narrative versus case study

Difference Between Case Study And Narrative Research

• Success Team
• January 19, 2023

Top-Rated AI Meeting Assistant With Incredible ChatGPT & Qualitative Data Analysis Capabilities

Join 150,000+ individuals and teams who rely on speak ai to capture and analyze unstructured language data for valuable insights. streamline your workflows, unlock new revenue streams and keep doing what you love..

Get a 7-day fully-featured trial!

Research is an important part of any organization or business. There are two main types of research: case studies and narrative research. Both are valuable tools for gathering and analyzing information, but they have some important differences. Understanding the difference between case study and narrative research can help you select the best research method for your particular project.

What is Case Study Research?

Case study research is a type of qualitative research that focuses on a single case, or a small number of cases, to examine in depth. It seeks to understand a phenomenon by examining the context of the case and looking at the experiences, perspectives, and behavior of the people involved. Case study research is often used to explore complex social phenomena, such as poverty, health, education, and social change.

What is Narrative Research?

Narrative research is also a type of qualitative research that focuses on understanding how people make sense of their experiences. It involves collecting and analyzing stories, or narratives, from participants. These stories can be collected through interviews, focus groups, or other data collection techniques. By examining the stories in detail, researchers can gain insights into how people think about and make sense of the world around them.

Differences Between Case Study and Narrative Research

The most important differences between case study and narrative research are the focus and the type of data collected. Case studies focus on a single case or a small number of cases, while narrative research focuses on understanding how people make sense of their experiences. Case studies typically rely on quantitative data, such as surveys and measurements, while narrative research relies on qualitative data, such as interviews, stories, and observations.

Which is Better?

The answer to this question depends on the research question and the type of data needed to answer it. If the goal is to understand a single case in depth, then a case study is the best approach. If the goal is to understand how people make sense of their experiences, then narrative research is the best approach. In some cases, it may be beneficial to use a combination of both approaches.

Case study and narrative research are both valuable tools for gathering and analyzing information. Understanding the difference between the two can help you select the best research method for your particular project. While case studies are useful for understanding a single case in depth, narrative research is better for understanding how people make sense of their experiences. In some cases, it may be beneficial to use a combination of both approaches.

How To Use The Best Large Language Models For Research With Speak

Step 1: Create Your Speak Account

To start your transcription and analysis, you first need to create a Speak account . No worries, this is super easy to do!

Get a 7-day trial with 30 minutes of free English audio and video transcription included when you sign up for Speak.

To sign up for Speak and start using Speak Magic Prompts, visit the Speak app register page here .

Step 2: Upload Your Research Data

We typically recommend MP4s for video or MP3s for audio.

However, we accept a range of audio, video and text file types.

You can upload your file for transcription in several ways using Speak:

Accepted Audio File Types

Accepted video file types, accepted text file types, csv imports.

You can also upload CSVs of text files or audio and video files. You can learn more about CSV uploads and download Speak-compatible CSVs here .

With the CSVs, you can upload anything from dozens of YouTube videos to thousands of Interview Data.

Publicly Available URLs

You can also upload media to Speak through a publicly available URL.

As long as the file type extension is available at the end of the URL you will have no problem importing your recording for automatic transcription and analysis.

YouTube URLs

Speak is compatible with YouTube videos. All you have to do is copy the URL of the YouTube video (for example, https://www.youtube.com/watch?v=qKfcLcHeivc ).

Speak will automatically find the file, calculate the length, and import the video.

If using YouTube videos, please make sure you use the full link and not the shortened YouTube snippet. Additionally, make sure you remove the channel name from the URL.

Speak Integrations

As mentioned, Speak also contains a range of integrations for Zoom , Zapier , Vimeo and more that will help you automatically transcribe your media.

This library of integrations continues to grow! Have a request? Feel encouraged to send us a message.

Step 3: Calculate and Pay the Total Automatically

Once you have your file(s) ready and load it into Speak, it will automatically calculate the total cost (you get 30 minutes of audio and video free in the 7-day trial - take advantage of it!).

If you are uploading text data into Speak, you do not currently have to pay any cost. Only the Speak Magic Prompts analysis would create a fee which will be detailed below.

Once you go over your 30 minutes or need to use Speak Magic Prompts, you can pay by subscribing to a personalized plan using our real-time calculator .

You can also add a balance or pay for uploads and analysis without a plan using your credit card .

Step 4: Wait for Speak to Analyze Your Research Data

If you are uploading audio and video, our automated transcription software will prepare your transcript quickly. Once completed, you will get an email notification that your transcript is complete. That email will contain a link back to the file so you can access the interactive media player with the transcript, analysis, and export formats ready for you.

If you are importing CSVs or uploading text files Speak will generally analyze the information much more quickly.

Step 5: Visit Your File Or Folder

Speak is capable of analyzing both individual files and entire folders of data.

When you are viewing any individual file in Speak, all you have to do is click on the "Prompts" button.

If you want to analyze many files, all you have to do is add the files you want to analyze into a folder within Speak.

You can do that by adding new files into Speak or you can organize your current files into your desired folder with the software's easy editing functionality.

Step 6: Select Speak Magic Prompts To Analyze Your Research Data

What are magic prompts.

Speak Magic Prompts leverage innovation in artificial intelligence models often referred to as "generative AI".

These models have analyzed huge amounts of data from across the internet to gain an understanding of language.

With that understanding, these "large language models" are capable of performing mind-bending tasks!

With Speak Magic Prompts, you can now perform those tasks on the audio, video and text data in your Speak account.

Step 7: Select Your Assistant Type

To help you get better results from Speak Magic Prompts, Speak has introduced "Assistant Type".

These assistant types pre-set and provide context to the prompt engine for more concise, meaningful outputs based on your needs.

To begin, we have included:

Choose the most relevant assistant type from the dropdown.

Step 8: Create Or Select Your Desired Prompt

Here are some examples prompts that you can apply to any file right now:

• Create a SWOT Analysis
• Give me the top action items
• Create a bullet point list summary
• Tell me the key issues that were left unresolved
• Tell me what questions were asked
• Create Your Own Custom Prompts

A modal will pop up so you can use the suggested prompts we shared above to instantly and magically get your answers.

If you have your own prompts you want to create, select "Custom Prompt" from the dropdown and another text box will open where you can ask anything you want of your data!

Step 9: Review & Share Responses

Speak will generate a concise response for you in a text box below the prompt selection dropdown.

In this example, we ask to analyze all the Interview Data in the folder at once for the top product dissatisfiers.

You can easily copy that response for your presentations, content, emails, team members and more!

Speak Magic Prompts As ChatGPT For Research Data Pricing

Our team at Speak Ai continues to optimize the pricing for Magic Prompts and Speak as a whole.

Right now, anyone in the 7-day trial of Speak gets 100,000 characters included in their account.

If you need more characters, you can easily include Speak Magic Prompts in your plan when you create a subscription.

You can also upgrade the number of characters in your account if you already have a subscription.

Both options are available on the subscription page .

Alternatively, you can use Speak Magic Prompts by adding a balance to your account. The balance will be used as you analyze characters.

Completely Personalize Your Plan 📝

Here at Speak, we've made it incredibly easy to personalize your subscription.

Once you sign-up, just visit our custom plan builder and select the media volume, team size, and features you want to get a plan that fits your needs.

No more rigid plans. Upgrade, downgrade or cancel at any time.

Claim Your Special Offer 🎁

When you subscribe, you will also get a free premium add-on for three months!

That means you save up to $50 USD per month and $150 USD in total.

Once you subscribe to a plan, all you have to do is send us a live chat with your selected premium add-on from the list below:

• Premium Export Options (Word, CSV & More)
• Custom Categories & Insights
• Bulk Editing & Data Organization
• Recorder Customization (Branding, Input & More)
• Media Player Customization
• Shareable Media Libraries

We will put the add-on live in your account free of charge!

What are you waiting for?

Refer Others & Earn Real Money 💸

If you have friends, peers and followers interested in using our platform, you can earn real monthly money.

You will get paid a percentage of all sales whether the customers you refer to pay for a plan, automatically transcribe media or leverage professional transcription services.

Use this link to become an official Speak affiliate.

Check Out Our Dedicated Resources📚

• Speak Ai YouTube Channel
• Guide To Building Your Perfect Speak Plan

Book A Free Implementation Session 🤝

It would be an honour to personally jump on an introductory call with you to make sure you are set up for success.

Just use our Calendly link to find a time that works well for you. We look forward to meeting you!

Top-Rated AI Meeting Assistant With Incredible ChatGPT & Qualitative Data Analysis Capabilities​

Save 99% of your time and costs!

Use Speak's powerful AI to transcribe, analyze, automate and produce incredible insights for you and your team.

