Journal of Advanced Nursing, 1997, 25, 1210–1219
Cognitive/concept mapping: a teaching strategy
for nursing
Anita C. All, RN PhD
Associate Professor, College of Nursing, University of Oklahoma, Health Sciences
Center, Oklahoma City, Oklahoma, USA
and Robyn L. Havens, RN MS
Assistant Professor, School of Nursing, Department of Adult Nursing,
The Medical College of Georgia, Augusta, GA USA
Accepted for publication 22 May 1996
Journal of Advanced Nursing 25, 1210–1219
Cognitive/concept mapping: a teaching strategy for nursing
Cognitive/concept mapping is an educational strategy that takes into consideration
the principles of educational psychology. The most important single factor that
influences learning is what the learner already knows. 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. The purpose of the
following paper is to present concept mapping as a learning/teaching strategy for
nursing students and nursing faculty. Examples of maps will be presented along
with suggestions about how they can be used to plan care for a particular client or
to learn more about the nursing care of a specific disease process.
A LL A.C. & H AVENS R.L. (1997)
COGNITIVE MAPS
Cognitive maps or concept maps are graphic or pictorial
arrangements of the key concepts that deal with a specific
subject matter. These maps are useful tools that can be
utilized to represent the structure of knowledge in a form
that is psychologically compatible with the way human
beings construct meaning. Cognitive/concept maps present a hierarchical structure of concepts and propositions.
Each map represents an individual’s personal expression
of meaning for the selected material or subject matter
(Naidu 1990, Novak 1988, Phillips 1994).
The theory of knowledge (epistemology) underlying cognitive/concept maps holds that the new meaning humans
construct about events or objects is based upon their prior
knowledge. Each individual acquires a unique framework
of concepts and propositions over time. The perceived
regularity an individual sees in events or objects varies from
person to persons, due to the uniqueness of the individuals’s framework developed over time (Novak 1990a & b,
Novak & Gowin 1988, Novak & Tyler 1977). A goal of nursing education is to move students away from rote learning
modes toward meaningful learning.
Students who employ meaningful learning are expected
to retain knowledge over time and they, consequently, find
ways to connect new information with more general prior
learned material. Three key factors are associated with
meaningful learning. First, meaningful learning involves
the assimilation of new concepts and propositions into
existing cognitive structures. Secondly, knowledge is
organized hierarchically in cognitive structure, and most
new learning involves placing concepts and propositions
into existing hierarchies. The third factor is related to the
idea that knowledge acquired by rote learning will not be
assimilated. 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 (Irvine 1995).
Correspondence Dr Anita All, University of Oklahoma, Health Sciences
Center, College of Nursing, Oklahoma City, Oklahoma 73190 USA
1210
© 1997 Blackwell Science Ltd
Concept mapping
Memory systems
Humans store and process information in three memory
systems which are: the sensory register, short term memory
(STM), and long term memory (LTM). Processing of information begins when contact is made between the physical
energy from the environment and the organism’s receptor
cells. The sensory register stores the information received
from these receptor cells. The properties of the sensory
register, although it is a memory system, are very dierent
from the properties of LTM. Information in the sensory
register lasts a very short time and, more importantly, the
information, at this early state, has not been processed for
meaning. Individuals are not aware of their sensory register. Meaning is attached to information in the sensory
register by the concept of pattern recognition. Pattern recognition extracts information from the sensory register and
matches it with a representation in long-term memory.
The incoming information has then obtained meaning.
Attention is the concept that determines which information will be processed in situations where all the information cannot be processed. The rapid decay and erasure
of the sensory register insures vivid representation of new
information (Ellis & Hunt 1983).
The second processing and storing system is the working
or short-term memory (STM). The STM is designed to
explain events occurring at the conscious level.
Individuals are most aware of their STM when it fails.
Perhaps the most important aspect of memory is retention
and recall (Buzan 1984). Short-term memory retains information briefly and its capacity is limited. STM is a conceptual system which not only stores information, but also
serves a work space for rehearsing, coding, retrieving, and
decision-making. As information arrives into short-term
memory, relationships must be established in order for the
items to be organized (chunked) into a single unit.
