case study nursing education

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Henry and Ertha Williams

Julia morales and lucy grey, millie larsen.

• Developing Interprofessional Education and Practice in Oral Health
• Importance of Oral-Systemic Health in Older Adults
• Performing Oral Health Assessments on Aging Patients
• Oral Health for the Older Adult Living in the Community
• Elder Abuse in the United States
• Geriatric Syndromes
• Mental Health Needs of Older Adults
• Student-Led Geriatric Nursing Conference: Evidence in Practice
• Teaching Oral Health Care for Older Adults
• Using Case Study Betsy to Understand Down's Syndrome & Dementia
• Using Cinema to Enhance Teaching Issues Related to Older Adults
• Using the Monologue of Doris Smith to Understand Situational Decision-Making
• Caring for the Caregiver
• Caring for the Older Adult at Risk for Falling
• Coordinating and Managing Care During Transitions Among Care Settings
• End-of-Life Decision Making for Older Adults: Competent and Compassionate Care
• Myths of Aging
• Using Continuing Care Retirement Communities to Enhance a Better Understanding of Older Adults
• ACE.S Knowledge Domains
• ACE.S Essential Nursing Actions
• ACE.S Framework
• ACE.S Development & History
• ACE.S Additional Resources
• ACE.S Video Library

ACE.S Unfolding Cases

An unfolding case is one that evolves over time in a manner that is unpredictable to the learner. New situations develop and are revealed with each encounter. Every ACE unfolding case uses the highly regarded unfolding case model developed for Advancing Care Excellence for Seniors (ACE.S) . Each case includes the following:

• A first-person monologue that introduces the family and the complex problems they are facing.
• Simulation scenarios designed to help students practice assessing function and expectations of their patient(s), with links to appropriate evidence-based assessment tools. Suggestions for debriefing are included.
• An innovative final assignment that asks students to finish the story .
• Instructor toolkits with suggestions on how to use the various components of the unfolding cases and incorporate them into the curriculum.

These unfolding cases combine the power of storytelling with the experiential nature of simulation scenarios. They are intended to create a robust, meaningful experience for students, one that provides a simulated experience of continuity of care and that will help them integrate the Essential Knowledge Domains and Nursing Actions into their practice of nursing. We hope you will give them a try! Standardized/Simulated patients are recommended for all ACE simulations. If you are not already familiar with the Association for Standardized Patient Educators Standards of Best Practice, we encourage you to review them.

Learn more about unfolding cases by visiting the  How to Use an Unfolding Case  page.

Sherman "Red" Yoder

Nln leadership development program for simulation educators project mapping the ace.s unfolding cases to the aacn essentials.

Project Disclaimer: Simulation leadership projects are a requirement for the Leadership Development Program for Simulation Educators. All projects are then placed within SIRC for the benefit of the nursing education community. Inclusion of this specific project does not constitute an endorsement by the NLN of the AACN Essentials.

Unfolding Cases with Older Adults from Other ACE Programs

Butch sampson (ace.v), eugene shaw (ace.v), ertha williams (ace.z), george palo (ace.z), judy and karen jones (ace.z), mike walker (ace+).

Health Case Studies

(29 reviews)

Glynda Rees, British Columbia Institute of Technology

Rob Kruger, British Columbia Institute of Technology

Janet Morrison, British Columbia Institute of Technology

Copyright Year: 2017

Publisher: BCcampus

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Jessica Sellars, Medical assistant office instructor, Blue Mountain Community College on 10/11/23

This is a book of compiled and very well organized patient case studies. The author has broken it up by disease patient was experiencing and even the healthcare roles that took place in this patients care. There is a well thought out direction and... read more

Comprehensiveness rating: 5 see less

This is a book of compiled and very well organized patient case studies. The author has broken it up by disease patient was experiencing and even the healthcare roles that took place in this patients care. There is a well thought out direction and plan. There is an appendix to refer to as well if you are needing to find something specific quickly. I have been looking for something like this to help my students have a base to do their project on. This is the most comprehensive version I have found on the subject.

Content Accuracy rating: 5

This is a book compiled of medical case studies. It is very accurate and can be used to learn from great care and mistakes.

Relevance/Longevity rating: 5

This material is very relevant in this context. It also has plenty of individual case studies to utilize in many ways in all sorts of medical courses. This is a very useful textbook and it will continue to be useful for a very long time as you can still learn from each study even if medicine changes through out the years.

Clarity rating: 5

The author put a lot of thought into the ease of accessibility and reading level of the target audience. There is even a "how to use this resource" section which could be extremely useful to students.

Consistency rating: 5

The text follows a very consistent format throughout the book.

Modularity rating: 5

Each case study is individual broken up and in a group of similar case studies. This makes it extremely easy to utilize.

Organization/Structure/Flow rating: 5

The book is very organized and the appendix is through. It flows seamlessly through each case study.

Interface rating: 5

I had no issues navigating this book, It was clearly labeled and very easy to move around in.

Grammatical Errors rating: 5

I did not catch any grammar errors as I was going through the book

Cultural Relevance rating: 5

This is a challenging question for any medical textbook. It is very culturally relevant to those in medical or medical office degrees.

I have been looking for something like this for years. I am so happy to have finally found it.

Reviewed by Cindy Sun, Assistant Professor, Marshall University on 1/7/23

Interestingly, this is not a case of ‘you get what you pay for’. Instead, not only are the case studies organized in a fashion for ease of use through a detailed table of contents, the authors have included more support for both faculty and... read more

Interestingly, this is not a case of ‘you get what you pay for’. Instead, not only are the case studies organized in a fashion for ease of use through a detailed table of contents, the authors have included more support for both faculty and students. For faculty, the introduction section titled ‘How to use this resource’ and individual notes to educators before each case study contain application tips. An appendix overview lists key elements as issues / concepts, scenario context, and healthcare roles for each case study. For students, learning objectives are presented at the beginning of each case study to provide a framework of expectations.

The content is presented accurately and realistic.

The case studies read similar to ‘A Day In the Life of…’ with detailed intraprofessional communications similar to what would be overheard in patient care areas. The authors present not only the view of the patient care nurse, but also weave interprofessional vantage points through each case study by including patient interaction with individual professionals such as radiology, physician, etc.

In addition to objective assessment findings, the authors integrate standard orders for each diagnosis including medications, treatments, and tests allowing the student to incorporate pathophysiology components to their assessments.

Each case study is arranged in the same framework for consistency and ease of use.

This compilation of eight healthcare case studies focusing on new onset and exacerbation of prevalent diagnoses, such as heart failure, deep vein thrombosis, cancer, and chronic obstructive pulmonary disease advancing to pneumonia.

Each case study has a photo of the ‘patient’. Simple as this may seem, it gives an immediate mental image for the student to focus.

Interface rating: 4

As noted by previous reviewers, most of the links do not connect active web pages. This may be due to the multiple options for accessing this resource (pdf download, pdf electronic, web view, etc.).

Grammatical Errors rating: 4

A minor weakness that faculty will probably need to address prior to use is regarding specific term usages differences between Commonwealth countries and United States, such as lung sound descriptors as ‘quiet’ in place of ‘diminished’ and ‘puffers’ in place of ‘inhalers’.

The authors have provided a multicultural, multigenerational approach in selection of patient characteristics representing a snapshot of today’s patient population. Additionally, one case study focusing on heart failure is about a middle-aged adult, contrasting to the average aged patient the students would normally see during clinical rotations. This option provides opportunities for students to expand their knowledge on risk factors extending beyond age.

This resource is applicable to nursing students learning to care for patients with the specific disease processes presented in each case study or for the leadership students focusing on intraprofessional communication. Educators can assign as a supplement to clinical experiences or as an in-class application of knowledge.

Reviewed by Stephanie Sideras, Assistant Professor, University of Portland on 8/15/22

The eight case studies included in this text addressed high frequency health alterations that all nurses need to be able to manage competently. While diabetes was not highlighted directly, it was included as a potential comorbidity. The five... read more

The eight case studies included in this text addressed high frequency health alterations that all nurses need to be able to manage competently. While diabetes was not highlighted directly, it was included as a potential comorbidity. The five overarching learning objectives pulled from the Institute of Medicine core competencies will clearly resonate with any faculty familiar with Quality and Safety Education for Nurses curriculum.

The presentation of symptoms, treatments and management of the health alterations was accurate. Dialogue between the the interprofessional team was realistic. At times the formatting of lab results was confusing as they reflected reference ranges specific to the Canadian healthcare system but these occurrences were minimal and could be easily adapted.

The focus for learning from these case studies was communication - patient centered communication and interprofessional team communication. Specific details, such as drug dosing, was minimized, which increases longevity and allows for easy individualization of the case data.

While some vocabulary was specific to the Canadian healthcare system, overall the narrative was extremely engaging and easy to follow. Subjective case data from patient or provider were formatted in italics and identified as 'thoughts'. Objective and behavioral case data were smoothly integrated into the narrative.

The consistency of formatting across the eight cases was remarkable. Specific learning objectives are identified for each case and these remain consistent across the range of cases, varying only in the focus for the goals for each different health alterations. Each case begins with presentation of essential patient background and the progress across the trajectory of illness as the patient moves from location to location encountering different healthcare professionals. Many of the characters (the triage nurse in the Emergency Department, the phlebotomist) are consistent across the case situations. These consistencies facilitate both application of a variety of teaching methods and student engagement with the situated learning approach.

Case data is presented by location and begins with the patient's first encounter with the healthcare system. This allows for an examination of how specific trajectories of illness are manifested and how care management needs to be prioritized at different stages. This approach supports discussions of care transitions and the complexity of the associated interprofessional communication.

The text is well organized. The case that has two levels of complexity is clearly identified

The internal links between the table of contents and case specific locations work consistently. In the EPUB and the Digital PDF the external hyperlinks are inconsistently valid.

The grammatical errors were minimal and did not detract from readability

Cultural diversity is present across the cases in factors including race, ethnicity, socioeconomic status, family dynamics and sexual orientation.

The level of detail included in these cases supports a teaching approach to address all three spectrums of learning - knowledge, skills and attitudes - necessary for the development of competent practice. I also appreciate the inclusion of specific assessment instruments that would facilitate a discussion of evidence based practice. I will enjoy using these case to promote clinical reasoning discussions of data that is noticed and interpreted with the resulting prioritizes that are set followed by reflections that result from learner choices.

Reviewed by Chris Roman, Associate Professor, Butler University on 5/19/22

It would be extremely difficult for a book of clinical cases to comprehensively cover all of medicine, and this text does not try. Rather, it provides cases related to common medical problems and introduces them in a way that allows for various... read more

Comprehensiveness rating: 4 see less

It would be extremely difficult for a book of clinical cases to comprehensively cover all of medicine, and this text does not try. Rather, it provides cases related to common medical problems and introduces them in a way that allows for various learning strategies to be employed to leverage the cases for deeper student learning and application.

The narrative form of the cases is less subject to issues of accuracy than a more content-based book would be. That said, the cases are realistic and reasonable, avoiding being too mundane or too extreme.

These cases are narrative and do not include many specific mentions of drugs, dosages, or other aspects of clinical care that may grow/evolve as guidelines change. For this reason, the cases should be “evergreen” and can be modified to suit different types of learners.

Clarity rating: 4

The text is written in very accessible language and avoids heavy use of technical language. Depending on the level of learner, this might even be too simplistic and omit some details that would be needed for physicians, pharmacists, and others to make nuanced care decisions.

The format is very consistent with clear labeling at transition points.

The authors point out in the introductory materials that this text is designed to be used in a modular fashion. Further, they have built in opportunities to customize each cases, such as giving dates of birth at “19xx” to allow for adjustments based on instructional objectives, etc.

The organization is very easy to follow.

I did not identify any issues in navigating the text.

The text contains no grammatical errors, though the language is a little stiff/unrealistic in some cases.

Cases involve patients and members of the care team that are of varying ages, genders, and racial/ethnic backgrounds

Reviewed by Trina Larery, Assistant Professor, Pittsburg State University on 4/5/22

The book covers common scenarios, providing allied health students insight into common health issues. The information in the book is thorough and easily modified if needed to include other scenarios not listed. The material was easy to understand... read more

The book covers common scenarios, providing allied health students insight into common health issues. The information in the book is thorough and easily modified if needed to include other scenarios not listed. The material was easy to understand and apply to the classroom. The E-reader format included hyperlinks that bring the students to subsequent clinical studies.

Content Accuracy rating: 4

The treatments were explained and rationales were given, which can be very helpful to facilitate effective learning for a nursing student or novice nurse. The case studies were accurate in explanation. The DVT case study incorrectly identifies the location of the clot in the popliteal artery instead of in the vein.

The content is relevant to a variety of different types of health care providers and due to the general nature of the cases, will remain relevant over time. Updates should be made annually to the hyperlinks and to assure current standard of practice is still being met.

Clear, simple and easy to read.

Consistent with healthcare terminology and framework throughout all eight case studies.

The text is modular. Cases can be used individually within a unit on the given disease process or relevant sections of a case could be used to illustrate a specific point providing great flexibility. The appendix is helpful in locating content specific to a certain diagnosis or a certain type of health care provider.

The book is well organized, presenting in a logical clear fashion. The appendix allows the student to move about the case study without difficulty.

The interface is easy and simple to navigate. Some links to external sources might need to be updated regularly since those links are subject to change based on current guidelines. A few hyperlinks had "page not found".

Few grammatical errors were noted in text.

The case studies include people of different ethnicities, socioeconomic status, ages, and genders to make this a very useful book.

I enjoyed reading the text. It was interesting and relevant to today's nursing student. There are roughly 25 broken online links or "pages not found", care needs to be taken to update at least annually and assure links are valid and utilizing the most up to date information.

Reviewed by Benjamin Silverberg, Associate Professor/Clinician, West Virginia University on 3/24/22

The appendix reviews the "key roles" and medical venues found in all 8 cases, but is fairly spartan on medical content. The table of contents at the beginning only lists the cases and locations of care. It can be a little tricky to figure out what... read more

Comprehensiveness rating: 3 see less

The appendix reviews the "key roles" and medical venues found in all 8 cases, but is fairly spartan on medical content. The table of contents at the beginning only lists the cases and locations of care. It can be a little tricky to figure out what is going on where, especially since each case is largely conversation-based. Since this presents 8 cases (really 7 with one being expanded upon), there are many medical topics (and venues) that are not included. It's impossible to include every kind of situation, but I'd love to see inclusion of sexual health, renal pathology, substance abuse, etc.

Though there are differences in how care can be delivered based on personal style, changing guidelines, available supplies, etc, the medical accuracy seems to be high. I did not detect bias or industry influence.

Relevance/Longevity rating: 4

Medications are generally listed as generics, with at least current dosing recommendations. The text gives a picture of what care looks like currently, but will be a little challenging to update based on new guidelines (ie, it can be hard to find the exact page in which a medication is dosed/prescribed). Even if the text were to be a little out of date, an instructor can use that to point out what has changed (and why).

Clear text, usually with definitions of medical slang or higher-tier vocabulary. Minimal jargon and there are instances where the "characters" are sorting out the meaning as well, making it accessible for new learners, too.

Overall, the style is consistent between cases - largely broken up into scenes and driven by conversation rather than descriptions of what is happening.

There are 8 (well, again, 7) cases which can be reviewed in any order. Case #2 builds upon #1, which is intentional and a good idea, though personally I would have preferred one case to have different possible outcomes or even a recurrence of illness. Each scene within a case is reasonably short.

Organization/Structure/Flow rating: 4

These cases are modular and don't really build on concepts throughout. As previously stated, case #2 builds upon #1, but beyond that, there is no progression. (To be sure, the authors suggest using case #1 for newer learners and #2 for more advanced ones.) The text would benefit from thematic grouping, a longer introduction and debriefing for each case (there are learning objectives but no real context in medical education nor questions to reflect on what was just read), and progressively-increasing difficulty in medical complexity, ethics, etc.

I used the PDF version and had no interface issues. There are minimal photographs and charts. Some words are marked in blue but those did not seem to be hyperlinked anywhere.

No noticeable errors in grammar, spelling, or formatting were noted.

I appreciate that some diversity of age and ethnicity were offered, but this could be improved. There were Canadian Indian and First Nations patients, for example, as well as other characters with implied diversity, but there didn't seem to be any mention of gender diverse or non-heterosexual people, or disabilities. The cases tried to paint family scenes (the first patient's dog was fairly prominently mentioned) to humanize them. Including more cases would allow for more opportunities to include sex/gender minorities, (hidden) disabilities, etc.

The text (originally from 2017) could use an update. It could be used in conjunction with other Open Texts, as a compliment to other coursework, or purely by itself. The focus is meant to be on improving communication, but there are only 3 short pages at the beginning of the text considering those issues (which are really just learning objectives). In addition to adding more cases and further diversity, I personally would love to see more discussion before and after the case to guide readers (and/or instructors). I also wonder if some of the ambiguity could be improved by suggesting possible health outcomes - this kind of counterfactual comparison isn't possible in real life and could be really interesting in a text. Addition of comprehension/discussion questions would also be worthwhile.

Reviewed by Danielle Peterson, Assistant Professor, University of Saint Francis on 12/31/21

This text provides readers with 8 case studies which include both chronic and acute healthcare issues. Although not comprehensive in regard to types of healthcare conditions, it provides a thorough look at the communication between healthcare... read more

This text provides readers with 8 case studies which include both chronic and acute healthcare issues. Although not comprehensive in regard to types of healthcare conditions, it provides a thorough look at the communication between healthcare workers in acute hospital settings. The cases are primarily set in the inpatient hospital setting, so the bulk of the clinical information is basic emergency care and inpatient protocol: vitals, breathing, medication management, etc. The text provides a table of contents at opening of the text and a handy appendix at the conclusion of the text that outlines each case’s issue(s), scenario, and healthcare roles. No index or glossary present.

