Figure 27-2 Concept maps showing pathophysiology of diabetes mellitus. (A) Lack of insulin leads to two basic problems. (B) Cell starvation and hyperglycemia cause specific reactions in the body. (C) Further reactions and derangements occur. This represents a domain of the concept map. (continues)

INSULIN

causes

Cell starvation

Hyperglycemia

!

!

A

INSULIN

causes

Cell starvation

Hyperglycemia

!

!

leads to

produces

produces

triggers

Osmotic

diuresis

Ketogenesis

Gluconeogenesis

causes

POLYPHAGIA

B

POLYURIA

secretion

POLYURIA

increases

of Na & K

triggers

POLYDIPSIA

causes

dehydration

produces

leads to

causes

causes

hypoperfusion

hypovolemia

hypoxia

hemoconcentration

C

63442_CH27_F0002_a.eps

63442_CH27_F0002_a.eps

430 Chapter 27 • NursiNg proCess MappiNg

secretion

of Na & K

causes

hemoconcentration

volemia

increases

leads to

hypo

ued)

xia

YURIA

iggers

ydration

. (contin

leads to

causes

tr

causes

Hyperglycemia

Osmotic

diuresis

hypo

POL

deh

!

GIA

produces

increases

INL

iggers

YPHA

hypoperfusion

U

tr

S

o metabolic acidosis

POL

IN

causes

causes

lactic acid

production

vation

YDIPSIA

ysiology leading t

POL

thoph

Cell star

produces

Gluconeogenesis

!

tinuing paon

etosisK

) C(D

leads to

produces

etogenesis

e 27-2

K

Figur

D

Using the Method 431

ia,

, polyur

secretion

of Na & K

causes

hemoconcentration

es mellitus

volemia

increases

leads to

hypo

xia

tions of diabet

YURIA

iggers

ydration

esta

leads to

causes

tr

Hyperglycemia

Osmotic

diuresis

causes

hypo

POL

deh

!

.

GIA

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increases

our of the manif

IN

tionships

L

iggers

YPHA

hypoperfusion

U

tr

ela

S

ting f

POL

IN

causes

causes

esen

epr, r

lactic acid

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vation

YDIPSIA

ept map

POL

onc

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d

e c

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Gluconeogenesis

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omplet

ia and metabolic acidosis and their r

etosis

The c

K

causes

Metebolic

acidosis

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leads to

produces

etogenesis

e 27-2

K

dipsia, polyphag

Figur poly

E

432 Chapter 27 • NursiNg proCess MappiNg

Teaching this way is adaptable to almost any pathophysiology and can also be used to teach anatomy and physiology, pharmacology, and treatment modalities.

Inspiration 8, a concept mapping software, allows the user to input information in an outline format, a foundation of the lecture format. The outline is easily converted to the map format and the instructor can edit as needed. It is a great and simple way to utilize concept maps in lecture.

enhancing learning and critical thinking skills

Traditional note taking and study techniques, such as flash cards and outlining chapters, tend to fracture knowledge. Concepts are not seen in relation to other knowledge using these techniques and are not assimilated (Vacek, 2009).

According to De Simone (2007), concept mapping allows students to classify and arrange information on paper. Thus, they can see missing information, areas that need to be further explored and relationships between facts. Students who utilize concept maps in this way have a higher degree of involvement in learning and retain more knowledge (Covey, 2005; De Simone, 2007; Vacek, 2009).

Cmap tools, a free downloadable software package, allows users to work collaboratively to develop concept maps. Students work in groups to answer questions assigned in class. For example, one group may answer the question,

“What causes hypertension?” while another works on “What are the macrovas-cular effects of hypertension?” Once completed, the concept maps are available, via the Web site, for all students in the class to use or modify. Working together, the students develop skills necessary for critical thinking, as well as interpersonal skills useful in their chosen profession (Fig. 27-3).

Introduction to concept mapping as a learning tool can be done in a nonthreatening way in the classroom. Case studies are a proven means of stimulating critical thinking in the classroom. This is an active learning technique that requires analysis of information, recall of facts, and reasoning to understand pathophysiology, patient problems, or other concepts (Sandstrom, 2006). After the case study is presented, students are divided into groups, provided with large sheets of paper (bulletin board paper works well) and markers. They may be given focus questions and key words to guide their map-making experience. During the first encounters with this process the instructor may need to provide significant guidance. However, students become adept at this process with a few experiences (De Simone, 2007).

organizing care

The traditional nursing care plan, linear and columnar in design, prevents visualization of the patient as a whole. Significantly, the patient is seen one problem at Using the Method 433

y lead to

t Disease

Ma

Hear

Causes

ascularV

Resistance

Increased

anced Age

Causes

Stress

Begins

ation of the

Adv

Activ

Causes

Fight or Flight Response

.

