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Table of Contents
ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 1  |  Page : 21-30

Concept mapping, conventional teaching methods and knowledge of nurses


1 II Year M.Sc.(N) Student, Teerthanker Mahaveer CON, Moradabad, India
2 Assoc Professor, Teerthanker Mahaveer CON, Moradabad, India

Date of Web Publication11-Jun-2020

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Source of Support: None, Conflict of Interest: None


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  Abstract 


The demand for quality in care and improved health outcomes is on the rise due to increase in the complexity and diversity of health care needs. Nurses being in the frontline should be a critical thinkers in order to be a partner in clinical governance and decision making. The traditional teaching methods commonly practiced at colleges and universities provide students with theoretical knowledge and invariably fail to prepare them for keeping up with the clinical challenges in the health care. Various strategies are employed in nursing education to improve the critical thinking, knowledge and clinical practice. Concept mapping is an effective tool which enables them to understand the concept and think critically to handle the patient care issues. This article aims to provide a brief introduction of concept mapping and assesses the effect of concept mapping on knowledge of nurses and nursing students compared to conventional teaching methods. Pub Med-Medline database was used as search engine for literature review. Specific search strategy and key terms were used to search database. Six research studies, out of 20 reviews supported that concept mapping was better than conventional teaching methods. The review concludes that concept mapping is useful and more successful in stimulating critical thinking among nursing students. Concept mapping was found to be more effective than the conventional teaching method in increasing meaningful learning, encouraging them to connect current knowledge to their prior learning, and also provided an opportunity to gain further knowledge. It can be used as a clinical teaching-learning method to enhance critical thinking in nursing students.

Keywords: concept mapping, conventional teaching method, nursing students


How to cite this article:
Yadav S, Mohammad I. Concept mapping, conventional teaching methods and knowledge of nurses. Indian J Cont Nsg Edn 2018;19:21-30

How to cite this URL:
Yadav S, Mohammad I. Concept mapping, conventional teaching methods and knowledge of nurses. Indian J Cont Nsg Edn [serial online] 2018 [cited 2021 May 8];19:21-30. Available from: https://www.ijcne.org/text.asp?2018/19/1/21/286490






  Introduction Top


Health care needs of the population are increasing in its complexity and diversity today. The demand for quality in care and improved health outcomes is also on the rise. To meet this growing demand and need, nurses need to be not only compassionate professionals but must be individuals who can exhibit critical thinking and problem solving skills (Ab Latif, Mohamed, Dahlan, Nor, 2016). Traditional nursing education methods aim to prepare nursing students to provide comprehensive and competent nursing care without adequate emphasis on critical thinking that enhances nurses to analyse, prioritize, and organize new information (Farrag, 2016). However, the need for critical thinking ability for nurses has been recognized now and nurse educators have initiated efforts to imbibe critical thinking proficiency in nursing students through class room and clinical teaching methods.

Much research has been done regarding different methods of teaching critical thinking in different types of programs. Benner and Wrubel (1982) indicated the use of discussing critical incidents, joint rounds in improving critical thinking. Benner (1999) suggested research based thinking-in-action approach to enhance clinical enquiry. Various other methods described by Brunt (2005) are scenario based strategy discussion, clinical discussions, reflective writing, intuition, group work, purposeful thought process and reasoning. Conventional teaching methods such as nursing process and case studies have also been used to integrate critical thinking and clinical judgement skills in nurses and students (Nirmala & Shakunthala, 2011). Another effective method that has been recommended to improve critical thinking ability is concept mapping (Ab Latif et al., 2016). King and Shell (2002) suggested the use of concept mapping as both teaching strategy and evaluation of critical thinking. Concept mapping is an effective learning method which stimulates the students and facilitate critical thinking by encouraging them to connect current knowledge to their prior learning, and provides an opportunity to gain further, wide and varied knowledge on a number of concepts in a short span of time (Akinsanya & Williams, 2004).

