significance of case study in nursing

Why are Case Studies Important for Developing Clinical Judgment?

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• Oncology Nursing Forum
• Number 6 / November 2015

Case Study Research Methodology in Nursing Research

Diane G. Cope

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

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

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

Case Study Designs

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

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

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

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

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

Methodologic Issues

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

Application of Case Study Design in Nursing Research

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

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

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

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

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

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

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

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

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

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

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

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

About the Author(s)

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

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Understanding Nursing Case Studies from the basics

Nursing Case Studies

Nursing case studies are essential to nursing education because they offer a practical viewpoint that links theory to practice. They improve one's capacity for thinking critically, judgment, and real-world application in the healthcare industry. These studies offer an improved understanding of medical ideas and methods for treating patients, as well as a detailed understanding of complicated healthcare circumstances. Case studies facilitate the practical application of theoretical information by immersing students in actual healthcare scenarios. This innovative method not only helps students develop their critical thinking and decision-making abilities, but it also equips them to handle various patient care issues. Students are guaranteed to be well-prepared for the complexities of the healthcare industry thanks to the diverse learning acquired from nursing case studies. 

Importance of Nursing Services:

In the healthcare industry, nursing services have developed from a vocational program to an essential and all-encompassing profession. In the past, nursing was thought of as an institutional and medical support job. The needs and complexity of the medical area are increasing, making nursing vital career. Nursing services now include a broad variety of duties, such as team members, patient care, advocacy, and education. A change from providing help alone to adopting a comprehensive, scientific approach to patients' well-being that prioritizes compassionate care and methods supported by evidence characterizes the evolution of nursing.

Components of a Comprehensive Nursing Case Study

Nursing case studies are a vital resource for students because nursing education blends academic understanding with real-world application. This article explores the essential elements of an extensive nursing case study, emphasizing their value in both academic and real-world contexts.

Section 1: Patient Status - Building the Foundation

Nursing case study starts with nurses noting patient's status, which covers the patient's medical history, diagnosis, and state of health. Students need to be able to explain the significance of each element and why it was included. The patient's journey and the first symptoms that prompted medical attention are highlighted in this section. To truly master this area, you must write an integrated history that makes the patient come to life on paper, not merely deliver statistics. Knowing the patient's history establishes the framework for the next parts, giving the case study structure and significance.

Section 2: Nursing Assessment - A Personalized Insight

Nursing students perform individualized assessments of patients' conditions in the vital nursing assessment segment. It includes clarifying the assessment's goal and offering an insight into the nurse's opinions and views. In addition to observation and documentation, effective performance in this area requires information analysis and integration. It bridges theory and practice in practical patient care settings, showing an exceptional understanding of the patient's requirements and supporting medical diagnosis.

Section 3: Treatment Plan and Recommendations - Connecting the Gap Between Theory and Practice

This section of nursing case study focuses on how nursing interventions—such as treatments and medications—are used in reality. It's critical to justify the treatment plan selection by tying theoretical understanding to the patient's situation. Achieving success in this area involves demonstrating a thorough comprehension of the interventions' relevance for the particular illness or condition, illustrating how nursing strategies aid in the patient's recovery, and exhibiting critical thinking and a dedication to maximizing patient care.

Section 4: Implementation of Nursing Interventions – Applying the Theory

A key component of nursing education is the application of nursing interventions, which include students explaining and carrying out recommended treatments such the administration of medications, certain therapies, and nursing practices. This component demonstrates the nurse's competency in carrying out evidence-based procedures, bridging the knowledge gap between classroom instruction and practical implementation. In this part, students demonstrate their mastery of the nursing process and flexibility in responding to changing patient situations by detailing actions and providing justification for them.

Section 5: Patient Response and Monitoring - A Continual Assessment

Continuous evaluation of a patient's reaction to treatments is important, yet it's sometimes forgotten. This includes tracking vital indicators, observing behavioural shifts, and assessing advancement. Because healthcare circumstances are changing, nurses must modify their treatment plans accordingly. Students can demonstrate their flexibility and responsiveness to changing patient demands in this part, showcasing their excellent observational skills and dedication to patient-centred care.

