1. Carter-Templeton, Heather PhD, RN-BC
  2. Sackett Fitzgerald, Kay EdD, RN
  3. Carter, Melondie PhD, RN

Article Content


* Nursing informatics research continues to grow as the specialty matures.


* Research in acute care settings was most common, followed by nursing education.


* A wide variety of research designs are represented with many qualitative studies; randomized controlled trials are uncommon.


Faculty assigned to teach graduate nursing students must prepare them for today's modern healthcare environment. Effective use of online programs and applications assist in enhancing students' 21st century skills and engaging them in unique and new learning opportunities-many of which they may not have experienced when seeking previous nursing degrees. This article presents faculty experiences with an online concept mapping application used in an asynchronous graduate online nursing informatics course.



Concept maps are one example of a visual thinking technique. Concepts maps are often used to illustrate thoughts and connections as well as facilitate critical thinking in a nonlinear fashion. Concept maps have been used effectively in both clinical and academic settings1 and may facilitate student engagement with the study topic.2


Concept mapping used in nursing often functions as a conduit to demonstrate critical thinking, which entails reflection, originality, and understanding, and the application of theory in practice.3,4 Furthermore, the capability to illustrate the process of thinking is considered to be a key step in developing cognitive skills essential for practice in a professional setting.5 Concept mapping necessitates the author or developer to have an intellectual grasp on the topic, as opposed to depending on recall alone.6


Concept maps are graphics or illustrations that can be used to connect words, ideas, or elements to a core word or thought. The concept map facilitates communication of the relationships and connections in a visual manner.7 There are many ways to construct a concept map: on paper, a chalkboard, or a smart board. Traditional concept maps may be difficult to revise as the designer or author continues to modify and further illuminate the concepts being shown.


In recent years, a number of digital, user-friendly options have become available and easy to access via the Internet. Concept mapping software may be used by individuals or for collaboration in a group. Concept maps in a digital form may be saved and used later for review or to augment and explain concepts. Concept mapping applications may be accessed and used through computers, tablets, and smartphones to create visual depictions of content being studied. These tools allow for a more in-depth learning experience and conceivably allow for interesting collaborations among students.8


Many different programs with various looks and feels can be found when perusing the Internet for digital concept mapping tools. Some are available free and open source, supporting a number of genres such as social sciences, research, and project management. Most of the tools are versatile, allowing for mind mapping and/or concept mapping. The digital concept map may also support the inclusion of various file types such as audio or video files, hyperlinks, images, and attachments.8


Additionally, a digital concept map typically allows for easy revision and more clear and comprehensible maps.9,10 However, in the past, software costs may have discouraged the use of digital concept maps in the classroom or course. As a result, little discussion in the literature exists regarding the use of online or digital concept maps in online asynchronous courses.


Making matters complex, confusion surrounds terminology used to describe various visual thinking techniques. Unfortunately, many use closely related terms in reference to these techniques, causing misinterpretation for readers and researchers. For instance, some use the term concept map, while others use a closely related term yet the same idea is being described. Eppler7 demystifies the differences in mind maps, concept maps, conceptual diagrams, and visual metaphors, offering clarity for those making choices about applying appropriate visualization methods to display information, noting that there are distinct differences. Specifically, concept maps are used to show relationships between concepts and their examples. They usually have a "top-down" flow.7



Sundry techniques for node-link "mapping"7 exist and are often influenced by a number of disciplines such as computer science, business, psychology, and engineering. Even more specifically, multiple forms of concept maps exist. The type or form of concept maps is usually named for the characteristics being displayed or purpose of the map. These maps can range in complexity from simple to elaborate, often with overlapping connections. Figure 1 offers example images of multiple types of concept maps.

Figure 1 - Click to enlarge in new windowFIGURE 1. Example types of concept maps.


Concept maps, frequently considered creative educational tactics, have become increasingly popular in nursing education. They may also be viewed as an analytical means of learning due to the synthesis, organization, and prioritization that may occur when they are developed. In addition, a substantial amount of articles in nursing oriented literature support the use of concept mapping in nursing education to promote critical thinking.1,8


Some degree of research, mostly descriptive, has been done to verify the effects of concept mapping in education. The remainder of literature surrounding the topic discusses the creation of concept maps and use in nursing education.11 Some literature has focused on the use of concept maps with professional nurse development.12-14


In many cases, concept maps have been successfully used at the undergraduate level to help organize information and assessment data while planning care for assigned clinical patients.10 While limited literature discusses the use of concept mapping in graduate programs, feedback suggests that concept maps are helpful for students in planning and organizing information related to research and for strengthening understanding of complex concepts.15,16 Some authors suggest that meaningful learning results from organizing information as well as describing the relationships of concepts or ideas. Specifically, concept mapping advances careful thought in incorporating evidence and decisive judgments from the clinical environment.1



Nursing informatics roles and compliance issues was the second module of the graduate informatics course. Students were provided an overview of the module, objectives and assignments that were to be completed. Concept mapping as a mechanism for knowledge construction and sharing was introduced to students as a tool to help them learn and explore HIPAA, the Health Information Technology for Economic and Clinical Act (HITECH Act), and their relationship to technology. The learning objectives for this assignment were twofold. First, faculty wanted students to become more familiar with both HIPAA and the HITECH Act. And second, faculty wanted students to become familiar with a more novel technology, which led to integrating the digital concept mapping program into the assignment.


