Implementing a Reverse Case Study Interactive Design in the Classroom Setting

Saturday, 7 November 2015

Benjamin A. Smallheer, PhD, MSN, RN, ACNP-BC, CCRN
School of Nursing, Vanderbilt University School of Nursing, Nashville, TN, USA


The primary goal of nursing education is to prepare students to meet the diverse needs of patients in variable situations. In doing so, students must be prepared to function as a leader and advance science within the confines of safe and quality care delivery. In keeping with these goals, nursing education has been transforming to maintain the increasing demands and responsibility of the nursing profession. Nursing educators have therefore been challenged with developing and utilizing diverse and challenging methods to enhance critical thinking and knowledge of nursing students.

Previously, the use of the unfolding case study provides an adaptive and integrative strategy of learning, incorporating nursing care, critical thinking, prioritization, and pathophysiology with pharmacology into a developing scenario. The unfolding case study allows a culture of quality and safety to develop in the classroom setting. It is through these diverse methods that incorporation of the higher domains of Bloom’s Taxonomy into the academic and didactic setting is achieved.

The Theory of Multiple Intelligence highlights individuals’ unique skills and capabilities of learning through various intelligences. Based on the variable and distinctive methods through which students learn, a newer permutation to the standard unfolding case study is the reverse case study.

The reverse case study involves students in the development of multiple scenarios, thus using a constructive approach to learning. This method is considered a rich scholastic challenge, more capable of accurately representing the responsibilities of the nurse within the safety of the classroom setting. Utilizing a reverse case study design accentuates the student’s critical thinking and integration across content and provides a rich academic challenge involving the higher domains of Analyzing, Evaluating, and Creating within Bloom’s Taxonomy.


Traditional case studies are highly adaptable teaching strategies and have been utilized in a variety of disciplines. Within nursing academia, case studies may be used to examine nursing care, review principles of pathophysiology and/or pharmacology, challenge values and attitudes (ethical dilemmas), and investigate causes of error while enhancing clinical reasoning, critical thinking, facilitating self-learning, and promoting empathy

Though a creative way to stimulate conversation, integration, and critical thinking, the traditional unfolding case study is limited to the domains of remembering, understanding, and applying of Bloom’s Taxonomy. The reverse case study, however, provides a rich academic challenge while adequately representing the responsibilities of the bedside nurse.


The students were assigned randomly in groups of 5 or 6. The students were told that ANY and ALL resources may be used in construction of the final project. The patient presented in the case study was unable to provide sufficient information. In doing so, the minimal subjective information would create the dynamics within the case to catalyze free thinking and rationalization of decisions. A physical “bag of drugs” belonging to the patient was also given to each group. Students then analyze what information is provided, create the background information of “what happened”, and then completing the case aspects of “what to do next.”


Groups were highly engaged, interactive, and conversational on how specific aspects of the patient’s physical exam correlated with components of the medication table and past medical/surgical history. Teams often had to divide components of the project among themselves to assure adequate time for completion.  Collaboration, teamwork, and critical thinking were essential in bringing these components of the assignment together and having proper cohesion and incorporation from one section into another. 

Students reported feeling very stressed which required them to stay focused and not go off on tangents or “chase down a rabbit hole”. Numerous students identified the assignment as “fun”, “challenging” and very realistic to how a nurse must play the detective with patients who are unable to provide complete and adequate information to the medical provider.

Students commented on the gained perspective of the bedside nurse’s responsibility when admitting a patient who cannot give a clear history.  The significant contribution of the bedside RN to both the admission and discharge process was more readily experienced and understood through this assignment.


Nursing faculty continue to search for variable approaches to learning which will better prepare students for not only the alternative format questions posed by NCLEX, but also the complex nature of quality and safety required of a licensed provider. Unfolding case studies within the classroom allow students to experience the integrated nature of client centered care compared to learning through a focused system-by-system approach. Reverse case studies allow students to utilize the higher domains of analyzing, evaluating, and creating in Bloom’s Taxonomy. In doing so, students can demonstrate the full spectrum of the taxonomy and exhibit critical thinking and mastery of nursing content presented throughout a program of study.