Although easy to update, it should be noted that the cases are taking place in a Canadian healthcare system. Terms may be unfamiliar to some students including “province,” “operating theatre,” “physio/physiotherapy,” and “porter.” Units of measurement used include Celsius and meters. Also, the issue of managed care, health insurance coverage, and length of stay is missing for American students. These are primary issues that dictate much of the healthcare system in the US and a primary job function of social workers, nurse case managers, and medical professionals in general. However, instructors that wish to add this to the case studies could do so easily.

The focus of this text is on healthcare communication which makes it less likely to become obsolete. Much of the clinical information is stable healthcare practice that has been standard of care for quite some time. Nevertheless, given the nature of text, updates would be easy to make. Hyperlinks should be updated to the most relevant and trustworthy sources and checked frequently for effectiveness.

The spacing that was used to note change of speaker made for ease of reading. Although unembellished and plain, I expect students to find this format easy to digest and interesting, especially since the script is appropriately balanced with ‘human’ qualities like the current TV shows and songs, the use of humor, and nonverbal cues.

A welcome characteristic of this text is its consistency. Each case is presented in a similar fashion and the roles of the healthcare team are ‘played’ by the same character in each of the scenarios. This allows students to see how healthcare providers prioritize cases and juggle the needs of multiple patients at once. Across scenarios, there was inconsistency in when clinical terms were hyperlinked.

The text is easily divisible into smaller reading sections. However, since the nature of the text is script-narrative format, if significant reorganization occurs, one will need to make sure that the communication of the script still makes sense.

The text is straightforward and presented in a consistent fashion: learning objectives, case history, a script of what happened before the patient enters the healthcare setting, and a script of what happens once the patient arrives at the healthcare setting. The authors use the term, “ideal interactions,” and I would agree that these cases are in large part, ‘best case scenarios.’ Due to this, the case studies are well organized, clear, logical, and predictable. However, depending on the level of student, instructors may want to introduce complications that are typical in the hospital setting.

The interface is pleasing and straightforward. With exception to the case summary and learning objectives, the cases are in narrative, script format. Each case study supplies a photo of the ‘patient’ and one of the case studies includes a link to a 3-minute video that introduces the reader to the patient/case. One of the highlights of this text is the use of hyperlinks to various clinical practices (ABG, vital signs, transfer of patient). Unfortunately, a majority of the links are broken. However, since this is an open text, instructors can update the links to their preference.

Although not free from grammatical errors, those that were noticed were minimal and did not detract from reading.

Cultural Relevance rating: 4

Cultural diversity is visible throughout the patients used in the case studies and includes factors such as age, race, socioeconomic status, family dynamics, and sexual orientation. A moderate level of diversity is noted in the healthcare team with some stereotypes: social workers being female, doctors primarily male.

As a social work instructor, I was grateful to find a text that incorporates this important healthcare role. I would have liked to have seen more content related to advance directives, mediating decision making between the patient and care team, emotional and practical support related to initial diagnosis and discharge planning, and provision of support to colleagues, all typical roles of a medical social worker. I also found it interesting that even though social work was included in multiple scenarios, the role was only introduced on the learning objectives page for the oncology case.

Reviewed by Crystal Wynn, Associate Professor, Virginia State University on 7/21/21

The text covers a variety of chronic diseases within the cases; however, not all of the common disease states were included within the text. More chronic diseases need to be included such as diabetes, cancer, and renal failure. Not all allied... read more

The text covers a variety of chronic diseases within the cases; however, not all of the common disease states were included within the text. More chronic diseases need to be included such as diabetes, cancer, and renal failure. Not all allied health care team members are represented within the case study. Key terms appear throughout the case study textbook and readers are able to click on a hyperlink which directs them to the definition and an explanation of the key term.

Content is accurate, error-free and unbiased.

The content is up-to-date, but not in a way that will quickly make the text obsolete within a short period of time. The text is written and/or arranged in such a way that necessary updates will be relatively easy and straightforward to implement.

The text is written in lucid, accessible prose, and provides adequate context for any jargon/technical terminology used

The text is internally consistent in terms of terminology and framework.

The text is easily and readily divisible into smaller reading sections that can be assigned at different points within the course. Each case can be divided into a chronic disease state unit, which will allow the reader to focus on one section at a time.

Organization/Structure/Flow rating: 3

The topics in the text are presented in a logical manner. Each case provides an excessive amount of language that provides a description of the case. The cases in this text reads more like a novel versus a clinical textbook. The learning objectives listed within each case should be in the form of questions or activities that could be provided as resources for instructors and teachers.

Interface rating: 3

There are several hyperlinks embedded within the textbook that are not functional.

The text contains no grammatical errors.

Cultural Relevance rating: 3

The text is not culturally insensitive or offensive in any way. More examples of cultural inclusiveness is needed throughout the textbook. The cases should be indicative of individuals from a variety of races and ethnicities.

Reviewed by Rebecca Hillary, Biology Instructor, Portland Community College on 6/15/21

This textbook consists of a collection of clinical case studies that can be applicable to a wide range of learning environments from supplementing an undergraduate Anatomy and Physiology Course, to including as part of a Medical or other health... read more

This textbook consists of a collection of clinical case studies that can be applicable to a wide range of learning environments from supplementing an undergraduate Anatomy and Physiology Course, to including as part of a Medical or other health care program. I read the textbook in E-reader format and this includes hyperlinks that bring the students to subsequent clinical study if the book is being used in a clinical classroom. This book is significantly more comprehensive in its approach from other case studies I have read because it provides a bird’s eye view of the many clinicians, technicians, and hospital staff working with one patient. The book also provides real time measurements for patients that change as they travel throughout the hospital until time of discharge.

Each case gave an accurate sense of the chaos that would be present in an emergency situation and show how the conditions affect the practitioners as well as the patients. The reader gets an accurate big picture--a feel for each practitioner’s point of view as well as the point of view of the patient and the patient’s family as the clock ticks down and the patients are subjected to a number of procedures. The clinical information contained in this textbook is all in hyperlinks containing references to clinical skills open text sources or medical websites. I did find one broken link on an external medical resource.

The diseases presented are relevant and will remain so. Some of the links are directly related to the Canadian Medical system so they may not be applicable to those living in other regions. Clinical links may change over time but the text itself will remain relevant.

Each case study clearly presents clinical data as is it recorded in real time.

Each case study provides the point of view of several practitioners and the patient over several days. While each of the case studies covers different pathology they all follow this same format, several points of view and data points, over a number of days.

The case studies are divided by days and this was easy to navigate as a reader. It would be easy to assign one case study per body system in an Anatomy and Physiology course, or to divide them up into small segments for small in class teaching moments.

The topics are presented in an organized way showing clinical data over time and each case presents a large number of view points. For example, in the first case study, the patient is experiencing difficulty breathing. We follow her through several days from her entrance to the emergency room. We meet her X Ray Technicians, Doctor, Nurses, Medical Assistant, Porter, Physiotherapist, Respiratory therapist, and the Lab Technicians running her tests during her stay. Each practitioner paints the overall clinical picture to the reader.

I found the text easy to navigate. There were not any figures included in the text, only clinical data organized in charts. The figures were all accessible via hyperlink. Some figures within the textbook illustrating patient scans could have been helpful but I did not have trouble navigating the links to visualize the scans.

I did not see any grammatical errors in the text.

The patients in the text are a variety of ages and have a variety of family arrangements but there is not much diversity among the patients. Our seven patients in the eight case studies are mostly white and all cis gendered.

Some of the case studies, for example the heart failure study, show clinical data before and after drug treatments so the students can get a feel for mechanism in physiological action. I also liked that the case studies included diet and lifestyle advice for the patients rather than solely emphasizing these pharmacological interventions. Overall, I enjoyed reading through these case studies and I plan to utilize them in my Anatomy and Physiology courses.

Reviewed by Richard Tarpey, Assistant Professor, Middle Tennessee State University on 5/11/21

As a case study book, there is no index or glossary. However, medical and technical terms provide a useful link to definitions and explanations that will prove useful to students unfamiliar with the terms. The information provided is appropriate... read more

As a case study book, there is no index or glossary. However, medical and technical terms provide a useful link to definitions and explanations that will prove useful to students unfamiliar with the terms. The information provided is appropriate for entry-level health care students. The book includes important health problems, but I would like to see coverage of at least one more chronic/lifestyle issue such as diabetes. The book covers adult issues only.

Content is accurate without bias

The content of the book is relevant and up-to-date. It addresses conditions that are prevalent in today's population among adults. There are no pediatric cases, but this does not significantly detract from the usefulness of the text. The format of the book lends to easy updating of data or information.

The book is written with clarity and is easy to read. The writing style is accessible and technical terminology is explained with links to more information.

Consistency is present. Lack of consistency is typically a problem with case study texts, but this book is consistent with presentation, format, and terminology throughout each of the eight cases.

The book has high modularity. Each of the case studies can be used independently from the others providing flexibility. Additionally, each case study can be partitioned for specific learning objectives based on the learning objectives of the course or module.

The book is well organized, presenting students conceptually with differing patient flow patterns through a hospital. The patient information provided at the beginning of each case is a wonderful mechanism for providing personal context for the students as they consider the issues. Many case studies focus on the problem and the organization without students getting a patient's perspective. The patient perspective is well represented in these cases.

The navigation through the cases is good. There are some terminology and procedure hyperlinks within the cases that do not work when accessed. This is troubling if you intend to use the text for entry-level health care students since many of these links are critical for a full understanding of the case.

There are some non-US variants of spelling and a few grammatical errors, but these do not detract from the content of the messages of each case.

The book is inclusive of differing backgrounds and perspectives. No insensitive or offensive references were found.

I like this text for its application flexibility. The book is useful for non-clinical healthcare management students to introduce various healthcare-related concepts and terminology. The content is also helpful for the identification of healthcare administration managerial issues for students to consider. The book has many applications.

Reviewed by Paula Baldwin, Associate Professor/Communication Studies, Western Oregon University on 5/10/21

The different case studies fall on a range, from crisis care to chronic illness care. read more

The different case studies fall on a range, from crisis care to chronic illness care.

The contents seems to be written as they occurred to represent the most complete picture of each medical event's occurence.

These case studies are from the Canadian medical system, but that does not interfere with it's applicability.

It is written for a medical audience, so the terminology is mostly formal and technical.

Some cases are shorter than others and some go in more depth, but it is not problematic.

The eight separate case studies is the perfect size for a class in the quarter system. You could combine this with other texts, videos or learning modalities, or use it alone.

As this is a case studies book, there is not a need for a logical progression in presentation of topics.

No problems in terms of interface.

I have not seen any grammatical errors.

I did not see anything that was culturally insensitive.

I used this in a Health Communication class and it has been extraordinarily successful. My studies are analyzing the messaging for the good, the bad, and the questionable. The case studies are widely varied and it gives the class insights into hospital experiences, both front and back stage, that they would not normally be able to examine. I believe that because it is based real-life medical incidents, my students are finding the material highly engaging.

Reviewed by Marlena Isaac, Instructor, Aiken Technical College on 4/23/21

This text is great to walk through patient care with entry level healthcare students. The students are able to take in the information, digest it, then provide suggestions to how they would facilitate patient healing. Then when they are faced with... read more

This text is great to walk through patient care with entry level healthcare students. The students are able to take in the information, digest it, then provide suggestions to how they would facilitate patient healing. Then when they are faced with a situation in clinical they are not surprised and now how to move through it effectively.

The case studies provided accurate information that relates to the named disease.

It is relevant to health care studies and the development of critical thinking.

Cases are straightforward with great clinical information.

Clinical information is provided concisely.

Appropriate for clinical case study.

Presented to facilitate information gathering.

Takes a while to navigate in the browser.

Cultural Relevance rating: 1

Text lacks adequate representation of minorities.

Reviewed by Kim Garcia, Lecturer III, University of Texas Rio Grande Valley on 11/16/20

The book has 8 case studies, so obviously does not cover the whole of medicine, but the cases provided are descriptive and well developed. Cases are presented at different levels of difficulty, making the cases appropriate for students at... read more

The book has 8 case studies, so obviously does not cover the whole of medicine, but the cases provided are descriptive and well developed. Cases are presented at different levels of difficulty, making the cases appropriate for students at different levels of clinical knowledge. The human element of both patient and health care provider is well captured. The cases are presented with a focus on interprofessional interaction and collaboration, more so than teaching medical content.

Content is accurate and un-biased. No errors noted. Most diagnostic and treatment information is general so it will remain relevant over time. The content of these cases is more appropriate for teaching interprofessional collaboration and less so for teaching the medical care for each diagnosis.

The content is relevant to a variety of different types of health care providers (nurses, radiologic technicians, medical laboratory personnel, etc) and due to the general nature of the cases, will remain relevant over time.

Easy to read. Clear headings are provided for sections of each case study and these section headings clearly tell when time has passed or setting has changed. Enough description is provided to help set the scene for each part of the case. Much of the text is written in the form of dialogue involving patient, family and health care providers, making it easy to adapt for role play. Medical jargon is limited and links for medical terms are provided to other resources that expound on medical terms used.

The text is consistent in structure of each case. Learning objectives are provided. Cases generally start with the patient at home and move with the patient through admission, testing and treatment, using a variety of healthcare services and encountering a variety of personnel.

The text is modular. Cases could be used individually within a unit on the given disease process or relevant sections of a case could be used to illustrate a specific point. The appendix is helpful in locating content specific to a certain diagnosis or a certain type of health care provider.

Each case follows a patient in a logical, chronologic fashion. A clear table of contents and appendix are provided which allows the user to quickly locate desired content. It would be helpful if the items in the table of contents and appendix were linked to the corresponding section of the text.

The hyperlinks to content outside this book work, however using the back arrow on your browser returns you to the front page of the book instead of to the point at which you left the text. I would prefer it if the hyperlinks opened in a new window or tab so closing that window or tab would leave you back where you left the text.

No grammatical errors were noted.

The text is culturally inclusive and appropriate. Characters, both patients and care givers are of a variety of races, ethnicities, ages and backgrounds.

I enjoyed reading the cases and reviewing this text. I can think of several ways in which I will use this content.

Reviewed by Raihan Khan, Instructor/Assistant Professor, James Madison University on 11/3/20

The book contains several important health issues, however still missing some chronic health issues that the students should learn before they join the workforce, such as diabetes-related health issues suffered by the patients. read more

The book contains several important health issues, however still missing some chronic health issues that the students should learn before they join the workforce, such as diabetes-related health issues suffered by the patients.

The health information contained in the textbook is mostly accurate.

I think the book is written focusing on the current culture and health issues faced by the patients. To keep the book relevant in the future, the contexts especially the culture/lifestyle/health care modalities, etc. would need to be updated regularly.

The language is pretty simple, clear, and easy to read.

There is no complaint about consistency. One of the main issues of writing a book, consistency was well managed by the authors.

The book is easy to explore based on how easy the setup is. Students can browse to the specific section that they want to read without much hassle of finding the correct information.

The organization is simple but effective. The authors organized the book based on what can happen in a patient's life and what possible scenarios students should learn about the disease. From that perspective, the book does a good job.

The interface is easy and simple to navigate. Some links to external sources might need to be updated regularly since those links are subject to change that is beyond the author's control. It's frustrating for the reader when the external link shows no information.

The book is free of any major language and grammatical errors.

The book might do a little better in cultural competency. e.g. Last name Singh is mainly for Sikh people. In the text Harj and Priya Singh are Muslim. the authors can consult colleagues who are more familiar with those cultures and revise some cultural aspects of the cases mentioned in the book.

The book is a nice addition to the open textbook world. Hope to see more health issues covered by the book.

Reviewed by Ryan Sheryl, Assistant Professor, California State University, Dominguez Hills on 7/16/20

This text contains 8 medical case studies that reflect best practices at the time of publication. The text identifies 5 overarching learning objectives: interprofessional collaboration, client centered care, evidence-based practice, quality... read more

This text contains 8 medical case studies that reflect best practices at the time of publication. The text identifies 5 overarching learning objectives: interprofessional collaboration, client centered care, evidence-based practice, quality improvement, and informatics. While the case studies do not cover all medical conditions or bodily systems, the book is thorough in conveying details of various patients and medical team members in a hospital environment. Rather than an index or glossary at the end of the text, it contains links to outside websites for more information on medical tests and terms referenced in the cases.

The content provided is reflective of best practices in patient care, interdisciplinary collaboration, and communication at the time of publication. It is specifically accurate for the context of hospitals in Canada. The links provided throughout the text have the potential to supplement with up-to-date descriptions and definitions, however, many of them are broken (see notes in Interface section).

The content of the case studies reflects the increasingly complex landscape of healthcare, including a variety of conditions, ages, and personal situations of the clients and care providers. The text will require frequent updating due to the rapidly changing landscape of society and best practices in client care. For example, a future version may include inclusive practices with transgender clients, or address ways medical racism implicitly impacts client care (see notes in Cultural Relevance section).

The text is written clearly and presents thorough, realistic details about working and being treated in an acute hospital context.

The text is very straightforward. It is consistent in its structure and flow. It uses consistent terminology and follows a structured framework throughout.