‘Chunking’ (Ellis & Hunt 1983) or ‘Linking’ (Buzan 1984)
can serve to oset the extreme capacity limitations of
short-term memory. Telephone companies have taken this
work to heart, as demonstrated by the standard seven digit
telephone number. The most intellectually gifted person
can only process approximately seven items but they frequently excel at organizing concepts into meaningful
chunks of information. LTM is the third memory system.
A person’s survival is dependent upon LTM. Many
researchers believe that once information enters long-term
memory, it remains there permanently. Any forgetting that
occurs is due to an inability to retrieve information, not a
decaying process (Ellis & Hunt 1983).
SPATIAL LEARNING STRATEGIES
Recently the trend in cognitive and educational psychology has been research in the development and use of
spatial learning strategies that facilitate the organization,
presentation and acquisition of information (Lambiotte
et al. 1989, McCagg & Dansereau 1991). One such strategy
is a knowledge map (concept map). This two dimensional
graphical display presents information in the format of
node-link-node assemblies. Nodes contain key ideas and
the relationships are specified by the links between the
nodes. These two dimensional displays can be expertgenerated or student-generated. McCagg & Dansereau
(1991) presented the idea of expert and student generated
maps. Expert-generated maps are typically constructed to
maximize the communication between the student and the
facilitator. They have the greatest potential as text supplements that serve as pre-organizers, post-organizers, lecture props, and classroom handouts. They aid students in
identifying the main ideas and the macrostructure of the
content presented.
Student-generated maps, on the other hand, are generally less formal and represent an individual’s personal
interpretation of ideas and its attached meaning. Research
has documented that student-generated maps enhance
learning, facilitate discussions and improve student writing and outlining (Hirumi & Bowers 1991, Irvine 1995,
Schmid & Telaro 1990, Soyibo 1991). Although students
with low-ability may need more time mastering the technique of concept mapping their academic success has been
shown to increase with the use of mapping (Gold 1984,
McCagg & Dansereau 1991, Sinatra et al. 1984).
Individuals may choose to learn by rote or to learn meaningfully. Students who employ meaningful learning have
been shown to retain knowledge over an extensive time
span and find new, related learning progressively easier.
Central to this assumption is the idea that meaningful
learning requires students to connect newly introduced
material to more general prior-learned concepts (HeinzeFry & Novak 1990). Storage capacity of the brain is so large
that there are five factors involved that assist in the recall
of information. These factors are: (1) primacy, one will
recall the beginning more than the middle of an event; (2)
recency, tendency to recall very recent events; (3) linking,
recall of events that are connected to other events; (4) outstandingness, recall the strange, unusual, out of content,
or outstanding; and (5) review, anything reviewed will
tend to be more firmly lodged in the brain.
Meaningful learning occurs when the learner chooses to
seek relationships and to integrate new knowledge with
prior knowledge held in long-term memory. Meaningful
learning is dependent upon the new material to be learned,
the amount and quality of prior knowledge, and the extent
to which the learner is motivated to process and integrate
the new with the old. Cognitive or concept maps can be
powerful tools to aid meaningful learning and, consequently, the storage of information in long term memory
(Hirumi & Bowers 1991, Irvine 1995, McCagg & Dansereau
1991, Novak & Gowin 1988, Phillips 1994).
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
1211
A.C. All and R.L. Havens
Application of knowledge
Problem solving methodology has been used in science
and health care but there has often appeared to be a gap
between what the student has learned in basic courses and
the application of this knowledge in the clinical area.
Scientific method and nursing process are the tools that
have been used by health care providers to solve problems;
it has also been the foundation for medical and nursing
diagnosis. Hypotheses often must be created quickly to
meet the demands of changes in the health care setting.
One of the most creative parts of the process is recognition
by the student of the relationships between newly acquired
information and previously learned concepts or facts
(Heinze-Fry & Novak 1990, Horton et al. 1993, Roth &
Roychoudhury 1992, Small 1988).
The need for nurses to be critical thinkers has never
been more pressing. The profession of nursing has within
its grasp the opportunity and the ability to be a primary
player in the reorganization of the delivery of health care.