Using narrative analysis in qualitative research

Last updated

7 March 2023

Reviewed by

Jean Kaluza

After spending considerable time and effort interviewing persons for research, you want to ensure you get the most out of the data you gathered. One method that gives you an excellent opportunity to connect with your data on a very human and personal level is a narrative analysis in qualitative research. 

Master narrative analysis

Analyze your qualitative data faster and surface more actionable insights

• What is narrative analysis?

Narrative analysis is a type of qualitative data analysis that focuses on interpreting the core narratives from a study group's personal stories. Using first-person narrative, data is acquired and organized to allow the researcher to understand how the individuals experienced something. 

Instead of focusing on just the actual words used during an interview, the narrative analysis also allows for a compilation of data on how the person expressed themselves, what language they used when describing a particular event or feeling, and the thoughts and motivations they experienced. A narrative analysis will also consider how the research participants constructed their narratives.

From the interview to coding , you should strive to keep the entire individual narrative together, so that the information shared during the interview remains intact.

Is narrative analysis qualitative or quantitative?

Narrative analysis is a qualitative research method.

Is narrative analysis a method or methodology?

A method describes the tools or processes used to understand your data; methodology describes the overall framework used to support the methods chosen. By this definition, narrative analysis can be both a method used to understand data and a methodology appropriate for approaching data that comes primarily from first-person stories.

• Do you need to perform narrative research to conduct a narrative analysis?

A narrative analysis will give the best answers about the data if you begin with conducting narrative research. Narrative research explores an entire story with a research participant to understand their personal story.

What are the characteristics of narrative research?

Narrative research always includes data from individuals that tell the story of their experiences. This is captured using loosely structured interviews . These can be a single interview or a series of long interviews over a period of time. Narrative research focuses on the construct and expressions of the story as experienced by the research participant.

• Examples of types of narratives

Narrative data is based on narratives. Your data may include the entire life story or a complete personal narrative, giving a comprehensive account of someone's life, depending on the researched subject. Alternatively, a topical story can provide context around one specific moment in the research participant's life. 

Personal narratives can be single or multiple sessions, encompassing more than topical stories but not entire life stories of the individuals.

• What is the objective of narrative analysis?

The narrative analysis seeks to organize the overall experience of a group of research participants' stories. The goal is to turn people's individual narratives into data that can be coded and organized so that researchers can easily understand the impact of a certain event, feeling, or decision on the involved persons. At the end of a narrative analysis, researchers can identify certain core narratives that capture the human experience.

What is the difference between content analysis and narrative analysis?

Content analysis is a research method that determines how often certain words, concepts, or themes appear inside a sampling of qualitative data . The narrative analysis focuses on the overall story and organizing the constructs and features of a narrative.

What is the difference between narrative analysis and case study in qualitative research?

A case study focuses on one particular event. A narrative analysis draws from a larger amount of data surrounding the entire narrative, including the thoughts that led up to a decision and the personal conclusion of the research participant. 

A case study, therefore, is any specific topic studied in depth, whereas narrative analysis explores single or multi-faceted experiences across time. ​​

What is the difference between narrative analysis and thematic analysis?

A thematic analysis will appear as researchers review the available qualitative data and note any recurring themes. Unlike narrative analysis, which describes an entire method of evaluating data to find a conclusion, a thematic analysis only describes reviewing and categorizing the data.

• Capturing narrative data

Because narrative data relies heavily on allowing a research participant to describe their experience, it is best to allow for a less structured interview. Allowing the participant to explore tangents or analyze their personal narrative will result in more complete data. 

When collecting narrative data, always allow the participant the time and space needed to complete their narrative.

• Methods of transcribing narrative data

A narrative analysis requires that the researchers have access to the entire verbatim narrative of the participant, including not just the word they use but the pauses, the verbal tics, and verbal crutches, such as "um" and "hmm." 

As the entire way the story is expressed is part of the data, a verbatim transcription should be created before attempting to code the narrative analysis.

Video and audio transcription templates

• How to code narrative analysis

Coding narrative analysis has two natural start points, either using a deductive coding system or an inductive coding system. Regardless of your chosen method, it's crucial not to lose valuable data during the organization process.

When coding, expect to see more information in the code snippets.

• Types of narrative analysis

After coding is complete, you should expect your data to look like large blocks of text organized by the parts of the story. You will also see where individual narratives compare and diverge.

Inductive method

Using an inductive narrative method treats the entire narrative as one datum or one set of information. An inductive narrative method will encourage the research participant to organize their own story. 

To make sense of how a story begins and ends, you must rely on cues from the participant. These may take the form of entrance and exit talks. 

Participants may not always provide clear indicators of where their narratives start and end. However, you can anticipate that their stories will contain elements of a beginning, middle, and end. By analyzing these components through coding, you can identify emerging patterns in the data.

Taking cues from entrance and exit talk

Entrance talk is when the participant begins a particular set of narratives. You may hear expressions such as, "I remember when…," "It first occurred to me when…," or "Here's an example…."

Exit talk allows you to see when the story is wrapping up, and you might expect to hear a phrase like, "…and that's how we decided", "after that, we moved on," or "that's pretty much it."

Deductive method

Regardless of your chosen method, using a deductive method can help preserve the overall storyline while coding. Starting with a deductive method allows for the separation of narrative pieces without compromising the story's integrity.

Hybrid inductive and deductive narrative analysis

Using both methods together gives you a comprehensive understanding of the data. You can start by coding the entire story using the inductive method. Then, you can better analyze and interpret the data by applying deductive codes to individual parts of the story.

• How to analyze data after coding using narrative analysis

A narrative analysis aims to take all relevant interviews and organize them down to a few core narratives. After reviewing the coding, these core narratives may appear through a repeated moment of decision occurring before the climax or a key feeling that affected the participant's outcome.

You may see these core narratives diverge early on, or you may learn that a particular moment after introspection reveals the core narrative for each participant. Either way, researchers can now quickly express and understand the data you acquired.

• A step-by-step approach to narrative analysis and finding core narratives

Narrative analysis may look slightly different to each research group, but we will walk through the process using the Delve method for this article.

Step 1 – Code narrative blocks

Organize your narrative blocks using inductive coding to organize stories by a life event.

Example: Narrative interviews are conducted with homeowners asking them to describe how they bought their first home.

Step 2 – Group and read by live-event

You begin your data analysis by reading through each of the narratives coded with the same life event.

Example: You read through each homeowner's experience of buying their first home and notice that some common themes begin to appear, such as "we were tired of renting," "our family expanded to the point that we needed a larger space," and "we had finally saved enough for a downpayment."

Step 3 – Create a nested story structure

As these common narratives develop throughout the participant's interviews, create and nest code according to your narrative analysis framework. Use your coding to break down the narrative into pieces that can be analyzed together.

Example: During your interviews, you find that the beginning of the narrative usually includes the pressures faced before buying a home that pushes the research participants to consider homeownership. The middle of the narrative often includes challenges that come up during the decision-making process. The end of the narrative usually includes perspectives about the excitement, stress, or consequences of home ownership that has finally taken place. 

Step 4 – Delve into the story structure

Once the narratives are organized into their pieces, you begin to notice how participants structure their own stories and where similarities and differences emerge.

Example: You find in your research that many people who choose to buy homes had the desire to buy a home before their circumstances allowed them to. You notice that almost all the stories begin with the feeling of some sort of outside pressure.

Step 5 – Compare across story structure

While breaking down narratives into smaller pieces is necessary for analysis, it's important not to lose sight of the overall story. To keep the big picture in mind, take breaks to step back and reread the entire narrative of a code block. This will help you remember how participants expressed themselves and ensure that the core narrative remains the focus of the analysis.

Example: By carefully examining the similarities across the beginnings of participants' narratives, you find the similarities in pressures. Considering the overall narrative, you notice how these pressures lead to similar decisions despite the challenges faced. 

Divergence in feelings towards homeownership can be linked to positive or negative pressures. Individuals who received positive pressure, such as family support or excitement, may view homeownership more favorably. Meanwhile, negative pressures like high rent or peer pressure may cause individuals to have a more negative attitude toward homeownership.

These factors can contribute to the initial divergence in feelings towards homeownership.

Step 6 – Tell the core narrative

After carefully analyzing the data, you have found how the narratives relate and diverge. You may be able to create a theory about why the narratives diverge and can create one or two core narratives that explain the way the story was experienced.

Example: You can now construct a core narrative on how a person's initial feelings toward buying a house affect their feelings after purchasing and living in their first home.

Narrative analysis in qualitative research is an invaluable tool to understand how people's stories and ability to self-narrate reflect the human experience. Qualitative data analysis can be improved through coding and organizing complete narratives. By doing so, researchers can conclude how humans process and move through decisions and life events.

Learn more about qualitative transcription software

Get started today.

