Pages: 4

This book is intended for nursing and allied health researchers. It is less a how-to book and more a strategy and approach to finding shared solutions for common health problems from a nursing perspective, using case study methodology. The Introduction will talk about what case study methodology is, and why it is the best strategy for uncovering the experiences and meanings of importance to both client and provider. Case study method allows for the uncovering of important phenomena that lend to equitable decision-making processes. Solutions to chronic health problems may present themselves as novel or empirical but come from the client with assistance from the provider. This approach of negotiation is not new, but different from another standard of care that deduces a diagnosis based on empirical findings and offers prescriptions as the solution. Major concepts such as health trajectory, self-care, and stigmatization are uncovered best by using this research methodology.

Pages: 21

One’s philosophy or worldview drives the approach to any research inquiry. To begin, this chapter discusses the importance meaning has for the individual. In nursing, the best way to get at meaning is to listen to patients and then gain their trust to ask questions about their day-to-day life. Motivational approaches to communication are key and take time and patience. Combined, worldview, and motivational approaches inform my interest in case study research methods. A discussion of meaning and levels of meaning orient the reader to ways to conceptualize the phenomenon of interest. Social constructionism and social constructionist perspectives (Sarbin & Kitsuse, 19945) assist the reader in bridging meaning and experience. Here the emphasis is on understanding how an individual creates and employs construction to guide their behavior. This perspective is influenced by George Mead (19346) and others who pursued the theme of symbolic interactionism. A link can be made between chronic conditions and “social problems” such as ill health and health inequities. In this chapter the emphasis is on experiential phenomenon rather than cognitive, more in line with nursing’s holistic approach to human caring. Specific theories and philosophies are discussed from a historical context.

Pages: 10

Up to this point the discussion has focused on the accuracy of defining the case, the fit to the phenomena of interest and the underlying philosophical underpinning driving the inquiry. Nonetheless, confusion remains as to how nurses use the method. Most qualitative nursing research, while exploratory or descriptive in nature, does not aim to measure outcomes based on the evidence. Rather the aim is to expand knowledge for the sake of building theory. This chapter outlines papers that illustrate the appropriateness of a nursing case study methodology. The first will compare three processes of case study research. That is followed by providing the results of integrative reviews of how case study method is used in nursing research.

Pages: 5

Just as translation of study findings into clinical practice is an objective of nursing research, so is attention to clients’ health and illness trajectories. It has been defined as the changing course of health and illness. This chapter reviews the historical trends in chronic illness trajectory work and current considerations in determining health trajectory. Examples of guidelines, frameworks, theories, and models will illustrate not only the importance of illness trajectory research but the contributions to nursing knowledge development. While everyone has a unique set of health and illness experiences, for every condition there is a “typical” experience that can be used as a point of comparison to the “atypical.” This chapter also introduces a way of looking at health and illness trajectory that is framed by both objective and subjective functional status at varying points in time. Using a biopsychosocial lens, the researcher frames the health or illness experiences along a trajectory or path. This chapter concludes with the discussion of how case study methods are well suited to uncovering illness trajectory.

Pages: 9

Self-care management is at the heart of health and healing. While negotiation between provider and client is important, a person’s awareness of their own health needs and strategies for success often can prevent chronic deterioration. However, not all health needs are known, preventable or easily managed without help. While several chronic conditions can improve with help from providers. Building on what is known and what is working well, a plan for self-care can be created or tested for its effectiveness. Feedback and continued communication are key to sustainability and maintenance of new health behaviors. Currently the U.S. government is aiming to allocate more federal dollars to ensure barriers to accessing healthcare are removed (Artiga & Hinton, 20187; Fink & Mercado, 20238) yet adequate resources are not yet realized. Racism, poverty, stigma, and discriminatory law enforcement practices continue to be barriers to health equity. In this chapter the terms self-management and self-care are interchangeable. Several self-management theories will be described covering the period of 1960 to the present. Studies using case method will illustrate the fit between this research method and effective self-care management.

Pages: 5

Chronic conditions carry stigma. “By definition, we believe the person with a stigma is not quite human” (Goffman, 196312, p. 5). Stigma is seen as a “readily discernible discredited attribute, such as skin color or body size” (Clair, 201813, p. 318). Nearly anything that is different from the group is considered “abnormal” and subject to stigma. Public stigma is pervasive in our society (Parcesepe & Cabassa, 201314), and may be present in the delivery of healthcare. For example, it is experienced by persons who are aging, who use injection drugs, who have mental illness, who use cannabis, and who are incarcerated15. Blaming and shaming do nothing to improve poor health and can exacerbate a declining illness trajectory. Research has found that less attention has been paid to concealable stigma identities (such as mental illness) (Quinn & Earnshaw, 2011, 201316). Because stigma is so pervasive in society the impact on mental health is significant (Corrigan & Watson, 200217). In this chapter, challenges to self-care management and stigma often coexist. This chapter explores ways in which providers can address and remediate the negative impacts of stigma in persons with chronic conditions using case study method and evidence-based models of care.

Pages: 5

Case study methodology is extremely useful to the provider who is working with clients or communities toward achieving better health and well-being. Creswell (1998)11 and Yin (2014)12 agree that qualitative methods such as case study are linked to creating models or theories, as they best describe, explore, and understand the phenomena in real-life contexts. One objective of nursing inquiry is to translate the discovered information into practical clinical decision-making, to be used in creating a roadmap for innovation. Underlying this approach to care is an emphasis on health equity and meeting people where they are in their health or illness trajectories. This chapter provides three examples that illustrate the impact of stigma as perceived by persons who use cannabis, persons who use injection drugs, and persons with incarceration experience and offer strategies to improve self-care.

Pages: 4

Most researchers agree that in the right circumstances case study methodology is the best research approach to understanding human experience. This notion has not changed in over 20 years, yet there continues to be confusion about the methodology. Language use and misuse certainly have added to this confusion, but the goal of science and scientists is to tease out operational definitions and terms. Moving this methodology more into the mainstream is the responsibility of those using the methodology to define and explain distinctions for all readers. This may require the work of writing general research textbooks, classroom lectures and publications that discuss case study methodology. Of equal importance is to give voice to the voiceless. As has been illustrated, human beings can change their attitudes and behaviors toward others and themselves. Appreciative inquiry, a strengths-based approach to addressing challenging situations, is discussed as an essential strategy in caring for persons with stigmatizing chronic conditions. In this chapter, the emphasis is on moving from current to future applications of case study method.