Nurses will need to think critically in order to become
aware and reflective of their role and identity in the world
and in relationship to things, events, and other people. In
order to think critically nurses must be able to examine
assumptions, beliefs, propositions, and the meaning and
uses of words, statements, and arguments (Bandman &
Bandman 1995). This clarification must begin in the educational settings. Critical thinking is also of a practical
importance in nursing education. It defines the conditions
under which sound and valid conclusions are drawn.
Critical thinking facilitates the use of the nursing process.
It is liberating and assists nurses in becoming more
eective in all aspects of life and work.
Critical thinking
Critical thinking has been defined in various ways, but the
most practical definition is that it is the rational examination of ideas, inferences, assumptions, principles,
arguments, conclusions, issues, statements, beliefs, and
actions. Rational examination of these terms includes
scientific reasoning, nursing process, decision making, and
reasoning in controversial issues. It utilizes language,
formulating problems, clarifying and explicating
assumptions, weighing evidence, evaluating conclusions, discriminating between dierent arguments, and
seeking the justification of facts and values (Bandman &
Bandman 1995). This process results in credible beliefs
and actions.
USE OF CONCEPT/COGNITIVE MAPS
The use of concept/cognitive maps has primarily been
documented in the educational literature. Significant studies have reported increased recall of prose in academically
precocious students, and improved comprehension in
1212
recall skills of poor readers and disabled readers. Mapping
can be utilized to assist students to learn the underlying
structures of written discourse. Practice and time using
mapping procedures is recommended in all research studies (Foster-Havercamp 1988, Gold 1984, Mastropieri &
Scruggs 1983, McCagg & Dansereau 1991, Miccinati 1988,
Sinatra et al. 1984, 1986). Visual representation aided students in seeing how ideas meshed with their previous
knowledge. They could visually demonstrate how the
main ideas were logically related to subordinate ones.
Mapping procedures have been found to motivate students to represent ideas visually, thus causing them to analyse, evaluate and reason critically, all necessary for
meaningful learning. Miccinati (1988) reported that volunteers given three hours of mapping instruction scored
higher on holistic scores when writing essays. These volunteers used more cohesive linage, wrote longer essays,
and used more supportive details. Cognitive maps have
been suggested as a way students can share the responsibility for learning. Cognitive mapping then is used not
only as a teaching strategy, but also a study strategy.
Study of the eectiveness of cognitive/concept maps has
continued in the 1990s. Naidu (1990) developed a student
workbook that taught students the use of the concept map
as a study aid. Research done since the development of
concept mapping as a viable educational tool has supported that these maps can help teachers become more
eective (Beyerbach & Smith 1990, Hoz et al. 1990) and
these maps can serve as an aid in curriculum development (Starr & Krajeik 1990). Phillips (1994) has documented the usefulness of concept maps as a creative teaching/learning strategy in teaching concepts of intravenous
therapy. It was found to be particularly useful in the understanding of complications connected with intravenous
therapy.
Concept/cognitive maps for meaningful learning
Concept maps aid in clarifying to the student and the
teacher the small number of key ideas that must be focused
upon or attended to for any specified learning task. A map
can provide a visual road map showing some of the pathways that can be taken to connect the meanings of concepts
(Heinze-Fry & Novak 1990, Horton et al. 1993, Irvine 1995,
McCagg & Dansereau 1991, Novak 1990a & b; Novak &
Gowin 1988). After a learning task has been completed,
concept maps can provide a schematic summary of what
has been learned.
The capacity for using written or spoken symbols to represent perceived regularities in events or objects is distinctly an aspect of human learning. An awareness of the
explicit role language plays in the exchange of information
is necessary in order to understand the value and purpose
of concept mapping. It is central to all aspects of education.
Ideas that are novel, powerful, and profound are often very
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
Concept mapping
dicult to contemplate. Time and meditation are often
needed to accomplish reflective thinking. Reflective thinking involves rearrangement of concepts. Concepts are put
together and separated time and time again to aid in meaningful learning. The making and remaking of concept maps
gives students needed practice in reflective thinking
(Novak & Gowin 1988, Roth & Roychoudhury 1992).