Being a series of 8 separate case studies, this text is easily and readily divisible into smaller sections. The text was designed to be taken apart and used piece by piece in order to serve various learning contexts. The parts of each case study can also be used independently of each other to facilitate problem solving.

The topics in the case studies are presented clearly. The structure of each of the case studies proceeds in a similar fashion. All of the cases are set within the same hospital so the hospital personnel and service providers reappear across the cases, giving a textured portrayal of the experiences of the various service providers. The cases can be used individually, or one service provider can be studied across the various studies.

The text is very straightforward, without complex charts or images that could become distorted. Many of the embedded links are broken and require updating. The links that do work are a very useful way to define and expand upon medical terms used in the case studies.

Grammatical errors are minimal and do not distract from the flow of the text. In one instance the last name Singh is spelled Sing, and one patient named Fred in the text is referred to as Frank in the appendix.

The cases all show examples of health care personnel providing compassionate, client-centered care, and there is no overt discrimination portrayed. Two of the clients are in same-sex marriages and these are shown positively. It is notable, however, that the two cases presenting people of color contain more negative characteristics than the other six cases portraying Caucasian people. The people of color are the only two examples of clients who smoke regularly. In addition, the Indian client drinks and is overweight, while the First Nations client is the only one in the text to have a terminal diagnosis. The Indian client is identified as being Punjabi and attending a mosque, although there are only 2% Muslims in the Punjab province of India. Also, the last name Singh generally indicates a person who is a Hindu or Sikh, not Muslim.

Reviewed by Monica LeJeune, RN Instructor, LSUE on 4/24/20

Has comprehensive unfolding case studies that guide the reader to recognize and manage the scenario presented. Assists in critical thinking process. read more

Has comprehensive unfolding case studies that guide the reader to recognize and manage the scenario presented. Assists in critical thinking process.

Accurately presents health scenarios with real life assessment techniques and patient outcomes.

Relevant to nursing practice.

Clearly written and easily understood.

Consistent with healthcare terminology and framework

Has a good reading flow.

Topics presented in logical fashion

Easy to read.

No grammatical errors noted.

Text is not culturally insensitive or offensive.

Good book to have to teach nursing students.

Reviewed by april jarrell, associate professor, J. Sargeant Reynolds Community College on 1/7/20

The text is a great case study tool that is appropriate for nursing school instructors to use in aiding students to learn the nursing process. read more

The text is a great case study tool that is appropriate for nursing school instructors to use in aiding students to learn the nursing process.

The content is accurate and evidence based. There is no bias noted

The content in the text is relevant, up to date for nursing students. It will be easy to update content as needed because the framework allows for addition to the content.

The text is clear and easy to understand.

Framework and terminology is consistent throughout the text; the case study is a continual and takes the student on a journey with the patient. Great for learning!

The case studies can be easily divided into smaller sections to allow for discussions, and weekly studies.

The text and content progress in a logical, clear fashion allowing for progression of learning.

No interface issues noted with this text.

No grammatical errors noted in the text.

No racial or culture insensitivity were noted in the text.

I would recommend this text be used in nursing schools. The use of case studies are helpful for students to learn and practice the nursing process.

Reviewed by Lisa Underwood, Practical Nursing Instructor, NTCC on 12/3/19

The text provides eight comprehensive case studies that showcase the different viewpoints of the many roles involved in patient care. It encompasses the most common seen diagnoses seen across healthcare today. Each case study comes with its own... read more

The text provides eight comprehensive case studies that showcase the different viewpoints of the many roles involved in patient care. It encompasses the most common seen diagnoses seen across healthcare today. Each case study comes with its own set of learning objectives that can be tweaked to fit several allied health courses. Although the case studies are designed around the Canadian Healthcare System, they are quite easily adaptable to fit most any modern, developed healthcare system.

Content Accuracy rating: 3

Overall, the text is quite accurate. There is one significant error that needs to be addressed. It is located in the DVT case study. In the study, a popliteal artery clot is mislabeled as a DVT. DVTs are located in veins, not in arteries. That said, the case study on the whole is quite good. This case study could be used as a learning tool in the classroom for discussion purposes or as a way to test student understanding of DVTs, on example might be, "Can they spot the error?"

At this time, all of the case studies within the text are current. Healthcare is an ever evolving field that rests on the best evidence based practice. Keeping that in mind, educators can easily adapt the studies as the newest evidence emerges and changes practice in healthcare.

All of the case studies are well written and easy to understand. The text includes several hyperlinks and it also highlights certain medical terminology to prompt readers as a way to enhance their learning experience.

Across the text, the language, style, and format of the case studies are completely consistent.

The text is divided into eight separate case studies. Each case study may be used independently of the others. All case studies are further broken down as the focus patient passes through each aspect of their healthcare system. The text's modularity makes it possible to use a case study as individual work, group projects, class discussions, homework or in a simulation lab.

The case studies and the diagnoses that they cover are presented in such a way that educators and allied health students can easily follow and comprehend.

The book in itself is free of any image distortion and it prints nicely. The text is offered in a variety of digital formats. As noted in the above reviews, some of the hyperlinks have navigational issues. When the reader attempts to access them, a "page not found" message is received.

There were minimal grammatical errors. Some of which may be traced back to the differences in our spelling.

The text is culturally relevant in that it includes patients from many different backgrounds and ethnicities. This allows educators and students to explore cultural relevance and sensitivity needs across all areas in healthcare. I do not believe that the text was in any way insensitive or offensive to the reader.

By using the case studies, it may be possible to have an open dialogue about the differences noted in healthcare systems. Students will have the ability to compare and contrast the Canadian healthcare system with their own. I also firmly believe that by using these case studies, students can improve their critical thinking skills. These case studies help them to "put it all together".

Reviewed by Melanie McGrath, Associate Professor, TRAILS on 11/29/19

The text covered some of the most common conditions seen by healthcare providers in a hospital setting, which forms a solid general base for the discussions based on each case. read more

The text covered some of the most common conditions seen by healthcare providers in a hospital setting, which forms a solid general base for the discussions based on each case.

I saw no areas of inaccuracy

As in all healthcare texts, treatments and/or tests will change frequently. However, everything is currently up-to-date thus it should be a good reference for several years.

Each case is written so that any level of healthcare student would understand. Hyperlinks in the text is also very helpful.

All of the cases are written in a similar fashion.

Although not structured as a typical text, each case is easily assigned as a stand-alone.

Each case is organized clearly in an appropriate manner.

I did not see any issues.

I did not see any grammatical errors

The text seemed appropriately inclusive. There are no pediatric cases and no cases of intellectually-impaired patients, but those types of cases introduce more advanced problem-solving which perhaps exceed the scope of the text. May be a good addition to the text.

I found this text to be an excellent resource for healthcare students in a variety of fields. It would be best utilized in inter professional courses to help guide discussion.

Reviewed by Lynne Umbarger, Clinical Assistant Professor, Occupational Therapy, Emory and Henry College on 11/26/19

While the book does not cover every scenario, the ones in the book are quite common and troublesome for inexperienced allied health students. The information in the book is thorough enough, and I have found the cases easy to modify for educational... read more

While the book does not cover every scenario, the ones in the book are quite common and troublesome for inexperienced allied health students. The information in the book is thorough enough, and I have found the cases easy to modify for educational purposes. The material was easily understood by the students but challenging enough for classroom discussion. There are no mentions in the book about occupational therapy, but it is easy enough to add a couple words and make inclusion simple.

Very nice lab values are provided in the case study, making it more realistic for students.

These case studies focus on commonly encountered diagnoses for allied health and nursing students. They are comprehensive, realistic, and easily understood. The only difference is that the hospital in one case allows the patient's dog to visit in the room (highly unusual in US hospitals).

The material is easily understood by allied health students. The cases have links to additional learning materials for concepts that may be less familiar or should be explored further in a particular health field.

The language used in the book is consistent between cases. The framework is the same with each case which makes it easier to locate areas that would be of interest to a particular allied health profession.

The case studies are comprehensive but well-organized. They are short enough to be useful for class discussion or a full-blown assignment. The students seem to understand the material and have not expressed that any concepts or details were missing.

Each case is set up like the other cases. There are learning objectives at the beginning of each case to facilitate using the case, and it is easy enough to pull out material to develop useful activities and assignments.

There is a quick chart in the Appendix to allow the reader to determine the professions involved in each case as well as the pertinent settings and diagnoses for each case study. The contents are easy to access even while reading the book.

As a person who attends carefully to grammar, I found no errors in all of the material I read in this book.

There are a greater number of people of different ethnicities, socioeconomic status, ages, and genders to make this a very useful book. With each case, I could easily picture the person in the case. This book appears to be Canadian and more inclusive than most American books.

I was able to use this book the first time I accessed it to develop a classroom activity for first-year occupational therapy students and a more comprehensive activity for second-year students. I really appreciate the links to a multitude of terminology and medical lab values/issues for each case. I will keep using this book.

Reviewed by Cindy Krentz, Assistant Professor, Metropolitan State University of Denver on 6/15/19

The book covers eight case studies of common inpatient or emergency department scenarios. I appreciated that they had written out the learning objectives. I liked that the patient was described before the case was started, giving some... read more

The book covers eight case studies of common inpatient or emergency department scenarios. I appreciated that they had written out the learning objectives. I liked that the patient was described before the case was started, giving some understanding of the patient's background. I think it could benefit from having a glossary. I liked how the authors included the vital signs in an easily readable bar. I would have liked to see the labs also highlighted like this. I also felt that it would have been good written in a 'what would you do next?' type of case study.

The book is very accurate in language, what tests would be prudent to run and in the day in the life of the hospital in all cases. One inaccuracy is that the authors called a popliteal artery clot a DVT. The rest of the DVT case study was great, though, but the one mistake should be changed.

The book is up to date for now, but as tests become obsolete and new equipment is routinely used, the book ( like any other health textbook) will need to be updated. It would be easy to change, however. All that would have to happen is that the authors go in and change out the test to whatever newer, evidence-based test is being utilized.

The text is written clearly and easy to understand from a student's perspective. There is not too much technical jargon, and it is pretty universal when used- for example DVT for Deep Vein Thrombosis.

The book is consistent in language and how it is broken down into case studies. The same format is used for highlighting vital signs throughout the different case studies. It's great that the reader does not have to read the book in a linear fashion. Each case study can be read without needing to read the others.

The text is broken down into eight case studies, and within the case studies is broken down into days. It is consistent and shows how the patient can pass through the different hospital departments (from the ER to the unit, to surgery, to home) in a realistic manner. The instructor could use one or more of the case studies as (s)he sees fit.

The topics are eight different case studies- and are presented very clearly and organized well. Each one is broken down into how the patient goes through the system. The text is easy to follow and logical.

The interface has some problems with the highlighted blue links. Some of them did not work and I got a 'page not found' message. That can be frustrating for the reader. I'm wondering if a glossary could be utilized (instead of the links) to explain what some of these links are supposed to explain.

I found two or three typos, I don't think they were grammatical errors. In one case I think the Canadian spelling and the United States spelling of the word are just different.

This is a very culturally competent book. In today's world, however, one more type of background that would merit delving into is the trans-gender, GLBTQI person. I was glad that there were no stereotypes.

I enjoyed reading the text. It was interesting and relevant to today's nursing student. Since we are becoming more interprofessional, I liked that we saw what the phlebotomist and other ancillary personnel (mostly different technicians) did. I think that it could become even more interdisciplinary so colleges and universities could have more interprofessional education- courses or simulations- with the addition of the nurse using social work, nutrition, or other professional health care majors.

Reviewed by Catherine J. Grott, Interim Director, Health Administration Program, TRAILS on 5/5/19

The book is comprehensive but is specifically written for healthcare workers practicing in Canada. The title of the book should reflect this. read more

The book is comprehensive but is specifically written for healthcare workers practicing in Canada. The title of the book should reflect this.

The book is accurate, however it has numerous broken online links.

Relevance/Longevity rating: 3

The content is very relevant, but some links are out-dated. For example, WHO Guidelines for Safe Surgery 2009 (p. 186) should be updated.

The book is written in clear and concise language. The side stories about the healthcare workers make the text interesting.

The book is consistent in terms of terminology and framework. Some terms that are emphasized in one case study are not emphasized (with online links) in the other case studies. All of the case studies should have the same words linked to online definitions.

Modularity rating: 3

The book can easily be parsed out if necessary. However, the way the case studies have been written, it's evident that different authors contributed singularly to each case study.

The organization and flow are good.

Interface rating: 1

There are numerous broken online links and "pages not found."

The grammar and punctuation are correct. There are two errors detected: p. 120 a space between the word "heart" and the comma; also a period is needed after Dr (p. 113).

I'm not quite sure that the social worker (p. 119) should comment that the patient and partner are "very normal people."

There are roughly 25 broken online links or "pages not found." The BC & Canadian Guidelines (p. 198) could also include a link to US guidelines to make the text more universal . The basilar crackles (p. 166) is very good. Text could be used compare US and Canadian healthcare. Text could be enhanced to teach "soft skills" and interdepartmental communication skills in healthcare.

Reviewed by Lindsey Henry, Practical Nursing Instructor, Fletcher on 5/1/19

I really appreciated how in the introduction, five learning objectives were identified for students. These objectives are paramount in nursing care and they are each spelled out for the learner. Each Case study also has its own learning... read more

I really appreciated how in the introduction, five learning objectives were identified for students. These objectives are paramount in nursing care and they are each spelled out for the learner. Each Case study also has its own learning objectives, which were effectively met in the readings.

As a seasoned nurse, I believe that the content regarding pathophysiology and treatments used in the case studies were accurate. I really appreciated how many of the treatments were also explained and rationales were given, which can be very helpful to facilitate effective learning for a nursing student or novice nurse.

The case studies are up to date and correlate with the current time period. They are easily understood.

I really loved how several important medical terms, including specific treatments were highlighted to alert the reader. Many interventions performed were also explained further, which is great to enhance learning for the nursing student or novice nurse. Also, with each scenario, a background and history of the patient is depicted, as well as the perspectives of the patient, patients family member, and the primary nurse. This really helps to give the reader a full picture of the day in the life of a nurse or a patient, and also better facilitates the learning process of the reader.

These case studies are consistent. They begin with report, the patient background or updates on subsequent days, and follow the patients all the way through discharge. Once again, I really appreciate how this book describes most if not all aspects of patient care on a day to day basis.

Each case study is separated into days. While they can be divided to be assigned at different points within the course, they also build on each other. They show trends in vital signs, what happens when a patient deteriorates, what happens when they get better and go home. Showing the entire process from ER admit to discharge is really helpful to enhance the students learning experience.

The topics are all presented very similarly and very clearly. The way that the scenarios are explained could even be understood by a non-nursing student as well. The case studies are very clear and very thorough.

The book is very easy to navigate, prints well on paper, and is not distorted or confusing.

I did not see any grammatical errors.

Each case study involves a different type of patient. These differences include race, gender, sexual orientation and medical backgrounds. I do not feel the text was offensive to the reader.

I teach practical nursing students and after reading this book, I am looking forward to implementing it in my classroom. Great read for nursing students!

Reviewed by Leah Jolly, Instructor, Clinical Coordinator, Oregon Institute of Technology on 4/10/19

Good variety of cases and pathologies covered. read more

Good variety of cases and pathologies covered.

Content Accuracy rating: 2

Some examples and scenarios are not completely accurate. For example in the DVT case, the sonographer found thrombus in the "popliteal artery", which according to the book indicated presence of DVT. However in DVT, thrombus is located in the vein, not the artery. The patient would also have much different symptoms if located in the artery. Perhaps some of these inaccuracies are just typos, but in real-life situations this simple mistake can make a world of difference in the patient's course of treatment and outcomes.

Good examples of interprofessional collaboration. If only it worked this way on an every day basis!

Clear and easy to read for those with knowledge of medical terminology.

Good consistency overall.

Broken up well.

Topics are clear and logical.

Would be nice to simply click through to the next page, rather than going through the table of contents each time.

Minor typos/grammatical errors.

No offensive or insensitive materials observed.

Reviewed by Alex Sargsyan, Doctor of Nursing Practice/Assistant Professor , East Tennessee State University on 10/8/18

Because of the case study character of the book it does not have index or glossary. However it has summary for each health case study outlining key elements discussed in each case study. read more

Because of the case study character of the book it does not have index or glossary. However it has summary for each health case study outlining key elements discussed in each case study.

Overall the book is accurately depicting the clinical environment. There are numerous references to external sites. While most of them are correct, some of them are not working. For example Homan’s test link is not working "404 error"

Book is relevant in its current version and can be used in undergraduate and graduate classes. That said, the longevity of the book may be limited because of the character of the clinical education. Clinical guidelines change constantly and it may require a major update of the content.

Cases are written very clearly and have realistic description of an inpatient setting.

The book is easy to read and consistent in the language in all eight cases.

The cases are very well written. Each case is subdivided into logical segments. The segments reflect different setting where the patient is being seen. There is a flow and transition between the settings.

Book has eight distinct cases. This is a great format for a book that presents distinct clinical issues. This will allow the students to have immersive experiences and gain better understanding of the healthcare environment.

Book is offered in many different formats. Besides the issues with the links mentioned above, overall navigation of the book content is very smooth.

Book is very well written and has no grammatical errors.

Book is culturally relevant. Patients in the case studies come different cultures and represent diverse ethnicities.

