Complex clinical case histories close the theory-practice gap, providing an effective conduit between higher education and clinical practice .


When did you first introduce the innovation?

Between 12 and 24 months ago

Please describe the innovation you have developed

The setting for this innovation is been developed as part of a collaborative Critical Care Nursing programme delivered by Manchester Metropolitan University and The Greater Manchester Critical Care Network (Degree and Masters level).

The educators have developed case studies that reflect the dynamic and complex nature of caring for patients within critical care. These are used during the 12 month critical care programme as a means to provide students with the opportunity to link theory to practice, critically evaluating the issues and treatment options with their peers, while maintaining a patient centred approach. Typically the student will attend a study day, where they will divided into groups and given a case history, which they will consider, and agree a holistic plan of care, as they would in practice. The groups share these with each other. They then receive further tuition, before returning to consider changes to their patients condition, such as changing test results or observations. A revised plan is now agreed. In this way the students apply and test their knowledge, and learn from each other as well as the tutors.

What prompted you to develop this innovation?

The introduction of these complex case histories is the result of a 2 year action research PhD study evaluating the curriculum of this Critical Care Programme. Classroom observations of all the existing study days highlighted a didactic lecture based approach, with very short case histories, that lacked any depth and were more a short question and answer session, with no links to the role of the nurse. The innovation was introduced by the educators provide a patient centred approach to study, which allows the students to become more active in their learning, to think as nurses, working together to plan and evaluate their care, just as they would in practice.

In your view, what is it about this innovation that makes it different/important?

The innovation has been successful in closing the gap between higher education and developing students clinical practice.

It links the theory of critical care nursing directly to practice, focusing on patient centred care. The constructivist teaching approach facilitates an active role for learners, peer to peer discussion, critical thinking, decision making and the evaluation of care. The approach provided an effective balance between academic theory, providing a strong evidence base for care, and combines this with tacit knowledge in the complex real world of critical care nursing practice. It is extremely well evaluated by students and tutors, as part of blended approach to teaching and learning within higher education.

To what extent does your innovation make use of existing approaches, resources or technologies?

The approach build upon the existing use of case studies, adapting them to reflect the complexity of critical care. However, this type of unravelling case studies could be transferable to many different settings, and are merely a conduit to bridge the theory-practice divide. The approach fits with the development of higher order thinking skills and is therefore suitable for degree and Masters level study. In many ways it sits closely with the use of simulation technologies, in its problem solving, practice focused approach.

To what degree has this innovation led to changes in education or clinical practice?

Case studies are now routinely used as teaching strategy on this programme, which has an intake of 120 students per year.

What evidence do you have of the impact of the innovation?

Post course questionnaires / focus groups conducted with all students completing the course over period of 2 years.

Were the study days were useful in developing your clinical practice? Yes = 96% [S13 cohort]

Has this course influenced your clinical decision-making?
Yes 86% (n=19) No 14% (n=3) (F14 cohort)

Data indicates an increasing level of student confidence and competence over last 18 months since the case studies were introduced, increasing from 3.8 /5 in September 2013 to 4.3 / 5 in February 2015

(‘0’ indicating no improvement & 5 indicating a very high level of improvement).


R: ‘case studies – I think that develops your skills…We did a lot of group work, presenting things back & they did help us… to talk about things… To critically analyse & to critically evaluate stuff

O: ‘the case studies were the best part… case studies got into our minds what we were going to do’. [S12 (30/8/2013,

‘made my decision-making stronger’ (S13, participant.2)
‘case studies allow us to empathise with both patients & staff & make the learning more realistic *’ (F13 participant.12) x 7 similar

84% students made strong links between academic study & improving their clinical practice -supports view that we are delivering teaching that impacts service delivery (February 2015 cohort) .

There is also evidence that students agree that case studies assist them to develop higher order thinking skills:

Did any teaching methods help you develop your critical thinking skills? Yes 86% No 9% [no response = 1]

Please elaborate & provide examples: Themes & number of students citing them

Simulation x 12 Case studies x 10 Discussions x 8 Lectures x 5


‘simulation & case scenarios are excellent’ (F14 cohort: participants 11, 19, 8)

‘Discussion & case studies are best’ (F14 cohort: participants 13, 21)

‘scenarios brought evidence to practice’ (participant 17)

To what degree has the innovation been disseminated in your organisation or elsewhere?

This evidence has been shared with the team at the Greater Manchester Critical Care Network.

Please provide details of any plans you have to disseminate the innovation in the future.

The data will be shared with the national critical care education network in October 2015.

Plans to submit abstract widely regarding findings of the two action research study when the data collection concludes in September 2015.