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Case studies.

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Case studies are stories that are used as a teaching tool to show the application of a theory or concept to real situations. Dependent on the goal they are meant to fulfill, cases can be fact-driven and deductive where there is a correct answer, or they can be context driven where multiple solutions are possible. Various disciplines have employed case studies, including humanities, social sciences, sciences, engineering, law, business, and medicine. Good cases generally have the following features: they tell a good story, are recent, include dialogue, create empathy with the main characters, are relevant to the reader, serve a teaching function, require a dilemma to be solved, and have generality.

Instructors can create their own cases or can find cases that already exist. The following are some things to keep in mind when creating a case:

  • What do you want students to learn from the discussion of the case?
  • What do they already know that applies to the case?
  • What are the issues that may be raised in discussion?
  • How will the case and discussion be introduced?
  • What preparation is expected of students? (Do they need to read the case ahead of time? Do research? Write anything?)
  • What directions do you need to provide students regarding what they are supposed to do and accomplish?
  • Do you need to divide students into groups or will they discuss as the whole class?
  • Are you going to use role-playing or facilitators or record keepers? If so, how?
  • What are the opening questions?
  • How much time is needed for students to discuss the case?
  • What concepts are to be applied/extracted during the discussion?
  • How will you evaluate students?

To find other cases that already exist, try the following websites:

  • The National Center for Case Study Teaching in Science , University of Buffalo. SUNY-Buffalo maintains this set of links to other case studies on the web in disciplines ranging from engineering and ethics to sociology and business
  • A Journal of Teaching Cases in Public Administration and Public Policy , University of Washington

For more information:

  • World Association for Case Method Research and Application

Book Review :  Teaching and the Case Method , 3rd ed., vols. 1 and 2, by Louis Barnes, C. Roland (Chris) Christensen, and Abby Hansen. Harvard Business School Press, 1994; 333 pp. (vol 1), 412 pp. (vol 2).

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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

Students working on projects in a classroom

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

  • How can we limit food waste in the cafeteria?
  • How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
  • How can we improve school attendance?
  • How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

  • The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
  • Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
  • The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
  • The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

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Enrich your students’ educational experience with case-based teaching

The NCCSTS Case Collection, created and curated by the National Center for Case Study Teaching in Science, on behalf of the University at Buffalo, contains over a thousand peer-reviewed case studies on a variety of topics in all areas of science.

Cases (only) are freely accessible; subscription is required for access to teaching notes and answer keys.

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Development of the NCCSTS Case Collection was originally funded by major grants to the University at Buffalo from the National Science Foundation , The Pew Charitable Trusts , and the U.S. Department of Education .

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Case studies

Adolescent education and skills.

Improving students' mental health in Bangladesh

Improving the quality of lower secondary through inquiry-based learning and skills development (Argentina)

An online career portal strengthens career guidance among secondary students in India and helps them plan for future educational and work opportunities (India)

Lessons on youth-led action towards climate advocacy and policy (India)

Learning, life skills and citizenship education and social cohesion through game-based sports – Nashatati Programme (Jordan)

Mental health promotion and suicide prevention in schools (Kazakhstan)

A multi-level, cross-sectoral response to improving adolescent mental health (Mongolia)

The Personal Project (Morocco)  

Improving adolescents’ learning in violence-affected areas through blended in-person and online learning opportunities - Communities in Harmony for Children and Adolescents (Mexico)

A community-based approach to support the psychosocial wellbeing of students and teachers (Nicaragua)

Flexible pathways help build the skills and competencies of vulnerable out-of-school adolescents (United Republic of Tanzania)

Climate change and education

Schools as platforms for climate action (Cambodia)

Paving the way for a climate resilient education system (India)

Youth act against climate and air pollution impacts (Mongolia)

Early childhood education

Early environments of care: Strengthening the foundation of children’s development, mental health and wellbeing (Bhutan)

Native language education paves the way for preschool readiness (Bolivia)

Developing cross-sector quality standards for children aged 0-7 (Bulgaria)

Expanding quality early learning through results-based financing (Cambodia)

Harnessing technology to promote communication, education and social inclusion for young children with developmental delays and disabilities (Croatia, Montenegro, and Serbia)

Scaling up quality early childhood education in India by investing in ongoing professional development for officials at the state, district and local levels (India)

Strengthening early childhood education in the national education plan and budget in Lesotho to help children succeed in primary and beyond (Lesotho)

Enhancing play-based learning through supportive supervision (Nigeria)

Learning social and emotional skills in pre-school creates brighter futures for children (North Macedonia)

How developing minimum standards increased access to pre-primary education (Rwanda)

Expanding access to quality early childhood education for the most excluded children (Serbia)

Advancing early learning through results-based financing (Sierra Leone)

Lessons learned from designing social impact bonds to expand preschool education (Uzbekistan)

Equity and inclusion

Inclusive education for children with disabilities.

Strengthening policies to mainstream disability inclusion in pre-primary education (Ethiopia)

National early screening and referrals are supporting more young children with disabilities to learn (Jamaica)

Ensuring inclusive education during the pandemic and beyond (Dominican Republic)

Championing inclusive practices for children with disabilities (Ghana)

Accessible digital textbooks for children in Kenya (Kenya)

Planning for inclusion (Nepal)

Harnessing the potential of inclusive digital education to improve learning (Paraguay)

Gender equality in education

Sparking adolescent girls' participation and interest in STEM (Ghana)

Non-formal education and the use of data and evidence help marginalized girls learn in Nepal (Nepal)

Getting girls back to the classroom after COVID-19 school closures (South Sudan)

Education in emergencies

Creating classrooms that are responsive to the mental health needs of learners, including refugees (Poland)

Return to school (Argentina)

Learning from the education sector’s COVID-19 response to prepare for future emergencies (Bangladesh)

Prioritising learning for Rohingya children (Bangladesh)

Prioritizing children and adolescents’ mental health and protection during school reopening (Brazil)

Learning where it is difficult to learn: Radio programmes help keep children learning in Cameroon

Reaching the final mile for all migrant children to access education (Colombia)

Supporting the learning and socio-emotional development of refugee children (Colombia)

Mission Recovery (Democratic Republic of the Congo)

The National Building the Foundations for Learning Program, CON BASE (Dominican Republic)

Mental health and psychosocial well-being services are integrated in the education system (Ecuador)

Improving access to quality education for refugee learners (Ethiopia)

The Learning Passport and non-formal education for vulnerable children and youth (Lebanon)

Accelerated Learning Programme improves children’s learning in humanitarian settings (Mozambique)

Responding to multiple emergencies – building teachers’ capacity to provide mental health and psychosocial support before, during, and after crises (Mozambique)

Teaching at the right level to improve learning in Borno State (Nigeria)

Remedial catch-up learning programmes support children with COVID-19 learning loss and inform the national foundational learning strategy (Rwanda)

Learning solutions for pastoralist and internally displaced children (Somalia)

Recovering learning at all levels (South Africa)

How radio education helped children learn during the COVID-19 pandemic and aftermath (South Sudan)

Addressing learning loss through EiE and remedial education for children in Gaza (State of Palestine)

Providing psychosocial support and promoting learning readiness during compounding crises for adolescents in Gaza (State of Palestine)

Inclusion of South Sudanese refugees into the national education system (Sudan)

Inclusion of Syrian refugee children into the national education system (Turkey)

Including refugee learners so that every child learns (Uganda)

Learning assessments

Assessment for learning (Afghanistan)

Formative assessment places student learning at the heart of teaching (Ethiopia)

Strengthening teacher capacity for formative assessment (Europe and Central Asia)

All students back to learning (India)

Strengthening the national assessment system through the new National Achievement Survey improves assessment of children’s learning outcomes (India)

A new phone-based learning assessment targets young children (Nepal)

Adapting a remote platform in innovative ways to assess learning (Nigeria)

Assessing children's reading in indigenous languages (Peru)

Southeast Asia primary learning metrics: Assessing the learning outcomes of grade 5 students (Southeast Asia)

Minimising learning gaps among early-grade learners (Sri Lanka)

Assessing early learning (West and Central Africa)

Primary education / Foundational Literacy and Numeracy

Supporting Teachers to Improve Foundational Learning for Syrian Refugee Students in Jordan

Empowering teachers in Guinea: Transformative solutions for foundational learning

Improving child and adolescent health and nutrition through policy advocacy (Argentina)

Online diagnostic testing and interactive tutoring (Bulgaria)

Supporting the socio-emotional learning and psychological wellbeing of children through a whole-school approach (China)

Engaging parents to overcome reading poverty (India)

Integrated school health and wellness ensure better learning for students (India)

Instruction tailored to students’ learning levels improves literacy (Indonesia)

A whole-school approach to improve learning, safety and wellbeing (Jamaica)

Multi-sectoral programme to improve the nutrition of school-aged adolescents (Malawi)

Parents on the frontlines of early grade reading and math (Nigeria)

Training, inspiring and motivating early grade teachers to strengthen children’s skills in literacy and numeracy (Sierra Leone) Life skills and citizenship education through Experiential Learning Objects Bank (State of Palestine)

Curriculum reform to meet the individual needs of students (Uzbekistan)

Improving early grade reading and numeracy through ‘Catch-Up,’ a remedial learning programme (Zambia)

Reimagine Education / Digital learning

Education 2.0: skills-based education and digital learning (Egypt)

Empowering adolescents through co-creation of innovative digital solutions (Indonesia)

Virtual instructional leadership course (Jamaica)

Learning Bridges accelerates learning for over 600,000 students (Jordan)

Unleashing the potential of youth through the Youth Learning Passport (Jordan)

Lessons learned from the launch of the Learning Passport Shkollat.org (Kosovo)

Opening up the frontiers of digital learning with the Learning Passport (Lao PDR)

Building teachers’ confidence and capacity to provide online learning (Maldives)

Mauritania’s first digital learning program: Akelius Digital French Course (Mauritania)

Mitigating learning loss and strengthening foundational skills through the Learning Passport (Mexico)

Expanding digital learning opportunities and connectivity for all learners (Tajikistan)

For COVID-19 education case studies, please click here and filter by area of work (Education) and type (Case Study / Field Notes).

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Using Case Studies to Teach

sample case study education

Why Use Cases?

Many students are more inductive than deductive reasoners, which means that they learn better from examples than from logical development starting with basic principles. The use of case studies can therefore be a very effective classroom technique.

Case studies are have long been used in business schools, law schools, medical schools and the social sciences, but they can be used in any discipline when instructors want students to explore how what they have learned applies to real world situations. Cases come in many formats, from a simple “What would you do in this situation?” question to a detailed description of a situation with accompanying data to analyze. Whether to use a simple scenario-type case or a complex detailed one depends on your course objectives.

Most case assignments require students to answer an open-ended question or develop a solution to an open-ended problem with multiple potential solutions. Requirements can range from a one-paragraph answer to a fully developed group action plan, proposal or decision.

Common Case Elements

Most “full-blown” cases have these common elements:

  • A decision-maker who is grappling with some question or problem that needs to be solved.
  • A description of the problem’s context (a law, an industry, a family).
  • Supporting data, which can range from data tables to links to URLs, quoted statements or testimony, supporting documents, images, video, or audio.

Case assignments can be done individually or in teams so that the students can brainstorm solutions and share the work load.

The following discussion of this topic incorporates material presented by Robb Dixon of the School of Management and Rob Schadt of the School of Public Health at CEIT workshops. Professor Dixon also provided some written comments that the discussion incorporates.

Advantages to the use of case studies in class

A major advantage of teaching with case studies is that the students are actively engaged in figuring out the principles by abstracting from the examples. This develops their skills in:

  • Problem solving
  • Analytical tools, quantitative and/or qualitative, depending on the case
  • Decision making in complex situations
  • Coping with ambiguities

Guidelines for using case studies in class

In the most straightforward application, the presentation of the case study establishes a framework for analysis. It is helpful if the statement of the case provides enough information for the students to figure out solutions and then to identify how to apply those solutions in other similar situations. Instructors may choose to use several cases so that students can identify both the similarities and differences among the cases.

Depending on the course objectives, the instructor may encourage students to follow a systematic approach to their analysis.  For example:

  • What is the issue?
  • What is the goal of the analysis?
  • What is the context of the problem?
  • What key facts should be considered?
  • What alternatives are available to the decision-maker?
  • What would you recommend — and why?