Go from raw data to valuable insights with a flexible research platform

Editor’s picks

Last updated: 21 December 2023

Last updated: 16 December 2023

Last updated: 6 October 2023

Last updated: 25 November 2023

Last updated: 12 May 2023

Last updated: 15 February 2024

Last updated: 11 March 2024

Last updated: 12 December 2023

Last updated: 18 May 2023

Last updated: 6 March 2024

Last updated: 10 April 2023

Last updated: 20 December 2023

Latest articles

Related topics, log in or sign up.

Get started for free

Narrative Analysis 101

Everything you need to know to get started

By: Ethar Al-Saraf (PhD)| Expert Reviewed By: Eunice Rautenbach (DTech) | March 2023

If you’re new to research, the host of qualitative analysis methods available to you can be a little overwhelming. In this post, we’ll  unpack the sometimes slippery topic of narrative analysis . We’ll explain what it is, consider its strengths and weaknesses , and look at when and when not to use this analysis method. 

Overview: Narrative Analysis

• What is narrative analysis (simple definition)
• The two overarching approaches  
• The strengths & weaknesses of narrative analysis
• When (and when not) to use it
• Key takeaways

What Is Narrative Analysis?

Simply put, narrative analysis is a qualitative analysis method focused on interpreting human experiences and motivations by looking closely at the stories (the narratives) people tell in a particular context.

In other words, a narrative analysis interprets long-form participant responses or written stories as data, to uncover themes and meanings . That data could be taken from interviews, monologues, written stories, or even recordings. In other words, narrative analysis can be used on both primary and secondary data to provide evidence from the experiences described.

That’s all quite conceptual, so let’s look at an example of how narrative analysis could be used.

Let’s say you’re interested in researching the beliefs of a particular author on popular culture. In that case, you might identify the characters , plotlines , symbols and motifs used in their stories. You could then use narrative analysis to analyse these in combination and against the backdrop of the relevant context.

This would allow you to interpret the underlying meanings and implications in their writing, and what they reveal about the beliefs of the author. In other words, you’d look to understand the views of the author by analysing the narratives that run through their work.

The Two Overarching Approaches

Generally speaking, there are two approaches that one can take to narrative analysis. Specifically, an inductive approach or a deductive approach. Each one will have a meaningful impact on how you interpret your data and the conclusions you can draw, so it’s important that you understand the difference.

First up is the inductive approach to narrative analysis.

The inductive approach takes a bottom-up view , allowing the data to speak for itself, without the influence of any preconceived notions . With this approach, you begin by looking at the data and deriving patterns and themes that can be used to explain the story, as opposed to viewing the data through the lens of pre-existing hypotheses, theories or frameworks. In other words, the analysis is led by the data.

For example, with an inductive approach, you might notice patterns or themes in the way an author presents their characters or develops their plot. You’d then observe these patterns, develop an interpretation of what they might reveal in the context of the story, and draw conclusions relative to the aims of your research.

Contrasted to this is the deductive approach.

With the deductive approach to narrative analysis, you begin by using existing theories that a narrative can be tested against . Here, the analysis adopts particular theoretical assumptions and/or provides hypotheses, and then looks for evidence in a story that will either verify or disprove them.

For example, your analysis might begin with a theory that wealthy authors only tell stories to get the sympathy of their readers. A deductive analysis might then look at the narratives of wealthy authors for evidence that will substantiate (or refute) the theory and then draw conclusions about its accuracy, and suggest explanations for why that might or might not be the case.

Which approach you should take depends on your research aims, objectives and research questions . If these are more exploratory in nature, you’ll likely take an inductive approach. Conversely, if they are more confirmatory in nature, you’ll likely opt for the deductive approach.

Need a helping hand?

Strengths & Weaknesses

Now that we have a clearer view of what narrative analysis is and the two approaches to it, it’s important to understand its strengths and weaknesses , so that you can make the right choices in your research project.

A primary strength of narrative analysis is the rich insight it can generate by uncovering the underlying meanings and interpretations of human experience. The focus on an individual narrative highlights the nuances and complexities of their experience, revealing details that might be missed or considered insignificant by other methods.

Another strength of narrative analysis is the range of topics it can be used for. The focus on human experience means that a narrative analysis can democratise your data analysis, by revealing the value of individuals’ own interpretation of their experience in contrast to broader social, cultural, and political factors.

All that said, just like all analysis methods, narrative analysis has its weaknesses. It’s important to understand these so that you can choose the most appropriate method for your particular research project.

The first drawback of narrative analysis is the problem of subjectivity and interpretation . In other words, a drawback of the focus on stories and their details is that they’re open to being understood differently depending on who’s reading them. This means that a strong understanding of the author’s cultural context is crucial to developing your interpretation of the data. At the same time, it’s important that you remain open-minded in how you interpret your chosen narrative and avoid making any assumptions .

A second weakness of narrative analysis is the issue of reliability and generalisation . Since narrative analysis depends almost entirely on a subjective narrative and your interpretation, the findings and conclusions can’t usually be generalised or empirically verified. Although some conclusions can be drawn about the cultural context, they’re still based on what will almost always be anecdotal data and not suitable for the basis of a theory, for example.

Last but not least, the focus on long-form data expressed as stories means that narrative analysis can be very time-consuming . In addition to the source data itself, you will have to be well informed on the author’s cultural context as well as other interpretations of the narrative, where possible, to ensure you have a holistic view. So, if you’re going to undertake narrative analysis, make sure that you allocate a generous amount of time to work through the data.

When To Use Narrative Analysis

As a qualitative method focused on analysing and interpreting narratives describing human experiences, narrative analysis is usually most appropriate for research topics focused on social, personal, cultural , or even ideological events or phenomena and how they’re understood at an individual level.

For example, if you were interested in understanding the experiences and beliefs of individuals suffering social marginalisation, you could use narrative analysis to look at the narratives and stories told by people in marginalised groups to identify patterns , symbols , or motifs that shed light on how they rationalise their experiences.

In this example, narrative analysis presents a good natural fit as it’s focused on analysing people’s stories to understand their views and beliefs at an individual level. Conversely, if your research was geared towards understanding broader themes and patterns regarding an event or phenomena, analysis methods such as content analysis or thematic analysis may be better suited, depending on your research aim .

Let’s recap

In this post, we’ve explored the basics of narrative analysis in qualitative research. The key takeaways are:

• Narrative analysis is a qualitative analysis method focused on interpreting human experience in the form of stories or narratives .
• There are two overarching approaches to narrative analysis: the inductive (exploratory) approach and the deductive (confirmatory) approach.
• Like all analysis methods, narrative analysis has a particular set of strengths and weaknesses .
• Narrative analysis is generally most appropriate for research focused on interpreting individual, human experiences as expressed in detailed , long-form accounts.

If you’d like to learn more about narrative analysis and qualitative analysis methods in general, be sure to check out the rest of the Grad Coach blog here . Alternatively, if you’re looking for hands-on help with your project, take a look at our 1-on-1 private coaching service .

Psst... there’s more!

This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

You Might Also Like:

Thanks. I need examples of narrative analysis

Here are some examples of research topics that could utilise narrative analysis:

Personal Narratives of Trauma: Analysing personal stories of individuals who have experienced trauma to understand the impact, coping mechanisms, and healing processes.

Identity Formation in Immigrant Communities: Examining the narratives of immigrants to explore how they construct and negotiate their identities in a new cultural context.

Media Representations of Gender: Analysing narratives in media texts (such as films, television shows, or advertisements) to investigate the portrayal of gender roles, stereotypes, and power dynamics.

Where can I find an example of a narrative analysis table ?

Please i need help with my project,

how can I cite this article in APA 7th style?

please mention the sources as well.

My research is mixed approach. I use interview,key_inforamt interview,FGD and document.so,which qualitative analysis is appropriate to analyze these data.Thanks

Which qualitative analysis methode is appropriate to analyze data obtain from intetview,key informant intetview,Focus group discussion and document.

I’ve finished my PhD. Now I need a “platform” that will help me objectively ascertain the tacit assumptions that are buried within a narrative. Can you help?

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Finder SG, Bliton MJ, editors. Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project [Internet]. Cham (CH): Springer; 2018. doi: 10.1007/978-3-319-90955-4_11

Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project [Internet].

Standardizing the case narrative.

Lisa Rasmussen .

Affiliations

Published online: September 12, 2018.

This chapter is a meta-commentary on case commentaries in the present volume, which highlight potential hazards of using case narratives to evaluate clinical ethics consultation. I argue that in several ways, the commentaries illustrate how important it is, given the attestation model currently used to evaluate the practice of clinical ethics consultation, to develop an idea of a standardized narrative in clinical ethics consultation. If we do not, we risk mistaking clear, eloquent, or rhetorically impressive case narratives for rigorous, ethically appropriate consultations.

