Generalising to theory: the use of a multiple case study design to investigate needs assessment and quality of care in community nursing

This paper outlines the detail of the case study method used in a project c ommissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context o f the NHS and Community Care Act, 1990. It explains the methodological proc edures and analytic processes which led to integration of data across the w hole study, focusing on the role of a prior theoretical framework in case s tudy design. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (N = 134 visits), concentrating on their p ractice of assessing needs, and on liaison and collaboration within teams a nd across sectors. They were interviewed after the observation period (N = 33 practitioners), to determine the extent of formality they attached to ea ch assessment, and elicit information about aspects which may be embedded i n everyday practice as well as those recorded for explicit requirements. The preliminary analysis resulted in the modification of a model for assess ing service quality, and identified various points where a 'policy-practice gap' might arise between policies and practice in both the health service and education. The practicalities of operationalising a multiple case study design into research are highlighted, and the mechanism for 'generalising to theory' illustrated. (C) 2000 Elsevier Science Ltd. All rights reserved.