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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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StatPearls [Internet].

Case study: 33-year-old female presents with chronic sob and cough.

Sandeep Sharma ; Muhammad F. Hashmi ; Deepa Rawat .

Affiliations

Last Update: February 20, 2023 .

  • Case Presentation

History of Present Illness:  A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician’s office six months ago. At that time, she was diagnosed with acute bronchitis and treated with bronchodilators, empiric antibiotics, and a short course oral steroid taper. This management did not improve her symptoms, and she has gradually worsened over six months. She reports a 20-pound (9 kg) intentional weight loss over the past year. She denies camping, spelunking, or hunting activities. She denies any sick contacts. A brief review of systems is negative for fever, night sweats, palpitations, chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation changes, muscular changes, and increased bruising or bleeding. She admits a cough, shortness of breath, and shortness of breath on exertion.

Social History: Her tobacco use is 33 pack-years; however, she quit smoking shortly prior to the onset of symptoms, six months ago. She denies alcohol and illicit drug use. She is in a married, monogamous relationship and has three children aged 15 months to 5 years. She is employed in a cookie bakery. She has two pet doves. She traveled to Mexico for a one-week vacation one year ago.

Allergies:  No known medicine, food, or environmental allergies.

Past Medical History: Hypertension

Past Surgical History: Cholecystectomy

Medications: Lisinopril 10 mg by mouth every day

Physical Exam:

Vitals: Temperature, 97.8 F; heart rate 88; respiratory rate, 22; blood pressure 130/86; body mass index, 28

General: She is well appearing but anxious, a pleasant female lying on a hospital stretcher. She is conversing freely, with respiratory distress causing her to stop mid-sentence.

Respiratory: She has diffuse rales and mild wheezing; tachypneic.

Cardiovascular: She has a regular rate and rhythm with no murmurs, rubs, or gallops.

Gastrointestinal: Bowel sounds X4. No bruits or pulsatile mass.

  • Initial Evaluation

Laboratory Studies:  Initial work-up from the emergency department revealed pancytopenia with a platelet count of 74,000 per mm3; hemoglobin, 8.3 g per and mild transaminase elevation, AST 90 and ALT 112. Blood cultures were drawn and currently negative for bacterial growth or Gram staining.

Chest X-ray

Impression:  Mild interstitial pneumonitis

  • Differential Diagnosis
  • Aspiration pneumonitis and pneumonia
  • Bacterial pneumonia
  • Immunodeficiency state and Pneumocystis jiroveci pneumonia
  • Carcinoid lung tumors
  • Tuberculosis
  • Viral pneumonia
  • Chlamydial pneumonia
  • Coccidioidomycosis and valley fever
  • Recurrent Legionella pneumonia
  • Mediastinal cysts
  • Mediastinal lymphoma
  • Recurrent mycoplasma infection
  • Pancoast syndrome
  • Pneumococcal infection
  • Sarcoidosis
  • Small cell lung cancer
  • Aspergillosis
  • Blastomycosis
  • Histoplasmosis
  • Actinomycosis
  • Confirmatory Evaluation

CT of the chest was performed to further the pulmonary diagnosis; it showed a diffuse centrilobular micronodular pattern without focal consolidation.

On finding pulmonary consolidation on the CT of the chest, a pulmonary consultation was obtained. Further history was taken, which revealed that she has two pet doves. As this was her third day of broad-spectrum antibiotics for a bacterial infection and she was not getting better, it was decided to perform diagnostic bronchoscopy of the lungs with bronchoalveolar lavage to look for any atypical or rare infections and to rule out malignancy (Image 1).

Bronchoalveolar lavage returned with a fluid that was cloudy and muddy in appearance. There was no bleeding. Cytology showed Histoplasma capsulatum .

Based on the bronchoscopic findings, a diagnosis of acute pulmonary histoplasmosis in an immunocompetent patient was made.

Pulmonary histoplasmosis in asymptomatic patients is self-resolving and requires no treatment. However, once symptoms develop, such as in our above patient, a decision to treat needs to be made. In mild, tolerable cases, no treatment other than close monitoring is necessary. However, once symptoms progress to moderate or severe, or if they are prolonged for greater than four weeks, treatment with itraconazole is indicated. The anticipated duration is 6 to 12 weeks total. The response should be monitored with a chest x-ray. Furthermore, observation for recurrence is necessary for several years following the diagnosis. If the illness is determined to be severe or does not respond to itraconazole, amphotericin B should be initiated for a minimum of 2 weeks, but up to 1 year. Cotreatment with methylprednisolone is indicated to improve pulmonary compliance and reduce inflammation, thus improving work of respiration. [1] [2] [3]

Histoplasmosis, also known as Darling disease, Ohio valley disease, reticuloendotheliosis, caver's disease, and spelunker's lung, is a disease caused by the dimorphic fungi  Histoplasma capsulatum native to the Ohio, Missouri, and Mississippi River valleys of the United States. The two phases of Histoplasma are the mycelial phase and the yeast phase.

Etiology/Pathophysiology 

Histoplasmosis is caused by inhaling the microconidia of  Histoplasma  spp. fungus into the lungs. The mycelial phase is present at ambient temperature in the environment, and upon exposure to 37 C, such as in a host’s lungs, it changes into budding yeast cells. This transition is an important determinant in the establishment of infection. Inhalation from soil is a major route of transmission leading to infection. Human-to-human transmission has not been reported. Infected individuals may harbor many yeast-forming colonies chronically, which remain viable for years after initial inoculation. The finding that individuals who have moved or traveled from endemic to non-endemic areas may exhibit a reactivated infection after many months to years supports this long-term viability. However, the precise mechanism of reactivation in chronic carriers remains unknown.

Infection ranges from an asymptomatic illness to a life-threatening disease, depending on the host’s immunological status, fungal inoculum size, and other factors. Histoplasma  spp. have grown particularly well in organic matter enriched with bird or bat excrement, leading to the association that spelunking in bat-feces-rich caves increases the risk of infection. Likewise, ownership of pet birds increases the rate of inoculation. In our case, the patient did travel outside of Nebraska within the last year and owned two birds; these are her primary increased risk factors. [4]

Non-immunocompromised patients present with a self-limited respiratory infection. However, the infection in immunocompromised hosts disseminated histoplasmosis progresses very aggressively. Within a few days, histoplasmosis can reach a fatality rate of 100% if not treated aggressively and appropriately. Pulmonary histoplasmosis may progress to a systemic infection. Like its pulmonary counterpart, the disseminated infection is related to exposure to soil containing infectious yeast. The disseminated disease progresses more slowly in immunocompetent hosts compared to immunocompromised hosts. However, if the infection is not treated, fatality rates are similar. The pathophysiology for disseminated disease is that once inhaled, Histoplasma yeast are ingested by macrophages. The macrophages travel into the lymphatic system where the disease, if not contained, spreads to different organs in a linear fashion following the lymphatic system and ultimately into the systemic circulation. Once this occurs, a full spectrum of disease is possible. Inside the macrophage, this fungus is contained in a phagosome. It requires thiamine for continued development and growth and will consume systemic thiamine. In immunocompetent hosts, strong cellular immunity, including macrophages, epithelial, and lymphocytes, surround the yeast buds to keep infection localized. Eventually, it will become calcified as granulomatous tissue. In immunocompromised hosts, the organisms disseminate to the reticuloendothelial system, leading to progressive disseminated histoplasmosis. [5] [6]

Symptoms of infection typically begin to show within three to17 days. Immunocompetent individuals often have clinically silent manifestations with no apparent ill effects. The acute phase of infection presents as nonspecific respiratory symptoms, including cough and flu. A chest x-ray is read as normal in 40% to 70% of cases. Chronic infection can resemble tuberculosis with granulomatous changes or cavitation. The disseminated illness can lead to hepatosplenomegaly, adrenal enlargement, and lymphadenopathy. The infected sites usually calcify as they heal. Histoplasmosis is one of the most common causes of mediastinitis. Presentation of the disease may vary as any other organ in the body may be affected by the disseminated infection. [7]

The clinical presentation of the disease has a wide-spectrum presentation which makes diagnosis difficult. The mild pulmonary illness may appear as a flu-like illness. The severe form includes chronic pulmonary manifestation, which may occur in the presence of underlying lung disease. The disseminated form is characterized by the spread of the organism to extrapulmonary sites with proportional findings on imaging or laboratory studies. The Gold standard for establishing the diagnosis of histoplasmosis is through culturing the organism. However, diagnosis can be established by histological analysis of samples containing the organism taken from infected organs. It can be diagnosed by antigen detection in blood or urine, PCR, or enzyme-linked immunosorbent assay. The diagnosis also can be made by testing for antibodies again the fungus. [8]

Pulmonary histoplasmosis in asymptomatic patients is self-resolving and requires no treatment. However, once symptoms develop, such as in our above patient, a decision to treat needs to be made. In mild, tolerable cases, no treatment other than close monitoring is necessary. However, once symptoms progress to moderate or severe or if they are prolonged for greater than four weeks, treatment with itraconazole is indicated. The anticipated duration is 6 to 12 weeks. The patient's response should be monitored with a chest x-ray. Furthermore, observation for recurrence is necessary for several years following the diagnosis. If the illness is determined to be severe or does not respond to itraconazole, amphotericin B should be initiated for a minimum of 2 weeks, but up to 1 year. Cotreatment with methylprednisolone is indicated to improve pulmonary compliance and reduce inflammation, thus improving the work of respiration.

The disseminated disease requires similar systemic antifungal therapy to pulmonary infection. Additionally, procedural intervention may be necessary, depending on the site of dissemination, to include thoracentesis, pericardiocentesis, or abdominocentesis. Ocular involvement requires steroid treatment additions and necessitates ophthalmology consultation. In pericarditis patients, antifungals are contraindicated because the subsequent inflammatory reaction from therapy would worsen pericarditis.

Patients may necessitate intensive care unit placement dependent on their respiratory status, as they may pose a risk for rapid decompensation. Should this occur, respiratory support is necessary, including non-invasive BiPAP or invasive mechanical intubation. Surgical interventions are rarely warranted; however, bronchoscopy is useful as both a diagnostic measure to collect sputum samples from the lung and therapeutic to clear excess secretions from the alveoli. Patients are at risk for developing a coexistent bacterial infection, and appropriate antibiotics should be considered after 2 to 4 months of known infection if symptoms are still present. [9]

Prognosis 

If not treated appropriately and in a timely fashion, the disease can be fatal, and complications will arise, such as recurrent pneumonia leading to respiratory failure, superior vena cava syndrome, fibrosing mediastinitis, pulmonary vessel obstruction leading to pulmonary hypertension and right-sided heart failure, and progressive fibrosis of lymph nodes. Acute pulmonary histoplasmosis usually has a good outcome on symptomatic therapy alone, with 90% of patients being asymptomatic. Disseminated histoplasmosis, if untreated, results in death within 2 to 24 months. Overall, there is a relapse rate of 50% in acute disseminated histoplasmosis. In chronic treatment, however, this relapse rate decreases to 10% to 20%. Death is imminent without treatment.

  • Pearls of Wisdom

While illnesses such as pneumonia are more prevalent, it is important to keep in mind that more rare diseases are always possible. Keeping in mind that every infiltrates on a chest X-ray or chest CT is not guaranteed to be simple pneumonia. Key information to remember is that if the patient is not improving under optimal therapy for a condition, the working diagnosis is either wrong or the treatment modality chosen by the physician is wrong and should be adjusted. When this occurs, it is essential to collect a more detailed history and refer the patient for appropriate consultation with a pulmonologist or infectious disease specialist. Doing so, in this case, yielded workup with bronchoalveolar lavage and microscopic evaluation. Microscopy is invaluable for definitively diagnosing a pulmonary consolidation as exemplified here where the results showed small, budding, intracellular yeast in tissue sized 2 to 5 microns that were readily apparent on hematoxylin and eosin staining and minimal, normal flora bacterial growth. 

  • Enhancing Healthcare Team Outcomes

This case demonstrates how all interprofessional healthcare team members need to be involved in arriving at a correct diagnosis. Clinicians, specialists, nurses, pharmacists, laboratory technicians all bear responsibility for carrying out the duties pertaining to their particular discipline and sharing any findings with all team members. An incorrect diagnosis will almost inevitably lead to incorrect treatment, so coordinated activity, open communication, and empowerment to voice concerns are all part of the dynamic that needs to drive such cases so patients will attain the best possible outcomes.

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Histoplasma Contributed by Sandeep Sharma, MD

Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies.

Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies.

Disclosure: Deepa Rawat declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

  • Cite this Page Sharma S, Hashmi MF, Rawat D. Case Study: 33-Year-Old Female Presents with Chronic SOB and Cough. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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  • Volume 21, Issue 1
  • What is a case study?
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  • Roberta Heale 1 ,
  • Alison Twycross 2
  • 1 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
  • 2 School of Health and Social Care , London South Bank University , London , UK
  • Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E2C6, Canada; rheale{at}laurentian.ca

https://doi.org/10.1136/eb-2017-102845

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What is it?

Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research. 1 However, very simply… ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’. 1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables. 2

Often there are several similar cases to consider such as educational or social service programmes that are delivered from a number of locations. Although similar, they are complex and have unique features. In these circumstances, the evaluation of several, similar cases will provide a better answer to a research question than if only one case is examined, hence the multiple-case study. Stake asserts that the cases are grouped and viewed as one entity, called the quintain . 6  ‘We study what is similar and different about the cases to understand the quintain better’. 6

The steps when using case study methodology are the same as for other types of research. 6 The first step is defining the single case or identifying a group of similar cases that can then be incorporated into a multiple-case study. A search to determine what is known about the case(s) is typically conducted. This may include a review of the literature, grey literature, media, reports and more, which serves to establish a basic understanding of the cases and informs the development of research questions. Data in case studies are often, but not exclusively, qualitative in nature. In multiple-case studies, analysis within cases and across cases is conducted. Themes arise from the analyses and assertions about the cases as a whole, or the quintain, emerge. 6

Benefits and limitations of case studies

If a researcher wants to study a specific phenomenon arising from a particular entity, then a single-case study is warranted and will allow for a in-depth understanding of the single phenomenon and, as discussed above, would involve collecting several different types of data. This is illustrated in example 1 below.

Using a multiple-case research study allows for a more in-depth understanding of the cases as a unit, through comparison of similarities and differences of the individual cases embedded within the quintain. Evidence arising from multiple-case studies is often stronger and more reliable than from single-case research. Multiple-case studies allow for more comprehensive exploration of research questions and theory development. 6

Despite the advantages of case studies, there are limitations. The sheer volume of data is difficult to organise and data analysis and integration strategies need to be carefully thought through. There is also sometimes a temptation to veer away from the research focus. 2 Reporting of findings from multiple-case research studies is also challenging at times, 1 particularly in relation to the word limits for some journal papers.

Examples of case studies

Example 1: nurses’ paediatric pain management practices.

One of the authors of this paper (AT) has used a case study approach to explore nurses’ paediatric pain management practices. This involved collecting several datasets:

Observational data to gain a picture about actual pain management practices.

Questionnaire data about nurses’ knowledge about paediatric pain management practices and how well they felt they managed pain in children.

Questionnaire data about how critical nurses perceived pain management tasks to be.

These datasets were analysed separately and then compared 7–9 and demonstrated that nurses’ level of theoretical did not impact on the quality of their pain management practices. 7 Nor did individual nurse’s perceptions of how critical a task was effect the likelihood of them carrying out this task in practice. 8 There was also a difference in self-reported and observed practices 9 ; actual (observed) practices did not confirm to best practice guidelines, whereas self-reported practices tended to.

Example 2: quality of care for complex patients at Nurse Practitioner-Led Clinics (NPLCs)

The other author of this paper (RH) has conducted a multiple-case study to determine the quality of care for patients with complex clinical presentations in NPLCs in Ontario, Canada. 10 Five NPLCs served as individual cases that, together, represented the quatrain. Three types of data were collected including:

Review of documentation related to the NPLC model (media, annual reports, research articles, grey literature and regulatory legislation).

Interviews with nurse practitioners (NPs) practising at the five NPLCs to determine their perceptions of the impact of the NPLC model on the quality of care provided to patients with multimorbidity.

Chart audits conducted at the five NPLCs to determine the extent to which evidence-based guidelines were followed for patients with diabetes and at least one other chronic condition.

The three sources of data collected from the five NPLCs were analysed and themes arose related to the quality of care for complex patients at NPLCs. The multiple-case study confirmed that nurse practitioners are the primary care providers at the NPLCs, and this positively impacts the quality of care for patients with multimorbidity. Healthcare policy, such as lack of an increase in salary for NPs for 10 years, has resulted in issues in recruitment and retention of NPs at NPLCs. This, along with insufficient resources in the communities where NPLCs are located and high patient vulnerability at NPLCs, have a negative impact on the quality of care. 10

These examples illustrate how collecting data about a single case or multiple cases helps us to better understand the phenomenon in question. Case study methodology serves to provide a framework for evaluation and analysis of complex issues. It shines a light on the holistic nature of nursing practice and offers a perspective that informs improved patient care.

  • Gustafsson J
  • Calanzaro M
  • Sandelowski M

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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How to Write a Nursing Case Study [Examples, Format, & Tips]

A nursing case study is a deep analysis of the health situation of a patient. This article answers all the questions about the proper way to prepare this kind of writing. It also suggests some writing tipis and features free nursing case study examples.

✒️ Case Study Topics for Nursing Students

  • 🩺️ The Basics
  • 💉 Nursing Case Study: Writing Rules

📑 Nursing Case Study Format

📝 nursing case study examples.