Concept maps are an explicit, overt representation of the
concepts and propositions held by an individual. Missing
linkages between concepts often suggest a need for new
information. Meaningful learning is accomplished by the
anchoring of new ideas or concepts with previously
acquired knowledge (Horton et al. 1993). Horton et al.
(1993) reported, after examining 19 studies, that concept
mapping raised individual student achievement on average from the 50th to the 68th percentile. Concept maps
can be motivational for students and misconceptions can
be discovered by teachers and students (Heinze-Fry &
Novak 1990). Maps present a clear picture of what students
are thinking.
I MPLICATI ONS FOR NURSING
Learning to read eectively presents many students with
a dilemma. A concept map can serve as a general road map
for reading and helps break the meaninglessness of the
reading. Nursing students are exposed to vast amounts of
reading and often this material is very specific, technical,
and new to the students. Expert-generated maps and student-generated maps can both be utilized as a tool to assist
students ‘wade’ through information in a meaningful
manner.
Concept maps could be useful in student preparation for
clinical experiences. Concept mapping could be taught to
nursing students to assist them in organizing the data
obtained in pre-planning for clinical experience and then
presented at pre- and/or post-clinical conferences.
Additionally, cognitive/concepts maps could provide
advanced organization for reading assignments and
classroom activities.
The use of collaboration in learning is becoming a concept used in many curriculums. This type of communication is necessary after graduation for socialization into
the profession. Critical thinking has become an integral
part of everyday functioning within today’s health care
system (Bandman & Bandman 1995). When students work
together they communicate. Students communicate their
ideas about steps in the task, understanding of the current
status of information, what is not known, and rationale for
making decisions (Roth & Roychoudhury 1992). Small
group activities in post clinical conferences or classroom
settings are a means for students to review and organize all the concepts of what has been studied in a particular unit. Individual understanding of concepts undergo
modification as students receive peer and faculty feedback.
Figure 1 is an example of the first attempt at a concept
map constructed by a student during her first clinical
experience.
Feedback
The map provides many details about the signs, symptoms,
causes and treatment of asthma. The missing element in
this particular map was more detailed attention to nursing
and the ways nurses can enter into the treatment of this
client. Feedback is necessary for all elements to be added
to the next mapping attempt of this student.
There is a great need for nursing students to understand
the larger questions and problems of their chosen field.
Without this understanding, students may only commit
unassimilated data to short-term memory. Rote learning
cannot help nursing students deal with the complex problems they will face during their careers. Nursing students
must link learned facts, concepts, and principles with new
knowledge in order to make sound decisions.
Figure 2 shows a student’s perception of a client with
nephrotic syndrome. This particular student addressed the
symptoms, common treatment, diagnostic tests, education
and nursing implications. This student needs feedback
from peers and faculty to increase his/her perception that
education may not be separate and dierent from nursing
implications.
Figures 3 and 4 are students’ concept maps dealing with
particular disease processes. One student was able to visually represent that urinary retention can be an acute or
chronic condition and that there may be dierent causes.
The student was able to discuss the interventions that the
nurse needed to consider when providing care. Cervical
cancer was chosen by the other student and the resulting
map represented a picture of diagnostic tests, treatments,
and nursing actions.
The only instructions that these particular students were
given about constructing a map were
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there was no right or wrong way to do the map;
the map should be what they felt was useful
information;
to take risks and try out dierent representations.
Figure 5 represents a student’s map after a post clinical
conference that addressed the nursing process as a tool for
planning care and constructing concept maps. It assisted
the student to understand that they are not separate and
dierent strategies but dierent graphic representations of
the same principles of care.
The most widely used method of clinical assignment is
by the instructor reviewing clients on a specific unit and
then assigning a particular client to a specified student.
The move out into the community necessitates preparation
by students of what they might encounter in providing
care outside the acute care setting. Historically, literature
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
1213
A.C. All and R.L. Havens
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Figure 1 A concept map of asthma
1214
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
Concept mapping
Concept Map
Symptoms
Treatment
• SCB
• haemodialysis
• oedemia
• chest tube (haemothorax)
• proteinaemia
• perma cath
• lipidemia
• pain
Diagnostic Tests
Nephrotic
Syndrome
• CBC c diff.
