Concept mapping: an effective, active teaching-learning method.
ABSTRACT Nurse educators, under pressure to prepare graduates who are able to think critically and solve problems in a variety of clinical practice settings, require active teaching strategies to promote meaningful learning, instead of relying on traditional methods that promote rote memorization. A review of the current state of the science with regard to concept mapping demonstrates that this teaching-learning method assists nurse educators to prepare graduates to think critically in the complex health care environment. However, further research is needed to determine the effectiveness of concept mapping on the graduate's performance on the NCLEX exam and on critical thinking and prioritization skills in the clinical environment.Key Words Concept Mapping--Critical Thinking--Nursing Education --Teaching-Learning Method
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THE ABILITY TO THINK CRITICALLY and solve problems in a variety of clinical practice settings is a requirement for new nurse graduates. For faculty, factors such as increased patient acuity, shorter hospital stays, and increasing demands on transitional care, long-term care, and home health care have contributed to a growing need to use active teaching strategies to promote meaningful learning. As Black, Green, Chapin, and Owens have stated, "The student in the new millennium can no longer depend on rote memorization to make the transition from theory to clinical" (1, p. 6). * Concept mapping is an active teaching strategy that can help nurse educators prepare graduates to think critically in today's complex health care environment. THIS ARTICLE examines empirical studies on the use of concept maps as a teaching-learning method in nursing and discusses the effectiveness and limitations for teaching and learning and implications for nursing education.
Definitions and Theoretical Framework Meaningful learning, based on Ausubel's assimilation theory of learning (2), is the theoretical foundation for concept mapping. Ausubel used the term meaningful learning to identify a process of integrating new knowledge acquired by individuals with relevant knowledge that they already possess. He believed that as an individual learns new knowledge, knowledge is rearranged and reordered to allow the learner to develop meaning and understanding of the concepts. Learning is more likely to occur when information is presented in meaningful ways that assist the learner to develop links between the old and new concepts.
Novak and Gowin first introduced concept mapping in 1984 to facilitate the process of meaningful learning. They defined the concept map as a schematic diagram that represents key concepts in a framework of propositions (3, p. 15). The authors also outlined criteria that can be used by nurse educators when evaluating the student's concept map. These specifically address the student's understanding and linkage of concepts.
In 1997, All and Havens defined concept mapping as a pictorial arrangement of key concepts that are unique to a specific subject (4). Koehler noted that in nursing education, concept maps are developed from assessment data collected by students either through case studies or their clinical assignments (5). The concept map develops as students diagram the relationships among various clinical data.
Concept mapping assists students to develop relationships among different bits of information (4,6-10) and build on previous knowledge and skills (7,11). As a motivator for student learning (12), concept maps result in higher academic achievement (12-14). In nursing education, maps have been used to help students develop critical thinking skills (6,9,10,15,16), provide holistic, patient-centered care (9), prepare for clinical learning activities (7), and link theory to clinical practice (1,10,17). Irvine noted that concept mapping assists in the development of meaningful learning and may help nurse educators become more effective as teachers (18).
Concept maps have been used in lectures (4-6,12), group work (5), class discussion (19), skills laboratories (19), and clinical learning activities (4-7,12,20). They are also used in continuing education activities (21,22), staff development (21-23), and in patient education (24).
Several authors have recommended replacing traditional care plans with concept mapping (5,9,20). The rationale for this recommendation is based on the notion that care plans typically are done in a retrospective manner with emphasis on students' using the correct format as they develop a single patient problem. Often this process is very structured, resulting in students' copying information directly from textbooks.
The Identification of Research Studies A literature review was conducted to identify research studies on the use of concept mapping as a teaching-learning method in nursing education. Computerized searches of PubMed, CINAHL, ERIC, and Academic Search Premier databases from 1980 to November 2004 used the following keywords: concept mapping, nursing education, and research. The goal was to find evidence on which to base nursing education recommendations for the use of concept mapping as a teaching-learning method.
Seven research studies were found that focus on the use of concept mapping in undergraduate nursing courses such as fundamentals, research, pharmacology, medical-surgical, and pediatrics (21,22,25-29). Five studies were conducted in the United States; two were conducted in Australia. The studies are summarized in Table 1 (page 200).
Of the seven studies, five involved the use of pretests and posttests; two involved posttests only. The mean sample size for all studies was 48 (range 6 to 111 participants). Three had sample sizes between 50 and 100; in three studies, the sample size was less than 50. Methods for sample selection varied. All studies used a convenience sample; two used random selection and one study used random assignment for the selection of participants. Two studies compared control and experimental group outcomes. The duration of the studies ranged from 28 hours to 16 weeks; most studies lasted between 10 and 16 weeks.
