descriptive case study in nursing

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Characteristics of Qualitative Descriptive Studies: A Systematic Review

MSN, CRNP, Doctoral Candidate, University of Pennsylvania School of Nursing

Justine S. Sefcik

MS, RN, Doctoral Candidate, University of Pennsylvania School of Nursing

Christine Bradway

PhD, CRNP, FAAN, Associate Professor of Gerontological Nursing, University of Pennsylvania School of Nursing

Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. However, limited discussions regarding QD are found in the existing literature. In this systematic review, we identified characteristics of methods and findings reported in research articles published in 2014 whose authors identified the work as QD. After searching and screening, data were extracted from the sample of 55 QD articles and examined to characterize research objectives, design justification, theoretical/philosophical frameworks, sampling and sample size, data collection and sources, data analysis, and presentation of findings. In this review, three primary findings were identified. First, despite inconsistencies, most articles included characteristics consistent with limited, available QD definitions and descriptions. Next, flexibility or variability of methods was common and desirable for obtaining rich data and achieving understanding of a phenomenon. Finally, justification for how a QD approach was chosen and why it would be an appropriate fit for a particular study was limited in the sample and, therefore, in need of increased attention. Based on these findings, recommendations include encouragement to researchers to provide as many details as possible regarding the methods of their QD study so that readers can determine whether the methods used were reasonable and effective in producing useful findings.

Qualitative description (QD) is a label used in qualitative research for studies which are descriptive in nature, particularly for examining health care and nursing-related phenomena ( Polit & Beck, 2009 , 2014 ). QD is a widely cited research tradition and has been identified as important and appropriate for research questions focused on discovering the who, what, and where of events or experiences and gaining insights from informants regarding a poorly understood phenomenon. It is also the label of choice when a straight description of a phenomenon is desired or information is sought to develop and refine questionnaires or interventions ( Neergaard et al., 2009 ; Sullivan-Bolyai et al., 2005 ).

Despite many strengths and frequent citations of its use, limited discussions regarding QD are found in qualitative research textbooks and publications. To the best of our knowledge, only seven articles include specific guidance on how to design, implement, analyze, or report the results of a QD study ( Milne & Oberle, 2005 ; Neergaard, Olesen, Andersen, & Sondergaard, 2009 ; Sandelowski, 2000 , 2010 ; Sullivan-Bolyai, Bova, & Harper, 2005 ; Vaismoradi, Turunen, & Bondas, 2013 ; Willis, Sullivan-Bolyai, Knafl, & Zichi-Cohen, 2016 ). Furthermore, little is known about characteristics of QD as reported in journal-published, nursing-related, qualitative studies. Therefore, the purpose of this systematic review was to describe specific characteristics of methods and findings of studies reported in journal articles (published in 2014) self-labeled as QD. In this review, we did not have a goal to judge whether QD was done correctly but rather to report on the features of the methods and findings.

Features of QD

Several QD design features and techniques have been described in the literature. First, researchers generally draw from a naturalistic perspective and examine a phenomenon in its natural state ( Sandelowski, 2000 ). Second, QD has been described as less theoretical compared to other qualitative approaches ( Neergaard et al., 2009 ), facilitating flexibility in commitment to a theory or framework when designing and conducting a study ( Sandelowski, 2000 , 2010 ). For example, researchers may or may not decide to begin with a theory of the targeted phenomenon and do not need to stay committed to a theory or framework if their investigations take them down another path ( Sandelowski, 2010 ). Third, data collection strategies typically involve individual and/or focus group interviews with minimal to semi-structured interview guides ( Neergaard et al., 2009 ; Sandelowski, 2000 ). Fourth, researchers commonly employ purposeful sampling techniques such as maximum variation sampling which has been described as being useful for obtaining broad insights and rich information ( Neergaard et al., 2009 ; Sandelowski, 2000 ). Fifth, content analysis (and in many cases, supplemented by descriptive quantitative data to describe the study sample) is considered a primary strategy for data analysis ( Neergaard et al., 2009 ; Sandelowski, 2000 ). In some instances thematic analysis may also be used to analyze data; however, experts suggest care should be taken that this type of analysis is not confused with content analysis ( Vaismoradi et al., 2013 ). These data analysis approaches allow researchers to stay close to the data and as such, interpretation is of low-inference ( Neergaard et al., 2009 ), meaning that different researchers will agree more readily on the same findings even if they do not choose to present the findings in the same way ( Sandelowski, 2000 ). Finally, representation of study findings in published reports is expected to be straightforward, including comprehensive descriptive summaries and accurate details of the data collected, and presented in a way that makes sense to the reader ( Neergaard et al., 2009 ; Sandelowski, 2000 ).

It is also important to acknowledge that variations in methods or techniques may be appropriate across QD studies ( Sandelowski, 2010 ). For example, when consistent with the study goals, decisions may be made to use techniques from other qualitative traditions, such as employing a constant comparative analytic approach typically associated with grounded theory ( Sandelowski, 2000 ).

Search Strategy and Study Screening

The PubMed electronic database was searched for articles written in English and published from January 1, 2014 to December 31, 2014, using the terms, “qualitative descriptive study,” “qualitative descriptive design,” and “qualitative description,” combined with “nursing.” This specific publication year, “2014,” was chosen because it was the most recent full year at the time of beginning this systematic review. As we did not intend to identify trends in QD approaches over time, it seemed reasonable to focus on the nursing QD studies published in a certain year. The inclusion criterion for this review was data-based, nursing-related, research articles in which authors used the terms QD, qualitative descriptive study, or qualitative descriptive design in their titles or abstracts as well as in the main texts of the publication.

All articles yielded through an initial search in PubMed were exported into EndNote X7 ( Thomson Reuters, 2014 ), a reference management software, and duplicates were removed. Next, titles and abstracts were reviewed to determine if the publication met inclusion criteria; all articles meeting inclusion criteria were then read independently in full by two authors (HK and JS) to determine if the terms – QD or qualitative descriptive study/design – were clearly stated in the main texts. Any articles in which researchers did not specifically state these key terms in the main text were then excluded, even if the terms had been used in the study title or abstract. In one article, for example, although “qualitative descriptive study” was reported in the published abstract, the researchers reported a “qualitative exploratory design” in the main text of the article ( Sundqvist & Carlsson, 2014 ); therefore, this article was excluded from our review. Despite the possibility that there may be other QD studies published in 2014 that were not labeled as such, to facilitate our screening process we only included articles where the researchers clearly used our search terms for their approach. Finally, the two authors compared, discussed, and reconciled their lists of articles with a third author (CB).

Study Selection

Initially, although the year 2014 was specifically requested, 95 articles were identified (due to ahead of print/Epub) and exported into the EndNote program. Three duplicate publications were removed and the 20 articles with final publication dates of 2015 were also excluded. The remaining 72 articles were then screened by examining titles, abstracts, and full-texts. Based on our inclusion criteria, 15 (of 72) were then excluded because QD or QD design/study was not identified in the main text. We then re-examined the remaining 57 articles and excluded two additional articles that did not meet inclusion criteria (e.g., QD was only reported as an analytic approach in the data analysis section). The remaining 55 publications met inclusion criteria and comprised the sample for our systematic review (see Figure 1 ).

Flow Diagram of Study Selection

Of the 55 publications, 23 originated from North America (17 in the United States; 6 in Canada), 12 from Asia, 11 from Europe, 7 from Australia and New Zealand, and 2 from South America. Eleven studies were part of larger research projects and two of them were reported as part of larger mixed-methods studies. Four were described as a secondary analysis.

Quality Appraisal Process

Following the identification of the 55 publications, two authors (HK and JS) independently examined each article using the Critical Appraisal Skills Programme (CASP) qualitative checklist ( CASP, 2013 ). The CASP was chosen to determine the general adequacy (or rigor) of the qualitative studies included in this review as the CASP criteria are generic and intend to be applied to qualitative studies in general. In addition, the CASP was useful because we were able to examine the internal consistency between study aims and methods and between study aims and findings as well as the usefulness of findings ( CASP, 2013 ). The CASP consists of 10 main questions with several sub-questions to consider when making a decision about the main question ( CASP, 2013 ). The first two questions have reviewers examine the clarity of study aims and appropriateness of using qualitative research to achieve the aims. With the next eight questions, reviewers assess study design, sampling, data collection, and analysis as well as the clarity of the study’s results statement and the value of the research. We used the seven questions and 17 sub-questions related to methods and statement of findings to evaluate the articles. The results of this process are presented in Table 1 .

CASP Questions and Quality Appraisal Results (N = 55)

Note . The CASP questions are adapted from “10 questions to help you make sense of qualitative research,” by Critical Appraisal Skills Programme, 2013, retrieved from http://media.wix.com/ugd/dded87_29c5b002d99342f788c6ac670e49f274.pdf . Its license can be found at http://creativecommons.org/licenses/by-nc-sa/3.0/

Once articles were assessed by the two authors independently, all three authors discussed and reconciled our assessment. No articles were excluded based on CASP results; rather, results were used to depict the general adequacy (or rigor) of all 55 articles meeting inclusion criteria for our systematic review. In addition, the CASP was included to enhance our examination of the relationship between the methods and the usefulness of the findings documented in each of the QD articles included in this review.

Process for Data Extraction and Analysis

To further assess each of the 55 articles, data were extracted on: (a) research objectives, (b) design justification, (c) theoretical or philosophical framework, (d) sampling and sample size, (e) data collection and data sources, (f) data analysis, and (g) presentation of findings (see Table 2 ). We discussed extracted data and identified common and unique features in the articles included in our systematic review. Findings are described in detail below and in Table 3 .

Elements for Data Extraction

Data Extraction and Analysis Results

Note . NR = not reported

Quality Appraisal Results

Justification for use of a QD design was evident in close to half (47.3%) of the 55 publications. While most researchers clearly described recruitment strategies (80%) and data collection methods (100%), justification for how the study setting was selected was only identified in 38.2% of the articles and almost 75% of the articles did not include any reason for the choice of data collection methods (e.g., focus-group interviews). In the vast majority (90.9%) of the articles, researchers did not explain their involvement and positionality during the process of recruitment and data collection or during data analysis (63.6%). Ethical standards were reported in greater than 89% of all articles and most articles included an in-depth description of data analysis (83.6%) and development of categories or themes (92.7%). Finally, all researchers clearly stated their findings in relation to research questions/objectives. Researchers of 83.3% of the articles discussed the credibility of their findings (see Table 1 ).

Research Objectives

In statements of study objectives and/or questions, the most frequently used verbs were “explore” ( n = 22) and “describe” ( n = 17). Researchers also used “identify” ( n = 3), “understand” ( n = 4), or “investigate” ( n = 2). Most articles focused on participants’ experiences related to certain phenomena ( n = 18), facilitators/challenges/factors/reasons ( n = 14), perceptions about specific care/nursing practice/interventions ( n = 11), and knowledge/attitudes/beliefs ( n = 3).

Design Justification

A total of 30 articles included references for QD. The most frequently cited references ( n = 23) were “Whatever happened to qualitative description?” ( Sandelowski, 2000 ) and “What’s in a name? Qualitative description revisited” ( Sandelowski, 2010 ). Other references cited included “Qualitative description – the poor cousin of health research?” ( Neergaard et al., 2009 ), “Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research” ( Pope & Mays, 1995 ), and general research textbooks ( Polit & Beck, 2004 , 2012 ).

In 26 articles (and not necessarily the same as those citing specific references to QD), researchers provided a rationale for selecting QD. Most researchers chose QD because this approach aims to produce a straight description and comprehensive summary of the phenomenon of interest using participants’ language and staying close to the data (or using low inference).

Authors of two articles distinctly stated a QD design, yet also acknowledged grounded-theory or phenomenological overtones by adopting some techniques from these qualitative traditions ( Michael, O'Callaghan, Baird, Hiscock, & Clayton, 2014 ; Peacock, Hammond-Collins, & Forbes, 2014 ). For example, Michael et al. (2014 , p. 1066) reported:

The research used a qualitative descriptive design with grounded theory overtones ( Sandelowski, 2000 ). We sought to provide a comprehensive summary of participants’ views through theoretical sampling; multiple data sources (focus groups [FGs] and interviews); inductive, cyclic, and constant comparative analysis; and condensation of data into thematic representations ( Corbin & Strauss, 1990 , 2008 ).

Authors of four additional articles included language suggestive of a grounded-theory or phenomenological tradition, e.g., by employing a constant comparison technique or translating themes stated in participants’ language into the primary language of the researchers during data analysis ( Asemani et al., 2014 ; Li, Lee, Chen, Jeng, & Chen, 2014 ; Ma, 2014 ; Soule, 2014 ). Additionally, Li et al. (2014) specifically reported use of a grounded-theory approach.

Theoretical or Philosophical Framework

In most (n = 48) articles, researchers did not specify any theoretical or philosophical framework. Of those articles in which a framework or philosophical stance was included, the authors of five articles described the framework as guiding the development of an interview guide ( Al-Zadjali, Keller, Larkey, & Evans, 2014 ; DeBruyn, Ochoa-Marin, & Semenic, 2014 ; Fantasia, Sutherland, Fontenot, & Ierardi, 2014 ; Ma, 2014 ; Wiens, Babenko-Mould, & Iwasiw, 2014 ). In two articles, data analysis was described as including key concepts of a framework being used as pre-determined codes or categories ( Al-Zadjali et al., 2014 ; Wiens et al., 2014 ). Oosterveld-Vlug et al. (2014) and Zhang, Shan, and Jiang (2014) discussed a conceptual model and underlying philosophy in detail in the background or discussion section, although the model and philosophy were not described as being used in developing interview questions or analyzing data.

Sampling and Sample Size

In 38 of the 55 articles, researchers reported ‘purposeful sampling’ or some derivation of purposeful sampling such as convenience ( n = 10), maximum variation ( n = 8), snowball ( n = 3), and theoretical sampling ( n = 1). In three instances ( Asemani et al., 2014 ; Chan & Lopez, 2014 ; Soule, 2014 ), multiple sampling strategies were described, for example, a combination of snowball, convenience, and maximum variation sampling. In articles where maximum variation sampling was employed, “variation” referred to seeking diversity in participants’ demographics ( n = 7; e.g., age, gender, and education level), while one article did not include details regarding how their maximum variation sampling strategy was operationalized ( Marcinowicz, Abramowicz, Zarzycka, Abramowicz, & Konstantynowicz, 2014 ). Authors of 17 articles did not specify their sampling techniques.

Sample sizes ranged from 8 to 1,932 with nine studies in the 8–10 participant range and 24 studies in the 11–20 participant range. The participant range of 21–30 and 31–50 was reported in eight articles each. Six studies included more than 50 participants. Two of these articles depicted quite large sample sizes (N=253, Hart & Mareno, 2014 ; N=1,932, Lyndon et al., 2014 ) and the authors of these articles described the use of survey instruments and analysis of responses to open-ended questions. This was in contrast to studies with smaller sample sizes where individual interviews and focus groups were more commonly employed.

Data Collection and Data Sources

In a majority of studies, researchers collected data through individual ( n = 39) and/or focus-group ( n = 14) interviews that were semistructured. Most researchers reported that interviews were audiotaped ( n = 51) and interview guides were described as the primary data collection tool in 29 of the 51 studies. In some cases, researchers also described additional data sources, for example, taking memos or field notes during participant observation sessions or as a way to reflect their thoughts about interviews ( n = 10). Written responses to open-ended questions in survey questionnaires were another type of data source in a small number of studies ( n = 4).

Data Analysis

The analysis strategy most commonly used in the QD studies included in this review was qualitative content analysis ( n = 30). Among the studies where this technique was used, most researchers described an inductive approach; researchers of two studies analyzed data both inductively and deductively. Thematic analysis was adopted in 14 studies and the constant comparison technique in 10 studies. In nine studies, researchers employed multiple techniques to analyze data including qualitative content analysis with constant comparison ( Asemani et al., 2014 ; DeBruyn et al., 2014 ; Holland, Christensen, Shone, Kearney, & Kitzman, 2014 ; Li et al., 2014 ) and thematic analysis with constant comparison ( Johansson, Hildingsson, & Fenwick, 2014 ; Oosterveld-Vlug et al., 2014 ). In addition, five teams conducted descriptive statistical analysis using both quantitative and qualitative data and counting the frequencies of codes/themes ( Ewens, Chapman, Tulloch, & Hendricks, 2014 ; Miller, 2014 ; Santos, Sandelowski, & Gualda, 2014 ; Villar, Celdran, Faba, & Serrat, 2014 ) or targeted events through video monitoring ( Martorella, Boitor, Michaud, & Gelinas, 2014 ). Tseng, Chen, and Wang (2014) cited Thorne, Reimer Kirkham, and O’Flynn-Magee (2004)’s interpretive description as the inductive analytic approach. In five out of 55 articles, researchers did not specifically name their analysis strategies, despite including descriptions about procedural aspects of data analysis. Researchers of 20 studies reported that data saturation for their themes was achieved.