• SMA 10
Medicines
• zaroxolyn 5 : bid
• prednisone 5 mg : qd
R.E.C.
• Lasix 120 mg : bid
• PT/PTT
• KCL 1000
• CXR
• clonidine 0.1 mg : bid
• U/A
• Oscal : tid c meal
Diagnostic Implications
Education
• take temp q 8 hrs and report
if ≥ 38.5
• teach patient about
perma cath care
• take BP q 8 hrs and report if
systolic > 160 or < 100 and if
diastolic > 105 or < 50
• importance of proper diet
• patient to take daily weights
at home and call doctor
if abnormal
• take respirations q 8 hrs and
report if > 24
• stress importance of compliance
with haemodialysis
• monitor fluid In and Out
Figure 2 Concept map of nephrotic syndrome
has revealed support for students obtaining assignments a
day or two in advance (McCoin & Jenkins 1988, Mitchell
& Krainovick 1982). Mitchell & Krainovick (1982) did note
that advance assignment might not be appropriate for all
levels of students, for example, those nearing graduation.
Nursing students frequently find the vast amount of data
gathered from visiting the clinical faculty overwhelming.
They do no know how to organize the data and connect it
with previous knowledge. Concept mapping could provide
this organization and aid the student in developing a nursing diagnosis and plan of care. More than one concept map
may be needed for a patient.
CONSTRUCTION OF CONCEPT MAPS
Concepts and propositions are organized with the most
general, most important concepts at the top of the map,
and with progressively more specific, less important concepts lying under the more inclusive concepts. The
specific structure is context-dependent. Concept maps are
most useful to the person who constructs them (HeinzeFry & Novak 1990, Horton et al. 1993, Irvine 1995, McCagg
& Dansereau 1991, Novak 1988, Roth & Roychoudhury
1992).
Initially, map construction is done by identifying relevant concepts in the material. From this identification a
hierarchical structure is developed selecting appropriate
linkages to form valid propositions. Two or three versions
of a map often need to be constructed in order to obtain a
valid, satisfying map. The processing of information that
occurs during concept map construction requires and
encourages meaningful learning (Heinze-Fry & Novak
1990, Novak & Gowin 1988). The task of nursing educators
is to provide content and feedback.
Educators are the motivating force in successful concept
mapping. Promotion of a positive reaction to mapping and
its eectiveness can be accomplished by giving sucient
time in class for creating maps, allowing for individual
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
1215
A.C. All and R.L. Havens
Urinary Retention
A state in which an individual cannot initiate or complete evacuation of accumulated urine from the bladder
Urinary retention, whether acute or chronic
can be a significant threat to a person's well-being
and may significantly alter their body image
ACUTE
CHRONIC
Causes of Chronic
Clinical Findings
• absence of voided urine
Causes of Acute
• surgery
• diagnostic procedures
involving the urinary tract
• distended bladder that can be
palpated above the level of the
symphysis pubis
• patient may complain of increasing
discomfort and pain accompanied
by elevated BP
• weak or absent
detrusor contraction
• bladder obstruction,
at or below the
bladder outlet,
usually caused by
urethral strictures,
prostatic hypertrophy,
or bladder neck
tumours
Treatment
• delivery of a baby
• medications such as
anaesthesia,
antihistamines,
and anticholinergerics
• obstruction of the urinary
system
• anxiety and muscle
tension due to fear,
stress and pain
• a one-time catheterization
• if more than 500 to 1000 ml of urine is
drained from the bladder, an indwelling
Foley catheter may be ordered
• suprapubic cystostomy (an opening into
the bladder through a small incision in
the abdominal wall) may be necessary so
that a Foley catheter may be directly
inserted into the bladder
Nursing Intervention
• if an indwelling catheter is used while a patient is hospitalized, the nurse should make sure that the area
