Case Study Methodology

A case study is a research methodology focused on gaining an in-depth understanding of a particular phenomenon within a specific time. It is a popular approach among qualitative researchers Case studies are commonly used in organisational studies, nursing and clinical sites, across the social sciences and in other fields (Yin, 2013); and there is some suggestion that the case study method is increasingly being used, with growing confidence, as a rigorous research strategy in its own right (Stake, 2003). Robson (2002: P.146) defined a case study as:

“A strategy for doing research which involves an empirical investigation of a particular contemporary phenomenon within its real-life context using multiple source of evidence”.

Case studies can also be used to explain, describe or explore phenomena in everyday contexts (Yin, 2009). According to Yin (2013) a case study is comprised of five components, and these are followed to structure this research: a study question; its proposition (if any); its unit of analysis; the logic linking the data to the propositions; and the criteria for interpreting the findings. In designing the inquiry, these components are organised and consistent with each other. Extra attention has been given to the fourth and fifth components focusing on the planning of the data collection and analysis, as recommended by (Yin, 2009). In relation to these components, the relevant literature regarding the case under study was reviewed before conducting any data collection (Section 3.2, 3.3).

Case studies may utilise multiple methods of data collection and do not rely on a single technique (Ary et al., 2014). Interviewing, observation, reviewing documents, and other methods may be applied (Ary et al., 2014). Whatever techniques are applied, all are focused on a single phenomenon or entity and attempt to collect data that can help comprehend or understand the focus of the study.

Table 4-3 indicates the strengths and weaknesses of the different data collection techniques for case study research, as identified by Stake (1995) and Yin (2009).

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Table 4-3: Type of evidence Yin (2009, P80).

Source of

Evidence Strengths Weaknesses

Documentation _{Stable - repeated review} Unobtrusive - exist prior to case study

Exact - names, etc.

Broad coverage - extended time span

Retrievability – difficult Biased selectivity

Reporting bias - reflects author bias Access - may be blocked

Archival Records _{Same as above}

Precise and quantitative

Same as above

Privacy might inhibit access Interviews _{Targeted - focuses on case}

study topic

Insightful - provides perceived causal inferences

Bias due to poor questions Response bias

Incomplete recollection

Reflexivity - interviewee expresses what interviewer wants to hear Direct

Observation Reality - covers events in real _time Contextual - covers event context

Time-consuming

Selectivity - might miss facts Reflexivity - observer’s presence might cause change

Cost - observers need time Participant

Observation Same as above

Insightful into interpersonal behaviour

Same as above

Bias due to investigator’s actions Physical Artefacts _{Insightful into cultural}

features

Insightful into technical operations

Selectivity Availability

Documents are physical materials in which facts or ideas have been recorded and can reveal a great deal about the people or organisation that produced them and the social context in which they emerged (Prior, 1974). They can take on different forms Yin (2009); such as agendas, letters, minutes of meetings, memoranda, or any relevant document that could add to the database of the case study (Stake, 1995). All are useful and rich sources of information for a qualitative researcher (Stake, 1995; Creswell, 2003; Yin, 2009). The documents should be reviewed carefully to ensure validity and to avoid unnecessary data

85 being included in the database. Documentary review can be used to verify evidence that is gathered from other sources. Over-reliance on documents can contribute to exploration of the wrong leads by inexperienced investigators (Yin, 2009). Documentary analysis is a social research method and an important research tool in its own right; it is an invaluable part of most schemes of triangulation (Prior, 1974). It refers to the various procedures involved in analysing and interpreting data generated from the examination of documents and records relevant to a particular study (Prior, 1974). Archival documents include service records, charts, maps, lists of names, survey data and others such as personal records and diaries. The accuracy of the records should be evaluated carefully before using them (Yin, 2013).

The interview is one of the most vital sources of case study information. Yin (2009, P.90) states that:

"Most commonly, case study interviews are of an open-ended nature, in which you can ask key respondents about the facts of a matter as well as their opinions about events.”

Focus groups are another type of interview. Comprising a small group of participants purposively chosen to fit key criteria and who have similar characteristics, these discussions aim to provide qualitative data in a focused dialogue (Morgan, 1997). This dialogue is the ‘interaction element’ that is the key point in understanding how focus groups can be used to generate a different type of collected data than is possible from a face-to-face interview (Billson, 2005). Direct observation is a useful technique for providing additional information about the case being studied (Yin, 2013). Direct observation occurs when the researcher conducts a field visit to gather data. The observation could be as simple as casual activities or as formal as measuring and recording behaviours. In this study, it was not deemed necessary to observe the participants, considering that the focus was predominantly on their perspectives and, therefore, it was what they had to say that was important. Participant observation is a special technique of observation in which the researcher is an active observer in the study. This technique provides opportunities to perceive reality from the perspective of the observer “inside” the case rather than externally (Stake, 1995). The last source of evidence is a physical artefact that includes tools, instruments, artworks, notebooks, computer output and other physical evidence that can be used during a field visit (Yin, 2013).

86 Case studies allow researchers to use multiple source of evidence that help to address a range of behavioural and historical issues (Stake, 2003; Baxter & Jack, 2008; Yin, 2013). The purpose is to use several sources of data as a triangulation of evidence. Triangulation increases the reliability of the data collection and is considered a strength within case study research (Baxter & Jack, 2008). A case study attempts to illustrate the subject’s entire range of behaviours and the relationship of these behaviours to the subject’s history and context (Brown, 2008). The researcher goal was to ascertain the influence of degree education as a minimum entry requirement into nursing practice on the planning and development of the nursing workforce, based on evidence from multiple resources. In this study, the researcher did not consider it sufficient to use a single data collection method. It is important to understand why there are minimum educational requirements and what factors contribute to this phenomenon by employing a holistic systems-based approach (macro, meso and micro).

The case methodology approach in this study is a single-case design that required one unit of analysis, where events are limited to a single phenomenon (Yin, 2013). This allows the researcher to build theory where little data or theory exists in the current literature (Yin, 2009). In this case, the researcher is able to respond flexibly to the emergent discoveries made during the data collection process due to the nature of the case study design that allows for the creation of innovative theory by combining paradoxical evidence from different levels (macro, meso, and micro) into a unified theory.

In this research, the “case” or the “unit of analysis” is the policy relating to the entry requirements for nursing and their implementation. At a deeper level, implications of the way in which this research is conducted are explored and this will entail the consideration of all aspects that could affect the results, ensuring that the data is analysed precisely and systematically (Yin, 2013). In order to provide a more inclusive view of which factors influence the minimum educational requirements for entry-level practice as a registered nurse in SA, multiple methods of data collection were considered and selected. These include; document analysis, in-depth interviews with stakeholders and focus groups of a sample of practising nurses at the meso and micro levels. Each of these data collection methods was selected to help understand or interpret the focus of the study. Thus, they required different skills from the researcher.

87 As previously mentioned the existing research on the case topic is extremely limited; to my knowledge, there is no existing study that forms a baseline for research on this topic and it is therefore important that the study is exploratory. The case study needs to be exploratory because no one has yet explored the implication of degree entry requirements for professional nurses in Saudi Arabia. For example, this study is about a relatively unknown issue. Therefore, it is important to determine what is going on, from the perspectives of people working within the health system and functioning at all three levels, as a basis for future planning. A case study approach was appropriate for this study since it allowed the researcher to build evidence where little data or theory existed in the current literature (Stake, 2003; Baxter & Jack, 2008; Yin, 2013). This approach was also suitable since it allowed the researcher to respond flexibly to the emerging discoveries made during the data collection process. For all the reasons given, a qualitative case study design was deemed appropriate for this research.