Presentation of Findings

Researchers described participants’ experiences of health care, interventions, or illnesses in 18 articles and presented straightforward, focused, detailed descriptions of facilitators, challenges, factors, reasons, and causes in 15 articles. Participants’ perceptions of specific care, interventions, or programs were described in detail in 11 articles. All researchers presented their findings with extensive descriptions including themes or categories. In 25 of 55 articles, figures or tables were also presented to illustrate or summarize the findings. In addition, the authors of three articles summarized, organized, and described their data using key concepts of conceptual models ( Al-Zadjali et al., 2014 ; Oosterveld-Vlug et al., 2014 ; Wiens et al., 2014 ). Martorella et al. (2014) assessed acceptability and feasibility of hand massage therapy and arranged their findings in relation to pre-determined indicators of acceptability and feasibility. In one longitudinal QD study ( Kneck, Fagerberg, Eriksson, & Lundman, 2014 ), the researchers presented the findings as several key patterns of learning for persons living with diabetes; in another longitudinal QD study ( Stegenga & Macpherson, 2014 ), findings were presented as processes and themes regarding patients’ identity work across the cancer trajectory. In another two studies, the researchers described and compared themes or categories from two different perspectives, such as patients and nurses ( Canzan, Heilemann, Saiani, Mortari, & Ambrosi, 2014 ) or parents and children ( Marcinowicz et al., 2014 ). Additionally, Ma (2014) reported themes using both participants’ language and the researcher’s language.

In this systematic review, we examined and reported specific characteristics of methods and findings reported in journal articles self-identified as QD and published during one calendar year. To accomplish this we identified 55 articles that met inclusion criteria, performed a quality appraisal following CASP guidelines, and extracted and analyzed data focusing on QD features. In general, three primary findings emerged. First, despite inconsistencies, most QD publications had the characteristics that were originally observed by Sandelowski (2000) and summarized by other limited available QD literature. Next, there are no clear boundaries in methods used in the QD studies included in this review; in a number of studies, researchers adopted and combined techniques originating from other qualitative traditions to obtain rich data and increase their understanding of the phenomenon under investigation. Finally, justification for how QD was chosen and why it would be an appropriate fit for a particular study is an area in need of increased attention.

In general, the overall characteristics were consistent with design features of QD studies described in the literature ( Neergaard et al., 2009 ; Sandelowski, 2000 , 2010 ; Vaismoradi et al., 2013 ). For example, many authors reported that study objectives were to describe or explore participants’ experiences and factors related to certain phenomena, events, or interventions. In most cases, these authors cited Sandelowski (2000) as a reference for this particular characteristic. It was rare that theoretical or philosophical frameworks were identified, which also is consistent with descriptions of QD. In most studies, researchers used purposeful sampling and its derivative sampling techniques, collected data through interviews, and analyzed data using qualitative content analysis or thematic analysis. Moreover, all researchers presented focused or comprehensive, descriptive summaries of data including themes or categories answering their research questions. These characteristics do not indicate that there are correct ways to do QD studies; rather, they demonstrate how others designed and produced QD studies.

In several studies, researchers combined techniques that originated from other qualitative traditions for sampling, data collection, and analysis. This flexibility or variability, a key feature of recently published QD studies, may indicate that there are no clear boundaries in designing QD studies. Sandelowski (2010) articulated: “in the actual world of research practice, methods bleed into each other; they are so much messier than textbook depictions” (p. 81). Hammersley (2007) also observed:

“We are not so much faced with a set of clearly differentiated qualitative approaches as with a complex landscape of variable practice in which the inhabitants use a range of labels (‘ethnography’, ‘discourse analysis’, ‘life history work’, narrative study’, ……, and so on) in diverse and open-ended ways in order to characterize their orientation, and probably do this somewhat differently across audiences and occasions” (p. 293).

This concept of having no clear boundaries in methods when designing a QD study should enable researchers to obtain rich data and produce a comprehensive summary of data through various data collection and analysis approaches to answer their research questions. For example, using an ethnographical approach (e.g., participant observation) in data collection for a QD study may facilitate an in-depth description of participants’ nonverbal expressions and interactions with others and their environment as well as situations or events in which researchers are interested ( Kawulich, 2005 ). One example found in our review is that Adams et al. (2014) explored family members’ responses to nursing communication strategies for patients in intensive care units (ICUs). In this study, researchers conducted interviews with family members, observed interactions between healthcare providers, patients, and family members in ICUs, attended ICU rounds and family meetings, and took field notes about their observations and reflections. Accordingly, the variability in methods provided Adams and colleagues (2014) with many different aspects of data that were then used to complement participants’ interviews (i.e., data triangulation). Moreover, by using a constant comparison technique in addition to qualitative content analysis or thematic analysis in QD studies, researchers compare each case with others looking for similarities and differences as well as reasoning why differences exist, to generate more general understanding of phenomena of interest ( Thorne, 2000 ). In fact, this constant comparison analysis is compatible with qualitative content analysis and thematic analysis and we found several examples of using this approach in studies we reviewed ( Asemani et al., 2014 ; DeBruyn et al., 2014 ; Holland et al., 2014 ; Johansson et al., 2014 ; Li et al., 2014 ; Oosterveld-Vlug et al., 2014 ).

However, this flexibility or variability in methods of QD studies may cause readers’ as well as researchers’ confusion in designing and often labeling qualitative studies ( Neergaard et al., 2009 ). Especially, it could be difficult for scholars unfamiliar with qualitative studies to differentiate QD studies with “hues, tones, and textures” of qualitative traditions ( Sandelowski, 2000 , p. 337) from grounded theory, phenomenological, and ethnographical research. In fact, the major difference is in the presentation of the findings (or outcomes of qualitative research) ( Neergaard et al., 2009 ; Sandelowski, 2000 ). The final products of grounded theory, phenomenological, and ethnographical research are a generation of a theory, a description of the meaning or essence of people’s lived experience, and an in-depth, narrative description about certain culture, respectively, through researchers’ intensive/deep interpretations, reflections, and/or transformation of data ( Streubert & Carpenter, 2011 ). In contrast, QD studies result in “a rich, straight description” of experiences, perceptions, or events using language from the collected data ( Neergaard et al., 2009 ) through low-inference (or data-near) interpretations during data analysis ( Sandelowski, 2000 , 2010 ). This feature is consistent with our finding regarding presentation of findings: in all QD articles included in this systematic review, the researchers presented focused or comprehensive, descriptive summaries to their research questions.

Finally, an explanation or justification of why a QD approach was chosen or appropriate for the study aims was not found in more than half of studies in the sample. While other qualitative approaches, including grounded theory, phenomenology, ethnography, and narrative analysis, are used to better understand people’s thoughts, behaviors, and situations regarding certain phenomena ( Sullivan-Bolyai et al., 2005 ), as noted above, the results will likely read differently than those for a QD study ( Carter & Little, 2007 ). Therefore, it is important that researchers accurately label and justify their choices of approach, particularly for studies focused on participants’ experiences, which could be addressed with other qualitative traditions. Justifying one’s research epistemology, methodology, and methods allows readers to evaluate these choices for internal consistency, provides context to assist in understanding the findings, and contributes to the transparency of choices, all of which enhance the rigor of the study ( Carter & Little, 2007 ; Wu, Thompson, Aroian, McQuaid, & Deatrick, 2016 ).

Use of the CASP tool drew our attention to the credibility and usefulness of the findings of the QD studies included in this review. Although justification for study design and methods was lacking in many articles, most authors reported techniques of recruitment, data collection, and analysis that appeared. Internal consistencies among study objectives, methods, and findings were achieved in most studies, increasing readers’ confidence that the findings of these studies are credible and useful in understanding under-explored phenomenon of interest.

In summary, our findings support the notion that many scholars employ QD and include a variety of commonly observed characteristics in their study design and subsequent publications. Based on our review, we found that QD as a scholarly approach allows flexibility as research questions and study findings emerge. We encourage authors to provide as many details as possible regarding how QD was chosen for a particular study as well as details regarding methods to facilitate readers’ understanding and evaluation of the study design and rigor. We acknowledge the challenge of strict word limitation with submissions to print journals; potential solutions include collaboration with journal editors and staff to consider creative use of charts or tables, or using more citations and less text in background sections so that methods sections are robust.

Limitations

Several limitations of this review deserve mention. First, only articles where researchers explicitly stated in the main body of the article that a QD design was employed were included. In contrast, articles labeled as QD in only the title or abstract, or without their research design named were not examined due to the lack of certainty that the researchers actually carried out a QD study. As a result, we may have excluded some studies where a QD design was followed. Second, only one database was searched and therefore we did not identify or describe potential studies following a QD approach that were published in non-PubMed databases. Third, our review is limited by reliance on what was included in the published version of a study. In some cases, this may have been a result of word limits or specific styles imposed by journals, or inconsistent reporting preferences of authors and may have limited our ability to appraise the general adequacy with the CASP tool and examine specific characteristics of these studies.

Conclusions

A systematic review was conducted by examining QD research articles focused on nursing-related phenomena and published in one calendar year. Current patterns include some characteristics of QD studies consistent with the previous observations described in the literature, a focus on the flexibility or variability of methods in QD studies, and a need for increased explanations of why QD was an appropriate label for a particular study. Based on these findings, recommendations include encouragement to authors to provide as many details as possible regarding the methods of their QD study. In this way, readers can thoroughly consider and examine if the methods used were effective and reasonable in producing credible and useful findings.

Acknowledgments

This work was supported in part by the John A. Hartford Foundation’s National Hartford Centers of Gerontological Nursing Excellence Award Program.

Hyejin Kim is a Ruth L. Kirschstein NRSA Predoctoral Fellow (F31NR015702) and 2013–2015 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar. Justine Sefcik is a Ruth L. Kirschstein Predoctoral Fellow (F31NR015693) through the National Institutes of Health, National Institute of Nursing Research.

Conflict of Interest Statement

The Authors declare that there is no conflict of interest.

Contributor Information

Hyejin Kim, MSN, CRNP, Doctoral Candidate, University of Pennsylvania School of Nursing.

Justine S. Sefcik, MS, RN, Doctoral Candidate, University of Pennsylvania School of Nursing.

Christine Bradway, PhD, CRNP, FAAN, Associate Professor of Gerontological Nursing, University of Pennsylvania School of Nursing.