Causes

Leads to

Causes

e

ursing

y lead to

Ma

tension

Causes

Hyper

Leads to

High Sodium Intak

Causes

ary Black School of N

Causes

iction

Leads to

olumeV

pstate, M

Atherosclerosis

asoconstr

tension.

V

SC-U

Causes

, U

Causes

High Blood

yper

Leads to

Leads to

Leads to

ine RetentionUr

Causes

Sidney Ritts, SN

ia

wing causes of h

y lead to

y Disease

Causes

Causes

olyurP

Leads to

Ma

ission from

Can lead to

Kidne

Leads to

High Blood Osmolality

High Cholesterol

ept map sho

Leads to

ith perm

Conc

Can cause

Obesity

e 27-3

Leads to

Causes

Resistance

Source: Reprinted w

Type II Diabetes

Increased Insulin

Figur

434 Chapter 27 • NursiNg proCess MappiNg

.

pain, pain

decreases

appetite and

can impair

metabolism

, decreased

.

Poor nutritional

status increases

form essentials.

.

vation techniques.

y status.

ces.

vation techniques.

y stasis,

y.

for infection

s energy resour

Immobility can

lead to pooling

of secretions,

urinar

increasing risk

ve and document response to activity

each energy conser

each patient and caregivers to recognize

Activity Intolerance R/T pain, decreased nutritional

status, impaired gas exchange, AEB fatigue,

and weakness.

1. Assess patient’s level of mobility

2. Assess nutritional status.

3. Assess cardiopulmonar

4. Obser

5. Anticipate patient’s needs.

6. Prioritize tasks and only per

7. Encourage physical activity consistent with

patient’

8. Provide emotional support and promote positive

attitude regarding abilities.

9. T

10. T

signs of physical overactivity

each patient nutritional requirements related to disease process.

each patient and caregivers energy conser

ing the clinical da

Impaired nutrition: Less than body requirements R/T

intake & increased metabolic needs AEB decreased protein & albumin, NPO status, weakness, fatigue

1. Assess nutritional status, including daily wts,

monitoring lab values, calorie count.

2. Administer IV fluids as ordered.

3. Administer parenteral nutrition as ordered.

4. T

5. T

,

t dur

mobility

movement

tien

Pain decreases

increases pain

.

40 yo male

UOP 60 cc/hr

Foley catheter

67” 170 lb NKDA

status

c/o abd pain x 3 days

Decreased

nutritional

or their pa

pain 8/10 to surgical site

increases risk

for infection

w/N/V/D abd distension x 24

hours hx of diverticulitis POD 1, S/P

T101 O2 Sat 94% 2 L/min NC C/O

colectomy VS: HR 104, 108/52, RR 22,

o do f

.

t plans t

.

, HR, and RR, diaphoresis, anxiety

.

.

,

t the studen

y.

.

ventions.

y effort.

view of wha

y.

ver

, onset, duration, precipitating, or relieving factors.

vation techniques, about oxygen therapy

, severity

.

e map is an o

y.

, and confusion.

y status including lungs sounds, sputum, increased SOB.

y toilet and encourage use of incentive spirometr

A car

Hypoxia increases pain

Decreased tissue oxygenation increases risk for infection

ve/monitor for accompanying signs and symptoms of pain, i.e., increased BP

e 27-4

each patient and caregivers to report pain.

each and encourage use of incentive spirometr

each patient and family oxygen conser

each patient and caregivers importance of above inter

each patient and caregivers signs and symptoms of infection and when to report.

Pain R/T surgical incision AEB patient complaint

1. Assess for pain, including quality

2. Obser

3. Assess patient’s expectations of pain control and past experiences.

4. Respond immediately to complaints of pain.

5. Administer analgesics as ordered, monitoring for effectiveness and side effects 6. Provide for adequate rest and quiet environment.

7. Employ nonpharmacological pain relief measures appropriately 8. T

9. Instruct patient to evaluate and report effectiveness of pain relief measures.

Impaired gas exchange R/T hypoventilation & atelectasis AEB

increased HR & RR, need for oxygen to maintain stats, easy fatigability complaints of SOB

1. Assess lung sounds, noting adventitious sounds or decreased ventilation.

2. Assess for signs and symptoms of hypoxemia, including tachypnea, tachycardia, lethargy

3. Monitor pulse oximetr

4. Maintain oxygen administration as ordered to maintain oxygen saturation above 90%

5. Position patient in high fowlers to decrease respirator 6. T

7. Assist with and pace activities to decrease oxygen consumption.

8. T

Risk for infection R/T surgical incision, central venous access, impaired nutritional status, impaired gas exchange

1. Monitor for signs & symptoms of infections, including elevated temp, redness, swelling, pain, purulent drainage at incision, IV & drain sites.