Reviewed by Justin Berry, Physical Therapist Assistant Program Director, Northland Community and Technical College, East Grand Forks, MN on 8/2/18

This text provides eight patient case studies from a variety of diagnoses, which can be utilized by healthcare students from multiple disciplines. The cases are comprehensive and can be helpful for students to determine professional roles,... read more

This text provides eight patient case studies from a variety of diagnoses, which can be utilized by healthcare students from multiple disciplines. The cases are comprehensive and can be helpful for students to determine professional roles, interprofessional roles, when to initiate communication with other healthcare practitioners due to a change in patient status, and treatment ideas. Some additional patient information, such as lab values, would have been beneficial to include.

Case study information is accurate and unbiased.

Content is up to date. The case studies are written in a way so that they will not be obsolete soon, even with changes in healthcare.

The case studies are well written, and can be utilized for a variety of classroom assignments, discussions, and projects. Some additional lab value information for each patient would have been a nice addition.

The case studies are consistently organized to make it easy for the reader to determine the framework.

The text is broken up into eight different case studies for various patient diagnoses. This design makes it highly modular, and would be easy to assign at different points of a course.

The flow of the topics are presented consistently in a logical manner. Each case study follows a patient chronologically, making it easy to determine changes in patient status and treatment options.

The text is free of interface issues, with no distortion of images or charts.

The text is not culturally insensitive or offensive in any way. Patients are represented from a variety of races, ethnicities, and backgrounds

This book would be a good addition for many different health programs.

Reviewed by Ann Bell-Pfeifer, Instructor/Program Director, Minnesota State Community and Technical College on 5/21/18

The book gives a comprehensive overview of many types of cases for patient conditions. Emergency Room patients may arrive with COPD, heart failure, sepsis, pneumonia, or as motor vehicle accident victims. It is directed towards nurses, medical... read more

The book gives a comprehensive overview of many types of cases for patient conditions. Emergency Room patients may arrive with COPD, heart failure, sepsis, pneumonia, or as motor vehicle accident victims. It is directed towards nurses, medical laboratory technologists, medical radiology technologists, and respiratory therapists and their roles in caring for patients. Most of the overview is accurate. One suggestion is to provide an embedded radiologist interpretation of the exams which are performed which lead to the patients diagnosis.

Overall the book is accurate. Would like to see updates related to the addition of direct radiography technology which is commonly used in the hospital setting.

Many aspects of medicine will remain constant. The case studies seem fairly accurate and may be relevant for up to 3 years. Since technology changes so quickly in medicine, the CT and x-ray components may need minor updates within a few years.

The book clarity is excellent.

The case stories are consistent with each scenario. It is easy to follow the structure and learn from the content.

The book is quite modular. It is easy to break it up into cases and utilize them individually and sequentially.

The cases are listed by disease process and follow a logical flow through each condition. They are easy to follow as they have the same format from the beginning to the end of each case.

The interface seems seamless. Hyperlinks are inserted which provide descriptions and references to medical procedures and in depth definitions.

The book is free of most grammatical errors. There is a place where a few words do not fit the sentence structure and could be a typo.

The book included all types of relationships and ethnic backgrounds. One type which could be added is a transgender patient.

I think the book was quite useful for a variety of health care professionals. The authors did an excellent job of integrating patient cases which could be applied to the health care setting. The stories seemed real and relevant. This book could be used to teach health care professionals about integrated care within the emergency department.

Reviewed by Shelley Wolfe, Assistant Professor, Winona State University on 5/21/18

This text is comprised of comprehensive, detailed case studies that provide the reader with multiple character views throughout a patient’s encounter with the health care system. The Table of Contents accurately reflected the content. It should... read more

This text is comprised of comprehensive, detailed case studies that provide the reader with multiple character views throughout a patient’s encounter with the health care system. The Table of Contents accurately reflected the content. It should be noted that the authors include a statement that conveys that this text is not like traditional textbooks and is not meant to be read in a linear fashion. This allows the educator more flexibility to use the text as a supplement to enhance learning opportunities.

The content of the text appears accurate and unbiased. The “five overarching learning objectives” provide a clear aim of the text and the educator is able to glean how these objectives are captured into each of the case studies. While written for the Canadian healthcare system, this text is easily adaptable to the American healthcare system.

Overall, the content is up-to-date and the case studies provide a variety of uses that promote longevity of the text. However, not all of the blue font links (if using the digital PDF version) were still in working order. I encountered links that led to error pages or outdated “page not found” websites. While the links can be helpful, continued maintenance of these links could prove time-consuming.

I found the text easy to read and understand. I enjoyed that the viewpoints of all the different roles (patient, nurse, lab personnel, etc.) were articulated well and allowed the reader to connect and gain appreciation of the entire healthcare team. Medical jargon was noted to be appropriate for the intended audience of this text.

The terminology and organization of this text is consistent.

The text is divided into 8 case studies that follow a similar organizational structure. The case studies can further be divided to focus on individual learning objectives. For example, the case studies could be looked at as a whole for discussing communication or could be broken down into segments to focus on disease risk factors.

The case studies in this text follow a similar organizational structure and are consistent in their presentation. The flow of individual case studies is excellent and sets the reader on a clear path. As noted previously, this text is not meant to be read in a linear fashion.

This text is available in many different forms. I chose to review the text in the digital PDF version in order to use the embedded links. I did not encounter significant interface issues and did not find any images or features that would distract or confuse a reader.

No significant grammatical errors were noted.

The case studies in this text included patients and healthcare workers from a variety of backgrounds. Educators and students will benefit from expanding the case studies to include discussions and other learning opportunities to help develop culturally-sensitive healthcare providers.

I found the case studies to be very detailed, yet written in a way in which they could be used in various manners. The authors note a variety of ways in which the case studies could be employed with students; however, I feel the authors could also include that the case studies could be used as a basis for simulated clinical experiences. The case studies in this text would be an excellent tool for developing interprofessional communication and collaboration skills in a variety healthcare students.

Reviewed by Darline Foltz, Assistant Professor, University of Cincinnati - Clermont College on 3/27/18

This book covers all areas listed in the Table of Contents. In addition to the detailed patient case studies, there is a helpful section of "How to Use this Resource". I would like to note that this resource "aligns with the open textbooks... read more

This book covers all areas listed in the Table of Contents. In addition to the detailed patient case studies, there is a helpful section of "How to Use this Resource". I would like to note that this resource "aligns with the open textbooks Clinical Procedures for Safer Patient Care and Anatomy and Physiology: OpenStax" as noted by the authors.

The book appears to be accurate. Although one of the learning outcomes is as follows: "Demonstrate an understanding of the Canadian healthcare delivery system.", I did not find anything that is ONLY specific to the Canadian healthcare delivery system other than some of the terminology, i.e. "porter" instead of "transporter" and a few french words. I found this to make the book more interesting for students rather than deter from it. These are patient case studies that are relevant in any country.

The content is up-to-date. Changes in medical science may occur, i.e. a different test, to treat a diagnosis that is included in one or more of the case studies, however, it would be easy and straightforward to implement these changes.

This book is written in lucid, accessible prose. The technical/medical terminology that is used is appropriate for medical and allied health professionals. Something that would improve this text would to provide a glossary of terms for the terms in blue font.

This book is consistent with current medical terminology

This text is easily divided into each of the 6 case studies. The case studies can be used singly according to the body system being addressed or studied.

Because this text is a collection of case studies, flow doesn't pertain, however the organization and structure of the case studies are excellent as they are clear and easy to read.

There are no distractions in this text that would distract or confuse the reader.

I did not identify any grammatical errors.

This text is not culturally insensitive or offensive in any way and uses patients and healthcare workers that are of a variety of races, ethnicities and backgrounds.

I believe that this text would not only be useful to students enrolled in healthcare professions involved in direct patient care but would also be useful to students in supporting healthcare disciplines such as health information technology and management, medical billing and coding, etc.

Table of Contents

• Introduction

Case Study #1: Chronic Obstructive Pulmonary Disease (COPD)

• Learning Objectives
• Patient: Erin Johns
• Emergency Room

Case Study #2: Pneumonia

• Day 0: Emergency Room
• Day 1: Emergency Room
• Day 1: Medical Ward
• Day 2: Medical Ward
• Day 3: Medical Ward
• Day 4: Medical Ward

Case Study #3: Unstable Angina (UA)

• Patient: Harj Singh

Case Study #4: Heart Failure (HF)

• Patient: Meryl Smith
• In the Supermarket
• Day 0: Medical Ward

Case Study #5: Motor Vehicle Collision (MVC)

• Patient: Aaron Knoll
• Crash Scene
• Operating Room
• Post Anaesthesia Care Unit (PACU)
• Surgical Ward

Case Study #6: Sepsis

• Patient: George Thomas
• Sleepy Hollow Care Facility

Case Study #7: Colon Cancer

• Patient: Fred Johnson
• Two Months Ago
• Pre-Surgery Admission

Case Study #8: Deep Vein Thrombosis (DVT)

• Patient: Jamie Douglas

Appendix: Overview About the Authors

Ancillary Material

About the book.

Health Case Studies is composed of eight separate health case studies. Each case study includes the patient narrative or story that models the best practice (at the time of publishing) in healthcare settings. Associated with each case is a set of specific learning objectives to support learning and facilitate educational strategies and evaluation.

The case studies can be used online in a learning management system, in a classroom discussion, in a printed course pack or as part of a textbook created by the instructor. This flexibility is intentional and allows the educator to choose how best to convey the concepts presented in each case to the learner.

Because these case studies were primarily developed for an electronic healthcare system, they are based predominantly in an acute healthcare setting. Educators can augment each case study to include primary healthcare settings, outpatient clinics, assisted living environments, and other contexts as relevant.

About the Contributors

Glynda Rees teaches at the British Columbia Institute of Technology (BCIT) in Vancouver, British Columbia. She completed her MSN at the University of British Columbia with a focus on education and health informatics, and her BSN at the University of Cape Town in South Africa. Glynda has many years of national and international clinical experience in critical care units in South Africa, the UK, and the USA. Her teaching background has focused on clinical education, problem-based learning, clinical techniques, and pharmacology.

Glynda‘s interests include the integration of health informatics in undergraduate education, open accessible education, and the impact of educational technologies on nursing students’ clinical judgment and decision making at the point of care to improve patient safety and quality of care.

Faculty member in the critical care nursing program at the British Columbia Institute of Technology (BCIT) since 2003, Rob has been a critical care nurse for over 25 years with 17 years practicing in a quaternary care intensive care unit. Rob is an experienced educator and supports student learning in the classroom, online, and in clinical areas. Rob’s Master of Education from Simon Fraser University is in educational technology and learning design. He is passionate about using technology to support learning for both faculty and students.

Part of Rob’s faculty position is dedicated to providing high fidelity simulation support for BCIT’s nursing specialties program along with championing innovative teaching and best practices for educational technology. He has championed the use of digital publishing and was the tech lead for Critical Care Nursing’s iPad Project which resulted in over 40 multi-touch interactive textbooks being created using Apple and other technologies.

Rob has successfully completed a number of specialist certifications in computer and network technologies. In 2015, he was awarded Apple Distinguished Educator for his innovation and passionate use of technology to support learning. In the past five years, he has presented and published abstracts on virtual simulation, high fidelity simulation, creating engaging classroom environments, and what the future holds for healthcare and education.

Janet Morrison is the Program Head of Occupational Health Nursing at the British Columbia Institute of Technology (BCIT) in Burnaby, British Columbia. She completed a PhD at Simon Fraser University, Faculty of Communication, Art and Technology, with a focus on health information technology. Her dissertation examined the effects of telehealth implementation in an occupational health nursing service. She has an MA in Adult Education from St. Francis Xavier University and an MA in Library and Information Studies from the University of British Columbia.

Janet’s research interests concern the intended and unintended impacts of health information technologies on healthcare students, faculty, and the healthcare workforce.

She is currently working with BCIT colleagues to study how an educational clinical information system can foster healthcare students’ perceptions of interprofessional roles.

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• Volume 21, Issue 1
• What is a case study?
• Article Text
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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.

Read the full text or download the PDF:

Promoting Learning Using Case-Based Strategies in Nursing Professional Development

Affiliation.

• 1 Jobeth Pilcher, EdD, RN-BC, is Faculty Member, Capella University, Minneapolis, Minnesota. She recently retired as Nurse Professional Development Specialist for the Center for Learning Innovation and Practice, Baylor Scott and White Health, Dallas, Texas.
• PMID: 29975313
• DOI: 10.1097/NND.0000000000000458

Realistic situations can be used to develop a variety of learning activities, including case reports, standard and evolving case studies, and problem-based learning. Most case-based strategies are aimed at promoting learner interaction, problem solving, and collaborative learning. This article provides a description and discussion of how each can be applied. Hints for developing the different types of cases are included, followed by specific examples.

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• NextGen NCLEX

Faculty Case Studies

The purpose of this project was to develop a repository of NextGen NCLEX case studies that can be accessed by all faculty members in Maryland.

Detailed information about how faculty members can use these case students is in this PowerPoint document .

The case studies are in a Word document and can be modified by faculty members as they determine. 

NOTE: The answers to the questions found in the NextGen NCLEX Test Bank  are only available in these faculty case studies. When students take the Test Bank questions, they will not get feedback on correct answers. Students and faculty should review test results and correct answers together.

The case studies are contained in 4 categories: Family (13 case studies), Fundamentals and Mental Health (14 case studies) and Medical Surgical (20 case studies). In addition the folder labeled minireviews contains PowerPoint sessions with combinations of case studies and standalone items. 

Family  ▾

• Attention Deficit Hyperactivity Disorder - Pediatric
• Ectopic Pregnancy
• Febrile Seizures
• Gestational Diabetes
• Intimate Partner Violence
• Neonatal Jaundice
• Neonatal Respiratory Distress Syndrome
• Pediatric Hypoglycemia
• Pediatric Anaphylaxis
• Pediatric Diarrhea and Dehydration
• Pediatric Intussusception
• Pediatric Sickle Cell
• Postpartum Hemmorhage
• Poststreptococcal Glomerulonephritis Pediatric
• Preeclampsia

Fundamentals and Mental Health  ▾

• Abdominal Surgery Postoperative Care
• Anorexia with Dehydration
• Catheter Related Urinary Tract Infection
• Deep Vein Thrombosis
• Dehydration Alzheimers
• Electroconvulsive Therapy
• Home Safety I
• Home Safety II
• Neuroleptic Maligant Syndrome
• Opioid Overdose
• Post Operative Atelectasis
• Post-traumatic Stress
• Pressure Injury
• Substance Use Withdrawal and Pain Control
• Suicide Prevention
• Tardive Dyskinesia
• Transfusion Reaction
• Urinary Tract infection

Medical Surgical  ▾

• Acute Asthma
• Acute Respiratory Distress
• Breast Cancer
• Chest Pain (MI)
• Compartment Syndrome
• Deep Vein Thrombosis II
• End Stage Renal Disease and Dialysis
• Gastroesphageal Reflux
• Heart Failure
• HIV with Opportunistic Infection
• Ketoacidosis
• Liver Failure
• Prostate Cancer
• Spine Surgery
• Tension Pneumothorax
• Thyroid Storm
• Tuberculosis

Community Based  ▾

Mini Review  ▾

• Comprehensive Review
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• Medical Surgical Nursing
• Mental Health Review
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• Mini Review Training for Website
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• Pediatric Review

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CUNY Lehman College Nursing Education, Research, and Practice Center City University of New York Helps Heal Nursing Shortage Gap

Bronx, New York USA

The Challenge

The Department of Nursing at Lehman College was located within an older classroom building that was never intended to house nursing skills training. Instructors created makeshift patient rooms and simulation environments, but the real-life environment setting that benefits nursing students was missing. Their space also did not meet current health care standards for minimum room areas and bedside clearances, making bedside training difficult, especially when multiple students were involved. As the only 4-year college in the Bronx, with nursing being one of the top five- majors at the school, CUNY asked HKS to give the nursing program the physical prominence on campus to match the critical nature of educating nurses. The goal was to impact local health outcomes in the disparity-challenged Bronx and to make strides toward mitigating the area’s nursing shortage.   

The Design Solution

The Lehman College Nursing Education, Research, and Practice Center promotes student success by providing real-life immersive learning environments lacking in their previous facilities. The first level of the new 4-story building is dedicated to a lobby, computer lab, classrooms and a student lounge. Levels 2 and 3 house graduate research labs, faculty offices, dean’s suite, conference rooms and more classrooms. The inclusion of graduate labs for supporting and furthering doctoral research reinforces Lehman’s commitment to creating leaders in nursing. In the basement, students find state-of-the-art nursing skills labs and simulation lab. The basement level was built into the hillside, allowing daylighting from the north, so all skills and simulation rooms are daylit and have exterior views, as a true patient room would in a hospital. These improved learning environments are tailored to the pedagogy and student needs.

A central theme of the healing power of nature is reflected in the interior color palette of green and natural tones, with daylighting and views to nature promoted on all levels of the building. The nursing labs are adjacent to each other, which is convenient for students and faculty, and allows for training in the continuum of care and interdisciplinary scenarios.

The Design Impact

The Nursing Education, Research, and Practice Center features leading technologies to support the education of nurses capable of caring for the underserved population of the Bronx. College administrators emphasized the importance of having trained nurses in the local workforce who can speak the various second languages prevalent in the Bronx, and who can understand the culture of their patient population, such as diet and cultural traditions.

The college is a leading institution for social mobility in New York state and the Northeast. Earning a degree in nursing and passing the NCLEX sets a student up for a $70,000 annual salary, which can boost a low-income family into the middle class.