  • ⏱️ Tips on Quick Writing

🔗 References

A nursing case study is an in-depth analysis of the health situation of an individual patient.

A nursing case study is an in-depth analysis of the health situation of an individual patient.

The analysis is based on:

  • medical history,
  • other relevant criteria.

In most cases, you will be asked to diagnose to suggest the first aid measures. Alternatively, nurses can be asked to describe a patient in their practice and analyze the correctness of their actions. The purpose is to recreate a realistic hospital setting in the classroom and make students reflect on the treatment process from diagnosis to treatment.

  • Anaphylactic shock in a teenager with peanut allergy.
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  • The use of massage therapy in relieving pain.
  • The challenges facing medicine in 2024.
  • How does modern technology impact nursing?
  • The significance of regular follow-up appointments with the healthcare provider.
  • What are the primary treatments for postpartum depression?
  • The use of steroids in cancer treatment.

🩺️ Nursing Case Study: What Is It About?

As a nursing student, you should understand that no two patients are the same. Each has a unique clinical record and condition. And although most nursing case study tasks will ask you to suggest a diagnosis or treatment, your focus should rest on the patient.

Busy nurses can sometimes see their patients in the framework of an illness to be treated or a procedure to be fulfilled. But you should do your best to remember that each patient is a living person with a complex set of needs, emotions, and preferences. A ready-made textbook answer is rarely the best solution for them. Moreover, it rarely helps to analyze a condition in isolation from the patient.

In a nursing case study, your task is to analyze a disorder or illness as a part of a specific medical situation. If you don’t do that, your case study becomes an essay (theoretical and generalized). It is the difference between the two assignment types.

Once again:

A case study in nursing emphasizes the particular patient’s condition. Meanwhile, a nursing essay will explore the disease, prevention methods, treatment, or possible consequences of the disease.

Even if the case is hypothetical, it should focus on the suggested reality. On the other hand, essays are usually literature-based. You are expected to do some reading for a case study too, but you should research and present the information within the context of the patient. In simple terms, a case study uses information in the actual application, and an essay uses it for the sake of generalized suggestions.

💉 How to Write a Nursing Case Study: 3 Key Rules

  • Do the fieldwork. Before setting your hands to writing, you should collect all of the available materials: clinical notes, results of medical tests, x-rays, sickness records, etc. Use this information to draw a clear picture of the story. It is always helpful to ask yourself, “What is interesting or unusual about this patient’s condition?” In the course of writing, recall your answer from time to time not to get lost in words. It will help you to convey a definite and appropriate message.

The picture contains the 3 key rules of nursing case study writing.

  • Stick to the facts. A nursing case study should be an accurate description of the actual situation. Restrain from speculating about the inherent mechanisms of the illness or the general treatment methodology. In fact, students are rarely prepared enough to discuss pathology and physiology. Leave this to reputable experts. The best result you can provide in a case study is an honest account of clinical events.
  • Concentrate on the patients and their progress. Remember that a nursing case study is a story of a patient’s progress and not a narrative about their nurse. No matter how efficiently the medical specialist acted, it would be incorrect to add any praiseful remarks. The optimal way is to tell the story in its logical and time order and outline the result of treatment. In this case, the outcome will speak for itself.

Introduction

It is where you should tell the reader why this case is interesting . Place your study in a social or historical context. If, during your preliminary research, you found some similar cases, describe them briefly. If you had a hard time diagnosing the patient or your proposed treatment is complicated, mention it here. Don’t forget to cite the references to each of them!

The introduction should not exceed several paragraphs. The purpose is to explain why the reader will benefit from reading about the case.

The picture contains a list of structural components of a nursing case study,

Case Presentation

  • Why did the patient seek medical help? (Describe the symptoms.)
  • What is known about the patient? (Mention only the information that influenced your diagnosis. Otherwise, explain why some information is irrelevant to the diagnosis.)
  • Stick to the narrative form. (Make it a story!)
  • What are the variants for diagnosis? (Make a shortlist of possible disorders that fall under the patient’s symptoms. But make it specific: not just “pneumonia” but “bilateral pneumonia,” for example. Besides, this point is optional.)
  • What were the results of your clinical examination? (If you saw the patient in person.)
  • Explain the results of lab tests. (The words “positive” or “negative” are not always clear.)

Actions and Their Results

This section describes the care that has been provided and/or is planned. You can answer the following questions in narrative form . If some information is missing, skip the point:

  • What preliminary actions have been taken? (Be specific: not just “wound care,” but “wound cleaning and dressing.”)
  • How long has the patient been under care?
  • Has the previous treatment given any visible result?
  • Why was it suspended or finished?
  • Why did the patient withdraw from treatment (if applicable)?
  • How could you improve the patient’s condition if the result was negative?
  • If the disease is incurable (like in the case of diabetes), which activities would stabilize the patient’s condition?
  • If possible, include the patient’s reports of their own physical and mental health.

In this section, you should identify your questions about the case. It is impossible to answer all of them in one case study. Likewise, it is unreal to suggest all the relevant hypotheses explaining the patient’s condition. Your purpose is to show your critical thinking and observation skills. Finalize your conclusion by summarizing the lessons you learned from the nursing case study.

Whenever you directly or indirectly cite other sources or use data from them, add these books and documents to the references list. Follow the citation style assigned by your professor. Besides, 15 items are already too much. Try to make a list of up to 10. Using textbooks as references can be viewed as bad manners.

Include all the tables, photographs, x-rays, figures, and the journal of medication usage in this section. Unless required otherwise in the assignment, start each item from a new page, naming them “Appendix A,” “Appendix B…”.

Below you will find case study samples for various topics. Using them as a reference will improve your writing. If you need more ideas, you are welcome to use our free title-generating tool .

  • Case study: healing and autonomy.
  • Sara’s case study: maternal and child nursing.
  • COPD medical diagnostics: case study.
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  • Alzheimer disease: the patient case study.
  • The treatment of foot ulcers in diabetic patients: case study.
  • Hypertension: C.D’s case study.
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  • Major depressive disorder case.
  • Case study of the patient with metabolic syndrome .
  • Pulmonary analysis case study .
  • Older adults isolation: Case study .
  • The holistic care: Case study .
  • Medical ethics: Case study .
  • Patient diagnoses and treatment: Case study .
  • Obesity case study: Mr. C .
  • Nurse Joserine: Case study problems .
  • Chronic stable angina: Case study .
  • Fetal abnormality: Case study .
  • Researching SOAP: Case study .
  • Case study for a patient with hormonal disorders .
  • Obesity in the elderly: The case study .
  • “Walking the Tightrope”: A case study analysis .
  • ARNP approach: Case study analysis .
  • Case study on biomedical ethics in the Christian narrative .
  • Thermal injury: Case study .
  • Ethical dilemma in nursing: Case study .
  • Asthma: A case study of the patient .
  • Asthma discharge plan: Mini case study .
  • Case study: An ethics of euthanasia .
  • Case study: Head-to-toe assessment steps .
  • Pain management strategies: Case study .
  • Case study: Inflammatory bowel disease .
  • Sleep deprivation and insomnia: The case study .
  • The case study of a heart failure .
  • Porphyria cutanea tarda: Disease case study .
  • Case study: Hardy Hospital case summary .
  • Obesity and its complications: Case study .
  • Angina disease case study .
  • Nursing ethics case study .
  • Case study of a patient: Assessment and treatment plan .
  • Cecile case study: Mrs. J .
  • Nursing power in the emergency department: Case study .
  • Heart failure case study: Mrs. J .
  • Application of ethics in nursing: Case study .
  • Sudden visual impairment: Case study .
  • Epidemiology case study: Outbreak at Watersedge — Public health discovery game .
  • Wellness of senior citizens: Case study .
  • Healthcare organization evaluation: Case study of Banner Health .

⏱️ Bonus: Tips on Writing a Case Study in Record Time

Need to prepare a case study on nursing or in another field? Below you’ll find a collection fo tips that will help you do it as quickly as possible!

3 Shortcuts for a Quick Start

If you’re about to start writing a case study, you should check yourself if you’re not doing any of the following:

  • spending too much time on selecting a topic;
  • reading too much before selecting a topic;
  • making conclusions too early – creating bias.

Instead of killing time doing the three useless things discussed above, consider these:

  • Choose approach. Note that there are 2 major approaches to case studies: the analytical approach (investigating possible reasons without making any conclusions) and problem-oriented approach (focusing on a particular problem and investigating it).
  • Skim some sources (DON’T READ THEM). Select several sources. Simply skim abstracts and conclusions.
  • Start making notes early. Simply reading is ineffective unless you’re lucky to have a phenomenal memory. Always make notes of any useful arguments.

4 Shortcuts Not to Get Stuck in the Middle

Even if you kick started your case study, it’s too early to celebrate it. Consider the following traps in the middle of the project:

  • Watch the structure. The classic logical structure is your formula of success. It will help you move from one point to another without the unnecessary procrastination:
  • Respect the logic. Make your case study flow – make logical transitions between the different parts and make it consistent. Avoid changing your position throughout the paper.
  • Be detail-oriented. Any trifle deserves attention when you write a case study.
  • Avoid bias. Be sure that all your opinions are based on the specific arguments form the case study. Avoid pouring your biased views into the project.

3 Shortcuts for a Happy Ending

  • Offer a realistic solution. College case study is a rehearsal of real-life situations. Take the responsibility for your suggestions.
  • Keep your conclusion short. Avoid repeating the details and don’t include any new information.
  • Consider creating a Power Point. If your task is not only writing a case study, but also presenting it – why not create PowerPoint slides to help you?

As the last step on your way to a perfect nursing case study, prepare the title page. Its format usually depends on the professor’s requirements. But if you know the citation style, our Title Page Maker is a perfect tool to apply the right formatting and accelerate the process. And if you have any know-how on how to write a medical case study, you are very welcome to share it with other students in the comments below.

❓ Nursing Case Study: FAQ

What is a case study in nursing.

A nursing case study explores the condition of a patient. It is based on previous clinical records, lab reports, and other medical and personal information. A case study focuses on the patient and describes the treatment that was (or should be) applied and its (expected) outcome.

How to Write a Nursing Case Study?

  • Collect the bulk of data available about the patient.
  • Read literature about the diagnosed condition.
  • Focus on the individual patient and their symptoms.
  • Describe the situation and outline its development in time.
  • Analyze the actions of the medical personnel that have been done.
  • Plan further treatment of the patient.

Why Are Case Studies Good for Nursing Students?

Nursing case studies offer you a priceless opportunity to gain experience of different patient conditions and cure methods without visiting the clinic. You can think about whether the proposed treatment was appropriate or wrong and suggest a better solution. And the best thing, your teacher will indicate your mistakes (and no patient will be hurt in the process).

Why Are Case Studies Important in Nursing?

  • You learn to distinguish the relevant data and analyze it.
  • You learn to ask the right questions.
  • You learn to evaluate the severity of symptoms.
  • You learn to make better diagnoses.
  • You train your critical thinking in terms of treatment methods
  • Case studies are in-class simulators of authentic atmosphere in a clinical ward.
  • What is a case study? | Evidence-Based Nursing
  • Case Studies – Johns Hopkins Medicine
  • Case Study Research Design in Nursing
  • Case study report for Nursing | Learning Lab – RMIT University
  • Case Study or Nursing Care Study? – jstor

Research Paper Analysis: How to Analyze a Research Article + Example

Film analysis: example, format, and outline + topics & prompts.

This website is intended for healthcare professionals

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Akhtar N, Lee L Utilization and complications of central venous access devices in oncology patients. Current Oncology.. 2021; 28:(1)367-377 https://doi.org/10.3390/curroncol28010039

BD ChloraPrep: summary of product characteristics.. 2021; https://www.bd.com/en-uk/products/infection-prevention/chloraprep-patient-preoperative-skin-preparation/chloraprep-smpc-pil-msds

Chloraprep 10.5ml applicator.. 2022a; https://www.bd.com/en-uk/products/infection-prevention/chloraprep-patient-preoperative-skin-preparation/chloraprep-patient-preoperative-skin-preparation-product-line/chloraprep-105-ml-applicator

Chloraprep 3ml applicator.. 2022b; https://www.bd.com/en-uk/products/infection-prevention/chloraprep-patient-preoperative-skin-preparation/chloraprep-patient-preoperative-skin-preparation-product-line/chloraprep-3-ml-applicator

Website.. 2021; https://www.cdc.gov/cancer/preventinfections/providers.htm

Ceylan G, Topal S, Turgut N, Ozdamar N, Oruc Y, Agin H, Devrim I Assessment of potential differences between pre-filled and manually prepared syringe use during vascular access device management in a pediatric intensive care unit. https://doi.org/10.1177/11297298211015500

Clare S, Rowley S Best practice skin antisepsis for insertion of peripheral catheters. Br J Nurs.. 2021; 30:(1)8-14 https://doi.org/10.12968/bjon.2021.30.1.8

Caguioa J, Pilpil F, Greensitt C, Carnan D HANDS: standardised intravascular practice based on evidence. Br J Nurs.. 2012; 21:(14)S4-S11 https://doi.org/10.12968/bjon.2012.21.Sup14.S4

Easterlow D, Hoddinott P, Harrison S Implementing and standardising the use of peripheral vascular access devices. J Clin Nurs.. 2010; 19:(5-6)721-727 https://doi.org/10.1111/j.1365-2702.2009.03098.x

Florman S, Nichols RL Current approaches for the prevention of surgical site infections. Am J Infect Dis.. 2007; 3:(1)51-61 https://doi.org/10.3844/ajidsp.2007.51.61

Gorski LA, Hadaway L, Hagle M Infusion therapy standards of practice. J Infus Nurs.. 2021; 44:(S1)S1-S224 https://doi.org/10.1097/NAN.0000000000000396

Guenezan J, Marjanovic N, Drugeon B Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, openlabel, single centre, randomised-controlled, two-by-two factorial trial [published correction appears in Lancet Infect Dis. 2021 Apr 6]. Lancet Infect Dis.. 2021; 21:(7)1038-1048 https://doi.org/10.1016/S1473-3099(20)30738-6

Gunka V, Soltani P, Astrakianakis G, Martinez M, Albert A, Taylor J, Kavanagh T Determination of ChloraPrep® drying time before neuraxial anesthesia in elective cesarean delivery: a prospective observational study. Int J Obstet Anesth.. 2019; 38:19-24 https://doi.org/10.1016/j.ijoa.2018.10.012

Ishikawa K, Furukawa K Staphylococcus aureus bacteraemia due to central venous catheter infection: a clinical comparison of infections caused by methicillin-resistant and methicillin-susceptible strains. Cureus.. 2021; 13:(7) https://doi.org/10.7759/cureus.16607

Loveday HP, Wilson JA, Pratt RJ Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect.. 2014; 86:(S1)S1-70 https://doi.org/10.1016/S0195-6701(13)60012-2

Promoting safer use of injectable medicines.. 2007; https://healthcareea.vctms.co.uk/assets/content/9652/4759/content/injectable.pdf

Standards for infusion therapy. 4th edn.. 2016; https://www.rcn.org.uk/clinical-topics/Infection-prevention-and-control/Standards-for-infusion-therapy

Taxbro K, Chopra V Appropriate vascular access for patients with cancer. Lancet.. 2021; 398:(10298)367-368 https://doi.org/10.1016/S0140-6736(21)00920-X

Case Studies

Gema munoz-mozas.

Vascular Access Advanced Nurse Practitioner—Lead Vascular Access Nurse, The Royal Marsden NHS Foundation Trust

View articles · Email Gema

Colin Fairhurst

Vascular Access Advanced Clinical Practitioner, University Hospitals Plymouth NHS Trust

View articles

Simon Clare

Research and Practice Development Director, The Association for Safe Aseptic Practice

View articles · Email Simon

nursing case study examples

Intravenous (IV) access, both peripheral and central, is an integral part of the patient care pathways for diagnosing and treating cancer. Patients receiving systemic anticancer treatment (SACT) are at risk for developing infections, which may lead to hospitalisation, disruptions in treatment schedules and even death ( Centers for Disease Control and Prevention, 2021 ). However, infection rates can be reduced and general patient outcomes improved with the evidence-based standardisation of IV practice, and the adoption of the appropriate equipment, such as peripheral IV cannulas, flushing solutions and sterile IV dressings ( Easterlow et al, 2010 ).

Cancer treatment frequently involves the use of central venous catheters (CVCs)-also referred to as central venous access devices (CVADs)—which can represent a lifeline for patients when used to administer all kinds of IV medications, including chemotherapy, blood products and parenteral nutrition. They can also be used to obtain blood samples, which can improve the patient’s quality of life by reducing the need for peripheral stabs from regular venepunctures ( Taxbro and Chopra, 2021 ). CVCs are relatively easy to insert and care for; however, they are associated with potential complications throughout their insertion and maintenance.

One serious complication of CVC use is catheter-related bloodstream infections (CRBSIs), which can increase morbidity, leading to prolonged hospitalisation and critical use of hospital resources ( Akhtar and Lee, 2021 ). Early-onset CRBSIs are commonly caused by skin pathogens, and so a cornerstone of a CRBSI prevention is skin antisepsis at the time of CVC insertion. Appropriate antisepsis (decontamination/preparation) of the site for CVC insertion can prevent the transmission of such skin pathogens during insertion, while reducing the burden of bacteria on the CVC exit site ( Loveday et al, 2014 ).

