The Progress of Case Teaching Method for Postgraduate Nursing Education

Ying-Ming Sun,Na Sun,Ying Wang

1Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin,3001617,China;

2Department of Nursing Administration,Tianjin First Centre Hospital,Tianjin,300192,China.

Abstract The development of postgraduate nursing education is a major tendency of the nursing industry in the future.Cultivation method is closely related to the progress of nursing postgraduate talents.In order to provide proper education support,this article reviews the progress of the development of case teaching method in postgraduate nursing education,the concept of case teaching,the development status around the world.Moreover,this review specially reviewed the application process of case teaching method.

Keywords:Case Teaching,Postgraduate,Nursing Education

Introduction

The “13th Five-Year Plan” pointed out that without universal health,there wouldn’t be comprehensive well-off.Under the trend of advocating the health of the whole people,the society has put forward higher requirements for clinical nursing services following the continuous development of modern medical model[1].The education to cultivate excellent nursing talents encountered severe challenges.As a high-level nursing talent cultivation,postgraduate nursing education is a major tendency of the nursing industry in the future.With the new period,the new curriculum reform continues to deepen,the case teaching method changed the training concept of nursing graduate students,broke the traditional "indoctrination"teaching mode,and brought new thinking and new motivation to the teaching work.The case teaching method shows a unique advantage in the training of nursing postgraduate students.But for now,the implementation of case teaching method still faces many problems,such as,immature clinical nursing case database construction,lack of systematic teaching organization procedures and insufficient evaluation of case teaching effects [2].So as to provide a reference for further research and reform of teaching methods,this article reviews the progress of the development of case teaching method in postgraduate nursing education,the concept of case teaching,the development status around the world and also the application process of case teaching method.

1 Background and concept of case teaching method

Case teaching as a new type of educational method can be traced back to the New Haven Medical Association in 1788.Foreign scholars believe that case teaching is a student-centered active learning method.In 1871,Harvard Law School used case teaching for the first time,which changed the classroom teaching from "teaching" to "learning",and achieved good results [3].Subsequently,Harvard Medical School adopted two forms of case teaching,clinical practice and clinical pathology conference,to reform the traditional medical teaching at that time.In 1984,the"World Case Teaching Method Application and Research Society" was established,which means that the case teaching method research work officially entered the stage of global international exploration[4].

Case teaching has been in development for more than 100 years.Foreign scholars have continuously studied and perfected the theory and application of case teaching.With the in-depth research and practice of case teaching all around the world,case discussion has become an effective teaching method cited in teaching in various fields including nursing [5].In foreign countries,especially in countries with advanced nursing education in Europe and America,nursing case teaching has formed a relatively mature teaching model.In order to adapt to the development of the times and improve the teaching effect in China,the teaching methods are gradually inclined to"student-centered" teaching methods,such as team teaching mode (TBL),problem-based teaching mode(PBL) and case teaching mode (CBL).The concept of case teaching method has not been accurately concluded yet.Domestic scholar Li [6] pointed out:Case teaching is a case-based process in which students improve their ability to understand,analyze and solve problems through reading,thinking and discussing.Chinese scholar pointed out that case teaching is based on a certain teaching goal to select a certain teaching case,a teaching method characterized by student participation,which promotes students to change from passive acceptance of knowledge to active participation in learning.In general,the case teaching method raises students to the height of the teaching subject,and the teacher only plays a guiding and regulating role in the whole teaching process.Each step of the teaching activities including classroom organization,classroom discussion and after-class summary.All of the above is completed by the students themselves.The case teaching method is based on mastering relevant theoretical knowledge,starting from clinical practice activities,designing specific case scenarios,and analyzing the questions through discussions and answers [7].Under the careful guidance of teachers,the questions are analyzed through discussions and answers to enable students to understand and master the knowledge they have learned and improve students' comprehensive ability[8].It can be seen that the essence of case teaching is a teaching method that stimulates students' internal learning motivation and guides students to flexibly use corresponding theoretical knowledge to solve problems by presenting real or simulated events.