• Adams JA, Anderson RA, Docherty SL, Tulsky JA, Steinhauser KE, Bailey DE., Jr Nursing strategies to support family members of ICU patients at high risk of dying. Heart & Lung. 2014; 43 (5):406–415. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ahlin J, Ericson-Lidman E, Norberg A, Strandberg G. Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people. Scandinavian Journal of Caring Sciences. 2014; 28 (2):355–363. [ PubMed ] [ Google Scholar ]
• Al-Zadjali M, Keller C, Larkey L, Evans B. GCC women: causes and processes of midlife weight gain. Health Care for Women International. 2014; 35 (11–12):1267–1286. [ PubMed ] [ Google Scholar ]
• Asemani O, Iman MT, Moattari M, Tabei SZ, Sharif F, Khayyer M. An exploratory study on the elements that might affect medical students' and residents' responsibility during clinical training. Journal of Medical Ethics and History of Medicine. 2014; 7 :8. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Atefi N, Abdullah KL, Wong LP, Mazlom R. Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study. International Nursing Review. 2014; 61 (3):352–360. [ PubMed ] [ Google Scholar ]
• Ballangrud R, Hall-Lord ML, Persenius M, Hedelin B. Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study. Intensive and Critical Care Nursing. 2014; 30 (4):179–187. [ PubMed ] [ Google Scholar ]
• Benavides-Vaello S, Katz JR, Peterson JC, Allen CB, Paul R, Charette-Bluff AL, Morris P. Nursing and health sciences workforce diversity research using. PhotoVoice: a college and high school student participatory project. Journal of Nursing Education. 2014; 53 (4):217–222. [ PubMed ] [ Google Scholar ]
• Bernhard C, Zielinski R, Ackerson K, English J. Home birth after hospital birth: women's choices and reflections. Journal of Midwifery and Women's Health. 2014; 59 (2):160–166. [ PubMed ] [ Google Scholar ]
• Borbasi S, Jackson D, Langford RW. Navigating the maze of nursing research: An interactive learning adventure. 2nd. New South Wales, Australia: Mosby/Elsevier; 2008. [ Google Scholar ]
• Bradford B, Maude R. Fetal response to maternal hunger and satiation - novel finding from a qualitative descriptive study of maternal perception of fetal movements. BMC Pregnancy and Childbirth. 2014; 14 :288. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Burns N, Grove SK. The practice of nursing research: Conduct, critique, & utilization. 5th. Philadelphia, PA: Elsevier/Saunders; 2005. [ Google Scholar ]
• Canzan F, Heilemann MV, Saiani L, Mortari L, Ambrosi E. Visible and invisible caring in nursing from the perspectives of patients and nurses in the gerontological context. Scandinavian Journal of Caring Sciences. 2014; 28 (4):732–740. [ PubMed ] [ Google Scholar ]
• Carter SM, Littler M. Justifying knowledge, justifying methods, taking action: Epistemologies, methodologies, and methods in qualitative research. Qualitative Health Research. 2007; 17 (10):1316–1328. [ PubMed ] [ Google Scholar ]
• Critical Appraisal Skills Programme (CASP 2013) 10 questions to help you make sense of qualitative research. Oxford: CASP; 2013. Retrieved from http://media.wix.com/ugd/dded87_29c5b002d99342f788c6ac670e49f274.pdf . [ Google Scholar ]
• Chan CW, Lopez V. A qualitative descriptive study of risk reduction for coronary disease among the Hong Kong Chinese. Public Health Nursing. 2014; 31 (4):327–335. [ PubMed ] [ Google Scholar ]
• Chen YJ, Tsai YF, Lee SH, Lee HL. Protective factors against suicide among young-old Chinese outpatients. BMC Public Health. 2014; 14 :372. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Cleveland LM, Bonugli R. Experiences of mothers of infants with neonatal abstinence syndrome in the neonatal intensive care unit. Journal of Obstetric Gynecologic, & Neonatal Nursing. 2014; 43 (3):318–329. [ PubMed ] [ Google Scholar ]
• Corbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory. 3rd. Thousand Oaks, CA: Sage Publications; 2008. [ Google Scholar ]
• Corbin JM, Strauss A. Grounded theory research: Procedures, canons and evaluation criteria. Qualitative Sociology. 1990; 13 (1):3–21. [ Google Scholar ]
• DeBruyn RR, Ochoa-Marin SC, Semenic S. Barriers and facilitators to evidence-based nursing in Colombia: perspectives of nurse educators, nurse researchers and graduate students. Investigación y Educación en Enfermería. 2014; 32 (1):9–21. [ PubMed ] [ Google Scholar ]
• Denzin NK, Lincoln YS. The Discipline and practice of qualitative research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. 2nd. Thousand Oaks, CA: Sage Publications; 2000. pp. 1–28. [ Google Scholar ]
• Ewens B, Chapman R, Tulloch A, Hendricks JM. ICU survivors' utilisation of diaries post discharge: a qualitative descriptive study. Australian Critical Care. 2014; 27 (1):28–35. [ PubMed ] [ Google Scholar ]
• Fantasia HC, Sutherland MA, Fontenot H, Ierardi JA. Knowledge, attitudes and beliefs about contraceptive and sexual consent negotiation among college women. Journal of Forensic Nursing. 2014; 10 (4):199–207. [ PubMed ] [ Google Scholar ]
• Friman A, Wahlberg AC, Mattiasson AC, Ebbeskog B. District nurses' knowledge development in wound management: ongoing learning without organizational support. Primary Health Care Research & Development. 2014; 15 (4):386–395. [ PubMed ] [ Google Scholar ]
• Gaughan V, Logan D, Sethna N, Mott S. Parents' perspective of their journey caring for a child with chronic neuropathic pain. Pain Management Nursing. 2014; 15 (1):246–257. [ PubMed ] [ Google Scholar ]
• Hammersley M. The issue of quality in qualitative research. International Journal of Research & Method in Education. 2007; 30 (3):287–305. [ Google Scholar ]
• Hart PL, Mareno N. Cultural challenges and barriers through the voices of nurses. Journal of Clinical Nursing. 2014; 23 (15–16):2223–2232. [ PubMed ] [ Google Scholar ]
• Hasman K, Kjaergaard H, Esbensen BA. Fathers' experience of childbirth when non-progressive labour occurs and augmentation is established. A qualitative study. Sexual & Reproductive HealthCare. 2014; 5 (2):69–73. [ PubMed ] [ Google Scholar ]
• Higgins I, van der Riet P, Sneesby L, Good P. Nutrition and hydration in dying patients: the perceptions of acute care nurses. Journal of Clinical Nursing. 2014; 23 (17–18):2609–2617. [ PubMed ] [ Google Scholar ]
• Holland ML, Christensen JJ, Shone LP, Kearney MH, Kitzman HJ. Women's reasons for attrition from a nurse home visiting program. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2014; 43 (1):61–70. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Johansson M, Hildingsson I, Fenwick J. 'As long as they are safe--birth mode does not matter' Swedish fathers' experiences of decision-making around caesarean section. Women and Birth. 2014; 27 (3):208–213. [ PubMed ] [ Google Scholar ]
• Kao MH, Tsai YF. Illness experiences in middle-aged adults with early-stage knee osteoarthritis: findings from a qualitative study. Journal of Advanced Nursing. 2014; 70 (7):1564–1572. [ PubMed ] [ Google Scholar ]
• Kawulich BB. Participant observation as a data collection method. Forum: Qualitative Social Research. 2005; 6 (2) Art. 43. Retrieved from http://www.qualitative-research.net/index.php/fqs/article/view/466/997 . [ Google Scholar ]
• Kerr D, McKay K, Klim S, Kelly AM, McCann T. Attitudes of emergency department patients about handover at the bedside. Journal of Clinical Nursing. 2014; 23 (11–12):1685–1693. [ PubMed ] [ Google Scholar ]
• Kneck A, Fagerberg I, Eriksson LE, Lundman B. Living with diabetes - development of learning patterns over a 3-year period. International Journal of Qualitative Studies on Health and Well-being. 2014; 9 :24375. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Krippendorf K. Content analysis: An introduction to its methodology. 2nd. Thousand Oaks, CA: Sage Publications; 2004. [ Google Scholar ]
• Larocque N, Schotsman C, Kaasalainen S, Crawshaw D, McAiney C, Brazil E. Using a book chat to improve attitudes and perceptions of long-term care staff about dementia. Journal of Gerontological Nursing. 2014; 40 (5):46–52. [ PubMed ] [ Google Scholar ]
• Li IC, Lee SY, Chen CY, Jeng YQ, Chen YC. Facilitators and barriers to effective smoking cessation: counselling services for inpatients from nurse-counsellors' perspectives--a qualitative study. International Journal of Environmental Research and Public Health. 2014; 11 (5):4782–4798. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lux KM, Hutcheson JB, Peden AR. Ending disruptive behavior: staff nurse recommendations to nurse educators. Nurse Education in Practice. 2014; 14 (1):37–42. [ PubMed ] [ Google Scholar ]
• Lyndon A, Zlatnik MG, Maxfield DG, Lewis A, McMillan C, Kennedy HP. Contributions of clinical disconnections and unresolved conflict to failures in intrapartum safety. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2014; 43 (1):2–12. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ma F, Li J, Liang H, Bai Y, Song J. Baccalaureate nursing students' perspectives on learning about caring in China: a qualitative descriptive study. BMC Medical Education. 2014; 14 :42. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ma L. A humanbecoming qualitative descriptive study on quality of life with older adults. Nursing Science Quarterly. 2014; 27 (2):132–141. [ PubMed ] [ Google Scholar ]
• Marcinowicz L, Abramowicz P, Zarzycka D, Abramowicz M, Konstantynowicz J. How hospitalized children and parents perceive nurses and hospital amenities: A qualitative descriptive study in Poland. Journal of Child Health Care. 2014 [ PubMed ] [ Google Scholar ]
• Martorella G, Boitor M, Michaud C, Gelinas C. Feasibility and acceptability of hand massage therapy for pain management of postoperative cardiac surgery patients in the intensive care unit. Heart & Lung. 2014; 43 (5):437–444. [ PubMed ] [ Google Scholar ]
• McDonough A, Callans KM, Carroll DL. Understanding the challenges during transitions of care for children with critical airway conditions. ORL Head and Neck Nursing. 2014; 32 (4):12–17. [ PubMed ] [ Google Scholar ]
• McGilton KS, Boscart VM, Brown M, Bowers B. Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: perspectives of licensed nursing staff. International Journal of Nursing Studies. 2014; 51 (6):917–926. [ PubMed ] [ Google Scholar ]
• Michael N, O'Callaghan C, Baird A, Hiscock N, Clayton J. Cancer caregivers advocate a patient- and family-centered approach to advance care planning. Journal of Pain and Symptom Management. 2014; 47 (6):1064–1077. [ PubMed ] [ Google Scholar ]
• Miller WR. Patient-centered outcomes in older adults with epilepsy. Seizure. 2014; 23 (8):592–597. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Milne J, Oberle K. Enhancing rigor in qualitative description: a case study. Journal of Wound Ostomy & Continence Nursing. 2005; 32 (6):413–420. [ PubMed ] [ Google Scholar ]
• Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description - the poor cousin of health research? BMC Medical Research Methodology. 2009; 9 :52. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• O'Shea MF. Staff nurses' perceptions regarding palliative care for hospitalized older adults. The American Journal of Nursing. 2014; 114 (11):26–34. [ PubMed ] [ Google Scholar ]
• Oosterveld-Vlug MG, Pasman HR, van Gennip IE, Muller MT, Willems DL, Onwuteaka-Philipsen BD. Dignity and the factors that influence it according to nursing home residents: a qualitative interview study. Journal of Advanced Nursing. 2014; 70 (1):97–106. [ PubMed ] [ Google Scholar ]
• Oruche UM, Draucker C, Alkhattab H, Knopf A, Mazurcyk J. Interventions for family members of adolescents with disruptive behavior disorders. Journal of Child and Adolescent Psychiatric Nursing. 2014; 27 (3):99–108. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Parse RR. Qualitative inquiry: The path of sciencing. Sudbury, MA: Jones and Barlett; 2001. [ Google Scholar ]
• Peacock SC, Hammond-Collins K, Forbes DA. The journey with dementia from the perspective of bereaved family caregivers: a qualitative descriptive study. BMC Nursing. 2014; 13 (1):42. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Peterson WE, Sprague AE, Reszel J, Walker M, Fell DB, Perkins SL, Johnson M. Women's perspectives of the fetal fibronectin testing process: a qualitative descriptive study. BMC Pregnancy and Childbirth. 2014; 14 :190. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Polit DF, Beck CT. Nursing research: principles and methods. 7. Philadelphia, PA: Lippincott Williams & Wilkins; 2004. [ Google Scholar ]
• Polit DF, Beck CT. International differences in nursing research, 2005–2006. Journal of Nursing Scholarship. 2009; 41 (1):44–53. [ PubMed ] [ Google Scholar ]
• Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 9. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012. [ Google Scholar ]
• Polit DF, Beck CT. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. 8. Philadelphia, PA: Wolters Kluwer Health; Lippincott Willians & Wilkins; 2014. Supplement for Chapter 14: Qualitative Descriptive Studies. Retrieved from http://downloads.lww.com/wolterskluwer_vitalstream_com/sample-content/9781451176797_Polit/samples/CS_Chapter_14.pdf . [ Google Scholar ]
• Pope C, Mays N. Qualitative research in health care. 3rd. Victoria, Australia: Blackwell Publishing; 2006. [ Google Scholar ]
• Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995; 311 (6996):42–45. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Raphael D, Waterworth S, Gott M. The role of practice nurses in providing palliative and end-of-life care to older patients with long-term conditions. International Journal of Palliative Nursing. 2014; 20 (8):373–379. [ PubMed ] [ Google Scholar ]
• Saldana J. Longitudinal qualitative research: Analyzing change through time. Walnut Creek, CA: AltaMira Press; 2003. [ Google Scholar ]
• Sandelowski M. Whatever happened to qualitative description? Research in Nursing & Health. 2000; 23 (4):334–340. [ PubMed ] [ Google Scholar ]
• Sandelowski M. What's in a name? Qualitative description revisited. Research in Nursing & Health. 2010; 33 (1):77–84. [ PubMed ] [ Google Scholar ]
• Santos HP, Jr, Sandelowski M, Gualda DM. Bad thoughts: Brazilian women's responses to mothering while experiencing postnatal depression. Midwifery. 2014; 30 (6):788–794. [ PubMed ] [ Google Scholar ]
• Sharp R, Grech C, Fielder A, Mikocka-Walus A, Cummings M, Esterman A. The patient experience of a peripherally inserted central catheter (PICC): A qualitative descriptive study. Contemporary Nurse. 2014; 48 (1):26–35. [ PubMed ] [ Google Scholar ]
• Soule I. Cultural competence in health care: an emerging theory. ANS Advances in Nursing Science. 2014; 37 (1):48–60. [ PubMed ] [ Google Scholar ]
• Stegenga K, Macpherson CF. "I'm a survivor, go study that word and you'll see my name": adolescent and cancer identity work over the first year after diagnosis. Cancer Nursing. 2014; 37 (6):418–428. [ PubMed ] [ Google Scholar ]
• Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative. 5th. Philadelphia, PA: Lippincott Williams & Wilkins; 2011. [ Google Scholar ]
• Sturesson A, Ziegert K. Prepare the patient for future challenges when facing hemodialysis: nurses' experiences. International Journal of Qualitative Studies on Health and Well-being. 2014; 9 :22952. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sullivan-Bolyai S, Bova C, Harper D. Developing and refining interventions in persons with health disparities: the use of qualitative description. Nursing Outlook. 2005; 53 (3):127–133. [ PubMed ] [ Google Scholar ]
• Sundqvist AS, Carlsson AA. Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy. Scandinavian Journal of Caring Sciences. 2014; 28 (2):281–288. [ PubMed ] [ Google Scholar ]
• Thomson Reuters. EndNote X7. 2014 Retrieved from http://endnote.com/product-details/x7 .
• Thorne S. Data analysis in qualitative research. Evidence Based Nursing. 2000; 3 :68–70. [ Google Scholar ]
• Thorne S, Reimer Kirkham S, O’Flynn-Magee K. The analytic challenge in interpretive description. International Journal of Qualitative Methods. 2004; 3 (1):1–11. [ Google Scholar ]
• Tseng YF, Chen CH, Wang HH. Taiwanese women's process of recovery from stillbirth: a qualitative descriptive study. Research in Nursing & Health. 2014; 37 (3):219–228. [ PubMed ] [ Google Scholar ]
• Vaismoradi M, Jordan S, Turunen H, Bondas T. Nursing students' perspectives of the cause of medication errors. Nurse Education Today. 2014; 34 (3):434–440. [ PubMed ] [ Google Scholar ]
• Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences. 2013; 15 (3):398–405. [ PubMed ] [ Google Scholar ]
• Valizadeh L, Zamanzadeh V, Fooladi MM, Azadi A, Negarandeh R, Monadi M. The image of nursing, as perceived by Iranian male nurses. Nursing & Health Sciences. 2014; 16 (3):307–313. [ PubMed ] [ Google Scholar ]
• Villar F, Celdran M, Faba J, Serrat R. Barriers to sexual expression in residential aged care facilities (RACFs): comparison of staff and residents' views. Journal of Advanced Nursing. 2014; 70 (11):2518–2527. [ PubMed ] [ Google Scholar ]
• Wiens S, Babenko-Mould Y, Iwasiw C. Clinical instructors' perceptions of structural and psychological empowerment in academic nursing environments. Journal of Nursing Education. 2014; 53 (5):265–270. [ PubMed ] [ Google Scholar ]
• Willis DG, Sullivan-Bolyai S, Knafl K, Zichi-Cohen M. Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research. West J Nurs Res. 2016 [ PubMed ] [ Google Scholar ]
• Wu YP, Thompson D, Aroian KJ, McQuaid EL, Deatrick JA. Commentary: Writing and Evaluating Qualitative Research Reports. J Pediatr Psychol. 2016; 41 (5):493–505. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Zhang H, Shan W, Jiang A. The meaning of life and health experience for the Chinese elderly with chronic illness: a qualitative study from positive health philosophy. International Journal of Nursing Practice. 2014; 20 (5):530–539. [ PubMed ] [ Google Scholar ]

• Site Search
• MU Libraries Gateway
• Ellis Library
• Engineering Library
• Veterinary Medical Library
• More Libraries & Collections
• Distance Education Students
• Medical Students
• Nursing Students and Nurses
• Patients & Everyday Health
• Borrow & Checkout
• Electronic and Print Reserves
• Expert Search Service
• Interlibrary Loan and Document Delivery
• Photocopying
• Request a Library Purchase
• Room Reservations
• Citation Styles and Tools
• Evidence Based Medicine
• Find Articles
• Mobile Medical Resources
• Research by Subject
• Workshops & Videos
• Giving Opportunities
• Maps/Directions
• Staff Directory
• University of Missouri Libraries
• Library Guides
• Health Sciences Library

Evidence Based Nursing Practice

• Study Design and Methodology
• PICO(T) and Clinical Questions
• Literature Review
• Documenting EBP
• Additional Sources & Assistance
• MUHC Evidence Based Practice Model

Levels of Evidence

As the different study designs have different strengths, and weakness, they have been ranked in levels of evidence.  Simply put, the strongest designs are at the top, the weakest at the bottom.  The pyramid is a convenient symbol for this, as there are usually fewer randomized trials say, than case reports.

For an interactive version, go to:   https://library.muhealth.org/evidencepyramid/

Click on the image to see larger version. 

Study Types/Designs

Case Report - a write up of the case of an individual patient; a clinical presentation.  Often the first report of a new disease or disease trend.

Case Series - a write up of the cases of several patients all undergoing similar treatment.

Case-Control Study -  a comparison of study subjects with a particular disease/risk factor (cases) to those without (controls).  These have also been called retrospective studies.  A good design for rare diseases but easy to get poor data.

Clinical Trial - an experimental study in which subjects receive an intervention.  Preferably subjects are assigned to either treatment or no treatment/placebo (see Controlled Clinical Trial).  Some trials compare multiple treatments, e.g. the subjects could be assigned to: Treatment A, Treatment B, No treatment/placebo.  The different groups are called arms.   This is the best study design for testing effect of interventions.

Cohort Study -  a group of subjects followed through time.  Cohort studies can be used to track effect of an exposure, e.g. all subjects had been exposed to lead in their housing, or they can track a cohort not exposed.  They have also been called prospective studies.  This is a strong design for determining risk and incidence. 

Controlled Clinical Trial - a Clinical Trial where there is a control group receiving a comparison treatment or no treatment/placebo.

Cross Sectional Study - a descriptive study that documents the number of people with a particular disease or risk factor.

Randomized Controlled Trial - Same as Controlled Clinical Trial, with the added benefit of the subjects being randomly assigned to treatment/no treatment arms.  This avoids selection bias as all subjects have an equal chance of being assigned to any one of the treatment/no treatment arms.  Random assignment can be accomplished using machine generated random number tables.  Assigning subjects using methods such as coin tosses or assigning even-odd numbers is considered pseudo-randomization. 

Review articles are not considered evidence .  One exception to this are Systematic Reviews - including their subset, Meta-Analysis . 

Why are Systematic Reviews included in the evidence based pantheon?  They aim for documented, exhaustive and comprehensive searching for all research on a specified topic.  Most other types of reviews either do not document their search and collection of the research nor do they verify that they have completed an exhaustive and comprehensive search. 

All things random

In evidence based practice, much is made of Randomized Control Trials (i.e. clinical trials where participants are randomized assigned to an interventions, including a control group.)  Why?   Randomized Control Trials - RCTs - can show cause and effect not just association.

However, they are not the only study design available.  This page provides a glossary (left column) of some of them.  For more info & a nifty chart, check out CEBM's Study Design site.

Making sense of it all

Study designs can be classified as descriptive or analytical .  The analytical studies have more power, or ability to predict, than descriptive studies and therefore rank higher in the evidence based world.

Descriptive studies give us a snap shot of what is happening.  Surveys, case reports, cross sectional studies (using surveys) are descriptive.  They cannot show cause and effect, but they can show prevalence or incidence.  They can also be useful in spotting trends.

Analytical studies measure the relationship between factors.  Cohort studies and randomized control trials are analytical.  They show cause and effect.

For more information or in depth definitions, see College of Veterinary Medicine, Washington State University.

• << Previous: Literature Review
• Next: Documenting EBP >>
• Last Updated: May 23, 2024 12:41 PM
• URL: https://libraryguides.missouri.edu/EBNP

Measuring fundamental care using complexity science: A descriptive case study of a methodological innovation

Affiliations.

• 1 College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
• 2 Caring Futures institute, Adelaide, SA, Australia.
• 3 Flinders University College of Nursing and Health Sciences, Adelaide, SA, Australia.
• 4 Aged Care Consumer Advocate and Community Activist, Victoria, Australia.
• PMID: 34137100
• DOI: 10.1111/jocn.15905

Aims and objectives: This paper presents an exploratory account of an innovative methodology to record and evaluate fundamental care. Fundamental care is defined as the care required by everyone for survival, health and welfare.

Background: Fundamental care has been informed by the development and testing of the Fundamentals of Care Framework, which describes how fundamental care is complex and multidimensional, and consists of three interrelated dimensions and 38 elements. This accords with a broader re-examination of care provision as part of a complex adaptive system in which existing linear models of cause and effect are inadequate to describe the totality of activity.

Design: Informed by graph theory and complexity science, this paper presents a novel methodological innovation. It uses the Fundamentals of Care Framework to create a Matrix to quantify the relationships between different elements within the Framework.

Methods: We use a Matrix methodology to process care recipient narratives to generate three outputs: a heat map, a summary table and a network analysis.

Conclusions: The three outputs serve to quantify and evaluate fundamental care in a multidimensional manner. They capture different perspectives (care recipients and their families, direct care providers and care managers) to improve care outcomes. The future aim is to advance this exploration into digitalising and operationalising the Matrix in a user-friendly manner for it to become a real-time mechanism to evaluate and potentially predict patterns of fundamental care.

Keywords: complex adaptive systems; complexity science; fundamentals of care; network analysis; nursing.

