and implementing interventions. This might involve developing a care plan, suggesting lifestyle modifications, or coordinating with other healthcare professionals for specialized care. These interventions aim to address the diagnosed issues and improve the patient’s health outcomes.

What is the Purpose of a Case Analysis?

Why do nurses engage in the elaborate process of a case study analysis? What purposes does it serve, and how does it contribute to the broader nursing field?

• Enhancing Patient Care: A nursing case study analysis aims to improve patient care. When a nurse begins analyzing a patient’s case, they are honing their ability to provide effective, personalized care.
• Refining Critical Thinking Skills: A case analysis requires active engagement, thoughtful consideration, and deliberate analysis. Nurses must interpret data, make diagnoses, and plan interventions, all of which demand a high degree of cognitive ability.
• Bridging Theory and Practice: A case study allows nurses to apply theoretical concepts to real-world contexts, demonstrating the practical implications of nursing principles. This deepens their understanding of these concepts and reinforces their learning.
• Fostering Reflective Learning: As nurses evaluate their interventions’ outcomes, they reflect, assessing their actions and learning from their experiences. This cultivates an attitude of continuous learning and promotes personal and professional growth.

Difference Between a Nursing Research Paper and a Case Study

Here are the differences between these two important facets of nursing literature:

Research Paper

A nursing research paper explores a particular topic or concept in depth. Its purpose is to contribute new insights or validate or challenge existing theories. It seeks to add to the collective understanding of a topic and often aims to solve a larger problem or answer a complex question.

A research paper often employs a systematic and structured approach. This might involve a literature review, an experimental study, a survey, or a qualitative investigation, depending on the nature of the research topic. The methodology is often rigorous and has strict guidelines to ensure the validity and reliability of the results.

A research paper generally follows the IMRaD format—Introduction, Methods, Results, and Discussion. Each section has a specific role, contributing to the overall narrative of the paper.

A case study takes a single patient situation or a unique medical scenario and delves into it with microscopic attention. The primary aim is to apply theoretical knowledge to practical, real-life scenarios, enhancing understanding and application.

The case study method employs a more focused approach. It concentrates on a single instance or scenario, using interviews, observations, and medical records review to gain insights. Its strength lies in its detail and specificity.

A case study begins with an introduction of the patient or the situation, followed by a detailed account of the patient’s history, diagnosis, treatment, and the nurse’s role. The focus is on presenting a chronological and detailed narrative of the patient’s journey.

Types of Nursing Case Studies

Here are the five primary types of case studies:

• Problem-Oriented Case Studies: These studies focus on a specific problem encountered in nursing practice. Whether it’s a challenging patient condition, a complex care scenario, or an organizational issue, problem-oriented case studies zero in on the problem. They detail the problem’s context, dissect its causes, and evaluate the solutions implemented.
• Critical Case Studies: They delve into cases with significant implications for nursing practice. These could be landmark cases, rare medical conditions, or novel nursing interventions. A critical analysis case study aims to illuminate the unique aspects and derive valuable lessons. They often lead to advancements in nursing knowledge, influencing nursing practices and policies.
• Historical Case Studies: As the name suggests, historical case studies delve into past nursing scenarios. They offer a retrospective analysis of a patient case, nursing intervention, or healthcare event. They allow for reflecting on past actions, evaluating their outcomes, and extracting lessons for future practice.
• Illustrative Case Studies: Descriptive or illustrative case studies are designed to ‘illustrate’ or ‘describe’ a particular nursing situation or condition. These case studies provide a detailed narrative of the case, painting a vivid picture for the reader. They serve to familiarize the readers with the case’s intricacies, enhancing their understanding and empathy. They are useful for educating patients or the general public about specific health conditions or nursing procedures.
• Collective Case Studies: Multiple case studies involve the analysis of more than one case. The goal is to derive insights from a collective analysis, recognizing patterns, differences, and similarities across the cases. This type of case study is especially useful for comparing different nursing approaches, understanding the variability in patient responses, or evaluating the impact of a particular nursing intervention across multiple scenarios.

6 Steps for Writing a Case Study Analysis

Writing a nursing case study analysis requires a systematic approach to ensure all necessary details are covered and accurately presented. The case study approach allows in-depth, multi-faceted explorations of complex issues in real-life settings. Here is a step-by-step guide to facilitate this process:

Preparation

Preparation means collecting, collating, and comprehending all available patient case information. First, take the patient’s medical history to understand the current health situation. It may include details about previous diagnoses, treatments, hospitalizations, allergies, and family history of diseases.

Check nursing assessments that were conducted. These assessments serve as a foundation for nursing care, offering vital clues about the patient’s health status at different times. Information about the patient’s vital signs, physical examination findings, lab results, and psychosocial assessments can help unravel the case’s complexity.

Review the treatment plans initiated to have insights into the healthcare team’s approach to managing the patient’s condition. Lastly, include the outcomes. What was the response to the treatments initiated? How did the patient’s condition evolve over time? Outcomes, both expected and unexpected, offer a reality check. They help understand the interventions’ effectiveness and provide opportunities for reflection and learning.

Introduction

Introducing your case study analysis is a gateway to the patient’s story, providing crucial initial details and laying the groundwork for in-depth exploration. Present a snapshot of the patient’s background that involves sharing key details, such as the patient’s age and gender, which can influence disease prevalence, presentation, and response to treatment.

