PROFESSIONAL DEVELOPMENT
Written communication: from staff nurse to nurse consultant
Part 4: case studies John Fowler
1004
experience of the illness, and how they and their loved ones cope and adjust to its various stages that is of significance to the nurse. Personally, I don’t think there should be any rules as to how case studies should be structured or written; it depends on who is doing it and for what purpose. Consider the following three scenarios. If I were the mentor of a first-year student nurse I would ask them to write a case study in note form of a particular patient, asking them to cover areas and aspects of the person’s background and lifestyle that are relevant to their condition, an overview of the illness, previous and current treatment, and how that was affecting the person’s physical, psychological and social self. I would ask the student to present that patient to me and possibly other students verbally as a focus for discussion. Asking the student to write inital notes helps them to deepen their reflection, and organise and prioritise their thoughts. Then asking them to present without their notes helps build confidence and enhance their learning. If I, as a clinical nurse specialist (CNS), wanted to share some good practice then I would consider publishing a case study in a clinically based journal such as BJN. As with all case studies, I would want to keep the patient central to the case study so that people reading the article experienced a real understanding of and empathy with the patient. I would also want to communicate to the readers the nature of the illness, the treatment, side effects and complications. A useful way of covering these factual areas is to use text boxes or tables, allowing the narrative of the case study to flow. While I would expect a case study from the student nurse to be fairly descriptive, I would expect the CNS to write in a reflective way, sharing with the reader alternative options that they considered and the rationale and evidencebase for their decision making. A staff nurse might write a case study for publication in a journal like BJN but they may also write a series of case studies as learning material for students and healthcare assistants
working on their ward. Think back to how you learnt about your specialty. If you are like me then you would have learnt some of it by studying, trying to remember text book signs and symptoms, but more significantly, I learnt about people and their illnesses by reading stories written by patients about their experiences or reading case studies. It’s much easier to remember facts when you can picture them attached to a real person. So if you are a staff nurse, why not try developing some learning resources that are people-centred. I once listened to an eminent nurse talk about their PhD study which focused on an in-depth case study of one patient over a period of several years. At the time I remember thinking, somewhat superficially, that he should have had far more patients to increase the significance of the PhD. Now, with greater understanding of different research styles and having an increased value of nursing as people-centred, I have come to realise how significant and valid that PhD study was. In the next article I will examine ways of writing and presenting literature reviews. BJN Fowler J (2014a) Written communication: from staff nurse to nurse consultant. Part 1 Core principles. Br J Nurs 23(15): 866 Fowler J (2014b) Written communication: from staff nurse to nurse consultant. Part 2: patient records. Br J Nurs 23(16): 910 Fowler J (2014c) Written communication: from staff nurse to nurse consultant. Part 3: email communication. Br J Nurs 23(17): 958 Fowler J (1981) Community nursing case study: the ups and downs in the life of Betty. Nurs Times 77(4): 146-150
Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2014 MA Healthcare Ltd
T
his is the fourth article in the ‘staff nurse to nurse consultant’ series. Previous articles have explored: clarity, precision and brevity as general principles of written communication (Fowler, 2014a), writing patient records (Fowler, 2014b) and email communications (Fowler 2014c). This issue examines the writing and use of case studies by the clinically based nurse. Future articles will cover: literature reviews and research, incident reporting, raising concerns, business plans, portfolios and reflections, CVs and letters of application. While working as a community psychiatric nurse 33 years ago, I published my first article (Fowler, 1981), a case study about a woman called Betty who had a long-term mood disorder. At that time, case studies were a significant part of nursing assessments in pre- and post-registration courses and in clinically based patient reviews. Nurses of all grades were expected to present a case study to their colleagues of a patient who was either unusual, particularly interesting or who presented complex nursing problems that needed wider discussion. In the 1990s, as the nursing profession strived to establish its academic foundations, lecturers, journal editors and journal reviewers began to frown on descriptive case studies with literature reviews, nursing models and multi-referenced articles becoming the norm. Sadly, the interesting accounts of patient care disappeared from many journals and articles became far more removed from reflections of individualised and holistic care. Thankfully, as the nursing profession has now become a little more confident in its academic foundations, we are rediscovering the valuable part that case studies have to play in everyday clinical care, in sharing good practice via publication, in a focus for team problem solving and also in research studies. Case studies focus on the person who is ill rather than the illness itself. While case studies should include details of the illness, the medical treatment, the diagnosis, signs, symptoms and complications, it is essentially the person, their
British Journal of Nursing, 2014, Vol 23, No 18
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights reserved.