2 Research status of case teaching method at home and abroad

2.1 Research status abroad

Case teaching in foreign countries has been very mature in terms of theoretical explanation and teaching practice.Up to now,countries such as Europe and the United States have formed a nearly complete case teaching system and achieved rich research results,such as the establishment of a special case development center,R & D case database department,inter-school case exchange center,etc.The above academic achievements are helpful to clarify case teaching methods,define professional terminology,and plan teaching programs,etc.Sapeni [9] believe that case teaching method can make class time for higher-level learning and evaluation,which is more effective than traditional indoctrination teaching.In the teaching of nursing theory courses,case discussion is often used as an auxiliary teaching method in conjunction with lecture teaching,but the use of case teaching as a dominant position has a positive effect on the cultivation of students 'clinical thinking ability and can more stimulate students' creativity.Kaddoura[8] divided 103 three-year nursing students into an experimental group and a control group.The experimental group was taught by case teaching method,and the control group was taught by traditional teaching method.The results showed that the students in the experimental group had significantly higher scores in critical thinking tests and scores than the control group in all dimensions.Cazrattana et al.[10] conducted that case teaching for senior nursing students,guided the students to apply knowledge to solve problems through cases,and then used qualitative interview methods to study their impact on students' critical thinking ability.It is a real learning experience,and it enables them to discover from their learning experience and learn to view and think about issues from a broader perspective.The case teaching method can not only strengthen students'ability to apply the knowledge learned,enhance team awareness and improve communication skills,but also expand students' thinking and cultivate their dedication.

2.2 Research status in China

Case teaching in China is still in its embryonic stage.It was first introduced to the country by a business delegation visiting the United States in 1979,which had a profound impact on Chinese education.Later,domestic education scholars carried out in-depth research on it and promoted it.Case teaching is being actively developed and applied in major universities in my country,such as clinical ICU nurse training assessment,internal medicine nursing,obstetrics and gynecology nursing.Wen et al.[11] showed,a study of ICU intern nurses in the First Affiliated Hospital of Wenzhou Medical University,that the proposed case teaching can effectively improve the professional level of intern nurses and improve the quality of nursing teaching.Hang et al.[12] applied case teaching combined with authenticity evaluation in the experimental teaching of community nursing,and found that this teaching method is conducive to the cultivation of students' comprehensive ability,and is conducive to the improvement of teachers' teaching ability and quality promoting teaching,learning and evaluation.Wang et al.[13] compared case teaching with traditional teaching in evidence-based nursing teaching,and concluded that the introduction of case teaching method in evidence-based nursing teaching can truly improve the ability of teachers and students to "teach" and "learn".Lu et al.[14] explored the case teaching method in internal surgical nursing teaching.She uses a progressive case,which runs through the patient's entire illness from hospital to discharge (or referral,death,etc.).Involving patients with diseases,social and psychological issues of patients and their families,and coping with problems.The case is divided into different situations according to the development of the disease to enable students to experience clinical nursing procedures through case study and discussion [15].Obviously,the case teaching method has a very positive effect on the cultivation of nursing talents,and the effect is better than the ordinary case teaching method.Whether it is theoretical teaching or practical teaching,nursing cases will be an important teaching method in the future.

3 Specific implementation of case teaching method

3.1 Nursing case design

If you want to effectively develop students' ability to solve practical problems,you need to introduce good cases with real situations into the classroom.After reviewing more than 100 medical case design related research,Kim from the University of Washington School of Medicine and colleagues reviewed the five core elements of medical case design:①Relevance means that the story situation designed in the case must be related to the student's level,learning goals and objectives;②Authenticity means that the case must be authentic,and the case description should have moderate interference content,gradually revealing the theme;③Participation means that the content of the case should be rich enough to enable students to find problems from multiple perspectives and participate in the discussion;④Challenge means that the case should be difficult;⑤Guidance means that the writing of cases should be based on the knowledge that students have learned before,so that students can apply and consolidate existing knowledge in case learning [16].These five elements suggest that the design of cases cannot be rigidly copied from the textbooks.The design of nursing cases should consider the "inferior structure" of clinical nursing situations in reality.The material of Yizhi Nursing Case is not only limited to the syllabus and content of the textbook,but also should be compiled with the actual medical records.For example,placing the case in a complex real environment,including physical,psychological,social,spiritual,cultural and other elements,guides students to identify the problem to be solved in a complex situation,and explores many different solutions to the problem.It is helpful to cultivate students' ability to solve inferior structural problems [17].Modern nursing requires holistic nursing concept as a guide to implement nursing activities.The nurse's holistic nursing concept is an important factor that affects the in-depth development of holistic nursing.If the design of nursing cases can fully integrate the elements of holistic nursing,it will undoubtedly be more beneficial to the cultivation of students' overall nursing ability.

