Abstract
In nursing research, methodology is expected to bear a direct relationship to the anticipated outcomes of the study, through epistemological approaches to answering the question or realising aims. There is also a clarity of effort in determining the effectiveness and application of study findings. We respect and value our specialist activity and our specialised research to direct the empirical analysis of nursing as a direct clinical intervention as well as a science of humanities (Chinn and Kramer 2015; Anthony and Jack 2009).
In this paper, Brogan et al. relate the various definitions of case study, case based enquiry, case-comparison, case-study methodology usefully. There is an interesting historical development of the enquiry method, considering the pragmatic nature of naturalistic enquiry, interpretive/constructivist philosophy and the qualitative paradigm. When reflecting this historical perspective to the current understanding, almost all papers considered commence with a defensive rationalisation that health care, and often health is a complex topic, and therefore … ‘an increasing use of case study as a method in nursing research’ requires an examination of such methodology. There is no rationale in any paper considered to explain this second part of the statement. Indeed the fact that some nurse researchers define ‘case’ as a single site, or a single condition/patient offers too narrow a classification of the term, and often ignores the broadest context of the singular phenomenon under study – which is frequently influenced by a barrage of external factors usually ignored.
The authors of this paper agree on the confusion caused by the various research approaches under the ‘case study’ heading. For example Anthony and Jack (2009) discuss their review of 42 papers based on the method, and support Brogan et al.’s analysis of the contextualised understanding of the case study researchers’ concern with including data from the background systems, structures and processes which influence and interact with the phenomenon under scrutiny. It is due to the specific differences in the surrounding material from which and with which the phenomenon is viewed that a broad conceptualisation of cases and data can be seen as influencing the context and the activity of the case. In order to appreciate this breadth of data and consider how it causes the phenomenon, what is necessary and what is not; an embedded element is used to direct the analysis. Scholtz and Tietje (2002) exemplify this approach to analysis of complex and multifaceted data in their exploration of embedded social and industrial constructs using a lens approach.
Brogan et al. enrich the understanding of case study and apply the classic multi-method case analysis ideal to a specific nursing research development in nursing care research. They consider the utility of such an approach and articulate the concept in palliative care contexts. The analysis of complex data forms a comprehensive comparison of processes, decisions, and influences both within and across specific units or sites of interest where specific typology of data is considered. In conducting a detailed analysis the similarities and the differences between and within each unit of interest can be synthesised. Both quantitative and qualitative data can therefore be used to exemplify a finding and consider external effect and internal influence from an innovative direction.
Nursing research is ready to develop new boundaries of knowledge in this way, and enhance by clarity of understanding applied nursing interventions, educational and assessment approaches, and the influence of policy on nursing leadership in clinical practice as they migrate from secondary to primary settings. Embedded case study methodology provides opportunity for exploration of multiple data and material and form the analytic frame to underpin selection of such useful cases. Brogan et al. carefully define their aim to raise the quality of case study research by description of the process, and refining case study parameters for boundary definition. Rigour in a systematic and comprehensive research process is a direct product of nursing knowledge health service management and economics based on clinical, psychological, physiological and sociological detail which offers a substantive contribution to practice and policy development. This paper provides a significant underpinning of the methodology and careful discussion of the established in-depth multi-source case study approach.