2. Monitor respirator

3. Monitor urine for cloudiness, foul smell, and sediment.

4. Use and encourage frequent hand washing.

5. Use aseptic technique for dressing changes.

6. Ensure Foley catheter is draining with no dependent loops and tubing is anchored appropriately Provide catheter care daily

7. Provide respirator

8. Limit visitors.

9. T

10. T

Figur

Conclusion 435

a time, with no connection indicated between the problems. Also, these care plans are not usually used for planning; rather they are used to summarize care provided or that should have been provided (Covey, 2005; Taylor & Wros, 2007).

Care mapping can be used as a component of a traditional care plan. It puts the patient’s problems on one page and organizes problems in a way that makes sense to the student. A care map is not the complete care plan, but is an overview of what the student plans to do for their patient during the clinical day (Fig. 27-4).

It is completed after the student has gathered information during preplanning.

A complete nursing care plan includes the care map, attached forms that detail each nursing diagnosis (including rationales and outcomes), the client database, assessment, medication sheets, etc.

An attractive element of the care map is that important information, including problems, assessment data, and planned interventions, is on one page and can be easily carried and referenced throughout the clinical day. Notes regarding patient response and other relevant data can be jotted down on the care map.

Additionally, the care map allows the student to make connections between different nursing diagnoses and interventions. It is sometimes difficult for students to grasp that interventions for one nursing diagnosis can negatively impact another nursing diagnosis. For example, the common intervention of giving the patient an opioid for pain can impact that patient’s gas exchange. When these nursing diagnoses are on separate pages they are easily compartmentalized and the student can overlook these connections. With a care map, connections are indicated using lines and arrows with words that indicate the connection. Students frequently state that care maps help them understand that patient problems have complex links to each other that need to be considered when planning care.

conclusIon

Nursing and health education are by no means unique in the requirement of their students to develop critical thinking skills. The development of these skills is imperative for the healthcare provider to successfully care for their patients. Critical thinking allows the user to take rotely learned concepts and connect or link them to understand the complex problems that affect their clients. Utilizing concept maps offers a method that is easily adaptable throughout the curriculum and is inherently individualized. It provides a visualization of knowledge guided by the particular student’s learning style and understanding of material. While initial implementation may be difficult and seem unwieldy, the benefits of concept mapping as a teaching and learning tool are unquestionable. If we are to educate students to become the best nurses possible, we must continually adapt and modify our teaching methods to meet the demand of the constantly changing profession and student.

436 Chapter 27 • NursiNg proCess MappiNg

references

Ausubel, D. P. (1963). The psychology of meaningful verbal learning. New York: Grune and Stratton.

Ausubel, D. P., Novak, J. D., & Hanesian, H. (1978). Educational psychology: A cognitive view. New York: Holt, Rinehart, and Winston.

Covey, D. (2005). Using concept maps to foster critical thinking. In L. Caputi, & L. Engelmann (Eds.), Teaching nursing: The art and science (pp. 634–651). Glen Ellyn, IL: College of DuPage Press.

De Simone, C. (2007). Applications of concept mapping. College Teaching, 55(1), 33–36.

Gardner, G., & Hatch, T. (1990). Multiple intelligences go to school: Educational implications of the theory of multiple intelligences (Tech. Rep. No. 4). New York: Center for Technology in Education.

Kelly, E., & Young, A. (1996). Models of nursing education for the 21st century. Review of Nursing Research in Nursing Education, 7, 1–39.

Liling, H., & Suh-Ing, H. (2005). Concept maps as an assessment tool in a nursing course. The Journal of Professional Nursing, 3, 141–149.

Novak, J. D., Cañas, A. J. (2008). The Theory Underlying Concept Maps and How to Construct and use them, Technical Report IHMC CmapTools 2006-01 Rev 01-2008. Florida Institute for Human and Machine Cognition. Retrieved January 8, 2010 from: http://cmap.ihmc.us/Publications/

ResearchPapers/TheoryUnderlyingConceptMaps.pdf

Sandstrom, S. (2006). Use of case studies to teach diabetes and other chronic illnesses to nursing students. Journal of Nursing Education, 45(6), 229–232.

Taylor, J., & Wros, P. (2007). Concept mapping: A nursing model for care planning. Journal of Nursing Education, 46(5), 211–216.

Vacek, J. E. (2009). Using a conceptual approach with concept mapping to promote critical thinking.

Journal of Nursing Education, 48(1), 45–48.

Wagner, W. (1994). Teaching/learning process. Presented at the Teaching Skills for Health Professions Educators, St. Simon’s Island, GA.

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