Section 6: Reflection and Critical Analysis - Fostering Continuous Improvement

Through critical analysis of their choices, behaviours, and patient care, reflective techniques in nursing case studies help students become more self-aware and pinpoint their areas of strength and weakness. Through this setting, students may talk about difficulties, moral dilemmas, and the psychological effects of their work. Critical analysis and reflection highlight a student's capacity for learning from experiences, encouraging ongoing development and showcasing a dedication to both professional and personal advancement.

Section 7: Interprofessional Collaboration - Emphasizing Team Dynamics

The nurse's communication with other paramedics like doctors, therapists, and support personal highlights the value of interprofessional teamwork in healthcare. It emphasizes that the best possible outcomes for patients are possible because of excellent communication, cooperation, and shared decision-making. A complete, patient-centred care approach is supported when an assignment places a strong emphasis on interprofessional collaboration. This helps students exhibit their grasp of healthcare and their ability to operate well in a team.

Section 8: Ethical Considerations and Cultural Competence - Ensuring Holistic Care

The significance of ethical issues and cultural competency in nursing practice is emphasized in this section. It emphasizes the difficulties encountered when providing patient care, the significance of honouring cultural differences, and the promotion of patient liberty. The viewpoint of assignment assistance emphasizes the value of moral judgment and culturally conscious methods in nursing practice, indicating a student's understanding of many aspects affecting patient care.

Conclusion:

Nursing case studies are essential to nursing education because they close the knowledge gap between theory and practice, improving students' ability to think critically, make decisions, and apply theory to practical situations. Students are well-prepared for prosperous careers in the healthcare industry by the combination of case studies and assignment help services. Nursing students who embrace diversity are better able to create case studies and develop the skills needed to succeed in the complicated world of healthcare.

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Patients’ Lived Experiences During the Transplant and Cellular Therapy Journey pp 9–17 Cite as

Creating a Patient-Centered Case Study

• Jennifer Holl 5 ,
• Lisa Wesinger 6 ,
• Judi Gentes 7 ,
• Carissa Morton 8 &
• Jean Coffey 9  
• First Online: 25 August 2023

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Case studies provide an invaluable record of professional clinical practice and have been used in medicine since the late 1800s to describe both traditional and unusual presentations of specific disease pathologies. In medicine, case studies traditionally take a detached, objective approach to outlining the clinical course of a disease and its treatment. In keeping with the holistic approach to patient care found in nursing and using the theoretical foundations established in Jean Watson’s Theory of Human Caring as well as the Relationship-Based Care Model, this research team sought to revolutionize the case study paradigm and deconstruct the traditional case study approach, placing the patient, instead of the provider, at the center of the narrative. This new case study method intercalates the clinicians’ analysis of the case with the patient’s commentary. This chapter outlines the methods and theoretical underpinnings used to create a patient-centered case study and seeks to provide nurses with a creative alternative to the traditional, objective case study approach. Implications for future research include whether using patient-centered case studies, instead of traditional case studies, provide a valuable learning tool to educate nurses.

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Holl, J., Wesinger, L., Gentes, J., Morton, C., Coffey, J. (2023). Creating a Patient-Centered Case Study. In: Coffey, J., Hill Jr., J.M., Long, T., McGrath, E.B. (eds) Patients’ Lived Experiences During the Transplant and Cellular Therapy Journey. Springer, Cham. https://doi.org/10.1007/978-3-031-25602-8_2

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7 steps to successful nursing case study writing.

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

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

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

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

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

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

Importance of nursing case study writing.

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

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

Steps when writing a nursing case study paper.

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

These important steps include:

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

Defining the Problem

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

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

Gathering Information

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

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

Developing Alternatives

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

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

Analyzing the Alternatives

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

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

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

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

Selecting the Best Alternative

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

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

Implementing the Solution

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

Evaluating the Outcome

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

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

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

Conclusion.

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

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Main Tips On How To Write a Case Study Analysis

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

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

What is a Case Study Analysis in Nursing?

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

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

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

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

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

What is the Purpose of a Case Analysis?

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

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

Difference Between a Nursing Research Paper and a Case Study

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

Research Paper

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

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

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

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

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

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

Types of Nursing Case Studies

Here are the five primary types of case studies:

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

6 Steps for Writing a Case Study Analysis

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

Preparation

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

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

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

Introduction

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

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

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

Background Information

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

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

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

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

Proposed Solutions

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

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

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

Recommendations

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

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

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

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

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

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

Nursing Case Study Analysis Example

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

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

Final Thoughts on Case Study Analysis

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

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

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

FAQs on How To Write a Case Study Analysis

What is a case study analysis.

