Preparing NPs for Primary Care: Unraveling Complexity with Unfolding Cases

Abstract

Patients with comorbid mental and physical illnesses often present in the primary care setting. To explore the complexities of caring for these patients, a Behavioral Health Therapeutics course was developed and taught in the first semester of a Doctor of Nursing Practice program. This article describes the research, theories, and curricular innovations used in the online learning environment, which provide the foundation for the course and reflect the essential changes called for in the 2010 Carnegie report. Highlighted in this article is the unfolding case study method using Backward Design by Wiggins and McTighe in the planning phase, Zull's model for engaging the brain in the Implementation phase, and grading criteria created from Tanner's "Case for Cases: A Pedagogy for Developing Habits of Thought" in the evaluation phase.

The Effectiveness of Unfolding Case Studies on ADN Nursing Students' Level of Knowledge and Critical Thinking Skills

“…Nursing students have suggested that unfolding case studies enhanced their critical thinking skills and problem-solving abilities (Day, 2011;Dutra, 2013;Himes & Ravert, 2012;Page, Kowlowitz, & Alden, 2010;Popil, 2011;Yousey, 2013), increased their collaboration and teamwork (Forneris et al, 2012), and offered preparatory guidance into their professional nurse role (Bennett et al, 2011;Himes & Ravert, 2012;Lewenson & Truglio-Londrigan, 2013;West et al, 2012). In addition, an increase in student engagement (Dutra; Popil), satisfaction, and self-esteem (Himes & Ravert, 2012;Mills et al, 2014) was noted as a result of exposure to unfolding case studies.…”

“…Unfolding case studies have been used within simulation experiences (Filer, Champlin, & Hunt, 2012;Johnson et al, 2012;McCormick, Slavy, & Fuller, 2013;Mills et al, 2014), as an on-line component (Anderson, Page, & Wendorf, 2013;Bennett, Kennedy, & Donato, 2011;Johnson & Flagler, 2013;Lewenson & Truglio-Londrigan, 2013;Yousey, 2013), and within didactic courses (Dudas, 2012;Dutra, 2013;West, Usher, & Delaney, 2012).…”

Using unfolding case scenarios to promote clinical reasoning for nurse practitioner students

“…Traditional case studies are static and generally present a point-in-time situation with related data, where students are asked to consider the information and recommend a course of action. Alternatively, an unfolding or evolving case study mirrors the experience of an illness situation over time and provides sequential information about a patient's illness as they live through this experience (Bennett et al, 2011; Moench, 2019). The National League for Nursing (2020) describes an unfolding case as one that changes over time, with new information being learned at each encounter.…”

Technology and teaching: Avoiding the pitfalls, increasing student engagement, and improving outcomes

“…[4,5] Additional research data supports the use of new pedagogies [3] and the use of unfolding case studies to bring clinical application opportunities to new material. [6,7] Recognizing education over the last 20 years has evolved from chalkboards and discussions or overhead projectors, to the overuse of tools such as PowerPoint, we, as faculty, are constantly trialing new technologies and education strategies to better engage the student. This process challenges our view as educators about how to best present the concepts and learning objectives in a way that moves us along the continuum of Bloom's taxonomy from knowledge to the actual application and synthesis of information or new way of thinking.…”