The nursing science has been changing daily specially in the last two decades. In today's technologically advanced world, the challenge for nursing faculty is to teach students critical thinking (CT) skills and the ability to practice competently in a variety of clinical situations (1). The main goal of nursing education is to transfer of nursing science to students and help of them to enhance the required skills and insights for nursing care (2). For meeting of new educational needs in nursing, nurse educators must be aware about diversity of learning environments and new teaching methods and use of these methods for teaching. Also instructors must help the students to enhance their ability for problem solving in future (3). According to Fitzpatrick (2004), teaching is a complex activity that involves mastery of content, classroom discipline, techniques of organization, and teaching skills (4).
One way to enhance and develop nursing education is to determine the effect of teaching methods on nursing student‘s achievements and teaching effectiveness at nursing colleges. Today's it is focused on changing of educational methods from traditional to new teaching methods that causes active learning in students. Moreover, in nursing education the interest in improving student‘s achievements and the quality of teaching effectiveness have been increased over the time (5,6).
In general, teaching methods is categorized in two groups. First group is teacher-centered methods, such as lecture (7). In these methods, the teacher speaks in most of time (8). In traditional teaching method, only the teacher decides on teaching- learning process. This method tends to produce shallow, surface thinkers who primarily rely on rote memory rather than careful understanding of the content (9). Second group is student-centered teaching method. In this method, student is active during the learning process. And now it is focused on this form of teaching (10).
Nursing is a practice based profession that using of teacher centered methods decreases the effectiveness of teaching and student‘s achievements. Students must be participated actively in teaching process and they must not to be an inactive audience merely. So, nursing instructors could use nontraditional teaching method to help students to learn critical thinking and problem solving skills (6). The development of these skills requires students to engage in discussions to become active participants in their own learning (11). Basic elements of active learning include talking, active listening, reading, writing and reflecting (12).
One of these strategies that lead to active learning in student and prepare them for implementing of nursing care, is case-based teaching method. This method was first introduced in the 1870s by Harvard school faculty. But it was not used for several years. It used in business and law schools at Harvard University in 1999. Lately, case-based teaching has been adopted by various disciplines including nursing both as a teaching strategy and as a problem-solving and decision-making tool (13).
Case based teaching engages students and teachers in active dialogue about nursing situations by helping learners analyze an authentic case to identify client problems, compare and evaluate optional solutions, and decide how to deal with clinical situations. This method demands active participation and interactions between learner and teacher. It also offers students opportunities to discuss real-life situations and nursing challenges in a safe environment and stimulates students to think critically about the cases (14). In fact, this method can be defined by contrasting it with the traditional lecture-based method (13).
In the Case Method, a ‘case’ is built up as a scenario by teacher around a real situation and presented in classroom. The situation contains a problem that must be solved and requires decision-making. The Case Method requires a certain amount of time (45-90 minutes) and usually only one case can be addressed per sitting. This works well with groups of up to 20-30 students. The teacher present the scenario and the students listen and take notes carefully. Then they will have opportunity to think about it. The teacher asks open ended question. What is the scenario? The students are participated in discussions and the teacher shows any necessary information such as lab tests, symptoms, etc. The teacher’s role is to act as an initiator/moderator/facilitator for the group discussion and directs the students to goals (15).
Case based teaching can be used to meet educational goal, facilitate learning for application in clinical environment and problem solving strategy. This method is used to explore and describe a case and help to develop science about real-life situations (16).
Despite the diversity of new teaching method, the nursing faculties use these methods seldom and nursing education is done by traditional methods. Although the case method is used in many academic disciplines, the scientific base of this method is lacking for the design, effect and evaluation of teaching cases (17). So the aim of this study was to assess the opinion of nursing student about case-based teaching method and comparison with lecture in Zanjan Faculty of Nursing and Midwifery in 2011.
This is a quasiexperimental study which 30 senior nursing students spending the intensive care curriculum (dialysis, 0/5 unit) in Zanjan Faculty of Nursing and Midwifery were selected. The content of session was divided randomly in two parts. First part (acute renal failure) was presented with case-based teaching method and second part (chronic renal failure) was presented with lecture. Each method was done during 45 minute. According to the researcher experience and similarity of content, these subjects were selected for teaching.
In this study we used the following five stages for case-based teaching suggested by Kaddoura(13): 1). The case study needs to focus on the most important concepts to be learned. 2). the teacher should consider different questions about the case. 3). the learning environment needs to be open, safe, and nonthreatening to facilitate students' participation. 4). all students should be engaged in the learning activity. 5). summarization of key points by teacher is essential.
At the beginning of session, the objectives were said and a case was presented. The case was a 26 yr old woman who had severe bleeding during caesarian section. She had hypotension symptom (systolic BP=60-90mmHg) and rapid pulse (120 per min). She was relatively conscious. Her skin was cold and wet. She had nausea and vomiting. Other symptoms and manifestation of disease were shown to the students. Laboratory tests, medical graghies and urine analysis was explained (urine output=12cc/hr, K=6/2 meq/dl, BUN=45, Cr=3/1). Then the teacher asked students to participated actively in classroom discussion and diagnose her disease. Finally the renal failure diagnosis was identified by students according to the teacher guidlines. Since this complication had been occurred during a day, so it was considered as acute renal failure. In each step, the teacher explained the symptoms and treatment of acute renal failure and the students was referred to the case that mentioned at the beginning of session and they discussed about it. The teacher asked different questions about the case and the students learned the disease gradually. This process was continued to the end of session. Then the conclusion was made by teacher.
