Part 1: Contemporary issues in nursing
Leading article
Revisiting innovative approaches to teaching
and learning in nursing programmes: Educators’
experiences with the use of a case-based teaching
approach at a nursing school
O. Adejumo*
e-mail:
L. Fakude*
e-mail:
N. Linda*
e-mail:
*School of Nursing
University of the Western Cape
Bellville, South Africa
Abstract
Innovative approaches to teaching and learning have been acclaimed by educators in
health care related professions as being more suitable to teaching future professionals,
and to engendering critical thinking, as well as the competencies that are relevant to the
needs of the society. This article focuses on teachers’ concerns about the implementation
of the case-based method of teaching at a school of nursing in the Western Cape, South
Africa. Teachers involved in this method of teaching for at least two years provided
qualitative data through a series of focus group discussions (4 FGDs) organised
according to the different year levels of the nursing programme of the School of
Nursing, so as to be able to contextualise answers to the study questions. The FGDs were
followed by a one-day consensus workshop for all educators involved in case-based
teaching for a shared discussion that concentrated on finding solutions for the future.
Concerns raised included issues about the facilitation role of the teacher; the role of the
student; curriculum alignment; assessment methods; and the role of the environment
in case-based teaching and learning settings. Recommended solutions were aligned to
the identified concerns.
Keywords: case-based teaching approach, undergraduate nursing, challenges, nurse
educators, shared discussions, environment of teaching
© Unisa Press ISSN 1011-3487 1694 SAJHE 28 (6) 2014 pp 1694–1707
, Revisiting innovative approaches to teaching and learning in nursing programmes
INTRODUCTION
The case-based learning (CBL) approach is an andragogical (adult teaching/
learning) approach that examines contextualised questions which are based upon
clinical or non-clinical ‘real-life’ problems. In CBL, a structured concept is presented
in a standardised case format where each student exposed to the case has a clear
understanding of the issues to be solved (Lunney 2008). CBL uses a guided inquiry
method and provides more structure during small-group sessions. Hayward and
Cairns (2001, 233) state that ‘the use of cases allows students to integrate and apply
developing clinical and basic science knowledge and skills such as clinical reasoning,
critical thinking, problem solving, and interpersonal ability to hypothetical or real
case scenarios’.
Case-based teaching and learning approaches have been used for years and are
reputed for providing an excellent environment for acquiring an understanding of
professional and ethical issues, knowledge of contemporary issues, or the ability
to understand solutions in a global and societal context (Prince and Felder 2006).
However, several studies have been devoted to investigating the discomfort commonly
associated with innovative approaches to teaching and learning with a view to
providing solutions for assisting further developments and the implementation of
creative teaching. In a study to investigate the role of discussion groups in a case-
based environment, Flynn and Klein (2001) found that students were dissatisfied with
the amount of time available to prepare for the cases, as well as for group discussions.
In similar studies, concerns have been raised about assessment measures that could
appropriately gauge the performance of individual students in groups while a CBL
approach is being used.
The case-based approach was introduced and documented at a nursing school at
the turn of the millennium in 2004. At the time of preparing this article, the case-
based approach had graduated four cohorts of students until the end of 2012 by using
mainly the case-based approach in the nursing modules (ie, excluding modules like
Chemistry, Physics, Human Biology, and Pharmacology taught by colleagues in the
Science Faculty). Educators from diverse backgrounds and with varying experience
in teaching methodologies had been participating in the teaching–learning process at
the School of Nursing. Most of the educators were educated and trained in the tradition
of a content-based curriculum and were only keen to teach the way they had been
taught. The decision to introduce innovative approaches to teaching and learning thus
compelled educators, particularly those in the undergraduate programme teaching
nursing modules, to make adjustments in their teaching approach, with no alternative
but to teach in a CBL format. This process of adjustment that entailed learning a new
way of teaching and learning was sometimes scrutinised by omnipresent managerial
officers to ensure that compliance brought some uniqueness to the emotional climate
and they verbalised concerns about the success of the case-based approach.