Evidence-based practice for the prevention of a CRBSIs and other healthcare-associated infections recommends skin antisepsis prior to insertion of a vascular-access device (VAD) using a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution. This is recommended in guidelines such as epic3 ( Loveday et al, 2014 ), the Standards for Infusion Therapy ( Royal College of Nursing, 2016 ) and the Infusion Therapy Standards of Practice ( Gorski et al, 2021 ). A strong evidenced-backed product such as BD ChloraPrep™ ( Figure 1 ) has a combination of 2% chlorhexidine gluconate in 70% isopropyl alcohol that provides broad-spectrum rapid-action antisepsis, while the applicators facilitate a sterile, single-use application that eliminates direct hand-to-patient contact, helping to reduce cross-contamination and maintaining sterile conditions ( BD, 2021 ). The BD ChloraPrep™ applicator’s circular head allows precise antisepsis of the required area, and the sponge head helps to apply gentle friction in back-and-forth motion to penetrate the skin layers ( BD, 2021 ). BD ChloraPrep’s rapidacting, persistent and broad-spectrum characteristics and proven applicator system ( Florman and Nichols, 2007 ) make it a vital part of the policy and protocol for insertion, care and maintenance of CVCs in specialist cancer centres such as the Royal Marsden. Meanwhile, the use of BD PosiFlush™ Prefilled Saline Syringe ( Figure 2 ), a prefilled normal saline (0.9% sodium choride) syringe, is established practice for the flushing regime of VADs in many NHS Trusts.

nursing case study examples

The following five case studies present examples from personal experience of clinical practice that illustrate how and why clinicians in oncology and other disciplines use BD ChloraPrep ™ and BD PosiFlush ™ Prefilled Saline Syringe in both adult and paediatric patients.

Case study 1 (Andy)

Andy was a 65-year-old man being treated for metastatic colorectal cancer at the Royal Marsden NHS Foundation Trust specialist cancer service, which provides state-of-the-art treatment to over 60 000 patients each year.

Andy had a peripherally inserted central catheter (PICC) placed at the onset of his chemotherapy treatment to facilitate IV treatment. While in situ, PICCs require regular maintenance to minimise associated risks. This consists of a weekly dressing change to minimise infection and a weekly flush to maintain patency, if not in constant use. For ambulatory patients, weekly PICC maintenance can be carried out either in the hospital outpatient department or at home by a district nurse or family member trained to do so. Patients, relatives, carers and less-experienced nurses involved in PICC care (flushing and dressing) can watch a video on the Royal Marsden website as an aide memoir.

Initially, Andy decided to have his weekly PICC maintenance at the hospital’s nurse-led clinic for the maintenance of CVCs. At the clinic, Andy’s PICC dressing change and catheter flushing procedures were performed by a nursing associate (NA), who, having completed the relevant competences and undergone supervised practise, could carry out weekly catheter maintenance and access PICC for blood sampling.

In line with hospital policy, the PICC dressing change was performed under aseptic non-touch technique (ANTT) using a dressing pack and sterile gloves. After removal of the old dressing, the skin around the entry site and the PICC was cleaned with a 3 ml BD ChloraPrep™ applicator, using back-andforth strokes for 30 seconds and allowing the area to air dry completely before applying the new dressing. As clarified in a recent article on skin antisepsis (Clare and Rowley, 2020), BD ChloraPrep™ applicator facilitated a sterile, single-use application that eliminates direct hand-to-patient contact, which help reduce cross-contamination and maintaining ANTT. Its circular head allowed precise antisepsis around the catheter, and the sponge head helped to apply gentle friction in back-and-forth strokes to penetrate the skin layers.

Once the new dressing was applied, the NA continued to clean the catheter hub and change the needle-free connector. Finally, the catheter lumen was flushed with 10 ml of normal saline (0.9% sodium chloride) with a pre-filled saline syringe (BD PosiFlush™ Prefilled Saline Syringe). This involved flushing 1 ml at a time, following a push-pause technique, with positive pressure disconnection to ensure catheter patency. The classification of these syringes as medical devices enables NAs and other nonregistered members of the clinical team to support nursing staff with the care and maintenance of PICCs and other CVCs, within local policies and procedures. Using pre-filled syringes can save time and minimise the risk of contamination of the solution ( Ceylan et al, 2021 ).

The use of pre-filled 0.9% sodium chloride syringes facilitates home maintenance of PICCs for patients. When Andy did not need to attend hospital, his PICC maintenance could be performed by a family member. Patients and relatives could access the necessary equipment and training from the day-case unit or outpatient department. Home PICC maintenance is extremely beneficial, not just to providers, but also to patients, who may avoid unnecessary hospital attendance and so benefit from more quality time at home and a reduced risk of hospital-acquired infections. Many patients and relatives have commented on the convenience of having their PICC maintenance at home and how easy they found using the ChloraPrep™ and BD PosiFlush™ Prefilled Saline Syringe ‘sticks’.

Case study 2 (Gail)

Gail was as a 48-year-old woman being treated for bladder cancer with folinic acid, fluorouracil and oxaliplatin (FOLOX). She was admitted for a replacement PICC, primarily for continuous cytotoxic intravenous medication via infusion pump in the homecare setting. Her first PICC developed a reaction thought to be related to a sutureless securement device (SSD) anchoring the PICC. The device was removed, but this resulted in displacement of the PICC and incorrect positioning in the vessel (superior vena cava). Now unsafe, the PICC was removed, awaiting replacement, which resulted in a delayed start for the chemotherapy.

A second PICC placement was attempted by a nurse-led CVC placement team, and a line attempt was made in Gail’s left arm. Skin antisepsis was undertaken using a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution (ChloraPrep™). A BD ChloraPrep ™ 10 ml applicator was selected, using manufacturer’s recommendations, as per best practice guidance for CVC placement ( Loveday et al, 2014 ) and to comply with local policy for the use of ANTT. The BD ChloraPrep™ applicator allowed improved non-touch technique and helped facilitate good key-part and key-site protection, in line with ANTT ( Clare and Rowley, 2021 ).

The inserting clinician failed to successfully position the PICC in Gail’s left arm and moved to try on the right. On the second attempt, Gail noted the use of BD ChloraPrep™ and stated that she was allergic to the product, reporting a severe skin rash and local discomfort. The line placer informed the Gail that she had used BD ChloraPrep™ on the failed first attempt without issue, and she gave her consent to continue the procedure. No skin reaction was noted during or after insertion of the PICC.

BD ChloraPrep™ has a rapid-acting broad-spectrum antiseptic range and ability to keep fighting bacteria for at least 48 hours ( BD, 2021 ). These were tangible benefits during maintenance of the CVC insertion site, in the protection of key sites following dressing change and until subsequent dressing changes. There are reported observations of clinicians not allowing the skin to fully dry and applying a new dressing onto wet skin after removing old dressings and disinfecting the exit site with BD ChloraPrep™. This has been reported to cause skin irritation, which can be mistaken for an allergic reaction and lead the patient to think that they have an allergy to chlorhexidine. In our centre’s general experience, very few true allergic reactions have ever been reported by the insertion team. Improved surveillance might better differentiate between later reported reactions, possibly associated with a delayed response to exposure to BD ChloraPrep ™ at insertion, and local skin irritation caused by incorrect management at some later point during hospitalisation.

Staff training is an important consideration in the safe and correct use of BD ChloraPrep™ products and the correct use of adhesive dressings to avoid irritant contact dermatitis (ICD). It is worth noting that it can be difficult to differentiate between ICD and allergic contact dermatitis (ACD). Education and training should be multifaceted (such as with training videos and study days), allowing for different ways of learning, and monitored with audit. Local training in the benefits of using BD ChloraPrep™ correctly have been reinforced by adding simple instructions to ANTT procedure guidelines for CVC insertion and maintenance. Education on its own is often limited to a single episode of training, the benefit of using ANTT procedure guidelines is that they are embedded in a programme of audits and periodic competency reassessment. This makes sure that, as an integral part of good practice, skin antisepsis with BD ChloraPrep ™ is consistently and accurately retrained and assessed.

Gail’s case illustrates the importance of correct application of BD ChloraPrep ™ and how good documentation and surveillance are vital in monitoring skin health during the repeated use skindisinfection products. Care should be taken when recording ICD and ACD reactions, and staff should take steps to confirm true allergy versus temporary skin irritation.

Case study 3 (Beata)

Beata was a 13-year-old teenage girl being treated for acute myeloid leukaemia. Although Beata had a dual-lumen skin-tunnelled catheter in situ, a peripheral intravenous cannula (PIVC) was required for the administration of contrast media for computed tomography (CT) scanning. However, Beata had needlephobia, and so the lead vascular access nurse was contacted to insert the cannula, following ultrasound guidance and the ANTT. After Beata and her mother gave their consent to the procedure, the nurse gathered and prepared all the equipment, including a cannulation pack, single-use tourniquet, skin-antisepsis product, appropriate cannula, PIVC dressing, 0.9% sodium chloride BD PosiFlush ™ Prefilled Saline Syringe, sterile gel, sterile dressing to cover ultrasound probe and personal protective equipment.

Prior to PIVC insertion, a 4x5 cm area of skin underwent antisepsis with a 1.5 ml BD ChloraPrep ™ Frepp applicator, with back-and-forth strokes for 30 seconds, and was allowed to air-dry. The vascular access team prefer to use BD ChloraPrep ™ Frepp over single-use wipes, as the former is faster acting and provides the right volume to decontaminate the indicated area using ANTT ( Clare and Rowley, 2021 ).

Following insertion, the PIVC was flushed with a 10 ml BD PosiFlush ™ Prefilled Saline Syringe syringe, using a pushpause pulsatile technique, with positive pressure disconnection. Local policy recommends the use of pre-filled saline syringes, as they save time and minimise infection risk compared with manually drawn saline flushes ( Ceylan et al, 2021 ). The Trust also permits competent non-registered members of staff to perform PIVC insertion, which is more cost-effective than depending on registered nurses.

In Beata’s case, the team considered the use of BD ChloraPrep™ and BD PosiFlush™ Prefilled Saline Syringe to be essential for the prevention of VAD-associated infections, as well as increasing the quality of nursing care by saving time in the day-case and inpatient settings alike.

Case study 4 (Emma)

Emma, a 43-year-old woman diagnosed with acute lymphoblastic leukaemia, was scheduled for an allogenic stem-cell transplant and associated chemotherapy. To facilitate this, she attended the vascular access service at University Hospitals Plymouth NHS Trust for the insertion of a triple-lumen skin-tunnelled catheter. This was identified as the best VAD for her needs, because of its longevity, multiple points of access and decreased infection risk compared with other devices, such as PICCs.

This was Emma’s second advanced VAD insertion, having previously received an apheresis line due to poor peripheral venous access, to facilitate the prior stem-cell harvest. She was yet to receive any treatment, and, therefore, no immunodeficiency had been identified prior to the insertion procedure.

Trust policy for skin disinfection prior to the insertion or removal of PICC lines is a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution, BD ChloraPrep™. There is an exception for patient history of allergy or sensitivity to BD ChloraPrep™, where 10% povidone iodine is used instead. Emma had received BD ChloraPrep™ before, with no sign allergy or sensitivity, and so the vascular access team decided to use this product again for insertion. BD Chloraprep™ was used, in preference of other skin antisepsis options, due to the applicator’s ability to effectively penetrate the layers of the epidermis, as well as the ability to eliminate direct hand-to-skin contact between the operator and patient ( Clare and Rowley, 2021 ).

Insertion of a skin-tunnelled catheter first requires disinfection of a large area, including the neck and upper chest. Following the manufacturer’s coverage recommendations, a 10.5 ml BD ChloraPrep™ applicator was selected as most suitable to cover an area of 25x30 cm ( BD, 2022 a).

The applicator was activated by pinching the wings to allow the antiseptic solution to properly load onto the sponge. To ensure proper release of the solution, the applicator was held on the skin against the anticipated site of insertion until the sponge pad became saturated. Then, a back-and-forth rubbing motion was undertaken for a minimum of 30 seconds, ensuring that the full area to be used was covered. The solution was then left to dry completely, prior to full-body draping, leaving the procedural area exposed for the procedure. Generally, drying time takes from 30 to 60 seconds, but local policy is not restrictive, as allowing the solution to fully dry is of paramount importance ( Gunka et al, 2019 ). BD Chloraprep™ is effective against a wide variety of microorganisms and has a rapid onset of action ( Florman and Nichols, 2007 ). Therefore, it was felt to be the best option for procedural and ongoing care skin asepsis in a patient anticipated to be immunocompromised during treatment.

It is the normal policy of the Trust’s vascular access service to flush VADs using BD PosiFlush™ Prefilled Saline Syringes with 0.9% sodium chloride. Likewise, BD PosiFlush™ Prefilled Saline Syringes Sterile Pathway (SP) are used to prime all VADs prior to insertion and to check for correct patency once inserted. BD PosiFlush ™ Prefilled Saline Syringe were used in preference of other options, such as vials or bags, due to the absence of requirement for a prescription in the local organisation. They are treated as a medical device and, therefore, can be used without prescription. The advantage of this is that flushes can be administered in a nurse-led clinic, where prescribers are not always available. Aside from the logistical advantages, the use of pre-filled syringes reduces the risk of microbial contamination through preparation error and administration error through correct labelling ( National Patient Safety Agency, 2007 ) In Emma’s case, three BD PosiFlush™ SP Prefilled Saline Syringes were used to check patency and/or ascertain venous location following the insertion of the skin-tunnelled catheter.

In this case, both BD ChloraPrep ™ and BD PosiFlush ™ Prefilled Saline Syringe proved simple to use and helped achieve a successful procedural outcome for the patient.

Case study 5 (Frank)

Frank was a 47-year-old man who had been diagnosed with infective endocarditis following a trans-oesophageal echo. A few days later, to facilitate his planned treatment of 6 weeks of intravenous antibiotics to be administered 4-hourly every day, he was referred to the vascular access service for insertion of longterm IV access. To facilitate this administration, the decision was made to place a PICC.

Frank’s referral included a history of illegal intravenous drug use and details of the consequent difficulty the ward-based team had in finding suitable veins to obtain vascular access. His medical history also included infected abscesses in the left groin and methicillin-resistant Staphylococcus aureus (MRSA) colonisation.

First, Frank was administered suppression therapy for MRSA decolonisation. Following this and prior to PICC insertion, the skin antisepsis procedure was undertaken using a 2% chlorhexidine gluconate and 70% isopropyl alcohol solution, BD ChloraPrep™, in adherence to Trust policy ( Loveday et al, 2014 ). Specifically, BD ChloraPrep™ applicators are selected for their single-use application. They have been demonstrated to reduce the risk of infectious complications (catheter colonisation and local infection) by 92% compared with 5% povidone iodine (PVI) 69% ethanol ( Guenezan et al, 2021 ). A 3 ml BD ChloraPrep™ applicator was considered suitable to decontaminate an area sufficient for the intended PICC insertion procedure, as recommended by the manufacturer ( BD, 2022 b). It was applied using a back-and-forth motion for a minimum of 30 seconds and left to fully dry ( Loveday et al, 2014 ). Staphylococcus aureus bacteraemia’s have a mortality rate of 20-40% and are predominantly caused by VAD insertion ( Ishikawa and Furukawa, 2021 ), and, therefore, the need to reduce this risk was of particular importance for this patient due to the history of MRSA colonisation.

In Frank’s case, the use of BD ChloraPrep™ during the insertion procedure and for each subsequent dressing change episode participated in an uneventful period of treatment. The clinical challenges posed by the patients’ presentation of MRSA colonisation meant the risk of infection was increased but, through correct antisepsis, no adverse events were noted, and the full course of treatment was successfully administered through the PICC.

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Nursing Case Study Analysis [10 Examples & How-To Guides]

  • Rachel Rachel
  • August 6, 2022

What is a case study analysis?

A case study analysis is a detailed examination of a specific real-world situation or event. It is typically used in business or nursing school to help students learn how to analyze complex problems and make decisions based on limited information.

Preparing a good case study analysis is not an easy task and requires a lot of time and effort. This article provides some tips on how to write a case study analysis that will help you get the most out of your research and provide a solid foundation for your writing.(Nursing Case Study Analysis)

Nursing Case Study Analysis

Nurses are constantly faced with decisions that have to be made in a timely and effective manner. Often, these decisions are based on the available information, which may be limited.

In order to make the best possible decisions, nurses need to be able to analyze and interpret data. Nursing case studies are an important tool that can help nurses improve their decision-making skills.

10 Nursing Case Study Analysis Examples

How to write case study analysis in nursing.

A case study analysis requires you to investigate a nursing scenario, examine the alternative solutions, and propose the most effective solution using supporting evidence.(Nursing Case Study Analysis)

Nurses have to constantly make decisions that affect the lives of their patients. In order to ensure that these decisions are made correctly, nurses need to have strong problem-solving and critical-thinking skills. Case studies are an excellent way for nurses to hone these skills.

Writing a nursing case study analysis is not as difficult as it may first seem. Follow these steps and you will be well on your way to writing a successful case study analysis.(Nursing Case Study Analysis)

  • Read the case study carefully. As you read, take note of any key facts or information that could be important for your analysis.
  • Once you have finished reading the case study, identify the main problem or issue that needs to be addressed.
  • Brainstorm possible solutions to the problem or issue . Try to come up with a few different options.
  • Choose the best solution based on the information in the case study and your own clinical experience.
  • Write up your analysis in a clear and concise manner. Be sure to support your chosen solution with evidence from the case study and your own professional experience .

Here’s How To Write A Nursing Case Study

How do you analyze a case study in nursing?

A nursing case study is an in-depth examination of a single individual. It is usually used to identify new areas of knowledge or to validate existing knowledge.