Concept mapping is considered most useful tool in education worldwide. It was developed by Novak in 1970’s for visualizing the relationship among different concepts in his study (Novak & Canas, 2008). Concept mapping is an advanced educational method based on Ausubel’s Assimilation theory (Weibell, 2011). According to this theory, learning occurs when newly learned information is linked with the information previously stored in the brain. Concept map is a visual presentation of the meaningful relationship between concepts in a hierarchical structure which promote absorption capacity of the students about certain topics. It is a graphical method for representing a set of concepts which are placed in a thematic framework (Novak & Canas, 2008).

In a theoretical learning environment concept maps are useful tools in developing cognitive domains in students as the cognitive domain involves learning skills that predominantly involve thinking process (Farrag, 2016). Major or general concepts related to a disease condition is first listed and then the related specific concepts are progressively placed under the general concepts forming a hierarchical structure or a nonlinear frame work that can be diagrammatically represented (see [Figure 1]). Major concepts are circled or boxed. Lines are drawn to show relationships or links, and the direction of relationships is indicated with arrows. The interrelationships between general and specific concepts are indicated with connecting lines and relational statements. A concept map is a concise, two dimensional, schematic representation of the collection of concepts and linking relationships in a students’ knowledge set of a topic or a process. Concept maps can be used by individual students and groups as tools for learning, by teachers and students for remediation and by teachers for assessment (Bradshaw & Lowenstein, 2014).
Figure 1: Concept map for Hypertension

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The diagrammatic representation of concepts related to a disease condition or a health problem allows the student to understand disease progression, relationship between pathophysiology and symptoms and how diagnosis and interventions matter to enhance better outcomes. The process of developing the concept map allows the student to apply critical thinking process and also helps them to remember and retain new information effectively (Billings, & Halstead, 2009).

When concept maps are developed for patients in clinical settings it can be termed as concept care maps (Schuster, 2012). An example of concept care map is depicted in [Figure 2]. Concept care maps are used to organize information, group data, identify priorities, and visually demonstrate relationships between data (Hsu, 2004). Concept care mapping requires critical thinking as it requires analysing, organizing and sorting clinical data (Schuster, 2012). There are five steps in developing a concept care map (Schuster, 2002).
Figure 2: Concept Care Map

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Stepl. Develop a basic skeleton diagram

The main or admitting medical diagnosis and the patient’s personal data are written within a centered “circle or square” as the beginning of the diagram development. Based on the history and initial assessment, a problem list is created reflecting why the patient was admitted. Problems are written as broad terms and not as nursing diagnosis at this stage. For each problem a circle or square is drawn around the center circle/square forming a basic framework for the model.

Example of problem list for a patient with pneumonia - can’t breathe well, having trouble walking to bathroom, coughing productive, clear mucus, pale skin colour, fever and weakness.

Step 2: Analyze and categorize

In this step, a detailed assessment of the patient is done and more data on the illness is collected from laboratory tests and other investigations. The assessment findings are analysed and categorized under the problems that were listed earlier. Each problem is represented in a text box or shape drawn around the center circle or square.

Example

  • Physical Assessment Findings: Vitals: T-39.4oC, PR - 108/min, RR-44/min, BP-148/90 accessory muscle use, pallor, weakness, productive cough, decreased breath sounds, crackles on auscultation O saturation 80%, assist of one to ambulate
  • Laboratory tests : Total and differential counts,
  • Other investigations: Pulmonary Function Test, Echo cardiogram, Chest X ray


b. Categorizing data under related problems

Example

  • Can’t breathe well - accessory muscle use, shortness of breath, rales, rhonchi, CXR-pneumonia, productive cough, smoker, COPD
  • Weakness - needs assistance of one person for ambulation, feeling week


Step 3: Label and Link

In this step labels are developed by introducing nursing diagnosis for each set of problems listed. Next, each problem is prioritized in order of importance and numbered. Then the relationship between the nursing diagnosis with the corresponding data are identified and links are made between the nursing diagnosis.

