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Concept mapping is a technique that allows students to understand the relationships between ideas by creating a visual map of the connections. Concept maps allows the student to (1) see the connections between ideas they already have, (2) connect new ideas to knowledge that they already have, and (3) organize ideas in a logical but not rigid structure that allows future information or viewpoints to be included. Nursing students face a great need to understand the larger questions and problems of their chosen field. Unless there is understanding, students may only commit unassimilated data to short-term memory and no meaningful learning will occur. Meaningful learning is most likely to occur when information is presented in a potentially meaningful way and the learner is encouraged to anchor new ideas with the establishment of links between old and new material (All & Havens, 1997). Concept mapping is an effective teaching method for promoting critical thinking and is an excellent way to evaluate students' critical thinking because it is a visual representation of a student's thinking.

The concept map is an effective teaching tool that is fun, interactive, and effective. It can be used in a variety of settings. The concept map mirrors more closely real clinical situations by being dynamic as priorities shift. It is an innovative teaching tool that engages the student and prepares the student for future clinical decision-making in a complex and diverse healthcare environment

Description

A concept map consists of nodes or cells (often a circle) that contain a concept, item or question and links (lines). The links are labeled and denote direction with an arrow symbol. The labeled links indicate the relationship between the nodes. Words are used to label the links in order to more explicitly depict relationships.

Critical Questions:

• What is the central word, concept, research question or problem around which to build the map?
• What are the concepts, items, descriptive words or telling questions that can be associated with the concept, topic, research question or problem?

Suggestions:

• Use a top down approach, working from general to specific or use a free association approach by brainstorming nodes and then develop links and relationships.
• Use different colors and shapes for nodes and links to identify different types of information.
• Use different colored nodes to identify prior and new information.
• Use a cloud node to identify a question.
• Gather information to a question in the question node.
  

Constructing a preliminary concept map is helpful. This can be done by writing all of the concepts on Post-its, or by using a computer software program. Post-its allow a group to work on a whiteboard or butcher paper and to move concepts around easily This is necessary as one begins to struggle with the process of building a good hierarchical organization. Computer software programs are even better in that they allow moving of concepts together with linking statements and also the moving of groups of concepts and links to restructure the map. They also permit a computer printout, producing a nice product that can be e-mailed or in other ways easily shared with collaborators or other interested parties (Novak, n.d.).

• MindMapper (http://www.mindmapper.com/homepage.htm)
• SmartDraw (http://www.smartdraw.com/specials/flowchart.asp)
• Concept Draw (http://www.conceptdraw.com/en/products/mindmap/main.php)
• SMART Ideas (http://www.smarttech.com/products/smartideas/index.asp)
• Inspiration (http://www.inspiration.com/productinfo/Inspiration/index.cfm)
• Knowledge Manager (http://www.knowledgemanager.us/KM-KnowledgeManager-eng.htm)
  

Teaching and Evaluating with Concept Maps

Concept mapping is very useful in student preparation for clinical experiences. When used for the assessment and care of a patient with multiple health problems, data gathered allows the student to create a concept from the concepts or data collected. A common way to begin a concept map is to center the "reason for seeking care" or medical diagnosis on a large blank paper. Assessment data are arranged and linked to the center concept according to how the student thinks they fit bets. As concepts or data are added, links and relationships become evident and may change. Grouping and categorizing concepts give a holistic aspect to clinical decisions (King & Shell, 2002).

The concept map enables students to synthesize relevant data such as diagnoses, signs and symptoms, health needs, learning needs, nursing interventions, and assessments. Analysis of the data begins with the recognition of the interrelatedness of the concepts and a holistic vie of the client's health status as well as those concepts that affect the individual such as culture, ethnicity, and psychosocial state.

Once the preliminary concept map is complete, answering additional questions enable the student and instructor to make connections between concepts and begin formulating judgments and decisions. Once complete, the student and the instructor see all components simultaneously, providing a deeper and more complete understanding of the client's total needs. Development of the concept map forces the student to act upon previous knowledge, connect it with new knowledge, and apply it. It requires the student to have a mental grasp of the situation, rather than relying on rote memory. Review of the map with the student gives the instructor an opportunity to evaluate the student's thinking and an opportunity for immediate feedback on discrepancies and "missing links" (King & Shell, 2002).

Typical data in patient record. These data are typical of what student nurses find in medical records when gathering information for care plans or other assignments (King & Shell, 2002).

