Creating a Concept Map –

: Creating a Concept Map
Order Description
To complete:
¥ Create a concept map demonstrating the linkages and interrelationships of the theoretical concepts. Include a clear problem and purpose statement. Express relational statements linking the
concepts, literally and diagrammatically. You may use Microsoft Word, PowerPoint, or another software application of your choice; however, if you use a product that is not part of the Microsoft
Office Suite, you must be able to save it as a PDF or RTF file.
Include references from the literature to support your work.
Articles# 1 that must be used: Reference:
Veo, P. (2010). Concept mapping for applying theory to nursing practice. Journal For Nurses In Staff Development: JNSD: Official Journal Of The National Nursing Staff Development Organization, 26
(1), 17-22. Retrieved from
Concept Mapping for Applying Theory
Advocates of a return to theory-based practice believe that this will improve clinical outcomes and nurse satisfaction. The research question of whether concept mapping is an effective method of
teaching nurses how to apply theory to their daily practice was tested during an action research project conducted at a community hospital. Registered nurses serving on a practice council were
presented a review of nursing theory and given instruction on concept mapping. Symbols representing theoretical application were added to the usual concept map components of idea nodes and
interconnecting relationship lines. Participants developed concept maps of familiar nursing tasks and were able to apply the theoretical symbols to those maps. Although the limitations of action
research are evident in this study, observations of the members of the small participant group and their interview responses show a positive effect from the instructional intervention. The
researcher suggests that review of nursing theory and the use of concept mapping to analyze its application should be considered
for staff nurse development.
Nursing theory is described as housing the base of knowledge that guides nursing actions (Mitchell, 2002) and functions as a paradigm for the nurse (Parker, 2001a). Advocates of a return to
theory-based practice believe that this will improve nurse satisfac- tion and clinical outcomes as the values that form the basis of nursing theory give meaning to practice and influence care
(Fawcett, 2003). However, staff nurses may believe that theory is ‘‘for nursing educators to teach, not real nurses to use’’ (p. 215) rather than applied in client-focused activity (Woodward,
2003). In 2005, a research project that considered this disso- nance was conducted at a community hospital in the rural Midwest. An employee satisfaction survey at the facility showed nurses with
the lowest job satisfaction of all employee categories. In a serious effort to im- prove nurse morale, the hospital’s senior nursing lead- ership initiated structural and outreach activities to
positively change the nursing culture. These activities included improving nursing’s image in the hospital and
Parrie Veo, MEd, RN, NEA-BC, is Clinical Supervisor, PCRMC Medical Group, Rolla, Missouri.
the community, increasing education opportunities for nurses, and expanding councils that allow nurse par- ticipation in administrative decision making. In the spirit of this cultural evaluation
and change, discus- sions took place regarding the use of nursing theory to inform and give meaning to practice. Nurse preceptors said that staff nurses were often task driven and found it
difficult to explain how theory learned in school guided their daily work. The researcher, one of the facility’s administrative directors, was interested in how nurses could be taught to apply
theory to their daily practice and chose to test the effectiveness of using concept mapping for this purpose as a graduate proj- ect. The study falls under the category of action as a type of
qualitative research. Qualitative research is not experimental but descriptive in nature, with little quantifiable data on which to base practice decisions. Action research is undertaken to solve
an identified problem in the workplace, usually by parties who have a stake in such problem solving, and its limitation is the researcher as active participant (Gay & Airasian, 2003). This active
participation can have obvious and subtle influences both on the process of the study (in inter- acting with the participants) and on the researcher’s
Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
evaluation of the results (in critiquing his or her own performance).