An innovative approach to case analysis might be to have students  role-play the part of the people involved in the case. This not only actively engages students, but forces them to really understand the perspectives of the case characters. Videos or even field trips showing the venue in which the case is situated can help students to visualize the situation that they need to analyze.

Accompanying Readings

Case studies can be especially effective if they are paired with a reading assignment that introduces or explains a concept or analytical method that applies to the case. The amount of emphasis placed on the use of the reading during the case discussion depends on the complexity of the concept or method. If it is straightforward, the focus of the discussion can be placed on the use of the analytical results. If the method is more complex, the instructor may need to walk students through its application and the interpretation of the results.

Leading the Case Discussion and Evaluating Performance

Decision cases are more interesting than descriptive ones. In order to start the discussion in class, the instructor can start with an easy, noncontroversial question that all the students should be able to answer readily. However, some of the best case discussions start by forcing the students to take a stand. Some instructors will ask a student to do a formal “open” of the case, outlining his or her entire analysis.  Others may choose to guide discussion with questions that move students from problem identification to solutions.  A skilled instructor steers questions and discussion to keep the class on track and moving at a reasonable pace.

In order to motivate the students to complete the assignment before class as well as to stimulate attentiveness during the class, the instructor should grade the participation—quantity and especially quality—during the discussion of the case. This might be a simple check, check-plus, check-minus or zero. The instructor should involve as many students as possible. In order to engage all the students, the instructor can divide them into groups, give each group several minutes to discuss how to answer a question related to the case, and then ask a randomly selected person in each group to present the group’s answer and reasoning. Random selection can be accomplished through rolling of dice, shuffled index cards, each with one student’s name, a spinning wheel, etc.

Tips on the Penn State U. website: http://tlt.its.psu.edu/suggestions/cases/

If you are interested in using this technique in a science course, there is a good website on use of case studies in the sciences at the University of Buffalo.

Dunne, D. and Brooks, K. (2004) Teaching with Cases (Halifax, NS: Society for Teaching and Learning in Higher Education), ISBN 0-7703-8924-4 (Can be ordered at http://www.bookstore.uwo.ca/ at a cost of $15.00)

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Case-based learning.

Case-based learning (CBL) is an established approach used across disciplines where students apply their knowledge to real-world scenarios, promoting higher levels of cognition (see Bloom’s Taxonomy ). In CBL classrooms, students typically work in groups on case studies, stories involving one or more characters and/or scenarios.  The cases present a disciplinary problem or problems for which students devise solutions under the guidance of the instructor. CBL has a strong history of successful implementation in medical, law, and business schools, and is increasingly used within undergraduate education, particularly within pre-professional majors and the sciences (Herreid, 1994). This method involves guided inquiry and is grounded in constructivism whereby students form new meanings by interacting with their knowledge and the environment (Lee, 2012).

There are a number of benefits to using CBL in the classroom. In a review of the literature, Williams (2005) describes how CBL: utilizes collaborative learning, facilitates the integration of learning, develops students’ intrinsic and extrinsic motivation to learn, encourages learner self-reflection and critical reflection, allows for scientific inquiry, integrates knowledge and practice, and supports the development of a variety of learning skills.

CBL has several defining characteristics, including versatility, storytelling power, and efficient self-guided learning.  In a systematic analysis of 104 articles in health professions education, CBL was found to be utilized in courses with less than 50 to over 1000 students (Thistlethwaite et al., 2012). In these classrooms, group sizes ranged from 1 to 30, with most consisting of 2 to 15 students.  Instructors varied in the proportion of time they implemented CBL in the classroom, ranging from one case spanning two hours of classroom time, to year-long case-based courses. These findings demonstrate that instructors use CBL in a variety of ways in their classrooms.

The stories that comprise the framework of case studies are also a key component to CBL’s effectiveness. Jonassen and Hernandez-Serrano (2002, p.66) describe how storytelling:

Is a method of negotiating and renegotiating meanings that allows us to enter into other’s realms of meaning through messages they utter in their stories,

Helps us find our place in a culture,

Allows us to explicate and to interpret, and

Facilitates the attainment of vicarious experience by helping us to distinguish the positive models to emulate from the negative model.

Neurochemically, listening to stories can activate oxytocin, a hormone that increases one’s sensitivity to social cues, resulting in more empathy, generosity, compassion and trustworthiness (Zak, 2013; Kosfeld et al., 2005). The stories within case studies serve as a means by which learners form new understandings through characters and/or scenarios.

CBL is often described in conjunction or in comparison with problem-based learning (PBL). While the lines are often confusingly blurred within the literature, in the most conservative of definitions, the features distinguishing the two approaches include that PBL involves open rather than guided inquiry, is less structured, and the instructor plays a more passive role. In PBL multiple solutions to the problem may exit, but the problem is often initially not well-defined. PBL also has a stronger emphasis on developing self-directed learning. The choice between implementing CBL versus PBL is highly dependent on the goals and context of the instruction.  For example, in a comparison of PBL and CBL approaches during a curricular shift at two medical schools, students and faculty preferred CBL to PBL (Srinivasan et al., 2007). Students perceived CBL to be a more efficient process and more clinically applicable. However, in another context, PBL might be the favored approach.

In a review of the effectiveness of CBL in health profession education, Thistlethwaite et al. (2012), found several benefits:

Students enjoyed the method and thought it enhanced their learning,

Instructors liked how CBL engaged students in learning,

CBL seemed to facilitate small group learning, but the authors could not distinguish between whether it was the case itself or the small group learning that occurred as facilitated by the case.

Other studies have also reported on the effectiveness of CBL in achieving learning outcomes (Bonney, 2015; Breslin, 2008; Herreid, 2013; Krain, 2016). These findings suggest that CBL is a vehicle of engagement for instruction, and facilitates an environment whereby students can construct knowledge.

Science – Students are given a scenario to which they apply their basic science knowledge and problem-solving skills to help them solve the case. One example within the biological sciences is two brothers who have a family history of a genetic illness. They each have mutations within a particular sequence in their DNA. Students work through the case and draw conclusions about the biological impacts of these mutations using basic science. Sample cases: You are Not the Mother of Your Children ; Organic Chemisty and Your Cellphone: Organic Light-Emitting Diodes ;   A Light on Physics: F-Number and Exposure Time

Medicine – Medical or pre-health students read about a patient presenting with specific symptoms. Students decide which questions are important to ask the patient in their medical history, how long they have experienced such symptoms, etc. The case unfolds and students use clinical reasoning, propose relevant tests, develop a differential diagnoses and a plan of treatment. Sample cases: The Case of the Crying Baby: Surgical vs. Medical Management ; The Plan: Ethics and Physician Assisted Suicide ; The Haemophilus Vaccine: A Victory for Immunologic Engineering

Public Health – A case study describes a pandemic of a deadly infectious disease. Students work through the case to identify Patient Zero, the person who was the first to spread the disease, and how that individual became infected.  Sample cases: The Protective Parent ; The Elusive Tuberculosis Case: The CDC and Andrew Speaker ; Credible Voice: WHO-Beijing and the SARS Crisis

Law – A case study presents a legal dilemma for which students use problem solving to decide the best way to advise and defend a client. Students are presented information that changes during the case.  Sample cases: Mortgage Crisis Call (abstract) ; The Case of the Unpaid Interns (abstract) ; Police-Community Dialogue (abstract)

Business – Students work on a case study that presents the history of a business success or failure. They apply business principles learned in the classroom and assess why the venture was successful or not. Sample cases: SELCO-Determining a path forward ; Project Masiluleke: Texting and Testing to Fight HIV/AIDS in South Africa ; Mayo Clinic: Design Thinking in Healthcare

Humanities - Students consider a case that presents a theater facing financial and management difficulties. They apply business and theater principles learned in the classroom to the case, working together to create solutions for the theater. Sample cases: David Geffen School of Drama

Recommendations

Finding and Writing Cases

Consider utilizing or adapting open access cases - The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. Two examples of open databases are the Case Center on Public Leadership and Harvard Kennedy School (HKS) Case Program , which focus on government, leadership and public policy case studies.

  • Consider writing original cases - In the event that an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. See the following resources on case writing: Cooking with Betty Crocker: A Recipe for Case Writing ; The Way of Flesch: The Art of Writing Readable Cases ;   Twixt Fact and Fiction: A Case Writer’s Dilemma ; And All That Jazz: An Essay Extolling the Virtues of Writing Case Teaching Notes .

Implementing Cases

Take baby steps if new to CBL - While entire courses and curricula may involve case-based learning, instructors who desire to implement on a smaller-scale can integrate a single case into their class, and increase the number of cases utilized over time as desired.

Use cases in classes that are small, medium or large - Cases can be scaled to any course size. In large classes with stadium seating, students can work with peers nearby, while in small classes with more flexible seating arrangements, teams can move their chairs closer together. CBL can introduce more noise (and energy) in the classroom to which an instructor often quickly becomes accustomed. Further, students can be asked to work on cases outside of class, and wrap up discussion during the next class meeting.

Encourage collaborative work - Cases present an opportunity for students to work together to solve cases which the historical literature supports as beneficial to student learning (Bruffee, 1993). Allow students to work in groups to answer case questions.

Form diverse teams as feasible - When students work within diverse teams they can be exposed to a variety of perspectives that can help them solve the case. Depending on the context of the course, priorities, and the background information gathered about the students enrolled in the class, instructors may choose to organize student groups to allow for diversity in factors such as current course grades, gender, race/ethnicity, personality, among other items.  

Use stable teams as appropriate - If CBL is a large component of the course, a research-supported practice is to keep teams together long enough to go through the stages of group development: forming, storming, norming, performing and adjourning (Tuckman, 1965).

Walk around to guide groups - In CBL instructors serve as facilitators of student learning. Walking around allows the instructor to monitor student progress as well as identify and support any groups that may be struggling. Teaching assistants can also play a valuable role in supporting groups.

Interrupt strategically - Only every so often, for conversation in large group discussion of the case, especially when students appear confused on key concepts. An effective practice to help students meet case learning goals is to guide them as a whole group when the class is ready. This may include selecting a few student groups to present answers to discussion questions to the entire class, asking the class a question relevant to the case using polling software, and/or performing a mini-lesson on an area that appears to be confusing among students.  

Assess student learning in multiple ways - Students can be assessed informally by asking groups to report back answers to various case questions. This practice also helps students stay on task, and keeps them accountable. Cases can also be included on exams using related scenarios where students are asked to apply their knowledge.

Barrows HS. (1996). Problem-based learning in medicine and beyond: a brief overview. New Directions for Teaching and Learning, 68, 3-12.  

Bonney KM. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains. Journal of Microbiology and Biology Education, 16(1): 21-28.

Breslin M, Buchanan, R. (2008) On the Case Study Method of Research and Teaching in Design.  Design Issues, 24(1), 36-40.

Bruffee KS. (1993). Collaborative learning: Higher education, interdependence, and authority of knowledge. Johns Hopkins University Press, Baltimore, MD.

Herreid CF. (2013). Start with a Story: The Case Study Method of Teaching College Science, edited by Clyde Freeman Herreid. Originally published in 2006 by the National Science Teachers Association (NSTA); reprinted by the National Center for Case Study Teaching in Science (NCCSTS) in 2013.

Herreid CH. (1994). Case studies in science: A novel method of science education. Journal of Research in Science Teaching, 23(4), 221–229.

Jonassen DH and Hernandez-Serrano J. (2002). Case-based reasoning and instructional design: Using stories to support problem solving. Educational Technology, Research and Development, 50(2), 65-77.  

Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. (2005). Oxytocin increases trust in humans. Nature, 435, 673-676.

Krain M. (2016) Putting the learning in case learning? The effects of case-based approaches on student knowledge, attitudes, and engagement. Journal on Excellence in College Teaching, 27(2), 131-153.

Lee V. (2012). What is Inquiry-Guided Learning?  New Directions for Learning, 129:5-14.

Nkhoma M, Sriratanaviriyakul N. (2017). Using case method to enrich students’ learning outcomes. Active Learning in Higher Education, 18(1):37-50.

Srinivasan et al. (2007). Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Academic Medicine, 82(1): 74-82.