Student exposure to concept map development occurred in a variety of ways. In five studies, students were exposed to concept maps through classroom instruction, handouts, and examples. In one study, the researchers interviewed students and clinical instructors and constructed concept maps based on their comments and on information in the course syllabus. These were provided to students and clinical instructors for their review and input prior to data analysis. In the last study, the method of exposure was unclear.
In three of the six studies in which students created concept maps, students worked alone. In the other three studies, they worked in groups. Feedback on completed concept maps was received from peers in two studies and faculty in four studies. In two studies, students created concept maps in the classroom or clinical setting; in three studies, maps were created outside the classroom or clinical setting.
The following brief descriptions of the seven studies supplement the analysis in Table 1.
1. ROODA (25) found concept mapping to be an effective tool for improving the academic performance of sophomore-level BSN nursing students in an introductory nursing research course. Using an experimental group and comparable control, Rooda compared average exam grades on each of three exams administered during the course. Students in the experimental group commented that this course was the most informative they had completed and that the concept mapping teaching strategy was fun to use and helpful for learning content.
2. DALEY (21) constructed concept maps through structured interviews with students and faculty and from information obtained in a course syllabus for a unit on oxygenation. The purpose was to identify how first-year, first-semester associate degree nursing students applied theory to practice. The maps reflected the difficulty that beginning students have in linking concepts of the nursing process and basic science.
3. GAINES (26) examined the effectiveness of using concept maps as a teaching strategy for juniors in a BSN pharmacology course. Working in small groups, students developed concept maps for certain drug categories. Comparing exams with grades on concept maps, Gaines concluded that concept maps may help students attain success in the course and in the nursing program.
4. CAELLI (27) explored the effectiveness of concept mapping in helping beginning nursing students develop a positive concept of health. Students constructed concept maps related to health and brought them to lectures and small-group discussions. This provided an opportunity to debate appropriate linkages, concepts, and the identification of positive states of health. At the conclusion of the unit, students completed a final concept map. Caelli concluded that concept mapping can play an important role in assisting nurses toward health promotion practice.
5. DALEY, SHAW, BALISTRIERI, GLASENAPP, AND PIACENTINE (28) implemented concept mapping as a method for teaching and evaluating critical thinking in BSN students during the final semester of the senior year. Using a random sample of three students from each of six clinical groups, they compared first and last maps for hierarchical organization and differentiation of concepts. A significant improvement in the students' ability to conceptualize ideas and think critically was noted. Commenting that concept mapping requires in-depth preparation, students indicated that this teaching strategy may be more beneficial if introduced earlier in the curriculum. Faculty stated that the maps helped them assess which students were safe practitioners. Interestingly, faculty noted that students who had difficulty demonstrating their knowledge verbally were able to so with concept maps; more outspoken students, thought by faculty to understand the information, demonstrated misperceptions and knowledge gaps in their maps.
6. WILKES, COOPER, LEWIN, AND BATTS (22) used concept mapping as part of an independent learning package to teach science to RNs in a BSN program in Australia. Students rated this experience as a positive teaching strategy that facilitated their learning and understanding of concepts of homeostasis, cellular needs, acute inflammation, and blood pressure control. Faculty found that pride in the quality of concept maps was evidence of student motivation to learn. The use of concept maps allowed faculty to spend more time with students who were having a difficult time understanding concepts. The authors noted that concept mapping helped students link science with nursing practice.
7. WHEELER AND COLLINS (29) found concept mapping to be effective in helping junior-level BSN students develop critical thinking skills in the clinical setting. In general, scores on the California Critical Thinking Test (CCTT) increased after the completion of one semester of clinical experience. However, statistically significant differences were not found between the experimental and control groups, suggesting that both methods were effective in helping students develop critical thinking skills.
Comparison of Study Results An overview of study comparisons is found in Table 2 (page 202). This comparison of results focuses on three broad areas: student knowledge, student perceptions, and comments by faculty and students. Three studies suggested that students using concept maps were able to attain higher mean exam scores compared with other students; in two studies, results were statistically significant. In two studies, one of which was statistically significant, higher mean content mapping scores were obtained when comparing scores from initial concept maps with later maps. Two studies suggested an increase in critical thinking skills when students used concept maps to link knowledge and practice.
Students' perceptions regarding the use of concept maps appear to be positive. In three studies, students reported that concept mapping enhanced their ability to integrate knowledge and helped them retain complex information. Three studies identified student perceptions of concept mapping as an appropriate teaching-learning strategy. In one study, students reported an increased motivation to learn and an increased level of satisfaction with courses using concept mapping as a teaching method.
