R E S E A R C H B R I E F S

Concept Maps: A Strategy to Teach and Evaluate Critical ThinkingBarbara J. Daley, PhD, RN, Christine R. Shaw, PhD, RN, FNP Toni Balistrieri, MSN, RN, Kate Glasenapp, MSN,RN, and Linda Piacentine, MSN, RN CNRN

ABSTRACTThe purpose of this article is to describe

a study that implemented concept maps asa methodology to teach and evjiluate criti-cal thinking. Students in six senior clinicalgroups were taught to use concept maps.Students created three concept maps overthe course of the semester. Data analysisdemonstrated a group mean score of 40.38on the first concept map and 135.55 on thefinal concept map, for a difference of 98.16.The paired t value comparing the first con-cept map to the final concept map was-5.69. The data indicated a statistically sig-nificEint difference between the first andfinal maps. This difference is indicative ofthe students' increase in conceptual andcritical thinking.

I tell you one thing, if you learn it byyourself, if you have to get down and digfor it, it never leaves you. It stays thereas long as you live because you had to digit out of the mud before you learned whatit was (Wigginton, 1985, prologue).

—Aunt Addie Norton

In the preceding quote, Addie Nortonrefers to a special type of learning.This type of learning is defined as one

that requires an active process of think-ing, learning, and drawing relationships.

Dr. Daley is Assistant Professor, University ofWisconsin-Milwaukee, Dr. Shaw is ClinicalAssociate Professor, and Ms. Balistrieri, Ms.Glasenapp, and Ms. Piacentine are ClinicalInstructors. Marquette University College ofNursing, Milwaukee, Wisconsin.

Address reprint requests to Barbara J. Daley.PhD, RN, Assistant Professor, University ofWisconsin-Milwaukee, Enderis Hall, PO Box 413.Milwaukee, Wl 53201-0413.

The questions nurse educators face are:Do we teach students to think and learnin this fashion? Do we help studentsdevelop the critical-thinking skills thatwill facilitate a lifelong ability to "dig itout of the mud?'

The purpose of this article is todescribe a study that implemented con-cept maps as a methodology to teach andevaluate critical thinking. As nursing edu-cation has shifted to an emphasis on out-comes-oriented education, the issue ofteaching and evaluating critical thinkinghas come to the forefront. The NationalLeague for Nursing (NLN) now requiresthe demonstration of critical thinking ingraduates of all nursing programs in theUnited States (NLN, 1996).

One of the major issues in the teachingand evaluation of critical thinking is thedevelopment and use of tools and instru-ments that both foster the teaching, aswell as the measurement, of critical think-ing, specific to the context in which learn-ing occurs. Instruments exist that mea-sure general aspects of critical thinking(e.g., California Critical Thinking SkillsTest [Facione, 1992]; Watson-GlaserCritical Thinking Appraisal [Watson &Glaser, 1980]; The Cornell CriticalThinking Test [Ennis, Millman, & Tomko,1985]), but these instruments do not pos-sess a connection to the context of nursingpractice. This issue of the measurement ofcritical thinking within a particular con-text is important because if nurse educa-tors teach students to think critically andthen evaluate their performance usingunconnected, general measures we inessence have failed to demonstrate validi-

ty in our measurement of the concept ofcritical thinking.

Critical Thinking DefinedFollowing a Delphi research project,

the American Philosophical Association(APA) (1990), published a consensus defin-ition of critic£il thinking based on theviews of 46 published critical-thinkingtheorists from numerous disciplines. Thisdefinition states:

Critical thinking is the process ofpurposeful, self-regulatory judgment.This process gives reasoned considera-tion to evidence, contexts, conceptualiza-tions, methods, and criteria (APA, 1990,p. 2).

Facione (1995) states:Like many other descriptions of high-

er order thinking, the original Delphiauthors conceptualized a simultaneous,metacognitive, self-appraisal of one'sthinking process [that is, thinking aboutand evaluating one's thinking whileengaged in the process of purposefuljudgment]" (p. 2).

Concept maps, the teaching and evalu-ation tools used in this study, link directlyto the APA (1990) definition of criticalthinking. Concept maps are metacognitivetools that assist learners to develop a self-appraisal of their own individual thinkingprocesses. The maps foster a careful con-sideration of evidence drawn from clinicalpractice. Through use of concept maps,learners develop the ability to consider thecontext of nursing practice in their con-ceptualization of client problems. Finally,purposeful judgments are made regarding

42 Journal of Nursing Education

RESEARCH BRIEFS

(CONCEPTMAPSJ

(PROPOSmONS') r e p . . ^ (MOSTGENERAT)—

^ 6 —»^CONTEXT DEPENDENT^

MOST SPECIFIC

MOST IMPORTANT

LEAST IMPORTANT

09

• RAINING

.EXPLOSION

-PHOTOSYNTHESIS LWOMAN perception Is -

Figure 1: A concept map showing the key features and ideas that underlie concept maps. From Novak & Gowin (1984). Reprinted withpermission of Cambridge University Press.

interventions based on bow metbods andcriteria are linked to tbe conceptualizationof tbe problems.