Concept maps represent knowledge organized se- mantically in memory. They may be hand drawn or computer designed and are composed of concept or idea nodes (points or boxes) connected by relation-
ship links (directional lines; Jonassen, 2000). Concept mapping is used as a logic tool that engages learners in critical thinking (Ellermann, Kataoka-Yahiro, & Wong, 2006). Instead of rote
memorization of the subject’s content, the learner identifies important concepts presented and develops the map as a way of understanding those concepts by understanding their interrelationships (
Jonassen, 2000). As a method to connect new ideas to previous knowledge for meaningful learning (Novak & Gowin, 1984), concept mapping is appropriate for the adult as a competency- based learner
who wants to apply newly acquired skills or knowledge to real life situations (Knowles, Holton, & Swanson, 2005). In business settings, con- cept maps may be used to clarify and refine existing
processes or serve as job aids for performance-based instruction (Brethower & Smalley, 1998). Nursing school instructors assign concept maps to develop under- standing of the interaction of
multiple diseases (All & Havens, 1997; Ellermann et al., 2006) and as nonlinear care plans that teach the student the nursing process (Ellermann et al., 2006; Taylor & Wros, 2007). (The nursing
process is the term for circular problem solving, with standard components being assessment, planning, implementing, and evaluating.) Concept maps devel- oped by nursing students and scored by
faculty can be compared over time to determine the novice learner’s transition to expert critical thinker (Abel & Freeze, 2006; Hinck et al., 2006) who uses the cognitive skills of in-
terpretation, analysis, evaluation, inference, explanation, and self-regulation (Ignatavicius, 2001). Concept maps designed by experienced nurses of familiar nursing tasks require critical analysis
of the nursing process and actions associated with those tasks (Johns, 2003). The researcher proposed that the application of nursing theory can be represented on task maps.
In the planned course, key ideas of five nursing theo- ries were presented. The theories, arbitrarily chosen by the researcher as representative, were the caring actualized theory of Nightingale—
the patient has ca- pacity for self-healing facilitated by the nurse’s ability to create an environment conducive to health (Dunphy,
2001); the self-care deficit theory of Orem (2001)—the nurse provides compensatory care while assisting cli- ents to achieve competence in self-care for a goal of self-empowerment; the adaptation
theory of Roy—the nurse promotes patient adaptation in the physiological/ physical, self-concept/group identity, role function, and interdependence modes (Roy & Zhan, 2001); the mod- eling and
role-modeling theory of Erickson, Tomlin, and Swain (1983)—the nurse develops an image and understanding of the client’s world (modeling) and facilitates and nurtures the individual in attaining,
maintaining, and/or promoting health through pur- poseful interventions (role modeling); and the nursing as caring theory of Boykin and Schoenhofer (2001)—all humans are caring persons, with the
nurse coming to know, acknowledge, affirm, support, and celebrate the other as a caring person. Choosing a theory is not a simple task but a dynamic process requiring commit- ment by the nurse or
institution for ongoing analysis and evaluation of the effectiveness of theory (Parker, 2001b). However, for this study, the selection of a nursing theory was made by the participants after brief
review. The group chose the modeling and role- modeling theory for the application to practice exercise. Concept map symbols were developed for this theory’s aims of intervention, which include
building trust by understanding, promoting a positive orientation by nurturing self-esteem and hope, promoting client control while affirming and promoting client strengths, and setting mutual
health-directed goals (Hertz, 1997). (The original project plan envisioned each participant choosing his or her own theory for this exercise, but this was later modified to make group review of
each other’s maps more understandable. The researcher was pre- pared to develop concept map symbols to represent any of the five theories presented for selection.)
The hospital’s nurse practice council was approached to participate in the project. The purpose of the council is to improve nursing practice by review and evaluation of policies and procedures and
to introduce new evidence-based standards to the facility. Members of the council are staff nurse volunteers approved by their directors. They must be registered nurses with acceptable job
performance. At the time of the project, all the members were associate degree prepared, but no other demographic information, such as age or length of service, was obtained. A nurse preceptor with
a bachelor’s degree in nursing is the chairperson for all day meetings held monthly with various agenda. The chairperson was very supportive of the project and encouraged participation. The council
members were given a very brief description of the project and told
January/February 2010
Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
that it would consist of 1 to 2 hours of engagement each month for 4 months at the regularly scheduled council meetings. They appeared hesitant, although the chairperson later reported that they
were agree- able but unsure of what the experience would be. Reassurance was given that participation was optional, and informed consent was offered by the researcher. The consent form included
acknowledgment that the participants ‘‘are expected and encouraged to give feedback regarding the applicability of the topic and the method to their daily work experiences; such feed- back will be
respected and have no influence on any participant’s employment and/or performance ap- praisal.’’ As the chairperson was not a staff nurse, she was not considered a participant in the study,
although she was present for most of the encounters. Attendance at the council meetings is valued and considered man- datory, but patient care takes precedence and may require members to be absent
on meeting day. There also is attrition, with replacements for membership re- signation and medical leave. During the project period, 4 to 8 members were present at any given meeting. A total of 10
participants attended one or more of the four sessions. Six of those received the core lessons on using concept mapping to apply theory to practice.