Next, share why the patient sought medical care for a first clue to their health status. Was it a routine check-up that led to an unexpected discovery? Or perhaps the patient presented with specific symptoms, causing them concern? Then, outline the primary health concerns. What were the initial diagnoses or suspicions based on the assessments done? Were there any significant risks identified?

Finally, mention the challenges encountered during care, the strategies to address them, or the valuable lessons gleaned from the case. However, don’t give away too much – just enough to pique their interest and keep them reading.

Background Information

A key element of the background information is the patient’s medical history which sheds light on the patient’s health journey. Past medical diagnoses, treatments, lifestyle habits, and familial health patterns can explain the current health problem and guide future healthcare decisions.

The initial nursing assessments form an integral part of the background information. They include observations about the patient’s symptoms and vital signs and depict their health status at the point of care. Key details such as the patient’s blood pressure, heart rate, respiratory rate, temperature, pain level, and overall physical and mental state provide crucial baseline data against which progress can be measured.

Diagnostic tests, such as blood tests, imaging studies, or biopsies, offer objective insights into the patient’s condition. The results of these tests can confirm or rule out diagnoses, guide the choice of interventions, and help assess the effectiveness of treatments.

Lastly, highlight significant observations made during the care process. Did the patient’s condition improve or worsen over time? Were there any unexpected reactions or complications? How did the healthcare team respond? These observations offer a real-world view of the patient’s journey, providing an opportunity to reflect on the decisions made and the outcomes achieved.

Proposed Solutions

First, present the nursing interventions proposed to address the patient’s health concerns. Nursing interventions refer to nurses’ actions to improve patient outcomes, such as administering medication, providing health education, or coordinating care with other healthcare professionals.

Then, discuss the rationale behind each intervention. The rationale is the ‘why’ that justifies the ‘what.’ It explains why a particular intervention was chosen over others and how it is expected to contribute to the patient’s recovery or well-being.

Lastly, determine how each intervention was incorporated into the patient’s care plan. How was the medication administered? What teaching strategies were used for health education? How was care coordination achieved? These details help bring the care process to life, giving readers a peek into the realities of nursing practice.

Recommendations

Recommendations derive from carefully evaluating the patient’s journey, considering the outcomes observed, the challenges encountered, and the lessons learned. These recommendations aim to refine and optimize care processes, ensuring that nursing practice evolves and improves continually.

One common type of recommendation involves suggesting alternative interventions. Despite the best efforts, not all interventions yield the desired outcomes. In such cases, it’s beneficial to explore other potential solutions. These alternatives, informed by the latest evidence and expert opinion, can provide fresh approaches to the problem, opening up new avenues for patient recovery.

Another type of recommendation focuses on enhancing the implementation of interventions. Sometimes, the choice of intervention is sound, but the execution may fall short. Here, the recommendations may address areas such as improving the timing or technique of intervention delivery, enhancing patient education and engagement, or strengthening coordination among the healthcare team.

The review begins with a concise summary of the case. It revisits the patient’s background, the identified health concerns, the nursing interventions implemented, the outcomes observed, and the recommendations proposed. This brief recounting of the case helps anchor the detailed analysis in the reader’s mind.

Following the summary, it’s time for reflection. Reflective essay writing encourages practitioners to learn from their experiences and continuously improve their practice. Discuss the lessons learned from the case, the insights gained, and the challenges faced. This reflective dialogue enriches the case study analysis, transforming it from a simple narrative to a springboard for professional development and growth.

Lastly, the review addresses the case’s broader implications for nursing practice. How does this case contribute to our understanding of patient care? What does it reveal about the application of nursing theory in real-world scenarios? How can the insights from this case inform future nursing practice? By exploring these questions, the review extends the relevance of the case beyond its specific context, connecting it to the larger discourse on nursing care.

Nursing Case Study Analysis Example

This fictitious case involves a patient named “John,” who presents with Type 2 Diabetes and related complications.

Introduction John, a 63-year-old male, presented to the clinic complaining of persistent fatigue, frequent urination, and unexplained weight loss. As a nurse practitioner, I evaluated John’s condition and formulated a care plan. This case study analysis will explore John’s health journey, his health issues, the interventions undertaken, and the lessons gleaned from his case. Background Information John was diagnosed with Type 2 Diabetes five years ago. His medical history reveals that he has struggled to maintain his blood glucose levels within the recommended range. Despite being prescribed oral hypoglycemic agents and advised lifestyle modifications, he found adhering to the recommended regimen challenging. A recent HbA1c test showed a level of 9.5%, indicating poorly controlled diabetes. Proposed Solutions Given John’s condition, the mainstay of his management involved rigorous blood glucose control. His existing medication regimen was reviewed and adjusted to improve glycemic control. Simultaneously, a comprehensive diabetes self-management education (DSME) program was designed to enhance John’s understanding of diabetes and empower him to manage his condition effectively. The DSME covered essential topics such as the nature of diabetes, the importance of regular monitoring and medication adherence, diet and exercise guidelines, and coping strategies for managing stress and preventing complications. Recommendations Despite best efforts, John’s struggle with diabetes control highlights the need for individualized and holistic care approaches in managing chronic conditions like diabetes. In retrospect, introducing a more intensive support system early on, including regular follow-ups and mental health support, might have helped John better manage his condition. This case underlines the importance of comprehensive patient education and the need for healthcare professionals to recognize and address the psychosocial factors that can impact chronic disease management. Review John’s case provides valuable insights into the challenges of managing chronic conditions like diabetes. It underscores the need for a holistic and personalized approach to patient care beyond medical interventions. The lessons from this case highlight the importance of ongoing patient education, the need for mental health support in chronic disease management, and the value of early and proactive interventions. I hope that the experiences and reflections from this case will inform and enrich nursing practice, especially in chronic disease management.

