What’s in a Case?


Despite its usual relegation to the lowest rung on the hierarchical evidentiary ladder (Yin 2009), the case study – or the case in point – is a fundamental component of knowledge development within an applied practice field such as nursing. It is well understood that the individual experiential process of developing clinical wisdom in nursing is enacted through iterative interactions rich in the sharing of clinical narratives and thoughtful reflection on exemplary cases (Thorne 1997), building a base of what Benner and colleagues have termed our ‘clinical imagination’ (Benner et al. 2011). Luck and colleagues (2006), in a discussion of the case study as a research approach in Nursing Inquiry in 2006, further remind us of the special contribution that case-based inquiries can make to the evolving body of practice knowledge in fields such as nursing and health care, recognizing that ‘[t]he vagaries of the real-life clinical setting can confound methodologically purist researchers’ (103). From their perspective, case study research remains an under-explored and under-traversed bridge across traditional knowledge paradigms, offering a way of working with particularities that is sufficiently ontologically, epistemologically and methodologically flexible to inform broad knowledge application. Thus, these authors see case study methods as providing a delineated boundary for inquiry to exploit the insights that may be derived from careful study of an instance of a thing and to apply those insights to the ongoing project of comprehensive knowledge advancement. They encourage us to develop our sophistication in understanding how to draw upon it as a tool for both education and knowledge development.

Paley (2006) has also explored the case as an constituent element within nursing’s pattern of knowing, suggesting that it plays a role in creating a more inclusive approach to nursing knowledge development than does the more narrow standard of evidence-based practice. He recognizes the role of the case in ‘expert’ knowledge development as fundamental to the competent practice of a complex craft such as nursing. Citing Parker (2002, 139), Paley sees this more inclusive interpretation of disciplinary knowledge as a counter to the subversive shift of the evidence-based notion of ‘expertise’ which threatens the ‘commonplaces of nursing practice’ and therefore undermines professional autonomy. From this perspective, the ‘case’ serves as a reconstructive force within a dominant evidence-based scientific environment, and a means with which to retain our collective capacity to develop meaningful and clinically relevant expertise.

If ‘the case’ is to be considered relevant, then it becomes important to fine-tune our thinking about what differentiates a straightforward case report from a case instance that has relevance for the larger project of knowledge development in a field of study. Urban geographer Flyvbjerg (2006, 241) considers the case study as a ‘necessary and sufficient’ method for research in relation to certain kinds of questions in the social sciences, arguing that we need to deeply understand a given problematic in order to better understand how to deploy a case for the distinctive contributions that it can make. From this perspective, the key lies in the execution of the case study in such a manner that it serves as an interpretive vehicle and does not try to stand as a truth claim all on its own. Similarly, Jensen and Rodgers (2001), responding to a call to discontinue the publication of case studies as a credible research form within their field of public administration research, argued vigorously for recognition of the critical role that cases contribute to the cummulation of knowledge within a field. From their perspective, rather than fetishizing certain quality indices in our assessment of individual studies, it is important that we learn how to embrace what derives from multiple methods so that a cumulative portrait of a field can emerge.

Readers of this journal will recognize that Nursing Inquiry strives to make a particular contribution to the development of knowledge that extends beyond the expression of factual claims and opinions and into the realm of intellectual advancement of the discipline. While it publishes a variety of writing forms, including original clinical, philosophical and historical research, discussion papers, review articles and commentaries on a wide range of nursing and health-related topics, this journal seeks to select those manuscripts whose intended contribution is consistent with its aims and scope:

Nursing Inquiry is an international peer-reviewed journal of interest to nurses, health care professionals, social scientists and health policy makers on ideas and issues pertaining to nursing and healthcare. Established as a vehicle for critical reflection and substantive dialogue on topics of emerging interest internationally, it aims to foster debate and dialogue, advance new conceptualizations, and challenge current thought on a wide range of nursing and health phenomena.

Aspiring authors who may have submitted research reports are sometimes disappointed when Nursing Inquiry reviewers fail to find a fit with the aims and scope of this journal. Their less favorable evaluations are often contingent not on the conventional quality criteria with which one might evaluate a piece of discrete research or the technical elements on which one might judge scholarly writing, but on the author’s capacity to engage the reader in the larger intellectual conversation within which the individual study might represent an important case in point.

Nursing Inquiry warmly welcomes ‘the case’ as a distinctive mechanism for making a particular kind of contribution in the advancement of ideas within the discipline. However, as a philosophical read of the methodological literature makes entirely apparent, the presentation of a case, in and of itself, contributes little to that project, and may in fact at times serve as a distraction. Rather, the art of case-based research or consideration of case exemplars lies in the capacity to present a case such that it illuminates and disrupts assumptions derived from other forms of understanding, thereby making legitimate and original contributions to our theorizing and interpretation of a phenomenon. Similarly, while a straightforward presentation of a piece of research about a local condition, a national program, a distinctive intervention, or a specific phenomenon may be of profound interest to those who are also enmeshed within that specific entity, it will contribute little to the world of disciplinary ideas unless it is crafted and positioned in such a manner as to bring the reader into the nuances of the wider discourses influencing knowledge in the field within which the case is an illustration. Thus, whether ‘the case’ is a formal study using case-based methodology, or the individual study or report of a particular phenomenon is used as a ‘case in point’, to gain entry into the kind of conversation about ideas that Nursing Inquiry stands for, it must clearly position itself with the complexities and nuances of the field about which it seeks to enlighten us. We look forward to sustaining and advancing the Nursing Inquiry tradition of challenging the thinking that constitutes this marvelous discipline of ours.