Overall comments from students and faculty were positive regarding the use of concept mapping as an appropriate teaching and assessment tool. Students reported that the use of concept mapping was helpful for understanding complex information, identifying areas for further study, and preparing for exams. Faculty reported that the use of concept mapping assists in the assessment of students' knowledge and critical thinking skills and in the evaluation of clinical performance.
Discussion Analysis of the seven studies yielded three major themes. 1) Concept mapping results in generally positive effects on academic performance. 2) Concept mapping improves students' critical thinking abilities. 3) Concept mapping serves as an appropriate teaching method.
The use of concept maps was shown to enhance academic performance by enabling students to synthesize and retain complex information, thus promoting meaningful learning. And it appears to foster the development of critical thinking abilities, providing a way for faculty to measure students' ability to apply critical thinking skills to client situations. Gaines (26), who incorporated the use of concept mapping into lectures, concluded that their use may have helped decrease attrition by enhancing students' understanding of basic pharmacology. Students also used concept mapping to assist with preparation for class and clinical activities, linking theory with clinical practice, and clarifying key concepts.
While it appears from these studies that concept mapping is an effective teaching-learning method, the existing research on concept mapping is too limited for drawing generalizations. There is a lack of between-group studies and pretest to posttest research on knowledge acquisition. Sample sizes are small, there is a lack of instrument reliability and validity, and a lack of control for extraneous variables. Only two of the seven studies used a control group, and most lacked randomization. Therefore, the results reported here should be used with caution.
Recommendations for Further Research Further research regarding the use of concept mapping in nursing education is needed to address the best times to introduce concept maps, identify methods for assessment and evaluation, and understand how concept maps facilitate student learning and critical thinking abilities. Studies also need to focus on the integration of theory with clinical practice, the effects of using concept maps on NCLEX exam results, and the role of concept maps on knowledge development in practice among experienced nurses. It is important to note that studies need to be conducted on larger, heterogeneous samples in order to determine measurement reliability and validity.
Implications for Nursing Education Despite the limitations in these studies, it seems apparent that concept mapping has the potential to be an effective teaching strategy in nursing education. Wheeler and Collins state, "Concept mapping works. It works from the perspective of the educator trying to develop and measure critical thinking skills, and it works from the perspective of the student trying to master a very complex field" (29, p. 345). However, the challenge to nurse educators occurs when trying to measure outcomes objectively across time and students.
Daley and colleagues (28) recommended introducing concept mapping techniques to beginning level nursing students. If concept maps are to be used for evaluation criteria, students should be given feedback on their maps prior to this use (30). Faculty may choose to introduce concept maps through lectures, providing examples, and providing instruction.
Grading of concept maps can be based on Novak and Gowin's criteria (3). Alternately, the level of student achievement can be evaluated based on the inclusion of the steps in the nursing process and by the number of concepts, relationships identified, quality of relationships presented, and the degree of hierarchies established (7).
References
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Laura H. Clayton, MSN, RN, is an assistant professor of nursing education, Shepherd University, Shepherdstown, West Virginia. For more information, contact Ms. Clayton at [email protected].