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

How do you structure a case study assignment?

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

What is an example of case analysis?

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

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

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

What are the stages of a case study?

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

What is the purpose of a case study?

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

What are the qualities of a good case study?

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

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What Is a Case Study in Nursing?

Unique Characteristics of Nursing Students

A case study gives an in-depth look at an individual patient. In the realm of nursing, case studies focus on specific patients and provide information about their symptoms, their medical history and their diagnoses.

Uses of Case Studies

Nursing students may be given case studies and asked to diagnose patients based on information about the patients' symptoms, medical histories and other relevant details.

Alternatively, nursing students may be asked to write their own case studies. The students illustrate a case they have dealt with, explaining about the patient, the symptoms, the diagnosis, the treatments and information from a physical assessment.

Reading a case study and coming up with a diagnosis is a good way for nursing students to test the knowledge they've acquired in the classroom in a more realistic, clinical way. Writing case studies is also a useful learning tool; it forces students to reflect on the entire course of treatment for a patient, ranging from obtaining important information to diagnosis to treating the medical condition.

Completing a successful case study requires paying attention to and obtaining important relevant information. One of the best ways to do this is to ask the right questions. Think about the characteristics of the patient: the age, the sex, occupation, where they live. Students should pay attention to vitals, such as temperature and blood pressure. They should also consider the symptoms: How severe are they? When did they start? By asking a lot of questions and getting a lot of information, students who are writing and reading case studies can have enough information to make a better diagnosis.

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Lauren Griffin began writing professionally in 2010. Her articles appear on various websites, specializing in academics, food and other lifestyle topics. Griffin attended Columbia University and holds a Bachelor of Arts in psychology.

Motivation in nurse education practice: a case study approach

Affiliation.

• 1 School of Nursing and Midwifery, Trinity College, Ireland.
• PMID: 17170664
• DOI: 10.12968/bjon.2006.15.20.22300

"There are three things to remember about education. The first is motivation. The second one is motivation. The third one is motivation" (Maehr and Meyer, 1997 p372). It is important to understand motivation and the reasons why nurses, including educators and clinicians, need to continually motivate their students both in the classroom and within clinical practice. Using relevant literature, the following case study explores the significant issues pertinent in motivating a student undertaking a Postgraduate Diploma in Specialist Nursing. A combination of motivational and learning theories are used in the process of assisting this student to learn from her recent assessment failure and to become re-motivated. There is a discussion of the significance of this case and the key issues drawn from it, which may assist nursing staff in supporting student nurses to remain motivated within the clinical area.

Publication types

• Education, Nursing, Graduate / organization & administration*
• Faculty, Nursing* / organization & administration
• Interprofessional Relations
• Motivation*
• Nurse Clinicians / education
• Nurse Clinicians / psychology
• Psychological Theory
• Psychology, Educational*
• Social Support*
• Students, Nursing / psychology*

This website is intended for healthcare professionals

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Akhtar N, Lee L Utilization and complications of central venous access devices in oncology patients. Current Oncology.. 2021; 28:(1)367-377 https://doi.org/10.3390/curroncol28010039

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Chloraprep 3ml applicator.. 2022b; https://www.bd.com/en-uk/products/infection-prevention/chloraprep-patient-preoperative-skin-preparation/chloraprep-patient-preoperative-skin-preparation-product-line/chloraprep-3-ml-applicator

Website.. 2021; https://www.cdc.gov/cancer/preventinfections/providers.htm

Ceylan G, Topal S, Turgut N, Ozdamar N, Oruc Y, Agin H, Devrim I Assessment of potential differences between pre-filled and manually prepared syringe use during vascular access device management in a pediatric intensive care unit. https://doi.org/10.1177/11297298211015500

Clare S, Rowley S Best practice skin antisepsis for insertion of peripheral catheters. Br J Nurs.. 2021; 30:(1)8-14 https://doi.org/10.12968/bjon.2021.30.1.8

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Easterlow D, Hoddinott P, Harrison S Implementing and standardising the use of peripheral vascular access devices. J Clin Nurs.. 2010; 19:(5-6)721-727 https://doi.org/10.1111/j.1365-2702.2009.03098.x

Florman S, Nichols RL Current approaches for the prevention of surgical site infections. Am J Infect Dis.. 2007; 3:(1)51-61 https://doi.org/10.3844/ajidsp.2007.51.61