Final Thoughts on Case Study Analysis

Writing a nursing case study analysis demands a keen understanding of nursing concepts, critical thinking skills, and the ability to apply theory to practice. But, with a structured approach and thorough preparation, it is a rewarding and educational process that enhances nursing practice, contributes to better patient outcomes, and facilitates lifelong learning.

If you’re a nursing student or professional seeking assistance with your own case study analysis, research summary, argumentative essay, or academic writing, look no further. Our dedicated professional writers are well-versed in nursing principles, theories, and practices, making them perfectly equipped to craft high-quality, insightful, and personalized nursing case study analyses.

Ready to experience the difference? Place your order today, and let us support your journey to academic excellence and professional development. Let’s craft a nursing case study analysis that earns you high grades and enriches your nursing practice.

FAQs on How To Write a Case Study Analysis

What is a case study analysis.

A case study analysis critically evaluates a specific instance or event, often focused on a person or a small group. It helps in applying theoretical knowledge to practical situations.

How do you structure a case study assignment?

A case study format has an introduction, background information, proposed solutions, recommendations, and a review.

What is an example of case analysis?

Case analysis examples could involve examining a patient’s journey through a specific health condition. It would involve analyzing the patient’s health history, symptoms, treatment, and response to the care provided. An in-depth review of all these elements helps to understand the situation better, gain insights, and improve future patient care.

What is the difference between a case study and a case analysis?

A case study is an in-depth investigation of a single individual, group, or event to explore causation and find underlying principles. On the other hand, a case analysis often refers to examining and interpreting the data from the case study to formulate solutions or extract insights.

What are the stages of a case study?

A case study generally involves five stages: preparation, data collection, analysis, formulation of solutions, and essay conclusions or recommendations.

What is the purpose of a case study?

A case study aims to investigate a contemporary phenomenon within its real-life context, especially when the boundaries between phenomenon and context are not evident.

What are the qualities of a good case study?

A good case study is relevant, detailed, focused, provides a learning opportunity, and can generate useful results or insights contributing to the broader field of study.

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7 steps to successful nursing case study writing.

A nursing case study is a detailed study of a patient that is encountered during a nurse’s daily practice. They are usually written by nurses in training as part of their coursework, but they can also be written by experienced nurses as a way of sharing best practice.

Case studies are an important part of the nursing curriculum as they provide students with a real-life insight into the complexities of patient care. They also allow nurses to reflect on their own practice and identify areas where they could make improvements.

When writing a nursing case study, it is important to follow the instructions provided by your tutor. This will ensure that your case study is relevant and meets the required academic standards. It is also important to be clear and concise in your writing, and to use evidence-based sources to support your claims.

If you are struggling to write a nursing case study, there are a number of resources that can help you. The following books are all recommended reading for anyone wanting to write a case study:

• The Complete Guide to Case Study Research by Elaine M. Hubbell
• Nursing Case Studies: A Guide to Understanding and Writing Them by Jennifer R. Gray
• Writing Nursing Case Studies by Sally G. Reed

Once you have a good understanding of how to write a nursing case study, you will be able to produce high-quality studies that will be of benefit to both yourself and your patients.

Importance of nursing case study writing.

Nursing case studies are an important part of your nursing education. They provide you with the opportunity to apply the knowledge and skills you have learned in the classroom to real-world scenarios. Nursing case studies also allow you to develop critical thinking and problem-solving skills.

The nursing case study should be a detailed and accurate account of the care that was provided to the patient. It should be used to evaluate the outcome of that care and to identify any areas where improvements can be made.

Steps when writing a nursing case study paper.

There are various steps you should keep in mind in order to help you write a successful nursing case study.

These important steps include:

• Define the problem.
• Gathering information.
• Developing alternatives.
• Analyzing the alternatives.
• Selecting the best alternative.
• Implementing the solution.
• Evaluating the outcome.

Defining the Problem

When writing a nursing case study, it is important to first define the problem. The problem should be something that can be solved through nursing interventions. Once the problem is defined, the nursing case study can be written to discuss the interventions that were used to solve the problem.

Nursing case studies are a great way to learn about different nursing interventions and how they can be used to solve problems. By reading nursing case studies, nurses can learn about different diseases and conditions and how to treat them. Nursing case studies can also be used to teach other nurses about different interventions.

Gathering Information

When it comes to writing a nursing case study, the first and most important step is gathering information. This is where you will need to do your research and collect data from a variety of sources. Once you have all of the information you need, you can begin to write your case study.

It is crucial to gather information before starting to write your nursing case study. This ensures that you include all of the relevant information. This means including details about the patient’s medical history, symptoms, and treatment.

Developing Alternatives

Once you have all of the necessary information, you can begin developing alternatives for the patient’s treatment. This will involve looking at the different options and deciding which is best based on the specific case. You will need to consider the risks and benefits of each option before making a recommendation.

Once you have developed a few different options, you can then start writing the case study. This should include an overview of the patient’s history, their current condition, and the different treatment options that were considered. Be sure to explain why you ultimately recommended the chosen course of treatment.

