1

Using Concept Mapping to Promote Clinical Reasoning

Deanne A. Blach, MSN, RN, CNE

The goal for our session(s) today…

You will increase your knowledge about how to implement concept mapping as an active learning strategy for improved student clinical reasoning.

Definition

Concept Mapping

2

A Concept Map is…

An Visual Illustration

Key Concepts and Ideas

Framework of Propositions

Relationships

within a given

that represents

showingThis is the hard part!

PropositionsConcepts

Concept Maps

Labeled

Organized Knowledge

HierarchicallyStructured

WordsSymbols

Crosslinks

should have

Interrelationships

represent

has

Effective Learning

are

ContextDependent

necessary for

is

combine to form

are

with

to show

are

Theoretical Framework

Using Concept Mapping in Nursing Education

3

Educational/Learning Theories

• Adult Learning Theory (Knowles)

– Adults are self-directed and motivated.

– Adults desire useful information and are problem-centered.

Educational/Learning Theories

• Constructivism = (Bruner)

– Learning is constructed by the learner and builds on previous learning and experience.

Educational/Learning Theories

• Assimilation = (Ausubel) Meaningful learning

• Integrating new information with preexisting knowledge. This information is rearranged, reordered to develop special meaning to thelearner.

4

Assimilation of Learning

“I saw relationships with drugs, why they were taken, what the adverse effects were and how they effect lab values.”

Clinical Student

Educational/Learning Theories

Making connections between and among the most important concepts

Novak, J., & Gowin, D.B. (1984). Learning How to Learn. New York: Cambridge University Press.

How Concept Maps Foster Clinical

Reasoning

5

“I tell you one thing, if you learn it by yourself, if you have to get

down and dig for it, it never leaves you. It stays there as long as you live because you had to dig it out of the mud before you learned

what it was.Aunt Addie Norton

Concept Mapping – Active Learning Classroom, Lab & Clinical

• Learning is meaningful

• Their work is unique • Thoughts organized differently

• Learner-centered

• Collaborative Technique• Learning from each other

Concept Mapping – Active Learning Classroom, Lab & Clinical

• Promotes deep thinking

• Students must justify ideas and reasoning

• Opens up new possibilities

6

Superficial vs. Deep Learning

Superficial Learning

• Results from memorization and is short-lived

• Leads to fragmentation

• Does not require thinking

Deep Learning

• Results from making connections (Novak & Gowen) between and among the most important concepts

• Requires thinking

• Is not forgotten

Learning Domains

• Cognitive = Thinking

• Psychomotor = Doing

• Affective = Feeling

Active vs Passive Learning

Characteristics of active learning?

Small Group Activity

7

Concept Map as a Learning Tool

Organizing and representing knowledge

Concepts usually enclosed in circles or squares

Propositionsrelationships between

concepts which are connected by lines

Lineshave descriptive words detailing relationships.

Concept Mapping

• Learning has structure & organization

• Learner better able to synthesize,retain complex information

“I saw connections.”Clinical Student

• Correct misperceptions• Clarify content

• Make connections missed in care plan.• Link theory to clinical

Concept Maps help:

“It put the pieces of the puzzle together for me.”

Clinical Student

8

C

Concept Maps

(Conceptual Learning)

How Concept Maps Promote Clinical Reasoning

Big picture & events that contribute to

problem

C

Concept Maps

(Conceptual Learning)

Nursing actions & interdisciplinary interventions

Relationships among

conditions that impact

situation

Help to see

There is a focus on

Breakdown into smaller parts to see

Where to Use Concept Maps in Nursing

9

Concept Mapping in a CBC

• Classroom – use any concept studied in class to determine the “focus” problem.

• Use Concept Map instead of Care Plan

• Post-Clinical Conference - Map out a clinical patient using a concept from class

• Great for Patho connections!

• Pharmacology connections!