The impact on recruitment and retention of nursing students positively impacts local health outcomes and helps resolve the critical local nursing shortage situation.

Project Features

• Simulation center
• Nursing skills lab
• Faculty/staff offices
• Physical assessment lab
• Computer laboratories
• Student lounge and support space

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• Open access
• Published: 17 April 2024

Deciphering the influence: academic stress and its role in shaping learning approaches among nursing students: a cross-sectional study

• Rawhia Salah Dogham 1 ,
• Heba Fakieh Mansy Ali 1 ,
• Asmaa Saber Ghaly 3 ,
• Nermine M. Elcokany 2 ,
• Mohamed Mahmoud Seweid 4 &
• Ayman Mohamed El-Ashry   ORCID: orcid.org/0000-0001-7718-4942 5  

BMC Nursing volume  23 , Article number:  249 ( 2024 ) Cite this article

401 Accesses

Metrics details

Nursing education presents unique challenges, including high levels of academic stress and varied learning approaches among students. Understanding the relationship between academic stress and learning approaches is crucial for enhancing nursing education effectiveness and student well-being.

This study aimed to investigate the prevalence of academic stress and its correlation with learning approaches among nursing students.

Design and Method

A cross-sectional descriptive correlation research design was employed. A convenient sample of 1010 nursing students participated, completing socio-demographic data, the Perceived Stress Scale (PSS), and the Revised Study Process Questionnaire (R-SPQ-2 F).

Most nursing students experienced moderate academic stress (56.3%) and exhibited moderate levels of deep learning approaches (55.0%). Stress from a lack of professional knowledge and skills negatively correlates with deep learning approaches (r = -0.392) and positively correlates with surface learning approaches (r = 0.365). Female students showed higher deep learning approach scores, while male students exhibited higher surface learning approach scores. Age, gender, educational level, and academic stress significantly influenced learning approaches.

Academic stress significantly impacts learning approaches among nursing students. Strategies addressing stressors and promoting healthy learning approaches are essential for enhancing nursing education and student well-being.

Nursing implication

Understanding academic stress’s impact on nursing students’ learning approaches enables tailored interventions. Recognizing stressors informs strategies for promoting adaptive coping, fostering deep learning, and creating supportive environments. Integrating stress management, mentorship, and counseling enhances student well-being and nursing education quality.

Peer Review reports

Introduction

Nursing education is a demanding field that requires students to acquire extensive knowledge and skills to provide competent and compassionate care. Nursing education curriculum involves high-stress environments that can significantly impact students’ learning approaches and academic performance [ 1 , 2 ]. Numerous studies have investigated learning approaches in nursing education, highlighting the importance of identifying individual students’ preferred approaches. The most studied learning approaches include deep, surface, and strategic approaches. Deep learning approaches involve students actively seeking meaning, making connections, and critically analyzing information. Surface learning approaches focus on memorization and reproducing information without a more profound understanding. Strategic learning approaches aim to achieve high grades by adopting specific strategies, such as memorization techniques or time management skills [ 3 , 4 , 5 ].

Nursing education stands out due to its focus on practical training, where the blend of academic and clinical coursework becomes a significant stressor for students, despite academic stress being shared among all university students [ 6 , 7 , 8 ]. Consequently, nursing students are recognized as prone to high-stress levels. Stress is the physiological and psychological response that occurs when a biological control system identifies a deviation between the desired (target) state and the actual state of a fitness-critical variable, whether that discrepancy arises internally or externally to the human [ 9 ]. Stress levels can vary from objective threats to subjective appraisals, making it a highly personalized response to circumstances. Failure to manage these demands leads to stress imbalance [ 10 ].

Nursing students face three primary stressors during their education: academic, clinical, and personal/social stress. Academic stress is caused by the fear of failure in exams, assessments, and training, as well as workload concerns [ 11 ]. Clinical stress, on the other hand, arises from work-related difficulties such as coping with death, fear of failure, and interpersonal dynamics within the organization. Personal and social stressors are caused by an imbalance between home and school, financial hardships, and other factors. Throughout their education, nursing students have to deal with heavy workloads, time constraints, clinical placements, and high academic expectations. Multiple studies have shown that nursing students experience higher stress levels compared to students in other fields [ 12 , 13 , 14 ].

Research has examined the relationship between academic stress and coping strategies among nursing students, but no studies focus specifically on the learning approach and academic stress. However, existing literature suggests that students interested in nursing tend to experience lower levels of academic stress [ 7 ]. Therefore, interest in nursing can lead to deep learning approaches, which promote a comprehensive understanding of the subject matter, allowing students to feel more confident and less overwhelmed by coursework and exams. Conversely, students employing surface learning approaches may experience higher stress levels due to the reliance on memorization [ 3 ].

Understanding the interplay between academic stress and learning approaches among nursing students is essential for designing effective educational interventions. Nursing educators can foster deep learning approaches by incorporating active learning strategies, critical thinking exercises, and reflection activities into the curriculum [ 15 ]. Creating supportive learning environments encouraging collaboration, self-care, and stress management techniques can help alleviate academic stress. Additionally, providing mentorship and counselling services tailored to nursing students’ unique challenges can contribute to their overall well-being and academic success [ 16 , 17 , 18 ].

Despite the scarcity of research focusing on the link between academic stress and learning methods in nursing students, it’s crucial to identify the unique stressors they encounter. The intensity of these stressors can be connected to the learning strategies employed by these students. Academic stress and learning approach are intertwined aspects of the student experience. While academic stress can influence learning approaches, the choice of learning approach can also impact the level of academic stress experienced. By understanding this relationship and implementing strategies to promote healthy learning approaches and manage academic stress, educators and institutions can foster an environment conducive to deep learning and student well-being.

Hence, this study aims to investigate the correlation between academic stress and learning approaches experienced by nursing students.

Study objectives

Assess the levels of academic stress among nursing students.

Assess the learning approaches among nursing students.

Identify the relationship between academic stress and learning approach among nursing students.

Identify the effect of academic stress and related factors on learning approach and among nursing students.

Materials and methods

Research design.

A cross-sectional descriptive correlation research design adhering to the STROBE guidelines was used for this study.

A research project was conducted at Alexandria Nursing College, situated in Egypt. The college adheres to the national standards for nursing education and functions under the jurisdiction of the Egyptian Ministry of Higher Education. Alexandria Nursing College comprises nine specialized nursing departments that offer various nursing specializations. These departments include Nursing Administration, Community Health Nursing, Gerontological Nursing, Medical-Surgical Nursing, Critical Care Nursing, Pediatric Nursing, Obstetric and Gynecological Nursing, Nursing Education, and Psychiatric Nursing and Mental Health. The credit hour system is the fundamental basis of both undergraduate and graduate programs. This framework guarantees a thorough evaluation of academic outcomes by providing an organized structure for tracking academic progress and conducting analyses.

Participants and sample size calculation

The researchers used the Epi Info 7 program to calculate the sample size. The calculations were based on specific parameters such as a population size of 9886 students for the academic year 2022–2023, an expected frequency of 50%, a maximum margin of error of 5%, and a confidence coefficient of 99.9%. Based on these parameters, the program indicated that a minimum sample size of 976 students was required. As a result, the researchers recruited a convenient sample of 1010 nursing students from different academic levels during the 2022–2023 academic year [ 19 ]. This sample size was larger than the minimum required, which could help to increase the accuracy and reliability of the study results. Participation in the study required enrollment in a nursing program and voluntary agreement to take part. The exclusion criteria included individuals with mental illnesses based on their response and those who failed to complete the questionnaires.

socio-demographic data that include students’ age, sex, educational level, hours of sleep at night, hours spent studying, and GPA from the previous semester.

Tool two: the perceived stress scale (PSS)

It was initially created by Sheu et al. (1997) to gauge the level and nature of stress perceived by nursing students attending Taiwanese universities [ 20 ]. It comprises 29 items rated on a 5-point Likert scale, where (0 = never, 1 = rarely, 2 = sometimes, 3 = reasonably often, and 4 = very often), with a total score ranging from 0 to 116. The cut-off points of levels of perceived stress scale according to score percentage were low < 33.33%, moderate 33.33–66.66%, and high more than 66.66%. Higher scores indicate higher stress levels. The items are categorized into six subscales reflecting different sources of stress. The first subscale assesses “stress stemming from lack of professional knowledge and skills” and includes 3 items. The second subscale evaluates “stress from caring for patients” with 8 items. The third subscale measures “stress from assignments and workload” with 5 items. The fourth subscale focuses on “stress from interactions with teachers and nursing staff” with 6 items. The fifth subscale gauges “stress from the clinical environment” with 3 items. The sixth subscale addresses “stress from peers and daily life” with 4 items. El-Ashry et al. (2022) reported an excellent internal consistency reliability of 0.83 [ 21 ]. Two bilingual translators translated the English version of the scale into Arabic and then back-translated it into English by two other independent translators to verify its accuracy. The suitability of the translated version was confirmed through a confirmatory factor analysis (CFA), which yielded goodness-of-fit indices such as a comparative fit index (CFI) of 0.712, a Tucker-Lewis index (TLI) of 0.812, and a root mean square error of approximation (RMSEA) of 0.100.

Tool three: revised study process questionnaire (R-SPQ-2 F)

It was developed by Biggs et al. (2001). It examines deep and surface learning approaches using only 20 questions; each subscale contains 10 questions [ 22 ]. On a 5-point Likert scale ranging from 0 (never or only rarely true of me) to 4 (always or almost always accurate of me). The total score ranged from 0 to 80, with a higher score reflecting more deep or surface learning approaches. The cut-off points of levels of revised study process questionnaire according to score percentage were low < 33%, moderate 33–66%, and high more than 66%. Biggs et al. (2001) found that Cronbach alpha value was 0.73 for deep learning approach and 0.64 for the surface learning approach, which was considered acceptable. Two translators fluent in English and Arabic initially translated a scale from English to Arabic. To ensure the accuracy of the translation, they translated it back into English. The translated version’s appropriateness was evaluated using a confirmatory factor analysis (CFA). The CFA produced several goodness-of-fit indices, including a Comparative Fit Index (CFI) of 0.790, a Tucker-Lewis Index (TLI) of 0.912, and a Root Mean Square Error of Approximation (RMSEA) of 0.100. Comparative Fit Index (CFI) of 0.790, a Tucker-Lewis Index (TLI) of 0.912, and a Root Mean Square Error of Approximation (RMSEA) of 0.100.

Ethical considerations

The Alexandria University College of Nursing’s Research Ethics Committee provided ethical permission before the study’s implementation. Furthermore, pertinent authorities acquired ethical approval at participating nursing institutions. The vice deans of the participating institutions provided written informed consent attesting to institutional support and authority. By giving written informed consent, participants confirmed they were taking part voluntarily. Strict protocols were followed to protect participants’ privacy during the whole investigation. The obtained personal data was kept private and available only to the study team. Ensuring participants’ privacy and anonymity was of utmost importance.

Tools validity

The researchers created tool one after reviewing pertinent literature. Two bilingual translators independently translated the English version into Arabic to evaluate the applicability of the academic stress and learning approach tools for Arabic-speaking populations. To assure accuracy, two additional impartial translators back-translated the translation into English. They were also assessed by a five-person jury of professionals from the education and psychiatric nursing departments. The scales were found to have sufficiently evaluated the intended structures by the jury.

Pilot study

A preliminary investigation involved 100 nursing student applicants, distinct from the final sample, to gauge the efficacy, clarity, and potential obstacles in utilizing the research instruments. The pilot findings indicated that the instruments were accurate, comprehensible, and suitable for the target demographic. Additionally, Cronbach’s Alpha was utilized to further assess the instruments’ reliability, demonstrating internal solid consistency for both the learning approaches and academic stress tools, with values of 0.91 and 0.85, respectively.

Data collection

The researchers convened with each qualified student in a relaxed, unoccupied classroom in their respective college settings. Following a briefing on the study’s objectives, the students filled out the datasheet. The interviews typically lasted 15 to 20 min.

Data analysis

The data collected were analyzed using IBM SPSS software version 26.0. Following data entry, a thorough examination and verification were undertaken to ensure accuracy. The normality of quantitative data distributions was assessed using Kolmogorov-Smirnov tests. Cronbach’s Alpha was employed to evaluate the reliability and internal consistency of the study instruments. Descriptive statistics, including means (M), standard deviations (SD), and frequencies/percentages, were computed to summarize academic stress and learning approaches for categorical data. Student’s t-tests compared scores between two groups for normally distributed variables, while One-way ANOVA compared scores across more than two categories of a categorical variable. Pearson’s correlation coefficient determined the strength and direction of associations between customarily distributed quantitative variables. Hierarchical regression analysis identified the primary independent factors influencing learning approaches. Statistical significance was determined at the 5% (p < 0.05).

Table  1 presents socio-demographic data for a group of 1010 nursing students. The age distribution shows that 38.8% of the students were between 18 and 21 years old, 32.9% were between 21 and 24 years old, and 28.3% were between 24 and 28 years old, with an average age of approximately 22.79. Regarding gender, most of the students were female (77%), while 23% were male. The students were distributed across different educational years, a majority of 34.4% in the second year, followed by 29.4% in the fourth year. The students’ hours spent studying were found to be approximately two-thirds (67%) of the students who studied between 3 and 6 h. Similarly, sleep patterns differ among the students; more than three-quarters (77.3%) of students sleep between 5- to more than 7 h, and only 2.4% sleep less than 2 h per night. Finally, the student’s Grade Point Average (GPA) from the previous semester was also provided. 21% of the students had a GPA between 2 and 2.5, 40.9% had a GPA between 2.5 and 3, and 38.1% had a GPA between 3 and 3.5.

Figure  1 provides the learning approach level among nursing students. In terms of learning approach, most students (55.0%) exhibited a moderate level of deep learning approach, followed by 25.9% with a high level and 19.1% with a low level. The surface learning approach was more prevalent, with 47.8% of students showing a moderate level, 41.7% showing a low level, and only 10.5% exhibiting a high level.

Nursing students? levels of learning approach (N=1010)

Figure  2 provides the types of academic stress levels among nursing students. Among nursing students, various stressors significantly impact their academic experiences. Foremost among these stressors are the pressure and demands associated with academic assignments and workload, with 30.8% of students attributing their high stress levels to these factors. Challenges within the clinical environment are closely behind, contributing significantly to high stress levels among 25.7% of nursing students. Interactions with peers and daily life stressors also weigh heavily on students, ranking third among sources of high stress, with 21.5% of students citing this as a significant factor. Similarly, interaction with teachers and nursing staff closely follow, contributing to high-stress levels for 20.3% of nursing students. While still significant, stress from taking care of patients ranks slightly lower, with 16.7% of students reporting it as a significant factor contributing to their academic stress. At the lowest end of the ranking, but still notable, is stress from a perceived lack of professional knowledge and skills, with 15.9% of students experiencing high stress in this area.

Nursing students? levels of academic stress subtypes (N=1010)

Figure  3 provides the total levels of academic stress among nursing students. The majority of students experienced moderate academic stress (56.3%), followed by those experiencing low academic stress (29.9%), and a minority experienced high academic stress (13.8%).

Nursing students? levels of total academic stress (N=1010)

Table  2 displays the correlation between academic stress subscales and deep and surface learning approaches among 1010 nursing students. All stress subscales exhibited a negative correlation regarding the deep learning approach, indicating that the inclination toward deep learning decreases with increasing stress levels. The most significant negative correlation was observed with stress stemming from the lack of professional knowledge and skills (r=-0.392, p < 0.001), followed by stress from the clinical environment (r=-0.109, p = 0.001), stress from assignments and workload (r=-0.103, p = 0.001), stress from peers and daily life (r=-0.095, p = 0.002), and stress from patient care responsibilities (r=-0.093, p = 0.003). The weakest negative correlation was found with stress from interactions with teachers and nursing staff (r=-0.083, p = 0.009). Conversely, concerning the surface learning approach, all stress subscales displayed a positive correlation, indicating that heightened stress levels corresponded with an increased tendency toward superficial learning. The most substantial positive correlation was observed with stress related to the lack of professional knowledge and skills (r = 0.365, p < 0.001), followed by stress from patient care responsibilities (r = 0.334, p < 0.001), overall stress (r = 0.355, p < 0.001), stress from interactions with teachers and nursing staff (r = 0.262, p < 0.001), stress from assignments and workload (r = 0.262, p < 0.001), and stress from the clinical environment (r = 0.254, p < 0.001). The weakest positive correlation was noted with stress stemming from peers and daily life (r = 0.186, p < 0.001).

Table  3 outlines the association between the socio-demographic characteristics of nursing students and their deep and surface learning approaches. Concerning age, statistically significant differences were observed in deep and surface learning approaches (F = 3.661, p = 0.003 and F = 7.983, p < 0.001, respectively). Gender also demonstrated significant differences in deep and surface learning approaches (t = 3.290, p = 0.001 and t = 8.638, p < 0.001, respectively). Female students exhibited higher scores in the deep learning approach (31.59 ± 8.28) compared to male students (29.59 ± 7.73), while male students had higher scores in the surface learning approach (29.97 ± 7.36) compared to female students (24.90 ± 7.97). Educational level exhibited statistically significant differences in deep and surface learning approaches (F = 5.599, p = 0.001 and F = 17.284, p < 0.001, respectively). Both deep and surface learning approach scores increased with higher educational levels. The duration of study hours demonstrated significant differences only in the surface learning approach (F = 3.550, p = 0.014), with scores increasing as study hours increased. However, no significant difference was observed in the deep learning approach (F = 0.861, p = 0.461). Hours of sleep per night and GPA from the previous semester did not exhibit statistically significant differences in deep or surface learning approaches.