Thistlethwaite JE et al. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23.  Medical Teacher, 34, e421-e444.

Tuckman B. (1965). Development sequence in small groups. Psychological Bulletin, 63(6), 384-99.

Williams B. (2005). Case-based learning - a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med, 22, 577-581.

Zak, PJ (2013). How Stories Change the Brain. Retrieved from: https://greatergood.berkeley.edu/article/item/how_stories_change_brain

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Case Study Compilation

The SEL Integration Approach  Case Study Compilation  was developed with and for educators who work in a K-12 school setting, including teachers, paraprofessionals, counselors, SEL Directors, teacher leaders, & school principals, to provide examples of practice related to three questions:

  • What does it mean to focus on social-emotional development and the creation of positive learning environments?
  • How can educators integrate their approaches to social, emotional, and academic development?
  • What does it look, sound, and feel like when SEL is effectively embedded into all elements of the school day?

sample case study education

When read one at a time, the case studies offer snapshots of social-emotional learning in action; they describe daily routines, activities, and teachable moments within short vignettes. When read together, the case studies provide a unique picture of what it takes for a school to integrate social, emotional, and academic learning across grade levels, content areas, and other unique contexts.

The Case Study Compilation includes:

  • Eleven case studies:  Each case study highlights educator ‘moves’ and strategies to embed social-emotional skills, mindsets, and competencies throughout the school day and within academics. They each  conclude with a reflection prompt that challenges readers to examine their own practice. The case studies are written from several different perspectives, including teachers in the classroom and in distance learning environments, a school counselor, and district leaders.
  • Reflection Guide for Professional Learning:  The Reflection Guide offers an entry point for educators to think critically about their work with youth in order to strengthen their practice. School leaders or other partners may choose to use this Reflection Guide in a variety of contexts, including coaching conversations and staff professional development sessions.

View our accompanying Quick Reference Guide , Companion Guides , and Educator & School Leader Self-Reflection Tools .

“We must resist thinking in siloed terms when it comes to social-emotional learning (SEL), academics, and equity. Rather, these elements of our work as educators and partners go hand in hand.”

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In This Article Expand or collapse the "in this article" section Case Study in Education Research

Introduction, general overview and foundational texts of the late 20th century.

  • Conceptualisations and Definitions of Case Study
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Case Study in Education Research by Lorna Hamilton LAST REVIEWED: 27 June 2018 LAST MODIFIED: 27 June 2018 DOI: 10.1093/obo/9780199756810-0201

It is important to distinguish between case study as a teaching methodology and case study as an approach, genre, or method in educational research. The use of case study as teaching method highlights the ways in which the essential qualities of the case—richness of real-world data and lived experiences—can help learners gain insights into a different world and can bring learning to life. The use of case study in this way has been around for about a hundred years or more. Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues. Writers, such as Lawrence Stenhouse, advocated the use of case study as a form that teacher-researchers could use as they focused on the richness and intensity of their own practices. In addition, academic writers and postgraduate students embraced case study as a means of providing structure and depth to educational projects. However, as educational research has developed, so has debate on the quality and usefulness of case study as well as the problems surrounding the lack of generalizability when dealing with single or even multiple cases. The question of how to define and support case study work has formed the basis for innumerable books and discursive articles, starting with Robert Yin’s original book on case study ( Yin 1984 , cited under General Overview and Foundational Texts of the Late 20th Century ) to the myriad authors who attempt to bring something new to the realm of case study in educational research in the 21st century.

This section briefly considers the ways in which case study research has developed over the last forty to fifty years in educational research usage and reflects on whether the field has finally come of age, respected by creators and consumers of research. Case study has its roots in anthropological studies in which a strong ethnographic approach to the study of peoples and culture encouraged researchers to identify and investigate key individuals and groups by trying to understand the lived world of such people from their points of view. Although ethnography has emphasized the role of researcher as immersive and engaged with the lived world of participants via participant observation, evolving approaches to case study in education has been about the richness and depth of understanding that can be gained through involvement in the case by drawing on diverse perspectives and diverse forms of data collection. Embracing case study as a means of entering these lived worlds in educational research projects, was encouraged in the 1970s and 1980s by researchers, such as Lawrence Stenhouse, who provided a helpful impetus for case study work in education ( Stenhouse 1980 ). Stenhouse wrestled with the use of case study as ethnography because ethnographers traditionally had been unfamiliar with the peoples they were investigating, whereas educational researchers often worked in situations that were inherently familiar. Stenhouse also emphasized the need for evidence of rigorous processes and decisions in order to encourage robust practice and accountability to the wider field by allowing others to judge the quality of work through transparency of processes. Yin 1984 , the first book focused wholly on case study in research, gave a brief and basic outline of case study and associated practices. Various authors followed this approach, striving to engage more deeply in the significance of case study in the social sciences. Key among these are Merriam 1988 and Stake 1995 , along with Yin 1984 , who established powerful groundings for case study work. Additionally, evidence of the increasing popularity of case study can be found in a broad range of generic research methods texts, but these often do not have much scope for the extensive discussion of case study found in case study–specific books. Yin’s books and numerous editions provide a developing or evolving notion of case study with more detailed accounts of the possible purposes of case study, followed by Merriam 1988 and Stake 1995 who wrestled with alternative ways of looking at purposes and the positioning of case study within potential disciplinary modes. The authors referenced in this section are often characterized as the foundational authors on this subject and may have published various editions of their work, cited elsewhere in this article, based on their shifting ideas or emphases.

Merriam, S. B. 1988. Case study research in education: A qualitative approach . San Francisco: Jossey-Bass.

This is Merriam’s initial text on case study and is eminently accessible. The author establishes and reinforces various key features of case study; demonstrates support for positioning the case within a subject domain, e.g., psychology, sociology, etc.; and further shapes the case according to its purpose or intent.

Stake, R. E. 1995. The art of case study research . Thousand Oaks, CA: SAGE.

Stake is a very readable author, accessible and yet engaging with complex topics. The author establishes his key forms of case study: intrinsic, instrumental, and collective. Stake brings the reader through the process of conceptualizing the case, carrying it out, and analyzing the data. The author uses authentic examples to help readers understand and appreciate the nuances of an interpretive approach to case study.

Stenhouse, L. 1980. The study of samples and the study of cases. British Educational Research Journal 6:1–6.

DOI: 10.1080/0141192800060101

A key article in which Stenhouse sets out his stand on case study work. Those interested in the evolution of case study use in educational research should consider this article and the insights given.

Yin, R. K. 1984. Case Study Research: Design and Methods . Beverley Hills, CA: SAGE.

This preliminary text from Yin was very basic. However, it may be of interest in comparison with later books because Yin shows the ways in which case study as an approach or method in research has evolved in relation to detailed discussions of purpose, as well as the practicalities of working through the research process.

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Case Studies: Bringing Learning to Life and Making Knowledge Stick

Group of college students working with case studies

Learning by doing is a highly effective and proven strategy for knowledge retention. But sometimes, learning about others who have “done”—using case studies, for example—can be an excellent addition to or replacement for hands-on learning. Case studies―a vital tool in the problem-based learning toolkit—can turbocharge lessons in any subject, but they are particularly useful teaching aids in subjects like Medicine, Law or Forensic Science , where hands-on experiences may not initially be possible.

Here’s a look at how this type of problem-based learning functions to make learning stick and how any faculty member can use them to facilitate deeper, richer learning experiences:

Case studies complement theoretical information 

Reading about scientific principles in a textbook challenges students to think deductively and use their imagination to apply what they’re learning to real-world scenarios. It’s an important skill set. Not all information can or should be packaged up and handed to students, pre-formed; we want students to become critical thinkers and smart decision-makers who are capable of forming their own insights and opinions. 

However, the strategic use of case studies, as a companion to required reading, can help students see theoretical information in a new light, and often for the first time. In short, a case study can bring to life what is often dry and difficult material, transforming it into something powerful, and inspiring students to keep learning. Furthermore, the ability to select or create case studies can give students greater agency in their learning experiences, helping them steer their educational experiences towards topics they find interesting and meaningful. 

What does the research show about using case studies in educational settings? For one, when used in group settings, the use of case studies is proven to promote collaboration while promoting the application of theory. Furthermore, case studies are proven to promote the consideration of diverse cultures, perspectives, and ideas. Beyond that? They help students to broaden their professional acumen —a vitally necessary part of the higher education experience. 

Case studies can be what you want them to be, but they should follow a formula  

Faculty may choose to use case studies in any number of ways, including asking students to read existing case studies, or even challenging them to build their own case studies based on real or hypothetical situations. This can be done individually or in a group. It may be done in the classroom, at home, or in a professional setting. Case studies can take on a wide variety of formats. They may be just a few paragraphs or 30 pages long. They may be prescriptive and challenge readers to create a takeaway or propose a different way of doing things. Or, they may simply ask readers to understand how things were done in a specific case. Beyond written case studies, videos or slide decks can be equally compelling formats. One faculty member even asks students to get theatrical and act out a solution in their sociology class.  

Regardless of format, a case study works best when it roughly follows an arc of problem, solution and results. All case studies must present a problem that doesn’t have an immediately clear solution or result. For example, a medical student may read a case study detailing the hospital admission of a 42-year-old woman who presents to the emergency room with persistent and severe calf pain, but has normal blood tests and ultrasound imaging. What should the physician consider next? A law student might read a case study about an elderly man involved in a car accident who denies any memory of the event. What legal angles should be considered?

Case studies – get started

Are you eager to use case studies with your students? Cengage higher education titles typically contain case studies and real-world examples that bring learning to life and help knowledge stick. Below are some learning materials, spanning a range of subjects, that can help your students reap the proven benefits of case study learning:

Accounting, 29e

Award-winning authors Carl Warren, Jefferson P. Jones and William B. Tayler offer students the opportunity to analyze real-world business decisions and show how accounting is used by real companies.

Guide to Computer Forensics and Investigations, 7e

“Guide to Computer Forensics and Investigations” by Bill Nelson, Amelia Phillips, Christopher Steuart and Robert S. Wilson includes case projects aimed at providing practical implementation experience, as well as practice in applying critical thinking skills.

Business Ethics: Case Studies and Selected Readings, 10e

Marianne M. Jennings’ best-selling “Business Ethics: Case Studies and Selected Readings, 10e” explores a proven process for analyzing ethical dilemmas and creating stronger values.

Anatomy & Physiology, 1e

Author Dr. Liz Co includes a chapter composed entirely of case studies to give students additional practice in critical thinking. The cases can be assigned at the end of the semester or at intervals as the instructor chooses.

Psychopathology and Life: A Dimensional Approach, 11e

Christopher Kearney offers a concise, contemporary and science-based view of psychopathology that emphasizes the individual first. Geared toward cases to which most college students can relate, helping them understand that symptoms of psychological problems occur in many people in different ways.

Understanding Psychological Disorders Enhanced, 12e

In “Understanding Psychological Disorders Enhanced” by David Sue, Derald Sue, Diane M. Sue and Stanley Sue, students can explore current events, real-world case studies and the latest developments from the field.

Policing in the US: Past, Present, and Future, 1e

This comprehensive and timely text by Lorenzo M. Boyd, Melissa S. Morabito and Larry J. Siegel examines the current state of American policing, offering a fresh and balanced look at contemporary issues in law enforcement. Each chapter opens with a real-life case or incident.

Public Speaking: The Evolving Art, 5e

With a student-centered approach, “Public Speaking: The Evolving Art” by Stephanie J. Coopman and James Lull includes innovative solutions to current issues, including critically assessing the credibility of information sources. A diverse collection of sample student and professional presentations encourage students to consider chapter concepts in the context of real speeches.

Theory and Practice of Counseling and Psychotherapies, 11e

Dr. Gerald Corey’s best-selling text helps readers compare and contrast the therapeutic models expressed in counseling theories.