© 2021 John Wiley & Sons Ltd.

• Delivery of Health Care*
• Forecasting*

To read this content please select one of the options below:

Please note you do not have access to teaching notes, nursing associate apprenticeship – a descriptive case study narrative of impact, innovation and quality improvement.

Higher Education, Skills and Work-Based Learning

ISSN : 2042-3896

Article publication date: 7 September 2020

Issue publication date: 27 November 2020

The purpose of this article is to explore how one higher education institution (HEI) has embraced the apprenticeship agenda and is successfully providing an apprenticeship programme for nursing associates (NA) a new profession within health and social care in the United Kingdom.

Design/methodology/approach

This is a descriptive case study narrative about one programme from one HEI, selected for its relevance for the subject area of apprenticeships. This descriptive approach allows the provision of apprenticeships within HEI to be explored in depth by one institution.

This case study identifies the considerable value of apprenticeships within HEI for the students, the employers and the HEI. It also identifies that there are challenges within this. These findings will be of interest to those entering into the apprenticeship arena, especially within healthcare, and may inform an academic discourse in this area.

Research limitations/implications

It is acknowledged that this case study does not seek to compare apprenticeships with other programmes. However, there is value in providing an academic narrative around the challenges of this provision which will be informative for others developing higher apprenticeships in the United Kingdom or similar delivery of apprenticeship models internationally.

Practical implications

There is value in providing an academic narrative around the challenges of this provision which will be informative for others developing higher apprenticeships in the UK or similar delivery of apprenticeship models internationally

Social implications

These findings will be of interest to those entering into the apprenticeship arena, especially within healthcare, and will inform the academic discourse in this area.

Originality/value

This is original work and provides a new body of knowledge to the inform HEIs engaging with the relatively new context of higher and degree apprenticeships, as well as the new role within healthcare of the nursing associate.

• Higher apprenticeship
• Nursing associate
• Apprenticeship requirements
• Multiple stakeholders

Taylor, M. and Flaherty, C. (2020), "Nursing associate apprenticeship – a descriptive case study narrative of impact, innovation and quality improvement", Higher Education, Skills and Work-Based Learning , Vol. 10 No. 5, pp. 751-766. https://doi.org/10.1108/HESWBL-05-2020-0105

Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited

Related articles

We’re listening — tell us what you think, something didn’t work….

Report bugs here

All feedback is valuable

Please share your general feedback

Join us on our journey

Platform update page.

Visit emeraldpublishing.com/platformupdate to discover the latest news and updates

Questions & More Information

Answers to the most commonly asked questions here

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Descriptive Study of Nursing Students' Learning Styles. Case Study of the Professional Bachelor's Degree Cycle in Nursing of the Higher Institute of Nursing Professions and Health Techniques of Casablanca, Morocco

RESEARCH ARTICLE Descriptive Study of Nursing Students&#39; Learning Styles. Case Study of the Professional Bachelor&#39;s Degree Cycle in Nursing of the Higher Institute of Nursing Professions and Health Techniques of Casablanca, Morocco Abderrahmane Lamiri , Rabia Qaisar , Driss Khoaja , Omar Abidi , Hind Bouzoubaa and Abderrahim Khyati Interdisciplinary Group of Didactics of Science & Educational Sciences (GIDS&SE-ENSC), The Multidisciplinary Laboratory in Sciences and Information Communication and Education Technology (LAPSTICE), Faculty of Sciences Ben M&#39;sik, Hassan II. University of Casablanca, Casablanca, Morocco The Higher Institute of Nursing Professions and Health Techniques of Casablanca (ISPITSC), Morocco

Related Papers

American Journal of Nursing Science

Addis Adera Gebru

Mohammed Almaskari

Quick Response Code Abstract: Students&#39; learning styles have been the center of several studies. Nevertheless, it remains complex and can be affected by many factors. Nursing students, for instance, are required to learn large quantities of theoretical content in a short time, which necessitates the use of different learning styles during their studies. Learning in health professional programs, such as nursing, requires various ways of teaching and learning. Studying nursing requires the ability to perform a great variety of clinical skills. Exploring the students&#39; learning styles is considered one of the effective approaches for a good learning process. Many studies have explored the issue of learning styles among nursing students; however, there is little known about the learning styles of nursing students in Oman. Therefore, this article explains the importance of exploring the different learning styles among nursing students and it shed-lights on some theoretical models ...

Latha Venkatesan

Students have different learning styles and it is essential to understand it to select appropriate methods of teaching suitable to the learning styles of students for better learning outcomes. This study employed a descriptive and exploratory design. The study sample included 191nursing students: 97 students from I-year B.Sc (N) and 94 students from IV-year B.Sc (N) of Apollo college of Nursing, Chennai. Total enumerative sampling technique was adapted for this research study. A self administered questionnaire on VAK learning style indicators was used for collecting data. Most of the students are opting Kinesthetic learning style by I B.Sc (N) Yr Students, Majority of IV yr students are following the style of auditory Learning. From the result Beginners (I B.Sc (N) are following kinesthetic Style of Learning, but who is having experience in the field of Nursing (IV Yr B.Sc(N) are following auditory style of Learning. By this research, Beginners (discovery learners) are always used to adopt kinesthetic style of learning, since they are new to the field, Maturity students are used to adopt Auditory Learning.

The Open Nursing Journal

Abdulaziz Almarwani

Background: In Saudi Arabia, nursing education is developing fast due to high nursing demand. Alongside this development, nurse educators must identify and understand nursing students learning styles to ensure the multidimensional development of students learning experiences. Students&#39; preferred learning style is an essential element in determining students&#39; unique ways of processing new knowledge, information, and skills. Objective: This literature review aimed to identify the learning styles of undergraduate Saudi nursing students based on the premises of three learning style models: Kolb’s Model, Felder-Silverman Learning, and Visual, Aural, Read/Write, and Kinesthetic (VARK) Learning Styles Inventory. Methods: An integrative review of published studies on Saudi nursing students&#39; learning styles was conducted while adhering to predefined eligibility measures. The research strategy for this study was based on online international databases, such as PubMed, Medline, CIN...

Clinical Nursing Studies

June Kiblasan

International Nursing Review

Inaam A Khalaf

Texila International Journal of Nursing

Texila International Journal , Muhammad Afzal

Blended learning (BL) is positive development in education. This method provokes the learner's critical thinking and given different ways for implementation of their knowledge in real life. The objective of the study is to determine the difference of blended learning teaching strategy and lecture-based teaching strategy on the learning outcome of the undergraduate nursing students in Lahore, Pakistan. Quasi experimental study design was used by utilizing control and experimental groups for comprising two methods of students learning. 197 participants were recruited in control group and experimental groups. The study sample was determined through the convenient sampling method. In this study the establishing reliability and construct validity of the tool was 0.7 and 0.75 respectively. In addition to this internal consistency Cronbach's coefficient alpha was computed 0.70. Generally, the reliability and validity were considered acceptable and satisfactory above 0.70. The results findings revealed that blended learning has significant relationship with awareness (p= < 0.02) learning strategies (p= < 0.07) learning activities (p=< 0.06), evaluation (p=0.04) among the experimental groups. In the conclusion, blended learning significantly improves the learning of the students and provides the space for better skills in the clinical setting simultaneously. Thereafter, institutions, policy makers and regulatory bodies should incorporate this strategy in the nursing curriculum in Pakistan.

Eyad Alhelih

IOSR Journal of Nursing and Health Science

Premila Lee

Nurse Education in Practice

Shahram Baraz , Robabeh Memarian

RELATED PAPERS

Working Papers in Urban Language and Literacies , Britta Schneider

Immo Rebitschek , Aaron Retish

Physics of Plasmas

Manoj Bhuyan

Rivista Italiana di Ornitologia

Tullio Bagnati

Studies in Political Economy

Phillip Hansen

African Entomology

Comparative Biochemistry and Physiology Part A: Molecular &amp; Integrative Physiology

Pablo Díaz Rodriguez

Scientific Reports

Eisuke Fujita

Thomas Matte

European Journal of Gastroenterology &amp; Hepatology

Nurdan Tözün

Pensa E-Jurnal: Pendidikan Sains

Mita Diasanti

Septa Rahadian

Journal of Orthopaedic Surgery

Siddarth Kamath

CES Medicina

Daniel Vásquez B.

Archives of Cardiovascular Diseases Supplements

Alfredo Hernandez

Journal of EU Research in Business

Denis Gillet

Forensic Science, Medicine and Pathology

Karen Waters

Surgical Neurology International

Joseph Kass

Journal of Geriatric Oncology

Athanasios Pallis

邦德大学毕业证文凭学历认证办理 澳洲Bond文凭学历

International Sport Coaching Journal

Loel Collins

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• Write for Us
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 21, Issue 1
• What is a case study?
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• 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

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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.

Read the full text or download the PDF:

• ABOUT US About the Journal About the Publisher Editorial Board FAQs Journal Metrics --> Open Access Policy Quick Track Option -->
• ETHICAL GUIDELINES Allegations From whistleblowers Authorship Conflict of Interest Fabricating and Stating False Information Plagiarism Prevention Post Publication Discussions and Corrections Publishing Ethics Research Misconduct
• FOR EDITORS & REVIEWERS Editorial Management Editorial Policies Ensuring Content Integrity Ethical Guidelines for New Editors Guest Editor Guidelines Peer Review Workflow Publication Process Guidelines for Peer Reviewers
• FOR GUEST EDITORS Guidelines for Guest Editors
• FOR AUTHORS Archiving Policies Article Processing Charges Author Benefits Bentham Manuscript Processing System Corporate Membership Instructions for Authors Manuscript Transfer Facility Special Fee Waivers and Discounts
• Submit Manuscript
• MARKETING OPPORTUNITIES Advertise With Us Kudos Advertising Policy
• BECOME A PART Submit Abstract Online Submit Issue Proposal Become an Editorial Member Become a Reviewer Become a Section Editor Become an Executive Guest Editor Become a Member

Descriptive Study of Nursing Students' Learning Styles. Case Study of the Professional Bachelor's Degree Cycle in Nursing of the Higher Institute of Nursing Professions and Health Techniques of Casablanca, Morocco

E-Mail Address of Dr. Abderrahmane Lamiri

[email protected]

E-Mail Address of Dr. Rabia Qaisar

E-mail address of dr. driss khoaja, e-mail address of dr. omar abidi, e-mail address of dr. hind bouzoubaa, e-mail address of dr. abderrahim khyati, downloads 11,803.

• Last 6 Months 11,803
• Last 12 Months 11,803

Background:

Conclusion:.

Learning difficulties experienced by learners are among the most recurring problems in education and, without doubt, the most worrying. Thus, at the beginning of each year, we at the Higher Institute of Nursing Professions and Health Techniques of Casablanca, Morocco (ISPITSC) note the diversity of intrinsic characteristics in our students in the initial training of the Professional Bachelor's (PB) degree cycle in initial nursing training. We believe these characteristics are related to the varied difficulties of adaptation and learning encountered in the first year. However, a lack of knowledge of the learning styles adopted by our students prevents the teaching staff from detecting the difficulties encountered by the learners in assimilating new knowledge during the 3 years of their training course. The identification of these learning styles and subsequent readjustments in training would help improve the quality of training and guarantee an effective mobilisation of knowledge during various care activities, while allowing the acquisition of necessary skills in the context of quality care that meets the needs of patients.

The objective of this study is to identify the learning styles of nursing students in the BP nursing cycle at ISPITS Casablanca in Morocco and to classify their origin and nature according to the typology described by Honey and Mumford.

Our research used a diagnostic and screening instrument for learning styles developed by Honey and Mumford, the “Learning Style Questionnaire” (LSQ), an abbreviated French version of which (LSQ-Fa) has been translated by Fortin et al. A sample of 49 students received the data collection instrument.

The study obtained a response rate of 87.75% (43 students). The results are similar to the research that shows that reflector style is the preferred learning style of learners in PB nursing education. However, the study also identified an important category of students who have dual learning styles.

Given the gap between learners' teaching style and learning style and its consequences for the assimilation of the knowledge provided, nursing educators should adapt their educational strategies to the particularities of their students in order to reduce learning difficulties and promote the effective mobilisation of knowledge in various complex learning situations.

Authors & Information

Affiliations, information, published in.

Article Information

Article history.

ACKNOWLEDGEMENTS

Citations & metrics, export citation.

Select the format you want to export the citation of this publication.

Citation information is sourced from Crossref Cited-by service.

Article Usage (Last 30 Days)

Article usage (demographic), copyright & license, © 2020 lamiri .et al.

Open-Access License: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode . This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Address correspondence to this author at Ben M'sik Faculty of Science, Hassan II University, Interdisciplinary Group of Didactics of Science & Educational Sciences (GIDS&SE-ENSC), Multidisciplinary Laboratory in Sciences and Information Communication and Education Technology (LAPSTICE), Casablanca, Morocco; Tel: 00212 5227-04671; E-mail: [email protected]

Share article link

Copying failed.

Share on social media

• Open access
• Published: 21 May 2024

The mediating effects of self-efficacy and study engagement on the relationship between specialty identity and career maturity of Chinese nursing students: a cross-sectional study

• Yanjia Liu 1 , 2 ,
• Mei Chan Chong 2 ,
• Yanhong Han 1 ,
• Hui Wang 3 &
• Lijuan Xiong 1  

BMC Nursing volume  23 , Article number:  339 ( 2024 ) Cite this article

Metrics details

Career maturity is a crucial indicator of career preparedness and unpreparedness can cause the turnover of new nurses. Considerable empirical work demonstrates the potential associations between specialty identity, self-efficacy, study engagement, and career maturity. This study aimed to explore the mediation role of self-efficacy and study engagement on the relationships between specialty identity and career maturity among Chinese nursing students.

Four hundred twenty-six Chinese nursing students were recruited between September 11 and October 30, 2022. The online survey was conducted following the CHERRIES checklist. Electronic questionnaires assessed their perceived specialty identity, self-efficacy, study engagement, and career maturity. The descriptive analysis, Harman single-factor analysis, Pearson correlation tests, structural equation modeling, and the bootstrap method were employed in data analysis.

Bivariate correlation analysis identified a positive correlation between specialty identity, self-efficacy, study engagement, and career maturity ( r  = 0.276–0.440, P  < 0.001). Self-efficacy and study engagement partially mediated the relationship between specialty identity and career maturity. Self-efficacy and study engagement played a chain mediating role between specialty identity and career maturity.

Conclusions

The underlying mechanism can explain the relationships between specialty identity and career maturity: a direct predictor and an indirect effect through self-efficacy and study engagement. Policymakers and educators should emphasize the importance of specialty identity and provide tailored strategies for improving care maturity depending on nursing students’ specialty identity, self-efficacy, study engagement in the early stages of career development.

Peer Review reports

Introduction

The media visibility obtained by nursing during the COVID-19 pandemic has made the public aware of nurses’ role in promoting and maintaining health [ 1 ]. As the social environment becomes more conducive to nursing career development, adequate awareness and preparedness for nursing careers are driving nursing students to adapt to and be satisfied with their careers [ 2 , 3 ].

Career maturity is a crucial indicator of career preparedness [ 4 ], which is defined as the readiness to make age-appropriate career decisions with adequate information and accomplish career development-related tasks [ 5 ]. Unpreparedness and difficulties in taking on the nurse’s role were the main reasons newly graduated nursing students left nursing in their first years [ 6 ]. The turnover rate for new nurses in their first year of employment can reach as high as 69%, with a range of 12.10–69% [ 6 , 7 , 8 , 9 ]. In addition, new nurses who experienced higher levels of career maturity were also less likely to leave the profession [ 10 ]. Therefore, more research focusing on career maturity should re-engage nursing educators and managers and support the development of customized programs in the early stage of career development.

Specialty identity as a predictor to career maturity

Super’s theory emphasizes that career development is a lifelong activity closely related to individual maturity and experiences [ 11 ]. It encompasses the development of behaviors and professional identity [ 12 ]. Work values, including professional identity, are crucial for career development and can influence career maturity [ 13 ]. professional identity significantly correlates with high school students’ career maturity [ 14 ]. Additionally, specialty identity appears as a part of professional identity in studies worldwide [ 15 ]. To clarify this concept in student groups, specialty identity is defined as the emotional acceptance and recognition of learners based on their understanding of the specialty being studied, accompanied by positive external behaviors and an inner sense of satisfaction [ 15 ]. Therefore, this study proposes Hypothesis 1: specialty identity significantly predicts career maturity among Chinese nursing students.

The mediating effect of self-efficacy between specialty identity and career maturity

Self-efficacy and career maturity are positively related [ 16 , 17 ]. According to social cognitive theory, self-efficacy is a belief in a person’s ability to achieve their goal [ 18 ]. Regarding career maturity, self-efficacy could be an internal driver for students to dedicate themselves to the fields they have chosen [ 16 ]. Students with high self-efficacy can improve their professionalism and self-confidence, thereby achieving high degrees of career maturity [ 16 ]. Further, professional identity is found to be significantly correlated with self-efficacy [ 19 , 20 ]. Yao et al. [ 21 ] found that self-efficacy mediated between professional identity and self-reported competence among nursing students. Thus, this study poses Hypothesis 2: Self-efficacy is the mediating variable affecting specialty identity and career maturity among Chinese nursing students.