Written communication: from staff nurse to nurse consultant
Part 4: case studies John Fowler
1004
experience of the illness, and how they and their loved ones cope and adjust to its various stages that is of significance to the nurse. Personally, I don’t think there should be any rules as to how case studies should be structured or written; it depends on who is doing it and for what purpose. Consider the following three scenarios. If I were the mentor of a first-year student nurse I would ask them to write a case study in note form of a particular patient, asking them to cover areas and aspects of the person’s background and lifestyle that are relevant to their condition, an overview of the illness, previous and current treatment, and how that was affecting the person’s physical, psychological and social self. I would ask the student to present that patient to me and possibly other students verbally as a focus for discussion. Asking the student to write inital notes helps them to deepen their reflection, and organise and prioritise their thoughts. Then asking them to present without their notes helps build confidence and enhance their learning. If I, as a clinical nurse specialist (CNS), wanted to share some good practice then I would consider publishing a case study in a clinically based journal such as BJN. As with all case studies, I would want to keep the patient central to the case study so that people reading the article experienced a real understanding of and empathy with the patient. I would also want to communicate to the readers the nature of the illness, the treatment, side effects and complications. A useful way of covering these factual areas is to use text boxes or tables, allowing the narrative of the case study to flow. While I would expect a case study from the student nurse to be fairly descriptive, I would expect the CNS to write in a reflective way, sharing with the reader alternative options that they considered and the rationale and evidencebase for their decision making. A staff nurse might write a case study for publication in a journal like BJN but they may also write a series of case studies as learning material for students and healthcare assistants
working on their ward. Think back to how you learnt about your specialty. If you are like me then you would have learnt some of it by studying, trying to remember text book signs and symptoms, but more significantly, I learnt about people and their illnesses by reading stories written by patients about their experiences or reading case studies. It’s much easier to remember facts when you can picture them attached to a real person. So if you are a staff nurse, why not try developing some learning resources that are people-centred. I once listened to an eminent nurse talk about their PhD study which focused on an in-depth case study of one patient over a period of several years. At the time I remember thinking, somewhat superficially, that he should have had far more patients to increase the significance of the PhD. Now, with greater understanding of different research styles and having an increased value of nursing as people-centred, I have come to realise how significant and valid that PhD study was. In the next article I will examine ways of writing and presenting literature reviews. BJN Fowler J (2014a) Written communication: from staff nurse to nurse consultant. Part 1 Core principles. Br J Nurs 23(15): 866 Fowler J (2014b) Written communication: from staff nurse to nurse consultant. Part 2: patient records. Br J Nurs 23(16): 910 Fowler J (2014c) Written communication: from staff nurse to nurse consultant. Part 3: email communication. Br J Nurs 23(17): 958 Fowler J (1981) Community nursing case study: the ups and downs in the life of Betty. Nurs Times 77(4): 146-150
Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2014 MA Healthcare Ltd
T
his is the fourth article in the ‘staff nurse to nurse consultant’ series. Previous articles have explored: clarity, precision and brevity as general principles of written communication (Fowler, 2014a), writing patient records (Fowler, 2014b) and email communications (Fowler 2014c). This issue examines the writing and use of case studies by the clinically based nurse. Future articles will cover: literature reviews and research, incident reporting, raising concerns, business plans, portfolios and reflections, CVs and letters of application. While working as a community psychiatric nurse 33 years ago, I published my first article (Fowler, 1981), a case study about a woman called Betty who had a long-term mood disorder. At that time, case studies were a significant part of nursing assessments in pre- and post-registration courses and in clinically based patient reviews. Nurses of all grades were expected to present a case study to their colleagues of a patient who was either unusual, particularly interesting or who presented complex nursing problems that needed wider discussion. In the 1990s, as the nursing profession strived to establish its academic foundations, lecturers, journal editors and journal reviewers began to frown on descriptive case studies with literature reviews, nursing models and multi-referenced articles becoming the norm. Sadly, the interesting accounts of patient care disappeared from many journals and articles became far more removed from reflections of individualised and holistic care. Thankfully, as the nursing profession has now become a little more confident in its academic foundations, we are rediscovering the valuable part that case studies have to play in everyday clinical care, in sharing good practice via publication, in a focus for team problem solving and also in research studies. Case studies focus on the person who is ill rather than the illness itself. While case studies should include details of the illness, the medical treatment, the diagnosis, signs, symptoms and complications, it is essentially the person, their
British Journal of Nursing, 2014, Vol 23, No 18
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 23, 2015. For personal use only. No other uses without permission. . All rights reserved.