When analyzing a nursing case study, it is important to consider the following elements:

  • The patient’s medical history. This includes any prior illnesses, treatments, and medications.
  • The patient’s current condition. This includes symptoms, vital signs, and laboratory results.
  • The nurse’s observations. This includes the nurse’s notes on the patient’s condition and behavior.
  • The patient’s family and social history. This includes information on the patient’s family, friends, and social support network.(Nursing Case Study Analysis)
  • The patient’s response to treatment. This includes any changes in the patient’s condition or symptoms after receiving treatment.

How nursing practitioners can analyze Patient’s Cases

As a nurse practitioner, you will often be asked to provide a case analysis for your patients. This can be a daunting task, but there are some key elements that you should always include in your analysis.

  • The first element is the patient history. This should include any relevant medical history, as well as any personal information that may be pertinent to the case.
  • The second element is the physical examination. This should include a thorough examination of the patient, including any relevant test results.(Nursing Case Study Analysis)
  • The third element is the diagnosis. This is where you will provide your assessment of the patient’s condition and identify any potential problems.
  • The fourth element is the treatment plan. This is where you will outline the course of treatment that you recommend for the patient.
  • The fifth and final element is the prognosis. This is where you will provide your assessment of the likely outcome of the case, based on the information that you have gathered.

Steps of writing nursing case study analysis

Furthermore; there are different ways to approach writing a nursing case study analysis, but there are generally three main steps that need to be followed.

  • First, you will need to perform a thorough analysis of the case study. This means looking at all aspects of the case and trying to identify any key issues or problems.(Nursing Case Study Analysis)
  • Once you have done this, you will need to develop a hypothesis or research question that you can test.
  • Finally, you will need to write up your findings in a clear and concise manner.

Assuming that you have been given the task of writing a case study analysis, there are a few key steps that you will need to take in order to ensure that your document is well-written and informative.

  • Make sure that you understand all of the information presented in the case study , and take note of any key points or details that you think may be important.
  • What points do you want to make in your analysis?
  • What evidence will you use to support these points?
  • Once you have a good idea of what you want to say in your analysis, start organizing your thoughts and putting them into a coherent structure.(Nursing Case Study Analysis)
  • Once you have a rough outline of your case study analysis , start filling in the details. Flesh out your arguments and provide evidence to support them. In addition, make sure to address any counterarguments that could be made against your points.
  • Finally, conclude your analysis by summarizing your main points and providing any recommendations or suggestions for further action .

Nursing Case study Analysis Format and Structure

When it comes to writing a case study analysis, there is no one-size-fits-all approach. However, there is a general format and structure that you can follow to ensure your analysis is well-organized and flows smoothly. Here are the basics:

A nursing case study is a detailed study of a patient that is encountered by a nurse. The purpose of the case study is to provide a comprehensive view of the patient’s health condition and history. Nurse practitioners use case studies to enhance their ability to care for patients by providing them with a more complete picture of the patient’s health . Nurse practitioners may use different formats for their nursing case studies. However, all case studies should include certain key elements. These key elements include:

  • Patient information – This section should include basic demographic information about the patient, such as age, gender, race/ethnicity, and chief complaint
  • Medical history – This section should detail the patient’s past medical history, including any chronic conditions, medications, allergies, and surgeries.(Nursing Case Study Analysis)
  • Family history – This section should detail the patient’s family medical history, including any chronic conditions or genetic diseases that may be relevant to the patient’s current condition.
  • Social history – This section should detail the patient’s social circumstances, such as employment status, living situation, and alcohol/drug use.
  • Review of symptoms –A physical examination will help you to identify any physical abnormalities that may be causing or contributing to the patient’s condition.
  • Diagnostic testing – Diagnostic testing may be necessary in order to confirm or rule out a diagnosis . Common tests used in case analysis include blood work, imaging tests, and biopsies.
  • Treatment options – Once a diagnosis has been made, you will need to consider treatment options. Treatment options will vary depending on the diagnosis and the severity of the condition.(Nursing Case Study Analysis)
  • The prognosis (Evaluation and outcomes) – After considering all of the above factors, you will be able to give the patient a prognosis. The prognosis is an educated guess as to how the condition will progress.

When writing a nursing case study, nurse practitioners should use a clear and concise format. The format should be easy to follow and understand. Nurse practitioners should also include all of the key elements in their nursing case studies.

As a nurse practitioner, you will be required to conduct case analyses on patients in order to make treatment decisions. There are key elements that you will need to take into consideration when conducting a case analysis. These elements include the patient’s history, physical examination, laboratory data, and imaging studies.(Nursing Case Study Analysis)

By taking into consideration all of these elements, you will be able to develop a comprehensive picture of the patient’s condition. This will allow you to make an informed decision about the best course of treatment.

(Nursing Case Study Analysis)

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12+ Nursing Case Study Examples in PDF | DOC

Nursing Case Study Examples

ScienceDirect posted a nursing ethics case study where an end-stage prostate cancer patient, Mr. Green, confided to nursing staff about his plan to commit suicide. The patient asked the nurse to keep it a secret. The ethical problem is whether the nurse should tell the health care team members about the patient’s thought without his permission. The best ethical decision for this nursing case study was to share this critical information with other health care professionals, which was the action the nurse took. The team adhered to the proper self-harm and suicide protocol. The appropriate team performed a palliative therapy. As a result, the patient didn’t harm himself and died peacefully a few months after he was discharged.

What Is a Nursing Case Study?

A nursing case study is a detailed study of an individual patient. Through this type of research, you can gain more information about the symptoms and the medical history of a patient. It will also allow you to provide the proper diagnoses of the patient’s illness based on the symptoms he or she experienced and other affecting factors. Nursing students usually perform this study as part of their practicum, making it an essential experience because, through this research methodology , they can apply the lessons they have learned from school. The situation mentioned above was an excellent example of a nursing case study.

Nursing Case Study Segments

Typically, a nursing case study contains three main categories, such as the items below.

1. The Status of a Patient

In this section, you will provide the patient’s information, such as medical history, and give the current patient’s diagnosis, condition, and treatment. Always remember to write down all the relevant information about the patient. Other items that you can collect in this stage are the reasons for the patient to seek medical care and the initial symptoms that he or she is experiencing. After that, based on the gathered information, you will explain the nature and cause of the illness of the patient.

2. The Nursing Assessment of the Patient

In this stage, you will need to prepare your evaluation of the patient’s condition. You should explain each observation that you have collected based on the vital signs and test results. You will also explain each nursing diagnosis that you have identified and determine the proper nursing care plan for the patient.

3. The Current Care Plan and Recommendations

Describe the appropriate care plan that you can recommend to the patient based on the diagnosis, current status, and prognosis in detail, including how the care plan will affect his or her life quality. If needed, you can also evaluate the patient’s existing care plan and give recommendations to enhance it. It is also crucial to cite relevant authoritative sources that will support your recommendations .

12+ Nursing Case Study Examples

Now that you know what a nursing case study is and its stages, take a look at its actual samples by downloading the following documents. You can also use these files as a reference for creating your research paper.

1. Nursing Case Study Template

nursing case study template

  • Google Docs

Size: 77 KB

2. Free Nursing Student Care Plan Template

free nursing student care plan template

  • Apple Pages

Size: 27 KB

3. Nursing Action Case Study Example

nursing action case study example

Size: 75 KB

4. Hospital Nurseing Care Case Study Example

hospital nursein care case study example

Size: 558 KB

5. Nursing Health Case Study Example

nursing health case study example

Size: 71 KB

6. Fundamentals of Nursing Case Study Example

fundamentals of nursing case study example

Size: 217 KB

7. Sample Nursing Case Study Example

sample nursing case study example

Size: 105 KB

8. Nursing Research Case Study Example

nursing research case study example

Size: 267 KB

9. Standard Nursing Case Study Example

standard nursing case study

Size: 248 KB

10. Nursing Disability Case Study Example

nursing disability case study example

Size: 36 KB

11. Nursing care Patients Case Study Example

nursing care patients case study

Size: 113 KB

12. School of Nursing Case Study Example

school of nursing case study example

Size: 97 KB

13. Evaluation of Nursing Care Case Study Example

evaluation of nursing care case study example

Size: 18 KB

Steps on Nursing Process

Whether you are handling a patient with schizophrenia, pneumonia, diabetes, appendicitis, hypertension, COPD, etc, you will need to follow specific steps to ensure that you are executing the critical nursing process.

1. Assess the Patient

The first step of the nursing process requires critical thinking skills as it involves gathering both subjective and objective data. Subjective data includes verbal statements that you can collect from the patient or caregiver. In contrast, objective information refers to measurable and tangible data, such as vital signs, height, weight, etc. You can also use other sources of information, such as electronic health records, and friends that are in direct contact with the patient.

2. Diagnose the Patient

This critical step will help you in the next steps, such as planning and implementation of patient care. In this step, you will formulate a nursing diagnosis by applying clinical judgment. As a nurse, the North American Nursing Diagnosis Association (NANDA) will give you an up-to-date nursing diagnosis list, which will allow you to form a diagnosis based on the actual health problem.

3. Plan for a Proper Patient Care Plan

This part is where you will plan out the appropriate care plan for the patient. You will set this goal following the evidence-based practice (EDP) guidelines. The goal you will set should be specific, measurable, attainable, realistic, and timely ( SMART ).

4. Implement the Plan

In this stage, you can execute the plan that you have developed in the previous step. The implementation may need interventions such as a cardiac monitor, medication administration, etc.

5. Evaluate the Results

It is crucial to remember that every time the team does an intervention, you must do a reassessment to ensure that the process will lead to a positive result. You may need to reassess the patient depending on his progress, and the care plan may be modified based on the reassessment result.

Carrying out a nursing case study can be a delicate task since it puts the life of a person at stake. Thus, it requires a thorough investigation. With that said, it is essential to gain intensive knowledge about this type of study. Today, we have discussed an overview of how to conduct a nursing case study. However, if you think that you are having problems with your writing skills , we recommend you to consider looking for an essay writing service from the experts in the nursing department to ensure that the output follows the appropriate writing style and terminology.

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Clarifying case study research: examples from practice

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  • 1 School of Nursing and Midwifery, National University of Ireland, Galway.
  • PMID: 20450088
  • DOI: 10.7748/nr2010.04.17.3.41.c7745

Increasingly, nurse researchers are using case studies to explore phenomena in healthcare practice. A key characteristic of case study research is its ability to allow researchers to focus on complex situations while taking the context of the situation into account. This paper explores the two predominant theoretical approaches to case study research with examples of their use in practice and offers the novice researcher an introduction and practical overview of this approach.

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Next Generation NCLEX Case Study Sample Questions

One of the big changes on the Next Generation NCLEX exam is a shift toward case studies. Case studies often require a deeper level of critical thinking, and understanding diseases on a more in-depth level (especially the pathophysiology) will make these types of questions easier to answer.

In this article, you’ll be able to watch a free video to help you prepare for the new Next Generation NCLEX case study format. Nurse Sarah will walk you step-by-step through each scenario and help you understand how to use critical thinking and nursing knowledge to answer these types of questions.

Next Generation NCLEX Case Study Review Questions Video

NGN Case Study Sample Questions and Answers

First, let’s take a look at our case study summary below:

Case Study Summary:

A 68-year-old male is admitted with shortness of breath. He reports difficulty breathing with activity, lying down, or while sleeping. He states that in order to “breathe easier,” he has had to sleep in a recliner for the past week. The patient has a history of hypertension, myocardial infarction (2 years ago), and cholecystectomy (10 years ago). The patient is being transferred to a cardiac progressive care unit for further evaluation and treatment.

Question 1 of 6: The nurse receives the patient admitted with shortness of breath. What findings are significant and require follow-up? The options are listed below. Select all that apply.

To answer this first question in the NGN case study, let’s look at the information provided in the nursing notes and vital signs tabs provided:

next generation nclex, ngn case study, next generation nclex case study, next generation nclex questions and answers, ngn practice

This question is asking us to identify findings that are significant and require the nurse to follow-up. In other words, what is presenting that we can’t ignore but need to investigate further.

Therefore, let’s comb through the nursing notes and vital signs to see what is abnormal and requires follow-up.

First, the patient arrived to the room via stretcher. That’s fine and doesn’t necessarily require follow-up.

Next, the patient is alert and oriented x 4 (person, place, time, event). This tells us that the patient’s neuro status is intact so far. Therefore, the shortness of breath isn’t affecting the patient’s mental function yet (we have enough oxygen on board right now for brain activity).

However, the nurse has noticed the shortness of breath with activity and talking, which should not normally happen. This tells us something is wrong and is significant enough to require follow-up. We want to know why is this happening, is it going to get worse, etc.

The patient’s weight and vital signs were collected (this is good). Weight is 155 lbs. and BMI is within a healthy range (doesn’t tell us too much but may be useful later). The patient is also connected to a bedside monitor, so they need to be monitored constantly like on a progressive care unit.

The monitor shows sinus tachycardia . This is significant because it seems the patient’s shortness of breath is causing the heart to compensate by increasing the heart rate to provide more oxygen (hence the lungs may be compromised).

Then we find out that the lungs are indeed compromised because crackles are heard in both lungs , and this may be why our patient is short of breath. This is significant (could the patient have pulmonary edema?)

Then we find out the nurse has noted an S3. This is an extra heart sound noted after S2. And what jumps out to me about this is that it is usually associated with volume overload in the heart like in cases of heart failure . However, S3 may be normal in some people under 40 or during pregnancy, but that’s not the case with our patient based on what we read in the case summary.

Therefore, based on everything I’m reading in this case study, I’m thinking this patient may have heart failure, but we need those test results back (especially the echo and chest x-ray, and hopefully a BNP will be in there too).

We are also told that the patient has an 18 gauge IV inserted (which is good thing to have so we can give medications if required), orders have been received, labs drawn, and testing results are pending.

next generation nclex, nclex prep, nclex case study questions, nclex questions and answers, ngn review,

Now let’s look at the “Vital Signs” tab above, and ask yourself what is normal vs. abnormal for this patient (adult male).

  • The heart rate is high at 112 (tachycardia), and should normally be 60-100 bpm (see heart rhythms ).
  • Blood pressure is higher than normal (normal is 120/80), which indicates hypertension.
  • Oxygen saturation is 94% (this is on the low side as we’d normally want around 95% or higher, and the patient is on 4 L nasal cannula, which tells us the lungs are not okay).
  • Respiratory rate is increased (26 breaths per minute)…normal is 12-20 breaths per minute.

Based on the information we were provided, I’ve selected the answers below. These findings are significant and definitely require follow-up by the nurse.

next generation nclex questions and answers, next generation nclex answers, next generation nclex sample questions, ngn questions

When answering these NGN case study questions, it’s helpful to think of the ABCDE (airway, breathing, circulation, etc.) as all of these fall into that category. If we don’t follow-up on the shortness of breath, crackles, respiratory rate, o2 saturation (94% on 4 L nasal cannula), the respiratory system can further decline.

In addition, the sinus tachycardia, S3 gallop, and hypertension could indicate fluid overload in the heart. This may cause the heart to tire out and lead the lethal rhythm. On the other hand, temperature, pain, weight, and BMI are not abnormal and do not require follow-up.

See the Complete Next Generation NCLEX Case Study Review

Each question in the case study builds on the previous question. To see how these questions evolve based on the patient’s condition and labs, watch the entire Next Generation NCLEX Case Study Review video on our YouTube Channel (RegisteredNurseRN).

NCLEX Practice Quizzes

We’ve developed many free NCLEX review quizzes to test your knowledge on nursing topics and to help you prepare for the Next Generation NCLEX exam.

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10 nursing case study analysis examples [format + structure], bob cardens.

  • August 6, 2022

If you are a nursing student, you may be asked to write a case study analysis. This can be a daunting task, but it is possible to do if you follow some simple steps. Here we include Nursing Case Study Analysis Examples to help you get started.

First, read the case study and make sure you understand the situation. Next, identify the key players involved and their role in the case. Finally, analyze the data presented and draw your own conclusions.

Writing a case study analysis can be challenging, but it is also an excellent way to learn more about nursing care. By taking the time to understand the situation and identify the key players, you will be able to gain valuable insights that can be applied to future cases.

What You'll Learn

10 Nursing Case Study Analysis Examples

Nursing case study analysis format and structure.

When it comes to writing a case study analysis, there is no one-size-fits-all approach. However, there is a general format and structure that you can follow to ensure your analysis is well-organized and flows smoothly. Here are the basics:

A nursing case study is a detailed study of a patient that is encountered by a nurse. The purpose of the case study is to provide a comprehensive view of the patient’s health condition and history. Nurse practitioners use case studies to enhance their ability to care for patients by providing them with a more complete picture of the patient’s health. Nurse practitioners may use different formats for their nursing case studies. However, all case studies should include certain key elements. These key elements include:

As a nursing practitioner, you will be responsible for analyzing patient cases and providing care based on your findings. There are key elements that you must take into account when performing a case analysis in order to ensure that you are providing the best possible care for your patients.

  • The first element is the patient’s history. You will need to obtain a complete medical history in order to understand the background of the case and identify any potential risk factors.
  • Next, you will need to perform a physical examination of the patient. This will help you to identify any physical signs or symptoms that may be related to the case.
  • You will also need to order and review any laboratory tests or imaging studies that have been performed on the patient. These results can provide valuable information about the patient’s condition.
  • Once you have gathered all of this information, you will need to start piecing together the puzzle to form a diagnosis. This process will involve synthesizing all of the information you have gathered and making a determination about what is causing the patient’s symptoms.
  • Once you have made a diagnosis, you can start developing a treatment plan. This plan should be tailored specifically to the needs of the individual patient.