The mediating effect of study engagement between specialty identity and career maturity

Study engagement is a vital variable related to academic performance, achievement, persistence, and retention, which refers to a positive psychological process including attention, energy and effort in learning [ 22 , 23 ]. Astin’s theory of student involvement emphasizes that the significant environmental factors that can influence their engagement entail students’ backgrounds, such as residence, experiences, and academic involvement [ 24 ]. A significant correlation exists between study engagement and career maturity [ 25 ]. Moreover, Liu et al. [ 26 ] report that professional identity is positively correlated with study engagement, and the mediating role of study engagement in professional identity and career adaptability is significant. Based on the above evidence, this study posits Hypothesis 3: study engagement is the mediating variable affecting specialty identity and career maturity among Chinese nursing students.

The chain mediating effect of self-efficacy and study engagement between specialty identity and career maturity

Based on the aforementioned information, self-efficacy and study engagement may play a single mediating role between specialty identity and career maturity. However, the relationship between self-efficacy and study engagement remains to be clarified. In addition, whether these variables play a chain mediating effect between specialty identity and career maturity must be explored. Previous research has shown that self-efficacy positively correlates with study engagement [ 27 , 28 ]. The relationship between specialty identity and career maturity may be influenced by self-efficacy in the first place and by study engagement in the second. Therefore, this study proposes Hypothesis 4: Chain mediation describes the relationship among the four variables.

Overall, this study explores the relationship between specialty identity and career maturity. It also examines the potential mediation model of specialty identity, self-efficacy, and career maturity, the potential mediation model of specialty identity, study engagement, and career maturity, and the potential chain mediation of the four variables using mediation analysis.

This cross-sectional online survey was conducted among nursing students between September 11 and October 30, 2022. This online survey was designed, disseminated and conducted following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) [ 29 ] (see in the Supplement File 1 ). The online questionnaire entailed demographic sheet and four instruments with different question styles (single choice and Likert scales).

Variables and data collection instruments

Sociodemographic variables.

Sex (female, male), Higher education institution type (university, college), and Degree (diploma, bachelor’s).

• Specialty identity

The College Student Specialty Identity Scale (CSSIS) developed by Qin [ 15 ], was used to measure medical students’ specialty identity [ 30 ]. It is a 23-item scale with four subscales (cognitive, emotional, behavioral, and appropriateness). Students scored each item on a five-point Likert scale (1–5: strongly disagree to strongly agree). In Qin’s study, it had good reliability (α = 0.955) [ 15 ]. In the present study, Cronbach’s α was 0.949.

• Study engagement

Study engagement was assessed using the Utrecht Work Engagement Scale-Student (UWES-S) [ 31 ]. Schaufeli et al. [ 32 ] developed the UWES and revised its items to measure students’ study engagement. Li & Huang [ 31 ] introduced UWES-S, translated it into Chinese, and validated it among undergraduate students. The UWES-S comprises 17 items grouped into three subscales (vigor, dedication, and absorption) and uses a 7-point scale (0 = never, to 7 = always). The cumulative scores range from 0 to 102, with higher scores indicating greater study engagement. The internal consistency using Cronbach’s alpha was 0.919 [ 31 ]. In this study, Cronbach’s α = 0.956.

• Self-efficacy

This study used the Chinese version of the General Self-Efficacy Scale to assess self-efficacy [ 33 ]. Schwarzer et al. [ 34 ] developed the original version. It was adapted to the context of China and validated by Wang et al. [ 33 ]. It is a 10-item scale with a 4-point Likert scale (from completely incorrect to completely correct). Cronbach’s alpha was 0.871 in Wang et al.’s study [ 33 ]. In this study, Cronbach’s α = 0.899.

• Career maturity

Career maturity was measured using the validated Chinese version of the career maturity scale [ 35 ]. The original version developed by Lee [ 36 ] was translated into Chinese by Zhang et al. [ 35 ]. The instrument entails 34 items broken down into six subscales: career decisiveness (CD), career confidence (CC), career independence (CI), career value (CV), relational dependence (RD), and career reference (CR). A 5-point Likert scale, ranging from strongly disagree to strongly agree, was adopted. The range of total scores was 34–170, with higher values indicating higher levels of career maturity. Its reliability coefficient was 0.86, as measured using Cronbach’s alpha [ 35 ]. In this sample, Cronbach’s α = 0.900.

Participants and data collection procedure

This study was conducted at five higher education institutions in Hubei province, China. The target population, full-time nursing students, were surveyed using convenience sampling. The suggested minimum sample size based on Monte Carlo simulations studies was adopted [ 37 ], and the minimum and maximum sample sizes for structural equation models were 200 and 460 respectively [ 38 ]. The final sample size in the design stage was 250–575, accommodating a possible dropout rate of 20%.

For data collection, we uploaded the integrated questionnaires on Wenjuanxing ( https://www.wjx.cn/ , Acquired NO.168,902,709). This website offers the most popular and convenient tool for anonymous data collection and collecting data anonymously extraction. One investigator from each university or college was invited to collect the data. All investigators held master’s degrees and understood the critical points for questionnaire collection well. Simple training was conducted before questionnaire distribution. Each nursing student can review and change their answers if necessary, but they were provided only one chance to submit the online questionnaires. The individual IP address can be yielded after submissions and provided for verification. Finally, 560 questionnaires were administered. After double-checking and eliminating invalid questionnaires, 426 valid questionnaires were extracted, yielding an effective response rate of 76.07%.

Data analysis

After completing the descriptive analysis, Harman single-factor analysis was performed to assess the common method bias, and Pearson correlations were calculated in SPSS Version 26.0. Subsequently, structural equation modeling was validated, and the chain-mediation effect was examined using the bootstrap method in AMOS Version 23.0 with 5000 samples. The significance level was set at 0.05.

Ethical considerations

This study was approved by the Ethics Committee of Jingmen No. 2 People’s Hospital, affiliated to Jingchu University of Technology (Approval No.2020002-1). All students provided verbal consent to participate in the study and voluntarily completed and submitted the questionnaire.

Harman single-factor analysis

The self-reported nature of the data meant the possibility of common method bias [ 39 ]. The Harman single-factor analysis showed that the eigenvalues of the five common factors were greater than 1. The first common factor explained 35.50% of the variance, which is lower than the recommended threshold of 50% [ 40 ]. Therefore, no common method bias was detected.

Descriptive statistics and correlation analysis

The sociodemographic variables were as follows: female ( n  = 370, 86.85%), male ( n  = 56, 13.15%); university ( n  = 322, 75.59%), college ( n  = 104, 24.41%); freshmen ( n  = 101, 23.71%), sophomores ( n  = 166, 38.97%), juniors ( n  = 127, 29.81%), seniors ( n  = 32, 7.51%); Urban areas ( n  = 151, 35.45%), Rural areas ( n  = 275, 64.55%). The age of nursing students range from 18 to 25 (mean = 19.89, SD=1.27 ) (see Table  1 ).

Table  2 shows the mean scores of the four key variables were 80.40 ± 21.66, 57.56 ± 16.04, 26.23 ± 9.37, and 113.42 ± 31.61. Positive correlations were found between the key variables: specialty identity and study engagement ( r  = 0.276), specialty identity and self-efficacy ( r  = 0.319), specialty identity and career maturity ( r  = 0.300), study engagement and self-efficacy ( r  = 0.420), study engagement and career maturity ( r  = 0.319), and self-efficacy and career maturity ( r  = 0.440) (each p  < 0.001).

The chain-mediation effect analysis

A chain-mediation structural model was constructed with specialty identity as the independent variable, career maturity as the dependent variable, and self-efficacy and study engagement as the mediating variables. The model fitting results showed that χ 2 /df = 2.965, the comparative fit index = 0.963, the Tucker-Lewis index = 0.958, and the root mean square error of approximation = 0.068, indicating good model fit. The chain-mediation effect model diagram of specialty identity, self-efficacy, study engagement, and career maturity of nursing students is shown in Fig.  1 .

The chain mediation effect model diagram of specialty identity, self-efficacy, study engagement, and career maturity of nursing students

The bootstrapping method found that the 95% confidence interval (95% CI) of the chain-mediation path from specialty identity to career maturity was [0.002, 0.054], which did not include 0, indicating significance. Thus, two possible mediation effects were detected: the mediating roles of self-efficacy in the relationship between specialty identity and career maturity and of study engagement in the relationship between specialty identity and career maturity, both of which were significant with a 95% CI (see Table  3 ).

This study explored the relationships between specialty identity, self-efficacy, study engagement, and career maturity and demonstrated the mediation models in Chinese nursing students. The finding identified a positive correlation between specialty identity and career maturity, and specialty identity can influence career maturity in three ways: self-efficacy, study engagement, and self-efficacy → study engagement, supporting the four Hypotheses. Despite this study did not validate the potential confounders such as career resilience [ 20 ], career adaptability [ 26 ], and resource management [ 29 ], the findings may improve our understanding of the underlying mechanism of these four variables and provide meaningful ideas for taking measures to improve nursing students’ career maturity.

In this study, the findings revealed a positive correlation between specialty identity and career maturity, indicating that specialty identity could significantly predict career maturity in nursing students, which is consistent with previous studies [ 14 , 41 ]. However, most nursing students enrolled in nursing school with insufficient specialty identity owing to poor nursing image and a lack of acknowledgment of career growth [ 42 ], meaning their unpreparedness for learning nursing and career development. Specialty identity is an emotional foundation of career maturity, and it can serve as a powerful psychological adjustment when it comes to nursing students’ specialty or job selection. Therefore, the importance of specialty identity on career maturity should be valued by nurse educators and clinical mentors, and further studies should specifically develop and conduct the education program to verify the roles of specialty identity in the early stage of career development. For example, an innovative course about the power of nursing including embracing the healer’s art course, seed talk and reflection exercises was found to connect the nursing students’ values to their specialty identity, and facilitate their professional formation and the development of nursing practice [ 43 ].

The first pathway confirmed was the mediating role of self-efficacy in the relationship between specialty identity and career maturity, aligning with its mediating effect on professional identity and career maturity in a previous study [ 41 ]. When nursing students perceive higher levels of specialty identity, they may have a stronger sense of self-efficacy and achieve greater career maturity. This finding is consistent with the Knowledge–Attitude–Belief–Practice model [ 44 ]. For nursing students, specialty identity and self-efficacy can support attitudes and beliefs about learning nursing specialties [ 21 ] and play the role of internal driving strength in the chase for a feasible professional study plan and career plan. As a result, career maturity could be a feedback indicator for learning behaviors and career preparedness.

This study also verified the mediating effect of study engagement on specialty identity and career maturity. This finding is consistent with a mediation analysis confirming the mediating role of study engagement between professional identity and career maturity among pre-service kindergarten teachers [ 25 ]. This result also supports the predictive impact of study engagement on the beneficial development of careers [ 26 , 45 ]. The mediating effect of study engagement revealed that if nursing students perceive high levels of specialty identity, they might have greater study engagement, achieve more knowledge and skills related to the nursing specialty, and possess high degrees of career maturity to adapt to the nursing profession. However, this study identified the study engagement had a limited mediating effect with a low effect size. The possible reason is that nursing is a specialized and complex discipline, which requires lifelong learning as health needs change and medical technology advances. In a short period, study engagement can improve nursing knowledge and skills, which is conducive to career preparedness, but high levels of career maturity are the result of long-term study engagement especially since this career needs continued education or continued career development [ 46 ].

Additionally, these findings supported the assertion that the chain relationship between self-efficacy and study engagement mediates the relationship between specialty identity and career maturity. The indirect effect of the pathway, including self-efficacy, was greater than that of the chain pathway and the pathway, including a single study engagement. Higher specialty identity could yield higher self-efficacy [ 19 , 20 ], and higher self-efficacy is related to greater study engagement [ 27 , 28 ]. Thus, nursing students with higher specialty identity might have higher self-efficacy and greater study engagement, which leads to higher career maturity. This model also revealed that increased self-efficacy might contribute to nursing students’ high study engagement levels. When nursing students have a sense of high self-efficacy, their learning behaviors become more effective. They are more willing to devote themselves to learning, thus producing higher study engagement. Despite some studies have demonstrated the effect of interventions such as career planning group counseling [ 47 ] and self-reflection-focused career course [ 48 ] on nursing students’ career maturity, what we found in this study provide theoretical foundation for the development and implementation of multifaceted interventions to improve nursing students career maturity and career development. Furthermore, further attention should be given to the interdisciplinary collaborations, such as positive psychology and nursing education, that can be contribute to explore novel perspectives and approaches to studying career maturity.

This study had some limitations. First, the cross-sectional design without a longitudinal method fails to explore the changes in psychological variables over time, which might restrict the temporal and causal inference. Therefore, scholars should focus on exploring the trajectory changes of these variables, notably the mutability of these psychological features, in the further studies, and the longitudinal and sustained interventions like tutor systems and peer learning should be strongly encouraged. Second, the nursing students were selected from five schools in Hubei province, China, which might limit the generalizability to all Chinese nursing students. As there are disparities in the curriculum systems of different schools, the results could be impacted by cognitive errors caused by teaching philosophy and training purposes. Therefore, the potential influencing factors should be considered and other mediators excluding self-efficacy and study engagement also should be explored in further studies. Third, selection bias may arise from the application of convenience sampling. Therefore, scholars could employ probability sampling methods like random stratified sampling to recruit nursing students. Finally, since all instruments were self-reported, the true feelings of these nursing students were not captured or tracked. From this, the research designs to deepen the understanding of the mechanisms underlying nursing students’ career development, such as mixed-method study and qualitative study, should be considered.

A correlational and mediation analysis was used to examine the relationships between four variables. Specialty identity could be a predictive factor for nursing students’ career maturity. Most importantly, specialty identity can indirectly influence career maturity among nursing students through the mediating effect of self-efficacy, study engagement, and the chain mediating effect of self-efficacy and study engagement, supporting career-related theories. Policymakers and educators should focus on the value of specialty identity to promote nursing students’ career development. Specialty identity may be conducive to stimulating students with a strong sense of self-efficacy and robust study engagement. Nursing students with high self-efficacy and study engagement may perceive greater career maturity. Thus, scholars and educators should be encouraged to provide tailored career guidance programs and practical interventions to enhance nursing students’ career maturity in the early stage of career development.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Fawaz M, Anshasi H, Samaha A. Nurses at the Front line of COVID-19: roles,responsibilities, risks, and rights. Am J Trop Med Hyg. 2020;103(4):1341–2. https://doi.org/10.4269/ajtmh.20-0650 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kim J, Shin S. Development of the nursing practice readiness scale for new graduate nurses: a methodological study. Nurse Educ Pract. 2022;59:103298. https://doi.org/10.1016/j.nepr.2022.103298 .

Article   PubMed   Google Scholar  

Zhang J, Shields L, Ma B, et al. The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study. BMC Med Educ. 2022;22(1):548. https://doi.org/10.1186/s12909-022-03609-y .

Article   PubMed   PubMed Central   Google Scholar  

Lee I, Heok JW, Rojewski, Roger B. Hill. Classifying Korean adolescents’ career preparedness. Int J Educ Vocat Guid. 2013;13:25–45. https://doi.org/10.1007/s10775-012-9236-5 .

Article   Google Scholar  

Savickas ML. Career maturity: the construct and its measurement. Vocat Guid Q. 1984;32(4):222–31. https://doi.org/10.1002/j.2164-585X.1984.tb01585.x .

Casey K, Fink R, Jaynes C, Campbell L, Cook P, Wilson V. Readiness for practice: the senior practicum experience. J Nurs Educ. 2011;50(11):646–52. https://doi.org/10.3928/01484834-20110817-03 .

Chen SF, Fang YW, Wang MH, Wang TF. Effects of an Adaptive Education Program on the Learning, Mental Health and Work intentions of New Graduate nurses. Int J Environ Res Public Health. 2021;18(11):5891. https://doi.org/10.3390/ijerph181158915 . Published 2021 May 31.

Kovner CT, Brewer CS, Fatehi F, Jun J. What does nurse turnover rate mean and what is the rate? [published correction appears in Policy Polit Nurs Pract. 2017;18(4):216–217]. Policy Polit Nurs Pract. 2014;15(3–4):64–71. https://doi.org/10.1177/1527154414547953 .

Zhang YP, Huang X, Xu SY, Xu CJ, Feng XQ, Jin JF. Can a one-on-one mentorship program reduce the turnover rate of new graduate nurses in China? A longitudinal study. Nurse Educ Pract. 2019;40:102616. https://doi.org/10.1016/j.nepr.2019.08.010 .

Kawai K, Yamazaki Y. The effects of pre-entry career maturity and support networks in workplace on newcomers’ mental health. J Occup Health. 2006;48(6):451–61. https://doi.org/10.1539/joh.48.451 .

Super DE. A life-span, life-space approach to career development, edited by D Brown, L Brooks & Associates. Career choice and development: Applying contemporary theories to practice.1990.2nd edition. San Francisco: Jossey-Bass.