Faculty began searching for an online concept map program that was free and user-friendly and allowed for easy exporting of the student generated file into a format such as Microsoft Word or PowerPoint so that it could be uploaded into the learning management system and reviewed by course faculty. Multiple online concept mapping programs were reviewed, including, Gliffy, and Text2MindMap. (LKCollab, LLC, Milwaukee, WI; was eventually chosen because of the ease of use, no sign-up costs, and easy export to a document that could be submitted electronically.


As stated earlier, a main concept or topic serves as a central point to the concept map. In this case, students usually selected HIPAA and the HITECH Act as their central points. Using the online concept map program, students were able to express in a personal way how complex these laws are and how they relate to each other in the work they do on a day-to-day basis. The concept map provided a clear visual representation of the connections and relationships from the students' perspective.


Students were instructed to review assigned readings from their informatics text, selected articles, and Web pages from the US Department of Health and Human Services pertaining to HIPAA and the HITECH Act. Assignment instructions stated that students were to describe and share the implications of these laws in their day-to-day practices. The instructions prompted students to think about describing HIPAA and the HITECH Act to someone who had never heard of them before. Students were also provided a copy of the rubric (see Table 1), which assisted faculty with evaluation. However, the criteria for evaluating the concept maps were broad in an effort to encourage and facilitate learning and creative expression in a digital format.

Table 1 - Click to enlarge in new windowTable 1 Criteria for Evaluation in Concept Mapping Rubric

The rubric criteria included assignment instruction reiterated in the form of a table offering evaluation criteria and points possible for each criterion. The rubric listed descriptions and implications of the HITECH Act and HIPAA illustrated using an online concept map. In addition, minimal points were also awarded for correctly exporting and saving the file and for engaging in group blog discussions.


The course assignment information was created using instructions and guidance from Within the module, a review of concept mapping was offered. Examples of electronic concept maps (Figure 2) and basic information about concept mapping techniques from reliable online sources both in the written and YouTube video format (Google, Mountain View, CA) were included in the module assignment information.Table 2 provides information about select supplemental electronic resources students were provided to help them learn more about concept mapping.

Figure 2 - Click to enlarge in new windowFIGURE 2. Example concept maps.
Table 2 - Click to enlarge in new windowTable 2 Supplemental Information Provided to Students in Concept Mapping Assignment

After completion of the assignment, students were to share their concept maps in the form of an image into an assigned group blog dedicated for this purpose. The sharing of the concept maps appeared to be helpful based on responses by students. Many students reviewed and commented on their peers' concept maps and subsequent discussion often occurred. Commentary typically surrounded the choice of layout or arrangement and the implications identified for individuals in their practice.



All students were able to generate an online concept map with basic online instructions provided in the module. They were able export their concept maps into a Microsoft Word document (Microsoft, Redmond, WA) to be submitted via a personal assignment drop box within the online course and share it in the blogging area of the course. Anecdotal feedback suggests that, overall, students enjoyed the assignment, found the software to be easy to use, and concept maps facilitated their engagement in the learning process. One student remarked that the assignment was enjoyable and allowed for the opportunity to synthesize and visualize the material and actually understand and retain the information. Another student commented that he or she found the assignment interesting and he or she could see how this could help invigorate a group. In addition, many students remarked that they found the concept mapping tool and methods acquired in the assignment helpful in their practice or professional positions.


Numerous students have stated that they would continue to use concept maps in teaching or sharing with peers, finding them easy to use in meetings and group settings. Several students suggested concept mapping as a requirement in one of the first classes to help them with brainstorming, development, and clarification of project or research plans. Several students practically applied concept mapping by using it to plan and articulate their scholarly project plans and obtain feedback from their faculty advisor. Several students have applied concept maps during the dissemination phases of their work, using them in presentations in which they were sharing information about findings of their scholarly project.


Overall, faculty were also positive about the assignment. Some remarked that the assignment was a refreshing approach to helping students understand complex material, though important, may be considered dry to many. Students remained engaged and were interested in seeing their peers' concept maps in the blogging areas of the course. Students easily connected with each other with their posts and responses about the various perspectives offered by their peers.


Faculty reflecting on the assignment noted that there were variations in how students used concept maps. Students were permitted and encouraged to think freely about how these acts impacted their work. Ultimately, some students developed elaborate concept maps, while a few did the bare minimum yet still appeared to have completed the assignment successfully according to the rubric. These differences prompted some discussion about how the rubric functioned as written.



With the upsurge of online courses in higher education and graduate nursing programs, educators are examining new and novel approaches in teaching nursing concepts. The use of digital concept mapping holds promise for those in nursing education practice.


Digital concept mapping offers a fresh approach to displaying and organizing information. Moreover, a more interactive activity, such as digital concept maps may benefit students as they engage in the learning process, comprehend new material, and share information with their peers.




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