When writing a nursing case study, nurse practitioners should use a clear and concise format. The format should be easy to follow and understand. Nurse practitioners should also include all of the key elements in their nursing case studies. Nursing Case Study Analysis Examples

Nursing case study analysis examples

How to write a case study assignment

A case study is an in-depth analysis of a real-life situation or incident, as a way to illustrate content and theory to students. It is usually presented as a written report, but can also be done in the form of a presentation, video, or multimedia production.

Case studies are used in many different disciplines, including business, law, psychology, nursing, social work, and medical sciences.

A case study assignment is a type of paper that requires you to analyze a real-life or fictional situation and offer possible solutions. This can be a challenging task, but if you follow some basic guidelines, you can write a successful case study assignment.

Here are some tips on how to write a case study assignment:

  • Read the case study carefully. Make sure you understand the situation and the problem that needs to be solved.
  • Research the subject matter. You will need to have a good understanding of the relevant theories and concepts in order to offer possible solutions.
  • Read the case study carefully. This may seem obvious, but it is important to get a clear understanding of the situation before you start writing. Make sure you have all the relevant facts and figures to hand before you start.
  • Identify the key issues. Once you have read and understood the case study, you need to identify the key issues that it raises. These will form the basis of your analysis.
  • Research the law/theory applicable to the key issues. Once you have identified the key issues, you need to research the law or theory that applies to them. This will help you to form your arguments and conclusions.
  • Write your paper. Be sure to present your analysis in a clear and concise manner. Your paper should be well-organized and well-written

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Case studies demonstrating the value of nursing

The rcn is committed to demonstrating the value of nursing and building the capacity and capability of nurses to apply the principles of economic assessment in practice..

The RCN Demonstrating Value programme equips frontline staff with the skills, tools, and techniques to secure commitment for their service and support for ongoing development. Chose between the one-day masterclass or commission a full programme. 

Donna Hastings

An economic assessment of the child and family service at St Columba's Hospice

Donna Hastings Family Support Team Worker, St Columba's Hospice

Donna's case study was completed in 2020 and reflects 2020 prices

Read the case study

According to the Childhood Bereavement Network in 2014, 41,000 children were bereaved of a parent or primary care giver in the UK. Longitudinal studies show that children who are bereaved are less likely to thrive, and are less likely to reach their academic potential and do well in exams; they are less likely to have secure attached relationships later in life, and they are more likely to offend.

The Child and Family Support Service at St Columba's Hospice was established in December 2018, in recognition that there was a lack of pre- and post-bereavement support in relation to children and young people within a family. St Columba's Hospice has 340,000 people living within its catchment, with an estimate of 215 children who are bereaved each year as a result of a terminal illness, and the hospice wanted an innovative way of targeting these children and providing holistic family support.

Donna's economic assessment, based on a Cost Avoidance Approach (CAA) which looks at avoided spend (not necessarily a decreased spend), was designed to demonstrate the impact and value of the Child and Family Service. This involved both the provision of a service in the hospice and also outreach into the community, with a specific focus on schools. This service is directed towards the hospice population with the aim of mitigating a range of potential short, medium and long-term negative outcomes through providing early intervention.

Case studies are used to illustrate the short-term impacts of the service to date, followed by a discussion of the medium and long-term impacts of bereavement, which the service aims to mitigate.

The economic assessment illustrated the potential for the service to contribute to the avoidance of negative outcomes in approximately 125 children and young people year on year. As the service develops there is potential for further work to quantify the impact of the service in the medium to long term and monetise the potential costs avoided as a result.

You can contact Donna by email [email protected]

One page summary

Lynsey Cameron

An economic assessment of making Occupational Therapy Services more therapeutically led

Lynsey Cameron Senior Occupational Therapist, Ayrshire Hospice

Lynsey's case study was completed in 2019 and reflects 2019 prices

Occupational Therapist's (OTs) look at the barriers to engagement in daily activities. It is widely recognised that in palliative care, patients will functionally decline and with that comes significant losses in participation in day to day activities; roles; decision making and quality of life. However, it has been shown that participation in meaningful activities improves symptoms such as fatigue; pain and anxiety; allows patients to adapt and learn new strategies to maintain their independence; and also allows them to regain some control and enhance their quality of life despite their reduced ability in function. (Mills and Payne, 2014) Aware of the potential of participation in meaningful activities, Lynsey, a senior Occupational Therapist at Ayrshire hospice introduced practical group sessions to promote self-management in the hospice day services centre. In addition, Lynsey increased awareness of the role of occupational therapy in palliative care, and increased the confidence of the staff to refer to the service. She also improved the efficiency of the occupational therapy service. Lynsey demonstrated that with little set up or running costs and simply through service redesign, specialist palliative care OTs can increase the number of patients referred to their service. As well as demonstrating improvements in patients' perceptions of their and their carer's anxiety, Lynsey also highlighted the potential of her re-designed service to address practical issues and avoid costs elsewhere in the system. Examples included the avoidance of referrals to local authority OT services, the hospice counselling service and the hospice Respite and Response team. You can contact Lynsey by email: [email protected] .

Yvonne Whitehouse

Enhancing the day therapies service for people with palliative neurological conditions: an economic evaluation

Yvonne Whitehouse Day Therapies Manager, St Columba's Hospice

Yvonne's case study was completed in 2019 and reflects 2019 prices

Government policy in Scotland is to increase access to palliative and end of life care for all who can benefit from it. This includes people with progressive neuromuscular degenerative illnesses (such as Motor Neurone Disease [MND], Progressive Supranuclear Palsy [PSP], Multi-systems Atrophy [MSA] and Corticobasal Degeneration [CBD]) who have a high level of physical impairment and need full assistance with personal care, moving their limbs, eating, drinking and communicating.

Yvonne, Day Therapies Manager at St Columba's Hospice in Edinburgh, recognised that her current day therapies service model did not optimally support the needs of these patients. Therefore she proposed introducing an additional day ('assisted day') designed specifically to address their needs. Her economic assessment identifies the full costs of her service innovation. By bringing services to the hospice and tailoring these to each individual patient's needs, Yvonne identifies the benefits for patients, their families and the NHS, as well as the Hospice.

By engaging with stakeholders and enabling them to work differently, investing in volunteers and redeploying hospice staff, Yvonne has shown the difference that can be made with a modest investment. You can contact Yvonne by email: [email protected] .

Brona McGee and Mairi Clare McGowan

An economic evaluation of community services at St. Vincent’s Hospice

Brona McGee and Dr Mairi-Clare McGowan Director of Care and Consultant in Palliative Medicine, St. Vincent's Hospice

Brona and Mairi-Clare's case study was completed in 2019 and reflects 2019 prices

In order to ensure their services were addressing current need and in line with national policy, St Vincent's hospice in Howwood, Renfrewshire, commissioned a review of their community services. Six recommendations were proposed.

After exploring what a more integrated service might look like, Brona McGee, Director of Care and Mairi-Clare McGowan, Consultant in Palliative Medicine, St Vincent's Hospice, Howwood elected to focus their attention on two of the review recommendations. They developed proposals for service redesign in two distinct areas of their community services and applied the principles of economic assessment in each case. Whilst working as a team each took the lead in a specific area.

Brona focused on their bereavement /counselling service and using a cost-effectiveness approach compared the current one-to-one counselling service with a proposed hybrid approach incorporating both group support and one-to-one counselling options. Based on the assumption that the outcomes would be similar in each case and that the number of people accessing the service would remain the same, Brona demonstrated that her proposed service redesign was a more cost effective approach.

Mairi-Clare focused on the clinical nurse specialist community outreach service which currently provide specialist support and advice to patients and families affected by life-limiting conditions during normal working hours, Monday-Friday. The service-redesign and development proposed would maintain the benefits of the current service, extend its reach beyond those affected by cancer and further develop the range of support available to include hands-on practical support and carer respite a 7-days a week.

These ambitious plans would require investment so Mairi-Clare developed a costs consequence analysis and offered a range of options as to how these costs might be met.

You can contact Brona and Mairi-Clare by email: [email protected] and  [email protected] .

Margaret Cassidy

Economic evaluation to inform the redesign of a specialist palliative care nursing service

Margaret Cassidy Community and Day Services Manager, Ayrshire Hospice

Margaret's case study was completed in 2019 and reflects 2019 prices

In 2018, the Ayrshire Hospice commissioned a clinical service review which surfaced requests for greater out-of-hours accessibility of services in the community. In concluding that a seven-day community specialist palliative care nurse service could go some way towards addressing this perceived unmet need, Margaret Cassidy, Community and Day Services Manager, undertook an economic assessment of her proposed service redesign.

In this economic assessment Margaret sets out the costs and benefits of providing a seven-day service through the redeployment of the establishment currently deployed over five days. The potential positive and negative outcomes of the proposed service re-design were systematically validated through stakeholder engagement and benchmarking with another hospice.

The additional costs of service provision over weekends and bank holidays are presented as a consequence analysis. The potential benefits, including opportunities for cost that may be avoided elsewhere in the system, are identified.

Case studies reported by the respite and response team are used to illustrate where community specialist palliative care nurse availability could ensure a more timely response to patients' and families' immediate care and support needs, as well as increase the continuity and consistency of care. They also highlight the potential for the service to reduce the burden of care on out-of-hours services and prevent avoidable hospital admissions.

A systematic audit of calls taken by the hospice in-patient unit charge nurse over weekends demonstrates the potential to "release capacity to care" here too. A summary of indicative costs that may be avoided is presented and set against the costs of service redesign.

You can contact Margaret by email via Margaret Wilkie, Patient Services Director, [email protected] .

Ruth Wyn Williams

Nurse education: valuing the contribution of people with a learning disability

Ruth Wyn Williams Lecturer in Healthcare Sciences (Learning Disability), Bangor University

Ruth's case study was completed in 2019 and reflects 2019 prices

Ruth Wyn Williams argues that as a learning disability nurse working within a Higher Education Institute (HEI), she has a responsibility to ensure that the future nursing workforce is fit for purpose with the skills and knowledge to work in partnership with some of the most vulnerable individuals in society. Ruth sets out the policy imperatives for taking an interactive approach in her teaching and drawing on the expertise of people with learning disabilities and their families.

To illustrate the value of her interactive teaching methods, Ruth used a cost consequence approach to surface the additional costs incurred with a cohort of 3rd year undergraduate adult nursing students when compared with traditional didactic teaching methods. Ruth also set out the range of benefits which are potentially attributable, in part, to her intervention. Benefits not only for her students, but also those contributors with a learning disability, her HEI colleagues and the HEI itself.

By applying Kirkpatrick's evaluation framework, Ruth illustrates the positive reaction of her students to the approach taken and captures evidence of their learning. Ruth also gives consideration to the longer term impact of this learning on the behaviours of these students in their practice.

You can contact Ruth by email: [email protected] .

Briony McNelly

An Economic Assessment to evaluate the Bradford telemedicine service provided by the Metabolic Medicine team at Salford Royal Hospital

Briony McNelly Learning Disability Liaison Nurse, Northern Care Alliance NHS Group

Briony's case study was completed in 2018 and reflects 2018 prices

Briony McNelly has applied the principles of economic assessment to evaluate a specialist metabolic telemedicine service providing care closer to home for patients with inherited metabolic disorders. Briony shows the set up and running costs of the current nurse/AHP-led outreach telemedicine service with the Consultant linking in from Salford and considers the costs and benefits of this service when compared to a Consultant-led out-reach clinic. Presenting the tariff income as a benefit, Briony demonstrates that the telemedicine service is a considerably more efficient means of providing the service.

Briony then considers the potential costs and benefits of enhancing the roles and responsibilities of the nursing/AHP personnel providing the out-reach clinic and demonstrates the value of the model proposed.

Finally Briony illustrates the potential for increasing capacity to meet the rising demand for the service by demonstrating the costs and benefits of providing two outreach clinics per day instead of one (as currently provided).

You can contact Briony by email: [email protected] .

Delia Wainwright

Economic evaluation of the role of the non-medical Approved Clinician

Delia Wainwright General Manager, Devon Partnership NHS Trust

Delia’s case study was completed in 2018 and reflects 2018 prices

Delia Wainwright demonstrated the value of developing the role of a non-medical approved clinician for an inpatient learning disability service. Delia set out the policy drivers and local context for this role development and has shown that her proposal is both safe and cost effective. She argues that evidence shows there is no risk to quality or service delivery. Delia concludes that when fully implemented a non-medical approved clinician has the potential to release recurrent financial savings of £34,102.68 per annum. Compared to an agency locum Consultant Psychiatrist, a non-medical approved clinician is shown to be £101,506.68 per annum more cost efficient.

You can contact Delia by email: [email protected] .

Linda Phillips

Demonstrating the value of an acute Learning Disabilities liaison service within Hywel Dda University Health Board

Linda Phillips Community Learning Disability Nurse, Hywel Dda University Health Board

Linda's case study was completed in 2018 and reflects 2018 prices

Linda Phillips has shown how she and her colleagues will demonstrate the true value of a new Acute Learning Disability Liaison Service. In her report Linda sets out the policy drivers and local context for this service development. She details the full economic set up and running costs of the service as £80,700.45 in year one and £80,554.19 in year two.

Linda sets out a wide range of qualitative and quantitative benefits, some of which she has monetised. For example, Linda shows that by enabling a reduction in the length of hospital stay, costs are avoided. If the length of stay for 39% of patients with a learning disability is reduced by one day, £50,255.23 per year of costs would be avoided. However following peer review it was agreed reasonable to assume that approximately a third of patients admitted will have complex needs. Based on a current patient case study, Linda estimates potential cost avoidance could be between £582,689.25 and £791,859.75 per year. Furthermore, reduced length of stay will free up capacity and contribute to Welsh Government targets for A&E and referral to treatment times.

You can contact Linda by email:  [email protected] .

Kirsten Johnson

An economic assessment of the children's epilepsy nurse specialist role

Kirsten Johnson Roald Dahl Sapphire Epilepsy Nurse Specialist, Sherwood Forest Hospitals NHS Trust

Kirsten's case study was completed in 2017 and reflects 2017 prices

Epilepsy in children can be distressing for children and for their parents therefore NICE recommend that children, young people and their families have access to specialist nursing support. The ability to contact a specialist nurse at the point of need improves the management of the condition and service user's satisfaction; it can significantly improve the well-being of the child, reduce parental stress and avoid the use of other parts of the healthcare system, including acute services.

However prior to Kirsten's economic assessment, little was known of the economic benefits of a CNS-led service other than these quality benefits. Kirsten is a Roald Dahl Sapphire Epilepsy Nurse Specialist at Sherwood Forest Hospitals NHS Trust.

Through rigorous analysis of her records, Kirsten has demonstrated that just one aspect of her service, that is her telephone and advice line service, has avoided £84,778 costs in her trust in just one year. This aspect of her service has contributed to her trust meeting its 18 week waiting time target and her analysis has clearly demonstrated why this aspect of her service, which has hitherto been invisible, should be incorporated into the service tariff to increase her trust's income and enable further service development.

You can contact Kirsten by email: [email protected] .

Case study One page summary

Hannah Chaffe

An economic assessment of the Roald Dahl sapphire paediatric epilepsy nurse specialist service

Hannah Chaffe Roald Dahl Sapphire Paediatric Epilepsy Nurse Specialist, Ashford and St Peter's NHS Foundation Trust

Hannah's case study was undertaken in 2017 and reflects 2017 prices

One in 100 of the population in the United Kingdom are affected by epilepsy, a chronic illness which impacts on a person's emotional, physical, mental and social wellbeing. NICE recommends that children and young people with epilepsy should have access to an epilepsy specialist nurse.

Hannah, a Roald Dahl Sapphire Epilepsy Nurse Specialist at Ashford and St Peter's NHS Foundation Trust, supports children and young people with epilepsy and their families by helping them to be better equipped to manage their seizures. She supports the families by being the first point of contact for them, supporting them in the community by making home visits and training staff at schools and nurseries and providing care plans for each child. To demonstrate the value of her service, Hannah used a cost avoidance approach. She stratified her caseload using criteria she developed and ratified through peer review. She then examined 'typical' high dependency cases, applied a sensitivity analysis and predicted potential costs avoided. Hannah's predictions were then subjected to multidisciplinary peer review and Hannah concluded that her service may avoid between £23,210 - £65,296 per annum, when working with those with the greatest need at any one time. She plans to do further work to explore the impact of her service on those patients and families in the medium and low dependency categories.

You can contact Hannah by email [email protected] .

Edith Aimiuwu

An economic assessment of a nurse-led Transcranial Doppler (TCD) service

Edith Aimiuwu Roald Dahl Paediatric Haemoglobinopathy Clinical Nurse Specialist, Whittington Health NHS Trust

Edith's case study was completed in 2017 and reflects 2017 prices

Sickle cell disease is a recessive blood disorder caused by a mutation in the B- globin gene. Stroke is recognised as a major complication of sickle cell disease and the risk of stroke is estimated to be 250 times higher in those with sickle cell disease compared with the general population.

Annual Transcranial Doppler Scanning (TDS) is recommended for early identification of stroke risk factors in children with sickle cell disease between the ages of 2 and 16 years old. This enables referral on to other services for further investigations and early intervention with blood transfusion and medication management where indicated.

Hitherto, as far as we know, TDS has only been undertaken by senior medical staff trained in the use of the specialist equipment, for example the EZ-Dop mobile non-imaging scanning device. However Edith, Roald Dahl Paediatric Haemoglobinopathy Nurse Specialist at Whittington Health NHS Trust, has established a nurse-led TDS service and sought to demonstrate the value of her nurse-led service.