Schreuder AMG, Coetzee M, Careers. An organisational perspective. 2011. 4th edition. Cape Town: Juta.

Langley R, Du Toit R, Herbst DL. Manual for the career development questionnaire. Pretoria: Human Sciences Research Council. 1992; 157:373–422.

Dipeolu A, Deutch S, Hargrave S, Storlie CA. Developmentally relevant Career constructs: response patterns of youth with ADHD and LDs. Can J Career Dev. 2019;18(1):45–55.

Google Scholar  

Qin P. B.The characteristics and correlation study of college students’ specialty identity [Chinese]. Master thesis: Southwest University.2009.

Purwandika R, Ayriza Y. The influence of self-efficacy on career maturity of high school students in pacitan regency. In2nd International Seminar on Guidance and Counseling 2019 (ISGC 2019) 2020; (pp. 93–7). Atlantis.

Singh PK, Shukla RP. Relationship between career maturity and self-efficacy among male and female senior secondary students. MIER J Educational Stud Trends Practices. 2015 Nov;10:164–79. https://doi.org/10.52634/mier/2015/v5/i2/1486 .

Bandura A. On the functional properties of perceived self-efficacy revisited. J Manag. 2012;38(1):9–44.

Mei XX, Wang HY, Wu XN, Wu JY, Lu YZ, Ye ZJ. Self-Efficacy and Professional Identity among freshmen nursing students: a latent Profile and Moderated Mediation Analysis. Front Psychol. 2022;13:779986. https://doi.org/10.3389/fpsyg.2022.779986 .

Zhou Y, Chen S, Deng X, Wang S, Shi L. Self-efficacy and career resilience: the mediating role of professional identity and work passion in kindergarten teachers. J Psychol Afr. 2023;33(2):165–70. https://doi.org/10.1080/14330237.2023.2207052 .

Yao X, Yu L, Shen Y, Kang Z, Wang X. The role of self-efficacy in mediating between professional identity and self-reported competence among nursing students in the internship period: a quantitative study. Nurse Educ Pract. 2021;57:103252. https://doi.org/10.1016/j.nepr.2021.103252 .

Bond M, Buntins K, Bedenlier S, Zawacki-Richter O, Kerres M. Mapping research in student engagement and educational technology in higher education: a systematic evidence map. Int J Educational Technol High Educ. 2020;17(1):1–30. https://doi.org/10.1186/s41239-019-0176-8 .

Schaufeli WB, Martinez IM, Pinto AM, Salanova M, Bakker AB. Burnout and engagement in university students: a cross-national study. J Cross-Cult Psychol. 2002;33(5):464–81.

Astin AW. Student involvement: a developmental theory for higher education. InCollege student development and academic life, 2014 (pp. 251–62). Routledge.

Zhang L, Chen M, Zeng X, Wang X. The relationship between professional identity and career maturity among pre-service kindergarten teachers: the mediating effect of learning engagement. Open J Social Sci. 2018;6(6):167–86. https://doi.org/10.4236/jss.2018.66016 .

Liu X, Ji X, Zhang Y, Gao W. Professional Identity and Career adaptability among Chinese Engineering students: the Mediating Role of Learning Engagement. Behav Sci (Basel). 2023;13(6):480. https://doi.org/10.3390/bs13060480 .

Wu H, Li S, Zheng J, Guo J. Medical students’ motivation and academic performance: the mediating roles of self-efficacy and learning engagement. Med Educ Online. 2020;25(1):1742964. https://doi.org/10.1080/10872981.2020.1742964 .

Eysenbach G. Improving the quality of web surveys: the Checklist for reporting results of internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34. https://doi.org/10.2196/jmir.6.3.e34 .

Heo H, Bonk CJ, Doo MY. Influences of depression, self-efficacy, and resource management on learning engagement in blended learning during COVID-19. Internet High Educ. 2022;54:100856. https://doi.org/10.1016/j.iheduc.2022.100856 .

Zhang X, Sun B, Tian Z, et al. Relationship between honesty-credit, specialty identity, career identity, and willingness to fulfill the contract among rural-oriented tuition-waived medical students of China: a cross-sectional study. Front Public Health. 2023;11:1089625. https://doi.org/10.3389/fpubh.2023.1089625 .

Li X, Huang R. A revise of the UWES-S of Chinese college samples. Psychol Res. 2010;3(1):84–8.

Schaufeli WB, Salanova M, González-Romá V, Bakker AB. The measurement of engagement and burnout: a two sample confirmatory factor analytic approach. J Happiness Stud. 2002;3:71–92.

Wang CK, Hu ZF, Liu Y. Reliability and validity of General self-efficacy scale. Chin J Appl Psychol. 2001;7(1):37–40. https://doi.org/10.396 9/j.issn.1006-6020.2001.01.007. (in Chinese).

Schwarzer R, Mueller J, Greenglass E. Assessment of perceived general self-efficacy on the internet: data collection in cyberspace. Anxiety Stress Coping. 1999;12(2):145–61.

Zhang ZY, Rong Y, Guan YJ. Reliability and validity of Career Maturity Scale for Chinese College Students. J Southwest Normal Univ (Humanities Social Sci Edition). 2006;32(5):1–6. (in Chinese).

Lee KH. A cross-cultural study of the career maturity of Korean and United States high school students. J Career Dev. 2001;28(1):43–57. https://doi.org/10.1023/A:1011189931409 .

Kyriazos TA. Applied psychometrics: sample size and sample power considerations in factor analysis (EFA, CFA) and SEM in general. Psychology. 2018;9(08):2207. https://doi.org/10.4236/psych.2018.98126 .

Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample size requirements for structural equation models: an evaluation of power, bias, and solution propriety. Educ Psychol Meas. 2013;73(6):913–34.

Jordan PJ, Troth AC. Common method bias in applied settings: the dilemma of researching in organizations. Aust J Manage. 2020;45(1):3–14. https://doi.org/10.1177/0312896219871976 .

Duong CD. Psychological distress related to Covid-19 in healthy public (CORPD): a statistical method for assessing the validation of scale. MethodsX. 2022;9:101645. https://doi.org/10.1016/j.mex.2022.101645 .

Kornspan AS, Etzel EF. The relationship of demographic and Psychological Variables to Career Maturity of Junior College Student-Athletes. J Coll Student Dev. 2001;42(2):122–32.

Kandil F, El Seesy N, Banakhar M. Factors affecting students’ preference for nursing education and their intent to leave: a cross-sectional study. Open Nurs J. 2021;15(1):1–8. https://doi.org/10.2174/187443460211501000 .

WHO. Knowledge, Attitudes, and Practices (KAP) Surveys during Cholera Vaccination Campaigns: Guidance for Oral Cholera Vaccine Stockpile Campaigns. [(accessed on 15 July 2023)]. Available online: https://www.who.int/publications/m/item/knowledge-attitudes-and-practices-(kap)-surveys-during-cholera-vaccination-campaigns-guidance-for-oral-cholera-vaccine-stockpile-campaigns .

Peng MY, Yue X. Enhancing Career decision status of socioeconomically disadvantaged students through Learning Engagement: perspective of SOR Model. Front Psychol. 2022;13:778928. https://doi.org/10.3389/fpsyg.2022.778928 .

Day L, Ziehm SR, Jessup MA, Amedro P, Dawson-Rose C, Derouin A, Kennedy BB, Manahan S, Parish AL, Remen RN. The power of nursing: an innovative course in values clarification and self-discovery. J Prof Nurs. 2017;33(4):267–70. https://doi.org/10.1016/j.profnurs.2017.01.005 .

Mlambo M, Silén C, McGrath C. Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC Nurs. 2021;20(1):62. https://doi.org/10.1186/s12912-021-00579-2 .

Xie WY, Yang XL, Cai YM, Mo W, Shen ZM, Li YH, Zhou BF, Li YL. Evaluation of career planning group counseling and its effectiveness for intern male nursing students. BMC Med Educ. 2023;17(1):34. https://doi.org/10.1186/s12909-022-03981-9 .

Kim JH, Shin HS. Effects of self-reflection-focused career course on career search efficacy, career maturity, and career adaptability in nursing students: a mixed methods study. J Prof Nurs. 2020;36(5):395–403. https://doi.org/10.1016/j.profnurs.2020.03.003

Download references

Acknowledgements

We greatly appreciate the support of all nursing students from five schools in Hubei province for their voluntary participation in this study.

Not applicable.

Author information

Authors and affiliations.

Department of Nursing, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Yanjia Liu, Yanhong Han & Lijuan Xiong

Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

Yanjia Liu & Mei Chan Chong

Department of Medicine, Jingchu University of Technology, Jingmen, Hubei, China

You can also search for this author in PubMed   Google Scholar

Contributions

Study design: XLJ, CMC, HYH; Data collection and analysis: WH, LYJ; Manuscript preparation: LYJ, HYH. All authors reviewed the manuscript.

Corresponding author

Correspondence to Lijuan Xiong .

Ethics declarations

Ethics approval and consent to participate.

This study has been approved by the Ethical Review Committee of Jingmen No.2 People’s Hospital, affiliated with Jingchu University of Technology (Approval No.2022002-1). All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all subjects involved in the study.

Consent for publication

Not application.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Liu, Y., Chong, M.C., Han, Y. et al. The mediating effects of self-efficacy and study engagement on the relationship between specialty identity and career maturity of Chinese nursing students: a cross-sectional study. BMC Nurs 23 , 339 (2024). https://doi.org/10.1186/s12912-024-02002-y

Download citation

Received : 13 December 2023

Accepted : 08 May 2024

Published : 21 May 2024

DOI : https://doi.org/10.1186/s12912-024-02002-y

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Nursing students
• Mediating effect

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]

• Open access
• Published: 26 May 2024

Effect of standardized patient simulation-based pedagogics embedded with lecture in enhancing mental status evaluation cognition among nursing students in Tanzania: A longitudinal quasi-experimental study

• Violeth E. Singano 1 ,
• Walter C. Millanzi 1 &
• Fabiola Moshi 1  

BMC Medical Education volume  24 , Article number:  577 ( 2024 ) Cite this article

1 Altmetric

Metrics details

Nurses around the world are expected to demonstrate competence in performing mental status evaluation. However, there is a gap between what is taught in class and what is practiced for patients with mental illness among nursing students during MSE performance. It is believed that proper pedagogics may enhance this competence. A longitudinal controlled quasi-experimental study design was used to evaluate the effect of using standardized patient simulation-based pedagogics embedded with a lecture in enhancing mental status evaluation cognition among nursing students in Tanzania.

A longitudinal controlled quasi-experimental study design with pre-and post-test design studied 311 nursing students in the Tanga and Dodoma regions. The Standardized Patient Simulation-Based Pedagogy (SPSP) package was administered to the intervention group. Both groups underwent baseline and post-test assessments using a Interviewer-adminstered structured questionnaire as the primary data collection tool, which was benchmarked from previous studies. The effectiveness of the intervention was assessed using both descriptive and inferential statistics, specifically the Difference in Difference linear mixed model, and the t-test was carried out using IBM Statistical Package for Social Science (SPSS) software, version 25.

The participant’s mean age was 21 years ± 2.69 with 68.81% of the students being female. Following the training Students in the intervention group demonstrated a significant increase in MSE cognition post-test, with an overall mean score of ( M ± SD  = 22.15 ± 4.42;p = < 0.0001), against ( M ± SD  = 16.52 ± 6.30) for the control group.

A significant difference exists in the levels of cognition, among nursing students exposed to Mental Status Evaluation (MSE) materials through Standardized Patient Simulation-Based Pedagogy (SPSP) embeded with lectures. When MSE materials are delivered through SPSP along with lectures, the results are significantly superior to using lectures pedagogy alone.

Peer Review reports

Introduction

The most prominent and dominant strategy used to diagnose a mental health problem in a clinical setting is Mental status evaluation MSE [ 1 ]. The type of diagnosis is based on the chief signs and symptoms, and treatment is agreed upon accordingly. The MSE is data received using information gathered by the psychiatrist, clinician, and nurse from direct inquiries and passive assessment during the interview to determine the patient’s actual mental state. The purpose of evaluating the range of mental functions and behaviors at a particular moment gives crucial information for diagnosis and determining the disease’s severity, trajectory, and responsiveness to treatment. Countries such as the U.S. practice mental status evaluation as a diagnostic tool for the diagnosis of mental illness, and the rest of the world uses similar cataloging from the American Psychiatric Association [ 2 ]. Nursing students are expected to demonstrate competence in performing mental status evaluation. However, there is a gap between what is taught in class and what is practiced for patients with mental illness among nursing students during MSE performance. Classroom and clinical pedagogies, such as lecture role play and demonstrations, are implemented to facilitate MSE competencies among nursing students [ 3 ]. Scholars have reported conventional pedagogics such as lectures, demonstrations, and portfolios to be dominantly used in facilitating MSE learning among nursing students [ 4 ]. The predominant use of conventional pedagogy has been linked to anxiety, frustration, stress, and fear in nursing students when they encounter mentally ill patients during their clinical rotation [ 5 , 6 ].

Educators and health workers argue that these abilities are inadequate to provide evidence-based mental health nursing care. They may thus lead to prolonged hospital stays, remissions, drug-resistant and long-term adverse drug effects in mentally ill patients [ 7 ]. The study was conducted on the practices of the nursing students throughout clinical teaching in mental health hospitals and stated that there is a mismatch between theory and practice, insufficient instruction approaches, and an absence of person-mode nurses and coaching staff to facilitate MSE learning for nursing students appropriately [ 8 ]. A study by [ 9 ] on designing instruction to teach MSE reported that nursing students who taught MSE using conventional clinical pedagogics demonstrated inabilities to diagnose patient conditions plan patient care, prevent injury to patients and others, and provide specific management. Moreover, findings from [ 10 ] on the discrepancy between what occurs internally and externally in student mental health nursing showed a significant mismatch between theoretical mental health content knowledge and practical skills when nursing students are developed using conventional clinical pedagogy.

International and national organizations respond to Sustainable Development Goal number four, target number four (SDG), by emphasizing training institutions and teaching hospitals to adopt and implement innovative pedagogics in facilitating MSE learning for learners [ 11 ]. The incorporation of standardized patient simulation-based pedagogy (SPSP) as suggested by other scholars [ 12 , 13 ], appears to demonstrate academic potential, such as enhancing learners’ cognitive and empowering them with self-efficacy when performing MSE. Simulation offers a chance to make cases more challenging without endangering clients, families, or students, as nursing students in clinical practice are frequently tasked with working with amicable and amenable clients and families [ 14 ]. The SP comes to life in front of the learners in the state-of-the-art lab. Students can practice their diagnosis and develop therapeutic clinical expertise in the laboratories, which are offered in a friendly environment [ 15 ].

Similarly, a pilot study using a mixed method was done in Baccalaureate nursing education in the US to examine the use of SPSP compared with the traditional hours used for learning mental health, showing nursing students who received SPSP showed increased confidence and cognition about mental health by 25% compared to traditional hours [ 16 ]. Good MSE cognition among nursing students may ultimately lead to timely and appropriate diagnosis and, thus, positive mental health outcomes for mental illness patients. While the adoption and implementation of SPSP are popular in other countries, published scholarly works are scarce about it in clinical nursing education for MSE cognition among nursing students in Tanzania. It may be time to invest in research about the effect of SPSP embedded with lecture on enhancing MSE cognition among nursing students in this country.

Method and materials

The methodology of this study complied with national and international research ethics. Moreover, the study was conducted by the University of Dodoma’s institutional postgraduate guidelines and standards.

The purpose of the current research was to evaluate the impact of standardized patient simulation-based pedagogy (SPSP) linked with lectures on mental status evaluation cognition among nursing students in Tanzania. To accomplish this, a longitudinal quasi-experimental study design was implemented.

Study population

The target demographic was made up of students enrolled in diploma nursing programs in the regions of Tanga and Dodoma. The study involved 311, diploma nursing students (the age between 16 and 32 years). The reason for selecting middle college nursing students is that they constitute a big population of the future nursing force, which is expected to deliver nursing mental health services in the peripheral community. This study believed that skills provided to the nursing students were beneficial for them since it is targeted to be delivered to the large population for timely diagnosis of mental illness disorders, which most of the population are living in remote areas with inadequate mental health services.

Sampling procedure and technique

The purposive sampling technique was used to sample nursing schools from two regions, 5 nursing schools from Dodoma Central zone and 2 nursing schools from Tanga in the Northern zone, where 311 nursing students sampled and (109) were in the intervention group and (202) nursing students were in the control group then the proportional calculation was done to get the required number of participant’s in each nursing school whereby the simple random sampling were done to select the requires number of participants in each class. After being explained the purpose, and benefit of this study, nursing students who were willing to participate in this study and signed the written informed consent form were included in this study.

Proportional for the intervention group

Whereby n = Total number of sample sizes for each group whether interventional Control croup.

N = Total number of students in both classes.

Nh = Total number of students in each class.

Two nursing schools from Tanga were Tanga College of Health and Allied Sciences (TACOHAS) with a total number of students of 97, college A, and Korogwe Nursing Training Center (KNTC) with a total number of students of 71, college B.

The proportion for college A;

Nh = 97 and 71.

nA = (109/168) 97 = 63.

