Unfolding Case Studies: Experiencing the Realities of Clinical Nursing Practice
Preface  To the StudentThe purpose of this workbook is to help you practice the critical skills of problem solving and applying information to common situations you encounter in your practice of professional nursing. The role of the professional nurse has become exceedingly more complex, as nurses must care for clients in shorter time periods and in a variety of settings such as home, hospital, outpatient clinics, and rehabilitation facilities. No longer do nurses have extended periods of time to process information and plan care. As insurance plans dictate shorter stays and/or fewer visits, nurses must be able to analyze situations, plan interventions, and respond quickly to ever-changing situations.The "Unfolding Cases Model" (Glendon and Ulrich, 1997) will give you practice in the skills you will need in the workplace. You will be asked to analyze realistic cases that unfold sequentially and follow the typical progression of common conditions or disorders. All cases are interspersed with focused questions to be answered by groups of students using common cooperative learning strategies (see Table 1). By using the case as a study guide prior to class, you will have some time to explore these focused questions individually, prior to your group involvement. This prior preparation will increase the effectiveness of the group strategy. Your instructor will brief you about the strategy she or he wishes you to use, as well as the process of how to report your group's findings to the entire class. An important aspect of learning and using critical thinking is being able to examine the varied perspectives of others. This cooperative learning group strategy exposes you to the alternative ideas and ways of thinking of your peers, thus multiplying the learning potential of the case. At the end of each case you will be asked to complete a reflective writing assignment that will allow you to investigate your individual thoughts, feelings, and ideas related to nursing practice issues or situations (see Table 2). In nursing practice we are frequently exposed to situations that oppose our personal values and beliefs. These cases will give you an opportunity to explore these issues and help you identify the nursing role. Your instructor may collect the cases prior to class discussion to determine your level of preparation for discussion of the case. In any instance, prior individual preparation will benefit both you and your group as you process the case in class.This book is designed to help you adapt to the new ways your instructors will be teaching in the new millennium. Research has shown that students learn best when they are actively involved in the process of learning and are not passive recipients of the teacher's expertise. You will notice that your instructors are using the lecture method less often and are relying on newer interactive group strategies. This can be very disturbing to you as a student who is used to previous methods that required you to merely take notes on what the instructor presented and regurgitate the same information back to them on a test. Now, in this model, the instructor poses a case and asks you and your peers to process it. They won't be just giving you the right answers. Your first impulse might be to think your instructor is not doing anything and that you are teaching yourself. This is a common feeling, but it is far from the truth. The instructor is merely changing his or her role in the teaching and learning process from being the center of knowledge to being one of manipulating the environment so that students can be involved in and discover the connections of things in an active fashion. Being actively involved will increase your learning. In the traditional lecture method, students quickly learn that it is not really necessary to read or prepare much prior to class because the teacher will tell them in the lecture everything that is really important. This way of thinking is erroneous in that today's world is filled with volumes of ever-changing information and no one could possibly know everything. Therefore, the most important job of the teacher is to create focus and teach you how to think. Information will change, but the skill of problem solving and critical thinking will benefit you forever. That is the purpose of this "Unfolding Case Model." (Glendon and Ulrich, 1997)In traditional methods, the majority of time you spend with the teacher is when she or he is presenting you with new information in a lecture. Until you have had the time to process that information, you are unaware of what you do not understand or what questions you have. It is when you are alone reviewing your notes and trying to process and apply information that you really need the teacher's help. In the new learning paradigm, students need to prepare individually by doing the reading assignments and/or looking at the case prior to class. Class time should be the time when the instructor helps students process information that they have already been exposed to through their own reading. The "Unfolding Case" method actualizes this line of thinking. In using this book, you need to read through the case before doing your reading assignment to help you emphasize the important content in the reading. As you read, jot down possible solutions to each of the focused questions. This~will help you as you interact with your peers to process the case in class. Your instructor will tell you which cooperative learning strategies to use and how to report your findings as a group. He or she may also use this same model at the end of a clinical for a post conference or as a clinical make-up assignment. As you complete the cases, it is our hope that you will work with your instructor and expand your ability to learn and grow as a professional.Sincerely,Kellie Glendon and Debbie Ulrich