The current article documents the attempts made to describe some of the concerns
raised by the educators and the solutions proffered for the successful implementation
1695
Leading article
Revisiting innovative approaches to teaching
and learning in nursing programmes: Educators’
experiences with the use of a case-based teaching
approach at a nursing school
O. Adejumo*
e-mail:
L. Fakude*
e-mail:
N. Linda*
e-mail:
*School of Nursing
University of the Western Cape
Bellville, South Africa
Abstract
Innovative approaches to teaching and learning have been acclaimed by educators in
health care related professions as being more suitable to teaching future professionals,
and to engendering critical thinking, as well as the competencies that are relevant to the
needs of the society. This article focuses on teachers’ concerns about the implementation
of the case-based method of teaching at a school of nursing in the Western Cape, South
Africa. Teachers involved in this method of teaching for at least two years provided
qualitative data through a series of focus group discussions (4 FGDs) organised
according to the different year levels of the nursing programme of the School of
Nursing, so as to be able to contextualise answers to the study questions. The FGDs were
followed by a one-day consensus workshop for all educators involved in case-based
teaching for a shared discussion that concentrated on finding solutions for the future.
Concerns raised included issues about the facilitation role of the teacher; the role of the
student; curriculum alignment; assessment methods; and the role of the environment
in case-based teaching and learning settings. Recommended solutions were aligned to
the identified concerns.
Keywords: case-based teaching approach, undergraduate nursing, challenges, nurse
educators, shared discussions, environment of teaching
© Unisa Press ISSN 1011-3487 1694 SAJHE 28 (6) 2014 pp 1694–1707
, Revisiting innovative approaches to teaching and learning in nursing programmes
INTRODUCTION
The case-based learning (CBL) approach is an andragogical (adult teaching/
learning) approach that examines contextualised questions which are based upon
clinical or non-clinical ‘real-life’ problems. In CBL, a structured concept is presented
in a standardised case format where each student exposed to the case has a clear
understanding of the issues to be solved (Lunney 2008). CBL uses a guided inquiry
method and provides more structure during small-group sessions. Hayward and
Cairns (2001, 233) state that ‘the use of cases allows students to integrate and apply
developing clinical and basic science knowledge and skills such as clinical reasoning,
critical thinking, problem solving, and interpersonal ability to hypothetical or real
case scenarios’.
Case-based teaching and learning approaches have been used for years and are
reputed for providing an excellent environment for acquiring an understanding of
professional and ethical issues, knowledge of contemporary issues, or the ability
to understand solutions in a global and societal context (Prince and Felder 2006).
However, several studies have been devoted to investigating the discomfort commonly
associated with innovative approaches to teaching and learning with a view to
providing solutions for assisting further developments and the implementation of
creative teaching. In a study to investigate the role of discussion groups in a case-
based environment, Flynn and Klein (2001) found that students were dissatisfied with
the amount of time available to prepare for the cases, as well as for group discussions.
In similar studies, concerns have been raised about assessment measures that could
appropriately gauge the performance of individual students in groups while a CBL
approach is being used.
The case-based approach was introduced and documented at a nursing school at
the turn of the millennium in 2004. At the time of preparing this article, the case-
based approach had graduated four cohorts of students until the end of 2012 by using
mainly the case-based approach in the nursing modules (ie, excluding modules like
Chemistry, Physics, Human Biology, and Pharmacology taught by colleagues in the
Science Faculty). Educators from diverse backgrounds and with varying experience
in teaching methodologies had been participating in the teaching–learning process at
the School of Nursing. Most of the educators were educated and trained in the tradition
of a content-based curriculum and were only keen to teach the way they had been
taught. The decision to introduce innovative approaches to teaching and learning thus
compelled educators, particularly those in the undergraduate programme teaching
nursing modules, to make adjustments in their teaching approach, with no alternative
but to teach in a CBL format. This process of adjustment that entailed learning a new
way of teaching and learning was sometimes scrutinised by omnipresent managerial
officers to ensure that compliance brought some uniqueness to the emotional climate
and they verbalised concerns about the success of the case-based approach.
The current article documents the attempts made to describe some of the concerns
raised by the educators and the solutions proffered for the successful implementation
1695