Gorski LA, Hadaway L, Hagle M Infusion therapy standards of practice. J Infus Nurs.. 2021; 44:(S1)S1-S224 https://doi.org/10.1097/NAN.0000000000000396

Guenezan J, Marjanovic N, Drugeon B Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, openlabel, single centre, randomised-controlled, two-by-two factorial trial [published correction appears in Lancet Infect Dis. 2021 Apr 6]. Lancet Infect Dis.. 2021; 21:(7)1038-1048 https://doi.org/10.1016/S1473-3099(20)30738-6

Gunka V, Soltani P, Astrakianakis G, Martinez M, Albert A, Taylor J, Kavanagh T Determination of ChloraPrep® drying time before neuraxial anesthesia in elective cesarean delivery: a prospective observational study. Int J Obstet Anesth.. 2019; 38:19-24 https://doi.org/10.1016/j.ijoa.2018.10.012

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Case Studies

Gema munoz-mozas.

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

View articles · Email Gema

Colin Fairhurst

Vascular Access Advanced Clinical Practitioner, University Hospitals Plymouth NHS Trust

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Simon Clare

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

View articles · Email Simon

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

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

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

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

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

Case study 1 (Andy)

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

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

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

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

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

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

Case study 2 (Gail)

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

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

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

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

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

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

Case study 3 (Beata)

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

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

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

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

Case study 4 (Emma)

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

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

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

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

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

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

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

Case study 5 (Frank)

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

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

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

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

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We proudly celebrate two Downstate Health Sciences University students, who joined more than 190 other students from 62 campuses to accept SUNY’s highest distinction for academic prowess and leadership.

From left to right: Chancellor John B. King Jr., Jessica Mineroff Gollogy, and Jeffrey Putman Ed.D.

I am proud to congratulate Jessica Mineroff Gollogly , a College of Medicine graduating student who made a career transition from music to medicine fueled by her passion for healing through the art of medicine.

Displaying a steadfast dedication to eradicating health disparities and enhancing access to healthcare within her community, she has exhibited exemplary leadership roles at the Brooklyn Free Clinic, Asylum Clinic, Health Equity, Advocacy, and Leadership (HEAL) Pathway, alongside other organizations devoted to advancing health justice. Jessica has also undertaken pioneering research focusing on health equity and has significantly advanced evidence-based medicine through her bench research contributions.

Tim enjoys serving Downstate and the community through various avenues, including the University Council, the Ophthalmology Club, and the Early Medical Education Program. His diverse interests include running, baking, programming, and repairing vintage wristwatches.

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Statistical significance or clinical significance? A researcher's dilemma for appropriate interpretation of research results

Hunny sharma.

Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

It is incredibly essential that the current clinicians and researchers remain updated with findings of current biomedical literature for evidence-based medicine. However, they come across many types of research that are nonreproducible and are even difficult to interpret clinically. Statistical and clinical significance is one such difficulty that clinicians and researchers face across many instances. In simpler terms, the P value tests all hypothesis about how the data were produced (model as whole), and not just the targeted hypothesis that it is intended to test (such as a null hypothesis) keeping in mind how reliable are the of the research results. Most of the times it is misinterpreted and misunderstood as a measure to judge the results as clinically significant. Hence this review aims to impart knowledge about “P” value and its importance in biostatistics, also highlights the importance of difference between statistical and clinical significance for appropriate interpretation of research results.

Introduction

Currently, in the publish or perish era where most of the researches are judged based on their statistically significant findings, it is often difficult for young researchers to interpret the correct findings of the research. The recent development of high-speed and more sophisticated computing power, utilizing high-end computers and statistical software packages, has resulted in a significant increase in the use of statistical methods, tests for hypothesis testing and reporting to the health literature. Unluckily, the appropriate interpretation of research results from the clinical point of not received similar interest.[ 1 ] This imbalance from decades to determine the actual importance of statistical and clinical significance and publication of such results in reputed indexed journals had led researchers to consider statistically significant results also as a clinically important one. It is essential to understand that publications in reputed indexed journals do not indicate that appropriate study design or statistics methods were used. This dilemma of the young researchers creates obstacles in their clinical decision-making and ultimately affects their role in Evidence-based practice.[ 2 ]