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Organizing Your Social Sciences Research Assignments

  • Annotated Bibliography
  • Analyzing a Scholarly Journal Article
  • Group Presentations
  • Dealing with Nervousness
  • Using Visual Aids
  • Grading Someone Else's Paper
  • Types of Structured Group Activities
  • Group Project Survival Skills
  • Leading a Class Discussion
  • Multiple Book Review Essay
  • Reviewing Collected Works
  • Writing a Case Analysis Paper
  • Writing a Case Study
  • About Informed Consent
  • Writing Field Notes
  • Writing a Policy Memo
  • Writing a Reflective Paper
  • Writing a Research Proposal
  • Generative AI and Writing
  • Acknowledgments

A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate  key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

  • The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
  • The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
  • The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
  • The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
  • The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

  • What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
  • Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
  • What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
  • How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II.  Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and  enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

  • Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
  • Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
  • Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
  • Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
  • Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
  • Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
  • Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III.  Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE:   The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV.  Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V.  Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

  • If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
  • If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
  • Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009;  Kratochwill,  Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education .  Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 :  General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 :  One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 :  The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 :  The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 :  It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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Using Case Study in Education Research

Using Case Study in Education Research

  • Lorna Hamilton - University of Edinburgh, UK
  • Connie Corbett-Whittier - Friends University, Topeka, Kansas
  • Description

This book provides an accessible introduction to using case studies. It makes sense of literature in this area, and shows how to generate collaborations and communicate findings.

The authors bring together the practical and the theoretical, enabling readers to build expertise on the principles and practice of case study research, as well as engaging with possible theoretical frameworks. They also highlight the place of case study as a key component of educational research.

With the help of this book, graduate students, teacher educators and practitioner researchers will gain the confidence and skills needed to design and conduct a high quality case study.

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

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'Drawing on a wide range of their own and others' experiences, the authors offer a comprehensive and convincing account of the value of case study in educational research. What comes across - quite passionately - is the way in which a case study approach can bring to life some of the complexities, challenges and contradictions inherent in educational settings. The book is written in a clear and lively manner and should be an invaluable resource for those teachers and students who are incorporating a case study dimension into their research work' - Ian Menter, Professor of Teacher Education, University of Oxford

'This book is comprehensive in its coverage, yet detailed in its exposition of case study research. It is a highly interactive text with a critical edge and is a useful tool for teaching. It is of particular relevance to practitioner researchers, providing accessible guidance for reflective practice. It covers key matters such as: purposes, ethics, data analysis, technology, dissemination and communities for research. And it is a good read!' - Professor Anne Campbell, formerly of Leeds Metropolitan University

'This excellent book is a principled and theoretically informed guide to case study research design and methods for the collection, analysis and presentation of evidence' -Professor Andrew Pollard, Institute of Educaiton, University of London

This publication provides easy text, giving differing viewpoints to establish definitions for case study research. This book has been recommended to the Fd students to support projects of action research.

This has again been recommended for students on the Foundation Degree and Degree programmes as it is an easy text, providing differing viewpoints to establish definitions for case study research. Additionally recommended on the reading list for the BA programmes to provide a clearer insight into using Case Studies in preschool and school environments.

This is an excellent book - very clear

This text clearly discusses the case study approach and would be useful for both undergraduate and post graduate learners.

An easily accessible text, giving alternative points of view on what case study research actually is and how it might be interpreted at doctoral level.

This is a pleasant read with a number of useful group and individual tasks for students to engage with as they think through designing and doing a project. These tasks for useful not just for case studies but can be adapted as students consider other research designs.

Offers a good understanding of case study research in a clear and accessible manner. A perfect starting point for the researcher new to the case study method and will also offer the experienced researcher some useful tips and insights.

This text is clearly written and argues strongly for using case study in educational research, despite the challenges this approach faces in the dynamic world of shifting research paradigms. Step-by-step guidance from initial ideas through to the reality of undertaking case study in educational research is helpful

The book is written in a practical way, which gives a clear guide for undergraduate students especially for those who are using case study in education research. I will definitely add this book to recommended reading lists.

Preview this book

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Activity 6.20 Questionnaire 2 p110

Activity 6.21 Sample interview teachers

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Frequently Asked Questions

What support can I offer my students around analyzing cases and preparing for discussion?

Case discussions can be a big departure from the norm for students who are used to lecture-based classes. The Case Analysis Coach is an interactive tutorial on reading and analyzing a case study. The Case Study Handbook covers key skills students need to read, understand, discuss and write about cases. The Case Study Handbook is also available as individual chapters to help your students focus on specific skills.

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The case method can be used in an online environment without sacrificing its benefits. We have compiled a few resources to help you create transformative online learning experiences with the case method. Learn how HBS brought the case method online in this podcast , gather some quick guidance from the article " How to Teach Any Case Online ", review the Teaching Cases Online Guide for a deep dive, and check out our Teaching Online Resources Page for more insights and inspiration.

After 35 years as an academic, I have come to the conclusion that there is a magic in the way Harvard cases are written. Cases go from specific to general, to show students that business situations are amenable to hard headed analysis that then generalize to larger theoretical insights. The students love it! Akshay Rao Professor, General Mills Chair in Marketing at the University of Minnesota

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sample case study education

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Case Interview: Complete Prep Guide

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Welcome to our preparation tips for case interviews!  Whether you are just curious about case interviews or are planning to apply for consulting internships or full-time jobs, these tips and resources will help you feel more prepared and confident.

sample case study education

A case interview is a role playing exercise in which an employer assesses how logically and persuasively you can present a case. Rather than seeing if you get the “correct” answer, the objective is to evaluate your thought process. ( Adapted with permission from Case In Point: Complete Case Interview Preparation by Marc Cosentino). 

Case interviews are very commonly used in the interview process for consulting firms and companies in similar industries. In the case interview, you will typically be given a business problem and then asked to solve it in a structured way. Learning this structure takes preparation and practice. You can learn more and practice using the resources listed below.  

Why are Case Interviews Used?

Case interviews allow employers to test and evaluate the following skills:

  • Analytical skills and logical ability to solve problems
  • Structure and thought process
  • Ability to ask for relevant data/information
  • Tolerance for ambiguity and data overload
  • Poise and communication skills under pressure and in front of a client

How can I prepare for Case Interviews?

1.) Read Management Consulted’s “Case Interview: Complete Prep Guide (2024)”

Management Consulted is a FREE resource for Tufts students : case and consulting resources such as 500 sample cases, Case Interview Bootcamp,  Market Sizing Drills, Math Drills, case videos, consulting firm directory, and more

2.) Review additional resources:

  • Case in Point – This book, by Marc Cosentino, is a comprehensive guide that walks you through the case interview process from beginning to end. This guide has helped many students over the years and can serve as an excellent foundation for how to approach business problems
  • Casequestions.com – The companion website to Marc Cosentino’s book listed above offers preparation for case interviews, along with links to top 50 consulting firms
  • Management Consulting Case Interviews: Cracking The Case – tips for case interviews from the other side of the table, from Argopoint, a Boston management consulting firm specializing in legal department consulting for Fortune 500 companies
  • Preplounge.com – Free case preparation access for to up to 6 practice interviews with peers, selected cases, and video case solutions
  • RocketBlocks – Features consulting preparation such as drills and coaching
  • Practice sample online cases on consulting firm websites such as McKinsey , BCG , Bain , Deloitte and more!  

3.) Schedule a mock case interview appointment with  Karen Dankers or Kathy Spillane , our advisors for the Finance, Consulting, Entrepreneurship, and Business Career Community.

4.) PRACTICE PRACTICE PRACTICE cases out loud on your own (yes, that can feel odd) or preferably, with another person. See #2 and #3 above for resources and ideas to find partners to practice live cases

5.) Enjoy and have fun solving business problems!

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  • Open access
  • Published: 14 May 2024

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

  • Jocelyn Schroeder 1 ,
  • Barbara Pesut 1 , 2 ,
  • Lise Olsen 2 ,
  • Nelly D. Oelke 2 &
  • Helen Sharp 2  

BMC Nursing volume  23 , Article number:  326 ( 2024 ) Cite this article

Metrics details

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.

The design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

During phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.

Systematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.

The survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Peer Review reports

Medical Assistance in Dying (MAiD) is permitted under an amendment to Canada’s Criminal Code which was passed in 2016 [ 1 ]. MAiD is defined in the legislation as both self-administered and clinician-administered medication for the purpose of causing death. In the 2016 Bill C-14 legislation one of the eligibility criteria was that an applicant for MAiD must have a reasonably foreseeable natural death although this term was not defined. It was left to the clinical judgement of MAiD assessors and providers to determine the time frame that constitutes reasonably foreseeable [ 2 ]. However, in 2021 under Bill C-7, the eligibility criteria for MAiD were changed to allow individuals with irreversible medical conditions, declining health, and suffering, but whose natural death was not reasonably foreseeable, to receive MAiD [ 3 ]. This population of MAiD applicants are referred to as Track 2 MAiD (those whose natural death is foreseeable are referred to as Track 1). Track 2 applicants are subject to additional safeguards under the 2021 C-7 legislation.

Three additional proposed changes to the legislation have been extensively studied by Canadian Expert Panels (Council of Canadian Academics [CCA]) [ 4 , 5 , 6 ] First, under the legislation that defines Track 2, individuals with mental disease as their sole underlying medical condition may apply for MAiD, but implementation of this practice is embargoed until March 2027 [ 4 ]. Second, there is consideration of allowing MAiD to be implemented through advanced consent. This would make it possible for persons living with dementia to receive MAID after they have lost the capacity to consent to the procedure [ 5 ]. Third, there is consideration of extending MAiD to mature minors. A mature minor is defined as “a person under the age of majority…and who has the capacity to understand and appreciate the nature and consequences of a decision” ([ 6 ] p. 5). In summary, since the legalization of MAiD in 2016 the eligibility criteria and safeguards have evolved significantly with consequent implications for nurses and nursing care. Further, the number of Canadians who access MAiD shows steady increases since 2016 [ 7 ] and it is expected that these increases will continue in the foreseeable future.

Nurses have been integral to MAiD care in the Canadian context. While other countries such as Belgium and the Netherlands also permit euthanasia, Canada is the first country to allow Nurse Practitioners (Registered Nurses with additional preparation typically achieved at the graduate level) to act independently as assessors and providers of MAiD [ 1 ]. Although the role of Registered Nurses (RNs) in MAiD is not defined in federal legislation, it has been addressed at the provincial/territorial-level with variability in scope of practice by region [ 8 , 9 ]. For example, there are differences with respect to the obligation of the nurse to provide information to patients about MAiD, and to the degree that nurses are expected to ensure that patient eligibility criteria and safeguards are met prior to their participation [ 10 ]. Studies conducted in the Canadian context indicate that RNs perform essential roles in MAiD care coordination; client and family teaching and support; MAiD procedural quality; healthcare provider and public education; and bereavement care for family [ 9 , 11 ]. Nurse practitioners and RNs are integral to a robust MAiD care system in Canada and hence need to be well-prepared for their role [ 12 ].

Previous studies have found that end of life care, and MAiD specifically, raise complex moral and ethical issues for nurses [ 13 , 14 , 15 , 16 ]. The knowledge, attitudes, and beliefs of nurses are important across practice settings because nurses have consistent, ongoing, and direct contact with patients who experience chronic or life-limiting health conditions. Canadian studies exploring nurses’ moral and ethical decision-making in relation to MAiD reveal that although some nurses are clear in their support for, or opposition to, MAiD, others are unclear on what they believe to be good and right [ 14 ]. Empirical findings suggest that nurses go through a period of moral sense-making that is often informed by their family, peers, and initial experiences with MAID [ 17 , 18 ]. Canadian legislation and policy specifies that nurses are not required to participate in MAiD and may recuse themselves as conscientious objectors with appropriate steps to ensure ongoing and safe care of patients [ 1 , 19 ]. However, with so many nurses having to reflect on and make sense of their moral position, it is essential that they are given adequate time and preparation to make an informed and thoughtful decision before they participate in a MAID death [ 20 , 21 ].

It is well established that nursing students receive inconsistent exposure to end of life care issues [ 22 ] and little or no training related to MAiD [ 23 ]. Without such education and reflection time in pre-entry nursing preparation, nurses are at significant risk for moral harm. An important first step in providing this preparation is to be able to assess the knowledge, values, and beliefs of nursing students regarding MAID and end of life care. As demand for MAiD increases along with the complexities of MAiD, it is critical to understand the knowledge, attitudes, and likelihood of engagement with MAiD among nursing students as a baseline upon which to build curriculum and as a means to track these variables over time.