Table 1. Characteristics and Findings of Study Author Design Sample Length of Intervention Rooda, 1994 Posttest comparison of Students enrolled in BSN two different classes nursing research course 16 weeks Control (n = 36, spring semester) and experimental (n = 24, subsequent fall semester) No significant differences in age, overall grade point averages, and gender Daley, 1996 Pre/Posttest Randomly selected associate degree Results of concept maps students enrolled in developed from student nursing fundamentals interviews were compared clinical (N = 6) with maps developed from instructor interviews Age 19 to 45, female and review of course syllabus. Gaines, 1996 Posttest BSN students enrolled in pharmacology course 10-week summer or (N = 54) 16-week fall course (each with 48 hours of Mean age = 24.7 class time) 44 women/ 10 men Ethnic breakdown: Comparison of concept African American, 43, maps and corresponding Asian, 5, Caucasian, 2, exam scores Hispanic, 4 Caelli, 1998 Pre/Posttest Paired concept maps from Australia beginning nursing 28-hour unit on health students (N = 111) Comparison of first and last concept maps Daley, Shaw, Pre/Posttest Three final semester Balistrieri, clinical BSN students Glasenapp, 16 weeks randomly selected from Piacentine, 1999 each of six clinical Comparison of first and groups for data analysis second concept maps and scoring (N = 18) following feedback from faculty Wilkes, Cooper, Pre/Post-test Students enrolled in one Lewin, Batts, of two classes 1999 Australia 14 weeks completing a science unit in an RN to BSN Comparison of first and program (N = 14) last concept maps in a nursing science course. Wheeler, Pre/Posttest Junior BSN clinical Collins, 2003 students 16 weeks Experimental (N = 44)/ Comparison of results control group (N = 32) from the overall Mean age = 23.7 years California Critical 72 women/4 men Thinking Test (CCTT) and Students randomly subscale scores for assigned to one of four analysis, evaluation, theory/clinical courses inference, deductive/ (adult health, inductive reasoning pediatrics, women's between the groups health, psychiatric nursing) for first half of semester, then randomly assigned to another course for second half. Students in adult health and one section of pediatrics prepared concept maps as part of weekly clinical preparation; students in other courses completed traditional care plans. Author Student Exposure and Study Findings Development of Concept Maps Rooda, 1994 Students developed Mean grade exam scores concept maps following were 76.8 percent and class instruction, 84.4 percent for control handouts, and group and experimental groups, practice. Feedback was respectively. This was initially received from found to be peers and faculty. statistically Concept maps were significant at 0.001 prepared during class (t = 4.65, df = 176.6). time. Overall mean scores were 4.53 and 4.25 for experimental and control groups, respectively. The difference between the mean scores was found to be statistically significant at the 0.001 level (t = -6.08, df = 97.3). Daley, 1996 Concept maps were The instructor and developed by researchers student concept maps following interviews revealed four areas of with students and difference between faculty and review of students and faculty: 1) course syllabus. students identified general assessment observations rather than meaningful observations; 2) students were unable to link goal setting and outcome establishment with the evaluation process; 3) students had difficulty linking clinical preparation/ study to actual clinical practice; 4) students had difficulty linking anatomy/physiology to clinical practice. Gaines, 1996 Students developed Significant correlations concept maps following of students' knowledge class discussion, were shown between three handouts, and group of eight concept maps practice in which they and exams. received faculty feedback. Concept maps created outside of class time. Caelli, 1998 Students developed Clarity of maps Australia concept maps outside of increased by 86 percent. class time. Seventy-six percent of students rated the use of concept mapping as an effective learning strategy for health (range 4 to 5 on 5-point Likert scale). Daley, Shaw, Students developed Comparison of concept Balistrieri, concept maps after class maps revealed that group Glasenapp, instruction and handouts scores were 40.38 and Piacentine, 1999 during clinical time/ 135.55 on first and received feedback from second concept maps, peers and faculty. respectively. This finding indicated a significant improvement (t = -5.69, p = 0.001) in the students' ability to conceptualize and think critically. Wilkes, Cooper, Students developed Student thinking changed Lewin, Batts, concept maps after class from "what is" at the 1999 Australia instruction, handouts, beginning of the course and group practice. to "how does" at the end Faculty provided of the course, feedback. suggesting acquisition of new knowledge/deeper understanding of content. Wheeler, After class instruction Overall mean CCTT Collins, 2003 and handouts, students experimental group score developed concept maps (M = 1.04, SEM = 0.44, outside of clinical p = 0.02) differed time. significantly from pretest scores, but scores did not differ significantly for control group (M = 0.23, SEM = 0.52, p = 0.52). Table 2. Comparison of Study Results STUDENT KNOWLEDGE Author(s) Higher mean Higher Higher Appropriate exam scores mean critical learning mapping thinking strategy/active scores scores learning Rooda X, S Daley Gaines X X Caelli X X Daley, Shaw, X, S X Balistrieri, Glasenapp, Piacentine, Wilkes, X Cooper, Lewin, Batts Wheeler & X, S X, S Collins STUDENT PERCEPTIONS Author(s) Increased Increased Increased knowledge learning satisfaction integration, motivation with course understanding, retention Rooda X X, S Daley Gaines X Caelli Daley, Shaw, Balistrieri, Glasenapp, Piacentine, Wilkes, X X Cooper, Lewin, Batts Wheeler & Collins COMMENTS Author(s) Positive Positive faculty student comments comments Rooda X Daley Gaines X Caelli X Daley, Shaw, X Balistrieri, Glasenapp, Piacentine, Wilkes, X X Cooper, Lewin, Batts Wheeler & X Collins KEY: X = Criterion met / S = Criterion statistically significant
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| Author: | Clayton, Laura H. |
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| Publication: | Nursing Education Perspectives |
| Date: | Jul 1, 2006 |
| Words: | 4153 |
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