3.2 Teaching organization and implementation

3.2.1 Grouping

The instructor randomly groups the students in advance and selects the leader of each group,and sends relevant materials such as cases,medical history and test results related to the case to each group.

3.2.2 Division of work

The team members divide and cooperate with each other to solve the problems in the case with the help of books,periodicals,databases or consulting teachers in the school library.

3.2.3 Case discussion

Choi and Lee [18] proposed "five-step method" to implement case teaching.That is:Step 1,understand the situation of the case and ask questions; Step 2,consider and analyze the actual case from multiple perspectives; Step 3,list possible solutions; Step 4,choose the appropriate solution and explain the reasons; Step 5,implement and evaluate the solution.These five steps and the nursing process"evaluation-diagnosis-plan-implementation-evaluation" the five cyclic steps provide a basic guidance framework for the organization and implementation of nursing case teaching.

3.2.4 Summary after class

The teacher in charge evaluates the performance of each group,summarizes the lessons of this course and arranges students to write the analysis report.

4 Discussion

4.1 Existing problems of case teaching method

Although the case teaching method is superior to the traditional teaching in improving the teaching effect,there are still some problems in the case teaching process,regardless of the case resources,faculty,student requirements and teaching facilities [19].

(1) Case resources:There is no corresponding nursing case database in China,which lags behind in the collection,collation and analysis of cases,which often leads to stale cases and lack of representation.

(2) Faculty:Yu et al.[20] pointed out in the analysis of the application of case teaching in basic nursing teaching that the application of case teaching method in basic nursing teaching is critical,and the teacher should summarize a set according to the teaching object Teaching concepts and methods of teaching students according to their aptitude.Only in this way can case teaching be more comprehensively promoted and applied,can students consolidate their basic knowledge,improve teaching quality,and cultivate high-quality talents.Hong et al.[21] also showed the key role of teachers in this process in the analysis of case teaching methods:nursing teachers should actively reform and innovate thinking,on the basis of fully understanding the learning characteristics of students,combined with teaching goals,have plans Use case teaching locally,and evaluate the teaching effect in a timely manner,and make appropriate adjustments to the specific teaching methods and process design to make case teaching more effective.

(3) Student requirements:Case teaching has more performance opportunities for extroverted students with good academic performance,while for introverted students,the performance is relatively silent,which leads to class polarization.Therefore,students should actively express themselves,so that they can really participate in it and gain a lot.

(4) Teaching facilities:The implementation of case teaching methods is different between different schools and teachers,and a relatively standard case teaching mode suitable for most students is lacking.Many colleges and universities use large classes to teach,and the ratio of teachers and students is not coordinated,which affects the smooth implementation of case teaching [22].Taking into account that there are some gaps between the level of case teaching in China and abroad,the main reason is the difference in teaching concepts,teaching methods and teaching content between China and foreign countries.In the teaching concept,we should reform the assessment method of exam-oriented education,increase the proportion of usual scores to improve students'initiative; the teaching method should be more open to let students participate; the teaching content should not be limited to the textbook content Should maximize the satisfaction of students' curiosity and personality development [23].

4.2 Enlightenment of case teaching method

As a high-level training talent in China,nursing graduates must not only learn basic cultural knowledge,but also learn to apply knowledge flexibly in clinical practice,and cultivate comprehensive qualities of proactively discovering,thinking and solving problems.Entering the postgraduate study stage is a transformation from learning to innovation,from learning knowledge (input) to creating knowledge (output).In this fast-growing big database and information era:the national higher education has been reformed and promoted,and multimedia teaching equipment has been continuously improved,we should grasp the current advantages and conditions,and further improve the following aspects in response to the above case teaching methods:training students Comprehensive quality; perfect teacher training mechanism; strengthen the construction of case database; reform the assessment system,etc.[24].Therefore,when cultivating high-level nursing talents,it is recommended to adopt a case teaching method that is more flexible and can create a broader thinking ability for students.