Aim, design, and setting

The aim of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context. We sought to explore both their willingness to be involved in the registered nursing role and in the nurse practitioner role should they chose to prepare themselves to that level of education. The design was a mixed-method, modified e-Delphi method that entailed item generation, item refinement through an expert faculty panel [ 24 , 25 , 26 ], and initial item validation through a cognitive focus group interview with nursing students [ 27 ]. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

Participants

A panel of 10 faculty from the two nursing education programs were recruited for Phase 2 of the e-Delphi. To be included, faculty were required to have a minimum of three years of experience in nurse education, be employed as nursing faculty, and self-identify as having experience with MAiD. A convenience sample of 5 fourth-year nursing students were recruited to participate in Phase 3. Students had to be in good standing in the nursing program and be willing to share their experiences of the survey in an online group interview format.

The modified e-Delphi was conducted in 3 phases: Phase 1 entailed item generation through literature and existing survey review. Phase 2 entailed item refinement through a faculty expert panel review with focus on content validity, prioritization, and revision of item wording [ 25 ]. Phase 3 entailed an assessment of face validity through focus group-based cognitive interview with nursing students.

Phase I. Item generation through literature review

The goal of phase 1 was to develop a bank of survey items that would represent the variables of interest and which could be provided to expert faculty in Phase 2. Initial survey items were generated through a literature review of similar surveys designed to assess knowledge and attitudes toward MAiD/euthanasia in healthcare providers; Canadian empirical studies on nurses’ roles and/or experiences with MAiD; and legislative and expert panel documents that outlined proposed changes to the legislative eligibility criteria and safeguards. The literature review was conducted in three online databases: CINAHL, PsycINFO, and Medline. Key words for the search included nurses , nursing students , medical students , NPs, MAiD , euthanasia , assisted death , and end-of-life care . Only articles written in English were reviewed. The legalization and legislation of MAiD is new in many countries; therefore, studies that were greater than twenty years old were excluded, no further exclusion criteria set for country.

Items from surveys designed to measure similar variables in other health care providers and geographic contexts were placed in a table and similar items were collated and revised into a single item. Then key variables were identified from the empirical literature on nurses and MAiD in Canada and checked against the items derived from the surveys to ensure that each of the key variables were represented. For example, conscientious objection has figured prominently in the Canadian literature, but there were few items that assessed knowledge of conscientious objection in other surveys and so items were added [ 15 , 21 , 28 , 29 ]. Finally, four case studies were added to the survey to address the anticipated changes to the Canadian legislation. The case studies were based upon the inclusion of mature minors, advanced consent, and mental disorder as the sole underlying medical condition. The intention was to assess nurses’ beliefs and comfort with these potential legislative changes.

Phase 2. Item refinement through expert panel review

The goal of phase 2 was to refine and prioritize the proposed survey items identified in phase 1 using a modified e-Delphi approach to achieve consensus among an expert panel [ 26 ]. Items from phase 1 were presented to an expert faculty panel using a Qualtrics (Provo, UT) online survey. Panel members were asked to review each item to determine if it should be: included, excluded or adapted for the survey. When adapted was selected faculty experts were asked to provide rationale and suggestions for adaptation through the use of an open text box. Items that reached a level of 75% consensus for either inclusion or adaptation were retained [ 25 , 26 ]. New items were categorized and added, and a revised survey was presented to the panel of experts in round 2. Panel members were again asked to review items, including new items, to determine if it should be: included, excluded, or adapted for the survey. Round 2 of the modified e-Delphi approach also included an item prioritization activity, where participants were then asked to rate the importance of each item, based on a 5-point Likert scale (low to high importance), which De Vaus [ 30 ] states is helpful for increasing the reliability of responses. Items that reached a 75% consensus on inclusion were then considered in relation to the importance it was given by the expert panel. Quantitative data were managed using SPSS (IBM Corp).

Phase 3. Face validity through cognitive interviews with nursing students

The goal of phase 3 was to obtain initial face validity of the proposed survey using a sample of nursing student informants. More specifically, student participants were asked to discuss how items were interpreted, to identify confusing wording or other problematic construction of items, and to provide feedback about the survey as a whole including readability and organization [ 31 , 32 , 33 ]. The focus group was held online and audio recorded. A semi-structured interview guide was developed for this study that focused on clarity, meaning, order and wording of questions; emotions evoked by the questions; and overall survey cohesion and length was used to obtain data (see Supplementary Material 2  for the interview guide). A prompt to “think aloud” was used to limit interviewer-imposed bias and encourage participants to describe their thoughts and response to a given item as they reviewed survey items [ 27 ]. Where needed, verbal probes such as “could you expand on that” were used to encourage participants to expand on their responses [ 27 ]. Student participants’ feedback was collated verbatim and presented to the research team where potential survey modifications were negotiated and finalized among team members. Conventional content analysis [ 34 ] of focus group data was conducted to identify key themes that emerged through discussion with students. Themes were derived from the data by grouping common responses and then using those common responses to modify survey items.

Ten nursing faculty participated in the expert panel. Eight of the 10 faculty self-identified as female. No faculty panel members reported conscientious objector status and ninety percent reported general agreement with MAiD with one respondent who indicated their view as “unsure.” Six of the 10 faculty experts had 16 years of experience or more working as a nurse educator.

Five nursing students participated in the cognitive interview focus group. The duration of the focus group was 2.5 h. All participants identified that they were born in Canada, self-identified as female (one preferred not to say) and reported having received some instruction about MAiD as part of their nursing curriculum. See Tables  1 and 2 for the demographic descriptors of the study sample. Study results will be reported in accordance with the study phases. See Fig.  1 for an overview of the results from each phase.

figure 1

Fig. 1  Overview of survey development findings

Phase 1: survey item generation

Review of the literature identified that no existing survey was available for use with nursing students in the Canadian context. However, an analysis of themes across qualitative and quantitative studies of physicians, medical students, nurses, and nursing students provided sufficient data to develop a preliminary set of items suitable for adaptation to a population of nursing students.

Four major themes and factors that influence knowledge, attitudes, and beliefs about MAiD were evident from the literature: (i) endogenous or individual factors such as age, gender, personally held values, religion, religiosity, and/or spirituality [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], (ii) experience with death and dying in personal and/or professional life [ 35 , 40 , 41 , 43 , 44 , 45 ], (iii) training including curricular instruction about clinical role, scope of practice, or the law [ 23 , 36 , 39 ], and (iv) exogenous or social factors such as the influence of key leaders, colleagues, friends and/or family, professional and licensure organizations, support within professional settings, and/or engagement in MAiD in an interdisciplinary team context [ 9 , 35 , 46 ].

Studies of nursing students also suggest overlap across these categories. For example, value for patient autonomy [ 23 ] and the moral complexity of decision-making [ 37 ] are important factors that contribute to attitudes about MAiD and may stem from a blend of personally held values coupled with curricular content, professional training and norms, and clinical exposure. For example, students report that participation in end of life care allows for personal growth, shifts in perception, and opportunities to build therapeutic relationships with their clients [ 44 , 47 , 48 ].

Preliminary items generated from the literature resulted in 56 questions from 11 published sources (See Table  3 ). These items were constructed across four main categories: (i) socio-demographic questions; (ii) end of life care questions; (iii) knowledge about MAiD; or (iv) comfort and willingness to participate in MAiD. Knowledge questions were refined to reflect current MAiD legislation, policies, and regulatory frameworks. Falconer [ 39 ] and Freeman [ 45 ] studies were foundational sources for item selection. Additionally, four case studies were written to reflect the most recent anticipated changes to MAiD legislation and all used the same open-ended core questions to address respondents’ perspectives about the patient’s right to make the decision, comfort in assisting a physician or NP to administer MAiD in that scenario, and hypothesized comfort about serving as a primary provider if qualified as an NP in future. Response options for the survey were also constructed during this stage and included: open text, categorical, yes/no , and Likert scales.

Phase 2: faculty expert panel review

Of the 56 items presented to the faculty panel, 54 questions reached 75% consensus. However, based upon the qualitative responses 9 items were removed largely because they were felt to be repetitive. Items that generated the most controversy were related to measuring religion and spirituality in the Canadian context, defining end of life care when there is no agreed upon time frames (e.g., last days, months, or years), and predicting willingness to be involved in a future events – thus predicting their future selves. Phase 2, round 1 resulted in an initial set of 47 items which were then presented back to the faculty panel in round 2.

Of the 47 initial questions presented to the panel in round 2, 45 reached a level of consensus of 75% or greater, and 34 of these questions reached a level of 100% consensus [ 27 ] of which all participants chose to include without any adaptations) For each question, level of importance was determined based on a 5-point Likert scale (1 = very unimportant, 2 = somewhat unimportant, 3 = neutral, 4 = somewhat important, and 5 = very important). Figure  2 provides an overview of the level of importance assigned to each item.

figure 2

Ranking level of importance for survey items

After round 2, a careful analysis of participant comments and level of importance was completed by the research team. While the main method of survey item development came from participants’ response to the first round of Delphi consensus ratings, level of importance was used to assist in the decision of whether to keep or modify questions that created controversy, or that rated lower in the include/exclude/adapt portion of the Delphi. Survey items that rated low in level of importance included questions about future roles, sex and gender, and religion/spirituality. After deliberation by the research committee, these questions were retained in the survey based upon the importance of these variables in the scientific literature.

Of the 47 questions remaining from Phase 2, round 2, four were revised. In addition, the two questions that did not meet the 75% cut off level for consensus were reviewed by the research team. The first question reviewed was What is your comfort level with providing a MAiD death in the future if you were a qualified NP ? Based on a review of participant comments, it was decided to retain this question for the cognitive interviews with students in the final phase of testing. The second question asked about impacts on respondents’ views of MAiD and was changed from one item with 4 subcategories into 4 separate items, resulting in a final total of 51 items for phase 3. The revised survey was then brought forward to the cognitive interviews with student participants in Phase 3. (see Supplementary Material 1 for a complete description of item modification during round 2).

Phase 3. Outcomes of cognitive interview focus group

Of the 51 items reviewed by student participants, 29 were identified as clear with little or no discussion. Participant comments for the remaining 22 questions were noted and verified against the audio recording. Following content analysis of the comments, four key themes emerged through the student discussion: unclear or ambiguous wording; difficult to answer questions; need for additional response options; and emotional response evoked by questions. An example of unclear or ambiguous wording was a request for clarity in the use of the word “sufficient” in the context of assessing an item that read “My nursing education has provided sufficient content about the nursing role in MAiD.” “Sufficient” was viewed as subjective and “laden with…complexity that distracted me from the question.” The group recommended rewording the item to read “My nursing education has provided enough content for me to care for a patient considering or requesting MAiD.”

An example of having difficulty answering questions related to limited knowledge related to terms used in the legislation such as such as safeguards , mature minor , eligibility criteria , and conscientious objection. Students were unclear about what these words meant relative to the legislation and indicated that this lack of clarity would hamper appropriate responses to the survey. To ensure that respondents are able to answer relevant questions, student participants recommended that the final survey include explanation of key terms such as mature minor and conscientious objection and an overview of current legislation.

Response options were also a point of discussion. Participants noted a lack of distinction between response options of unsure and unable to say . Additionally, scaling of attitudes was noted as important since perspectives about MAiD are dynamic and not dichotomous “agree or disagree” responses. Although the faculty expert panel recommended the integration of the demographic variables of religious and/or spiritual remain as a single item, the student group stated a preference to have religion and spirituality appear as separate items. The student focus group also took issue with separate items for the variables of sex and gender, specifically that non-binary respondents might feel othered or “outed” particularly when asked to identify their sex. These variables had been created based upon best practices in health research but students did not feel they were appropriate in this context [ 49 ]. Finally, students agreed with the faculty expert panel in terms of the complexity of projecting their future involvement as a Nurse Practitioner. One participant stated: “I certainly had to like, whoa, whoa, whoa. Now let me finish this degree first, please.” Another stated, “I'm still imagining myself, my future career as an RN.”

Finally, student participants acknowledged the array of emotions that some of the items produced for them. For example, one student described positive feelings when interacting with the survey. “Brought me a little bit of feeling of joy. Like it reminded me that this is the last piece of independence that people grab on to.” Another participant, described the freedom that the idea of an advance request gave her. “The advance request gives the most comfort for me, just with early onset Alzheimer’s and knowing what it can do.” But other participants described less positive feelings. For example, the mature minor case study yielded a comment: “This whole scenario just made my heart hurt with the idea of a child requesting that.”