• Introduction

This chapter is a meta-commentary on case commentaries, in which theoretical questions about method in clinical ethics consultation meet the concrete exigencies of the practice. The difficulty in this task is looking through the lens of a case narrative that is necessarily limited (because it is a distillation of an experience lived through days and weeks of interaction with many people), and a set of commentaries that are themselves limited. The view this perspective may give of a consultation is not the same as the view that might result from an observer accompanying a consultant throughout the case. For example, commenters in this volume uniformly note additional information that was not provided in an already long case narrative. We have no evidence about whether these issues were broached in the case consultation itself; what we do know is that these issues did not appear in the narrative. As a result, this is a book about narrative composition as much as it is about methods in clinical ethics consultation.

But questioning narrative composition of consultation summaries does generate profitable discussion about the field of clinical ethics consultation itself. As we move towards standardization and quality improvement in clinical ethics consultation, peer review is a vital component for evaluating consultants and consultations. In this, we are hampered by the fact that there is no sustainable mechanism for allowing peer review of full consultations, and even less chance of observing a single consultant’s practice over many cases. Instead, we have the proxy (as currently utilized in the Attestation model [Kodish et al. 2013 ]) of the consultant’s case study. A flaw in this model is the possibility that excellent consultants can be poor writers, and that gifted writers may be poor consultants (where by “gifted” and “poor” writing I am referring to narrative compositional choices in addition to word or style choices). If we are to be evaluated by our case narratives, we must try to control for features irrelevant to quality evaluation, such as narrative ability, rhetorical skill and seductive rococo vocabulary. 1

We may also want to control for the consultant’s perspective: What we choose to accent in a narrative is what is important or noteworthy about the case to us . 2 We may not be lying or adorning a story, but we are choosing a perspective from which to view a case, and when those choices are made in composing the case study, other possible choices become invisible. There are standard elements that may be almost universally expected in case summaries (such as identifying whether a patient is competent or has decisional capacity, and if not, who the decision maker is and under what governing rule [legal default, HCPA, etc.]), but many aspects of what is noteworthy about a case will be idiosyncratically determined. A person sensitized to issues of faith, gender, culture, or socioeconomic status may focus on or preferentially include these issues, where another person might personally note the presence of such features during the case consultation itself but not center or even mention them in a particular case narrative if they do not play a significant role.

The conclusion I have arrived at after considering “The Zadeh Scenario” and accompanying peer reviews is that if quality attestation is to be largely evaluated based on the case narratives submitted to the judging panel, we must develop a fairly uniform standard for case reports themselves, which is distinct from developing a uniform standard for how a consultation is conducted. 3 In what follows, I note several features of the peer reviews accompanying the Finder case that belie different notions of what should be included in a case summary. This may -- or may not -- in turn belie different notions of what questions should be explored as part of doing clinical ethics consultation as a practice.

• Disparate Targets of Commentaries

The overall perception a reader of the case and peer reviews is left with is of an impressionistic landscape. Reviewers pick and choose, some working chronologically through the case, others simply picking up pieces they find noteworthy and elaborating on their presence or absence from the case narrative. The organization and focus of each peer review is sui generis ; they are anything but standardized. While there are a few commonalities, most notably with respect to procedure, the peer reviews diverge quite significantly from each other. Two articles observe that it is not immediately obvious that this is a clinical ethics consultation (Tarzian, who concludes after discussion that it is a case consultation, and Rosell & Johnson, who ask but do not explicitly answer this question).

I think this unsystematic approach accurately represents the state of the field. But this must be changed if quality improvement is really what we are after. Systems help to control for the fact of cognitive limitation. We all know healthcare providers should wash their hands, for example, but it took a fairly rigid study and assurance mechanisms to reveal how frequently that did not happen and how controlling for hand-washing and other straightforward, already-verified practices could dramatically affect patient well-being (Haynes et al. 2009 ). Establishing a system that controls for human cognitive limitations (such as forgetfulness) merely does a better job of making what is desired actually happen than does leaving it up to chance. If case narratives are to be the coin of the new realm of attestation and quality improvement, systematicity in reporting is necessary. 4 Systems establish standards to which individual instances can be compared for adherence; without a system in case reporting, for example, we cannot immediately judge whether a consultation was poor, middling, or excellent based on how the report is written or on what is and is not included. If all we have to evaluate the case is a written report, and we lack a standard for evaluating the written report, we lack a true standard for evaluating a case. And so, questions about method in consultation become, under an attestation model, questions about method in consultation summaries . We must articulate the links between what should be done in a consultation and what must be included in a case report.

To illustrate this point, consider two categories of observations represented in Part Two’s peer reviews: proceduralism, and feminist and multicultural issues. Not all peer reviewers mention both; procedural concerns are cited in four of the five peer reviews, cultural concerns by only three, and feminist concerns by only one. Several other concerns are each mentioned by only one peer reviewer. What do these differences tell us about the practice of consultation and about the practice of writing consultation reports?

Proceduralism

By “proceduralism,” I mean a focus on proper consultation procedures as evidenced by the case narrative. Tarzian focuses on proceduralism most clearly, as evidenced in her subtitle, “A Focus on Process,” and notes that her experience as a chair and member of two different task forces on setting standards in clinical ethics consultation left her with “an appreciation for procedural standards in health care ethics consultation” (Tarzian 2018 : 75). Her initial comments, for example, focus on whether this case actually constituted an ethics consultation, and whether it was a case consultation or something else; to answer these questions, she turns to the Core Competencies for Healthcare Ethics Consultation (ASBH 2011; hereafter “CC”), the current standard in the field, if there is one. Later, she observes that in “The Zadeh Scenario,” “there is ambiguity in several procedural aspects of how this consultation was handled,” such as whether the role of the former consultant (Moore) was clarified for staff and whether Finder clarified what role he himself would play in the case, with the ultimate question being, Who is really in charge of the case and of communicating with various stakeholders? (Tarzian 2018 : 79). Another ambiguity Tarzian comments on is the extent to which medical uncertainty (and the accompanying ethical uncertainty) regarding appropriate treatments was articulated both for health care providers and the patient’s family; she points out that “a strategy for determining how these decisions are made” is missing (Tarzian 2018 : 83).

Armstrong similarly focuses on procedures by commenting positively on the fact that Finder prepares for the consultation by reviewing the electronic medical record and notifying the attending that he is now involved in the case. However, like Tarzian, Armstrong also wonders whether Finder clarified his role with the family, and why an account of who is making decisions (and why) is missing from the narrative. 5 As practicing CECs will know, there are probably more “informal” or “curbside” consultations than formal ones, and Armstrong points out that “a line can and should be drawn between creating a safe space to discuss and examine moral feelings and a responsibility to follow-up and take action on issues uncovered during such discussions.” Because Finder describes both formal and informal requests for consultation, yielding uncertainty about which this case should involve, Armstrong is highlighting the need for the field to create appropriate procedures for these different kinds of consultations.

Hynds’ first comment is that consultations should occur “upon request” (that is, not “self-authorize[d]”), so as to avoid the role of the Ethics Police, and observes that it is not clear whether the first consultant in this case (Dr. Moore) was formally consulted. He also wonders about the presumably “hierarchic relationship” between Dr. Finder and Dr. Moore (Hynds 2018 : 92) and about the “seemingly unstructured or semi-structured” engagement of consultants with participants (Hynds 2018 : 89). He recommends, too, that while Finder explains that consultants in this case met with stakeholders multiple times (and alone), it is better if “interventions are kept to a minimum and all the main players are generally present” (Hynds 2018 : 90). The main procedural concerns in Hynds’ peer review thus concern the formality and source of the consult request, the appropriate structure of interactions with stakeholders, and the professional relationship between consultants.

Frolic & Rubin, like Tarzian and Armstrong, comment on the apparent lack of role clarity in this case. Not only was the role unclear, they suggest, other procedures were as well. For example, procedural clarity was not evident in this case regarding the “various phases of ethics consultation;” it is not clear from the narrative whether the “ethics consultation in this case contributed to any positive outcome, beyond a good relationship between Finder and the family” (Frolic and Rubin 2018 : 59); and it is unclear “if and how the voices of the bedside staff were included in the consultation process” (Frolic and Rubin 2018 : 59). Many of these procedural issues are attributed to a lack of “formalization of both the ethics consultant’s role and process” (Frolic and Rubin 2018 : 59).

Four of the five peer reviewers included procedural concerns in their remarks, 6 but it is noteworthy that they did not all cite the same procedural concerns. The most frequently cited procedural issue was that “The Zadeh Scenario” does not demonstrate that Finder made his role, or that of his colleague Dr. Moore, clear to the patient’s family or the medical staff. (It is worth noting, though, that he may have and simply chose not to mention this in the narrative.) Beyond this node of agreement, however, stated concerns about procedure vary. Armstrong mentions the importance of distinguishing between formal and informal consultations; Hynds stresses the importance that consultants should wait to be called (rather than being proactive) and that consultation meetings should usually involve all stakeholders; and Frolic & Rubin observe that a lack of formalization of the process of consultation may be causing a number of problems.