• Patient Teaching

15 minutes before breakfast

15 minutes before dinner

DinnerLunchBreakfast

Patient Teaching: Use of Insulin for Treatment of DiabetesAdapted with permission Dr. Lillian Hill

Patient TeachingNoon

EveningMorning

Start earlySimple before complex

Provide examples

10

Gas ExchangeGas Exchange

Cellular Regulation

Gas Exchange

InflammationPerfusion

Related Concepts

11

Materials

« Large sheets of paper

« Markers, colored pencils

« Colored sticky notes

« Colored paper

« Magazine or clip-art pictures, colored newspaper advertisements

« Scissors

« Tape, glue sticks

« Computer Software www.inspiration.com

Main Idea

How to Make a Concept Map

Top Down Approach

Main Idea

Main Idea

Wagon Wheel or

Spoke Design

Modified Top Down

Approach

How to Make a Concept Map

http://www.inspiration.com/

12

Steps in Making A Concept Map

Step 1- Determine focus question/main concept

Step 2 – Clarify/define concepts & subconcepts

Step 3 – Parking lot for subconcepts.

Step 4 – Prioritize/organize info.

Step 5 – Arrange the subconcepts around central concept that is logical.

Step 6 – Draw lines to connect subconcepts

Step 7 – Label the lines with words that show relationship between subconcepts.

Step 8 – Add pictures, use colors.

Step 9 - Make a key and include references.

Step 1Define the Concept(s)

Determine the Focus Question

STEP #1

THE CONCEPT

Gas Exchange

STEP #1

THE CONCEPT

❑ Is the organizing principle,

or a classification of information.

❑ It can be limited or complex.

❑ Foundation or the building blocks of theory.

Giddens, 2013

The Concept

STEP #1

THE CONCEPT

13

1) Definition

Gas Exchange

“The process of O2 transport to the cells and CO2 transport away from the cells through ventilation and diffusion.”

Iggy and Workman, 2016

STEP #1

THE CONCEPT

Definitions of other closely related terms

Gas Exchange

✓ Ischemia ✓ Hypoxia ✓ Anoxia✓ Hypoxemia

STEP #1

THE CONCEPT

2) What is the Focus Question?What is the patient problem you want students to focus on?

STEP #1

THE CONCEPT

Gas Exchange

What is the priority plan of care for the patient with a Impaired Gas Exchange?

i.e. COPD, Asthma, ARDS

14

For Your Review Full page concept maps

Concept Map #1–

• Demonstrates the concept of Gas Exchange and interrelated concepts

Concept Map #2 –

• Demonstrates the nursing care for the patient with COPD

Clarify/define the concepts subconcepts and

interrelated concepts

Step #2 - Making A Concept Map

Gas Exchange

Cellular Regulation

Gas Exchange

InflammationPerfusion

Interrelated Concepts

STEP #1

THE CONCEPT

Clarifying terms by showing connections between concepts

15

Gas Exchange

STEP #1

THE CONCEPT

Have the students show the relationships between oxygen supply,

ventilation, GAS EXCHANGE, cardiovascular system and PERFUSION

(Full page CM back of handouts).

Gas Exchange

STEP #1

THE CONCEPT

Have the students define and show the relationships between

INFLAMMATION, GAS EXCHANGE, CELLULAR REGULATION

What is the relationship between INFLAMMATION

CELLULAR REGULATIONGAS EXCHANGE?

Inflammation

16

Poor asthma control → chronic INFLAMMATION →airway damage and altered CELLULAR

REGULATION → impairs GAS EXCHANGE.

Inflammation

Chronic Inflammation

Asthma

AlteredCellular

Regulation

With poor control causes

Can lead to airway

damage &

Causing hyperplasia of epithelial cells & bronchial

smooth muscle

Impaired Gas Exchange

STEP #1

THE CONCEPT

DetermineExemplars of Gas

Exchange

Gas Exchange

• Acute Resp Failure• Asthma• Atelectasis• COPD • Pneumonia • ARDS

• Aneurysm• HF• PAD• PE• Shock

PerfusionVentilation

Impaired Impaired

Giddens, 2013

STEP #1

THE CONCEPT

17

Perfusion

Define

The ability of the blood to transport O2 containing hemoglobin to cells and return CO2 containing hemoglobin to the alveoli.

Giddens (2013)

Perfusion

Define

Cellular Regulation

Define

18

❑ Pulmonary BP ↑ and blood flow thro lungs → poor PERFUSION and GAS EXCHANGE with HYPOXEMIA.

❑ ↑ workload of (R) heart → (cor pulmonale)

PoorPerfusion

Pulmonary Arterial Hypertension

Develop a Parking Lot

Step #3 - Making A Concept Map

Gas Exchange

Parking Lot(*students need to be familiar with content)

• Identify 15-20 key concepts– Make a list of concepts

– Place concepts in “parking lot”

– Rank order of importance

– Place concepts on the CM as the student determines where they fit

• Some concepts may not leave parking lot

19

Brainstorm the “Parking Lot”

1.