Based on the data gathered from the cognitive interview focus group of nursing students, revisions were made to 11 closed-ended questions (see Table  4 ) and 3 items were excluded. In the four case studies, the open-ended question related to a respondents’ hypothesized actions in a future role as NP were removed. The final survey consists of 45 items including 4 case studies (see Supplementary Material 3 ).

The aim of this study was to develop and validate a survey that can be used to track the growth of knowledge about MAiD among nursing students over time, inform training programs about curricular needs, and evaluate attitudes and willingness to participate in MAiD at time-points during training or across nursing programs over time.

The faculty expert panel and student participants in the cognitive interview focus group identified a need to establish core knowledge of the terminology and legislative rules related to MAiD. For example, within the cognitive interview group of student participants, several acknowledged lack of clear understanding of specific terms such as “conscientious objector” and “safeguards.” Participants acknowledged discomfort with the uncertainty of not knowing and their inclination to look up these terms to assist with answering the questions. This survey can be administered to nursing or pre-nursing students at any phase of their training within a program or across training programs. However, in doing so it is important to acknowledge that their baseline knowledge of MAiD will vary. A response option of “not sure” is important and provides a means for respondents to convey uncertainty. If this survey is used to inform curricular needs, respondents should be given explicit instructions not to conduct online searches to inform their responses, but rather to provide an honest appraisal of their current knowledge and these instructions are included in the survey (see Supplementary Material 3 ).

Some provincial regulatory bodies have established core competencies for entry-level nurses that include MAiD. For example, the BC College of Nurses and Midwives (BCCNM) requires “knowledge about ethical, legal, and regulatory implications of medical assistance in dying (MAiD) when providing nursing care.” (10 p. 6) However, across Canada curricular content and coverage related to end of life care and MAiD is variable [ 23 ]. Given the dynamic nature of the legislation that includes portions of the law that are embargoed until 2024, it is important to ensure that respondents are guided by current and accurate information. As the law changes, nursing curricula, and public attitudes continue to evolve, inclusion of core knowledge and content is essential and relevant for investigators to be able to interpret the portions of the survey focused on attitudes and beliefs about MAiD. Content knowledge portions of the survey may need to be modified over time as legislation and training change and to meet the specific purposes of the investigator.

Given the sensitive nature of the topic, it is strongly recommended that surveys be conducted anonymously and that students be provided with an opportunity to discuss their responses to the survey. A majority of feedback from both the expert panel of faculty and from student participants related to the wording and inclusion of demographic variables, in particular religion, religiosity, gender identity, and sex assigned at birth. These and other demographic variables have the potential to be highly identifying in small samples. In any instance in which the survey could be expected to yield demographic group sizes less than 5, users should eliminate the demographic variables from the survey. For example, the profession of nursing is highly dominated by females with over 90% of nurses who identify as female [ 50 ]. Thus, a survey within a single class of students or even across classes in a single institution is likely to yield a small number of male respondents and/or respondents who report a difference between sex assigned at birth and gender identity. When variables that serve to identify respondents are included, respondents are less likely to complete or submit the survey, to obscure their responses so as not to be identifiable, or to be influenced by social desirability bias in their responses rather than to convey their attitudes accurately [ 51 ]. Further, small samples do not allow for conclusive analyses or interpretation of apparent group differences. Although these variables are often included in surveys, such demographics should be included only when anonymity can be sustained. In small and/or known samples, highly identifying variables should be omitted.

There are several limitations associated with the development of this survey. The expert panel was comprised of faculty who teach nursing students and are knowledgeable about MAiD and curricular content, however none identified as a conscientious objector to MAiD. Ideally, our expert panel would have included one or more conscientious objectors to MAiD to provide a broader perspective. Review by practitioners who participate in MAiD, those who are neutral or undecided, and practitioners who are conscientious objectors would ensure broad applicability of the survey. This study included one student cognitive interview focus group with 5 self-selected participants. All student participants had held discussions about end of life care with at least one patient, 4 of 5 participants had worked with a patient who requested MAiD, and one had been present for a MAiD death. It is not clear that these participants are representative of nursing students demographically or by experience with end of life care. It is possible that the students who elected to participate hold perspectives and reflections on patient care and MAiD that differ from students with little or no exposure to end of life care and/or MAiD. However, previous studies find that most nursing students have been involved with end of life care including meaningful discussions about patients’ preferences and care needs during their education [ 40 , 44 , 47 , 48 , 52 ]. Data collection with additional student focus groups with students early in their training and drawn from other training contexts would contribute to further validation of survey items.

Future studies should incorporate pilot testing with small sample of nursing students followed by a larger cross-program sample to allow evaluation of the psychometric properties of specific items and further refinement of the survey tool. Consistent with literature about the importance of leadership in the context of MAiD [ 12 , 53 , 54 ], a study of faculty knowledge, beliefs, and attitudes toward MAiD would provide context for understanding student perspectives within and across programs. Additional research is also needed to understand the timing and content coverage of MAiD across Canadian nurse training programs’ curricula.

The implementation of MAiD is complex and requires understanding of the perspectives of multiple stakeholders. Within the field of nursing this includes clinical providers, educators, and students who will deliver clinical care. A survey to assess nursing students’ attitudes toward and willingness to participate in MAiD in the Canadian context is timely, due to the legislation enacted in 2016 and subsequent modifications to the law in 2021 with portions of the law to be enacted in 2027. Further development of this survey could be undertaken to allow for use in settings with practicing nurses or to allow longitudinal follow up with students as they enter practice. As the Canadian landscape changes, ongoing assessment of the perspectives and needs of health professionals and students in the health professions is needed to inform policy makers, leaders in practice, curricular needs, and to monitor changes in attitudes and practice patterns over time.

Availability of data and materials

The datasets used and/or analysed during the current study are not publicly available due to small sample sizes, but are available from the corresponding author on reasonable request.

Abbreviations

British Columbia College of Nurses and Midwives

Medical assistance in dying

Nurse practitioner

Registered nurse

University of British Columbia Okanagan

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We would like to acknowledge the faculty and students who generously contributed their time to this work.

JS received a student traineeship through the Principal Research Chairs program at the University of British Columbia Okanagan.

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Schroeder, J., Pesut, B., Olsen, L. et al. Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study. BMC Nurs 23 , 326 (2024). https://doi.org/10.1186/s12912-024-01984-z

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Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study

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  • Hülya Türkmen   ORCID: orcid.org/0000-0001-6187-9352 1 ,
  • Bihter Akın   ORCID: orcid.org/0000-0002-3591-3630 2 &
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The study aimed to determine the effects of high-risk pregnancy on prenatal stress levels. The study was conducted with a case-control design in Turkey in September-December 2019. The sample included pregnant women diagnosed with high-risk pregnancy and were at their 36th or later gestational weeks as the case group ( n  = 121) and healthy pregnant women as the control group ( n  = 245). The Antenatal Perceived Stress Inventory (APSI) and the Revised Prenatal Distress Questionnaire (NUPDQ-17 Item Version) were used to assess the stress levels of the participants in the study. It was determined that high-risk pregnancy was associated with higher rates of prenatal stress (APSI: p  < 0.001, effect size = 0.388; NUPDQ: p  = 0.002, effect size = 0.272) compared to the control group. The results of the linear regression analysis showed that high-risk pregnancy affected APSI (R 2  = 0.043, p  < 0.001) and NUPDQ (R 2  = 0.033, p  = 0.009) scores, but education levels, number of pregnancies, and number of abortions did not affect APSI and NUPDQ scores. According to the results of this study, high-risk pregnant women are in a risk group for stress. It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category and provide psychological support to pregnant women who have high stress levels or are hospitalized.

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Introduction

A high-risk pregnancy is a significant health problem that threatens the health of the pregnant woman, the health of her fetus, and ultimately the health of her newborn, increases the risk of morbidity and mortality, and has physiological, psychological, social, and economic aspects (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ). Chronic diseases existing before pregnancy and problems that arise during pregnancy can make a pregnancy risky. Pregnant women with gestational diabetes mellitus, preeclampsia/eclampsia, potential threat of preterm labor, cervical insufficiency, premature rupture of membranes, vaginal bleeding, Rh incompatibility, intrauterine growth retardation, and infections are in the high-risk category (Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; ACOG, 2019 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ; ACOG, 2018 ).

Approximately 10% of all pregnancies in the world are considered to be in the high-risk category (Cincioğlu et al., 2020 ; Gourounti et al., 2015a , b ; Göüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ). According to Turkey Demographic and Health Survey (TNSA) 2018 data, 35% of pregnancies in Turkey are in the high-risk category (Hacettepe University Institute of Population Studies, 2019 ).

Good mental health during pregnancy is important for the health of both the pregnant woman and her fetus (Gümüşdaş et al., 2014 ). In a high-risk pregnancy, the normal outcome of the pregnancy and the birth of a healthy baby are threatened. These pregnant women have a variety of health needs that must be met. If these needs are not met, the mother may experience extreme stress and anxiety (Ölçer & Oskay, 2015 ). In the case of intense stress caused by the risks of pregnancy, the elevation of catecholamines such as cortisol and epinephrine may increase the possibility of pregnancy complications (e.g., preeclampsia) and adversely affect pregnancy outcomes (e.g., intrauterine growth retardation) (Atasever & Çelik, 2018 ; Cetin et al., 2017 ; Deshpande, 2016 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2013 ). Moreover, newborns exposed to extreme stress during the intrauterine period may have permanent health problems later in their lives (Graignic-Philippe et al., 2014 ; MacKinnon et al., 2018 ; Van De Loo et al., 2016 ).

It is seen that distress in pregnancy has a high prevalence ranging between 11.9% and 63.5% in studies conducted in Turkey (Yüksel et al., 2013 ; Çapık et al., 2015 ; Gözüyeşil & Düzgün, 2021 ). It is very important that health professionals identify pregnant women at risk of stress to ensure a healthy pregnancy process and protect the fetus and newborn from the harmful effects of stress. This way, more careful monitoring of pregnant women at risk of stress can be ensured, and the negative consequences of stress can be prevented with appropriate interventions (Williamson et al., 2023 ; Atasever & Çelik, 2018 ; Pinar et al., 2022 ). It is reported in the international literature that mental problems such as anxiety and stress are more common in high-risk pregnancies than in healthy pregnancies (Byatt et al., 2014 ; Abedian et al., 2015 ; Gourounti et al., 2015a , b ). In Turkey, there are few studies examining the prenatal stress levels of high-risk pregnant women. However, in these studies, the prenatal stress levels of women with healthy and high-risk pregnancies were not compared, and only the stress levels of high-risk pregnancies were determined (Gözüyeşil & Düzgün, 2021 ; Üzar-Özçetin & Erkan, 2019 ). Current evidence indicates that studies describing the concept of prenatal stress in high-risk pregnancies with different diagnoses are needed to learn more about the complex aspects of prenatal stress and identify the sociodemographic and obstetric factors that may lead to high-risk pregnancies for early diagnosis (Pinar et al., 2022 ; Hung et al., 2021 ; Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ). For this reason, it is thought that this study will guide healthcare professionals who provide care for women with high-risk pregnancies about the services they will provide.

This study aims to prospectively determine the effects of high-risk pregnancies on prenatal stress levels compared to healthy pregnant women, using two different measurement instruments.

Materials and methods

Research questions.

Does high-risk pregnancy have an impact on prenatal stress?

What are the factors affecting the prenatal distress levels of women diagnosed with high-risk pregnancy?

Is there a difference in prenatal stress levels among different high-risk pregnancy diagnoses?

Design and settings

This case-control study was conducted to determine the difference between the stress levels of women with healthy and high-risk pregnancies. In other words, it was aimed to determine the suspected causal effect of high-risk pregnancy on prenatal stress levels. This case-control study was carried out between September and December 2019 at the Obstetrics and Gynecology Inpatient and Outpatient Clinics of Atatürk City Hospital in the Balıkesir province of Turkey. The case and control groups included women who were selected from the same hospital.