Example

  • Problem - Can’t breath well - Productive cough, green mucus, shortness of breath, patient restless, pallor, O2saturation - 80%
  • Nursing diagnosis - Ineffective gas exchange related to decreased lung function


Step 4: Identify goals, interventions and outcomes

Measurable goals and outcomes are listed under each nursing diagnosis. Nursing interventions are planned that will achieve the established goals.

Example

  • The objective can be to improve gas exchange as evidenced by O2 saturation levels above 94%
  • Interventions will include positioning, initiating O therapy, chest physio and administering antibiotics


Step 5: Evaluate patient responses

This step involves writing down the impressions and inferences regarding patient’s response to the interventions. Evaluating patient responses enables the nurse to determine if interventions were effective or not effective.

Example

  • O saturation has improved to 92%, patient less restless and has started sleeping.
  • The conceptual way of writing care plans motivates the student to be creative compared to the linear way of writing plans. The exercise on finding relationships and linking concepts allows students to think critically and helps them to understand and retain information that they learned in their memory.



  Literature Review Top


Much research has been carried out to compare concepts maps with other teaching methods on the effect of knowledge and practice of nursing students. As part of a course requirement the first author conducted a literature review on effectiveness of concept mapping on knowledge of nurses and nursing students compared to conventional methods of teaching using the available data base in his institution.

Aim

The aim of this review was to find the effectiveness of concept mapping on knowledge or critical thinking of nurses compared to conventional teaching methods


  Methods Top


A narrative review method was undertaken to identify the evidence of effectiveness of concept mapping on knowledge of nurses when compared to conventional teaching methods. Narrative reviews may be undertaken when authors have restricted access to all available literature and they intend to analyse a subset of literature on the topic. Hence there is a selection bias and therefore the findings are mainly descriptive and give a limited understanding of the topic (Uman, 2011). In this review comparison of concept mapping with conventional teaching methods was selected as the area of interest, and a search was conducted in online database PubMed-Medline to retrieve quantitative research articles published from 2012 to Aug 2017. Only English language studies were included. The search terms used in this review were effectiveness, concept mapping, conventional, teaching methods, knowledge, education and nursing, nurses. Full text articles only were included for final evaluation.



Inclusion criteria

Types of Interventions

  • Concept mapping compared to other conventional methods such as lecture, care plans, discussion and standard methods


  • Study design

  • Quasi-experimental study, experimenta, randomized controlled trial


  • Type of Participants

  • Nursing professionals, student nurses


  • Settings

  • Academic institution, University


  • Outcome

  • Knowledge, knowledge of skill



  Review Process Top


A PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) flow chart was used to guide the process of review.

PRISMA diagram depicts the flow of information through different phases of a systematic review (PRISMA, 2015). It maps out the number of records identified, scanned, included and excluded and the reasons for exclusion. In this review although PRISMA process was used, the review stopped with the description of the findings in the reviewed articles and did not include meta-analysis or synthesis of evidence levels (see [Figure 3]).
Figure 3: PRISMA flow chart showing study selection process

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  Results Top


The PubMed-Medline search was done by using the keywords and synonyms were used for already found articles. A total of 22, 15, 544 articles were found in the initial search among which 20, 30,141 articles were excluded because of the limitation in year and the subscription status and the remaining 1,85,403 articles screened after de-duplication. Out of which 1, 85, 187 articles were excluded as it was not matching with the criteria and the rest of 216 articles were reviewed. 196 more studies were excluded as only abstracts or limited information from articles was available. Full text article assessed for eligibility was 20 and only 6 articles were reviewed because it fulfilled all the criteria of review.

