Objetivo General

Case study methods involve a collection and recording of data about a case or cases and the preparation of a report or a presentation of the case (Stenhouse, 1985). The case study in its simplest form involves the researcher making a detailed examination of a single subject, group or phenomenon (Bogdan & Bilken, 2007). A case is selected which is typical or is representative of other cases. However, a sample of one case cannot be said to be representative of other cases. Case study research is not a sampling research where a case is studied in order to understand others (Stake, 1994). Case studies are conducted in order to understand a ‘unique’ or an interesting case or phenomenon. Yin (1994) contends case studies are empirical inquiries that investigate a contemporary phenomenon within its real life context. Stake (1995a) however, views case study as a research strategy that can either be qualitative or quantitative in nature, or a synthesis of both approaches, and states it is “a process of learning about the case and the product of our learning” (p. 237). Appleton’s (2002) description of case study research as an “intensive analysis in which the inquirer attempts to examine and understand key variables to determine the “dynamics of a situation” (p. 82) is also applicable to this study.

I chose to use Stake’s (1995a) intrinsic single case study design (Figure 7), which I felt was most appropriate and relevant to my research topic. Intrinsic case studies attempt to understand a case or a unit of analysis without trying to project the findings to other similar cases. In intrinsic case studies, the researcher may have an intrinsic interest in a particular ‘case’ because nothing or very little is known about the case and there is a need to better understand it. According to Stake, case studies are useful strategies for research when the boundaries between the phenomenon and the context are not

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clearly evident, and the interrelationship of people and the context tend to be significant in the search for a helpful explanation of the phenomenon under investigation. He therefore advocates the use of a disciplined and qualitative method of inquiry.

There are four key elements that characterise case studies – they are contexts, boundaries, time and intensity (Mariano, 1993). Lincoln and Guba (1985) agree with studying a phenomenon in its context, which is important for a number of reasons. These are first, the research activity and interaction with the phenomenon under study should take place in its entity in order to fully understand it. Second, the context is an important element in determining the study findings and its interpretation. Values are inherent and intrinsic components of the contexts and can influence the findings of the research study, and last the “belief in complex mutual shaping rather than linear causation which suggest that the phenomenon must be studied in its full scale influence field” (Lincoln & Guba, 1985, p. 39). This view of case study research is applicable to this study as the case under investigation is located within the wider context of nursing and within Fiji as a country in the Pacific. This wide context makes the case under investigation complex, and would influence the analysis of information collected in this study.

Mariano (1993) and Stake (1995a) both contend the boundaries of the case study investigation are clearly demarcated so that the researcher clearly identifies what ‘is’ and ‘is not’ the case. This was important in this study as the boundaries of authority between the FSNs management and Fiji’s Ministry of Health are not clear, and decision making processes often overlap. This is evident in how the FSN is precariously located within the direct administration of the Ministry of Health through the Director of Nursing Services. Therefore the FSN lacks academic and professional autonomy in the sense that the Nurses, Midwives and Nurse Practitioners’ Board of Fiji closely monitors the activities of the School starting from its programme implementation to the final examination of its candidates through its academic arm called the Nurses Academic Committee. The Ministry of Health itself is involved heavily within the School’s major

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activities, having representatives on the selection committee, students’ disciplinary committee, and the supervision of all external examinations of the School (Downes, 2001a). The prominence of the role of the Director of Nursing services within the Fiji School of Nursing’s business plan is indicative of the type of external influence the School receives from the Ministry of Health. All teaching and auxiliary staff appointments are made by the Ministry of Health and not the Fiji School of Nursing (Usher, 2005).

The development and the review of the curriculum under study is the result of a decision by the Ministry of Health and not the Fiji School of Nursing. For an outsider, the boundaries between the context of nursing education and the unit of analysis, which is the curriculum under study, are unclear. For insiders like me, such unclear boundary lines and external decision-making have been a cause of frustration as they contribute to no clear line of authority.

Ragin (1992) also described the importance of boundaries defining cases in terms of “places and periods”. This study clearly identifies the period of study as from the year 2004 in which the case, the Diploma of Nursing curriculum, was first implemented in Fiji and 2008 when this study was conducted. Therefore the boundary of the case is identified by time or period. The fourth element of a case study described by Mariano (1993) is the importance of the researcher having sufficient time within the case under study to become familiar with it. The researcher requires adequate time allowance during the research process to be fully immersed within the setting, and to focus in- depth on the case itself in order to ‘unearth the intricacies and the subtleties’ of the case (Stake, 1994), and so the investigation and data collection methods are fully exhausted (Appleton, 2002). This requirement was met fully, as I have spent the preceding two years (2004 to 2006) coordinating and teaching within the programme. In addition to this, I spent over three months of data collection on site in Fiji.

The case in this study is the Diploma of Nursing curriculum currently taught within its real life context in Fiji. It is an example of an educational change initiated externally to

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the Fiji School of Nursing. That is, the curriculum was written and developed by Australian consultants from the James Cook University in Australia with very little input from the local faculty at the Fiji School of Nursing. After the curriculum was endorsed by the Nurses, Midwives and Nurse Practitioners’ Board of Fiji, the curriculum consultants responsible for the newly developed curriculum pushed for its implementation in August 2004 and continued to supervise its implementation for the first three years.

Figure 7. The intrinsic type 2 embedded single case study design

CONCEPTUAL FRAMEWORK: VANUA & FULLAN’S CHANGE THEORY

CONTEXT:

FIJI'S NURSE EDUCATION CASE:

2004 DIPLOMA OF NURSING CURRICULUM Policy & Curriculum

Documents

Interviews – Individual and Group Talanoa

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This curriculum was chosen as the ‘case’ for this study because there were many concerns raised by faculty and stakeholders before and during the implementation of the programme. Teachers expressed concerns that they did not understand the new competency-based curriculum model, and that the competencies to be used in clinical assessments were not identified. The teachers were alarmed they lacked knowledge of the curriculum approach to implement it with confidence. The teaching methods advocated in the new curriculum were new and most teachers were not educationally prepared to use them. Previous nursing curricula in Fiji had used Primary Health Care and body systems approaches. Teachers were familiar with a mastery method of assessment used in the previous curriculum.