The hospital where the study was conducted hosted a total of 4,152 deliveries in 2018. Approximately 10% of all pregnancies are considered to be in the high-risk category (Sinaci et al., 2020 ). The sample size required to conduct the study was calculated as 134 high-risk pregnant women using the Epi Info StatCalc program based on an assumed population size of 4152, prevalence of 10%, margin of error of 5%, and in a 95% confidence interval. The study was completed with a total of 384 pregnant women, including 134 high-risk pregnant women and 250 healthy pregnant women, who accepted to participate in the study and filled out the consent form. However, the data of 13 pregnant women in the case group and 5 pregnant women in the control group were excluded from the study because they filled out the data collection forms incompletely. For the case group ( n  = 121), the post hoc power analysis (G*Power 3.1) revealed a medium effect size and a power of 0.421.

The inclusion criteria of the study were being in a gestational week further than 36 weeks, not having a psychiatric diagnosis, and being 18 years old or order. Pregnant women who were hospitalized in the Obstetrics and Gynecology Inpatient Clinic, were diagnosed with high-risk pregnancy by a physician, and met the inclusion criteria were included in the high-risk pregnancy group. In the control group, pregnant women who were healthy, were at or above their 36th gestational week, and visited the Outpatient Clinics were included. Women who wanted to leave the study or responded incompletely to the data collection forms were excluded. After those who met the inclusion criteria were included, no pregnant women withdrew from the study by their own accord. However, 18 pregnant women were excluded from the study because they filled out the forms incompletely.

High-risk pregnancies were defined as the presence of one or more of the following: pre-existing chronic diseases, preeclampsia, gestational diabetes mellitus (GDM), vaginal bleeding, placenta previa, threat of preterm labor, premature rupture of membranes, intrauterine growth retardation (IUGR), fetal anomaly/distress, multiple pregnancy, polyhydramnios/oligohydramnios, Rh incompatibility, and infectious diseases (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ).

Data collection

A Personal Information Form, the Antenatal Perceived Stress Inventory, and the Prenatal Distress Questionnaire were administered to the participants. The participants were informed about the study, the purpose of the study was explained to them, and their written consent was obtained. The data collection forms were administered to the participants by the first author. The data were collected based on the self-reports of the participants. The data collection period was between September and December 2019. The interviews lasted about 15 min for each participant.

Personal information form

The form which was prepared by the researchers in line with the literature consisted of a total of 20 questions on some characteristics of the participants, including their sociodemographic characteristics and obstetric history (Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ).

Antenatal perceived stress inventory (APSI)

The Turkish validity and reliability study of the inventory developed by Razurel et al. ( 2014 ) to assess perceived stress in the prenatal period was performed by Atasever and Çelik ( 2018 ). The inventory is applied to pregnant women at the 36th -39th gestational weeks. It is a 5-point Likert-type scale (very much = 5 points, much = 4 points, quite = 3 points, a little = 2 points, none = 1 point) and consists of 12 items and 3 dimensions. Its dimensions are Medical and Obstetric Risks/Fetal Health, Psychosocial Changes during Pregnancy, and Prospect of Childbirth. The minimum and maximum scores that can be obtained from the inventory are 12 and 60. High scores indicate high levels of stress perceived by pregnant women. In the study conducted by Atasever and Çelik, Cronbach’s alpha internal consistency coefficient for APSI was found to be 0.70, while this coefficient was found as 0.81 in this study.

Revised prenatal distress questionnaire ((NUPDQ)-17 Item Version)

The questionnaire developed by Yali and Lobel ( 1999 ) to determine the levels of stress experienced by women regarding pregnancy-related issues was revised by Lobel ( 2008 ). The Turkish validity and reliability study of the questionnaire was performed by Yüksel et al. ( 2011 ). The questionnaire is in the form of a 3-point Likert-type scale (very much = 2 points, a little = 1 point, none = 0 point) and consists of 17 items. The questionnaire is unidimensional. The minimum and maximum scores that can be obtained from the questionnaire are 0 and 34. High scores indicate that pregnant women have high levels of prenatal distress. Cronbach’s alpha internal consistency coefficient for NUPDQ was found to be 0.85 in the study performed by Yüksel et al., while it was found as 0.82 in this study.

Statistical analysis

Frequency, percentage, mean, and standard deviation values were used in the data analyses. Whether the data had normal distribution was tested using the Kolmogorov-Smirnov test. The Chi-squared test and independent-samples t-test methods were used to identify the differences between groups in terms of the sociodemographic and obstetric information of the participants. The Mann-Whitney U Test was used to determine the differences between the case and control groups in terms of their total APSI, APSI subscale, and total NUPDQ scores. The Type I error level was accepted as p  < 0.05. A Cohen’s d value of 0.20 is considered to indicate a small effect size, a value of 0.50 is considered to show a medium effect size, and a value of 0.80 or greater is interpreted as a large effect size (Özsoy & Özsoy, 2013 ). Since education, number of pregnancies, and number of miscarriages, which are thought to have an impact on stress levels, may be confounding factors, the linear regression analysis in this study was carried out to determine whether these factors or high-risk pregnancy affected the stress levels of the participants (Models 1 and 2). As a result of the Mann-Whitney U Test, a significant difference was found between high-risk pregnancies and healthy pregnancies in terms of “psychosocial changes during pregnancy” and “prospect of childbirth”. For this reason, APSI dimensions were collected in a single model, and a linear regression analysis was performed for the further analysis of the relationship between high-risk pregnancy and the APSI dimension scores of the participants (Model 3). The variable with the highest β coefficient was considered the relatively most significant independent variable. Multicollinearity was ignored in case of Tolerance > 0.20 and variance inflation factors (VIF) < 10. R 2 shows what percentage of the dependent variable is explained by the independent variables. According to Cohen, R 2 values of 0.0196, 0.1300, and 0.2600 are the lower thresholds for small, medium, and large effect sizes, respectively (Özsoy & Özsoy, 2013 ). One-Way MANOVA was also conducted to see whether there was a difference in stress levels during pregnancy between the case and control groups. The comparison of the stress levels of the participants in the case group based on their diagnoses was conducted with the Kruskal-Wallis test.

Ethical considerations

For the study to be carried out, approval was obtained from the Clinical Research Ethics Committee of the Faculty of Medicine of the University, and written permission was obtained from the institution where the study would be conducted (2019/123). The purpose of the study was explained to the pregnant women who agreed to participate, and they were informed that their identifying information would be kept confidential. The written consent of the participants was obtained with the Volunteer Information Form. The participants in both the case and control groups who were thought to need counseling were referred to a specialist for psychological support.

Table  1 shows the sociodemographic and obstetric characteristics of the participants. There was no significant difference between the women in the case and control groups in terms of age, whether they had an income-generating job, income status, place of residence, parity, number of living children, status of having a planned pregnancy, and smoking status ( p  > 0.05). It was determined that the participants in the case group had significantly lower education levels than those in the control group ( p  < 0.001). Moreover, the number of pregnancies ( p  = 0.036) and the number of abortions ( p  = 0.012) in the case group were found significantly higher than those in the control group. These results supported the hypothesis that some sociodemographic and obstetric characteristics of women are associated with high-risk pregnancies.

According to the Kolmogorov-Smirnov test results, the total APSI and NUPDQ scores of the participants were not normally distributed ( p  < 0.001). Table  2 shows the stress levels of the participants compared based on their scale scores. The total APSI ( p  < 0.001, Cohen’s d = 0.388) and total NUPDQ ( p  = 0.002, Cohen’s d = 0.272) scores of the participants in the case group were significantly higher than those of the participants in the control group. The APSI Psychosocial Changes during Pregnancy ( p  < 0.001, Cohen’s d = 0.473) and Prospect of Childbirth ( p  < 0.001, Cohen’s d = 0.314) dimension scores of the participants in the case group were also significantly higher than those of the participants in the control group. These results supported the hypothesis that prenatal stress levels are higher in high-risk pregnancies than in healthy pregnancies.

Table  3 shows the stress levels of the participants with different diagnoses in the case group. In terms of risky pregnancies, the most frequently observed diagnoses were the threat of preterm labor in 37.2% of the participants in the case group, vaginal bleeding/placenta previa in 20.7%, and gestational diabetes mellitus in 10.7%. No statistically significant correlation was found between the diagnoses of the participants in the case group and their total APSI or NUPDQ scores ( p  > 0.05). This result did not support the hypothesis that there is a difference in prenatal stress levels based on differences in high-risk pregnancy diagnoses.

In the linear regression analysis, Model 1 included APSI on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between APSI and high-risk pregnancies, where the former explained 4.3% of the total variance in the latter (R 2  = 0.043) ( p  < 0.001). Model 2 included NUPDQ on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between NUPDQ and high-risk pregnancies, where the former explained 3.3% of the total variance in the latter (R 2  = 0.033) ( p  = 0.009). Model 3 included APSI dimensions, and it was determined that there was a significant relationship between psychosocial changes during pregnancy and high-risk pregnancy, where the former explained 5.7% of the total variance in the latter ( R  = 0.057) ( p  < 0.001) (Table  4 ).

As a result of the MANOVA, it was determined that having a high-risk or a pregnancy was associated with significant differences in the combined set of dependent variables (APSI and NUPDQ total scores), F = 6.231, p  = 0.002, Wilk’s Lambda = 0.967. There were significant differences between the case and control groups in terms of their APSI psychosocial changes during pregnancy and prospect of childbirth dimension scores, F = 7.258, p  < 0.001, Pillai’s Trace = 0.057. (Table  5 ).

This study determined the stress levels of pregnant women with high-risk and healthy pregnancies. Stress experienced in high-risk pregnancies can have negative effects in terms of the pregnancy process and maternal and fetal health (Atasever & Çelik, 2018 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2011 ). Therefore, it is thought that the results of this study will contribute to the literature.

It was determined in this study that the education levels of the high-risk pregnant women, who constituted the case group, were lower compared to the healthy pregnant women in the control group. Other studies in the literature have shown that risk factors in pregnancy are at higher rates in women with low educational levels (Annagür et al., 2014 ; Soğukpınar et al., 2018 ; Topalahmetoğlu et al., 2017 ; Türkmen, 2019 ). It is thought that as education levels increase, the knowledge levels of pregnant women about the management of risk factors in pregnancy increase, and these situations are intervened with in the early period. Moreover, high education levels can also prevent factors that may cause a high-risk pregnancy such as malnutrition, ill-advised exercise practices, and lack of antenatal care. For this reason, considering the results of our study, it is recommended that health professionals provide education to pregnant women with low education levels about prenatal care, proper nutrition, exercise, and antenatal follow-ups.

The numbers of pregnancies and abortions among the participants in the case group in this study were significantly higher compared to those in the control group. In the study by Orbay et al. ( 2017 ), the number of pregnancies among pregnant women with GDM was lower than the number of pregnancies among those without GDM. Cincioğlu et al. ( 2020 ) found the mean number of abortions among pregnant women with risky pregnancies to be 1.31 ± 0.71. As the number of pregnancies increases, the potential risks of pregnancy also increase. More frequent monitoring of pregnant women with a high number of abortions by health professionals and providing information about family planning methods to women with a high number of pregnancies will prevent high-risk pregnancies.

High-risk pregnancies consist of many obstetric pathologies including maternal chronic diseases. Every pathologic condition experienced during pregnancy can affect the women’s stress levels (Sinaci et al., 2020 ). In this study, two different scales were used to measure the stress levels of the participants, and the stress levels of the participants in the case group were found to be higher than the stress levels of those in the control group. Gözübebek and Düzgün (2021) stated that 63.5% of pregnant women diagnosed with risky pregnancies experienced distress. Üzar-Özçetin and Erkan ( 2019 ) reported high perceived stress levels in high-risk pregnant women. In their meta-analysis study, Amiri and Behnezhad ( 2019 ) revealed that diabetes during pregnancy was a risk factor for anxiety symptoms, and diabetes increased the risk of anxiety by up to 48%. Other studies in the literature have shown that high-risk pregnant women also have high anxiety levels (Byatt et al., 2014 ; Denis et al., 2012 ; Gourounti et al., 2015a , b ; McDonald et al., 2021 ; Orbay et al., 2017 ; Sinaci et al., 2020 ; Hung et al., 2021 ).