Table  4 presents a multivariate linear regression analysis examining the factors influencing the learning approach among 1110 nursing students. The deep learning approach was positively influenced by age, gender (being female), educational year level, and stress from teachers and nursing staff, as indicated by their positive coefficients and significant p-values (p < 0.05). However, it was negatively influenced by stress from a lack of professional knowledge and skills. The other factors do not significantly influence the deep learning approach. On the other hand, the surface learning approach was positively influenced by gender (being female), educational year level, stress from lack of professional knowledge and skills, stress from assignments and workload, and stress from taking care of patients, as indicated by their positive coefficients and significant p-values (p < 0.05). However, it was negatively influenced by gender (being male). The other factors do not significantly influence the surface learning approach. The adjusted R-squared values indicated that the variables in the model explain 17.8% of the variance in the deep learning approach and 25.5% in the surface learning approach. Both models were statistically significant (p < 0.001).

Nursing students’ academic stress and learning approaches are essential to planning for effective and efficient learning. Nursing education also aims to develop knowledgeable and competent students with problem-solving and critical-thinking skills.

The study’s findings highlight the significant presence of stress among nursing students, with a majority experiencing moderate to severe levels of academic stress. This aligns with previous research indicating that academic stress is prevalent among nursing students. For instance, Zheng et al. (2022) observed moderated stress levels in nursing students during clinical placements [ 23 ], while El-Ashry et al. (2022) found that nearly all first-year nursing students in Egypt experienced severe academic stress [ 21 ]. Conversely, Ali and El-Sherbini (2018) reported that over three-quarters of nursing students faced high academic stress. The complexity of the nursing program likely contributes to these stress levels [ 24 ].

The current study revealed that nursing students identified the highest sources of academic stress as workload from assignments and the stress of caring for patients. This aligns with Banu et al.‘s (2015) findings, where academic demands, assignments, examinations, high workload, and combining clinical work with patient interaction were cited as everyday stressors [ 25 ]. Additionally, Anaman-Torgbor et al. (2021) identified lectures, assignments, and examinations as predictors of academic stress through logistic regression analysis. These stressors may stem from nursing programs emphasizing the development of highly qualified graduates who acquire knowledge, values, and skills through classroom and clinical experiences [ 26 ].

The results regarding learning approaches indicate that most nursing students predominantly employed the deep learning approach. Despite acknowledging a surface learning approach among the participants in the present study, the prevalence of deep learning was higher. This inclination toward the deep learning approach is anticipated in nursing students due to their engagement with advanced courses, requiring retention, integration, and transfer of information at elevated levels. The deep learning approach correlates with a gratifying learning experience and contributes to higher academic achievements [ 3 ]. Moreover, the nursing program’s emphasis on active learning strategies fosters critical thinking, problem-solving, and decision-making skills. These findings align with Mahmoud et al.‘s (2019) study, reporting a significant presence (83.31%) of the deep learning approach among undergraduate nursing students at King Khalid University’s Faculty of Nursing [ 27 ]. Additionally, Mohamed &Morsi (2019) found that most nursing students at Benha University’s Faculty of Nursing embraced the deep learning approach (65.4%) compared to the surface learning approach [ 28 ].

The study observed a negative correlation between the deep learning approach and the overall mean stress score, contrasting with a positive correlation between surface learning approaches and overall stress levels. Elevated academic stress levels may diminish motivation and engagement in the learning process, potentially leading students to feel overwhelmed, disinterested, or burned out, prompting a shift toward a surface learning approach. This finding resonates with previous research indicating that nursing students who actively seek positive academic support strategies during academic stress have better prospects for success than those who do not [ 29 ]. Nebhinani et al. (2020) identified interface concerns and academic workload as significant stress-related factors. Notably, only an interest in nursing demonstrated a significant association with stress levels, with participants interested in nursing primarily employing adaptive coping strategies compared to non-interested students.

The current research reveals a statistically significant inverse relationship between different dimensions of academic stress and adopting the deep learning approach. The most substantial negative correlation was observed with stress arising from a lack of professional knowledge and skills, succeeded by stress associated with the clinical environment, assignments, and workload. Nursing students encounter diverse stressors, including delivering patient care, handling assignments and workloads, navigating challenging interactions with staff and faculty, perceived inadequacies in clinical proficiency, and facing examinations [ 30 ].

In the current study, the multivariate linear regression analysis reveals that various factors positively influence the deep learning approach, including age, female gender, educational year level, and stress from teachers and nursing staff. In contrast, stress from a lack of professional knowledge and skills exert a negative influence. Conversely, the surface learning approach is positively influenced by female gender, educational year level, stress from lack of professional knowledge and skills, stress from assignments and workload, and stress from taking care of patients, but negatively affected by male gender. The models explain 17.8% and 25.5% of the variance in the deep and surface learning approaches, respectively, and both are statistically significant. These findings underscore the intricate interplay of demographic and stress-related factors in shaping nursing students’ learning approaches. High workloads and patient care responsibilities may compel students to prioritize completing tasks over deep comprehension. This pressure could lead to a surface learning approach as students focus on meeting immediate demands rather than engaging deeply with course material. This observation aligns with the findings of Alsayed et al. (2021), who identified age, gender, and study year as significant factors influencing students’ learning approaches.

Deep learners often demonstrate better self-regulation skills, such as effective time management, goal setting, and seeking support when needed. These skills can help manage academic stress and maintain a balanced learning approach. These are supported by studies that studied the effect of coping strategies on stress levels [ 6 , 31 , 32 ]. On the contrary, Pacheco-Castillo et al. study (2021) found a strong significant relationship between academic stressors and students’ level of performance. That study also proved that the more academic stress a student faces, the lower their academic achievement.

Strengths and limitations of the study

This study has lots of advantages. It provides insightful information about the educational experiences of Egyptian nursing students, a demographic that has yet to receive much research. The study’s limited generalizability to other people or nations stems from its concentration on this particular group. This might be addressed in future studies by using a more varied sample. Another drawback is the dependence on self-reported metrics, which may contain biases and mistakes. Although the cross-sectional design offers a moment-in-time view of the problem, it cannot determine causation or evaluate changes over time. To address this, longitudinal research may be carried out.

Notwithstanding these drawbacks, the study substantially contributes to the expanding knowledge of academic stress and nursing students’ learning styles. Additional research is needed to determine teaching strategies that improve deep-learning approaches among nursing students. A qualitative study is required to analyze learning approaches and factors that may influence nursing students’ selection of learning approaches.

According to the present study’s findings, nursing students encounter considerable academic stress, primarily stemming from heavy assignments and workload, as well as interactions with teachers and nursing staff. Additionally, it was observed that students who experience lower levels of academic stress typically adopt a deep learning approach, whereas those facing higher stress levels tend to resort to a surface learning approach. Demographic factors such as age, gender, and educational level influence nursing students’ choice of learning approach. Specifically, female students are more inclined towards deep learning, whereas male students prefer surface learning. Moreover, deep and surface learning approach scores show an upward trend with increasing educational levels and study hours. Academic stress emerges as a significant determinant shaping the adoption of learning approaches among nursing students.

Implications in nursing practice

Nursing programs should consider integrating stress management techniques into their curriculum. Providing students with resources and skills to cope with academic stress can improve their well-being and academic performance. Educators can incorporate teaching strategies that promote deep learning approaches, such as problem-based learning, critical thinking exercises, and active learning methods. These approaches help students engage more deeply with course material and reduce reliance on surface learning techniques. Recognizing the gender differences in learning approaches, nursing programs can offer gender-specific support services and resources. For example, providing targeted workshops or counseling services that address male and female nursing students’ unique stressors and learning needs. Implementing mentorship programs and peer support groups can create a supportive environment where students can share experiences, seek advice, and receive encouragement from their peers and faculty members. Encouraging students to reflect on their learning processes and identify effective study strategies can help them develop metacognitive skills and become more self-directed learners. Faculty members can facilitate this process by incorporating reflective exercises into the curriculum. Nursing faculty and staff should receive training on recognizing signs of academic stress among students and providing appropriate support and resources. Additionally, professional development opportunities can help educators stay updated on evidence-based teaching strategies and practical interventions for addressing student stress.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to restrictions imposed by the institutional review board to protect participant confidentiality, but are available from the corresponding author on reasonable request.

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Acknowledgements

Our sincere thanks go to all the nursing students in the study. We also want to thank Dr/ Rasha Badry for their statistical analysis help and contribution to this study.

The research was not funded by public, commercial, or non-profit organizations.

Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

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Ayman M. El-Ashry & Rawhia S. Dogham: conceptualization, preparation, and data collection; methodology; investigation; formal analysis; data analysis; writing-original draft; writing-manuscript; and editing. Heba F. Mansy Ali & Asmaa S. Ghaly: conceptualization, preparation, methodology, investigation, writing-original draft, writing-review, and editing. Nermine M. Elcokany & Mohamed M. Seweid: Methodology, investigation, formal analysis, data collection, writing-manuscript & editing. All authors reviewed the manuscript and accept for publication.

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Dogham, R.S., Ali, H.F.M., Ghaly, A.S. et al. Deciphering the influence: academic stress and its role in shaping learning approaches among nursing students: a cross-sectional study. BMC Nurs 23 , 249 (2024). https://doi.org/10.1186/s12912-024-01885-1

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A mixed methods study using case studies prepared by nursing students as a clinical practice evaluation tool

Ana maría palmar‐santos.

1 Nursing Department, Faculty of Medicine, Autonomous University of Madrid, Madrid Spain

2 Member of the Nursing and Health Care Research Group of the Health Research Institute “Puerta de Hierro‐Segovia de Arana” (IDIPHISA), Majadahonda Spain

Cristina Oter‐Quintana

Ricardo olmos.

3 Social Psychology and Methodology Department, Faculty of Psychology, Autonomous University of Madrid, Madrid Spain

Azucena Pedraz‐Marcos

4 Health Care Research Unit, Institute of Health Carlos III; Nursing Department, Faculty of Medicine, Autonomous University of Madrid, Spain

Juana Robledo‐Martin

5 Member of the Gregorio Marañon Health Research Institute, IiSGM, Madrid Spain

Associated Data

Data available on request from the authors: The data that support the findings of this study are available from the corresponding author upon reasonable request.

To identify the presence of variability in the evaluation of case studies prepared by nursing students during their primary care rotations based on the existing evaluation rubric. To explore the difficulties experienced by link lecturers and students in preparing and evaluating case studies.

A mixed methods study.

The scores for the rubric items and the final grades for the case studies were collected from a sample of 132 cases. Qualitative information was collected by conducting open‐ended interviews with lecturers and a focus group session with students.

Statistically significant differences were identified between the lecturers' mean final grades [ F (5.136) = 3.984, p  = 0.002] and a variety of items in the evaluation rubric ( p  < 0.05). In addition, effect sizes [ η 2 (≈0.14)] of considerable magnitude were found.

Two themes emerged from the qualitative data: (1). the challenge of preparing the case studies and (2). the variable nature of the evaluations.

1. INTRODUCTION

Clinical training of nursing students is an essential part of the nursing degree curriculum. In the European context, this training is determined by a European Union directive and accounts for ‘at least one half of the minimum duration of the training’. The same directive states that ‘this training shall take place in hospitals and other health institutions and the community, under the responsibility of nursing teachers, in cooperation with and assisted by other qualified nurses’ (Directive 2005/36/EC of the European Parliament,  2005 ). Evaluating skills in a real‐life environment with a multitude of different professionals accompanying the students' learning process poses a challenge for institutions training future nursing professionals (Almalkawi et al.,  2018 ; Pramila‐Savukoski et al.,  2020 ).

Evaluating the acquisition of clinical practice skills is an ongoing task for clinical mentors that poses a constant challenge (Tuomikoski et al.,  2020 ). Although clinical mentors have improved the evaluation procedures and rubrics at their disposal (Stanley et al.,  2020 ), they continue to call for greater communication with universities (Bos et al.,  2015 ). At most institutions, this continuous evaluation process is supplemented by reflective evaluation in an attempt to measure not only performance but also the thought processes leading to that performance, that is, critical thinking and decision‐making. Various methods and tools have been used for this purpose, including portfolios (Buckley et al.,  2009 ), reflective journals (Hwang et al.,  2018 ), case scenarios and 360‐degree evaluations (González‐Gil et al., 2020 ) and performance checklist and assessment tests, like in the Objective Structured Clinical Examination (OSCE) (Sabzi et al.,  2018 ). These methods have all proven effective in evaluating nursing students' clinical practice and are considered not only evaluation tools but also learning tools (Driessen,  2017 ).

2. BACKGROUND

Case studies have been widely used in nursing theory training because they help students to build on the basic knowledge taught and to collect information and analyse it to make diagnoses and support interventions (O'Rourke & Zerwic,  2016 ). In addition, there is considerable research on the use of case studies in simulation settings, which are practical environments where students gain confidence before moving on to clinical practice (Wong & Kowitlawakul,  2020 ). Case studies have been included in OSCEs as part of the final evaluation of skills acquired through clinical practice (Kelly et al.,  2016 ) and as tools for learning critical thinking and decision‐making skills in healthcare institutions (Englund,  2020 ). At our university, the students study the nursing process and the standardised nursing languages (North American Nursing Diagnosis Classification (NANDA), Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC)) in the first year. In the second and third years, the students are asked to prepare a clinical case consisting in designing a care plan for a person or a family in their clinical practice unit. The students must develop the different phases of the nursing process: assessment, diagnosis, planning, implementation and evaluation of their care plan. They must use the standardised nursing languages too. To guide this process, the student is supervised by a link lecturer, who can be an academic lecturer (full lecturer) or a clinical lecturer (assistant lecturer), who combines their teaching work at the university with clinical activity. The grade obtained in the clinical case is part of the overall evaluation of the clinical practice module, which also includes other components such as being assessed by the clinical nurse responsible for mentoring them at the clinical placement and a self‐evaluation component. This kind of summative assessment with several tools used in direct patient care and simulated practice, which are marked using a multi‐level observational rubric, supplemented by self‐evaluation of clinical performance, is in line with the findings of Clemett and Raleigh ( 2021 ) in their systematic review.

Despite the wide use and positive outcomes gained from cases studies, students still feel that the evaluation of their clinical practice varies depending on the clinical nurse mentor, who decides what is relevant in ‘the real world’ and the link lecturer, who, despite being relatively invisible to students during their clinical practice, has a major influence on their final grade (Foster et al.,  2015 ; Helminen et al.,  2016 ).

3. THE STUDY

The aim of this study is twofold. On the one hand, to identify the presence of variability in the evaluation of case studies prepared by nursing students during their primary care rotations based on a module's existing evaluation rubric. On the other hand, to explore the difficulties experienced by link lecturers and students in preparing and evaluating case studies.

4.1. Design

A mixed methods design was used, analysing the scores given to the case studies during the evaluation and qualitative information on link lecturers' and students' assessments of the evaluation process.

4.2. Population and sample

The study was carried out during the 7‐week rotation of third‐year students on primary care clinical placements during the 2018–2019 academic year. The study population included 132 students, who prepared a case study during their rotation in primary care, and 6 link lecturers, who assessed their case studies. Each case study was evaluated by the link lecturer responsible for monitoring that student during the clinical practices in that period. During the 2018–2019 academic year, evaluation of the primary care case studies was undertaken by six link lecturers.

4.3. Data collection

Data were collected in the following ways: the scores awarded to the 132 case studies by the various link lecturers, a focus group session with the participating students and in‐depth interviews with the lecturers involved in their evaluation.

Data were collected on the following variables: the link lecturer responsible for evaluating each student, the final grade for each student's case and the grades awarded to each of the items in the evaluation rubric. This rubric (see Annex  1 ) is the tool usually used by link lecturers to correct clinical cases. This evaluation tool was developed by a group of nursing professors with extensive experience in the preparation of clinical cases but has not been subjected to a formal validation process.

Four of the six link lecturers were interviewed since two of the link lecturers had participated in the development of the research project and their participation in the interviews was not considered appropriate. Of the four link lecturers interviewed: one was an academic lecturer (full lecturer) and three were clinical lecturers (who combine clinical care with teaching). An interview script covering the following topics was used: experience in evaluating case studies; the influence of the aspects they value most and least on the grades they award; difficulties in using the rubric and recommendations for improvement (see Annex  2 ). The interviews lasted between 40 and 60 min and took place in a space chosen by each participant. They were audio‐recorded and then transcribed for analysis.

Students with the highest and lowest grades in the case study were invited to participate in a focus group session. To ensure the heterogeneity of the group, students evaluated by different link lecturers were represented. For the focus group session, a thematic script was created, addressing aspects relating to the preparation of students' case studies during their clinical placements and recommendations for improvement (see Annex  3 ). Five students participated in the focus group, which was led by a moderator accompanied by an observer who took notes during the development of the session. All students actively participated in the discussion. The focus group session lasted 90 min and was audio‐recorded and transcribed for subsequent analysis, after obtaining informed consent from all participants.