The researcher presented a course of instruction that consisted of four monthly lessons each lasting 1 to 2 hours and with the following content (see Table 1). Lesson 1 consisted of an overview of
nursing theory, key ideas from five nursing theories, and discussion on choosing a theory. An important component of the project introduction was to establish theory as a philosophy or paradigm for
practice. Lesson 2 provid- ed a review of the first lesson, group selection of a nursing theory for the application to practice exercise, an overview of concept mapping with samples shown, and the
computer-aided development of a concept map for the common task of making dinner. In that map, the person performing the task of making dinner represents the nurse in this lesson, with the family
members receiving the dinner representing the client. Optional homework was assigned to develop a hand- or computer-drawn concept map of a familiar nursing task. It was acknowledged that no two
maps, even of the same task, would be alike. Map-making rules were established that included colored shapes for the steps of the nursing process and function labels for the interconnecting
relationship lines (see Table 2). Lesson 3 consisted of a review of the first two lessons, demonstration of theory application by adding theo- retical symbols to the dinner map and development of
individual concept maps of familiar nursing tasks.
Inserted onto the relationship lines on the dinner map were symbols (U, S, C, and M) for key ideas in locations where those ideas would influence the concepts of the task. The symbols represented
the modeling and role- modeling theory’s aims of intervention: understanding/ trust, self-esteem/hope, client control/strengths, and mu- tual goals (see Figure 1). Two concept maps done as homework
were reviewed. The other participants were instructed to make individual hand-drawn concept maps of familiar nursing tasks. All were to insert the theoretical symbols where appropriate and then
present their maps to the group. Lesson 4 was a review of the course content.
This action project resulted in limited measurable data, which consists of preintervention and postintervention opinion surveys. However, because of the disparate sample sizes, those results are
provided only to show the study content, not as valid evidence. The researcher’s observa- tions and the postintervention interviews are used for evaluation and to support the conclusions from the
Opinion Survey
A five-item survey was designed to measure partici- pants’ opinion and understanding of nursing theory, the nursing process, applying theory to practice, and theory giving meaning to practice.
Results could show
Concept Mapping for Applying Theory to Practice Course
of Instruction for Four Monthly Lessons
Lesson 1: review of nursing theory Overview of nursing theory
Key ideas of five nursing theories Discussion on choosing a theory
Lesson 2: concept mapping
Group selection of a theory for the application to practice exercise
Overview of concept mapping with samples
Development of sample concept map Lesson 3: applying theory to practice
Demonstration of theory application by adding theoretical symbols to the sample concept map
Concept map development of familiar nursing tasks, with theoretical symbols added
Lesson 4: course review
Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
FIGURE 1 Sample concept map of the common task of making dinner. Theoretical application is indicated by symbols (U, S, C, and M) representing the modeling and role-modeling theory’s aims of
whether or not gains were made because of the instructional intervention. The survey tool used a Likert scale (strongly disagree, disagree, undecided, agree, and strongly agree) and to support
anonymity did not have an identifier such as name. Nine of the 10 participants completed the preintervention opinion survey as they entered the project at the first or second sessions. Five of the
6 participants who received the core lessons on using concept mapping to apply theory to practice completed the postintervention survey. The postintervention survey form had a comment section
added. Only one survey had comments: ‘‘I enjoyed the presentations. I did gain some knowledge and it will be helpful in my daily tasks.’’ The unmatched sample sizes reflect the inconsistent
participation, and so no con- clusions will be made from the survey point compar-
isons (see Table 3). Although associate degree programs may have limited focus on nursing theory in their curricula, the respondents to the survey answered that they were familiar with one or more
nursing theories. However, none of the participants claimed a particular theoretical paradigm.
The researcher initially sensed participants’ wariness, as evidenced by cool demeanor and few comments. This perception changed as council members later expressed interest in the topic. As homework
and during the third meeting, six participants developed concept maps for the tasks of administering medication, transfusing blood, ad- ministering an intravenous infusion, performing a quality
January/February 2010
Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
TABLE 2 Concept Map-Making Rules ………………………………………
Node colors and shapes
Assess = pink circle
Plan = blue square
Implement = orange rectangle
Evaluate = green diamond
Special influence = white rounded square Knowledge base = white rectangle
Theory application
U = understanding/trust
S = self-esteem/hope
C = client control/strengths M = mutual goals
Connecting lines
Unidirectional or bidirectional arrows
Line labels Addressed by Assists Determines Evidenced by Influences Orders Relates to Results in
assurance review of a medical record, preparing time records for payroll, and inserting a urinary catheter. One of the maps done at home had been drawn with computer-aided design software. Those
who did not work in direct patient care realized that they used the
nursing process in their daily tasks. The participants took turns presenting their maps, some of which included the theoretical symbols, to the group. Prompted by the researcher and with
suggestions from the other partici- pants, all were able to indicate where theory could be applied within the concept relationships of their maps.
