Collaborative Strategies: Unfolding Cases

Glendon and Ulrich (1997) introduced the unfolding case as a student-centered approach to prepare students to 1) think critically by problem solving and examining issues from various perspectives or contexts; 2) communicate effectively in speaking, writing, and interaction with others; and 3) reflect on their own learning to make it meaningful and to continuously improve themselves.

Unfolding cases is a variation of the case study method. It presents an ever-changing case or scenario that students process sequentially. An unfolding case usually contains three paragraphs, although individual educators could design as many additional paragraphs as they need to meet their learning goals.

The first paragraph sets the stage for the scenario. It includes pertinent background information related to the characters of the case, the initial situation they encounter, and focused questions.

Paragraph #1 Example: Day 1 0800 Molly is a 10-year-old European-American female admitted to Children's Hospital with cardiomyopathy. She has been seen several times in recent years for pneumonia. A cardiac catheterization is planned for tomorrow. Her weigh is 27.7 kg. The night nurse indicates in report that Molly has dyspnea on exertion and tires easily. She also has circumoral cyanosis and clubbing of the fingers. (Glendon & Ulrich, 1997)

Groups of students interact to process the focused questions and then share their interactions with the entire class. To facilitate discussion and interaction among peers, cooperative learning strategies such as "roundtable"; "think, pair, and share"; and "pass the problem" are used.

Focused Questions Example:

Group 1 Relate the current clinical data to child's diagnosis. What data are important to collect
Group 2

What standardized teaching is included in preoperative and postoperative preparation for a cardiac catheterization?

How would you individualize this teaching for a 10-year-old child?

Group 3 Develop and prioritize a list of nursing diagnoses for Molly followed by 3 nursing interventions for each diagnosis.
After all 3 groups have finished, each group must pass the problem to another group. Each group processes their list of nursing diagnoses and interventions, refining and adding more to the list; groups present their findings. (Glendon & Ulrich, 1997)

Then the second paragraph is revealed. This paragraph could reflect a change in time, build on the last paragraph, or include a new focus.

Paragraph #2 Example: Day 2, 0930, cardiac catheterization. The child returns from the procedure. Her color remains dusky around the lips. RR18, no retracting of nasal flaring noted, BP WNL. R femoral site has dressing saturated with bright read blood. Peripheral pulses are strong and equal. (Glendon & Ulrich, 1997)

Students again process the questions of this paragraph and share the findings through cooperative learning exercises.

Focused Questions Example:

Student Pairs

What could be happening with the introduction of this new data?

What data are needed to support your conclusion?

What do you do if you decide there are abnormalities?

Pairs are called upon to report (Glendon & Ulrich, 1997)

At this point any further paragraphs are sequentially revealed, building on the case or changing its focus.

Paragraph #3 Example: Discharge day. Instructions are written as follow: Home O2 therapy at night. Draw protimes once per week. Medications of digoxin 0,125 mg q 12 hours PO and captopril 12.5 mg PO q8 hours. You have already called the company that supplies her O2 therapy and find the family has been denied service because of a lack of insurance. You find out mom is not on welfare. In your interactions with mom yesterday, she confides to you that she has a "nervous" problem and takes numerous medications which cost a lot of money. Mom also needs frequent reminding related to the child's needs and you are beginning to wonder if she is capable of following a medication schedule for Molly. (Glendon & Ulrich, 1997)

Focused Questions Example:

Group 1, 2, 3

Considering your role as coordinator of care, how would you plan for discharge: What course of action is indicated with the addition of new data related to mom? Consider the options and decide on the best approach.

Report each group's findings. (Glendon & Ulrich, 1997)

The final step is an individual reflective writing exercise that could encourage students to plan for their future learning needs, to think about and share individual reactions, and to reflect on and thus reinforce the learning experience.

Reflecting Writing Prompt: Suppose that when you reported excessive bleeding to the physician after the cardiac catheterization, the physician responded with "lots of kids bleed, don't worry about it." How would you feel and what would you do? (Glendon & Ulrich, 1997)

Try it yourself:

  • Develop an unfolding case in three paragraphs; include focused questions.

 

References:

  • Glendon, K. & Ulrich, D.L. (1997). Unfolding Cases: An Experiential Learning Model. Nurse Educator, 22(4), pp. 15-18.
Collaborative Strategies
Peer Teaching 
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