Case-based learning offers realistic, relevant, and effective active learning strategies to enhance clinical judgment and decision-making. Principles of situated cognition provide the foundation for the use of cases in teaching nursing students to function competently as practicing nurses.
Teaching the next generation of registered nurses (RNs) requires a sharp focus on safety, clinical judgment, competency, and priority-setting. Active learning strategies that require decision-making at the bedside will best enable new RNs to meet the needs of clinical practice. According to the principles of situated cognition, students need to practice these priority-setting and clinical judgment skills while immersed in client care situations that realistically depict the work of nursing.
So, what is situated cognition? Essentially, it is creating experiences where decisions made in nursing school replicate the place where decisions will be made in nursing practice. Consider a lecture of cues and actions related to a diagnosis without details or lacking the context of a patient care situation. Students may memorize material and regurgitate this information on a test, but then often lack the ability to apply principles when providing real patient care. In converse, placing students within realistic cases, high fidelity simulations, immersive virtual or virtual reality simulations, and actual clinical experiences to replicate the bedside will facilitate more skilled decision-making.
Nursing faculty often lean heavily on clinical and simulation experiences to provide the venue for situated cognition and decision-making at the point of care. These experiences may be limited by exposure to clients representing different needs, treatments, and responses. Although clinical experiences may offer the most apparent site for operationalizing, it is difficult to ensure that students make independent decisions, care for complex clients, or meet clinical objectives in every clinical day. Other factors that must be considered include the ability to provide specialty experiences, such as mental health, pediatrics, and women’s health, along with the limited active and autonomous decision-making opportunities afforded to students during clinical rotations. To augment clinical and simulation learning, nursing faculty seek effective, realistic, authentic, and evidence-based strategies to foster student clinical judgment and expand decision-making capacity.
Case-based learning, such as Lippincott Client Cases for Clinical Judgment (Client Cases), provides important tools to supplement clinical and simulation experiences and increases student autonomous decision-making. Exposure to specialty and leadership experiences ensures critical learning needs are met within a realistic client care environment. As students independently “live” within the case, they practice nursing care, answer high-level questions, set sound priorities while taking care of clients, and reflect on care provided while working within the Client Cases environment.
Based on their initial work setting, some new RNs may be asked to assign patients to other nurses, juggle more clients in an assignment than ever before, delegate to others, and make time pressured decisions. Most assuredly, students will see clients with multiple co-morbidities, confront unknown contexts and health-defining variables, and assume higher levels of responsibility than they have ever experienced in nursing school. This is where complex, multi-factorial cases offer students the opportunity to read and interpret the electronic health record, encounter challenges in prioritization, and answer NCLEX®-style questions surrounded by information about assessments, laboratory findings, provider orders, and other components of care documentation.
Perhaps the greatest challenge confronted by novice registered nurses is in delegating, assigning new nurses, acting in the charge nurse role, and accepting assignments that are within their scope of practice. Students need to be exposed to learning experiences that replicate these challenges, such as those included in the Leadership Unit in Client Cases. True-to-life cases require students to make patient assignments while determining colleague’s skill levels and other variables. Students confront conflicts, errors, and challenges while engaging in high-level clinical reasoning. Cases that offer critical practice in delegation, setting priorities between clients, and negotiating changes in client status prepare students for the rigors of patient care. In a study by Liu (2024), students in an unfolding case-based learning cohort showed significantly enhanced perceived proficiency in conducting focused observation. While students are immersed in authentic cases, students can “live” the experience of client care while implementing the Clinical Judgment Measurement Model and determine care priorities. Case-based learning provides an important resource to prepare students for the demands of patient care and today’s nursing practice. Assigning Client Cases allows educators to map the work to the department’s curriculum map while guiding students’ clinical judgment development in an active classroom.
Five strategies for using the Lippincott Client Cases for Clinical Judgment in RN Education
1. Group case demonstration for leadership decision-making
In class, demonstrate one of the Leadership Unit Client Cases as a group. Discuss the implications that impact decision-making and clinical judgment. Then, assign groups of students to one of the Client Cases in the Leadership Unit that requires assignment making (Gabe, Jordan, Laura, Mary, Shania, Steven, Terrance). Ask students to identify the factors that inform decision-making. As a class, discuss elements of assignment making, including client age/care demands, client status/acuity, nursing skill level, number of staff, nursing education/experience levels, and other factors. Ask students to do a Quick Write reflection on how this information may be useful in their future nursing practice.
2. SBAR practice through “ticket to class” assignments
Assign a case as a “ticket to class” that meets class objectives/content/competencies. Then, in class each student creates an SBAR report and students compare their documents. Alternatively, the assignment can be “pick one of three cases” as a ticket to class, then, have pairs of students discuss the cases they chose, answering these questions.
- What actions should be completed by a Registered Nurse (RN)?
- What actions may be delegated to a Licensed Practice/Vocational Nurse (LPN/LVN)?
- What actions may be delegated to unlicensed assistive personnel (UAP)?
- What information should be reported to a healthcare provider (HCP)?
3. Compare and contrast pre-class case analysis
Ask students to complete two Client Cases as pre-work for class; ensure the clients selected meet class-specific objectives/outcomes/competencies. Have students complete a Compare and Contrast on the two cases, listing five characteristics that are the same about the cases and five elements that are different. Reinforce that identified characteristics are related to class material and not associated with client demographics alone. Collect the hand-written Compare and Contrast assignments as Admit Tickets. Discuss findings as part of opening the class and preparing the students for learning.
4. Interactive SBAR and hand-off reporting exercise
In class, have students select and complete a Client Case that relates to class objectives/content/competencies. Following completion of the case, students select a situation or event in the case and write an SBAR on that event. Then students write a bulleted list of information to be passed to the oncoming nurse as part of a Hand-Off Report. Have students Speed-Date with several colleagues providing the SBAR and Hand-Off Reports to each other. Debrief with the entire class about the key aspects of the cases within the parameters of class objectives/content/competencies.
5. Medication cross-reference and clinical application
In clinical, have students identify four medications that their client is currently receiving that day. Have students search the Medication Index for Client Cases representing patients who take one of the medications. Students should complete the four clients and fill out a Medication Information Sheet discussing all four medications, including the therapeutic effects, side effects, evaluating effectiveness, and related nursing implications. This activity may be completed by students during clinical “down time” or as clinical preparation. Conduct a post-conference discussing how the medication used in the clinical area and in the Client Cases compared and key lessons learned in this exercise.