Conceptual FrameworkAusubel, Novak, and Hanesian's (1986)

assimilation tbeory of learning served astbe conceptual framework for tbis study.Within tbis theoretical framework, Ausubelet al. (1986) advocate tbat learners shiftaway from behavioral learning strategies tocognitive learning strategies. Ausubel et al.(1986) believes learners do not learn bymemorizing, ratber they learn by organiz-ing, relating, and subsuming concepts intotheir cognitive structures. When learningin a meaningful fashion, concepts arelinked and assimilated so learners createunique and idiosyncratic meanings andorganization of information. This uniquemeaning includes concepts of new material,concepts of what the learners already know,and concepts from the context in which thelearners are engaging in the learning.Ausubel et al. (1986) differentiated the con-cepts of meaningful learning and rotelearning. In their terms, rote learning is aform of memorizing in which learnersengage so new information can be repeatedin an examination format. Meaningful

Creating a Concept Map

1. Select the topic, reading, or client for whom you wish to develop the map.

2. Identify the most general concepts first and place them at the top of the map.

3. Identify the more specific concepts that are related in some way to the general con-cepts.

4. Tie the general and specific concepts together with linking words in some fashion thatmake sense or has meaning to you.

5. Look for cross-linkages between the more general and more specific concepts.

6. Discuss, share, think about, and revise the map.

To learn more about concept mapping, see chapters 2 and 3 in Novak and Gowin (1984).

learning, on the other hand, is the processof creating propositional links between newand existing knowledge. Learners createand construct knowledge by linking con-cepts togetber in unique ways. Through theprocess of meaningful learning, learnersdemonstrate that the knowledge being cre-ated has a particular meaning and organi-zation. The process of constructing a knowl-edge base allows instructors and lesimersto develop a sbared meaning through dis-cussion of the conceptual relationships.

Learning With Concepts. Accordingto Ausubel et al. (1986), concept learningoccurs in three ways. First, the learners

subsume lower-order concepts under high-er-order concepts in a hierarchical fash-ion. This process of subsumption involvesrearranging and reordering conceptualunderstanding and meanings. Learnersfirst may learn the higher-order conceptand then subsume the lower-order con-cepts, or learners may learn the lower-order concepts and then relate them to thehigher-order one. Learners essentially areusing a process of both inductive anddeductive thinking to develop a conceptu-al hierarchy and organization that facili-tates learning and remembering concepts.For example, students may develop an

January 1999, Vol. 38, No. 1 43

RESEARCH BRIEFS

Scoring Criteria for Concept Maps

Propositions: Is the meaning relationship between two concepts indicated by the con-necting line and linking word(s)? Is the relationship valid? For each meaningful, validproposition show, score 1 point.

Hierarchy: Does the map show hierarchy? Is each subordinate concept more specificand less general than the concept drawn above it (in the context of the material beingmapped)? Score 5 points for each valid level of the hierarchy.

Cross Links: Does the map show meaningful connections between one segment of theconcept hierarchy and another segment? Is the relationship shown significant and valid?Score 10 points for each cross link that is both valid and significant and 2 points for eachcross link that is valid but does not illustrate a synthesis between sets of related conceptsor propositions. Cross links can indicate creative ability and special care should be givento identifying and rewarding its expression. Unique or creative cross links might receivespecial recognition, or extra points.

Examples: Specific events or objects that are valid instances of those designated by theconcept label can be scored 1 point each. (These are not circled because they are notconcepts.)

From Novak and Gowin (1984).

understanding of the concept of communi-cation in one course and subsume it underthe concept of family history-taking in asubsequent course.

Second, the learners progressively dif-ferentiate concepts in the cognitive struc-ture. This progressive differentiationinvolves an analytical process wherelearners break down the newly learnedconcepts into component parts. For exam-ple, beginning nursing students may pro-gressively differentiate the concept of vitalsigns into the components of temperature,respiration, blood pressure, and pulse.

Third, the learners learn through aprocess of integrative reconciliation.Integrative reconciliation is a synthesisprocess in which learners take the con-cepts that have been differentiated andseek connections between different con-cepts. For example, students may demon-strate integrative reconciliation whenthey begin to make connections betweenclients' vital signs, medical status, andassessment data.

Concept Mapping: What Is It?Based on the work of Ausubel et al. (1986),Novak and Gowin 11984) operationalizedmeaningful learning and assimilation the-ory by creating concept maps. "A conceptmap is a schematic device for representinga set of concept meanings embedded in aframework of propositions" (Novak &Gowin, 1984, p. 15). Concept maps are cre-ated with the broader, more inclusive con-cepts at the top of the hierarchy, connect-

ing through linking words with other con-cepts that can be subsumed. This toolfacilitates understanding of conceptualrelationships and the structure of knowl-edge. "Concept maps...are a representa-tion of meaning or ideational frameworksspecific to a domain of knowledge, for agiven context of meaning" (Novak, 1990, p.29). Figure 1 depicts a concept mapdemonstrating the essential ingredients ofconcept maps. Note the maps are devel-oped to represent Ausubel et al.'s (1986)assimilation theory of learning and fostera process of meaningful learning. Conceptmaps have concept labels depicting therelationships among new and previousknowledge. The concepts labels are linkedto form propositions stored in the learners'cognitive structures. Concept maps havesome type of hierarchy that is often depen-dent on the context of the learning.Concept maps facilitate students' under-standing of conceptual relationships andthe structure of knowledge. When used asa strategy to facilitate learning, conceptmaps allow instructors and students toshare information, discuss conceptualrelationships, and correct misperceptionsin the learned information.