Analyzing the Alternatives

When you are given a nursing case study to write, the first step is to read the case thoroughly. Make sure you understand the situation and the patient’s history. Once you have a good understanding of the case, you can start to analyze the alternatives.

There are usually three alternatives in a nursing case study: nursing intervention, medical intervention, and no intervention. You will need to evaluate each alternative and decide which is best for the patient.

Nursing intervention is usually the first choice because it is the least invasive and has the least risk. Medical intervention is usually the next choice because it is more invasive but has a higher chance of success. No intervention is usually the last choice because it means doing nothing and letting the patient’s condition worsen.

Once you have evaluated the alternatives, you can start to write your case study. Remember to include all of the important information, such as the patient’s history, the alternatives you considered, and your recommendation.

Selecting the Best Alternative

When you are presented with a nursing case study, the first thing you need to do is identify the problem. Once you have identified the problem, you need to gather information about the patient. This information will help you to develop a plan of care. Once you have developed a plan of care, you need to select the best alternative.

The best alternative is the one that will best meet the needs of the patient. When selecting the best alternative, you need to consider the patient’s preferences, the severity of the problem, the risks and benefits of each alternative, and the resources available.

Implementing the Solution

Once you have selected the best alternative, you need to implement the plan of care. After you have implemented the plan of care, you need to evaluate the patient’s response. If the patient’s condition improves, you need to continue the plan of care. If the patient’s condition does not improve, you need to reevaluate the plan of care and select a different alternative.

Evaluating the Outcome

A nursing case study is a detailed account of a patient’s medical history and treatment. It is used to evaluate the outcome of a patient’s care and to identify any areas where improvements can be made.

When writing a nursing case study, it is important to include a detailed description of the patient’s symptoms and medical history. The case study should also include a discussion of the treatment that was provided and the outcome of that treatment.

It is also important to discuss any areas where improvements could be made in the care that was provided. This could include changes to the treatment plan, changes to the way that the patient was monitored, or changes to the way that the patient’s symptoms were managed.

Conclusion.

Writing a successful nursing case study can be a challenging task. However, by following the steps provided in this blog that is, first defining the problem, gathering information, developing alternatives., analyzing the alternatives, selecting the best alternative, implementing the solution and evaluating the outcome. You will be able to write a top-notch nursing case study that meets your requirements.

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10 nursing case study analysis examples [format + structure], bob cardens.

• August 6, 2022

If you are a nursing student, you may be asked to write a case study analysis. This can be a daunting task, but it is possible to do if you follow some simple steps. Here we include Nursing Case Study Analysis Examples to help you get started.

First, read the case study and make sure you understand the situation. Next, identify the key players involved and their role in the case. Finally, analyze the data presented and draw your own conclusions.

Writing a case study analysis can be challenging, but it is also an excellent way to learn more about nursing care. By taking the time to understand the situation and identify the key players, you will be able to gain valuable insights that can be applied to future cases.

What You'll Learn

10 Nursing Case Study Analysis Examples

Nursing case study analysis format and structure.

When it comes to writing a case study analysis, there is no one-size-fits-all approach. However, there is a general format and structure that you can follow to ensure your analysis is well-organized and flows smoothly. Here are the basics:

A nursing case study is a detailed study of a patient that is encountered by a nurse. The purpose of the case study is to provide a comprehensive view of the patient’s health condition and history. Nurse practitioners use case studies to enhance their ability to care for patients by providing them with a more complete picture of the patient’s health. Nurse practitioners may use different formats for their nursing case studies. However, all case studies should include certain key elements. These key elements include:

As a nursing practitioner, you will be responsible for analyzing patient cases and providing care based on your findings. There are key elements that you must take into account when performing a case analysis in order to ensure that you are providing the best possible care for your patients.

• The first element is the patient’s history. You will need to obtain a complete medical history in order to understand the background of the case and identify any potential risk factors.
• Next, you will need to perform a physical examination of the patient. This will help you to identify any physical signs or symptoms that may be related to the case.
• You will also need to order and review any laboratory tests or imaging studies that have been performed on the patient. These results can provide valuable information about the patient’s condition.
• Once you have gathered all of this information, you will need to start piecing together the puzzle to form a diagnosis. This process will involve synthesizing all of the information you have gathered and making a determination about what is causing the patient’s symptoms.
• Once you have made a diagnosis, you can start developing a treatment plan. This plan should be tailored specifically to the needs of the individual patient.

When writing a nursing case study, nurse practitioners should use a clear and concise format. The format should be easy to follow and understand. Nurse practitioners should also include all of the key elements in their nursing case studies. Nursing Case Study Analysis Examples

How to write a case study assignment

A case study is an in-depth analysis of a real-life situation or incident, as a way to illustrate content and theory to students. It is usually presented as a written report, but can also be done in the form of a presentation, video, or multimedia production.

Case studies are used in many different disciplines, including business, law, psychology, nursing, social work, and medical sciences.

A case study assignment is a type of paper that requires you to analyze a real-life or fictional situation and offer possible solutions. This can be a challenging task, but if you follow some basic guidelines, you can write a successful case study assignment.