around the insertion is clean and dry at all times. This will help decrease the risks of a UTI occurring. Also,
the nurse should assess for persistent burning at the catheter site, cloudy urine, or odorous urine
• encourage the patient to ↑ fluid intake to help lessen the possibility of UTI
• encourage the patient to turn from side to back to side (if possible) because this promotes drainage
•
when using an indwelling catheter or suprapubic cystostomy urinary output, along c signs of bladder
distention, should be monitored closely. →
Nursing Interventions
• for the patient who will have an indwelling catheter and suprapubic cystostomy
after hospitalization, the nurse should educate the patient on the importance of
keeping the insertion clean and dry, as well as how to do so
• due to the threat to well-being and body image brought on by urinary retention
and/or its treatment, the nurse will need to help the patient cope c any reactions
or feelings associated c this change in lifestyle
• for the individual c postoperative urinary retention the following may be
attempted before catheterization: ↑ patient's activity soon after surgery, encourage
patient to take deep breaths to relax muscles, running H2O may ease the
patient's anxiety
Figure 3 A concept map of urinary retention; a state in which an individual cannot imitate or complete evacuation of accumulated
urine from the bladder
1216
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
Concept mapping
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Answer any questions
about procedure
Provide for client
privacy and dignity
Advise client to avoid sex
and douching 48 hrs. prior
CERVICAL
CANCER
Advise client that she
will be notified of results
Risk factors and interventions to reduce risk
Pap smear
Explain procedure
to ↓ anxiety
Risk
Sexual activity begun
at young age
Having multiple sex
partners
Having sexual relations:
c risky men
The development of
cervical dysplasia
Having multiple pregnancies
Treatments & related interventions
Vaginal radiation therapy (implant)
Diagnostic procedures
Provide emotional
support D/T client anxiety
Maintain client privacy
and dignity
Cervical biopsy
Nurse intervention
Teach client to avoid sex
at an early age
Advise client to limit # of
partners
Advise client to
use a condom and avoid
sex c an STD infected man
Educate clients on the
importance of annual Pap smears
Advise client to have
repeat Pap and if indicated,
a cervical biopsy to dx.
Answer any client concerns
about procedure
Provide pad afterwards
for vaginal bleeding
Advise client to avoid
douching, tampons and intercourse
for 2 weeks afterward
Tell client to report any
abnormal bleeding/discharge
Prolonged menstrual periods
causing extra blood loss
Watery vaginal discharge
Slight spotting inbetween
periods
Late
Profuse bleeding or haemorrhage
causing hypovolemia and
nutritional/fluid imbalance
Pain R/T tumour
S & S and related nursing interventions
Early
S&S
Advise client to take in
extra fluid and iron supplement
O/T the blood loss
Advise client to see their Dr.
and have Pap smear to screen
for cancer
Advise client to see Dr. and
have a screening Pap smear
S&S
Control bleeding as necessary
and maintain nutritional and fluid
balance O/T loss of blood
Assess pain; provide comfort
measures (position changes, support
for painful area, relaxation)
Admin meds. for pain as ordered
Figure 4 A concept map of cervical cancer
variation in the structure and appearance, and encouraging
their use by integrating this strategy into assignments
(Irvine 1995). The ability to eciently identify and assimilate key concepts within printed text, lectures, and the
various clinical settings is crucial to academic success
(Hirumi & Bowers 1991). Additionally, concept maps have
been useful in improving academic writing.
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
1217
A.C. All and R.L. Havens
:
pr
oto
co
l
ee
d
be
am ed t
dr
ail
bu o
sr
lat
e
pa aise
tie d
nt wh
is
e
n
in
be
be
d
ins po d in
tru siti
l
ct on owe
pa to st
tie
nt floor
to
for ask
as
st.
