Creating a Concept Map – custom papers
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: Creating a Concept MapOrder DescriptionTo 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 theconcepts, 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 MicrosoftOffice 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 https://eds.b.ebscohost.com.ezp.waldenulibrary.orgConcept Mapping for Applying TheoryAdvocates 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 ofteaching 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 werepresented 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 andinterconnecting 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 actionresearch 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. Theresearcher suggests that review of nursing theory and the use of concept mapping to analyze its application should be consideredfor 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 totheory-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 withthe 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 topositively 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.JOURNAL FOR NURSES IN STAFF DEVELOPMENTthe community, increasing education opportunities for nurses, and expanding councils that allow nurse par- ticipation in administrative decision making. In the spirit of this cultural evaluationand 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 itdifficult 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 applytheory 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 ofqualitative 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 solvean 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 activeparticipation can have obvious and subtle influences both on the process of the study (in inter- acting with the participants) and on the researcher’sCopyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.17evaluation of the results (in critiquing his or her own performance).CONCEPT MAPPINGConcept 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 rotememorization 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 learnerwho 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 existingprocesses 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 ofmultiple 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 nursingprocess 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 byfaculty 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 analysisof 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.NURSING THEORIESIn 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 adaptationtheory 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 androle-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 thenurse 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 orinstitution 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 briefreview. 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 includebuilding trust by understanding, promoting a positive orientation by nurturing self-esteem and hope, promoting client control while affirming and promoting client strengths, and setting mutualhealth-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 ofeach 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.)PARTICIPANTSThe 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 andto 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 jobperformance. 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 witha 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 councilmembers were given a very brief description of the project and toldJanuary/February 201018Copyright @ 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 theywere 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 includedacknowledgment 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 berespected 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 absenton 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 10participants attended one or more of the four sessions. Six of those received the core lessons on using concept mapping to apply theory to practice.COURSE OF INSTRUCTIONThe 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 ofnursing 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 forpractice. 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 thecomputer-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 familymembers 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 twomaps, 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 interconnectingrelationship 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 ofindividual concept maps of familiar nursing tasks.JOURNAL FOR NURSES IN STAFF DEVELOPMENTInserted 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 representedthe 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 homeworkwere 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 thenpresent their maps to the group. Lesson 4 was a review of the course content.EVALUATIONThis action project resulted in limited measurable data, which consists of preintervention and postintervention opinion surveys. However, because of the disparate sample sizes, those results areprovided 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 thestudy.Opinion SurveyA 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 showTABLE 1Concept Mapping for Applying Theory to Practice Courseof Instruction for Four Monthly Lessons………………………………………Lesson 1: review of nursing theory Overview of nursing theoryKey ideas of five nursing theories Discussion on choosing a theoryLesson 2: concept mappingGroup selection of a theory for the application to practice exerciseOverview of concept mapping with samplesDevelopment of sample concept map Lesson 3: applying theory to practiceDemonstration of theory application by adding theoretical symbols to the sample concept mapConcept map development of familiar nursing tasks, with theoretical symbols addedLesson 4: course reviewCopyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.19FIGURE 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 ofintervention.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 supportanonymity 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 the6 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 sectionadded. 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 inconsistentparticipation, 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 morenursing theories. However, none of the participants claimed a particular theoretical paradigm.ObservationThe 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 homeworkand during the third meeting, six participants developed concept maps for the tasks of administering medication, transfusing blood, ad- ministering an intravenous infusion, performing a qualityJanuary/February 201020Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.TABLE 2 Concept Map-Making Rules ………………………………………Node colors and shapesAssess = pink circlePlan = blue squareImplement = orange rectangleEvaluate = green diamondSpecial influence = white rounded square Knowledge base = white rectangleTheory applicationU = understanding/trustS = self-esteem/hopeC = client control/strengths M = mutual goalsConnecting linesUnidirectional or bidirectional arrowsLine labels Addressed by Assists Determines Evidenced by Influences Orders Relates to Results inassurance 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. Thosewho did not work in direct patient care realized that they used thenursing 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 withsuggestions from the other partici- pants, all were able to indicate where theory could be applied within the concept relationships of their maps.InterviewThe 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 completedthe 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 onpaper 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 ofshowing 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 topractice 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 wasmeaningful, 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 staffnurses 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 inwriting 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 Agree1. 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%JOURNAL FOR NURSES IN STAFF DEVELOPMENT21Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.SUMMARY AND CONCLUSIONSApplying 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 toimprove 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 amethod 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 forunderstanding 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 ofnursing 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 theinstructional 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 theparticipants 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- standinghow 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 interviewresponses 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 nursingtheory 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 amarked in- crease in nurse morale.)Article #2 That must also be used. Reference:Comfort Theory and Its Application to Pediatric NursingKatharine Kolcaba; Marguerite A. DiMarcoDisclosuresPediatr Nurs. 2005;31(3):187-194. Retrieved from https://www.medscape.com/viewarticle/507387_10This can be found on the web.
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