Arguing that the outcomes are identical for a nurse-led and a consultant-led service, Edith demonstrated that a nurse-led service is as effective, more efficient and offers enhanced continuity of care.

Edith has been a Roald Dahl Nurse for 13 years, firstly at North Middlesex University Hospital NHS Trust and then at Whittington Health NHS Trust since 2006. She works with children and young people (aged from 3 months to 18 years) with Sickle Cell Disease and Thalassaemia, both inherited blood disorders.

As a Roald Dahl Nurse, Edith acts as a named nurse and is a point of contact for the patients and families. She co-ordinates care by liaising with internal and external agencies. Her work is not confined to the hospital, as she works in the community supporting her patients at their schools by writing up the child's care plans, giving health advice and educating the teaching staff and pupils. She has a supportive and educational role assisting the child to manage their own condition and identify signs and symptoms that need prompt medical attention. Edith also smooths the pathway for patients within the hospital.

You can contact Edith by email: [email protected] .

Natalie Baines

An economic assessment of the paediatric epilepsy nurse service within a district general hospital

Natalie Baines Roald Dahl Sapphire Epilepsy Nurse Specialist, Royal Surrey County Hospital NHS Foundation Trust

Natalie's case study was undertaken in 2017 and reflects 2017 prices

Approximately 50 million people worldwide (WHO, 2016), and about 600,000 in the UK are effected by epilepsy (Epilepsy Action, 2016). Epilepsies are a common childhood neurological disorder giving rise to recurrent seizures. Three in 1000 children with a diagnosis of epilepsy, aged 17 years or younger, take anti-epileptic medication to control their seizures (NICE, 2012). Managing seizures improves health outcomes and can help to minimise any detrimental impact on social, educational and employment activity (NICE, 2012). However epilepsy is not a static condition and children and families can struggle with the high level of uncertainty and unpredictability regarding 'when the next seizure' is going to occur. This also created a challenge for Natalie, when demonstrating the value of her CNS-led service.

Natalie, a Roald Dahl Sapphire Epilepsy Nurse Specialist at Royal Surrey County Hospital NHS Foundation Trust, identified approximately 170 children and young people on her caseload. To better understand her workload at any one time, she developed a patient classification system which she validated though peer review. This allowed her to stratify her caseload into three categories of dependency levels which reflected the level of input required from her service. Acknowledging that the dependency of any one child can change on a regular basis and a child may transition between the various levels of dependency throughout their time within the service, Natalie selected a 'typical' case within each category to illustrate the impact of her service.

In her high dependency group, for example, Natalie illustrated how working intensively with a family over a three-month period, she helped stabilise a child's epilepsy through effective medication management, supported parents in managing their anxieties and enabled school staff to accept the child back into school. At the same time, it was argued that these interventions avoided the use of other primary and secondary care services. By using a sensitivity analysis, Natalie argued that her service, providing timely intervention with patient and families when their need is greatest may avoid the healthcare system costs of between £26,320 and £78,960 per annum. She also acknowledged that these figures did not take into account other costs avoided as a consequence of her intervention such as lost parental work time, rearranging childcare for siblings, extra hospital costs including parking and hospital food for parents.

You can contact Natalie by email: [email protected] .

Vicky Souster

Economic assessment of a practice nurse training programme

Vicky's case study was completed in June 2016 and reflects 2016 prices

In 2007, the London Borough of Tower Hamlets had a shortage of well-trained Practice Nurses (PNs). Severe problems with patient access to GPs showed Tower Hamlets performed poorly compared to other English Primary Care Trusts (PCTs).

At the same time, an increasing number of people were moving into the Borough, which drove a rise in the incidence of chronic disease, especially heart disease, chronic obstructive pulmonary disease and diabetes.

In response, Tower Hamlets PCT commissioned research into effective recruitment and training programmes which would attract new PNs into the Borough. Training for PNs had previously been haphazard and the idea of a formal two-year degree programme was welcomed.

To make the transition from hospital to practice nursing in primary care safe and attractive, a new team was established. The role of Clinical Mentor was created to provide training on site and facilitate an Action Learning Group.

Vicky Souster was the Tower Hamlets PCT manager. Vicky recently completed an economic assessment which demonstrates that the programme enabled staff to be recruited and retained effectively in Tower Hamlets, with low attrition rates: 38% of staff trained over the last 7 years are still working in the Borough.

Of 40 nurses who completed PN training only 2 returned to hospital posts. High quality PNs release appointments for GPs, which improves access figures and reduces pressure on the system. The training prepares future clinical leaders.

Using her findings, Vicky has recommend that investment in this PN training model continues within Tower Hamlets and is rolled out nationally.

You can contact Vicky by email: [email protected].

Kay Greveson

IBD Passport: Evidence-based online resource to support travel with Inflammatory Bowel Disease

Kay Greveson Inflammatory Bowel Disease Nurse Specialist, Centre for Gastroenterology, Royal Free London NHS Foundation Trust

Kay's case study was completed in June 2016 and reflects 2016 prices

Travellers with inflammatory bowel disease (IBD) are at greater risk of travel-related morbidity. Research has found between 15-20% incidence of travel-related illness in IBD, and 27% of patients are incorrectly given live vaccinations prior to travel while receiving immunomodulator therapy. This is potentially life-threatening as the patient could contract the infection that they are being vaccinated against, therefore impacting on NHS services by increasing hospital visits for specialist consultations and possible inpatient admission in the event of post-vaccination complications.

Travel insurance in the UK covers many aspects of travel, but there are often caveats for chronic disease, particularly if the traveller is under regular specialist follow-up. Obtaining adequate insurance can often be difficult and incur additional premiums, but travelling without adequate cover carries the risk significant personal medical costs.

As a result of these findings, Kay Greveson, IBD Clinical Nurse Specialist at Royal Free Hospital in London, developed an IBD Passport; a dedicated, evidence-based, non-profit IBD travel advice website to enhance informed, safe travel. She undertook an economic assessment to show the potential impact and value of the website for patient and healthcare professional users.

Kay conducted an online user feedback survey, which was sent to 415 registered IBD patient website users. The results demonstrate that the IBD passport has the potential to improve knowledge of travel-related issues in IBD, including awareness and increased uptake of vaccinations, travel insurance and seeking expert advice prior to travel.

Assigning monetary value to the passport proved challenging due to the many variables that exists with the traveler, and more so when chronic disease is added. The economic benefits of such a resource reflects the likelihood of preventing or reducing the risk of an illness, and incorporates all the expenses of a travel-related illness.

You can contact Kay by email: [email protected]

Shaun Watson

Economic Assessment of the Community HIV Clinical Nurse Specialist role

Shaun Watson Community HIV Clinical Nurse Specialist, Chelsea & Westminster NHS Foundation Trust

Shaun's case study was completed in May 2015 and reflects 2015 prices

The challenge posted by HIV is ever-changing, with an ageing HIV positive population, the long-term effects of antiretroviral therapy (ART) and rising rates of HIV and sexually transmitted infection. In 2014 there was an estimated 103,700 people living with HIV in the UK, with 613 deaths (PHE, 2015).

The role of the community based HIV clinical nurse specialist (Community HIV CNS) has a long and varied history. Initially, the role was commissioned to provide specialist management for those living with HIV/AIDS who wanted to live (and die) at home and be supported with the co-ordination of services, plus the requisite palliative care for those who wished to remain in their own homes.

As HIV evolved, the role developed in response, providing specialist advice and expertise around HIV care, side-effect management and adherence to (at the time) complicated ART. The current emphasis of the Community HIV CNS role is one of complex case management, which has been described as "the process of planning, coordinating and reviewing the care of an individual" and supporting HIV self-care and management. Whilst these roles vary across the UK, the overarching remit for most Community HIV CNS is the management of a cohort of patients to prevent avoidable hospital (re)admissions and speed up discharge from wards.

Chelsea & Westminster NHS Foundation Trust Clinical Nurse Specialist (HIV Community) Shaun Watson argues that CNS roles such as his are often viewed as a luxury. By undertaking an economic assessment, Shaun demonstrates that his role not only adds value but avoids considerable costs. By supporting adherence to ART therapy alone, Shaun estimates that with a caseload of 60 - 70 patients, his intervention avoids between £162,500 and £260,000 of ART waste. Consequently the avoidance of the onward transmission of HIV saves between £3,360,000 -£4,320,000 per annum. Furthermore, by presenting three case studies, Shaun illustrates how his role avoids significant costs elsewhere in the system, such as ambulance services, A&E departments, hospital beds days, GP appointments and mental health services.

You can contact Shaun by email [email protected] .

Case Study One Page Summary

Carrie Jackson

Implementing a District and Community Nursing workload tool, to determine safe staffing levels and skill mix in a community care provider organisation

Director England Centre for Practice Development, Faculty of Health and Well Being, Canterbury Christ Church University, Kent

Carolyn's case study was completed in March 2016 and reflects 2016 prices

The demand for care closer to home is rapidly increasing, which is putting pressure on organisations to safe deliver district and community nurse caseloads, staffing levels and skills mix. Despite such pressures, alternative systems for managing workloads is limited because of a national shortfall of robust workforce evidence.

Within the context of a larger study, Carrie Jackson, Director, England Centre for Practice Development at Canterbury Christ Church University, performed an economic assessment to consider the costs and the benefits of implementing Cassandra, a community workload analysis tool from the perspective of a community care provider.

Cassandra would be accessed through a web-based platform, available on mobiles, tablets and computers and would enable organisations to systematically capture workforce data about what care was being delivered, in which context, by which grades of staff and what care was being missed or left undone.

Carrie found that the annual set up and running costs to the organisation of using Cassandra are very small in comparison with the potential savings that could be made in terms of improvements in staffing levels, quality of care and the patient experience.

The particular strengths of Cassandra are that it reflects the multidimensional complexity of care being delivered across different populations and geographical areas, whilst also demonstrating what care is being missed or left undone, potentially saving community care providers thousands of pounds each year.

Carrie found that Cassandra is also helpful in managing staff wellbeing through measures that focus on the reduction of additional hours worked and overall sickness levels across the organisation, both of which, if not monitored, can negatively affect team resilience.

You can contact Carrie by email [email protected] .

Jacqui Prieto

Optimising the use of bladder ultrasound scanners to improve the quality and safety of patient care and reduce costs

Clinical Nurse Specialist and NIHR Senior Clinical Lecturer, University Hospitals Southampton NHS Foundation Trust and Associate Professor, University of Southampton

Jacqui's case study was completed in March 2016 and reflects 2016 prices

Portable bladder ultrasound scanning technology is a fast, painless and non-invasive way to measure urine volume in the bladder. As an alternative to bladder catheterisation, it has been shown to significantly reduce urinary tract infection (UTI), and increase patient satisfaction.

Bladder scanning has become routine in acute care, but despite its availability to the NHS for more than two decades, adoption has been slow and inconsistent. In order to optimise use in Southampton University Hospital NHS Foundation Trust, Dr Jacqui Prieto, Associate Professor and Clinical Nurse Specialist, undertook an economic assessment to establish a strategy for future use.

Jacqui put forward a compelling case. The amount of money saved by using the scanner and avoiding catheterisation was estimated to be around £1,226,822 per year. This did not include the cost of bacteraemia attributed to urinary tract infections. Avoided spend associated with using a scanner, such as fewer treatment delays and overnight stays in hospital were recognised as additional savings.

The set up and running costs of a scanner was estimated to be met within 6 to 24 months, after which significant ongoing cost efficiencies would be realised over its 8 to 10 year lifespan. Co-ordinated management of the Trust's bladder scanners was considered advantageous in order to create efficiencies within the system, improving access, use and training across the Trust.

Although Jacqui's recommendations would not be expected to generate major cost savings, they would ensure resources are better allocated, together with a coordinated system for capital replacement.

You can contact Jacqui by email on [email protected] .

Louise Price

Implementation of an Electronic Palliative Care Coordination System (EPaCCS) in Lincolnshire using My RightCare©

Louise Price Professional Lead EPaCCS (Palliative and End of Life care), St Barnabas Lincolnshire Hospice

Louise's case study was completed in March 2016 and reflects 2016 prices

In 2011 and 2013 the national VOICES (Views of Informal Carers for the Evaluation of Services) survey raised concerns from bereaved carers in Lincolnshire about the coordination of palliative and end of life patient care. The survey found that patients on a shared register received better coordination of care and improved outcomes, however over 70% of patients were not found on any such register. To help address this problem, Lincolnshire's four clinical commissioning groups (CCGs) commissioned the implementation of an Electronic Palliative Care Coordination System or EPaCCS to facilitate the sharing of essential information between providers. Successful implementation enables decisions made between clinicians and patients to be recorded, shared and accessed at the point of delivery.

Louise Price, the Professional Lead for EPaCCS implementation in Lincolnshire, is clear that whilst EPaCCS provides an electronic means of communication, the initiative itself is not about deploying an IT solution. Instead, the IT enables the EPaCCS outcomes to be achieved.

Louise undertook an economic assessment of EPaCCS implementation in Lincolnshire which she developed following an extensive scoping exercise to learn from the experiences of the national pilot implantation sites. Louise concluded that implementation and future refinement must be clinically led to ensure behavioural, cultural and clinical change; the My RightCare© App would facilitate integrated care planning within and across sectors; stakeholder (particularly GP) engagement and CCG endorsement was fundamental; information Governance (IG) must be addressed early; training and education was key; a phased approach to implementation was required, acknowledging the diversity and size of Lincolnshire; dovetailing to LHAC Neighbourhood Teams, Urgent and Proactive Care Programmes was required; additional funding would need to be secured.

Louise costed the annual investment required to progress EPaCCS across Lincolnshire for the next 3 years and set these costs against the benefits that would be realised. Louise noted that there were benefits of implementing EPaCCS within Lincolnshire for patients, CCGs, providers and the system. Where data were available benefits have been monetised. Louise plans to continue to update her case study as more data becomes available. Her case study will support the decision-making of the four Lincolnshire CCGs, as whether to continue to invest in the current model of implementation.

You can contact Louise by email on [email protected] .

Case study One page summary (coming soon)

Presentation from a breakfast event, Demonstrating the value of nurse-led innovations in End of Life Care, which took place on 27 April 2016

Stephanie McCarthy

Clinical Stocks management utilising NHS Supply Chain systems

Stephanie McCarthy Procurement Specialist Nurse, Clinical Procurement, Derby Teaching Hospitals NHS Foundation Trust

Stephanie's case study was completed in December 2015 and reflects 2015 prices

Derby Teaching Hospitals NHS Foundation Trust has over 1,100 beds and cares for more than one million people every year. With such a high volume of patients, there is a need for staff to work as efficiently and effectively as possible.

Stephanie McCarthy, Clinical Procurement Specialist Nurse, proposed a change to the way the Trust manages the purchasing of ward consumables, which is serviced by a third-party provider called ISS World.

Stephanie focused on 49 clinical areas across the Trust, which each purchased consumables from NHS Supply Chain (NHSSC) in a different way, leading to wastage of products and staff time.

The Trust adopted NHSSC's 'top-up' system which works to an agreed stock level that cannot be manually overridden.

By performing an economic assessment of a pilot for the new system, Stephanie found that relationships between clinical areas and the top-up service provider improved and staff had greater confidence in the system. Her findings firmly reinforced the value of nursing expertise in the procurement process, in particular how experienced senior nurses can support colleagues through change.

By closely examining three case study wards Stephanie identified that the average saving per bed day across the three wards was £0.87. Multiplying this figure by the total number of occupied bed days within the Trust from January - December 2015 indicated potential annual savings from the project of £275K.

Stephanie is now planning to implement the NHSSC top-up system on other sites across the Trust.

You can contact Stephanie by email [email protected] .

Brendan McLoughlin

Impact of access to on line peer support on Improving Access to Psychological Therapies (IAPT) service usage and cost

Brendan McLoughlin then Clinical Lead, Ealing IAPT, West London Mental Health NHS Trust

Brendan's case study was completed in December 2015 and reflects 2015 prices

Common Mental Illness (CMI) affects one in six of the UK population. Depression and anxiety as a result of CMI causes significant numbers of people to claim long term sickness benefits.

The Improving Access to Psychological Therapies (IAPT) programme was implemented on the premise that providing Cognitive Behavioural Therapy (CBT) to people claiming long term sickness benefits for mental illness would pay for itself by reducing claimant numbers.

There has been growing interest in the potential of online peer support in the IAPT programme. One such example is the Big White Wall (BWW); a service commissioners made available to everyone referred to the IAPT service in Hounslow from 2014 onwards.

When CMI patients log on to BWW, they see a number of "bricks" which represent an issue online members want to talk about. The service is monitored by a qualified therapist.

Brendan McLoughlin, Clinical Lead Ealing IAPT at West London Mental Health NHS Trust, carried out an economic assessment of the BWW service. He identified that a total of 1073 patients were offered prescriptions to access the network. 316 people activated their access to the service, and of these, 72 used the BWW for more than 1 hour.

Brendan found no significant differences in the number of clinical sessions, duration of clinical sessions or clinical outcomes between those who used the BWW network for more than 1 hour, and patients who experienced the usual service. He concluded that further research is needed to establish any impact of BWW on wider services such as primary care, or in reducing sickness absence.

You can contact Brendan by email  [email protected] .

