singular combinations of diverse arrays of methodological approaches directed
toward maintaining empirical intimacy with the one or more temporally and
spatially defined objects researchers construct and target for study” (p. 153).
What does this mean? In nursing, case studies are frequently used to report
the story of one patient, including details such as diagnosis, nursing care, and
influential environmental factors. Articles about quality improvement projects
are also considered case studies. The case study report provides enough detail
so that the reader feels informed about that particular situation.
The case study approach, which originated from sociology, informs nurses
about phenomena through the information that it provides. Case studies can
be exploratory, but they are typically descriptive or explanatory and answer
research questions that ask “how” or “why” (Yin, 2013). The selection of a case or
cases for study is based on the cases’ representativeness of a particular situation.
Cases may also be selected for their potential to describe or explain a theory.
Case studies involve direct observation of the situation and are best used as
a research approach when studying events that are currently happening and
when the researcher has little or no control over these events. Yin (2013) notes
that “the case study’s unique strength is its ability to deal with a full variety of
evidence—documents, artifacts, interviews, and observations” (p. 8). A case study
typically includes an introduction that focuses on the area of clinical practice
and provides a review of the literature about the current knowledge in the area
(Aitken & Marshall, 2007). The introduction can also present a description about
a unique case and include information such as history, care, and outcomes.
Aitken and Marshall note “the discussion should provide a critique of the care
in the context of the known literature, including commentary on care that was
not effective and exploration of possible reasons for this” (p. 132). Implications
for practice and recommendations for future research should be included.
Just like for research studies, the merit of the case study must be evaluated
to determine its contribution to the evidence. Box 12-1 lists criteria for evalu-
ating a case study. Although the findings from case studies are not regarded
as highly as findings from research studies are, in some instances case study
findings can provide insight and understanding when little evidence is avail-
able, thus contributing to the body of knowledge in a specific clinical area. For
example, when a novel innovation is implemented, a case study may be the
only published information about the innovation.
Other sources of evidence in the first S of the pyramid are concept analyses.
Rogers and Knafl (2000) defined concepts as being “formed by the identification
of characteristics common to a class of objects or phenomena and the abstraction
and clustering of these characteristics, along with some means of expression
(most often a word)” (p. 78). For example, pain is an important concept in patient
KEY TERMS
case studies: A
description of a
single or novel
event; a unique
methodology
used in qualitative
research that may
also be considered
a design or strategy
for data collection
concept analyses:
Scholarly papers
that explore the
attributes and
characteristics of a
concept12.1 The Pyramid of the 5 Ss 311