Here are some tips on how to write a case study assignment:

• Read the case study carefully. Make sure you understand the situation and the problem that needs to be solved.
• Research the subject matter. You will need to have a good understanding of the relevant theories and concepts in order to offer possible solutions.
• Read the case study carefully. This may seem obvious, but it is important to get a clear understanding of the situation before you start writing. Make sure you have all the relevant facts and figures to hand before you start.
• Identify the key issues. Once you have read and understood the case study, you need to identify the key issues that it raises. These will form the basis of your analysis.
• Research the law/theory applicable to the key issues. Once you have identified the key issues, you need to research the law or theory that applies to them. This will help you to form your arguments and conclusions.
• Write your paper. Be sure to present your analysis in a clear and concise manner. Your paper should be well-organized and well-written

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Nursing Case Studies

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Case studies are essential in nursing schools for learning purposes. They provide in-depth information about a patient.

On their part, nursing case studies provide information about a patient’s symptoms, diagnoses, and medical history.

They help the students to interact with real-life scenarios, which facilitate their learning and acquisition of the knowledge, attitudes, and skills required in the clinical setting.

As a nursing student, you will have to write case studies to establish how they can apply your problem-solving and decision-making skills, depending on the patients’ scenarios that you encounter.

In this guideline, I will provide you with the relevant information on how to write a nursing case study essay that will impress your instructor and earn you more points.

Nursing Case Studies and its Importance

Did you know that a nursing case study is a snapshot is a scenario that occurred or is happening in any healthcare or nursing setting?

It can also entail the nursing educator deliberately creating a scenario in a simulated setting to help in correlating theory with practice.

Others contain details about patients that students have analyzed on the provided scenario.

Moreover, they enhance your critical thinking skills since you are required to analyze the patient’s information provided and develop a proper treatment plan.

You go through realistic scenarios to details considered as exciting and relevant that you will use to solve the patient’s problems.

Case studies help to integrate theory and practice and expose the learners to the ambiguity of the real clinical practice setting.

The Introduction Section for the Case Studies

The first part of the nursing case study introduces the topic.

For instance, if the case study is about cardiothoracic surgery, you introduce the topic, including brief details on how the nursing process occurs.

You should also provide some background information about the patient.

The introduction should also include details about the structure of the nursing case study essay and the subtopics covered in the body of the paper.

Body-Nursing Case Studies

The body of the case study explores the patient’s subjective and objective data, nursing diagnoses, establishment, and implementation of the intervention plan, and the evaluation of the patient’s outcomes.

I.        Subjective Data

Completing a successful nursing case study will entail obtaining relevant information about the patient.

It will include history taking about the patient’s presenting illness as well as other personal data about the patient like demographic information.

 II.        Objective Data

In this segment, you will include the data abstaining after performing a physical examination.

You will include the vital signs and the findings from the head-to-toe assessment of the patient .

 III.        Nursing Diagnoses

After examining the patient and putting all the symptoms and information into consideration, you have to come up with appropriate nursing diagnoses.

You should also include a rationale behind the diagnoses made.

For instance, if your diagnosis of the patient is cancer, you should report the presenting symptoms that indicate that the patient has cancer.

IV.        Treatment Plan and Intervention

Based on the identified diagnoses, you should develop an appropriate treatment plan and intervention for the patient.

You will discuss each treatment option and provide a rationale for recommending it and its role in improving the patient’s quality of life.

V.        Evaluation of the Intervention and Treatment Goals

At this point, explain how the interventions in the case analysis are working.

Remember to show if the treatment objectives are attained.

Is the intervention effective, or needs some modification?

Conclusion for the Case Studies

Conclude your great nursing case study with a summary of the presenting patient and the medical issue that you addressed.

You will sum up the interventions and the evaluations of the treatment plan. Use our top rated nursing writing services today and get nursing case study help.

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Case Studies

Gema munoz-mozas.

Vascular Access Advanced Nurse Practitioner—Lead Vascular Access Nurse, The Royal Marsden NHS Foundation Trust

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Colin Fairhurst

Vascular Access Advanced Clinical Practitioner, University Hospitals Plymouth NHS Trust

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Simon Clare

Research and Practice Development Director, The Association for Safe Aseptic Practice

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Intravenous (IV) access, both peripheral and central, is an integral part of the patient care pathways for diagnosing and treating cancer. Patients receiving systemic anticancer treatment (SACT) are at risk for developing infections, which may lead to hospitalisation, disruptions in treatment schedules and even death ( Centers for Disease Control and Prevention, 2021 ). However, infection rates can be reduced and general patient outcomes improved with the evidence-based standardisation of IV practice, and the adoption of the appropriate equipment, such as peripheral IV cannulas, flushing solutions and sterile IV dressings ( Easterlow et al, 2010 ).

Cancer treatment frequently involves the use of central venous catheters (CVCs)-also referred to as central venous access devices (CVADs)—which can represent a lifeline for patients when used to administer all kinds of IV medications, including chemotherapy, blood products and parenteral nutrition. They can also be used to obtain blood samples, which can improve the patient’s quality of life by reducing the need for peripheral stabs from regular venepunctures ( Taxbro and Chopra, 2021 ). CVCs are relatively easy to insert and care for; however, they are associated with potential complications throughout their insertion and maintenance.

One serious complication of CVC use is catheter-related bloodstream infections (CRBSIs), which can increase morbidity, leading to prolonged hospitalisation and critical use of hospital resources ( Akhtar and Lee, 2021 ). Early-onset CRBSIs are commonly caused by skin pathogens, and so a cornerstone of a CRBSI prevention is skin antisepsis at the time of CVC insertion. Appropriate antisepsis (decontamination/preparation) of the site for CVC insertion can prevent the transmission of such skin pathogens during insertion, while reducing the burden of bacteria on the CVC exit site ( Loveday et al, 2014 ).