Therefore, the number of participants in College A was 63.

nB = (109/168) 71 = 46.

Therefore, the number of participants in College B was 46 (making a total sample size of 109 for the intervention group).

The proportion for the control group in the Dodoma region

Five colleges offering Diplomas in nursing from Dodoma are DECCA College of Health and Allied Sciences (DECCA COHAS) with a total number of nursing students 60; Dodoma Institute of Health and Allied Sciences (DIHAS) with a total number of nursing students 81; Saint John’s University with a total number of nursing students of 45; Mvumi Institute of Health and Allied Sciences (MIHAS) with a total number of students of 19; Kondoa School of Nursing with a total number of 47;

Total number of students = 252.

nC = (217/252) 60 = 52.

nD = (217/252) 81 = 70.

nE = (217/252) 45 = 39.

nF = (217/252) 19 = 16.

nG = (217/252) 47 = 40.

Which makes a total sample size of 217.

The required number of participants was obtained through proportional calculation. To select participants, a simple random sampling method was employed by listing the names of students on pieces of paper. The selection was made by choosing participants for every 10th number on the list until the required number was reached, Fig.  1 illustrates this. To prevent contamination, interventional and control groups were assigned to different regions, and participants were not informed about the other study sites. Additionally, the researcher’s assistant was kept unaware of whether participants were part of the control or intervention groups.

Study design flow diagram Source: Study plan (2022)

Sample size estimation

The sample size n for this study was determined using WinPepi software version 11.65 [ 17 ]. Findings from the study on simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe Medical School [ 18 ] showed a pre-session mean score of 15.90 and a post-session mean score of 20.05. With a sample size of the effect size of 2, a significance of 95% confidence interval of 5% significance level, and a power of the study of 80%, the ratio of the sample size B: A is a ratio of 1:2.As shown in Fig.  2 , therefore, sample size (n) = 326 Participants (109 in A and 217 in B). This program has been used by different scholars and reported to have statistical validity and reliability in studies [ 19 , 20 , 21 ].

Source: Study plan (2022)

WinPepi program for sample size calculation.

Data collection procedure

After obtaining the necessary permissions, an available classroom was designated for the study. The Principal Investigator then introduced the study’s objectives to the participants. Once informed consent was obtained, the students were seated in separate chairs to prevent any potential copying or sharing of responses. Data collection was carried out by interviewer-administered structured questionnaire, with the trained researcher’s trainer. The Principal Investigator was present to provide clarifications when necessary. Once completed, the questionnaires were collected by the trained researcher trainer and securely stored in a locked cupboard by the Principal Investigator.

Data collection tool

This study employed a standardized structured questionnaire benchmarked from previous studies [ 22 ] with 33 items modified from a literature review. The adopted questionnaire for cognition has a test re-test approach which is used to assess the dependability of the study instrument (alpha reliability = 0.770, test-re-test reliability = 0.880). Therefore, the questionnaires used for data collection in this study consisted of two parts: Part “A” collected demographic characteristics profiles of the study participants, Part “B” assessed participants’ MSE cognition (28 items),

Nursing professionals were given the first draft of the instrument, and they were asked to reply to the open-ended questions, propose any changes they believed should be made, and suggest any additional items they thought should be added. Items having a relevancy score of less than 0.7 were removed, and adjustments to the wording were made to the expert’s suggestions. For face and construct validity, a preliminary draft was examined by a second nursing expert from a nursing faculty. Students in their second year of nursing ( n  = 33) provided comments on the tool’s usefulness. After comments from the experts and the nursing students, there were 5 questions from cognition questions that lacked face validity or content validity were removed. A total of 28 questions on cognition remain.

Reliability

To verify the tool’s capabilities for producing the expected results, a pilot study of 10% of the sample size was conducted. The statistical program for the Social Solution (SPSS) software version 25 was used to scale the results from the pilot study. The overall Cronbach’s alpha of cognition was 0.736. As recommended by previous scholars, a Cronbach’s Alpha (α) of ≥ 0.7 was considered a significantly reliable tool for the actual field data collection.

Variable measurement

A structured questionnaire benchmarked from previous studies was used to measure the variable pre- and post-intervention to test cognition. Cognition of MSE was measured using multiple-choice open-ended questions for baseline assessment and immediate 1-week post-intervention, the test had 28 questions for assessing MSE cognition with three domains including (2-questions) on the concept of MSE, (4-questions) on the content of MSE and (22-questions) on MSE implementation. Scores per each correct response ranged from ֞ 0 ֞ point for a wrong response to.

֞ 1 ֞ point for a correct response, and the highest score of MSE cognition were computed as a sum of each item, then cognition was explained as ֞ adequate cognition ֞ for participants who scored 50% and above, and the lowest score was explained as ֞ inadequate cognition ֞ for participants who scored < 50%. The domain of MSE cognition was also measured separately based on the total score that the nursing students scored out of the total score assigned to each domain then, the mean difference between the two groups was measured using a paired t-test.

The SPSP intervention

Table  1 shows the prescription of the intervention training. The intervention took 4 weeks to facilitate both MSE theory and practice. Topics of the MSE materials included a definition of MSE and steps in performing MSE to identify a client with mental illness. Two sessions were conducted in a week, lasting 120 min each. They were facilitated during the morning hours and were negotiated with the principles of the respective colleges. Two sessions were implemented to cover the MSE theoretical and practical sessions, respectively. Both English and Swahili were used alternatively at the convenience of research trainers and participants. The intervention group learned MSE using an SPSP embedded with a lecture compared to the control group, which learned the same MSE materials using lectures and real patient pedagogies. The rationale behind choosing these two approaches was to assess the impact of the intervention on two groups : those who were exposed to the MSE materials via SPSP embedded with lecture and went on to the skills laboratory to interview the SP who is trained and coached to portray sign and symptoms of mental illness, and those who were exposed through MSE lecture methods and actual patients in general medical wards without symptoms of mental illness. Upon completion of the data analysis, a comparison was made between the subjects who were exposed to the MSE materials through SP and the subjects who were exposed to the actual patient who did not exhibit any symptoms of mental illness. Before the intervention, participants in both groups were matched in their sociodemographic profiles, such as age, sex, education level, entry qualification, and marital status, to ensure their similarities before intervention. Pre-tests were then administered to participants to establish their baseline MSE cognition.

The MSE intervention focused on the area where nursing students struggled with technique questions to assess and determine if the patient exhibited the characteristics of hallucination, illusion, delusion, derealization, depersonalization, and insight, terms that can used commonly. To help nursing students understand that what the patient demonstrated or explained reflected the question asked, that failing to probe precisely what the patient was experiencing may lead to the wrong MSE conclusion, and that the SP was trained to answer the questions asked to reflect the reality of what the patient was suffering from, how these questions were asked was given more consideration.

Recruitment and training of SP and research trainers

Training of sp.

Professional actors who know mental health, work at a mental health facility, or have a family relative who has a mental illness, or encountered a person with a mental health problem and who were willing to help the student learn and be able to retain the script of the scenario was recruited as SP. Principles for preparing SPSP were found in the association of Standardized patient education standards, and practice [ 23 ] was applied to ensure SPSP is a safe work environment and training for role portray and feedback to students during debriefing. The agreed-upon formula, primary goals, duties, materials, and structure of the mental health scenario were covered during a weekly 2-hour training class. This class included instruction on scenario reading, guidance in verbal interaction techniques, input on the scenario, debriefing strategies, and discussions on how to reduce learner anxiety during the simulation experiences.

Before the rehearsal, each SP was provided with a scenario that outlined the signs and symptoms of a mentally ill patient. This scenario encompassed the various domains of MSE, with specific questions and answers to which the SP was required to respond in each domain. Emphasis was placed on the domains that nursing students commonly encountered difficulties with during mental status evaluation and clinical practice. For instance, they were trained on how to assess mood and affect, illusions and hallucinations, depersonalization and derealization, orientation, memory, intelligence, insight, and judgment. However, not all SPs were required to portray all domains of symptoms. This is because it’s uncommon for one patient to exhibit all possible symptoms simultaneously. Additionally, having all the symptoms portrayed by the SPs might lead to an exaggeration of the true symptoms of a real patient.

The SPs were thoroughly rehearsed using scenario scripts, and the research team, mental health experts, and nurse tutors who specialize in teaching mental health subjects reviewed their performances. The portrayal of the client’s character was observed, and the experts addressed any areas that required clarification or correction. Out of the four SPs who were willing to participate in this study, two were able to effectively portray the signs and symptoms of a mentally ill patient and were selected for the actual fieldwork implementation.

Implementation of MSE materials in an SPSP

Nursing students were assigned to the interventional group (typical education plus SPSP), which first completed both pre-tests before getting intervention. The MSE lecture method was taught to the students on the first day of the training by the researcher trainers focused on the definition of MSE, steps on performing MSE, and how to perform MSE to identify patient with mental illness disordes. The nursing students were then introduced to the simulation on the following day, and they were informed that the simulation would take place in a skills laboratory, nursing students were invited to the prepared skills laboratory, Students were seated on the semi-cycle sitting plan for easy visualization of the simulation, and then SP together with the nursing student who acted as a nurse were seated at the center and the researcher trainer was there to provide any assistance needed by students during simulation. Interventional students participated in two-hour simulation sessions, with a break in between to prevent student fatigue. Each group consisted of 5 to 8 students. Following the simulation pre-briefing on the scenario was done by the researcher trainer to make sure that they understood the whole simulation process, and SPSP orientation was included in each simulation. Thereafter each nursing student was provided with a checklist of the MSE categories to make a follow-up to what had been assessed during the simulation. SP was brought to the skills laboratory by his relatives dressed in dirty loose- jogging tracksuits and his hair was messy with a history of abnormal behavior characterized by abusive language, over-talkative, threatening his mother and others, reduced sleep during the night, grandiose delusion, persecutory delusion and hearing unknown voices, one nursing student was chosen from the class for each simulation to play the nurse role on how to perform MSE to the patient with abnormal behavior by using the technique and procedures learned during the lecture methods, and the other was designated as an observer. The positions of nurse and observer were available to all students. The duration of each simulation was 15 min, followed by a 10-minutes structural debriefing.

Evaluation of MSE materials in an SPSP

The three-part debrief paradigm, which entails defusing, identifying, and developing [ 24 ], served as the framework for the debriefing sessions. The trained researcher trainer was offered SPSP one-on-one organized time for debriefing immediately following each simulation exercise to examine psychological problems in role acting and how students’ emotional states influence their conduct and communication. To encourage cooperative learning, SP and nursing student observers discussed what they had noticed about communication and evaluation methods. Students playing nurses’ roles were encouraged to speak about their experiences. SP provided feedback via formative and summative methods that involved face-to-face engagement. The trained researcher trainer commented on the student’s responses.

Data analysis

The IBM statistical package of Social Science (SPSS) computer software program version 25 was used to analyze data. The frequency distribution table was used for data cleaning to ensure that all data was recorded accurately. To go through the data, labels had to be applied, value had to be checked and re-assigned for the open-ended questions, noise had to be checked, and the erroneous spellings verification for nominal response had to be rewritten. Additionally, the baseline and end-line data were combined and added during the procedure of the calculation of the important outcome A descriptive and inferential analysis was conducted based on the study’s goal. To calculate the frequencies and the percentage of each participant’s distribution between the two groups, a descriptive analysis was performed to examine participant characteristics Bar chats, mean values, and averages as well as tabular data, were all included in the descriptive evaluation. The pre-post mean score, and post-test mean score, for both the interventional and control groups were compared using the independent samples t-test. To evaluate the effect of the SPSP embedded with a lecture on MSE cognition, among nursing students from baseline to end line, the inferential analysis involved the differences in difference (DID) analysis using a Linear mixed model. A 95% Confidence interval set at a 5% (≤ 0.05) significance level was used to reject the null hypothesis. Results from the parameter multiple measurements were taken into consideration by models, and the groups were considered as fixed influences.

Difference–in–difference (DID) analysis for inferential analysis

By eliminating the confounding variables, difference-in-difference (D-I-D) analysis enables the comparison of changes over time in the results between interventions. The DID design examines the difference between the treatment groups by measuring the change in results between two-time intervals (pre and post) for the intervention and control groups, then subtracting one from another. In this research, the impact of the intervention on cognition change score was evaluated using difference-in-difference analysis using a linear mixed method. The outcomes of the variables’ repeated measurements were taken into account by the model. Interventions were regarded as having fixed effects in this analysis. The following formula is used to present the general fixed-effect DID mixed model

Time is an empty variable for the period, denoted as 1 when the outcome analysis was completed in the final stage and 0 for benchmark evaluation. Here, Y it is the final result for participant i at time t . This variable acts as a substitute variable for the intervention group. The combined parameter Time* Treatment is the relationship between time and the intervention, this ε it is also the amount of error for the participant i outcome measurements at the time t. The value of the intercept in the equation given parameter β 0 , represents the mean outcome value for the group receiving the intervention at the baseline measurement. β 1 is the change in an intervention group’s mean outcome variable between the baseline and the end line Parameter β 2 represents the variation in the mean result variable across individual interventions. The estimate and inference of the difference-in-difference between the two groups are provided by the coefficient of the interaction between groups.

Social demographic characteristics among nursing students

Distribution of the similarity of demographic characteristics among nursing students between intervention and control groups at the baseline. Table 2 reported that among the participants ( n  = 311), who indicated their age 34.86% ( n  = 38) for intervention and 54.46% ( n  = 110) for control were ranged between 21 and 32 years old with their age distribution ( p  = 0.0510) between groups, for those who indicated their gender 57.80% ( n  = 63) were female in intervention group and 68.81% (= 139) were from control group with ( p  = 0.0521) of their gender distribution between groups. However, for those who are single were many in both groups compared to those who are married 95.41% ( n  = 104) for intervention and 97.45% ( n  = 191) with ( p  = 0.3373*) of their distribution between marital status. The distribution of form four education entrance was higher compared to others with 76.15%( n  = 83) for control and 59.90% ( n  = 121) for intervention with ( p  = 0.0540) of their education level distribution between groups. Among all participants, 99.07% ( n  = 107) in intervention and 84.69% ( n  = 166) in control showed interest in nursing with ( p  = 0.0601) of their interest distribution between groups.

The effect of standardized patient simulation-based pedagogics embedded with lecture on MSE cognition among nursing students in Tanzania

As shown in Table  3 . below, the cognition pretest score of the concepts of MSE in the intervention group was ( M ± SD  = 0.87 ± 0.84) and the control group was M ± SD  = 0.81 ± 0.79, p  = 0.5341, the post-test results were M ± SD  = 1.33 ± 0.73 for the intervention group, and the control was M ± SD  = 1.17 ± 0.76; p  = 0.0785, so there is a marked change of MSE content from both groups. However, the MSE content on the baseline was ( M ± SD  = 2.63 ± 1.06) for the intervention and ( M ± SD  = 2.42 ± 0.95; p  = 0.0700) for the control group, the end line score for the intervention group was ( M ± SD  = 3.39 ± 0.80) and control group was ( M ± SD  = 2.85 ± 0.98; P  < 0.0001), baseline findings for implementation of MSE Intervention group scored ( M ± SD  = 11.4 ± 3.00) and control group scored ( M ± SD  = 9.85 ± 3.96; p  = 0.0076 for the pre-test intervention group scored ( M ± SD  = 17.42 ± 3.90) control group scored ( M ± SD  = 13.29 ± 4.58; p = < 0.0001).

The overall pretest was (M = 13.05, SD = 4.63) for intervention group, ( M ± SD  = 12.11 ± 5.21), p  = 0.1189 from control group posttest cognition was ( M ± SD  = 22.15 ± 4.42) for intervention and ( M ± SD  = 16.52 ± 6.30; p = < 0.0001) for control group. There is a significant change in cognition for the intervention and control group for the post-test. According to the substantial mean changes between the pre-test and post-test scores in all categories (Concepts, Content, Implementation, and Overall cognition) for the intervention group, it appears that the intervention has had a significant change effect on the cognition of nursing students in general. A small amount of progress is also seen in the control group, but overall, the intervention group exhibits more development.

Findings of nursing student’s cognition mean score between baseline and end line ( n  = 311)

The finding shows that the mean cognition increased from base to end line between the interventional group and the control group. As shown in Fig.  3 mean score of nursing student cognition increased by ( M ± SD  = 22.15 ± 4.42) for the intervention group, whereas cognition in the control group increased by ( M ± SD  = 16.52 ± 6.30). This implies that the change in cognition mean score from baseline to end line was higher in the intervention group than in the control group.

Source: Field data (2023)

Findings of nursing student’s cognition mean score between baseline and end-line.

DID analysis for MSE cognition among nursing students in Tanzania

The fitted model results are presented in Table  4 . The findings indicate that there was a significant improvement in cognition from the baseline to the end line, as indicated by a p-value of < 0.0001. The coefficient for the Difference-in-Differences (D-I-D) analysis, comparing the intervention group to the control arm, was 4.6950. This suggests that the change in cognition from baseline to end line was significantly higher in the intervention group compared to the control group.