Debbie Moores

Identifying the costs associated with changing the clinical management of falls

Trust Allied Health Professions Lead (Clinical area: Mental Health), South Staffordshire and Shropshire Healthcare NHS Foundation Trust

Debbie's case study was completed in 2015 and reflects 2015 prices

Marie Band

Supporting health and promoting exercise (SHAPE)

Marie Band SHAPE Programme Clinical Lead, Worcestershire Health and Care NHS Trust

Marie's case study was completed in December 2015 and reflects 2015 prices

People living with serious mental illness (SMI) have a reduced life expectancy of between 16 - 25 years, compared with the general population. This is mainly as a result of cardiovascular disease (CVD), and factors including poor diet and nutrition, smoking, drug and alcohol use, and poor access to health services.

In response to this pressing issue, the NGS Worcestershire Early Intervention Service began a 12 month pilot targeting the physical health and well-being of its patients. The service works with young people between the ages of 14-35 years who present with first episode psychosis and bipolar disorder.

In addition to a 12 week intensive programme, SHAPE offers participants an additional year’s free gym membership to encourage long-term adherence to the course. Although the project is in its infancy, emerging data from SHAPE suggests that it is helping to prevent weight gain in participants. In the longer-term, there is the potential for significant savings to be made from a reduction in demand for clinical services typically caused by patients with diabetes and at risk from CVD.

You can contact Marie by email [email protected] .

One Page Summary

Agimol Pradeep

Increasing awareness about organ donation in the South Asian community and reducing treatment costs

Agimol Pradeep Transplant Recipient Co-ordinator, Central Manchester Hospitals

Agimol's case study was completed in December 2015 and reflects 2015 prices

Dr Pradeep identified a need for education to increase knowledge and awareness about organ donation and to clarify misconceptions. Over a 24 month period she organised and delivered in a voluntary capacity over 300 sessions in the North West of England, and as a result, more than 3,000 South Asian people registered on the ODR, a 37.5% increase in registrants from the period 1999-2012.

Dr Pradeep completed an economic assessment to inform the commissioning of education programmes at a regional level that would focus on reaching young people within the South Asian community. Whilst any one donor may donate up to 9 organs, Dr Pradeep demonstrated that the costs of taking four patients off dialysis (two donors providing four kidneys) would more than cover the costs of a regionally based specialist nurse-led community education programme.  In addition to the costs avoided from stopping dialysis, she also noted further economic benefits: more people could benefit from other organs from these donors; there would be a greater potential of organ recipients contributing to the economy; her research had shown that community education increased the potential for live donations and had a wider impact on the health of the community.

You can contact Agimol by email: [email protected] .

Vicky Queen

Impact of a community peripatetic nursing team

Vicky Queen Acute Parkinson's Disease Nurse Specialist, Torbay & South Devon NHS Foundation Trust

Vicky's case study was completed in October 2015 and reflects 2015 prices

The increased use of agency and bank staff at Torbay and Southern Devon Health and Care Trust was putting significant pressure on the Trust's budget. In just one year, the Trust's agency bill was £304,200. Despite attempts to increase the size of the nursing bank, the inflexibility of this resource meant that as many as 35% of shifts would have to be covered by agency staff.

Although more flexible, some agency staff lacked knowledge of the local area (a key skill for community-based nursing), and the clinical skills to meet the Trust's needs. Vicky Queen, then Interim Head of Nursing at the Trust, proposed a solution - to create a peripatetic nursing team which provided nursing staff to both community teams and hospitals, when required.

An economic assessment of this new team soon illustrated significant cost savings of £65 per shift, when compared to agency staff.

Vicky, now Acute Parkinson’s Disease Nurse Specialist (PDNS) at the Trust, found the cost of the peripatetic team to be equal to that of the nursing bank. Crucially, the new peripatetic team had the stability and flexibility required to provide shifts when and where they are most needed.

You can contact Vicky by email [email protected] .

Angela Springett

Six Steps+: End of Life Care Programme for Care Homes

Angela Springett Practice Educator, St Wilfrid’s Hospice, Chichester, West Sussex

Angela's case study was completed in October 2015 and reflects 2015 prices

If care home staff are to confidently manage patients with complex needs at the end of life, it is important they are supported with the right skills and information. Using the Six Steps+ programme to build the competence and confidence of care home staff, Angela Springett, practice educator at St Wilfrid's Hospice in West Sussex, wanted to demonstrate to her commissioners the value of her intervention.

The programme focuses on six key areas: discussions at end of life; holistic assessment of the patient; the coordination of care; delivery of high quality care; care in the last days of life and care after death. Angela’s approach was to develop and accredit two End of Life Champions in ten care homes in the St Wilfrid’s Hospice catchment area of Chichester, Bognor Regis and the Manhood Peninsula. In turn, with managerial support, the accredited Champions implemented the Six Step+ principles within their care setting, educated the rest of the care home staff, and produced evidence to support this in the form of organisational and individual portfolios.

Angela wanted to demonstrate the economic value of her approach and looked at the costs avoided by enabling care home residents to spend their last days and end their lives in their place of choice, their care home, rather than be admitted to hospital.

Angela demonstrated that her intervention benefits patients, the standing of the care homes, and the wider health and social care economy. Her analysis illustrates that the avoidance of 6 hospital admissions covered the cost of the Six Steps Programme, making it cost neutral to potential commissioners. Any further reduction in admissions would result in further cost avoidance and potential financial savings, making a strong case for the programme to be introduced more widely.

You can email Angela at [email protected]

One page summary Report

Chris Benson

Making informed economic choices about future funding of bed days in a hospice specialist palliative care unit text in field

Chris Benson Director of Patient Care, St Peter's Hospice, Bristol

Chris's case study was completed in October 2015 and reflects 2015 prices

Charitable organisations such as hospices are often seen as the local providers of specialist palliative care beds. These are very expensive to run, and the increased dependency of patients means that workforce demands are higher and resources stretched.

St Peter’s Hospice, the only adult hospice in the Greater Bristol area, is a case in point. The hospice offers inpatient, outpatient and community services. Whilst the inpatient unit (IPU) is highly valued by patients and professionals, it accounts for just under 50% of the entire hospice budget. On numerous occasions, admissions to its 18 IPU beds had to be restricted due to pressures on workloads.

Director of Patient Care, Chris Benson, wanted to address the strain that this was placing on her nursing workforce. Counter-intuitively, she believed that by reducing the number of in-patient beds from 18 to 15 and increasing occupancy, she could actually release cash, increasing the capacity of her team and the quality of the overall service.

You can contact Chris by email [email protected]

Gary Whitwam

Out-Patient and Home Parenteral Infusion Therapy (OHPiT)

Gary Whitwam Nurse specialist for OHPiT, Isle of Wight NHS Trust

Gary's case study was completed in September 2015 and reflects 2015 prices

The Isle of Wight Out-patient and Home Parenteral Infusion Therapy (OHPiT) service was set up by Clinical Nurse Specialist Gary Whitwam and has been providing intravenous therapy to patients in the community for almost five years. As the service has evolved, activity has increased to a point that Gary felt compelled to demonstrate the true value of the service to patients, the Trust and the wider community in order to set out a case for the expansion of the OHPiT team.

Gary undertook an economic assessment and directly compared the cost of providing parenteral infusion therapy on an inpatient basis with the provision of the same treatment in the community. He discovered a range of patient and organizational benefits, including the promotion of patient choice, a reduction in the length of hospital stays and a fall in the rate of hospital acquired infections.

Gary determined that the OHPiT service was cost-effective, and that by further utilizing the service the Trust could create capacity within the hospital to see more patients with complex needs.

Gary Whitwam now works in Guernsey where he is a Night Clinical Coordinator at the Princess Elizabeth Hospital. Email [email protected]

Christine Fitzgerald

The true cost of recruitment

Christine Fitzgerald Matron, The Hillingdon Hospitals NHS Foundation Trust

Christine's case study was completed in September 2015 and reflects 2015 prices

In the past two years, Hillingdon Hospitals’ NHS Foundation Trust has experienced a shortage of band 5 nurses. The Trust has had to rely heavily on bank and agency staff in order to meet the needs of patients.

In response, Christine Fitzgerald, Matron for Medicine at the Hillingdon Hospital, pioneered a project to compare the cost of local recruitment initiatives with her own personal experience of overseas recruitment. Both strategies were aimed at improving recruitment processes and reducing agency spend.

Christine took a whole systems approach and included in her economic assessment the importance of buddying schemes for new recruits, the provision of accommodation and how language skills have an impact on patient care.

You can email Christine at [email protected]

Vanessa Gibson

Delivering a responsive and effective specialist community palliative care service in an environment of change

Vanessa Gibson Community Nursing Services Manager, St Richard’s Hospice, Worcester

Vanessa's case study was completed in August 2015 and reflects 2015 prices

If Vanessa's team was to cope with big increases in demand for specialist community palliative care services, she knew something had to change. Vanessa undertook a comprehensive service redesign which included the development of a telephone triage role, a single point of contact for all patients 24/7 and proactive caseload management. These changes, which cost very little, meant that community Clinical Nurse Specialists' time could be redeployed to care for patients with the most complex needs; GP consultation time saved and admissions to in-patient areas decreased. Vanessa recognised that this intensified the pressure on her CNS' and there is more work to be done to build resilience and prevent burnout in her team.

You can email Vanessa at  [email protected] .

David Hitt

A nurse-led Cognitive Behavioural Therapy service for local authority employees

David Hitt Cognitive Behaviour Therapy Nurse Therapist, Cardiff and Vale University Health Board

David's case study was completed in October 2015 and reflects 2015 prices

In 2008-09, 11.4 million working days were lost in Britain due to work-related stress, depression or anxiety. Cognitive Behavioural Therapy (CBT) intervention is recognised as clinically and cost effective for individuals with anxiety or depression who have been off work for four or more weeks. Despite strong evidence, access to psychological therapies is by no means universal.

The City of Cardiff Council recognised this unmet need in its workforce and partnered with the department of Liaison Psychiatry at Cardiff and Vale University Health Board, to provide psychological services, namely CBT.

This provision enabled the Council's occupational health department to refer employees who presented with anxiety or depression for a psychological assessment with the aim of promoting an earlier return to work.

David Hitt, cognitive behaviour therapy nurse therapist at Cardiff and Vale University Health Board, carried out an economic assessment of the new CBT provision.

Within the timeline of the economic assessment, 51 people had completed a course of CBT. The average course of CBT was 12 sessions, with each session lasting approximately one hour.

For every pound spent by the City of Cardiff Council, the total benefit was £2.47. Even allowing for the potential for natural recovery of 22% of patients in this case, the return on investment for every pound spent resulted in a £1.92 return.

David recommended incorporating these methods into the training of nurses and other front line staff to empower them to work with commissioners to avoid waste and release much needed cash within the health care system.

You can email David at [email protected] .

Janice Colligan

The virtual ward. Managing the care of patients with chronic (long-term) conditions in the community

Janice Colligan, Locality Manager, South Eastern Health and Social Care Trust

Janice's case study was completed in December 2015 and reflects 2015 prices

An estimated 17.5 million people in the UK are living with a chronic (long-term) condition. Historically, patients with respiratory conditions, diabetes and heart failure in the South Eastern Health and Social Care Trust experience prolonged admissions to hospital. To change the way these patients were managed, a virtual ward service was established.

The Virtual Ward ran as a pilot from January to March 2009 with a Nurse Practitioner in the role of Virtual Ward Coordinator. Due to its success, funding was provided to roll out the Model to three localities within the Trust in January 2010.

Janice Colligan, Operations Manager at South Eastern Health and Social Care Hospital's Older People's Service, performed an economic assessment of The Virtual Ward. She found it demonstrated considerable economic benefits: A&E attendance was reduced, hospital admissions were avoided and earlier hospital discharge was facilitated.

Over three years, 812 hospital admissions were avoided and 447 episodes of care were provided by the virtual ward service. The running costs in this period were £566,273, with costs avoided calculated at £8,804,529. This equates to a total saving of £8,238,256.

Virtual Ward staff gained expert knowledge and clinical skills in supporting patients with complex chronic disease, and the impact of reduced hospital admission also reduced the risk of potential hospital acquired infections.

Janice's assessment has proven invaluable in further developing the Model of Care to provide a service over 24 / 7, which will meet future service needs.

You can contact Janice by email at [email protected] .

Sheila Jones

Value of the nurse-led stoma care clinic

Sheila Jones Clinical Nurse Specialist (Stoma Care), Royal Glamorgan & Ysbyty Cwm Rhondda Hospitals

Sheila's case study was completed in December 2015 and reflects 2015 prices

A stoma is an opening on the front of the abdomen (tummy) which is made using surgery. It is a bud-like structure, which sits on the surface of the skin. There are three types of stoma. Patients who have inflammatory bowel disease or bowel cancer may require an ileostomy or a colostomy. These stoma provide an alternative outlet for waste products from the gut. A patient with bladder cancer, severe urinary incontinence or damage to their pelvis may require a urostomy. These stoma divert urine from the urinary tract. A stoma may be temporary (and reversed later) or permanent. Either way, having a stoma is a life changing event, and specialist nurses, like Sheila Jones and her colleagues at Royal Glamorgan Hospital, provide essential support to stoma patients and their families and carers.

Since 1992 the Stoma Care Service at Royal Glamorgan Hospital has been supporting the rehabilitation of stoma patients, and helping carers and family members to manage a significant change in lifestyle. It provides two types of nurse-led clinics, with the aim of detecting and treating anxieties and complications. Although the service is well respected, in the current economic climate it cannot rely on word of mouth to evidence its impact on patient care. With this in mind, Sheila decided to conduct an economic assessment and in doing so, identified a range of quality, productivity and prevention benefits for patient, stoma care nurses and the hospital.

The nurse-led Stoma Care Clinic ensures a well-defined pathway to support patients. It provides a patient-focused approach to diagnosis, care planning, treatment provision, follow up, and continuity of care. The holistic care and timely interventions provided by experienced, specialist nurses avoids costly care episodes and saves consultants, GPs and district nurses time, which can be used for other activity. Sheila demonstrated that an investment of £40K per annum to provide a nurse-led stoma care clinic avoids costs in the region of £150K per annum elsewhere in the system.

You can contact Sheila by email [email protected] . One page summary Case Study

Lee Cowie

Improving outcomes for children and young people with severe mental health conditions

Lee Cowie Nurse Consultant, NHS Fife CAMHS Intensive Therapy Service, Scotland

Lee's case study was completed in June 2013 and reflects 2013 prices

When NHS Fife closed its child and adolescent mental health inpatient unit in 2002, the Health Board set up a new nurse-led Intensive Therapy Service (ITS) to provide personalised community care for 8-18 year olds.

Under the leadership of Nurse Consultant Lee Cowie, Child & Adolescent Mental Health Service (CAMHS) brought together nurses, psychiatrists, psychologists and therapists to offer high-intensity home support, which is tailored to meet the needs of young people and their family and carers.

From April 2011 to May 2012, 38 11-17 year olds were referred to the CAMHS ITS. In total, 44 young people were discharged by the service. Previously all of these patients would have required some level of inpatient care, but because of CAMHS ITS, only two of those discharged from the ITS required a period of time in hospital.

Despite strong clinical evidence that community care was better for children and young people, Lee wanted to augment his case with economic evidence.

Lee demonstrated in the three years prior to his economic assessment there had been a £74,556 reduction in inpatient costs associated with his service. Lee also developed two hypothetical scenarios to further illustrate the value of his service. In the first he compared the costs of his service with what the old in-patient service would have cost 'in today's money', demonstrating that the community based CAMHS ITS was over £400,000 more efficient. In the second scenario, Lee also demonstrated that in the absence of his service (and the in-patient facility his service replaced), alternative inpatient care for the clients serviced by the ITS would cost his Health Board £1,227,072.

Lee subsequently used his evidence to promote community-based intensive therapy services for children and young people across Scotland and further afield.

You can email Lee at [email protected] .

Case study One page summary RCN Scotland policy briefing

Jill Nicholls

Economic assessment of a nurse-led heart failure liaison service in NHS Tayside

Jill Nicholls Heart Failure Specialist Nurse, NHS Tayside, Scotland

Jill's case study was completed in 2012 and reflects 2012 prices

A heart failure specialist nursing service in NHS Tayside delivers high-quality, patient-centred care at home that improves patient outcomes, cuts hospital admissions and avoids costs of over £250,000 per year.

Jill Nicholls was one of three Clinical Nurse Specialist's providing a nurse-led service for patients diagnosed with heart failure. The service had been running for 10 years and it had never been formally reviewed over that time. However the workload was ever increasing.

By undertaking the programme Jill was able to demonstrate the value of her service. Jill knew there were clinical benefits but by applying the principles of economic assessment laid down by HM Treasury, Jill was able to show economic benefits for NHS Tayside and the wider economy. In the process Jill uncovered that approximately 40% of patients who could benefit from her service were not being referred. Armed with this evidence Jill and her Director of Nursing Services explored how the rehabilitation and palliative care needs of all patients diagnosed with heart failure in NHS Tayside can be addressed more effectively and efficiently.

Jill Nicholls is a Heart Failure Specialist Nurse with NHS Tayside's HFNLS and is seconded part-time to serve as one of the Scottish Government's Heart Failure Hub Co-ordinators. She chairs the Heart Failure Nurse Forum in Scotland and also sits on the Scottish Intercollegiate Guidelines Network (SIGN) heart failure review group.

You can email Jill at [email protected] .

Rhonda Reilly

Children's continence nurse service - an affordable luxury?

Rhonda Reilly Specialist Nurse - Continence, Western Health and Social Care Trust, Northern Ireland

Rhonda's case study was completed in 2012 and reflects 2012 prices

In Northern Ireland Rhonda Reilly, Specialist Nurse - Continence, Western Health and Social Care Trust, Northern Ireland, has compared the costs and benefits of her one-stop comprehensive continence service for children and young people, with a routine service provided by a paediatric consultant.