4.4. Data analysis

The data from the case study evaluation were statistically analysed to assess any differences between link lecturers in the final grade they awarded to each case study and the grades they awarded to each of the items in the evaluation rubric. To analyse the data, a between‐subjects one‐factor ANOVA model was used (one lecturer representing one factor) using the total score given by the lecturer (the sum of all the rubric items) and each rubric item separately as the dependent variable. This was used to assess whether the average scores differed. Pairwise comparisons of lecturers were performed to establish whether lecturers differed in the average scores awarded using Tukey's method (controlling for the type I error rate). The statistical significance threshold for all analyses was set at 0.05. In addition, the assumptions of normality and homoscedasticity were fulfilled for the dependent variables. Normality was assessed using the Kolmogorov–Smirnov test. The assumption of homoscedasticity was assessed using Levene's test. When the assumption of the equality of variances was not met, Welch's corrected F ‐statistic was used. The non‐parametric Kruskal–Wallis test was also used to analyse whether the results were sensitive to the statistical model. The data were analysed using SPSS (version 25) software from IBM.

The qualitative data from the interviews and focus group sessions were analysed thematically using Braun and Clarke method ( 2006 ). All authors read and underlined the interview and focus group transcripts to familiarise themselves with the data and to identify the first emerging codes. At a series of analytical meetings, the authors identified potential themes by clustering the codes and created a relationship map to refine and link the themes found. This refinement of the themes led to the final report, which included quotes from participants and analytical notes on each theme.

4.5. Ethical considerations

This study is part of a teaching innovation project entitled ‘Strategies for harmonising clinical practice evaluation standards’, approved by the Autonomous University of Madrid Teaching Innovation Ethical Committee, involving internal and external evaluators, with reference number M_015.18_INN.

All individuals involved in the study participated voluntarily, were informed about the study objectives and signed an informed consent form. Students were assured that their participation would have no impact on their grades. To this end, double anonymisation was carried out at the time of recruitment and during transcription.

A total of 132 case study evaluations were collected from 6 lecturers, with the number of cases evaluated by each lecturer ranging between 18 and 26 (see Table  1 ).

Means, standard deviations and number of students ( N ) per lecturer based on final grades and rubric items.

Table  2 shows the results comparing the means of the six lecturers. The results of the parametric ANOVA model and the non‐parametric Kruskal–Wallis model are also provided, with a sensitivity analysis performed in consideration of the fact that the assumptions required by the ANOVA are not always met. The results suggest that the two statistical models are robust and consistent with one another. In virtually all items of the rubric (in addition to the final grade), there are statistically significant differences in the mean grades awarded between the lecturers. The items in which significant differences were identified between the lecturers using both statistical models were information analysis, planning, follow‐up of the individual's progress and written communication. In the final assessment and literature review, differences were detected only in the non‐parametric test. Furthermore, in the final grade, the effect size measure, η 2 , exhibited a considerable magnitude according to Cohen's criteria ( 1988 , ps. 280–287), where 0.01, 0.07 and 0.14 are set as criteria for weak, moderate and strong effect sizes respectively. Table  2 shows that in four of the eight items evaluated, the effect size was high.

Significance of ANOVA tests based on final grades and rubric items.

Note: Bold values indicate the statistical significance of p < 0.05.

Pairwise comparisons between all lecturers were also assessed and one lecturer was found to differ significantly from two other lecturers ( p  < 0.05). Lecturer 6, in particular, awarded significantly higher averages than lecturers 1 and 4 (see Table  1 ). Finally, the six lecturers were grouped into two categories according to their job category (academic lecturer or clinical lecturer) in order to analyse whether academic and clinical lecturers used the rubric differently. The T ‐test for independent samples was used to compare the averages. The results showed no significant differences in any of the items analysed or in the total, except for written communication. In this item, the group of academic lecturers ( M  = 0.38, SD = 0.12) awarded significantly lower average scores than the group of clinical lecturers ( M  = 0.47, SD = 0.06): T (93) = 5.281, p  < 0.001.

Regarding the qualitative phase of the study, the thematic analysis of the discourses from the interviews with the link lecturers and the focus group with the students generated two core categories:

• The challenge of preparing the case study
• The variable nature of the evaluations

5.1. The challenge of preparing the case study

The link lecturers participating in the study viewed case studies as an opportunity to integrate theory and practice. However, they highlighted students' difficulties in incorporating theory into the case they are working on. They also pointed out that students tended to focus their attention on the physical problems of the people they care for. They stressed that a reductionist, superficial nursing assessment will not lead to a deep understanding of the social and emotional problems of the individual under their care.

The link lecturers participating in the study explained that the limitations of the case study were due, on the one hand, to the incorporation of the nursing process into the computer system, which simplifies the approach of a comprehensive vision of said process, and on the other hand, to the internalisation of care models that fail to take a holistic view of the individual by nursing students during their placements.

So, I think that this may be influencing a lot […] that they are influenced a lot by the computer systems, which, in some way, shape how you think, or your own mentalization. But, sometimes, what I am seeing is that there are students who do not go further. (E1)

(They are preparing) a case with a mentor, who almost always has a hospital background, who is not teaching them a holistic approach to patients. (E4)

During the focus group, the students stated that the clinical nurse mentors helped them in choosing a patient and support them in preparing their case. However, they pointed out that sometimes the clinical nurse mentors failed to fully understand the work they must carry out, even questioning the practicality of this type of exercise for their future professional practice.

I've even heard that. They [clinical nurse mentors] say “but this is a waste of time, you're never going to do this…” If the person who is above you, so to speak, comes to you and says: “don't do that, it's nonsense” or “it's no use”, they're not exactly going to be of much help. (FG)

In the focus group, the students identified the lack of precise, uniform instructions from all link lecturers as to the structure and basic contents of the case study as one of the main difficulties involved in the process. This prompts them to prioritise the creation of their own case study, ‘the model case study’, for which they resort to the following: 1. reviewing learning materials from previous modules in their academic training; 2. using available bibliographic resources; and 3. compiling case studies carried out by colleagues or by themselves that have already been corrected. The students expressed that they felt that some of the instructions provided by link lecturers were contradictory and wondered whether those instructions reflect personal inclinations rather than academic criteria.

The link lecturers who participated in the study also pointed to the lack of a precise, standardised structure and content as particularly problematic when it came to helping them guide the student in the development of the clinical case. They considered that the fact that the students could receive different indications from each link lecturer contributed to generating confusion among them.

Yes, I see the fact that you can have a tutor every year as an inconvenience, […]each tutor asks you really one thing. Maybe it's not worth it, even if it's well done, it's not worth it, because they wants… "No, I don't want this, I want you to develop this pattern more for me", "I don't like this, remove it" , and then, suddenly, the following year, or in the following practice, you get another one, and it's the other way around, they likes what you had done at the beginning better. (FG)

I really don't think the problem is that students aren't trying hard enough, it's that they're quite disoriented. We're giving them different instructions if you like. (E2)

During the focus group, the students complained that case studies were expected to meet certain requirements without considering the reality in which they carry out their clinical placements, such as requiring the case study to be carried out in a home environment or demanding that the care plan designed to be put into practice. This last point is also noted by the interviewed link lecturers.

The students and link lecturers mentioned that they sometimes resorted to ‘embellishing’ the real case study with fictitious content as a way of fulfilling the requirements, or to taking more simplistic approaches enabling them to obtain results in the short term.

I understand that the student may have difficulty understanding that we propose a care plan, and an evaluation, above all […], but the evaluation is very difficult, an evaluation in three weeks [the duration of the internship], in primary care. It is that sometimes not even in three weeks is a wound managed, nor is a therapeutic eating plan managed, nor is a grieving coping plan managed, nor do you manage… it is that practically very little. (E4)

But to comply with all the requirements, I think that I personally, in some cases, and I think other people too, end up having to make something up in the end. And just for that, for a good grade, when in reality it's not entirely true. (FG)

5.2. The variable nature of the evaluations

Despite the evaluation rubric, the students participating in the focus group perceived differences in the demands made by different link lecturers. They believed that there was variability in the grading of the cases that was intrinsic to the lecturers themselves and did not reflect the quality of their work. Students felt evaluation discrepancies as ‘unfair’, indicating the need to establish common, precise standards in line with the level of skills to be acquired.

Really, I've had classmates whose cases would have been graded a 9 (by the mentors that I've had), but if I'd handed over my case to their mentor, my case would've got a 5 instead of an 8. That's unacceptable. (FG)

Link lecturers participating in the study viewed the rubric as an instrument that could sometimes ‘constrict’ the evaluation process by requiring a separate grade for each item, overlooking the fact that the final grade was based on the overall quality of the student's work rather than on the sum of the individual parts of the rubric.

The rubric (…) was a bit constricting, I mean, it didn't allow me (…) to be consistent with my impressions after evaluating the student and after adjusting the items to the main dimensions of the rubric. (E2)

The link lecturers reported that the tool displays a central tendency in grades, causing difficulties in the evaluation of the case studies when it comes to minimum and maximum grades. They also believed that there were items in the rubric that needed to be changed and that, in order to reduce variability, certain adjectives should be more specific, for example, ‘complete’, ‘consistent’ and ‘appropriate’. They argued that the fact that not all link lecturers were experts in nursing methodology, and evaluation strategies resulted in the rubric not being used properly or in each link lecturer using it ‘in their own way’ in the evaluation process.

Each of us evaluators evaluate in a different way, from a different perspective. I think we try to do it in the same way, but we end up doing it in a different way. We all have different professional experience, or different academic experience (…). Each one of us might add a different nuance to it. (E3)

Link lecturers also mentioned that students failed to take on board their recommendations for improvement, partly due to discrepancies as to what was considered relevant in each case study.

6. DISCUSSION

The results of our study suggest that, despite the availability of a rubric for evaluating case studies, there are statistically significant differences in the mean grades given by the sample of lecturers. This echoes the findings of previous studies suggesting that, although the availability of rubrics reduces between‐lecturer variability, rubrics fail to eliminate all differences attributable to lecturer idiosyncrasies (Bearman & Ajjawi,  2021 ).

The benefits of using rubrics include the possibility of directing students' efforts towards core aspects of learning. When teachers' expectations are made explicit to students, they are more likely to be met (Panadero & Jonsson,  2013 ). No mention was made of the utility of the rubric as a ‘guide’ for the learning process by the participating students. Rubrics have been justified in academia as a way of ensuring transparency in evaluation. However, without student participation in their development and use, they provide little support for student learning and evaluation (Bearman & Ajjawi,  2021 ; Kilgour et al.,  2020 ).

Case studies have been incorporated into nursing degrees as a tool for learning to apply critical reasoning to nursing diagnoses, outcomes and interventions. Most of the experiences reported refer to the use of case studies designed by teachers and incorporated into clinical practice by students (Popil,  2011 ) or in comparison with other methods, such as simulated patients (Karadag et al.,  2016 ). Several studies analysing the development of care plans by students based on real patients highlight the importance of nursing taxonomies (NANDA, NIC and NOC) in incorporating evaluation criteria into the case study objectives and improving nursing interventions of a less technical nature (Palese et al.,  2009 ). However, as in our study, students report that nurses working at the healthcare facilities where they are carrying out their clinical placements make marginal use of the nursing methodology. Link lecturers also highlight the biological approach occasionally permeating case studies. Echoing these findings, Türk et al. ( 2013 ) explain the significant presence of physiological diagnoses in care plans made by students based on Benner's Novice to Expert Model. To these authors, the fact that ‘novices’ tend to identify problems of a biological nature results from their limited capacity to understand the situation of the individual being cared for as a whole, to apply critical thinking and to take a holistic approach. It is expected that novices will develop these skills with experience as they become experts. At the same time, identification of psychosocial problems requires a level of communication skill that is not available to students in the early stages of their training.

In our study, students and link lecturers both said that the case study script lacked clarity and specificity. In this sense, students and mentors said that having a follow‐up structure, with specific tasks relating to the preparation of the case study, could be a viable avenue for improvement. This is consistent with a study by Brugnolli et al. ( 2011 ), where students reported that gradual, experiential and guided learning was the most appropriate mentoring tool for their learning process. Palese et al. ( 2008 ) found that students who had received more intensive mentoring in the development of critical thinking skills made fewer errors in the initial formulation of hypotheses in case studies.

Furthermore, in a review by Flott and Linden ( 2016 ), the interaction between mentors and students in clinical practice learning, along with the physical space where learning takes place and the organisational culture, were considered essential components of the clinical learning environment (CLE). Student ‘exposure’ to clinical practice conditions echoes existing findings in the literature regarding the gap between theory and practice. Solutions include greater involvement of link lecturers in the acquisition of clinical skills and experimentation with the realities of practice, as well as a greater presence of clinical mentors in theory training, allowing them to build more meaningful bonds with students (Masterson et al.,  2020 ). This is especially relevant in primary care, where the gap between the hospital setting and the academic environment has been highlighted by various authors (Peters et al.,  2015 ; Valaitis et al.,  2020 ).

Finally, in our study, students and link lecturers feel that they are expected to produce work in accordance with requirements that are far removed from the reality of care. The theory taught at educational institutions aims to provide general practice guidelines that may be meaningless when they materialise in the dynamic, changing world of clinical care, causing feelings of frustration and futility (Salifu et al.,  2019 ).

6.1. Limitations

This study has some limitations. First, for the exploration of the difficulties expressed by the students, only one focus group was conducted with nursing students. This affects the possibility that different student profiles could be represented within the group. Nevertheless, an attempt was made to ensure a certain heterogeneity of the attendees in terms of experiential characteristics considered relevant to the phenomenon under study, such as grades obtained in the clinical case and specific primary health centre of clinical practice. Another limitation of the study is the number of cases evaluated by each teacher, which made it necessary to use non‐parametric tests. It should also be noted that the participants were recruited from a single university institution. This limits transferability to other academic contexts. On the other hand, it should be noted that the rubric used in the elaboration of the clinical cases was developed by a group of expert teachers in this teaching methodology, and has not been subjected to a formal validation process. This prevents knowing the reliability and validity of the instrument to evaluate the clinical cases prepared by the student.

7. CONCLUSION

The use of case studies based on real individuals cared for by students during their practical training as an evaluation tool poses several challenges. Students and link lecturers point out the complexity of the process of preparing a case study and consider that having uniform, clear criteria in line with the reality of clinical settings is essential to facilitate this task. The use of case studies as an evaluation tool requires the availability of rubrics that concisely reflect lecturers' expectations as to the work to be carried out, which can be used by students as a roadmap in preparing their case study.

CONFLICT OF INTEREST STATEMENT

Acknowledgements.

This study is part of a teaching innovation project entitled ‘Strategies for harmonising clinical practice evaluation standards’, approved by the Autonomous University of Madrid Teaching Innovation Ethical Committee, involving internal and external evaluators, with reference number M_015.18_INN. We would like to thank the students and link lecturers for their collaboration in the study.

Rubric for evaluating case studies.

Interview guide for link lecturers., focus group guide..

Palmar‐Santos, A. M. , Oter‐Quintana, C. , Olmos, R. , Pedraz‐Marcos, A. , & Robledo‐Martin, J. (2023). A mixed methods study using case studies prepared by nursing students as a clinical practice evaluation tool . Nursing Open , 10 , 6592–6601. 10.1002/nop2.1919 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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PENN GLOBAL RESEARCH & ENGAGEMENT GRANT PROGRAM 2024 Grant Program Awardees

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In 2024, Penn Global will support 24 new faculty-led research and engagement projects at a total funding level of $1.5 million.

The Penn Global Research and Engagement Grant Program prioritizes projects that bring together leading scholars and practitioners across the University community and beyond to develop new insight on significant global issues in key countries and regions around the world, a core pillar of Penn’s global strategic framework. 

PROJECTS SUPPORTED BY THE HOLMAN AFRICA RESEARCH AND ENGAGEMENT FUND

• Global Medical Physics Training & Development Program  Stephen Avery, Perelman School of Medicine
• Developing a Dakar Greenbelt with Blue-Green Wedges Proposal  Eugenie Birch, Weitzman School of Design
• Emergent Judaism in Sub-Saharan Africa  Peter Decherney, School of Arts and Sciences / Sara Byala, School of Arts and Sciences
• Determinants of Cognitive Aging among Older Individuals in Ghana  Irma Elo, School of Arts and Sciences;  Iliana Kohler, School of Arts and Sciences
• Disrupted Aid, Displaced Lives Guy Grossman, School of Arts and Sciences
• A History of Regenerative Agriculture Practices from the Global South: Case Studies from Ethiopia, Kenya, and Zimbabwe Thabo Lenneiye, Kleinman Energy Center / Weitzman School of Design
• Penn Computerized Neurocognitive Battery Use in Botswana Public Schools Elizabeth Lowenthal, Perelman School of Medicine
• Podcasting South African Jazz Past and Present Carol Muller, School of Arts and Sciences
• Lake Victoria Megaregion Study: Joint Lakefront Initiative Frederick Steiner, Weitzman School of Design
• Leveraging an Open Source Software to Prevent and Contain AMR Jonathan Strysko, Perelman School of Medicine
• Poverty reduction and children's neurocognitive growth in Cote d'Ivoire Sharon Wolf, Graduate School of Education
• The Impacts of School Connectivity Efforts on Education Outcomes in Rwanda  Christopher Yoo, Carey Law School

PROJECTS SUPPORTED BY THE INDIA RESEARCH AND ENGAGEMENT FUND

• Routes Beyond Conflict: A New Approach to Cultural Encounters in South Asia  Daud Ali, School of Arts and Sciences
• Prioritizing Air Pollution in India’s Cities Tariq Thachil, Center for the Advanced Study of India / School of Arts and Sciences
• Intelligent Voicebots to Help Indian Students Learn English Lyle Ungar, School of Engineering and Applied Sciences

PROJECTS SUPPORTED BT THE CHINA RESEARCH AND ENGAGEMENT FUND

• Planning Driverless Cities in China Zhongjie Lin, Weitzman School of Design

PROJECTS SUPPORTED BY THE GLOBAL ENGAGEMENT FUND 

• Education and Economic Development in Nepal Amrit Thapa, Graduate School of Education
• Explaining Climate Change Regulation in Cities: Evidence from Urban Brazil Alice Xu, School of Arts and Sciences
• Nurse Staffing Legislation for Scotland: Lessons for the U.S. and the U.K.  Eileen Lake, School of Nursing
• Pathways to Education Development & Their Consequences: Finland, Korea, US Hyunjoon Park, School of Arts and Sciences
• Engaged Scholarship in Latin America: Bridging Knowledge and Action Tulia Falleti, School of Arts and Sciences
• Organizing Migrant Communities to Realize Rights in Palermo, Sicily  Domenic Vitiello, Weitzman School of Design
• Exploiting Cultural Heritage in 21st Century Conflict   Fiona Cunningham, School of Arts and Sciences
• Center for Integrative Global Oral Health   Alonso Carrasco-Labra, School of Dental Medicine

This first-of-its-kind Global Medical Physics Training and Development Program (GMPTDP) seeks to serve as an opportunity for PSOM and SEAS graduate students to enhance their clinical requirement with a global experience, introduce them to global career opportunities and working effectively in different contexts, and strengthens partnerships for education and research between US and Africa. This would also be an exceptional opportunity for pre-med/pre-health students and students interested in health tech to have a hands-on global experience with some of the leading professionals in the field. The project will include instruction in automated radiation planning through artificial intelligence (AI); this will increase access to quality cancer care by standardizing radiation planning to reduce inter-user variability and error, decreasing workload on the limited radiation workforce, and shortening time to treatment for patients. GMPTDP will offer a summer clinical practicum to Penn students during which time they will also collaborate with UGhana to implement and evaluate AI tools in the clinical workflow.