It was reported that low education levels, having a history of abortion, and a high number of pregnancies may cause prenatal stress (Atasever & Çelik, 2018 ). In this study, lower education levels and higher numbers of pregnancies and abortions were found in the case group than in the healthy control group. Since low education levels and high numbers of pregnancies and abortions were thought to be potential confounding factors in terms of prenatal stress, further analyses tests were performed, and it was determined that these factors did not affect stress levels to a significant extent. The research in this field may benefit from a more in-depth exploration of potential implications and confounding factors related to education.

In the studies performed by Üzar-Özçetin and Erkan ( 2019 ) and Yüksel et al. ( 2013 ), it was found that the stress levels of pregnant women who had experienced hospitalization due to any risk during pregnancy were high. It is considered that diagnosis methods, treatment methods, symptoms, complications, and their effects on the fetus for high-risk pregnancies cause great stress in pregnant women, and the fact that some pregnant women spend this process in the hospital increases their stress levels even further. For this reason, considering the results of our study, it is recommended that healthcare professionals inform the pregnant woman about her diagnosis and symptoms and explain each procedure to be performed, and that healthcare institutions provide more comfortable hospital rooms.

In this study, it was seen that the prenatal stress levels of the participants were high in terms of psychosocial changes during pregnancy. Intense stress can cause a sense of helplessness and hopelessness by depleting the energy of individuals, as well as negatively affecting their physical and mental health (Sharma & Rush, 2014 ). For this reason, healthcare professionals have an important role in the care of pregnant women with high-risk pregnancies. They should take an active role in the early diagnosis of at-risk pregnant women through qualified home visits and by initiating and continuing treatment. Advanced clinical guidelines and case management models should be developed for women having high-risk pregnancies.

In the study by Pinar et al. ( 2022 ), women with high-risk pregnancies were given training on stress management. After the training program, it was determined that 51.4% of the women in the intervention group and 75.7% in the control group experienced stress. Based on these results, it is recommended that healthcare professionals provide training, to ensure the active participation of the pregnant woman and her partner, on stress management to reduce the perceived stress, anxiety, and hopelessness levels of women in high-risk pregnancy cases. Additionally, these pregnant women should be provided with methods to cope with stress such as breathing exercises, relaxation exercises, appropriate physical exercises, visualization/yoga, massage therapy, music therapy, explanations about social support factors, and practices strengthening their spirituality (Ölçer & Oskay, 2015 ).

In this study, no significant difference was found in the prenatal stress levels of the participants in the case group based on their obstetric diagnoses of high-risk pregnancy. In the study by Byatt et al. ( 2014 ), no significant difference was identified between obstetric diagnoses in terms of anxiety levels in pregnant women. A high-risk pregnancy causes high stress levels in pregnant women due to similar diagnostic tests, treatment methods, hospitalization, complications, and fetal outcomes (Kent et al., 2015 ).

It is thought that high stress levels are not associated with obstetric diagnoses, and similar stress levels are experienced by all pregnant women aware of any risky situation during their pregnancies. Nevertheless, an increase in stress levels in risky pregnancies such as cases of preeclampsia may cause a further aggravation in the clinical status of women. Healthcare professionals should be aware of the higher stress levels of these pregnant women, they should help the pregnant woman express her feelings and thoughts by providing a reassuring communication environment, and plan appropriate consultancy, intervention, and care routines to help reduce their stress levels. These professionals can also coach high-risk pregnant women in terms of stress reduction and coping mechanisms. Pregnant women with high stress levels should be referred to a specialist for psychological support and therapy.

Strengths and limitations

The strength of this study was its prospective design with a control group. In this study, the use of two similar scales in terms of measuring the stress levels of pregnant women provided rigor and transparency compared to data obtained in previous studies. Since these scales were included in studies in Turkey only in the context of testing their validity and reliability in Turkish, it was decided to use them in the study as they measure stress levels in the prenatal period. A limitation of the study was that the pre-pregnancy stress levels of the participants, which would affect their present condition, were not measured in the study. Women with high stress levels before pregnancy have a higher risk of high-risk pregnancy. In other words, instead of high-risk pregnancy increasing stress levels, high stress levels may have affected the high-risk pregnancy statuses of the women. The results of the study also revealed a significant difference in education levels between the case and control groups. However, as a result of further analyses, it was determined that education did not affect prenatal stress levels.

In this study, it was determined that high-risk pregnancy affected prenatal stress. Moreover, it was found that the participants in the case group who had high-risk pregnancies had lower education levels and higher numbers of pregnancies and abortions compared to the participants in the control group with healthy pregnancies. This is why healthcare professionals are recommended to bear in mind that pregnant women with low education levels and a high number of pregnancies and abortions are at risk of high-risk pregnancies and monitor these pregnant women more frequently and carefully.

It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category, provide psychological support to pregnant women who have high stress levels or are hospitalized, offer them counseling and training opportunities (e.g., relaxation exercises, breathing exercises, practices strengthening their spirituality, music therapy), take appropriate precautions, and refer these pregnant women to specialists if needed. Moreover, since the stress levels of these pregnant women will increase even more during childbirth, alternative methods to reduce the fear of childbirth and childbirth pain should be explained.

It is recommended to organize educational programs such as trainings, seminars, and conferences on stress management during pregnancy for health professionals working in family health centers, community health centers, and gynecology departments.

Consequently, more studies with larger sample sizes are needed to compare diagnostic stress levels in high-risk pregnancies. In addition to prenatal stress and childbirth fear levels, future studies should also determine the stress levels of women before pregnancy for similar comparisons between high-risk and healthy pregnancies.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors express thanks to the mothers for participation in the study.

Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK). No funding was received to conduct the study.

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Study conception and design: Hülya TÜRKMEN.  Data collection:  Hülya TÜRKMEN.  Data analysis and interpretation:  Hülya TÜRKMEN.  Drafting of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.  Critical revision of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.

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Türkmen, H., Akın, B. & Erkal Aksoy, Y. Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-05956-z

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    The NCCSTS Case Collection, created and curated by the National Center for Case Study Teaching in Science, on behalf of the University at Buffalo, contains over a thousand peer-reviewed case studies on a variety of topics in all areas of science. Cases (only) are freely accessible; subscription is required for access to teaching notes and ...

  6. Education case studies

    Adapting a remote platform in innovative ways to assess learning (Nigeria) Assessing children's reading in indigenous languages (Peru) Southeast Asia primary learning metrics: Assessing the learning outcomes of grade 5 students (Southeast Asia) Minimising learning gaps among early-grade learners (Sri Lanka)

  7. Using Case Studies to Teach

    Advantages to the use of case studies in class. A major advantage of teaching with case studies is that the students are actively engaged in figuring out the principles by abstracting from the examples. This develops their skills in: Problem solving. Analytical tools, quantitative and/or qualitative, depending on the case.

  8. Case-Based Learning

    Case-Based Learning. Case-based learning (CBL) is an established approach used across disciplines where students apply their knowledge to real-world scenarios, promoting higher levels of cognition (see Bloom's Taxonomy ). In CBL classrooms, students typically work in groups on case studies, stories involving one or more characters and/or ...

  9. Case Study Compilation

    The Case Study Compilation includes: Eleven case studies: Each case study highlights educator 'moves' and strategies to embed social-emotional skills, mindsets, and competencies throughout the school day and within academics. They each conclude with a reflection prompt that challenges readers to examine their own practice. The case studies ...

  10. Case Study in Education Research

    Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues.

  11. What Is a Case Study?

    Revised on November 20, 2023. A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research. A case study research design usually involves qualitative methods, but quantitative methods are ...

  12. Case Studies: Bringing Learning to Life and Making Knowledge Stick

    Case studies - get started. Are you eager to use case studies with your students? Cengage higher education titles typically contain case studies and real-world examples that bring learning to life and help knowledge stick. Below are some learning materials, spanning a range of subjects, that can help your students reap the proven benefits of ...

  13. Write a teaching case study

    Teaching plan and objectives. Provide a breakdown of the classroom discussion time into sections. Include a brief description of the opening and closing 10-15 minutes, as well as challenging case discussion questions with comprehensive sample answers. Provide instructors a detailed breakdown of how you would teach the case in 90 minutes.

  14. PDF Handout 2 Case Studies

    Handout #2 provides case histories of four students: Chuck, a curious, highly verbal, and rambunctious six-year-old boy with behavior disorders who received special education services in elementary school. Juanita, a charming but shy six-year-old Latina child who was served as an at-risk student with Title 1 supports in elementary school.

  15. Writing a Case Study

    The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case ...

  16. Using Case Study in Education Research

    Using Case Study in Education Research. This book provides an accessible introduction to using case studies. It makes sense of literature in this area, and shows how to generate collaborations and communicate findings. The authors bring together the practical and the theoretical, enabling readers to build expertise on the principles and ...

  17. Cases

    The Case Analysis Coach is an interactive tutorial on reading and analyzing a case study. The Case Study Handbook covers key skills students need to read, understand, discuss and write about cases. The Case Study Handbook is also available as individual chapters to help your students focus on specific skills.

  18. Case Studies & Examples

    The National Center on Time and Learning produced case studies of four schools that have used increased time for teacher-led professional learning to improve school performance. Charlotte, N.C.'s Project L.I.F.T.: New Teaching Roles Create Culture of Excellence in High-Need Schools. This case study shows how Charlotte-Mecklenburg schools ...

  19. Case Studying Educational Research: A Way of Looking at Reality

    The research was predominantly qualitative and category-based, having as sample 42 Master´s dissertations, including single and multiple case studies, from students attending a Portuguese university.

  20. Case Studies in IPE

    Additional resources for finding and developing IPE case studies are available in Chapter 1 of ASHA's eBook on IPE and IPP in CSD. Case Study 1_Interprofessional Education for Inclusive Schools.pdf 90.87 KB. Case Study 2_Interprofessional Education for Inclusive Schools.pdf 104.84 KB.

  21. PDF CASE STUDIES OF STUDENTS WITH EXCEPTIONAL NEEDS

    he case studies in this chapter address the needs of students with the exceptionalities most often observed in classrooms. To prepare for the analysis of the studies, review your philosophy of education that you devel-oped in the last chapter to connect your strategies for helping students to your belief system about teaching. Remember, the ...

  22. PDF Bryan case Study

    CASE STUDY: Kenny. Present Levels of Performance (Reading, Math, Communication, Social Skills, Motor Skills, etc. . .) Reading: Vocabulary 9.0 Comprehension 10.0. Written Language: Passed state assessment test at proficiency level. Math: Passed state assessment test at the advanced proficiency level. Goals for Future Growth.

  23. Case Studies in Higher Education

    Teaching case studies can help students put theories into practice and is often useful in identifying problems not revealed through a more traditional approach. Gale Case Studies was created by university faculty and developed specifically for the classroom. This new higher education tool gives undergraduate students the chance to sharpen their ...

  24. 15 Real-Life Case Study Examples & Best Practices

    15 Real-Life Case Study Examples. Now that you understand what a case study is, let's look at real-life case study examples. In this section, we'll explore SaaS, marketing, sales, product and business case study examples with solutions. Take note of how these companies structured their case studies and included the key elements.

  25. Exploring history teachers' understanding of the role of professional

    The present study examined the understanding of Professional Learning Communities (PLCs) among history teachers in South Africa. The research focused on a sample of 10 teachers from five schools in the UMgungundlovu District in KwaZulu-Natal. Drawing on the theoretical framework of Community of Practice (CoP) and adopting a qualitative approach, the study employed a case study design and ...

  26. Case Interview: Complete Prep Guide

    How can I prepare for Case Interviews? 1.) Read Management Consulted's "Case Interview: Complete Prep Guide (2024)" Management Consulted is a FREE resource for Tufts students: case and consulting resources such as 500 sample cases, Case Interview Bootcamp, Market Sizing Drills, Math Drills, case videos, consulting firm directory, and more ...

  27. Developing a survey to measure nursing students' knowledge, attitudes

    Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada's legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses' (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education ...

  28. Effect of high-risk pregnancy on prenatal stress level: a ...

    The study aimed to determine the effects of high-risk pregnancy on prenatal stress levels. The study was conducted with a case-control design in Turkey in September-December 2019. The sample included pregnant women diagnosed with high-risk pregnancy and were at their 36th or later gestational weeks as the case group (n = 121) and healthy pregnant women as the control group (n = 245). The ...