Nursing Care Plans versus Concept Maps in the Enhancement of Critical Thinking Skills in Nursing Students Enrolled in a Baccalaureate Nursing Program

Article excerpt

Appropriate and effective critical thinking and problem solving is necessary for all nurses in order to make complex decisions that improve patient outcomes, safety, and quality of nursing care. With the current emphasis on quality improvement, critical thinking ability is a noteworthy concern within the nursing profession. An in-depth review of literature related to critical thinking was performed. The use of nursing care plans and concept mapping to improve critical thinking skills was among the recommendations identified. This study compares the use of nursing care plans and concept mapping as a teaching strategy for the enhancement of critical thinking skills in baccalaureate level nursing students. The California Critical Thinking Skills Test was used as a method of comparison and evaluation. Results indicate that concept mapping enhances critical thinking skills in baccalaureate nursing students.

The current health care environment has changed significantly over the past decade. Contributing factors include the increasing level of acuity and advances in equipment, medications, and treatments. Therefore, it is essential that nurses are able to critically analyze significant amounts of information in the clinical setting in order to determine the appropriate course of action based on patient data. The need for expert clinical judgment is an essential skill for every nurse.

The purpose of this study was to compare the difference in impact between care plans and concept maps on critical thinking skills of baccalaureate nursing students as determined by the California Critical Thinking Skills Test (CCTST; Facione & Facione, 1996). The research question for this study was, "Is there a significantly greater improvement in the critical thinking skills of baccalaureate students using concept maps than for students using nursing care plans?"


The literature identifies several strategies to improve critical thinking in students as well as in newly graduated nurses (Castellino & Schuster, 2002; Clayton, 2006; Daley, Shaw, Balistrieri, Glasenapp, & Piacentine, 1999; Ferrario, 2004; Hoffman, 2006; Khosravani, Manoochehri, & Memarian, 2005; King & Shell, 2002; Paul & Heaslip, 1995; Shin, Lee, Ha, & Kim, 2006; Spelic et al., 2001). Among those Tina Sinatra-Wilhelm, recommendations was the use of concept mapping in addition to nursing care planning to improve critical thinking skills.

Concept Mapping

The process of concept mapping is described by Kostovich, Poradzisz, Wood, and O'Brien (2007) as a strategy that promotes meaningful learning in student nurses as well as a useful tool for promoting critical thinking skills for nursing faculty. A holistic view of the patient was identified in the use of concept mapping by both students and faculty. These authors state that students can learn to recognize the relationships between the patient and his or her health issues in order to make appropriate clinical decisions. The use of concept mapping challenges the student to use new approaches to thinking, therefore enhancing critical thinking skills (see Figure 1).

Similarly, Taylor and Wros (2007) found that the process of concept mapping is well received by nursing students as well as nursing faculty. Some students had difficulty with concept maps, mainly those who identified problems with visual learning. According to Ellermann, Kataoka-Yahiro, and Wong (2006), concept mapping has been identified as a method that is geared toward the visual learner. Successful use may require faculty support to address different learning styles. Incorporating concept mapping into the classroom setting was also suggested to enhance the concept of critical thinking.

Nursing Care Planning

Nursing care planning was designed to teach nursing care in a systematic and structured way. The concept of the nursing care plan facilitates the identification of pertinent patient concerns, delegation and direction of nursing care, systematic collection of relevant assessment data to aid in formulating nursing diagnoses and a plan of care, implementation of the plan, and evaluation for effectiveness in order to improve patient outcomes. …


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