Evidence-based practice for the prevention of a CRBSIs and other healthcare-associated infections recommends skin antisepsis prior to insertion of a vascular-access device (VAD) using a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution. This is recommended in guidelines such as epic3 ( Loveday et al, 2014 ), the Standards for Infusion Therapy ( Royal College of Nursing, 2016 ) and the Infusion Therapy Standards of Practice ( Gorski et al, 2021 ). A strong evidenced-backed product such as BD ChloraPrep™ ( Figure 1 ) has a combination of 2% chlorhexidine gluconate in 70% isopropyl alcohol that provides broad-spectrum rapid-action antisepsis, while the applicators facilitate a sterile, single-use application that eliminates direct hand-to-patient contact, helping to reduce cross-contamination and maintaining sterile conditions ( BD, 2021 ). The BD ChloraPrep™ applicator’s circular head allows precise antisepsis of the required area, and the sponge head helps to apply gentle friction in back-and-forth motion to penetrate the skin layers ( BD, 2021 ). BD ChloraPrep’s rapidacting, persistent and broad-spectrum characteristics and proven applicator system ( Florman and Nichols, 2007 ) make it a vital part of the policy and protocol for insertion, care and maintenance of CVCs in specialist cancer centres such as the Royal Marsden. Meanwhile, the use of BD PosiFlush™ Prefilled Saline Syringe ( Figure 2 ), a prefilled normal saline (0.9% sodium choride) syringe, is established practice for the flushing regime of VADs in many NHS Trusts.

The following five case studies present examples from personal experience of clinical practice that illustrate how and why clinicians in oncology and other disciplines use BD ChloraPrep ™ and BD PosiFlush ™ Prefilled Saline Syringe in both adult and paediatric patients.

Case study 1 (Andy)

Andy was a 65-year-old man being treated for metastatic colorectal cancer at the Royal Marsden NHS Foundation Trust specialist cancer service, which provides state-of-the-art treatment to over 60 000 patients each year.

Andy had a peripherally inserted central catheter (PICC) placed at the onset of his chemotherapy treatment to facilitate IV treatment. While in situ, PICCs require regular maintenance to minimise associated risks. This consists of a weekly dressing change to minimise infection and a weekly flush to maintain patency, if not in constant use. For ambulatory patients, weekly PICC maintenance can be carried out either in the hospital outpatient department or at home by a district nurse or family member trained to do so. Patients, relatives, carers and less-experienced nurses involved in PICC care (flushing and dressing) can watch a video on the Royal Marsden website as an aide memoir.

Initially, Andy decided to have his weekly PICC maintenance at the hospital’s nurse-led clinic for the maintenance of CVCs. At the clinic, Andy’s PICC dressing change and catheter flushing procedures were performed by a nursing associate (NA), who, having completed the relevant competences and undergone supervised practise, could carry out weekly catheter maintenance and access PICC for blood sampling.

In line with hospital policy, the PICC dressing change was performed under aseptic non-touch technique (ANTT) using a dressing pack and sterile gloves. After removal of the old dressing, the skin around the entry site and the PICC was cleaned with a 3 ml BD ChloraPrep™ applicator, using back-andforth strokes for 30 seconds and allowing the area to air dry completely before applying the new dressing. As clarified in a recent article on skin antisepsis (Clare and Rowley, 2020), BD ChloraPrep™ applicator facilitated a sterile, single-use application that eliminates direct hand-to-patient contact, which help reduce cross-contamination and maintaining ANTT. Its circular head allowed precise antisepsis around the catheter, and the sponge head helped to apply gentle friction in back-and-forth strokes to penetrate the skin layers.

Once the new dressing was applied, the NA continued to clean the catheter hub and change the needle-free connector. Finally, the catheter lumen was flushed with 10 ml of normal saline (0.9% sodium chloride) with a pre-filled saline syringe (BD PosiFlush™ Prefilled Saline Syringe). This involved flushing 1 ml at a time, following a push-pause technique, with positive pressure disconnection to ensure catheter patency. The classification of these syringes as medical devices enables NAs and other nonregistered members of the clinical team to support nursing staff with the care and maintenance of PICCs and other CVCs, within local policies and procedures. Using pre-filled syringes can save time and minimise the risk of contamination of the solution ( Ceylan et al, 2021 ).

The use of pre-filled 0.9% sodium chloride syringes facilitates home maintenance of PICCs for patients. When Andy did not need to attend hospital, his PICC maintenance could be performed by a family member. Patients and relatives could access the necessary equipment and training from the day-case unit or outpatient department. Home PICC maintenance is extremely beneficial, not just to providers, but also to patients, who may avoid unnecessary hospital attendance and so benefit from more quality time at home and a reduced risk of hospital-acquired infections. Many patients and relatives have commented on the convenience of having their PICC maintenance at home and how easy they found using the ChloraPrep™ and BD PosiFlush™ Prefilled Saline Syringe ‘sticks’.

Case study 2 (Gail)

Gail was as a 48-year-old woman being treated for bladder cancer with folinic acid, fluorouracil and oxaliplatin (FOLOX). She was admitted for a replacement PICC, primarily for continuous cytotoxic intravenous medication via infusion pump in the homecare setting. Her first PICC developed a reaction thought to be related to a sutureless securement device (SSD) anchoring the PICC. The device was removed, but this resulted in displacement of the PICC and incorrect positioning in the vessel (superior vena cava). Now unsafe, the PICC was removed, awaiting replacement, which resulted in a delayed start for the chemotherapy.