At second part of session, the chronic renal failure was presented trough lecture during 45 min.
At the end of session, it was asked from student to compare two methods and fill the questionnaire.
The self constructed questionnaire was used for data collection. This questionnaire had two sections. Section 1 collected demographic data and section 2 contains 20 items about comparison of case-based teaching method with lecture from the view of nursing students. It was asked from students to determine their opinion about each item according to the 5 point likert scale (absolutely agree, agree, no idea, disagree, absolutely disagree). At the end part of questionnaire, it was asked from students to determine their satisfaction about case-based teaching method in 0-10 point scale.
Content validity of questionnaire was obtained and the alpha chronbach was 0/85. For prevention of bias, data was analyzed by another one. Data was analyzed with SPSS ver. 16 software and descriptive frequency and χ2 test.
For ethical considerations, all participants signed an informed consent after being informed adequately of the research study. They were assured of their anonymity and confidentiality of their information. Participants were informed that participation was voluntary and that they were free to withdraw at any time without affecting their current or future academic course assessments. All data was used only for research purpose.
A total of 30 third-year baccalaureate nursing students (16(53/3 %) female, 14(46/7%) male) participated in this study. They were all (100 %) single and mean age of them was 22/35±1/8 years.
Table 1 demonstrates the student’s opinion about comparison of case-based teaching method with lecture.
According to the results, the majority of participants (66/7%) completely agreed that case-based teaching method increases the reading comprehension of students as compared with lecture and it was the main characteristic of case-based teaching.
Also 61/9 percent of students said that case-based teaching have a better cover for objectives and retention of knowledge is perceived to be increased as compared with lecture.
More than half of students (57/1%) declared that case-based teaching is attractive than lecture and increases students motivation for learning. Moreover, this method facilitates the students learning and is applicable as compared with other teaching methods (Table 1).
The majority of students (66/7%) were agreed that case-based teaching method is better than lecture in overall.
Also the results showed that the students had high satisfaction about this new method, the mean score of satisfaction was 8/38±1/8 in a scale ranged from 0 to 10. But there was no differences between tow sex (p>0.05). Data analysis by chi square test showed no differences between tow sex about the characteristic of case-based teaching as compared with lecture.
Nowadays teacher are seeking the teaching methods that causes active learning in students (19). Case-based teaching method is a student centered method which facilitates students learning when a case is presented by teacher (13).
In this study, 66/7 percent of participants completely agreed that case-based teaching method increases the reading comprehension of students as compared with lecture. These results are consistent with the findings of Kunselman et al (2004). They found that case-based teaching is effective method for developing of students learning (20). According to Russelt (2007), this method is a student centered method which stimulates active participation of students (19). Kaddoura (2011) proposed that case-based teaching offers learners opportunities to make meaning of their own world of nursing through active participation in their own learning, developing inquiring minds and awareness of knowledge (13). Furthermore, this method is helpful in recalling of details and facts (12).
From the students view, retention of knowledge in case-based teaching is perceived to be increased and it increases student’s motivation for learning. These findings are in line with Stjernquist (2007) (15). According to Richardson (2008), the effective teaching key is active learning (22).
Moreover, when the students engage in their learning, they will enjoy their learning and it promotes motivation and so, retention of knowledge is perceived to be increased (23).
In our study, the majority of students believed that this new method is attractive than lecture. According to Kaddoura (2011), it is satisfying for educators to think that students might enjoy themselves while being engaged in their learning, as they learn something useful (13).
According to the results, collaboration of students in case teaching is high as compared with lecture. Kaddoura (2011) concluded that case-based teaching has been found to be a more effective instructional method than conventional lecture-based teaching for promoting students’ critical thinking and decision-making skills. So, he recommended this method in nursing faculty (13). While in lecture, the students are inactive (18).
In overall assessment, 85/4 percent of students had high satisfaction from case-based teaching. This result is consistent with kim et al (2006) who found that this new method is more effective than lecture and develops critical thinking and decision making skills (17).
While lecture is a traditional teaching method and used in nursing (7), but its efficacy is below (13). But there are some advantages for lecturing in the way that novice nursing students need teaching on unfamiliar information and how to use the acquired information (24). Charlton (2006) believes that lecture has low efficacy alone, but when it mixed with other active teaching method such as questioning and group discussion helps the students learning (8).
Similarly, Kaddoura (2011) conducted a study and found out that mean score of students critical thinking was high in case method (13). This corroborates to the experiences of Schaefer and Zygmont (2003) who also found that effective teaching requires nursing educators shift from a teacher centered to student – centered approach, which can foster independence in learning, creative problem- solving skills, a commitment to life- long learning and critical thinking (25).
In this study, case method was considered applicable in nursing education. These results are consistent with the findings of others (15, 26-31). Popil (2011) concluded that nurse educator must use case based teaching method in nursing faculty to develop critical thinking skills in students and nurses (18).
We would like to thank Zanjan University of Medical Sciences for all their supports.
Conflict of interest statement
Authors declare no conflict of interest.