The study’s results establish a strong correlation between the impact of Standardized Patient Simulation-Based Pedagogy embedded with lecture (SPSP) and the cognition scores of nursing students. In the final analysis, nursing students exposed to standardized patient-based simulation materials displayed a significantly higher level of cognition regarding Mental Status Evaluation (MSE) when compared to the control group. This outcome aligns with a study conducted at university of Queens Canada on the impact of SPSP in psychiatric nursing on mental health education, which demonstrated a significant cognition improvement [ 25 ].Additionally, nursing students who interacted with standardized patients (SP) during interviews were able to relate what they had learned from the designed teaching pedagogy during the simulation, the simulation’s method of delivery provided nursing students with ample time to interview the SP. The study done by [ 26 ] on the use of SPS to train new nurses supporting this findings that new nursing students cognition improved higher compared to control group whose not exposed to the SPS.

During simulation process in case where clarification was required or certain behaviors were not well understood by the learners, students could request the SP to repeat the behavior, but also the skills of the trained researcher on the delivering of the content contributed to the increasing nursing students’ cognition. This aligns with the findings of a study conducted in Australia to explore the effect of SPSP on mental health education. The study reported that students who used SPSP for teaching scored higher, felt safer, and experienced reduced anxiety levels during examinations, as demonstrated in research [ 27 , 28 ]. Given the challenge of exposing nursing students directly to realistic patients without prior practice in a skills laboratory, exposing nursing students in SPS demonstrated a significant higher level of cognition this changes are due to the fact that students were able to control the learning environment during the simulation, a similar study was conducted in Baccalaureate nursing education in the US to examine the use of SPSP compared to traditional hours dedicated to learning mental health. The study found that student nurses who received SPSP demonstrated a 25% increase in confidence and cognition about mental health compared to traditional instructional hours, as highlighted in the research by [ 16 ]. Observing others successfully perform Mental Status Evaluation (MSE) using Standardized Patients (SP) and receiving encouraging feedback from colleagues and facilitators played a pivotal role in boosting nursing students’ cognition. This research aligns with study done to compare SPS versus mannequins in mental health simulation, which posits that cognition is influenced by positive simulation modalities, guidance through observational learning, approval, and inspiration [ 29 ]. The training program encouraged students to focus on acquiring the necessary knowledge, and the briefing provided during simulation on how MSE should be conducted contributed to building students’ MSE cognition.

However, This outcome aligns with a study conducted by [ 30 ] on the use of SPSP in psychiatric nursing, which demonstrated a substantial improvement in nursing students’ understanding compared to traditional teaching methods. Specifically, the study reported an 80% increase in cognition acquisition when utilizing SPSP as opposed to conventional approaches. These findings are consistent with a study conducted by [ 31 ], which implemented various active teaching methods during simulation to enhance nursing students’ knowledge. Additionally, the manner in which SPs were trained to accurately portray signs and symptoms of patients was instrumental in this process. Furthermore, the design of the SP teaching materials fostered collaboration among nursing students, encouraging each student to actively participate in classroom activities. This collaborative approach played a vital role in enhancing their MSE cognition. These findings are consistent with the work of several scholars, such as [ 32 ] and [ 33 ], who have emphasized the significant contribution of peer-to-peer education in boosting nursing students’ sense of cognition.

The findings of this study suggested that using SPSP embedded with lectures will help increase nursing student MSE cognition among nursing students in Tanzania. This is because there is no skills laboratory for nursing students to practice before encountering a real patient, and the practicum sites for nursing students to practice mental health services, especially MSE, are few. For this reason, nursing students are required to travel far from their institution to practice. This is contrary to the Tanzania curriculum, which states that nursing students should practice in the skills laboratory before going to the clinical. Standardized patients in teaching mental status evaluation is a useful pedagogical method and increases the cognition of the nursing students, while it’s difficult to use real patients because it may cause inconveniences to the patient and the learner. MSE is challenging to assess because it cannot be directly assessed as a physical disease. Nursing students require the technique of performing MSE to get the real symptom from the patient.

Strength of the study

To improve the performance of nursing students, the study addressed clinical pedagogical deficiencies in clinical mental health nursing education on Mental status evaluation to better manage and diagnose people with mental diseases promptly. However, the study has managed to use a control group and enough sample to increase the validity of results and power of the study on the effect of SPSP and their outcome.

Suggestion for further studies

Future researchers should include this training among nursing students at higher institutions. Future studies should address the problems with the study’s design and expand on some of the topics that were not fully explored in this one. Based on the study’s shortcomings, there were several implications that another study might take into account.

Limitations of the study

The generalization of the study findings among nursing students in Tanzania will be difficult since the calculated sample size was 326 and the participants who were willing to participate in this study during actual data collection was 311, even though the response rate was 95%. The results of the study cannot be used to determine whether they apply to all Tanzanian nursing students this is because study participants were the nursing students from the middle college who are pursuing diplomas in nursing from Dodoma and Tanga Regions, and excluded the university students who are also learning MSE and are expected to deliver MSE service within the community, and they also suffer from a lack of stimulation of MSE in a skill-based environment. Consequently, results must be examined and analyzed carefully while considering them. The study employed purposive sampling that cannot tell exactly that the selected participants present the sample of nursing students in Tanzania. However, the Study did not show the separate effect of lecture as embedded in the SPSP training materials and how much contributed to the outcome of interest.

Data availability

The datasets that are used or analyzed in the current study are available from the corresponding author on reasonable request via [email protected] or [email protected].

Abbreviations

Mental Status Evaluation

• Standardized patient

Statistical Package of Social Sciences

Standardized patient Simulation Pedagogics

University of Dodoma

United states

World Health Organization

Rocha Neto HG, Estellita-Lins CE, Lessa JLM, Cavalcanti MT. Mental State Examination and Its Procedures—Narrative Review of Brazilian Descriptive Psychopathology. Front Psychiatry [Internet]. 2019;10. https://www.frontiersin.org/article/ https://doi.org/10.3389/fpsyt.2019.00077/full .

Ma F. Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). In: Encyclopedia of Gerontology and Population Aging [Internet]. Cham: Springer International Publishing; 2021. pp. 1414–25. https://link.springer.com/ https://doi.org/10.1007/978-3-030-22009-9_419 .

García-Mayor S, Quemada-González C, León-Campos Á, Kaknani-Uttumchandani S, Gutiérrez-Rodríguez L, del Mar, Carmona-Segovia A et al. Nursing students’ perceptions on the use of clinical simulation in psychiatric and mental health nursing by means of objective structured clinical examination (OSCE). Nurse Educ Today. 2021;100.

Thomas SP. Thoughts about Teaching Psychiatric-Mental Health Nursing. Issues Ment Health Nurs [Internet]. 2019;40(11):931–931. https://www.tandfonline.com/doi/full/10.1080/01612840.2019.1653729 .

Abraham SP, Cramer C, Palleschi H. Walking on Eggshells: Addressing Nursing Students’ Fear of the Psychiatric Clinical Setting. J Psychosoc Nurs Ment Health Serv [Internet]. 2018;56(9):5–8. https://journals.healio.com/doi/ https://doi.org/10.3928/02793695-20180322-01 .

Wedgeworth ML, Ford CD, Tice JR. I’m scared: Journaling Uncovers Student Perceptions Prior to a Psychiatric Clinical Rotation. J Am Psychiatr Nurses Assoc [Internet]. 2020;26(2):189–95. http://journals.sagepub.com/doi/ https://doi.org/10.1177/1078390319844002 .

Moges S, Belete T, Mekonen T, Menberu M. Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study. Int J Ment Health Syst [Internet]. 2021;15(1):42. https://ijmhs.biomedcentral.com/articles/ https://doi.org/10.1186/s13033-021-00464-0 .

Roy K, Nagalla M, Riba MB. Education in Psychiatry for Medical Specialists. In 2019. pp. 119–40. http://link.springer.com/ https://doi.org/10.1007/978-981-10-2350-7_8 .

Lenouvel E, Chivu C, Mattson J, Young JQ, Klöppel S, Pinilla S. Instructional Design Strategies for Teaching the Mental Status Examination and Psychiatric Interview: a Scoping Review. Acad Psychiatry [Internet]. 2022; https://link.springer.com/ https://doi.org/10.1007/s40596-022-01617-0 .

Marszalek MA, Faksvåg H, Frøystadvåg TH, Ness O, Veseth M. A mismatch between what is happening on the inside and going on, on the outside: a qualitative study of therapists’ perspectives on student mental health. Int J Ment Health Syst [Internet]. 2021;15(1):87. https://ijmhs.biomedcentral.com/articles/ https://doi.org/10.1186/s13033-021-00508-5 .

Silva M, De, Roland J. Mental Health Sustainable Dev. 2014;1–32.

Johnson KV, Scott AL, Franks L. Impact of standardized patients on first semester nursing students Self-Confidence, satisfaction, and communication in a simulated clinical case. SAGE Open Nurs. 2020;6(June).

Witt MA, McGaughan K, Smaldone A. Standardized Patient Simulation Experiences Improves Mental Health Assessment and Communication. Clin Simul Nurs [Internet]. 2018;23:16–20. https://doi.org/10.1016/j.ecns.2018.08.002 .

Oudshoorn A, Sinclair B. Using Unfolding Simulations to Teach Mental Health Concepts in Undergraduate Nursing Education. Clin Simul Nurs [Internet]. 2015;11(9):396–401. https://linkinghub.elsevier.com/retrieve/pii/S187613991500050X .

Edward K, Hercelinskyj J, Warelow P, Munro I. Simulation to Practice: Developing Nursing Skills in Mental Health–An Australian Perspective. Int Electron J Health Educ [Internet]. 2007;10(February 2014):60–4. http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ794196&login.asp&site=ehost-live%5Cnhttp://www.aahperd.org/iejhe/template.cfm?template=currentIssue.cfm#volume10

Soccio DA. Effectiveness of Mental Health Simulation in Replacing Traditional Clinical Hours in Baccalaureate Nursing Education. J Psychosoc Nurs Ment Health Serv [Internet]. 2017;55(11):36–43. https://journals.healio.com/doi/ https://doi.org/10.3928/02793695-20170905-03 .

Abramson JH. WINPEPI updated: Computer programs for epidemiologists, and their teaching potential. Epidemiol Perspect Innov [Internet]. 2011;8(1):1. http://www.epi-perspectives.com/content/8/1/1 .

Piette A, Service NH, Muchirahondo F, Mangezi W, Cowan FM. ‘ Simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe medical school. ’ 2015;(March).

Ganz JB, Earles-Vollrath TL, Heath AK, Parker RI, Rispoli MJ, Duran JB. A meta-analysis of single case research studies on aided augmentative and alternative communication systems with individuals with autism spectrum disorders. J Autism Dev Disord. 2012;42(1):60–74.

Article   Google Scholar  

Millanzi WC, Kibusi SM. Exploring the effect of problem based facilitatory teaching approach on motivation to learn: a quasi-experimental study of nursing students in Tanzania. BMC Nurs [Internet]. 2021;20(1):3. https://bmcnurs.biomedcentral.com/articles/ https://doi.org/10.1186/s12912-020-00509-8 .

Parker RI, Vannest KJ, Davis JL. Effect size in single-case research: a review of nine nonoverlap techniques. Behav Modif. 2011;35(4):303–22.

Gabriel A, Violato C. The development of a knowledge test of depression and its treatment for patients suffering from non-psychotic depression: a psychometric assessment. BMC Psychiatry [Internet]. 2009;9(1):56. https://bmcpsychiatry.biomedcentral.com/articles/ https://doi.org/10.1186/1471-244X-9-56 .

Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C et al. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Adv Simul [Internet]. 2017;2(1):10. http://advancesinsimulation.biomedcentral.com/articles/ https://doi.org/10.1186/s41077-017-0043-4 .

Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D Model of Debriefing: Defusing, Discovering, and Deepening. Semin Perinatol [Internet]. 2011;35(2):52–8. https://linkinghub.elsevier.com/retrieve/pii/S0146000511000048 .

Rabie A, Hakami A. Impact of standardised patient Simulation Training on clinical competence, knowledge, and attitudes in Mental. Health Nurs Educ. 2023;15(9).

Liu Y, Qie D, Wang M, Li Y, Guo D, Chen X, et al. Application of role reversal and standardized patient simulation (SPS) in the training of new nurses. BMC Med Educ. 2023;23(1):1–6.

Alexander L, Sheen J, Rinehart N, Hay M, Boyd L. Mental Health Simulation With Student Nurses: A Qualitative Review. Clin Simul Nurs [Internet]. 2018;14:8–14. https://linkinghub.elsevier.com/retrieve/pii/S1876139917301664 .

Skinner D, Kendall H, Skinner HM, Campbell C. Mental Health Simulation: Effects on Students’ Anxiety and Examination Scores. Clin Simul Nurs [Internet]. 2019;35:33–7. https://linkinghub.elsevier.com/retrieve/pii/S1876139919300222 .

Luebbert R, Perez A, Andrews A, Webster-Cooley T. Standardized Patients Versus Mannequins in Mental Health Simulation. J Am Psychiatr Nurses Assoc [Internet]. 2023;29(4):283–9. http://journals.sagepub.com/doi/10.1177/10783903231183322 .

Conway KA, Scoloveno RL. The Use of Standardized Patients as an Educational Strategy in Baccalaureate Psychiatric Nursing Simulation: A Mixed Method Pilot Study. J Am Psychiatr Nurses Assoc [Internet]. 2022;107839032211010. http://journals.sagepub.com/doi/ https://doi.org/10.1177/10783903221101049 .

Horntvedt M-ET, Nordsteien A, Fermann T, Severinsson E. Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC Med Educ [Internet]. 2018;18(1):172. https://bmcmededuc.biomedcentral.com/articles/ https://doi.org/10.1186/s12909-018-1278-z .

Kamali M, Hasanvand S, Kordestani-Moghadam P, Ebrahimzadeh F, Amini M. Impact of dyadic practice on the clinical self-efficacy and empathy of nursing students. BMC Nurs [Internet]. 2023;22(1):8. https://bmcnurs.biomedcentral.com/articles/ https://doi.org/10.1186/s12912-022-01171-y .

Riley J, Mandi DG, Bamouni J, Yaméogo RA, Naïbé DT, Kaboré E et al. No Title. Dasgupta K, editor. PLoS One [Internet]. 2021;4(1):e0205326. https://bmcresnotes.biomedcentral.com/articles/ https://doi.org/10.1186/s13104-018-3275-z .

Download references

Acknowledgements

Dr. W.C. Millanzi (PhD) and Dr. F. Moshi (PhD) are supervisors. This study was conducted by adhering to the international and national guidelines and the University of Dodoma postgraduate guidelines.

No source of funds.

Author information

Authors and affiliations.

Department of Nursing Management and Education, The University of Dodoma, Dodoma, Tanzania

Violeth E. Singano, Walter C. Millanzi & Fabiola Moshi

You can also search for this author in PubMed   Google Scholar

Contributions

V.E.S.: Conceptualization, data collection, data analysis, and writing the manuscript W.C.M.: Conceptualization, supervision, data interpretation, draft and reviewed the manuscript. F.M.: Conceptualization, supervision, data interpretation, draft and reviewed the manuscript. All authors approved the manuscript.

Corresponding author

Correspondence to Violeth E. Singano .

Ethics declarations

Ethical approval and consent to participate in the study.

It is imperative to carry out tasks properly for any research project to be considered, so all protocol processes, including ethical Clearance obtained by the UDOM Institutional Research Review Ethics Committee (IRREC) with research proposal ethical clearance number MA.84/261/61/37 and research permit number MA.84/261/02/35 for Dodoma Region and MA.84/261/02/36 for Tanga Region, Tanzania. Written informed consent was obtained from the participants; respondents participated in the study after being informed and understanding all information concerning the research process. Confidentiality is assured by ensuring that the names of the participants or the training institution are not shown on the data collection instruments or the data collected from them for research purposes. Respondents’ privacy was safeguarded by providing them with separate, unoccupied rooms. The principal investigator maintained a high level of focus throughout the investigation. Data were meticulously managed using a designated key folder exclusively by the Principal Investigator and were not shared externally without the express authorization of both the Principal Investigator and UDOM. In cases where students chose to discontinue their participation in the study, permission was granted after they provided a reason to the principal investigator. Additionally, the respective authorities in the sampled study settings were readily available to manage unforeseen events such as student fainting, asthma attacks, or collapses, as the researcher may not have been able to address these situations adequately.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Singano, V.E., Millanzi, W.C. & Moshi, F. Effect of standardized patient simulation-based pedagogics embedded with lecture in enhancing mental status evaluation cognition among nursing students in Tanzania: A longitudinal quasi-experimental study. BMC Med Educ 24 , 577 (2024). https://doi.org/10.1186/s12909-024-05562-4

Download citation

Received : 16 October 2023

Accepted : 16 May 2024

Published : 26 May 2024

DOI : https://doi.org/10.1186/s12909-024-05562-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Simulation pedagogics

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Case Study Research Method in Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

Related Articles

Research Methodology

Qualitative Data Coding

What Is a Focus Group?

Cross-Cultural Research Methodology In Psychology

What Is Internal Validity In Research?

Research Methodology , Statistics

What Is Face Validity In Research? Importance & How To Measure

Criterion Validity: Definition & Examples