The data extracted from the six studies are represented in [Table 1]. The summary of findings are as follows
Table 1: Data Extraction Table

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  • The available literature refined to get 6 quantitative studies
  • In this review, in all the research studies concept mapping method showed better outcomes compared to conventional teaching methods
  • Concept mapping was found to improve knowledge and critical thinking among nursing students



  Discussion Top


The studies were conducted in countries such as Thailand, Iran, and Egypt. Out of the six articles four articles were studies conducted in Iran. This could be based on the journals available for the author even though PubMed data base was used. The availability of full text journals through EBSCO or Pub Med in India depends on the type/levels at which the University or College pays subscription. Therefore there can be other articles which would not have appeared for screening. The subscribed packages of databases also include journals which are not related to nursing. This could also be the reason for a large number of inappropriate articles appearing from other journals. Another important finding is the differences in the sample sizes in each study which ranged from 32 (Moattari, Soleimani, Moghaddam, & Mehbodi, 2014) to 457 (Pattayakorn & Podimuang, 2015). All studies did not have justification for sample size and therefore the findings especially from studies with smaller samples are difficult to compare. In two studies the comparison group had traditional teaching methods, but what methods were used is not clear (Farrag, 2016; Moattari et al., 2014 ). Lecture method was the most common comparison method in most of the studies. It is not surprising, therefore, to note that the concept mapping was found to be more effective in improving knowledge in these studies as concept mapping is a student centered method where student is encouraged to think critically and be creative in developing concepts and identify relationships compared to the teacher centered monologistic lectures. Whether the involvement of student in itself has improved the outcome is something that needs to be further looked at.

All six studies involved nursing students and not nurses. Although there is a possibility that this review would not have included studies which might have been done among nursing professionals, one needs to consider the feasibility of introducing concept mapping in a busy work schedule of caring. Further, as the search terms were teaching methods in academic setting, studies with clinical nurses as subjects may not have been included. It is also evident that the duration of the intervention and the methods of introducing the intervention were different in every study. It was two sessions in one study (Aghakhani, Sharifnia, Eghtedar, & Torabizadeh, 2015) compared to 14 sessions in another study (Zadeh, Gandomani, Delaram, & Yekta, 2015).

The assessment methods used for measuring outcomes were also different and included measures such as check list, Likert scale, questionnaire and academic records. Therefore the findings although infer that concept mapping was better in bringing knowledge improvement in students compared to conventional methods, the conclusion needs further in-depth studies for results to be generalized. A meta-analysis based on a systematic review of literature from multiple data bases will bring stronger, reliable and generalizable evidence.

Yue, Zhang, Zhang, and Jin (2017) conducted a systematic review on effectiveness of concept mapping in the development of innovative thinking in clinical nursing practice. Thirteen trials were summarized in the systematic review and eleven trials were included in the Meta analysis. The pooled effect size revealed that concept mapping was efficient compared to other conventional teaching methods in improving critical thinking as measured by California critical thinking disposition inventory (CCTDI), California critical thinking skill test (CCTST) and Critical thinking scale (CTS). In this review the instruments used in the studies were almost similar. The systematic review concluded that concept mapping facilitates learners make decisions independently and helped learners to think innovatively and critically.

Concept mapping helped to cultivate the habit of open- mindedness, because it helped the student to connect the information, accept different ideas and recognise the problem as a whole. It was inquisitive in nature for acquiring knowledge and truth. Concept mapping also enables to think inductively and deductively so that the concepts can be organized using analytical skills. It promotes the learner to have a matured way of thinking independently (Yue et al., 2017). Traditional teaching learning methods fail to engage the student in active learning whereas concept mapping allows educators to focus on the learning outcomes in an active manner. It can be easily implemented and used to depict a clear picture of relationships. Nursing personnel can use concept mapping to focus on increasing organization of care, prioritizing problems that need to be addressed, and increasing nursing students’ critical thinking skills.


