Discussion paper
Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness

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Abstract

Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate.

This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care.

Section snippets

Case study and case-based research as a basis for inquiry

The terms case, case study, and case methods are used by a variety of authors [1], [2], [3], [4], [5], [6], [7] who each assign particular meanings and procedures for inquiry. Generally speaking, a case study is “an empirical inquiry that investigates a contemporary phenomenon within its real-life context” [8],p. 13. It is used to probe and analyse particular phenomena that is new, unexamined, or poorly understood. Case studies allow researchers to understand the how and why of contemporary

Identifying the case or cases and its elements

The identification of the case is critical to the nature and type of case study research. In interpretive case study, researchers are required to understand the case in context, where they information about the case and its context during prolonged engagement. Researchers aim to obtain internal consistency and meaningful information about the case and the problem, rather than to compare it with theory [9]. Generally speaking, there are three types of case study: intrinsic, instrumental, or

Role of the researcher

In case study, it is the researcher who is the instrument for data gathering and analysis, and who undertakes deep and prolonged engagement with the case(s) in the context. Researchers should consider their role during data gathering and analysis. Stake argues that the role of interpreter is to examine “the nature and quality of activities and processes, portraying them in narrative description and interpretive assertion” [3]. In such instances, the researcher is immersed in the context of the

Data collection and analysis – using ‘accounts’

Varieties of procedures are available to researchers within case study when engaging in the context of the study [1], [2], [3], [4], [5], [6], all of which place particular emphasis on recursive gathering and analysis of data. A feature common to case study methods and procedures is that there is often no discrete moment when data gathering or analysis begins. As Stake [3] points out:

It begins before there is commitment to do the study: backgrounding, acquaintance with other cases, first

Phases of data gathering, analysis, and interpretation

Data gathering and analysis in case study research is iterative and recursive and follows the lines of inquiry. Shaban’s [14] examination of paramedic clinical judgement and decision-making occurred during two iterative and recursive phases that followed two interconnected lines of enquiry, illustrated in Fig. 1.

In case study research the processes of data gathering and analysis occur concurrently and recursively. As illustrated in Fig. 1, the gathering and analysis of data in this study were

Presenting findings of case studies – formal reporting guidelines

Presenting the findings of case study research clearly, concisely and authentically is as important as the theoretical approach and methods used in the research. Too often researchers submit cases studies to journals examining new or emerging problems of significance but are so poorly presented that editors can only but reject them. Researchers must adopt formal reporting guidelines for the reporting of case studies and case-based research exist, including the CARE Guidelines (Consensus-based

Conclusion

Case study can enable the pursuit of evidence to support best practice in health care settings and is a defining feature of established and well-developed professions. Such efforts are critical to advancing professional practice. While classic high-level evidence such as randomised control trials are typically the most sought after forms of evidence, such forms of evidence are less common in areas such as emergency care compared to other health settings. In many instances, such forms of

Funding

There was no funding associated with this manuscript.

Provenance and conflicts of interest

  • Author Professor Ramon Shaban is the Editor in Chief of the Australian Emergency Nursing Journal but had no role or part in the peer review or editorial decision-making of this paper whatsoever, and was blinded to the manuscript in the Elsevier Editorial System.

  • Authors Professors Julie Considine and Marg Fry are the Deputy Editors in Chief of the Australian Emergency Nursing Journal but had no role or part in the peer review or editorial decision-making of this paper whatsoever, and was blinded

Acknowledgments

Author Ramon Shaban would like to thank Professor Claire Wyatt-Smith and Professor Joy Cumming for their guidance and supervision of the parent study reported in this paper.

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