The peer reviews are not mutually incompatible, so I do not mean to suggest that they demonstrate some radical disagreement about clinical ethics consultation. But they do present quite different pictures of what a case narrative should include. This may help explain the focus on procedure, because it is an area where we might hope for some consensus. However, even in the comments on procedural issues, these peer reviews reveal different priorities.

Multicultural and Feminist Perspectives

A quote from Dr. Moore indicates that the family is Persian, and three of the peer reviewers take up this fact for discussion. Rosell & Johnson observe only in passing that “the narrative gives several indicators of cultural normative difference in regard to making end of life decisions” (Rosell and Johnson 2018 : 103), while Tarzian and Armstrong offer more extended comments. Tarzian raises the idea of “cultural competence” in providing health care, and asserts that “[i]t’s clear that this [cultural difference] contributed substantially to the perceived conflicts between the Hamadani family and the staff caring for Mrs. Hamadani” (Tarzian 2018 : 78). However, she notes that although Finder recognized these possible cultural issues in the case, “it’s unclear whether or how he addressed these conflicts in his role as the ethics consultant” (Tarzian 2018 : 80). Armstrong challenges whether we should assume, based on the family’s Persian culture, that the patient would have wanted her family to make decisions for her.

Encountering a patient and family with a cultural foundation that might affect their approach to decision-making is common in clinical ethics consultation. Cultural difference can be a linchpin for an entire case – or completely irrelevant. Here, two out of five peer reviews did not even include mention of the issue; but even of the three that did, the responses to the cultural element of the case have next to no overlap. To be specific, one flags it but does not assess Dr. Finder’s performance or narrative based on it; one assumes that the cultural issue “contributed substantially to the perceived conflicts” and faults Finder for not discussing how he incorporated these concerns into his consultation; and one notes that culture is not dispositive of wishes when a patient has not stated her own wishes.

Gender and social norms can also play a significant role in clinical ethics cases, but only one author, Armstrong, comments on the role of gender in the case at hand. This case involves an incapacitated mother with one son and two daughters, but the only apparent candidate for decision-maker appears to be the son. Armstrong observes that the daughters have only first names but the son has a first and last name (and is called “Mr. Zadeh” in the narrative), and that “none of the female characters’ opinions regarding treatment independent of Mr. Zadeh’s interpretation are explored…both the patient and her daughters form a silent chorus for Mr. Zadeh” (Armstrong 2018 : 69). It is worth noting that only one of the five peer reviewers found the issue of gender worth noting.

• Other Issues

In addition to procedural and cultural concerns, several other concerns are mentioned in Part Two, though in most cases only one author mentions each feature. Armstrong, Rosell & Johnson, and Frolic & Rubin all focus on the absence of the patient’s voice in “The Zadeh Scenario,” but mostly in passing. Rosell & Johnson remark that “Mrs. Hamadani is mostly absent in this consultation activity” (Rosell and Johnson 2018 : 106); Frolic & Rubin raise the question about what the patient wants as the final and most important category in a list of questions that are not answered in the narrative; Armstrong, in her discussion of “the missing patient,” notes that by not mentioning any conversation with the patient about her wishes, “the case appears to presume that she did not wish to be involved in decision-making, or that her wishes were adequately represented by her children” (Armstrong 2018 : 68).

Armstrong and Frolic & Rubin comment on Finder’s use of the electronic medical record to track readmitted patients who have had ethical issues during past admissions. Frolic & Rubin “worry this could lead to some inadvertent role confusion (what exactly is the ethics consultant contributing by ‘checking in’ on a previous case?) as well as potential violation of the patient’s privacy” (Frolic and Rubin 2018 : 58). Armstrong also mentions privacy, but emphasizes more that this practice makes it difficult to know when a consultation has ended, and whether follow-up in this way is part of continuity of care.

Frolic & Rubin also stress the importance of a consultant’s self-examination and reflecting critically on one’s own practices, noting that Finder does not engage in this practice in this narrative. Armstrong comments that there was evidence of moral distress among healthcare providers, but that Finder does not indicate that this issue was explored at all in the narrative.

• Reflections

The peer reviews in Part Two, like “The Zadeh Scenario,” are rich, thoughtful, and appropriate. But even if all of them are correct, I cannot help but conclude that no case narrative short of a novella could hope to satisfy all of these informational demands, and perhaps not even then. This is not a judgment about the authors of the case or peer reviews, who are attuned to the limits of this format. They also did not compose their comments on the premise that they were working towards some paradigm in case narrative. This book is not meant to recommend a model for adoption in case studies. However, because Finder’s case is (as the peer reviewers note) a much richer, more contextual and detailed narrative than is customary, and yet still all five authors in Part Two find much lacking in the description, the conclusions drawn must also hold for case studies in general given that they tend to be much shorter, more generic, and lacking in detail and context. The case study is a limited vehicle, in other words, and if it is to form the basis of attestation in clinical ethics consultation, we must standardize what we expect to see in a case narrative.

Imagine if the peer reviewers on this case comprised an attestation panel. Although there is some overlap in their positive comments (e.g., most praised Finder for the care he showed the family), there is hardly any overlap in their critical comments. What would this mean for an attestation evaluation of Finder? This returns us to the difference between assessing a consultant’s practice and assessing a case report, because the assumption in the attestation model is that the practice can be evaluated via the case report. This assumption is problematic.

First, if these peer reviews are any indication, authors will have idiosyncratic framing mechanisms for writing case reports, and evaluators will have idiosyncratic responses to cases. For example, Finder may have noticed, explored, and eliminated a feminist concern from the narrative because it played no role, and only one commenter (Armstrong) mentions feminist concerns in her paper. The lack of mention of feminist concerns in the case is merely absence of evidence, not evidence of absence. Armstrong’s concern with the way the case narrative is written (e.g., that the daughters have only first names and the son a first and last name) may be legitimate, but it may be a concern with Finder’s narrative choices , not a concern with his consultation practice (except by tenuous inference between narrative choices and consultation practices).

Three peer reviewers mention cultural issues, reacting to Dr. Moore’s statement that the family is Persian and to Finder’s conclusion that “cultural elements” may have played a role in the case. But there are many more possible interpretations of this case narrative. We have no actual evidence that culture was at play, rather than religion, family dynamics, economic issues, etc. The fact that the family is Persian (are the children also Persian? Or are they Persians born in the US?) ends up being an easy heuristic for “value difference,” but it is a heuristic that may mislead. It is not implausible that culture affected the case, but culture is not monolithic, and we characterize individuals inappropriately if we assume that individual beliefs follow directly from cultural context. Finder may have been blind to these issues, exquisitely attuned to them, or somewhere in between; the commenters may have chosen to focus on “pet” concerns, may have drilled right to the heart of the case, or somewhere in between. We simply lack the information we would need to establish which is the case.

In the account of the proposed Attestation model (Kodish et al. 2013 ), the authors recognize the problem of interrater reliability (which is part, but not all, of the problem outlined above) and offer a mechanism to address it. As the evaluation of the portfolios moved forward, the 12 members of the assessment group “convened to establish assessment metrics” based on the portfolios they had received, then piloted the instruments for face validity and construct validity. It is the problem of “construct validity” – “the ability of the test to measure what is intended” – that I mean to focus on. What I have been illustrating in discussing these case commentaries is the problem of our lack of standards in case reports. If we think it is important to include in a case report a discussion of even those issues that played no significant role during the case, we must offer a template or framework of case reports that prompts discussion of such issues, even if that amounts to a statement that this issue was not relevant to the case. 7

Quality improvement procedures only work if they capture all and only what is appropriate to the task. We have a double-layer problem in the idea of an attestation model of assessing clinical ethics consultation, because we lack standards at the level of the individual consultation, and we haven’t even begun to discuss standard expectations of case summaries. This model of an extended case study with commentaries is worth repeating as we develop standards in the field, because such a process generates the diverse elements of a consultation and its reporting that practitioners find important. 8 As the field’s assessment mechanisms are shaped, these elements must be standardized and promulgated so that authors of case reports know the bases on which their cases will be assessed. Without clear direction regarding the necessary elements in a case report, attestation of abilities based on case summaries will be impossible, unfair, or arbitrary.