Ev
al
ati
en
ta
sn
is
res
pa
mi
e
h
d
ed g
sid le
ht nd
d
rig rm a
de
a
ee
of
en
nc e
a
t
sis lat
as mbu
a
to
lp
he
s:
for
me
y
sk
tco
a
lit
u
l
o
il
bi
M
dat
tw
o
O
y
n
a:
R
t
d
e
ili
tie
righ
lM
tic ob
pa eede
c
y
a
a
m
t
p
r
hem -sid
n
c
i
ra
e
li l p gain
as
ipa ed
th
ys
w
e
res
nee
al
nt o r
is in
ds
Ph
sic d
tie es t
y
a
h
arm
h
e
e
s
d
p ci
lp t
p ect
e
r
and
o
oa
out
f
e
ir
mb
com
ll d of af red
ex
leg
a
i
u
w e
p
e
late
e
t
m
s:
n us ord
a
m
e
i
i
n
I
t
tain
pa gain g as d/or
a
sR
c
le n
OM
re
mo hieve
to and an a
in u
orig
bili
ty
ci
naf
py
ina
ma
arm hysi era
fec
l
i
lev
ted
reg ntain
p l th
e
l of
y
join
b sica
by imen s da
phy
t
ily
phy
y
a
sica
p
h
s
e
hys
p
pre
sic
xer
l
:
ata
l
s
A
for
k
Ris
fear
apprehension
increased tensio
situational crisis
n
diagnosis of
cancer
brain and lung
threat to
self-concept
ie
on
facial tension
An
x
ati
s:
tion
rven
ths
inte
hclo
s stressors
outcomes:
was
patient identifie
wet
ty
g :
Re
in
rs ns
lat
ed
Nu ntio
ed
d
e
to
s
e
v
r
e
r
a
Th
n
e
te
f
d
s
rea
e
In
ts
d
ta
to
ee
or
on es
ien
i
t
n
p
t
rC
a
a u
p
s
p
x
u
a
q
ha
i
st
la
n
to
rs
ng
re chn
ue
t
io
n
fe
t
q
f
e
e
ei
a
e
t
t
ac
o
s
t
a
l
m
e
o
r
nH
lis
i
r
t
t
il
va
s
o
f
E
n
m
ea
m
o
e
in
a
f
lth
h
r
m
t
r
e
fe
e
f
w
d
St
o
w
o
l
s
atu
l
A
An
s
ir
sp
t
da
a:
rates
patient demonst
skills
effective coping
rates
patient demonst
iques
relaxation techn
rates
patient demonst
sion
decreased ten
sing
da
ta:
t
t hr
fo o m oat
r b ed nu
we
ro ic m
r
n
e
ch atio b
fle ak c
i
os ns
x
ou
sw mpa
co
gh
all ire
py
ow d
o
u
t o
ing
c
p
m
r at
es
o ep ien
f
:
nu ort a t w
p
il
m
h at
bn bse l
r av ient
es nce
n efl e
s
ra orm ex, a go will
te
al cle od
r
es ar l co
pir un ug
ati gs h
on an
d
Nur
Nutr
ition
Alter
ed: H
igh R
isk f
or Le
ss th
an B
ody R
equir
emen
ts
l
Eva
t
roa
in Th
+5
s:
ome
te
outc
lera
ill to
nt w
patie
iet
to
lar d
t
nce
regu
dva uid die
ill a
liq
nt w
om
patie r diet fr
la
regu
ys
sa
nt
g
ie
t
in
app
pa rts
ac
lied
to
u
im
r
h
at
thro
lg
at
ice b
ro
ia
th
ag a
ac
ppli
n
f
o
ed t
o
k
nd
thro
as
ice c
ha
at
m
hips
al
to s
as s
i
c
uc
n
oon
fa pai
as N k on
PO O
pop
:
s
of
sicle
K
es
se
to c
m
es
ool
thro
co
pr
t
x
a
u
t
e in
thro
o
s
nt a
orde at loze
ie p
se
n
red
at f of
es
by p ges as
p
hysic
pr
ie
l
x
ian
e
re
nt
Eva
tie rt
n
l
no i
pa fo
s pa
m
ha of
co
t
k
n s
tie ma
pa ial
c
fa
+4
Armband
Heplock
+5
Eval
at
ro
th
in Rt. upper lobe of lung +1
and Stage IV Brain Cancer
in Lt. Temperoparietal
section of Brain with
Rt. sided
Hemiparesis
ia
s
c
the n and cribed ise
/
rap
ist or
po
in
ps
te Nu
in
ic
rv rs
t
l
e
e
a
nt ing
ke
2- pa
io
1- ti
an
:
ns
95 en
data
d
hrs
:
b t
o
95 5
gi
g
e
r u
v
py
t i
1-31
v
e
o
w
e
co tpu
ee en
NPO nchosc lled
lig
rd t
ce
ro
n l
e
ad ht
t
2: iqu
for b ure can
d
nigh
1 id
v sn
ed
5
a
mid
n ac
proc
a s
a
c
2am
n
)
e ka
d nd
95 1 15 min
di ft
5p
2-1s.
