melancholy nurse sitting in hospital hallway
HealthFebruary 23, 2021

The reverse case study: An innovative approach to develop critical thinking skills

By: Heather Swift, MSN, RN
Year after year, new graduates lack critical thinking skills in real-life practice. A popular saying in nursing education is there is “Ivory Tower Nursing” and there is “Real Life Nursing.”

The truth is new graduate nurses are coming straight out into the field having the responsibility to care for complex patients with multiple comorbidities only knowing the “ivory tower nursing.” Many of these patients would’ve been in a step-down or critical care unit years ago and now they are on a normal medical-surgical floor, therefore likely that a new graduate will care for them.

As educators, we confidently state the student passed the required nursing courses, successfully completed clinical hours, and are now prepared to take the NCLEX®. NCLEX comes around and the student passes…now what. As educators, can we now confidently state that the student holds the critical thinking skills to be successful as a new graduate nurse? According to hospital leadership, they are not. It is nothing short of a reality shock for new graduates and a norm for hospital leadership.

Nursing education has evolved from a model of hands-on training to one of high academic rigor in a conscious attempt to meet the ever-changing landscape of health care delivery. The new graduate nurse must immediately deal with theory to practice gaps, decision-making inabilities, planning and organization difficulties, prioritization concerns and lastly, a lack of coping skills. Making their job that much more demanding and stressful.

The emphasis needs to be placed on how to better prepare and support our new nurses for professional practice and how to equip new nurses to manage the complex care needs of patients and families however, the research shows that the gap between academic nursing preparation and the expectations of clinical practice continues to exist.

How can we help?

This is a multifold question, which requires a multifold answer. However, I want to just touch on the incorporation of a reverse case study approach to the classroom (online or in-seat) and/or clinical. A reverse case study allows the student to develop the case from the data presented to them. It is a perfect example of an active learning activity that allows the student to become dynamically involved by building on previous knowledge and applying concepts to a new set of information.

This is a shift in thinking modalities for educators and students alike. But how exciting is it to see the “ah-ha” moments as the students develop the scenario by utilizing evidence-based research while simultaneously achieving several areas within Bloom’s taxonomy? win-win!

How to build a reverse case study

A reverse case study can be as simple as the instructor providing a list of medications and dosages to the students. The students would then make a patient scenario to include admitting diagnosis, nursing and medical interventions, labs and diagnostics, discharge planning and education. They can be as creative as they’d like however it must correlate with the medications given. This can be done as a solo assignment, but with groups, collaboration occurs which encourages critical thinking.

Another example is “Build a Patient.” The instructor can post a lecture (10–15 minutes) with a voiceover and reading prior to class with a correlating assignment to build a patient scenario based on the assigned reading/lecture as a ticket to class.

Let’s say the topic to cover is COPD. The student would then bring their patient scenario to class to include events leading up to admission, vital signs, labs, diagnostic tests, medications, assessment findings, nursing diagnosis and priorities, nursing interventions, worst-case scenarios to anticipate and prevent, and education for patient/family. This allows for a full understanding of the pathophysiology and nursing process for a specified patient- helping the student to think like a nurse and be prepared for real-life practice.

The end goal of a reverse case study

Utilizing this approach allows students to apply the nursing process to thoroughly develop a complete case study by critically thinking and using key concepts. Let us not forget that this is an individual one-of-a-kind works; therefore, googling the answers is not an option, only furthering the development of a student’s critical thinking skillset.

Our goal as educators needs to be so much more than a student passing a class and/or passing the NCLEX. Our goal needs to be to have well-prepared nurses that know how to apply concepts, critically think, prioritize, and organize a plan of care. Shifting how we deliver nursing concepts, will in return help our students be less shocked and better prepared for their first nursing job.

Heather Swift, MSN, RN
Expert Insights Contributor for Wolters Kluwer, Nursing Education
Lippincott Nursing Education
Preparing today’s students to become tomorrow’s nurses.