• Armstrong K (2018) Telling about engagement is not enough: seeking the “ethics” of ethics consultation in clinical ethics case reports. In: Finder SG, Bliton MJ (eds) Peer review, peer education, and modeling in the practice of clinical ethics consultation: the Zadeh project. Springer, Cham, pp 63–73. [ PubMed : 31314226 ]
• Chambers T (1999) The fiction of bioethics: cases as literary texts. Routledge, New York.
• Finder SG (2018) The Zadeh scenario. In: Finder SG, Bliton MJ (eds) Peer review, peer education, and modeling in the practice of clinical ethics consultation: the Zadeh project. Springer, Cham, pp 21–42. [ PubMed : 31314226 ]
• Frolic A, Rubin SB (2018) Critical self-reflection as moral practice: a collaborative meditation on peer review in ethics consultation. In: Finder SG, Bliton MJ (eds) Peer review, peer education, and modeling in the practice of clinical ethics consultation: the Zadeh project. Springer, Cham, pp 47–61. [ PubMed : 31314392 ]
• Haynes AB, Weiser TG, Berry WR, for the safe surgery saves lives study group et al (2009) A surgical safety checklist to reduce morbidity and mortality in global population. NEJM 360:491–449. [ PubMed : 19144931 ] [ CrossRef ]
• Hynds J (2018) Ethics consultation, professional praxis, and what it means to be a “consultant”. In: Finder SG, Bliton MJ (eds) Peer review, peer education, and modeling in the practice of clinical ethics consultation: the Zadeh project. Springer, Cham, pp 85–97. [ PubMed : 31314226 ]
• Kodish E, Fins JJ, Braddock C et al (2013) Quality attestation for clinical ethics consultants: a two-step model from the American Society for Bioethics and Humanities. Hastings Cent Rep 43(5):26–36. [ PMC free article : PMC4849543 ] [ PubMed : 24092588 ] [ CrossRef ]
• Rosell T, Johnson B (2018) This may, or may not, be an ethics consultation. In: Finder SG, Bliton MJ (eds) Peer review, peer education, and modeling in the practice of clinical ethics consultation: the Zadeh project. Springer, Cham, pp 99–107.
• Tarzian AJ (2018) Ethics consultation for Mrs. Hamadani: a focus on process. In: Finder SG, Bliton MJ (eds) Peer review, peer education, and modeling in the practice of clinical ethics consultation: the Zadeh project. Springer, Cham, pp 75–84. [ PubMed : 31314226 ]

For example, consider some of the ways commenters describe Finder’s narrative: “wondrously rich;” “polished;” “wonderfully detailed and engaging;” “rich and thoughtful;” a “gift.” Though some of this praise is (rightfully) due to gratitude for the fact that Finder makes himself vulnerable in this new mechanism for peer review, it is also an honest assessment of the way in which the narrative is written. Clearly the commenters did not shirk from challenging elements of the narrative due to their praise, but we know from the fields of psychology and sociology that style affects assessment. For example, in the “illusory effect,” a message delivered repeatedly is believed more frequently. By repeating claims about “caring for” or “listening to” a patient or family, a consultant could affect an assessment of the case narrative (and thus, the consultation itself) as including evidence that a consultant had the right attitude towards the participants.

As Tod Chambers puts it in his volume about the topic of written cases, The Fiction of Bioethics , “What ethicists have generally ignored is that cases – the data by which they test the relevance of moral theory – are fictions. That is, they are made up, constructed and thus follow conventions of representation that inevitably bias how one understands this information ” ( 1999 , p. 10; emphasis added).

Obviously in this case, Finder and Bliton have not conceived of the volume as focusing on what they argue is a paradigm case narrative. The purpose of the case narrative for the volume and the purpose of case studies written as part of a dossier for quality evaluation may be quite different. Therefore my comments are not directed at this volume’s device in particular, but rather, at the more general activity of evaluating consultants and consultations via written reports. (This also raises the question of what to call such writing: “case study” implies a quite distilled summary of a case, while “case narrative” implies a more contextualized account that invites the reader to consider stakeholders more as characters, with personalities, interior lives, and motivations. A discussion of what we should expect from cases summarized for attestation purposes should start with what to call them, and what general tenor they should have within this continuum of possibilities.)

I recognize that a likely consequence of systematizing or standardizing the case report will be a flattening of richness and detail. But flattening of variation is exactly the point of systems and standards, and it is not clear to me how one might steer between this Scylla and Charybdis. However, it does suggest that case studies or reports for credentialing purposes (in which careers might eventually be at stake) can exist simultaneously with richer narratives meant for other venues.

Armstrong goes further than Tarzian with this concern, offering an extended commentary on “the missing patient” in Finder’s narrative.

I have not included in this count Rosell & Johnson, who describe their commentary as a phenomenological analysis in an “interrogative” mode and do not couch their comments in “procedural” terms. However, many of their remarks may have procedural elements – for example, they note that patients have the right not to receive particular treatments or care from particular providers, and that they have the right under law and because of respect for autonomy to make decisions for themselves.

One possibility for ensuring comprehensiveness both during a consultation and in a case report is the use of a standardized checklist. I gave a presentation on such a mechanism at the International Conference on Clinical Ethics Consultation 2015, in New York, NY.

For example, journals could add a regular feature emulating this approach, and conferences such as the American Society for Bioethics and Humanities (ASBH) and the International Conference for Clinical Ethics consultation could provide conference slots for panels arranged for this commentary.

Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

• Cite this Page Rasmussen L. Standardizing the Case Narrative. 2018 Sep 12. In: Finder SG, Bliton MJ, editors. Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project [Internet]. Cham (CH): Springer; 2018. doi: 10.1007/978-3-319-90955-4_11
• PDF version of this page (298K)
• PDF version of this title (2.4M)

In this Page

Similar articles in pubmed.

• Just a Collection of Recollections: Clinical Ethics Consultation and the Interplay of Evaluating Voices. [HEC Forum. 2016] Just a Collection of Recollections: Clinical Ethics Consultation and the Interplay of Evaluating Voices. Bartlett VL, Bliton MJ, Finder SG. HEC Forum. 2016 Dec; 28(4):301-320.
• Philosophy of Healthcare Ethics Practice Statements: Quality Attestation and Beyond. [HEC Forum. 2018] Philosophy of Healthcare Ethics Practice Statements: Quality Attestation and Beyond. Notini L. HEC Forum. 2018 Dec; 30(4):341-360.
• Review (Meta-) Methodological Lessons for Ethics Consultation. [Peer Review, Peer Education, a...] Review (Meta-) Methodological Lessons for Ethics Consultation. Aulisio MP. Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project. 2018
• Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records. [Am J Bioeth. 2016] Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records. Pearlman RA, Foglia MB, Fox E, Cohen JH, Chanko BL, Berkowitz KA. Am J Bioeth. 2016; 16(3):3-14.
• Review Peer Review and Beyond: Towards a Dialogical Approach of Quality in Ethics Support. [Peer Review, Peer Education, a...] Review Peer Review and Beyond: Towards a Dialogical Approach of Quality in Ethics Support. Widdershoven GAM, Molewijk B, Metselaar S. Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project. 2018

Recent Activity

• Standardizing the Case Narrative - Peer Review, Peer Education, and Modeling in ... Standardizing the Case Narrative - Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

Case studies synthesis: a thematic, cross-case, and narrative synthesis worked example

• Published: 03 August 2014
• Volume 20 , pages 1634–1665, ( 2015 )

Cite this article

• Daniela S. Cruzes 1 ,
• Tore Dybå 1 ,
• Per Runeson 2 &
• Martin Höst 2  

7323 Accesses

92 Citations

4 Altmetric

Explore all metrics

Case studies are largely used for investigating software engineering practices. They are characterized by their flexible nature, multiple forms of data collection, and are mostly informed by qualitative data. Synthesis of case studies is necessary to build a body of knowledge from individual cases. There are many methods for such synthesis, but they are yet not well explored in software engineering. The objective of this research is to demonstrate the similarities and differences of the results and conclusions when applying three different methods of synthesis, and to discuss the challenges of synthesizing evidence from reported case studies in SE. We describe a worked example of three such methods where three independent teams synthesized two studies that investigated critical factors of trust in outsourced projects through thematic synthesis and cross-case analysis, and compared these to each other and also to an already published narrative synthesis. In addition, despite that the primary studies were well presented for synthesis, we identified challenges in the use of case studies synthesis methods related to the goals and research questions of the synthesis, the types and number of case studies, variations in context, limited access to raw data, and quality of the case studies. Thus, we recommend that the analysts should be aware of these challenges and try to account for them during the execution of the synthesis. We also recommend that analysts consider using more than one method of synthesis for sake of reliability of the results and conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Research Synthesis in Software Engineering

Practical relevance of software engineering research: synthesizing the community’s voice

Research in Global Software Engineering: A Systematic Snapshot

Ashrafian H, Darsi A, Athanasiou T (2011) Evidence synthesis: evolving methodologies to optimise patient care and enhance policy decisions in evidence synthesis in healthcare. Springer-Verlag, London

Google Scholar  

Babar MA, Verner JM, Nguyen PT (2007) Establishing and maintaining trust in software outsourcing relationships: an empirical investigation. J Syst Softw 80(9):1438–1449

Article   Google Scholar  

Bethel EC, Bernard RM (2010) Developments and trends in synthesizing diverse forms of evidence: beyond comparisons between distance education and classroom instruction. Am J Dist Educ 31(3):231–256

Cruzes DS, Dybå T (2010) “Synthesizing evidence in software engineering research”, ESEM, 1–10

Cruzes DS, Dybå T (2011a) Research synthesis in software engineering: a tertiary study”. IST 53(5):440–455

Cruzes DS, Dybå T (2011b) “Recommended Steps for Thematic Synthesis in Software Engineering”, ESEM: 275–284

Cruzes DS, Dybå T, Runeson P, Höst M (2011) Case Studies Synthesis: Brief Experience and Challenges for the Future. ESEM: 343–346

Dybå T (2013) Contextualizing empirical evidence. IEEE Softw 30(1):81–83

Dybå T, Dingsøyr T (2008) Strength of Evidence in Systematic Reviews in Software Engineering, ESEM’, pp 178–187.