Researchers must realize that a clinical study is valuable and is of importance to clinical practice when the results are appropriately interpreted. Every year hundreds of studies and clinical trials are conducted to test different hypothesis. These trials are entirely dependent on appropriate statistical tests to assess whether new therapies or treatment protocol are better in clinical practice as compared to the usual approach or methods. Researchers should understand what is the importance of both statistical and clinical significance.[ 3 ]

When looking from a clinical point of view, the statistically significant difference among groups is not of prime importance. If a well-conducted study shows a difference in treatment options within two groups, it is of prime importance to know whether that difference is of clinically importance or not.[ 4 ] Since sample size and measurement variability can easily influence the statistical results, a nonsignificant outcome does not imply that the new therapy or treatment protocol is not clinically useful.[ 5 , 6 ]

Hence this review aims to impart knowledge about “ P ” value and its importance in biostatistics, also highlights the importance of difference between statistical and clinical significance for appropriate interpretation of research results.

What does P value infer?

In simpler terms, the P value tests all hypothesis about how the data were produced (the whole model), not just the targeted hypothesis that it is intended to test (such as a null hypothesis).[ 7 ]

The P value is the likelihood that if every model assumption, including the test hypothesis, were correct, the chosen test statistic would have been at least as large as its observed value.[ 7 ]

The most common threshold value for the “ P ” we find in biomedical literature is 0.05 (or 5%), and most often the P value is distorted into a dichotomous number where results are considered “statistically significant” when P falls on or below a cut-off (usually 0.05) and otherwise its declared “nonsignificant”.[ 7 ]

Why are “ P ” values not enough?

According to Ron Wasserstein, ASA's executive director, the P value was never meant to substitute the scientific reasoning, which is of greater interest. P value, which is a number whose value can range from zero to one in relation to a threshold value, represents the probability that the difference between the groups is not by chance. A well-reasoned and scientifically driven explanation will always remain the basis of reporting scientific outcomes.[ 8 ]

On what factors does the “ P ” value depend?

It should be borne in mind that the “ P ” value only represents that to what extent the data are inconsistent or incompatible with a given specific statistical model (i.e., null hypothesis). Hence it only aims to accept or reject the null hypothesis rather than focusing on the research hypothesis. From a statistical point of view, it measures the strength of evidence against the null hypothesis.[ 9 ]

With the advancement in biostatistics, it is now clear that the “ P ” value can easily be affected by various factors like sample size, the magnitude of the relationship and error. Each of these factors can work independently or in combination to distort the study findings based on “ P ” values.[ 10 ]

(1) Effect of error on “ P ” values

In general, two types of errors that is, systematic and random error effects the “ P ” value.

“Systematic errors,” that is, “Non-random errors” of certain significant magnitude distorts the research results towards a specific direction or can result in altered observed association in either direction. This type of error generally occurs when a single examiner takes the measurement leading to an unintended bias of deviating the research results to his/her expectations or may also result from modification of the measuring technique. Hence, Systematic error is a systematic flaw in the measurement of a variable due to methodological error leading to underestimation or overestimation of measurements. The extent of systematic errors can be determined by re-examination and re-measurement of a certain sufficient number (i.e., 20%, not always applicable) of individuals again by material and method used in the agreement. Some statistical tests like paired t -test, the intraclass correlation and the Bland-Altman method can also help in the determination of systematic errors.[ 10 , 11 , 12 ]

A “random error” is defined as a variability of the data which cannot be explained. Random errors of high magnitude means trouble in reproducibility of the measurements, which may result in questionable methodology and questionable examiners’ ability. This occurs randomly across the population, ultimately distorting the results. Random errors can be minimized by taking a large number of samples or measurements. Let us understand this by taking an example of measuring Mid-Upper Arm Circumference (MUAC) of the population. While measuring the MUAC of each individual in the population, random error may exhibit itself in the form of random MUAC among individuals that is, less or more MUAC measured as compared to the actual measurement. This may be a result of how the tape was held while taking the measurement, at what position it was measured (ideally midway between the olecranon process and the acromion), and who was the researcher who took the measurement. Random error can be reduced by incorporating a large number of samples or measurements that is, the more study participants are included in these measurements, the smaller the effect of random error will become.[ 10 ]

(2) Effect of sample size on “ P ” values

It is well known that the P value depends on the sample size to a vast extent. More the sample size less will be the variability of the measurement or data, and more precise will be the measurement for the study population. With an increase in sample size, the magnitude of random error decreases and the study is more likely to find a significant relationship if it exists.[ 10 ]

(3) Effect of magnitude of relationship between groups on “ P ” values

P -value also relies on the magnitude of difference or relationship between the groups compared. In simpler terms, if the magnitude of difference between the two groups is more substantial, then it will be easy to detect and will have a small P value.[ 10 ]

What are the American Statistical Association (ASA) principal statements on statistical significance and P values?