Sample Concept Map with fictitious client data (King & Shell, 2002).

Concept Mapping for Clinical Care Planning

Castellino and Schuster (2002) describe the use of concept care plans instead of the column format care plans. Both students and faculty found that the concept care plans were specific to the client, concise, and organized care. The concept maps enabled a holistic view of the client and covered all client problems, and students learned to integrate and understand relationships between client problems. Faculty found that students learned to think critically and did not copy care plans from books as they did when using the column format. Schuster (2000) describes in detail the use of concept maps to replace traditional column care plans.

Step 1:

Based on clinical data collected, students develop a basic skeleton diagram of the health problems. The client's major medical diagnosis is written in the middle and then associated nursing diagnoses are added flowing outward. The nursing diagnoses written on the map are the actual problems, not potential problems. At this stage of the care planning process, it is more important that students recognize and focus on major problem areas.

Step 2: Data to support diagnosis.

In this step, students analyze and categorize data gathered. Students identify and group priority assessments related to the reason for admission and identify and group clinical assessment data, treatments, medications, and medical history data related to nursing diagnoses.

Step 3: Relationships between diagnoses.

Students can use different colored pen, dotted lines, etc to indicate relationships. This is illustrated by dotted lines in the Figure below. Faculty can verbally ask students to explain why they linked diagnoses if not obvious. A student soon recognizes that most of the problems the patient has are interrelated. Students and faculty can see the whole picture of what is happening with the client by looking at the map.

Step 4: Nursing interventions and evaluation.

Students number each medical and nursing diagnoses on their map. Either on the back of the map or a separate page, corresponding nursing interventions are listed for each of the numbered nursing diagnoses on the map. The interventions include key areas of assessment and monitoring as well as procedures or other therapeutic interventions. Faculty can have students write or verbally discuss rationale for nursing interventions.

Step 5: Using the Map

During clinical, students update the map in order to evaluate effectiveness of nursing care.

Group Activity

Concept mapping can also be used as a group activity. Initially, it may be more effective if the instructor demonstrates the development of a concept map from raw data and asks students as a group to make links, associations, and conclusions while emphasizing the dynamic nature of the concept map as new or changing data is added.

King and Shell (2002) the use of concept mapping as a teaching tool in clinical conferences. Using actual client data, the students are instructed to analyze and synthesize diagnoses, sign, symptoms, health needs, ethical/legal concerns, leadership/management issues, as well as nursing interventions that included assessment, planning, client teaching needs, and evaluation. Discussions allowed students to make connections not previously appreciated. This exercise offers the opportunity for increasing knowledge of client situations and practicing clinical decision making.

References

• All, A., & Havens, R. (1997). Cognitive/concept mapping: A teaching strategy in nursing. Journal of Advanced Nursing, 25(6), 1210-1219.
• Castellino, A., & Schuster, P. (2002). Evaluation of outcomes in nursing students using clinical concept map care plan. Nurse Educator, 27(4), 149-150.
• Glendon, K., & Ulrich, D. (1997). Unfolding case studies: An experiential learning model. Nurse Educator, 22(4), 15-18.
• Glendon, K., & Ulrich, D. (2001). Unfolding case studies: Experiencing the realities of clinical nursing practice. Upper Saddle River, NJ: Prentice Hall.
• Herrman, J. (2002). The 60-second nurse educator: Creative strategies to Inspire Learning. Nursing Education Perspective, 23(5), 222-237.
• King, M., & Shell, R. (2002). Teaching and evaluating critical thinking with concept maps. Nurse Educator, 27(5), 214-216.
• Mahlmeister, L. (2000, March). Critical thinking through case studies. Workshop presented at Creative Teaching for Nursing Educators, Memphis, Tennessee.
• Novak, J. (n.d.). The theory underlying concept maps and how to construct them. Retrieved from http://cmap.coginst.uwf.edu/info/
• Schuster, P. (2000). Concept mapping: Reducing clinical care plan paperwork and increasing learning. Nurse Educator, 25(2), 76-81.
• Simmons, S. (n.d.). An introduction to case education. Retrieved March 30, 2003, from http://www.decisioncase.edu/intro.htm
• Ulrich, D., & Glendon, K. (1999). Interactive group learning. NY: Springer Publishing.

Additional Sources:

• Castillo, S. (1999). Strategies, techniques, and approaches to thinking: Case studies in clinical nursing. Philadelphia: Saunders.