et er
m
NPO (14 hr y
as ca
:15
cop
s
to ts
to 2
cho
ch
n
n
o
l
r
lu
er can
for b t and
a
m
t
ed
kfas
–9p
brea
pm
nly
95 5 nack o
2-1s
NPO s – Late
ur
4 ho
ea he o
L.S. 46 yr. old W.F.
tm m r
MCG Hospital 3W368A
en o
t
Patient has Lung Cancer
Pain
ical
Eva
h
ns
Hig
tio
High Risk for Injury
data:
patient
asked
about in
formatio
chemot
n on
he
treatmen rapy and surg
ery
ts for ca
ncer
outcom
es:
patient
will expr
that the
ess
informat
ion is he
lpful
fear and
about tr anxiety
eatmen
ts will
be redu
ced
Patient
will
express
adequa
te know
ledge
Evaluatio
how did n
actually this patient
respond
ler
Nursing
Interventions:
assess cough refl
ex
en
fal
listen to lungs for
adventitious sou
nds
ow
erv
isk
tp
ass
Kn
g
le
rsin
dg
Nu tions:
n
t eD
rve
n
e
e
t
i
t
ef
in
pa rapy
l
l
ic
te
e
it
oth rgery
hem nd su ts for r Re
c
t
n
a
u
e ance
o
la
m
b
t
a
c
te
trea
tor
d
doc ture
to
t
a
ix apy
th
m
n
i
Ca
la
r a ther ent
p
e
x
d
e
nc
or hemo eatm cer
y
r
n
er
t
ma oth c
a
y
c
er
s
for
of b d surg
ion d and
t
s
ue eede
an
q
Su
nts as n
rg
atie
er p
w
s
Tr C ery
an
int
hr
sis
tions:
interven
Nursing
needed
assist as
late
to ambu
hig
as
Learning Outcome
Assess the health
status of individuals
in middlescent
families with actual
or potential chronic
health problems
ess respiratory
rate
ng
NPO p
exam
rsi
Tell patient why
Nu
data:
Figure 5 A concept map of lung cancer and brain cancer
CONCLUSION
One of the most important principles of educational
psychology is that the most important single factor that
influences learning is what the learner already knows. This
needs to be ascertained and then the learner is taught
accordingly. Concept mapping is such a learning/teaching strategy. A concept map is not a complete representation of the relevant concepts and propositions the learner
knows. It is a workable approximation from which stud1218
ents and instructors can consciously and deliberately
expand, move to meaningful learning, and move toward
critical thinking (Heinze-Fry & Novak 1990, Novak &
Gowin 1988).
Perhaps the three areas that oer the best application for
nursing students are extracting meanings from textbooks,
extracting meanings from laboratory and/or field studies,
and planning a paper. Pre-mapping textbook reading
assignments can clue students as to what misinterpretations they should watch for as they read. Concept maps
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1210–1219
Concept mapping
can help the student understand the course of instruction
and retention will be improved with meaningful learning
(Heinze-Fry & Novak 1990, Novak & Gowin 1988).
Students often enter the laboratory or field setting wondering what they are supposed to do or see. Their confusion is so great that they may not see the regularities in
the events or objects they are to observe. The students often
proceed with little purpose. Concept maps can be used to
help the students pre-identify key concepts and relationships. This will aid them in interpreting the events and
objects they are observing (Novak & Gowin 1988).
There is no best way to introduce concept mapping.
Students need to be introduced to their format, their application, their construction and convinced that maps will
help them see the nature and role of concepts and the
relationships that exist. The aim of concept maps is to help
students learn how to learn. Concept maps have been used
successfully in teaching and planning instruction in
English literature, mathematics, music, science, and engineering. They can become a useful strategy in instructing
nursing students in the classroom and clinical settings.
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