2.

3.

4.

5.

6.

7.

8.

9.

Guide Student to Include Essential Information

• Assessment data – subjective, objective

• Patient Problems

• Planning, Outcomes

• Interventions/ Rationale

• Evaluation

• Medications

• Laboratory Values

• Age – related considerations

❑ Assessment

❑O2 Administration

❑ Positioning

❑ Peak expiratory flow rate

❑Nebulizers

Clinical Nursing Skills for Gas Exchange

❑ Chest PT

❑ Suctioning

❑ ET, Trach care

❑ Chest tubes

❑Mechanical Ventilation

❑Medications

Giddens (2013)

20

Prioritize subconcepts in the parking lot

Step #4 - Making A Concept Map

#1#2

#3

Gas Exchange

Parking Lot

Some subconcepts don’t leave the parking lot…determine which ones are important

enough to keep.

Arrange the subconcepts that makes sense to the

learner

Step #5 - Making A Concept Map

Gas Exchange

21

Remember the “Parking Lot”

1. Gas Exchange

2. Perfusion

3. Alveoli

4. Oxygen transport

5. O2 - CO2 exchange

6. Ventilation

7. Diffusion

8. Inflammation

9. Acid-Base Balance

10.Cellular Regulation

11.Respiratory Acidosis

12.Cardiovascular system

13.Blood vessels

Another example … Remember the “Parking Lot”

1. Medical History

2. Assessment data - subjective, objective

3. Lung sounds

4. ABGs - Respiratory Acidosis

5. Interventions

6. Evaluation of effectiveness ofInterventions

7. Pertinent Lab Values

8. Medications – implications on heartrate, gas exchange

9. Positioning

10.Ventilation – vent settings

11.Perfusion assessment

Draw Lines (with arrows) to connect the subconcepts

Step #6 - Making A Concept Map

Gas Exchange

22

Using lines, connect these shapes (sub-concepts) linking them together (propositions) with a few words

on the lines describing what the relationship is between the two.

Asevidenced

by

dashed

lines

indicate a

possible

relationshiparrows can go

one way or both

way s

Successful outcome includes

Modifiable risk factors

include

Alveoli and Smallest Airways

Perfusion

Gas Exchange

Label the Lines (with a few KEY WORDS)

Step #7 - Making A Concept Map

Gas Exchange

23

Alveoli and Smallest Airways

Perfusion

Gas Exchange

Depends on the correct function

of

Contributes to

Results in

verify

Make sure to

As evidenced by

Connecting subconcepts with descriptive words

Alveoli and Smallest Airways

Perfusion

Gas Exchange

Depends on the correct function

of

Are the sitesfor direct

Any problem with ventilation will reduce Impairment

interfereswith

24

Add color and pictures

Step #8 - Making A Concept Map

Gas Exchange

Mr. M, 69 y.o. with early cognitive impairment admitted from home with confusion and

restlessness.

Assessment

Data

1 Priority Nursing

Diagnosis

Expected Outcome

objective data includes

Data supports the

The expected outcome is

Make connections

Cross links added

• Cross links show understanding of relationships

• Students need to recognize all subconcepts are related

• Selectively determine cross links

• Focus on a few good linking words

25

Constructing Propositions

• Most difficult for students

• Determine what linking phrases will clearly show the relationship between concepts

• Gives teacher insight into which concepts student has trouble integrating (evaluation)

Make a Key and Include References

Step #9 - Making A Concept Map

Gas Exchange

Concept Map Key

• Assessment Data

• Outcomes

• Nursing Diagnoses

• Interventions & Rationale

• Laboratory Values

• Evaluation

• Medication

Main Idea

26

Revision increases Clarity

A Concept Map is never finished

• Better overall structure

• Other concepts may need to be added

• Incorrect information corrected

Evaluation• Look for:

– Weekly progression

– Creativity

– Relationships between ideas

– Links in the Nursing Process

– Done in post-clinical conference

– Correct misperceptions about learned information

– P/F or can be graded

Learning Tool or Graded Assignment?

• What is the purpose of the CM?

• Evaluated sequentially

• Students take graded assignment more seriously

• Add to portfolio

27

Thank you!

Deanne Blach, MSN, RN, CNE

deanne@deanneblach.com

mailto:deanne@deanneblach.com