The interview questions were designed to be congru- ent with the course content. The six participants who received the core lessons of using concept mapping to apply theory to practice completed
the interview. On being asked what was the most interesting part of the course, responses were ‘‘choosing a theory,’’ ‘‘applying theory to practice’’ (the most frequent response), ‘‘putting on
paper what you are thinking,’’ and ‘‘the realization that (the) nursing (process) applies to many fields of nursing, not just direct nursing care.’’ All agreed that concept mapping is a good way of
showing the nursing process, but comments were made that this method is lengthy and very involved with detail. All also agreed that inserting theory into a concept map makes applying theory to
practice more understandable, with the com- ment that this would be especially helpful for a new nurse. There was unanimous agreement that this con- scious application of theory to practice was
meaningful, with one ‘‘somewhat’’ response and one statement that what was meaningful was the realization of how much goes into performing a task. There was near-unanimous agreement that staff
nurses would benefit from training in using concept mapping to apply theory to practice, with one ‘‘undecided’’ and one suggestion that this be put in computer-based learning format. ‘‘Undecided’’
was the primary response to the question of whether the hospital should select a particular nursing theory as a paradigm for nursing practice. There was one comment that this could be helpful in
writing policies but that a particular theory should not be ‘‘forced on nursing—that should be individual preference.’’
TABLE 3 Opinion Survey Results ………………………………………………………………………………….
Preintervention (n = 9) Postintervention (n = 5) Opinion Survey Items Agree Strongly Agree Agree Strongly Agree
1. I am familiar with one or more of the nursing theories. 89%
2. I utilize theory to guide my nursing practice. 78%
3. I use the nursing process (assess, plan, implement, and evaluate) 56% in my daily work.
4. I know how to apply nursing theory to the nursing process. 67%
5. I believe that nursing theory gives meaning to nursing practice. 78%
11% 80% 20% 0% 100% 0% 33% 60% 40%
11% 80% 20% 0% 60% 40%
Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Applying a theoretical paradigm to nursing practice is believed to improve nurse satisfaction, but staff nurses may not be skilled at doing this. Prompted by nursing leadership activities to
improve nurse morale at a com- munity hospital, this project tested concept mapping as an effective method for teaching nurses to apply the- ory to their practice of nursing. Concept mapping is a
method of learning that uses critical thinking to orga- nize ideas in symbolic concept nodes, with lines show- ing interrelationships among those nodes. Nurses can develop concept maps for
understanding disease pro- cesses, planning care, analyzing nursing tasks, and for use as evidence of competency. Inserting theoretical influ- ences symbolically onto task maps may increase under-
standing of how theory influences practice and give nurses the skill to draw on that paradigm when provid- ing nursing care. Experienced staff nurses were given lessons that included a review of
nursing theory and its application in developing concept maps of familiar tasks. Measurable data for evaluating this method are the re- sults of the opinion survey conducted before and after the
instructional intervention, but the inconsistent sam- ple sizes preclude valid comparison. Other limitations of the study are the immeasurable influence of the re- searcher’s interaction with the
participants and the im- pact of the theory review. Such a review is not a regular occurrence outside the academic setting and may have been a greater lesson than concept mapping in under- standing
how theory can affect daily practice. However, the six participants who received the core lessons were able to indicate theoretical application on the concept maps they made, and their interview
responses were generally positive about the method. The researcher suggests that there is value in providing training for nurses on how theory can be applied to their practice. Review of nursing
theory and the use of concept mapping to analyze its application should be considered for staff nurse development. (As a footnote, a later employee satisfaction survey at the facility showed a
marked in- crease in nurse morale.)
Article #2 That must also be used. Reference:
Comfort Theory and Its Application to Pediatric Nursing
Katharine Kolcaba; Marguerite A. DiMarco
Pediatr Nurs. 2005;31(3):187-194. Retrieved from
This can be found on the web.

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