The proposal will address today’s pressing crises of climate change, land degradation, biodiversity loss, and growing economic disparities with a holistic approach that combines regional and small-scale actions necessary to achieve sustainability. It will also tackle a key issue found across sub-Saharan Africa, many emerging economies, and economically developed countries that struggle to control rapid unplanned urbanization that vastly outpaces the carrying capacity of the surrounding environment.

The regional portion of the project will create a framework for a greenbelt that halts the expansion of the metropolitan footprint. It will also protect the Niayes, an arable strip of land that produces over 80% of the country’s vegetables, from degradation. This partnership will also form a south-south collaboration to provide insights into best practices from a city experiencing similar pressures.

The small-scale portion of the project will bolster and create synergy with ongoing governmental and grassroots initiatives aimed at restoring green spaces currently being infilled or degraded in the capital. This will help to identify overlapping goals between endeavors, leading to collaboration and mobilizing greater funding possibilities instead of competing over the same limited resources. With these partners, we will identify and design Nature-based Solutions for future implementation.

Conduct research through fieldwork to examine questions surrounding Jewish identity in Africa. Research will be presented in e.g. articles, photographic images, and films, as well as in a capstone book. In repeat site-visits to Uganda, South Africa, Ghana, and Zimbabwe, we will conduct interviews with and take photographs of stakeholders from key communities in order to document their everyday lives and religious practices.

The overall aim of this project is the development of a nationally representative study on aging in Ghana. This goal requires expanding our network of Ghanian collaborators and actively engage them in research on aging. The PIs will build on existing institutional contacts in Ghana that include:

1). Current collaboration with the Navrongo Health Research Center (NCHR) on a pilot data collection on cognitive aging in Ghana (funded by a NIA supplement and which provides the matching funds for this Global Engagement fund grant application);

2) Active collaboration with the Regional Institute for Population Studies (RIPS), University of Ghana. Elo has had a long-term collaboration with Dr. Ayaga Bawah who is the current director of RIPS.

In collaboration with UNHCR, we propose studying the effects of a dramatic drop in the level of support for refugees, using a regression discontinuity design to survey 2,500 refugee households just above and 2,500 households just below the vulnerability score cutoff that determines eligibility for full rations. This study will identify the effects of aid cuts on the welfare of an important marginalized population, and on their livelihood adaptation strategies. As UNHCR faces budgetary cuts in multiple refugee-hosting contexts, our study will inform policymakers on the effects of funding withdrawal as well as contribute to the literature on cash transfers.

The proposed project, titled "A History of Regenerative Agriculture Practices from the Global South: Case Studies from Ethiopia, Kenya, and Zimbabwe," aims to delve into the historical and contemporary practices of regenerative agriculture in sub-Saharan Africa. Anticipated Outputs and Outcomes:

1. Research Paper: The primary output of this project will be a comprehensive research paper. This paper will draw from a rich pool of historical and contemporary data to explore the history of regenerative agriculture practices in Ethiopia, Kenya, and Zimbabwe. It will document the indigenous knowledge and practices that have sustained these regions for generations.

2. Policy Digest: In addition to academic research, the project will produce a policy digest. This digest will distill the research findings into actionable insights for policymakers, both at the national and international levels. It will highlight the benefits of regenerative agriculture and provide recommendations for policy frameworks that encourage its adoption.

3. Long-term Partnerships: The project intends to establish long-term partnerships with local and regional universities, such as Great Lakes University Kisumu, Kenya. These partnerships will facilitate knowledge exchange, collaborative research, and capacity building in regenerative agriculture practices. Such collaborations align with Penn Global's goal of strengthening institutional relationships with African partners.

The Penn Computerized Neurocognitive Battery (PCNB) was developed at the University of Pennsylvania by Dr. Ruben C. Gur and colleagues to be administered as part of a comprehensive neuropsychiatric assessment. Consisting of a series of cognitive tasks that help identify individuals’ cognitive strengths and weaknesses, it has recently been culturally adapted and validated by our team for assessment of school-aged children in Botswana . The project involves partnership with the Botswana Ministry of Education and Skills Development (MoESD) to support the rollout of the PCNB for assessment of public primary and secondary school students in Botswana. The multidisciplinary Penn-based team will work with partners in Botswana to guide the PCNB rollout, evaluate fidelity to the testing standards, and track student progress after assessment and intervention. The proposed project will strengthen a well-established partnership between Drs. Elizabeth Lowenthal and J. Cobb Scott from the PSOM and in-country partners. Dr. Sharon Wolf, from Penn’s Graduate School of Education, is an expert in child development who has done extensive work with the Ministry of Education in Ghana to support improvements in early childhood education programs. She is joining the team to provide the necessary interdisciplinary perspective to help guide interventions and evaluations accompanying this new use of the PCNB to support this key program in Africa.

This project will build on exploratory research completed by December 24, 2023 in which the PI interviewed about 35 South Africans involved in jazz/improvised music mostly in Cape Town: venue owners, curators, creators, improvisers.

• Podcast series with 75-100 South African musicians interviewed with their music interspersed in the program.
• 59 minute radio program with extended excerpts of music inserted into the interview itself.
• Create a center of knowledge about South African jazz—its sound and its stories—building knowledge globally about this significant diasporic jazz community
• Expand understanding of “jazz” into a more diffuse area of improvised music making that includes a wide range of contemporary indigenous music and art making
• Partner w Lincoln Center Jazz (and South African Tourism) to host South Africans at Penn

This study focuses on the potential of a Megaregional approach for fostering sustainable development, economic growth, and social inclusion within the East African Community (EAC), with a specific focus on supporting the development of A Vision for An Inclusive Joint Lakefront across the 5 riparian counties in Kenya.

By leveraging the principles of Megaregion development, this project aims to create a unified socio-economic, planning, urbanism, cultural, and preservation strategy that transcends county boundaries and promotes collaboration further afield, among the EAC member countries surrounding the Lake Victoria Basin.

Anticipated Outputs and Outcomes:

1. Megaregion Conceptual Framework: The project will develop a comprehensive Megaregion Conceptual Framework for the Joint Lakefront region in East Africa. This framework, which different regions around the world have applied as a way of bridging local boundaries toward a unified regional vision will give the Kisumu Lake region a path toward cooperative, multi-jurisdictional planning. The Conceptual Framework will be both broad and specific, including actionable strategies, projects, and initiatives aimed at sustainable development, economic growth, social inclusion, and environmental stewardship.

2. Urbanism Projects: Specific urbanism projects will be proposed for key urban centers within the Kenyan riparian counties. These projects will serve as tangible examples of potential improvements and catalysts for broader development efforts.

3. Research Publication: The findings of the study will be captured in a research publication, contributing to academic discourse and increasing Penn's visibility in the field of African urbanism and sustainable development

Antimicrobial resistance (AMR) has emerged as a global crisis, causing more deaths than HIV/AIDS and malaria worldwide. By engaging in a collaborative effort with the Botswana Ministry of Health’s data scientists and experts in microbiology, human and veterinary medicine, and bioinformatics, we will aim to design new electronic medical record system modules that will:

Aim 1: Support the capturing, reporting, and submission of microbiology data from sentinel surveillance laboratories as well as pharmacies across the country

Aim 2: Develop data analytic dashboards for visualizing and characterizing regional AMR and AMC patterns

Aim 3: Submit AMR and AMC data to regional and global surveillance programs

Aim 4: Establish thresholds for alert notifications when disease activity exceeds expected incidence to serve as an early warning system for outbreak detection.

  Using a novel interdisciplinary approach that bridges development economics, psychology, and neuroscience, the overall goal of this project is to improve children's development using a poverty-reduction intervention in Cote d'Ivoire (CIV). The project will directly measure the impacts of cash transfers (CTs) on neurocognitive development, providing a greater understanding of how economic interventions can support the eradication of poverty and ensure that all children flourish and realize their full potential. The project will examine causal mechanisms by which CTs support children’s healthy neurocognitive development and learning outcomes through the novel use of an advanced neuroimaging tool, functional Near Infrared Spectroscopy (fNIRS), direct child assessments, and parent interviews.

The proposed research, the GIGA initiative for Improving Education in Rwanda (GIER), will produce empirical evidence on the impact of connecting schools on education outcomes to enable Rwanda to better understand how to accelerate the efforts to bring connectivity to schools, how to improve instruction and learning among both teachers and students, and whether schools can become internet hubs capable of providing access e-commerce and e-government services to surrounding communities. In addition to evaluating the impact of connecting schools on educational outcomes, the research would also help determine which aspects of the program are critical to success before it is rolled out nationwide.

Through historical epigraphic research, the project will test the hypothesis that historical processes and outcomes in the 14th century were precipitated by a series of related global and local factors and that, moreover, an interdisciplinary and synergistic analysis of these factors embracing climatology, hydrology, epidemiology linguistics and migration will explain the transformation of the cultural, religious and social landscapes of the time more effectively than the ‘clash of civilizations’ paradigm dominant in the field. Outputs include a public online interface for the epigraphic archive; a major international conference at Penn with colleagues from partner universities (Ghent, Pisa, Edinburgh and Penn) as well as the wider South Asia community; development of a graduate course around the research project, on multi-disciplinary approaches to the problem of Hindu-Muslim interaction in medieval India; and a public facing presentation of our findings and methods to demonstrate the path forward for Indian history. Several Penn students, including a postdoc, will be actively engaged.  

India’s competitive electoral arena has failed to generate democratic accountability pressures to reduce toxic air. This project seeks to broadly understand barriers to such pressures from developing, and how to overcome them. In doing so, the project will provide the first systematic study of attitudes and behaviors of citizens and elected officials regarding air pollution in India. The project will 1) conduct in-depth interviews with elected local officials in Delhi, and a large-scale survey of elected officials in seven Indian states affected by air pollution, and 2) partner with relevant civil society organizations, international bodies like the United Nations Environment Program (UNEP), domain experts at research centers like the Public Health Foundation of India (PHFI), and local civic organizations (Janagraaha) to evaluate a range of potential strategies to address pollution apathy, including public information campaigns with highly affected citizens (PHFI), and local pollution reports for policymakers (Janagraaha).

The biggest benefit from generative AI such as GPT, will be the widespread availability of tutoring systems to support education. The project will use this technology to build a conversational voicebot to support Indian students in learning English. The project will engage end users (Indian tutors and their students) in the project from the beginning. The initial prototype voice-driven conversational system will be field-tested in Indian schools and adapted. The project includes 3 stages of development:

1) Develop our conversational agent. Specify the exact initial use case and Conduct preliminary user testing.

2) Fully localize to India, addressing issues identified in Phase 1 user testing.

3) Do comprehensive user testing with detailed observation of 8-12 students using the agent for multiple months; conduct additional assessments of other stakeholders.

The project partners with Ashoka University and Pratham over all three stages, including writing scholarly papers.

Through empirical policy analysis and data-based scenario planning, this project actively contributes to this global effort by investigating planning and policy responses to autonomous transportation in the US and China. In addition to publishing several research papers on this subject, the PI plans to develop a new course and organize a forum at PWCC in 2025. These initiatives are aligned with an overarching endeavor that the PI leads at the Weitzman School of Design, which aims to establish a Future Cities Lab dedicated to research and collaboration in the pursuit of sustainable cities.

This study aims to fill this gap through a more humanistic approach to measuring the impact of education on national development. Leveraging a mixed methods research design consisting of analysis of quantitative data for trends over time, observations of schools and classrooms, and qualitative inquiry via talking to people and hearing their stories, we hope to build a comprehensive picture of educational trends in Nepal and their association with intra-country development. Through this project we strive to better inform the efforts of state authorities and international organizations working to enhance sustainable development within Nepal, while concurrently creating space and guidance for further impact analyses. Among various methods of dissemination of the study’s findings, one key goal is to feed this information into writing a book on this topic.

Developing cities across the world have taken the lead in adopting local environmental regulation. Yet standard models of environmental governance begin with the assumption that local actors should have no incentives for protecting “the commons.” Given the benefits of climate change regulation are diffuse, individual local actors face a collective action problem. This project explores why some local governments bear the costs of environmental regulation while most choose to free-ride. The anticipated outputs of the project include qualitative data that illuminate case studies and the coding of quantitative spatial data sets for studying urban land-use. These different forms of data collection will allow me to develop and test a theoretical framework for understanding when and why city governments adopt environmental policy.

The proposed project will develop new insights on the issue of legislative solutions to the nurse staffing crisis, which will pertain to many U.S. states and U.K. countries. The PI will supervise the nurse survey data collection and to meet with government and nursing association stakeholders to plan the optimal preparation of reports and dissemination of results. The anticipated outputs of the project are a description of variation throughout Scotland in hospital nursing features, including nurse staffing, nurse work environments, extent of adherence to the Law’s required principles, duties, and method, and nurse intent to leave. The outcomes will be the development of capacity for sophisticated quantitative research by Scottish investigators, where such skills are greatly needed but lacking.  

The proposed project will engage multi-cohort, cross-national comparisons of educational-attainment and labor-market experiences of young adults in three countries that dramatically diverge in how they have developed college education over the last three decades: Finland, South Korea and the US. It will produce comparative knowledge regarding consequences of different pathways to higher education, which has significant policy implications for educational and economic inequality in Finland, Korea, the US, and beyond. The project also will lay the foundation for ongoing collaboration among the three country teams to seek external funding for sustained collaboration on educational analyses.

With matching funds from PLAC and CLALS, we will jointly fund four scholars from diverse LAC countries to participate in workshops to engage our community regarding successful practices of community-academic partnerships.

These four scholars and practitioners from Latin America, who are experts on community-engaged scholarship, will visit the Penn campus during the early fall of 2024. As part of their various engagements on campus, these scholars will participate after the workshops as key guest speakers in the 7th edition of the Penn in Latin America and the Caribbean (PLAC) Conference, held on October 11, 2024, at the Perry World House. The conference will focus on "Public and Community Engaged Scholarship in Latin America, the Caribbean, and their Diasporas."

Palermo, Sicily, has been a leading center of migrant rights advocacy and migrant civic participation in the twenty-first century. This project will engage an existing network of diverse migrant community associations and anti-mafia organizations in Palermo to take stock of migrant rights and support systems in the city. Our partner organizations, research assistants, and cultural mediators from different communities will design and conduct a survey and interviews documenting experiences, issues and opportunities related to various rights – to asylum, housing, work, health care, food, education, and more. Our web-based report will include recommendations for city and regional authorities and other actors in civil society. The last phase of our project will involve community outreach and organizing to advance these objectives. The web site we create will be designed as the network’s information center, with a directory of civil society and services, updating an inventory not current since 2014, which our partner Diaspore per la Pace will continue to update.

This interdisciplinary project has four objectives: 1) to investigate why some governments and non-state actors elevated cultural heritage exploitation (CHX) to the strategic level of warfare alongside nuclear weapons, cyberattacks, political influence operations and other “game changers”; 2) which state or non-state actors (e.g. weak actors) use heritage for leverage in conflict and why; and 3) to identify the mechanisms through which CHX coerces an adversary (e.g. catalyzing international involvement); and 4) to identify the best policy responses for non-state actors and states to address the challenge of CHX posed by their adversaries, based on the findings produced by the first three objectives.

Identify the capacity of dental schools, organizations training oral health professionals and conducting oral health research to contribute to oral health policies in the WHO Eastern Mediterranean region, identify the barriers and facilitators to engage in OHPs, and subsequently define research priority areas for the region in collaboration with the WHO, oral health academia, researchers, and other regional stakeholders.

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