Dybå T, Sjøberg DIK, Cruzes DS (2012) What works for whom, where, when, and why?: on the role of context in empirical software engineering. ESEM: 19–28

Gerring J (2007) Case study research: principles and practices. Cambridge Univ. Press, New York

Khan S, VanWynsberghe R (2008) Cultivating the Under-Mined: Cross-Case Analysis as Knowledge Mobilization. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 9 (1), Art. 34, http://nbn-resolving.de/urn:nbn:de:0114-fqs0801348

Kitchenham BA, Dybå T, Jørgensen M (2004) Evidence-based Software Engineering, Proc. ICSE’04, Edinburgh, Scotland, 23–28 May, pp. 273–281

Kitchenham BA, Charters S (2007) Guidelines for performing Systematic Literature Reviews in Software Engineering, Version 2.3, Keele University, EBSE Technical Report, EBSE-2007-01

Kitchenham BA, Sjøberg DIK, Dybå T, Pfahl D, Brereton P, Budgen D, Höst M, Runeson P (2012) Three empirical studies on the agreement of reviewers about the quality of software engineering experiments. Inf Softw Technol 54(8):804–819

Larsson R (1993) Case survey methodology: quantitative analysis of patterns across case studies. Acad Manag J 36(6):1515–1546

Article   MathSciNet   Google Scholar  

Lucas WA (1974): The case survey method: Aggregating case experience. Santa Monica

Mays N, Pope C, Popay J (2005) Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 10:6–20

Miles MB, Huberman AM (1984) Qualitative Data Analysis: A Sourcebook of New Methods, Sage

Miles MB, Huberman AM (1994) Qualitative Data Analysis: An Expanded Source Book, Sage

Newig J, Fritsch O (2009) The case survey method and applications in political science. APSA 2009 Paper. Available at SSRN: ssrn.com/abstract = 1451643 (Toronto)

Nguyen PT, Babar MA, Verner JM (2006) Critical factors in establishing and maintaining trust in software outsourcing relationships. EASE, http://ewic.bcs.org/content/ConWebDoc/3709

Oza N, Hall T, Rainer A, Grey S (2005) Trust in software outsourcing relationships: an empirical investigation of Indian software companies. In: 9th International Conference on Empirical Assessment in Software Engineering (EASE 2005). Keele, UK

Oza N, Hall T, Rainer A, Grey S (2006) Trust in software outsourcing relationships: an empirical investigation of Indian software companies. IST 48:345–354

Popay J, Roberts H, Sowden A, Petticrew M, Britten N, Arai L, Roen K, Rodgers M (2010) Developing methods for the narrative synthesis of quantitative and qualitative data in systematic reviews of effects, Centre for Review and Dissemination, ESRC, http://www.york.ac.uk/inst/crd/projects/narrative_synthesis.htm . Assessed in Dec. 2012

Pope C, Mays N, Popay J (2007) Synthesizing Qualitative and Quantitative Health Evidence: A Guide to Methods, Open University Press

Ragin CC (1987) The Comparative Method: Moving Beyond Qualitative and Quantitative Strategies, Univ. of California Press

Runeson P, Höst M (2009) Guidelines for conducting and reporting case study research in software engineering”. Empir Softw Eng 14(2):131–164

Runeson P, Höst M, Rainer A, Regnell B (2012) Case Study Research in Software Engineering – Guidelines and Examples. Wiley, first edition, ISBN-10: 1118104358, ISBN-13: 978–1118104354

Šmite D, Wohlin C, Gorschek T, Feldt R (2010) Empirical evidence in global software engineering: a systematic review”. Empir Softw Eng 15(1):91–118

Thomas J, Harden A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews”. BMC Med Res Methodol 8:45

Article   MATH   Google Scholar  

Yin RK (2014) Case study research. Design and methods, 5th edn. Sage, London

Download references

Author information

Authors and affiliations.

Department of Information and Communication Technology (ICT), SINTEF, Trondheim, NO-7465, Norway

Daniela S. Cruzes & Tore Dybå

Department Computer Science, Lund University, Box 118, SE-221 00, Lund, Sweden

Per Runeson & Martin Höst

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Daniela S. Cruzes .

Additional information

Communicated by: Maurizio Morisio

Rights and permissions

Reprints and permissions

About this article

Cruzes, D.S., Dybå, T., Runeson, P. et al. Case studies synthesis: a thematic, cross-case, and narrative synthesis worked example. Empir Software Eng 20 , 1634–1665 (2015). https://doi.org/10.1007/s10664-014-9326-8

Download citation

Published : 03 August 2014

Issue Date : December 2015

DOI : https://doi.org/10.1007/s10664-014-9326-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Evidence-based software engineering
• Systematic reviews
• Research synthesis
• Find a journal
• Publish with us
• Track your research

• Laurel Learning Tips (Blog)
• Schedule Time to Discuss Your Needs
• 608-219-3594
• About Deborah Laurel
• Questions & Answers
• Capabilities Statement
• Training Philosophy
• Testimonials
• International Experience
• Where We've Been - Travelogue
• Whitepapers/Articles
• Our Curriculum Design Process
• Our Tailored Programs
• Energy Industry Training Experience for Deborah Laurel
• How to Get Energy Conservation Training Results
• Training: Designing for Lasting Change
• Let’s Turn the Lights OFF!
• Auditing Training From an Adult Learning Perspective
• Two Models of Adult Education
• Auditing for Quality Training
• Designing and Delivering Attitude-Changing Learning
• Designing and Delivering Dynamic Learning (4 Day)
• Designing Participant-Centered Curriculum
• 
Designing and Delivering Dynamic Learning (5 Day)
• How to Avoid Learner Overload
• How to Design an Accelerated Learning Program
• Increasing Training Effectiveness
• Polishing Presentation Skills
• Presentation Skills: Be Your Informative or Persuasive Best!
• Take the Pain Out of Training Design for Subject Matter Experts
• Technical Trainer’s Toolbox
• Custom Training Audits
• Audit Approach
• Training Audit Clients
• Curriculum Design Approach
• Technical Curriculum Design
• Banking Curriculum Design
• Energy Curriculum Design
• Classroom Training Overview
• Customized Training Programs
• Half-Day Workshops
• One-Day Workshops
• Two-Day Workshops
• Three-Day Workshops
• Four-Day Workshops
• Five-Day Workshops
• Virtual Training
• Self-Paced Learning

Tip #509: Directions for Writing a Narrative Case Study

• March 17, 2014
• case study , conversation , decisions , detail , development , dialogue , instructions , questions , success , thinking

“If written directions alone would suffice, libraries wouldn’t need to have the rest of the universities attached.” Judith Martin

I created these instructions for writing a narrative case study, for the benefit of three health professionals in Kenya who were contracted to create case studies for a US Agency for Industrial Development training program. Please see what you think:

A narrative case study is a story of a real life problem or situation that provides sufficient background data so that the problem can be analyzed and solved.

• A good case study is written in the form of a story.
• It has a problem for the readers to solve.
• It has characters who have names and use authentic dialogue.
• It is descriptive, with realistic details.
• The flow is easy to follow.
• There is sufficient information so that the readers can understand what the problem is and, after thinking about it and analyzing the information, come up with a proposed solution.
• It has pertinent questions that focus the readers on the key points.

Directions:

• Draw your information from real situations that were either resolved successfully or unsuccessfully.
• Your case study should include:
• A decision maker who is dealing with some question or problem that needs to be resolved;
• A description of the problem;
• An explanation of the context in which the problem occurred; and
• Sufficient supporting data.
• Your case study should provide the answers to these questions:
• What is the issue?
• Who is involved?
• When did the situation occur?
• Where did the situation take place?
• Why did the issue/problem arise?
• What key facts should be considered?
• What questions do the key characters need to resolve?
• What alternatives are available to the decision-maker?
• Your case study should have five sections:
• Introduction
• Answers to Questions [identify what the actual owner did in the situation]

If you would like a copy of the Narrative Case Study Template that accompanied these directions, just contact Deborah Laurel .

May your learning be sweet.

Related Posts

Tip #1022: my equatorial guinea adventure: heading home.