It could be argued that the nurse-led service, which operates an open referral system to all children in the Trust area aged 0-18 years, is a luxury. However, Rhonda developed a compelling case study demonstrating the value of the service which works with children and their families, as well as education and voluntary groups, providing continence related education and care plans.

Rhonda found that in order to maintain capacity and effectiveness within the service there is a need to expand its reach. It currently supports 200 patients a year.

Other benefits of the service include the provision of education to health care and education professionals on early intervention for children with continence difficulties, and health promotion activities to promote healthy bowel and bladder; which result in the avoidance of need to refer on to other agencies and provision of continence products. There is also a benefit to the patient of having care provided by an independent nurse prescriber, ensuring seamless care, increasing medication compliance and concordance and reducing the need for General Practitioner consultant to obtain prescription and subsequent GP review while on medication.

You can contact Rhonda at [email protected] .

Lindsay Semple

Outpatient Parenteral Antibiotic Therapy (OPAT)

Lindsay Semple OPAT Lead Nurse, NHS Greater Glasgow and Clyde

Lindsay's case study was completed in 2012 and reflects 2012 prices

Antibiotic therapy is used in all hospitals across the UK. At any one time it is estimated that about 30% of inpatients are receiving antibiotics and that half of these will be given intravenously (IV). Many patients require prolonged IV therapy and this dictates their length of stay in hospital. Many of these patients could be safely cared for in the community if the infrastructure to manage them was in place.

The primary driver of an Outpatient Parenteral Antimicrobial Therapy (OPAT) service is to improve quality. NHS Greater Glasgow and Clyde's Outpatient Parenteral Antibiotic Therapy (OPAT) pilot project redesigned the patient journey to offer a clinical and cost effective service for patients who hitherto were admitted to or kept in hospital for the administration of parenteral antibiotics. The service is patient focused and supports the policy driver to move care out of hospitals and into the community.

An economic assessment conducted by Lindsay Semple, OPAT Lead Nurse at NHS Greater Glasgow and Clyde found that between April 2011 and March 2012 the OPAT service avoided over 4,700 occupied bed days, lowered readmission rates and reduced patients' risk of developing a hospital acquired infection such as MRSA. Depending o the costs of an inpatient bed, Lindsay calculated that the costs avoided by the Health Board ranged from £1,773,324 - £3,408,405. Taking into account the costs of the OPAT service, Lindsay identified that the OPAT service saved at least £1,667,693.

Lindsay concluded that by increasing investment in the OPAT service by an additional £250,000, the service could be expanded to 7 days a week. This would allow a further 400 patients to be received into the service, avoiding NHS Greater Glasgow and Clyde £2,138,000. For every additional £1 invested in the service, GG&C HB could potentially save £8.55

You can contact Lindsay by email: [email protected] .

NHS Ayrshire & Arran Child’s Assessment and Plan

Jayne Miller Assistant Clinical Nurse Manager in the Early Years, Children and Families Community Nursing Service, NHS Ayrshire and Arran

Jayne’s case study was completed in 2012 and reflects 2012 prices

Read the case studies

An Ayrshire-wide audit identified a number of improvements needed in core record keeping standards. To facilitate communication and information sharing, and to address some of the deficits in standards, NHS Ayrshire and Arran developed an electronic Child Health Record.

The new system provides a framework for staff in the Children and Families Community Nursing Service to record appropriate assessment information. Other local services, including Community Paediatric Nursing staff and the Vulnerable Children's Health Team, also record information on the system.

Jayne Miller, Assistant Clinical Nurse Manager in the Early Years, Children and Families Community Nursing Service, undertook an economic assessment of the new service. She found that reducing duplication and sharing information saves nurse staff time. There are also economic benefits of Clinical Team Leaders and Service Managers having access to information, with the total avoided costs estimated at between £59,819.15 and £88,723.55 per annum.

Improved access to information supports clinical decision making, particularly within the out of hours period. In addition, the new system can be accessed by the Child Protection Health Team, enabling more timely provision of clinical supervision.

When families receive care from a range of professionals within different teams or agencies, the challenges of effective communication are exacerbated. Recording information within a single system reduces the need for children and families to repeat this information to those involved in their care.

You can contact Jayne by email at [email protected] .

One page summary RCN Scotland policy briefing

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The purpose of this project was to develop a repository of NextGen NCLEX case studies that can be accessed by all faculty members in Maryland.

Detailed information about how faculty members can use these case students is in this PowerPoint document .

The case studies are in a Word document and can be modified by faculty members as they determine. 

NOTE: The answers to the questions found in the NextGen NCLEX Test Bank  are only available in these faculty case studies. When students take the Test Bank questions, they will not get feedback on correct answers. Students and faculty should review test results and correct answers together.

The case studies are contained in 4 categories: Family (13 case studies), Fundamentals and Mental Health (14 case studies) and Medical Surgical (20 case studies). In addition the folder labeled minireviews contains PowerPoint sessions with combinations of case studies and standalone items. 

Family  ▾

  • Attention Deficit Hyperactivity Disorder - Pediatric
  • Ectopic Pregnancy
  • Febrile Seizures
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Fundamentals and Mental Health  ▾

  • Abdominal Surgery Postoperative Care
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  • Deep Vein Thrombosis
  • Dehydration Alzheimers
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  • HIV with Opportunistic Infection
  • Ketoacidosis
  • Liver Failure
  • Prostate Cancer
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Mini Review  ▾

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Practice learning experience case studies for nursing programmes

We're setting out some example scenarios and further information on how nursing students can demonstrate their proficiency in a range of practice learning environments.

We’ll continue to update this with examples in different practice learning environments. If you have any suggestions on the types of examples that would be useful to you,  please email us.

The following case studies are example scenarios based on people’s real experiences for the purpose of learning. All names are fictional.

General hospital setting - Adult

Haematology ward, community mental health team, acute hospital: learning disability liaison service and rheumatology outpatients.

  • Last updated: 22/01/2024

Home — Essay Samples — Nursing & Health — Pathophysiology — A Comprehensive Case Study and Nursing Care Approach

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A Comprehensive Case Study and Nursing Care Approach

  • Categories: Pathophysiology

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Published: Feb 13, 2024

Words: 2153 | Pages: 5 | 11 min read

Table of contents

Lab reports (case reports on prostate cancer, 2004), pathophysiology (alyssa v.), history (alyssa v.), nursing physical assessment (jasmine r.), related treatments (jasmine r.), nursing diagnosis and patient goals (ellie le. -also formatting, editing, flow, apa), nursing interventions (alyssa y.), evaluation (sam s.), references:.

  • Bowel problems: Radiation may irritate the bowel and cause diarrhea, blood in the stool, and rectal leakage. A diet plan may be assigned to reduce these problems. Most of these problems resolve on their own over time.
  • Urinary problems: Radiation may irritate the bladder and cause frequent urination, a burning sensation during urination, or blood in the urine. These problems may or may not improve over time.
  • Erection problems: Problems with erections may develop slowly over time.
  • Fatigue: Fatigue may last weeks to months after treatment is completed.
  • Lymphedema: Radiation may damage the lymph nodes around the prostate and may cause swelling or pain. Lymphedema can be treated with physical therapy, although it may not resolve completely.
  • Urine management: Encourage fluid intake to 3000 mL per day (Vera, 2019). Monitor urine output and specific gravity.
  • Infection: Maintain a clean environment in the patient’s room and ensure that every visitor washes their hands before interacting with the patient. Emphasize personal hygiene (Vera, 2019).
  • Pain: Assess the patient’s level of pain on a numeric rating scale of 0-10 (Vera, 2019).
  • Sexual function: Explain to the patient and patient’s partner that sexual function and/or desire may decrease or be impaired. Reassure the patient that this side effect is common and recommend assistance such as medicine or a sex therapist (Vera, 2019).

Recommendations (Alyssa Y.) (ACS, 2019)

  • Follow-up appointments that may consist of exams or lab tests to monitor cancer or side effects of treatment
  • PSA tests every 6 months for the first 5 years after treatment, and once a year thereafter
  • Maintain a healthy weight and diet
  • Participate in regular physical activity
  • Establish a support group (friends, family, counselors, etc.)
  • Long term gonadal suppression drugs
  • Abdominal sounds: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved January 16, 2020, from https://medlineplus.gov/ency/article/003137.htm
  • Alkaline Phosphatase. (n.d.). Retrieved January 16, 2020, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=alkaline_phosphatase
  • Anatomical Chart Company. (2002). Atlas of Pathophysiology. Springhouse, PA: Springhouse
  • Banasik J.L. & Copstead L.E. (2019). Pathophysiology. St. Louis, MO: Elsevier.
  • Case reports on prostate cancer. (2004). Retrieved from
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472886/.
  • Leslie, S.W., Soon-Sutton, T.L., Sajjad, H., Siref, L.E. (2019, October 8). Prostate Cancer.
  • Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470550/
  • Liver function tests. (2019, June 13). Retrieved January 16, 2020, from https://www.mayoclinic.org/tests-procedures/liver-function-tests/about/pac-20394595
  • NCI Dictionary of Cancer Terms. (n.d.). Retrieved January 16, 2020, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gleason-score
  • PDQ Adult Treatment Editorial Board. (2019, June 12). Prostate cancer treatment (PDQ)-Patient
  • version. National Cancer Institute. Retrieved from https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq
  • Prostate Cancer Risk Factors. (2019, August 1). Retrieved from
  • https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html
  • Tennant, F. (n.d.). Treat the Pain... Save a Heart. Retrieved January 16, 2020, from https://www.practicalpainmanagement.com/pain/other/co-morbidities/treat-pain-save-heart
  • The American Cancer Society medical and editorial content team (ACS). (2019, August 1).
  • Living as a prostate cancer survivor. Retrieved from https://www.cancer.org/cancer/prostate-cancer/after-treatment/follow-up.html
  • Radiation therapy for prostate cancer. Retrieved from https://www.cancer.org/cancer/prostate-cancer/treating/radiation-therapy.html
  • The American Cancer Society medical and editorial content team (ACS). (2019, December 18).
  • Hormone therapy for prostate cancer. Retrieved from https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html
  • Treating Prostate Cancer Spread to Bones. (2019, August 1). Retrieved from
  • https://www.cancer.org/cancer/prostate-cancer/treating/treating-pain.html
  • Wood, C. K., & Lockhart, J. S. (2000, April). Prostate Cancer : AJN The American Journal of Nursing. Retrieved from https://journals.lww.com/ajnonline/Abstract/2000/04001/Prostate_Cancer.11.aspx.
  • Vera, M. (2019, June 1). 13 cancer nursing care plans. Retrieved
  • from https://nurseslabs.com/cancer-nursing-care-plans/#Risk-for-Altered-Sexuality-Patterns

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nursing case study examples

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  1. Nursing Case Study Example

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  3. Sample case study: ASTHMA! : r/StudentNurse

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  1. Free Nursing Case Studies & Examples

    6 Steps to Replace Clinical Using Case Studies. 1. Watch the intro video as a group. Gather the entire class together and view the intro video. This video lays out the scenario for the given case study and helps them begin to consider the disease process. 2. Complete the first "Critical thinking check".

  2. Case Study: 33-Year-Old Female Presents with Chronic SOB and Cough

    Case Presentation. History of Present Illness: A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician's office six months ago.

  3. 5 Nursing Case Study Examples + Answer Guide

    Sample case study for nursing students can be a valuable tool in your preparation, helping you to develop critical thinking skills and apply your knowledge in real-world scenarios. That's why we've put together a list of 5 nursing case study examples, complete with answer guides, to help you prepare for the NCLEX -style questions you'll ...

  4. What is a case study?

    Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research.1 However, very simply… 'a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units'.1 A case study has also been described as an intensive, systematic investigation of a ...

  5. Nursing Case Studies

    A collection of case studies written by students in various fields of nursing, such as mental health, dermatology, renal failure, and more. Each case study provides a brief overview of the patient's condition, diagnosis, treatment, and outcomes. You can also find a comprehensive writing service by qualified academics in your field of study.

  6. How to Write a Nursing Case Study: Tips and Examples

    Nursing case studies are thorough stories that report the perplexing subtleties of patient experiences, offering a complex perspective on medical care conveyance, and are considered to be an ...

  7. How to Write a Nursing Case Study + Examples, Format, & Tips

    📝 Nursing Case Study Examples . Below you will find case study samples for various topics. Using them as a reference will improve your writing. If you need more ideas, you are welcome to use our free title-generating tool. Case study: healing and autonomy. Sara's case study: maternal and child nursing. COPD medical diagnostics: case study.

  8. Teaching clinical judgment through cases

    The NCSBN (2019) defined clinical judgment as the "observed outcome of critical thinking and decision making" (p. 1). With this process, the nurse assesses patients and clinical situations, identifies, and prioritizes patient problems and concerns, consider potential solutions and implements evidence-based solutions, and evaluates outcomes.

  9. Clinical Case Studies for the Family Nurse Practitioner

    1. Family nursing-Case studies. 2. Nurse practitioners-Case studies. I. Neal-Boylan, Leslie. [DNLM: 1. Family Nursing-Case Reports. 2. Nurse Practitioners-Case Reports. 3. Primary Care Nursing-Case Reports. WY 128] RT120.F34C55 2011 616'.09-dc22 2011012018 A catalogue record for this book is available from the British Library.

  10. British Journal of Nursing

    Case Studies. Intravenous (IV) access, both peripheral and central, is an integral part of the patient care pathways for diagnosing and treating cancer. Patients receiving systemic anticancer treatment (SACT) are at risk for developing infections, which may lead to hospitalisation, disruptions in treatment schedules and even death ( Centers for ...

  11. 60+ Hours Nursing Case Studies For Nursing Students

    Here is the second sample case study for nursing students: Case scenario: Nurse's notes: 0915: The client arrives at the emergency department (ED), and the writer receives a transfer of accountability (TOA) report from the home care nurse via telephone. Upon assessment, the right big toe has tophi and is erythematous and inflamed.

  12. Nursing Case Study Analysis [10 Examples & How-To Guides]

    1. Nursing Case Study Example - Meadowvale University School Of Nursing -. The case analysis explores some of the ways in which the curriculum development leader can adopt measures that enhance faculty support and development in the task of curriculum development (Nursing Case Study Analysis) Problem-solving case analysis. 2.

  13. Book Title: Nursing Case Studies by and for Student Nurses

    Case Study: Brian Foster DVT. DIC Case Study: Rosy McBloom. Case Study: Sepsis at the Seaside. . Renal and/or Endocrine. Diabetic Ketoacidosis: Roberto Cruz. Case Study: Molly has Diabetes. Chronic Kidney Disease: Kevin Ulyses Blanco. 'Case Study' : Molly has Diabetes.

  14. Nursing Case Study Examples

    A nursing case study is a detailed study of an individual patient, which allows you to gain more information about the symptoms and the medical history of a patient and provide the proper diagnoses of the patient's illness based on the symptoms he or she experienced and other affecting factors. Learn more about this type of research by reading the article.

  15. Clarifying case study research: examples from practice

    Increasingly, nurse researchers are using case studies to explore phenomena in healthcare practice. A key characteristic of case study research is its ability to allow researchers to focus on complex situations while taking the context of the situation into account. This paper explores the two predo …

  16. Next Generation NCLEX Case Study Sample Questions

    NGN Case Study Sample Questions and Answers. First, let's take a look at our case study summary below: ... Therefore, let's comb through the nursing notes and vital signs to see what is abnormal and requires follow-up. First, the patient arrived to the room via stretcher. That's fine and doesn't necessarily require follow-up.

  17. PDF IPE Six Case Studies

    4. The case studies 9 4.1 Methodology 9 4.2 Limitations 9 5. Description of case studies 10 5.1 Porto Alegre, Brazil 10 5.2 Edmonton, Alberta, Canada 10 5.3 Hamilton, Ontario, Canada 11 5.4 Andra Pradesh, India 11 5.5 Eastern Cape Province, South Africa 12 5.6 Philadelphia, PA, USA 12 6. Discussion 13 6.1 Summary of enablers in case studies 13

  18. Nursing Case Study Introduction

    Abby Rose. This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the "real-world" disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers ...

  19. 10 Nursing Case Study Analysis Examples [Format

    The nursing case study example on Death and Dying and answers questions on Suffering and the Fallenness of the World, Suffering and the Hope of Resurrection, Value of Life, Euthanasia, and Morally Justified Options, also offers an analysis of the sin of suicide. Explores Ethical end of life decision making.

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  21. Case studies demonstrating the value of nursing

    By closely examining three case study wards Stephanie identified that the average saving per bed day across the three wards was £0.87. Multiplying this figure by the total number of occupied bed days within the Trust from January - December 2015 indicated potential annual savings from the project of £275K.

  22. Faculty Case Studies

    The case studies are contained in 4 categories: Family (13 case studies), Fundamentals and Mental Health (14 case studies) and Medical Surgical (20 case studies). In addition the folder labeled minireviews contains PowerPoint sessions with combinations of case studies and standalone items. ... University of Maryland School of Nursing 655 W ...

  23. Practice learning experience case studies for nursing programmes

    Practice learning experience case studies for nursing programmes. We're setting out some example scenarios and further information on how nursing students can demonstrate their proficiency in a range of practice learning environments. We'll continue to update this with examples in different practice learning environments.

  24. A Comprehensive Case Study and Nursing Care Approach

    The patient is a 63-year-old, African-American retired firefighter and whose brother was recently diagnosed with prostate cancer. As a former firefighter, he has been able to maintain a healthy lifestyle with regular vitamin intake and no past medical history.