ASA on 8 th March 2016, in the event of the growing concern of misuse and misinterpretation of P values, gave six principal statements to improve conduct and interpretation of quantitative research and increase research reproducibility. The six principal statements issued regarding significance and P value which are as follows:

• P -value shows the extent of incompatibility of the data with the stated statistical model.[ 8 ]
• P -value is neither the measure of the probability of the studied hypothesis being true nor is the representation of the probability that study data were produced by random chance alone.[ 8 ]
• It is extremely important to note that any business model, policy decision, or conclusion related to any scientific study or experiment should not be based on the P value and merely on the fact whether it passes a specific threshold or not.[ 8 ]
• It is the moral duty of the authors and researchers to report the research or experimental findings to its full extent and with transparency.[ 8 ]
• A P value is neither represents the importance of research results nor is the representation of the effect size of the study.[ 8 ]
• P -value does not give a sufficient measure of evidence regarding a model or “hypothesis”.[ 8 ]

What are clinically significant outcomes?

The term “clinically significant” can be used for the researches in which clinically relevant results or outcomes are used to assess the effectiveness or efficacy of a treatment modality. When used the term “clinically significant” findings are those who make the patient improves the quality of life and makes him/her feel, function well.[ 13 ]

Clinically significant findings are those which improve medical care resulting in the improvement of individual's physical function, his/her mental status, and ability to engage in social life. The term improvement of quality of life in medical care deals with both subjective and objective terms. Here the term objective deals with improvement in performance status, duration of remission of disease, and prolongation of life-span, while subjective improvement in quality-of-life deals with improved mood, attitude, physical and social activity, feeling of general wellbeing, and the alleviation of distressing symptoms like pain, weakness, and discomfort.

Since statistical significance results do not necessarily mean that the results are clinically relevant and lead to improvement in the quality of life of the individuals. Hence, many outcomes can be statistically significant but not clinically relevant in a clinical point of view. Hence, clinicians and researchers should give importance to both statistical and clinical significance.[ 13 ]

A clinically relevant intervention justifies the effects which over-benefits the associated costs, harm, and the inconveniences caused to the individuals for whom it is targeted. The main difference between statistical and clinical significance is that the clinical significance observes dissimilarity between the two groups or the two treatment modalities, while statistical significance implies whether there is any mathematical significance to the carried analysis of the results or not.

Different studies can have a similar statistical significance but may differ significantly in clinical significance. Let's consider an example of two different chemotherapy agents for cancer. The first study estimates to increase the survival of treated patient with Drug A (Less Expensive than usual chemotherapeutic agents) by five years ( P = 0.01) and alpha being 0.005, similarly a Second study utilizing Drug B (Expensive than usual chemotherapeutic agents) estimates to increase the survival of treated patient by mere five months ( P = 0.01) and alpha being 0.005. In both cases, the statistical test is significant, but Drug B only increases the survival by only five months which is not clinically significant as compared to Drug A which increases survival by five years, nor useful in terms of cost-effectiveness and superiority when compared to already available chemotherapeutic agents.[ 14 , 15 ]

Hence from the above description of statistically significant and clinically significant results, it is clear that both the notations have the importance of their own. The statistically significant results may not of clinical importance, vice versa the results which are of clinical importance may not be statistically significant. It is high time now that the researchers, journal editors, and readers should take a keen interest in looking beyond the threshold “ P ” value and also consider the results from a clinical point of view rather than just assessing the worth of research by considering the “ P ” values. All the researchers should also take into account the design, sample size, effect size of the study, bias incorporated, and reproducibility of the study while analyzing the study results. An aware researcher with a logically and critically thinking mind is in the best position to evaluate research results and thereby applying them to practice evidence-based medicine. Logically, discussion of the clinically significant research results will increase discussion and understanding of the new treatment modalities and will help in the upliftment of evidence-based practice.

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