A second PICC placement was attempted by a nurse-led CVC placement team, and a line attempt was made in Gail’s left arm. Skin antisepsis was undertaken using a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution (ChloraPrep™). A BD ChloraPrep ™ 10 ml applicator was selected, using manufacturer’s recommendations, as per best practice guidance for CVC placement ( Loveday et al, 2014 ) and to comply with local policy for the use of ANTT. The BD ChloraPrep™ applicator allowed improved non-touch technique and helped facilitate good key-part and key-site protection, in line with ANTT ( Clare and Rowley, 2021 ).

The inserting clinician failed to successfully position the PICC in Gail’s left arm and moved to try on the right. On the second attempt, Gail noted the use of BD ChloraPrep™ and stated that she was allergic to the product, reporting a severe skin rash and local discomfort. The line placer informed the Gail that she had used BD ChloraPrep™ on the failed first attempt without issue, and she gave her consent to continue the procedure. No skin reaction was noted during or after insertion of the PICC.

BD ChloraPrep™ has a rapid-acting broad-spectrum antiseptic range and ability to keep fighting bacteria for at least 48 hours ( BD, 2021 ). These were tangible benefits during maintenance of the CVC insertion site, in the protection of key sites following dressing change and until subsequent dressing changes. There are reported observations of clinicians not allowing the skin to fully dry and applying a new dressing onto wet skin after removing old dressings and disinfecting the exit site with BD ChloraPrep™. This has been reported to cause skin irritation, which can be mistaken for an allergic reaction and lead the patient to think that they have an allergy to chlorhexidine. In our centre’s general experience, very few true allergic reactions have ever been reported by the insertion team. Improved surveillance might better differentiate between later reported reactions, possibly associated with a delayed response to exposure to BD ChloraPrep ™ at insertion, and local skin irritation caused by incorrect management at some later point during hospitalisation.

Staff training is an important consideration in the safe and correct use of BD ChloraPrep™ products and the correct use of adhesive dressings to avoid irritant contact dermatitis (ICD). It is worth noting that it can be difficult to differentiate between ICD and allergic contact dermatitis (ACD). Education and training should be multifaceted (such as with training videos and study days), allowing for different ways of learning, and monitored with audit. Local training in the benefits of using BD ChloraPrep™ correctly have been reinforced by adding simple instructions to ANTT procedure guidelines for CVC insertion and maintenance. Education on its own is often limited to a single episode of training, the benefit of using ANTT procedure guidelines is that they are embedded in a programme of audits and periodic competency reassessment. This makes sure that, as an integral part of good practice, skin antisepsis with BD ChloraPrep ™ is consistently and accurately retrained and assessed.

Gail’s case illustrates the importance of correct application of BD ChloraPrep ™ and how good documentation and surveillance are vital in monitoring skin health during the repeated use skindisinfection products. Care should be taken when recording ICD and ACD reactions, and staff should take steps to confirm true allergy versus temporary skin irritation.

Case study 3 (Beata)

Beata was a 13-year-old teenage girl being treated for acute myeloid leukaemia. Although Beata had a dual-lumen skin-tunnelled catheter in situ, a peripheral intravenous cannula (PIVC) was required for the administration of contrast media for computed tomography (CT) scanning. However, Beata had needlephobia, and so the lead vascular access nurse was contacted to insert the cannula, following ultrasound guidance and the ANTT. After Beata and her mother gave their consent to the procedure, the nurse gathered and prepared all the equipment, including a cannulation pack, single-use tourniquet, skin-antisepsis product, appropriate cannula, PIVC dressing, 0.9% sodium chloride BD PosiFlush ™ Prefilled Saline Syringe, sterile gel, sterile dressing to cover ultrasound probe and personal protective equipment.

Prior to PIVC insertion, a 4x5 cm area of skin underwent antisepsis with a 1.5 ml BD ChloraPrep ™ Frepp applicator, with back-and-forth strokes for 30 seconds, and was allowed to air-dry. The vascular access team prefer to use BD ChloraPrep ™ Frepp over single-use wipes, as the former is faster acting and provides the right volume to decontaminate the indicated area using ANTT ( Clare and Rowley, 2021 ).

Following insertion, the PIVC was flushed with a 10 ml BD PosiFlush ™ Prefilled Saline Syringe syringe, using a pushpause pulsatile technique, with positive pressure disconnection. Local policy recommends the use of pre-filled saline syringes, as they save time and minimise infection risk compared with manually drawn saline flushes ( Ceylan et al, 2021 ). The Trust also permits competent non-registered members of staff to perform PIVC insertion, which is more cost-effective than depending on registered nurses.

In Beata’s case, the team considered the use of BD ChloraPrep™ and BD PosiFlush™ Prefilled Saline Syringe to be essential for the prevention of VAD-associated infections, as well as increasing the quality of nursing care by saving time in the day-case and inpatient settings alike.

Case study 4 (Emma)

Emma, a 43-year-old woman diagnosed with acute lymphoblastic leukaemia, was scheduled for an allogenic stem-cell transplant and associated chemotherapy. To facilitate this, she attended the vascular access service at University Hospitals Plymouth NHS Trust for the insertion of a triple-lumen skin-tunnelled catheter. This was identified as the best VAD for her needs, because of its longevity, multiple points of access and decreased infection risk compared with other devices, such as PICCs.