  Importance in Education Top


  • Concept mapping is very useful for the students to attain high levels of knowledge. It is an evaluation tool for the educators to measure the growth and assess the student learning level
  • Linking words on the connecting lines of the concept map and representing concepts in a substantial manner, assist the nurse educator as a teacher to prioritize, organize and arrange the relationship between the concepts articulated
  • The concept mapping helps the student to plan innovative approach for organizing nursing care
  • It also facilitates in note taking without complexity, as well as to summarize and synthesize their study material
  • Concept mapping used by nurse educators is one of the modern teaching methods that have the effect of developing and increasing critical thinking, also developing a sense of ownership and empowerment of knowledge


Limitations related to literature review

  • A single data base was used for literature review and even that had restrictions on availability of articles according to subscription status
  • Strength and level of evidence was not calculated



  Conclusion Top


Concept mapping was better than conventional skill teaching methods. It can be used as a clinical teaching- learning activity to promote critical thinking in nursing students. It can also improve academic performance in problem solving approach. Future graduate nurses will be required to use critical thinking, designing, analyzing and solving various problems as they may face in any situation in the modern health care, where new advanced and sophisticated technologies are to be used. As we embrace the best teaching practice of concept mapping we will be able to develop critical thinking among nurses which is a mandate.

Conflicts of Interest: The authors have declared no conflicts of interest.



 
  References Top

1.
Ab Latif, R., Mohamed, R., Dahlan, A., & Nor, M. Z. M. (2016). Using Delphi technique: Making sense of consensus in concept mapping structure and multiple choice questions (MCQ). Education in Medicine Journal, 8(3).  Back to cited text no. 1
    
2.
Aein, F., & Aliakbari, F. (2017). Effectiveness of concept mapping and traditional linear nursing care plans on critical thinking skills in clinical pediatric nursing course. Journal of Education and Health Promotion, 6 (3).  Back to cited text no. 2
    
3.
Aghakhani, N., Sharifnia, H., Eghtedar, S., & Torabizadeh, C. (2015). The effect of concept mapping on the learning levels of students in taking the course of nursing care of patients with glandular diseases subject in Urmia University of Medical Sciences, Iran. Jundishapur Journal of Chronic Disease Care, 4(2).  Back to cited text no. 3
    
4.
Akinsanya, C., & Williams, M. (2004). Concept mapping for meaningful learning. Nurse Education Today, 24(1), 41-46.  Back to cited text no. 4
    
5.
Benner, P. (1999). Claiming the wisdom and worth of clinical practice. Nursing and Health Care Perspectives, 20(6), 312.  Back to cited text no. 5
    
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Billings, D. & Halstead, J. (2009). Teaching in nursing a guide for faculty (3rd ed.). St.Louis: Saunders Elsevier  Back to cited text no. 6
    
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Benner, P., & Wrubel, J. (1982). Skilled clinical knowledge: The value of perceptual awareness, part 1. The Journal of Nursing Administration, 12(5), 11-14.  Back to cited text no. 7
    
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Bradshaw, M. J., & Lowenstein, A.J. (2014). Innovative Teaching Strategies in Nursing. United States of America: Library of Congress.  Back to cited text no. 8
    
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Brunt, B. A. (2005). Models, measurement, and strategies in developing critical-thinking skills. The Journal of Continuing Education in Nursing, 36(6), 255-262.  Back to cited text no. 9
    
10.
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11.
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Yue, M., Zhang, M., Zhang, C., & Jin, C. (2017). The effectiveness of concept mapping on development of critical thinking in nursing education: A systematic review and meta-analysis. Nurse Education Today, 52, 87-94. doi: 10.1016/j.nedt.2017.02.018  Back to cited text no. 22
    
23.
Zadeh, N. R., Gandomani, H. S., Delaram, M., & Yekta, Z. P. (2015). Comparing the effect of concept mapping and conventional methods on nursing students’ practical skill score. Nursing and Midwifery Studies, 4(3).  Back to cited text no. 23
    


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  In this article
Abstract
Introduction
Literature Review
Methods
Review Process
Results
Discussion
Importance in Ed...
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