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Understanding case studies.

In this issue, Dion (2014) reports results of a qualitative case study of grief by the mother of a substance-abusing child. Case studies offer insights into the experiences of many different phenomena, conditions, and situations that are either typical or rare. Many readers may not realize case studies are a form of research with a rich and long history.

A case study is a research method focused on the intense study of one or a few cases (Sandelowski, 2011). In the context of specific phenomena and based on the purpose of the case study, researchers may use a variety of data sources including both narrative and numbers (Baxter & Jack, 2008; Creswell, 2006). In this column, I will discuss two types of case studies often seen in nursing--clinical case studies and qualitative case studies and their importance to clinical research.

Clinical Case Studies

Clinical case studies or case reports are a type of research that presents an interesting clinical condition of a patient (Flippin, 2010). These studies focus on a clinical disease or condition, the treatment, and patient response. Researchers review the medical and/or nursing literature and compare findings to the case. Clinical cases also can be used to present an innovative treatment or technique for a condition, or they can be focused on nursing care of a particular condition. Finally, they can be used for educational purposes as typical cases that illustrate some aspect of care (Frawley & Finney-Brown, 2013).

In many situations, clinical case studies are the first presentation of new or relatively rare diseases. The first cases of HIV were published as clinical case studies (Fee & Brown, 2006). Recent examples of case studies of interest to medical-surgical nurses include a case study of a patient with calciphylaxis (Schmitz & Reyes, 2009), dialysis and fatigue in a patient with end-stage renal disease (Horigan, Rocchiccioli, & Trimm, 2012), and a patient with pemphigus vulgaris (Pena et al., 2013).

Many nurses experience patient cases that could be published to illustrate important patient issues and conditions. In addition, case studies offer an excellent avenue for health care provider collaboration in presenting more than one professional viewpoint. One of my first published articles was a case study I wrote with a physician about two patients we had seen in the emergency room who experienced pseudo-anaphylaxis (Martyak & Connelly, 1988).

Qualitative Case Study

A qualitative case study uses mostly narrative data to facilitate exploration of a phenomenon, such as the grief experienced by the mother of a substance-abusing child (Dion, 2014). The use of qualitative methods of interpretation allows the researcher to delve into the meaning or essence of the phenomenon from the perspective of the person or people involved. In a case study, the researcher is striving for substantial depth in the analysis of the case.

In case study research, the investigator decides the nature of the case or unit of analysis. A case can be a person or it could be a dyad; in the Dion (2014) study, the dyad was the mother and her child. A family, program, policy, or clinical unit also could be considered a case depending on the purpose of a study. Boundaries are set to make the case clear to others (Baxter & Jack, 2008; Sandelowski, 2011).

In-depth data collection is necessary for a qualitative case study. For example, Dion (2014) conducted three 90-minute interviews. In addition, the author conducted a grief assessment and made field notes from telephone calls and e-mails. Many pieces of data thus need to be analyzed and interpreted. Themes are developed from the data to organize the presentation of the case into a meaningful whole. Each theme then is supported both by researcher analysis and quotations from the interviews. The researcher decides how to present the data or "tell the story" in a way that richly describes the experience or phenomenon. Readers thus can understand to some degree the experience or phenomenon for the person involved (Simons, 2009).

Qualitative case study research has been used in nursing to explore a wide variety of phenomena, such as 3 months in the symptom life of an adolescent with cancer (Docherty, Sandelowski, & Prosser, 2006), a medical-surgical nurse's perception of caring for a person with severe mental illness (Zoinierek & Clingerman, 2012), and the experience of a male victim of intimate partner violence (Nayback-Beebe & Yoder, 2012).

Nurses should consider this type of research as a way to study an issue, problem, or patient experience in depth. Either type of case study requires effort, time, and planning, but these studies can allow a depth not possible with larger numbers of participants.

REFERENCES

Baxter, R, & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researcher. The Qualitative Report, 13(4), 544-559.

Creswell, J. (2013). Qualitative Inquiry and research design: Choosing among five approaches. Thousand Oaks, CA: Sage.

Dion, K. (2014). That's what I mean by a hundred little, a thousand deaths ...': A case study of the grief experienced by the mother of a substance abusing child. MEDSURG Nursing, 23(6), 397-401, 421.

Docherty, S.L., Sandelowski, M., & Prosser, J.S. (2006). Three months in the symptom life of a teenage girl undergoing treatment for cancer. Research in Nursing & Health, 29, 294-310.

Fee, E., & Brown, T.M. (2006). Michael S. Gottlieb and the identification of AIDS. American Journal of Public Health, 96(6), 982-983.

Flippin, C. (2010). Case studies: The value of sharing experiences. Plastic Surgical Nursing, 30(1), 1-3.

Frawley, J., & Finney-Brown, T. (2013). Writing for publication: Case studies. Australian Journal of Herbal Medicine, 25(3), 1-3.

Horigan, A., Rocchiccioli, J., & Trimm, D. (2012). Dialysis and fatigue: Implications for nurses-a case study analysis. MEDSURG Nursing, 21(3), 158-175.

Martyak, T., & Connelly, L.M. (1988). Pseudoanaphylaxis: Two case studies. Military Medicine, 153, 96-97.

Nayback, A.M., & Yoder, L.H. (2012). The lived experience of a male survivor of intimate partner violence: A qualitative case study. MEDSURG Nursing, 21(2), 89-95.

Pena, S.B., Guimaraes, H., Bassoll, S., Casarin, S., Herdman, T., & Barros, A. (2013). Nursing diagnoses in pemphigus vulgaris: A case study. International Journal of Nursing Knowledge, 24(3), 176-179.

Sandelowski, M. (2011). "Casing" the research case study. Research in Nursing and Health, 24,153-159.

Schmitz, C., & Reyes, L. (2009). A case study, calciphylaxis: An exercise in human caring. MEDSURG Nursing, 18(4), 239-241.

Simons, H. (2009). Case study research in practice. Los Angeles, CA: Sage.

Zoinierek, C.D., & Clingerman, E.M. (2012). A medical-surgical nurse's perception of caring for a person with severe mental illness. Journal of American Psychiatric Nurses Association, 18(4), 226-235.

Lynne M. Connelly, PhD, RN, is Associate Professor and Director of Nursing, Benedictine College, Atchison, KS. She is Research Editor for MEDSURG Nursing.
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Title Annotation:Research Roundtable
Author:Connelly, Lynne M.
Publication:MedSurg Nursing
Geographic Code:1USA
Date:Nov 1, 2014
Words:1108
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