THE CASE STUDY

There were a number of ways to classify types of case study. For example, in Mitchell’s (1999) review he included illustrations from Gluckman’s (1961) essay, which listed three types of case study on a continuum from simple to complex: “the apt illustration”, “analysis of a social situation” and “the extended case study”.

Stake (1994) identifies three types of case study, which depend on the different purposes researchers may have. These are:

• Intrinsic case study - which is a study carried out because the researcher

wants to gain a better understanding of that particular case. The case itself is of interest rather than being representative.

• Instrumental case study - which is a particular case that provides insight

into an issue or offers a refinement of a theory. The case is of secondary interest as it is a means for the researcher to gain insight into something else. Yin (1994) calls a single case study of this nature a revelatory case study as it offers the investigator the opportunity to observe and analyse a phenomenon previously inaccessible to scientific investigation.

• Collective case study - which is the study of a number of cases jointly in

order to inquire into a phenomenon, population or condition. This is the same in many ways to the instrumental case study but involves a number of cases.

Stake (1995) points out that the fundamental difference between an intrinsic study and an instrumental study is the focus. Intrinsic case studies focus on the

particular case, whereas the instrumental study focus on the issues being explored, the case is of secondary importance.

In this study I was not interested in investigating a particular person or place, rather I was interested in the issues around how an individual with a specific learning difficulty could develop the competencies of a registered nurse. All pre­ registration nursing programmes in the UK must contain 50% theory, taught in higher education institutions, and 50% clinical practice. Students go to a wide range of clinical areas during the three years and encounter university lecturers and support officers, as well as clinical mentors, practice educators and a multi­ professional team of carers and support staff. Each student, the higher education institution where they were studying and each clinical placement they attend would in effect be an instrumental case study. As I intended to include more than one student and more than one clinical placement area, this study is what Stake (1994) would describe as a collective case study. Both instrumental and collective case

studies enable theory building and thereby widen and deepen understanding about particular phenomena or set of issues.

The selection of the case/s from a given population is very important because the set of subjects or entities available in the selected case/s defines the research sample to be used (Eisenhardt 1999). The population in respect of this study was all the institutions, encompassing the lecturers and learning needs support staff, approved by the Nursing and Midwifery Council to offer pre-registration nurse education, all of the pre-registration nursing students who have specific learning needs, i.e. dyslexia, and all of the clinical areas used in pre-registration nurse education. As the Nursing and Midwifery Council sets UK standards for pre­ registration nursing programmes and for the role and function of clinical mentors, with which all institutions must comply, the key decision I had to make was in respect of which institution to pick rather than which students or clinical mentors to include in the study. Stake (1995) comments that selecting case studies, even collective case studies,

“by sampling of attributes should not be the highest priority. Balance and variety are important; opportunity to leam is of primary importance” (p6).

To assist me in selecting the school of nursing to be used in the study, I set out four criteria, namely:

1. The school must offer all four branches of nursing: adult nursing, children’s nursing, learning disability nursing and mental health nursing.

2. The school must offer a wide range of clinical practice placements.

3. The school must be close enough to where I live to make it practical for me to carry out the study.

4. There must be dyslexic nursing student studying at the school.

I selected the School of Nursing, University of Glynrith, which appeared to meet the criteria listed above, around which to focus the study. It should be noted that when I initially approached them, the School was prepared to confirm that they

had some students who were dyslexic studying on the course, but I was not

dyslexic on the branch programmes until after I had secured ethical permission. (See section 5.9, page 95 on ethical considerations.)

The School of Nursing, University of Glynrith, used the clinical areas in three NHS Trusts, namely: Beacontop NHS Trust, Glynrith NHS Trust and Harrowend NHS Trust, as well as a small number of independent sector institutions for students studying on the child health and learning disability branches. The School annually audited all clinical areas to ensure they had appropriate facilities for the nursing students, as required by the Nursing and Midwifery Council. The School also provided training for the clinical mentors who provided support for the students and who assessed the students’ clinical competencies.

The University of Glynrith had well established student support services, including dedicated support for students who had specific learning needs like dyslexia. In addition to this, the School of Nursing also offered dedicated support to students with specific learning needs and had their own student counselling service.