I took the hotel shuttle to the airport and luckily there was a

Tip #1021: My Equatorial Guinea Adventure: Touring Malabo

I just returned from a two-hour car tour of Malabo. We went by

Tip #120: Equatorial Guinea: Day Five of Training

Today’s Topic: Making Presentations We recapped the previous four days by playing Jeopardy.

Two new virtual business workshops for Spring 2023

Presentation Skills: Learn to be informative and persuasive. 8:30-4:00 pm,  4/26/2023

Register here

Six Steps to Yes: Acquire instant influence in a virtual world. 8:30 – 12:30pm, 3/28/2023

It doesn’t have to be difficult to Deal with Difficult People .

Share This Post

Wisconsin Woman-Owned Business Enterprise

The Answer is Yes Certified Trainer

The Role of Narrative in one Case Study

Ancestral trauma across generations, a qualitative study.

Posted January 2, 2020

Traumatic external events, such as war, exile, and political strife, embed themselves in communities and individual psyches. Mental health professionals have resisted considering such external events with equal weight given to personal and familial ones.

Yet, a new book illuminates how external political events impact individual psychology. It also shows how narrative and the reconstruction of a life story is central to therapy . It documents one case history, a qualitative study that describes a patient in Turkey, “Mert,” an affluent businessman in his late 40s living in Istanbul.

The patient came to treatment troubled by a fear of ghosts and graveyards, a phobia suffered since childhood . He complained of sexual dysfunction as well: panic attacks during intercourse with his wife and, at times, loss of his erection and premature ejaculation. Mert grew up on the Black Sea coast in a rural village and recounts a childhood with no electricity or indoor plumbing. The patient says he was born in a toilet after his mother got up one night in a dream state to go to the bathroom and gave birth.

As the patient’s graveyard fear developed in latency and adolescence , Mert’s mother took him to the “village hodja,” a kind of Moslem priest who gave him a Muska or holy amulet for protection. At 17, the patient left the farmhouse where he grew up in his village and moved to Ankara to apply to the university, where a classmate helped him cheat on his entrance exam. After graduation, Mert used some family money to open a factory that made bricks in a poor section of Istanbul. Mert identified himself as a “Muslim-Armenian,” a Hemşinli who had assimilated within a majority of ethnic Turks within the general population.

The author builds on the work of Selma Fraiberg , Edna Adelson, and Vivian Shapiro and their classic essay “Ghosts in the Nursery,” which elaborates on the relationship between a parent's fraught early experience of the way they were raised and their own approach to parenting in later life. These psychoanalytic authors describe the transgenerational transmission of trauma, arguing that “in every nursery there are ghosts." They describe how "in an unguarded moment, a parent and child may find themselves reenacting a moment or a scene from another time with another set of characters.”

In a dream, the patient sees an unknown person catching a big snake and squeezing it, producing poisonous juice that the figure forces into Mert’s mouth. Through his free associations, the patient recalls a place he knew of as a child, one that the Hemshin people called the Canyon of Hell . This was a missing graveyard he had heard stories about and believed was the burial ground for Hemshin Christians, where they settled around 1700. It was also the site where they later fought a neighboring ethnic group, the Laz people, who forced thousands of the Hemshin over the edge of a mountain, pushing them to death in a ravine below. This hellish chasm is understood to represent the patient’s anxiety over the humiliation and shame associated with his Hemshim heritage, as well as the unconscious fear of being feminized and swallowed up.

Through the patient’s narrative, we learn that his ancestors would wrap their gold and jewelry in organic cyanide, which released noxious fumes to kill or deter any thief and bury these valuables in their cemeteries, gardens, and mountainsides. The therapist intuits that by telling the story of buried treasures, the patient was expressing deep ambivalence toward his past with its both glorified and troubling aspects. Mert recalls that some of his Hemshin forebearers referred to the Canyon of Hell as Sesli Kaya , Rock with a Voice. Through therapy, he, working alongside the clinician, continuing the reconstruction of his family history.

Much of the patient’s difficulties emerge from confusion around his large-group identity . The patient confides to his therapist that he thinks of himself as a “fake Turk” since his ancestors were Hemshin. He impregnates a widow, a woman who came to represent the patient’s humiliated self, his shame felt belonging to the Hemshin people: “Mert could be a man with an erect penis at the widow’s house since the humiliated self was externalized onto the woman. On the other hand, at his own home, he was a Hemşinli while his wife’s people were the ‘real’ Turks.”

Secrets emerge about the intertwining of ethnicity with masculinity and, through the patient's free associations, become linked to his persistent phobias. Research cited in the book shows a culture of domestic violence in certain regions of the Black and Caspian Sea, where the patient grew up. As a boy, Mert was taught to cut the heads off chickens in order to be manly. He recalls choking a puppy to death when he was a child and the honor killings that were frequent in his rural village. He begins to realize how his phobia of graveyards is tied to his childhood fantasy of being pushed into the Canyon of Hell and certain cultural assumptions about masculinity.

Mert comes to realize that he did not have good-enough parenting and that “as an adult, he became rich in order to ‘buy’ some ‘good-enough things,’ but still felt that he was not entitled to have them… He was both a ‘fake’ Turk and a ‘fake’ rich man, doomed to search for entitlement for ‘good-enough’ things.” Yet having a therapist, one replicating a loving child-mother relationship, allows the patient to make developmental advances and accomplish certain structural changes in his psyche: the integration of his self-representations and internal object images. The treatment goes on to explore the contamination of the patient's personal identity with his ancestors’ history, and the necessity of choosing what he wants to keep and to discard for improving his self-esteem and sexual relations with women.

The closing chapter called “Unexpected Ending” details how one day, government officials arrive from Ankara to “inspect” one of Mert’s building projects. This at a time when Turkish national identity had shifted to a religious and authoritarian regime, one recreating old Ottoman customs, such as building new mosques and requiring women to cover their heads and faces. The patient abruptly stopped coming to treatment and was never heard from again due to the corrupt workings of the government, which insisted the builder support party politics . The therapist is left wondering if the ruling party’s interference with the patient’s business and personal life would result in a return to his self-perception as a “fake Turk.”

Ghosts exist not only in the nursery but also in public squares and rural landscapes. This book calls attention to a form of deep listening attuned to how story reveals identity conflicts, large-group dynamics, and the transmission of trauma across generations.

Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery: A psychoanalytic approach to the problem of impaired infant-mother relationships . Science Direct, Journal of the American Academy of Child Psychiatry, 14(3): 387-421.

Volkan, V. (2019). Ghosts in the Human Psyche; The Story of A “Muslim Armenian.” Phoenix, Oxfordshire, UK.

Molly Castelloe, Ph.D., is an author specializing in group psychology and theater.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Teletherapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Therapy Center NEW
• Diagnosis Dictionary
• Types of Therapy

Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

• Coronavirus Disease 2019
• Affective Forecasting
• Neuroscience

HYPOTHESIS AND THEORY article

This article is part of the research topic.

Using Case Study and Narrative Pedagogy to Guide Students Through the Process of Science

Molecular Storytelling: A Conceptual Framework for Teaching and Learning with Molecular Case Studies Provisionally Accepted

• 1 School of Interdisciplinary Arts and Sciences, University of Washington Bothell, United States
• 2 Institute for Quantitative Biomedicine, Rutgers, The State University of New Jersey, United States
• 3 Research Collaboratory for Structural Bioinformatics Protein Data Bank, Rutgers, The State University of New Jersey,, United States

The final, formatted version of the article will be published soon.

Molecular case studies (MCSs) provide educational opportunities to explore biomolecular structure and function using data from public bioinformatics resources. The conceptual basis for the design of MCSs has yet to be fully discussed in the literature, so we present molecular storytelling as a conceptual framework for teaching with case studies. Whether the case study aims to understand the biology of a specific disease and design its treatments or track the evolution of a biosynthetic pathway, vast amounts of structural and functional data, freely available in public bioinformatics resources, can facilitate rich explorations in atomic detail. To help biology and chemistry educators use these resources for instruction, a community of scholars collaborated to create the Molecular CaseNet. This community uses storytelling to explore biomolecular structure and function while teaching biology and chemistry. In this article, we define the structure of an MCS and present an example. Then, we articulate the evolution of a conceptual framework for developing and using MCSs. Finally, we related our framework to the development of technological, pedagogical, and content knowledge (TPCK) for educators in the Molecular CaseNet. The report conceptualizes an interdisciplinary framework for teaching about the molecular world and informs lesson design and education research.

Keywords: Molecular education, Case studies, Technological pedagogical and content knowledge (TPCK), Molecular structure and function, molecular visualization, Bioinformatics education, conceptual modeling

Received: 31 Jan 2024; Accepted: 23 Apr 2024.

Copyright: © 2024 Trujillo and Dutta. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Caleb M. Trujillo, University of Washington Bothell, School of Interdisciplinary Arts and Sciences, Bothell, United States

People also looked at