This was Emma’s second advanced VAD insertion, having previously received an apheresis line due to poor peripheral venous access, to facilitate the prior stem-cell harvest. She was yet to receive any treatment, and, therefore, no immunodeficiency had been identified prior to the insertion procedure.

Trust policy for skin disinfection prior to the insertion or removal of PICC lines is a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution, BD ChloraPrep™. There is an exception for patient history of allergy or sensitivity to BD ChloraPrep™, where 10% povidone iodine is used instead. Emma had received BD ChloraPrep™ before, with no sign allergy or sensitivity, and so the vascular access team decided to use this product again for insertion. BD Chloraprep™ was used, in preference of other skin antisepsis options, due to the applicator’s ability to effectively penetrate the layers of the epidermis, as well as the ability to eliminate direct hand-to-skin contact between the operator and patient ( Clare and Rowley, 2021 ).

Insertion of a skin-tunnelled catheter first requires disinfection of a large area, including the neck and upper chest. Following the manufacturer’s coverage recommendations, a 10.5 ml BD ChloraPrep™ applicator was selected as most suitable to cover an area of 25x30 cm ( BD, 2022 a).

The applicator was activated by pinching the wings to allow the antiseptic solution to properly load onto the sponge. To ensure proper release of the solution, the applicator was held on the skin against the anticipated site of insertion until the sponge pad became saturated. Then, a back-and-forth rubbing motion was undertaken for a minimum of 30 seconds, ensuring that the full area to be used was covered. The solution was then left to dry completely, prior to full-body draping, leaving the procedural area exposed for the procedure. Generally, drying time takes from 30 to 60 seconds, but local policy is not restrictive, as allowing the solution to fully dry is of paramount importance ( Gunka et al, 2019 ). BD Chloraprep™ is effective against a wide variety of microorganisms and has a rapid onset of action ( Florman and Nichols, 2007 ). Therefore, it was felt to be the best option for procedural and ongoing care skin asepsis in a patient anticipated to be immunocompromised during treatment.

It is the normal policy of the Trust’s vascular access service to flush VADs using BD PosiFlush™ Prefilled Saline Syringes with 0.9% sodium chloride. Likewise, BD PosiFlush™ Prefilled Saline Syringes Sterile Pathway (SP) are used to prime all VADs prior to insertion and to check for correct patency once inserted. BD PosiFlush ™ Prefilled Saline Syringe were used in preference of other options, such as vials or bags, due to the absence of requirement for a prescription in the local organisation. They are treated as a medical device and, therefore, can be used without prescription. The advantage of this is that flushes can be administered in a nurse-led clinic, where prescribers are not always available. Aside from the logistical advantages, the use of pre-filled syringes reduces the risk of microbial contamination through preparation error and administration error through correct labelling ( National Patient Safety Agency, 2007 ) In Emma’s case, three BD PosiFlush™ SP Prefilled Saline Syringes were used to check patency and/or ascertain venous location following the insertion of the skin-tunnelled catheter.

In this case, both BD ChloraPrep ™ and BD PosiFlush ™ Prefilled Saline Syringe proved simple to use and helped achieve a successful procedural outcome for the patient.

Case study 5 (Frank)

Frank was a 47-year-old man who had been diagnosed with infective endocarditis following a trans-oesophageal echo. A few days later, to facilitate his planned treatment of 6 weeks of intravenous antibiotics to be administered 4-hourly every day, he was referred to the vascular access service for insertion of longterm IV access. To facilitate this administration, the decision was made to place a PICC.

Frank’s referral included a history of illegal intravenous drug use and details of the consequent difficulty the ward-based team had in finding suitable veins to obtain vascular access. His medical history also included infected abscesses in the left groin and methicillin-resistant Staphylococcus aureus (MRSA) colonisation.

First, Frank was administered suppression therapy for MRSA decolonisation. Following this and prior to PICC insertion, the skin antisepsis procedure was undertaken using a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution, BD ChloraPrep™, in adherence to Trust policy ( Loveday et al, 2014 ). Specifically, BD ChloraPrep™ applicators are selected for their single-use application. They have been demonstrated to reduce the risk of infectious complications (catheter colonisation and local infection) by 92% compared with 5% povidone iodine (PVI) 69% ethanol ( Guenezan et al, 2021 ). A 3 ml BD ChloraPrep™ applicator was considered suitable to decontaminate an area sufficient for the intended PICC insertion procedure, as recommended by the manufacturer ( BD, 2022 b). It was applied using a back-and-forth motion for a minimum of 30 seconds and left to fully dry ( Loveday et al, 2014 ). Staphylococcus aureus bacteraemia’s have a mortality rate of 20-40% and are predominantly caused by VAD insertion ( Ishikawa and Furukawa, 2021 ), and, therefore, the need to reduce this risk was of particular importance for this patient due to the history of MRSA colonisation.

In Frank’s case, the use of BD ChloraPrep™ during the insertion procedure and for each subsequent dressing change episode participated in an uneventful period of treatment. The clinical challenges posed by the patients’ presentation of MRSA colonisation meant the risk of infection was increased but, through correct antisepsis, no adverse events were noted, and the full course of treatment was successfully administered through the PICC.