Research QuestionsThe following research questions guid-

ed this inquiry:• Can concept maps be used to both

teach and evaluate critical thinking in

nursing education?• Will concept maps measure changes

in students' critical-thinking abilities overthe course of a semester?

• How do faculty and students evalu-ate the use of concept maps in nursingeducation?

MethodologyFaculty within the culminating clinical

course in a baccalaureate nursing pro-gram elected to use concept maps to fosterthe links between the theoretical and clin-ical components of the course. Course andclinical faculty invested time in learningto use concept maps. Six senior clinicalgroups in = 54) were taught to use conceptmaps as a learning strategy. During thefirst week of class, students were taughthow to create concept maps (see Sidebaron page 43). After this introductory ses-sion, students completed concept maps onthe scenario given to them in class. Thismap was used to demonstrate their under-standing of mapping, and they discussedthe maps in their clinical groups.Permission to conduct the study wasobtained, and each student provided writ-ten consent to have components of theirwork evaluated and incorporated in publi-cations. Additionally, students completedevaluation forms requesting their opinionof concept mapping as a learning strategy.

Over the course of the semester in theclinical setting, students created threeconcept maps depicting relationshipsamong the clients, pathophysiologic fac-tors, pharmacologic factors, and therapeu-tic nursing interventions. These mapswere used in postconferences as discus-sion tools to foster links between theoreti-cal course material and clients for whichthe students were providing care.

For the purposes of this study, thework of three students from each of thesix clinical groups (n = 18) was randomlyselected for data analysis and scoring.The first and final concept maps of thesemester were scored. Points were award-ed for the hierarchical organization of themaps, the progressive differentiation ofconcepts, and the integrative reconcilia-tion of the concepts. The Sidebar on thispage depicts the scoring formula used inthis study. Based on assimilation theory,the scoring formula awarded points forthe students' ability to create proposi-

44 Journal of Nursing Education

RESEARCH BRIEFS

MEDICATION OF AD

INSULIN

ANTIDIABETICAGENT

specifically \^ that

70/30

INCREASESGLUCOSE

TRANSPORT

INDOMETHACIN

related whichtaken to

NSGDX

are

rPAIN R/TARTHRITISCONDITION

ALTERED NUTRITIONMORE THAN

REQUIREMENTS

to

DECREASEBLOODGLUCOSE

rand

r

10UTIME

ATID and

may have

INSULIN-INDUCEDHYPOGLYCEMIA

and

\ l \HR FOR INJURY

R/T CNS ADVERSEREACTIONS

EVENING

KNOWLEDGEDEFICIT

ADVERSEREACTIONS and

forHYPOGLYCEMIA

IDDMHYPERGLYCEMIA

ANEMIA

HEADACHES

KNOWLEDGEDEFICIT

UTICARIADIZZINESS

IS

NON NARCOTICANALGESIC

that

APRODUCES ANTI INFLAMATORY

ANALGESIC ANDANTIPYRETIC EFFECTS

7for

ARTHRITIS

SCORING

PROPOSITIONS 23HIERARCHY 15CROSSLINKS 0

Figure 2; First map developed by a student participating in study.

tional links, and analyze and synthesizeinformation. Reliability was establishedby obtaining two independent scores oneach concept map. Correlation betweenthe two independent scores equaled .82.Content validity was validated by twoeducational researchers. These two edu-cational experts reviewed the theoreticalpremise underlying concept maps in rela-tion to the APA (1990) definition of criti-cal thinking.

Figure 2 is a sample of one student'smap at the beginning of the semesterNote this student chose to map the med-ications of the client for which care wasprovided. The map depicts a rather linearmode of thinking and demonstrates somepropositional statements, some levels ofhierarchy but virtually no cross links.When reviewing the student's map, it wasrelatively easy for faculty to identify infor-mation and thinking process in need of

further development. The same studentdeveloped the concept map in Figure 3 atthe end of the semester. In this final map,the student differentiated concepts, pro-vided significantly more propositionallinks, expanded the hierarchy in the map,and added additional cross links.

ResultsMap Scoring. Data analysis (Table)

demonstrated a group mean score of 40.38on the first concept map and 135.55 on thefinal concept map. for a difference of 98.16.The t value comparing the first conceptmap to the final concept map was -5.69 (p= .0011. The data indicated a statisticallysignificant difference between the firstand final map. This difference is indicativeof the students' increase in conceptual andcritical thinking.

Student Evaluation. Student com-

ments and evaluation of the process ofconcept mapping showed mixed reviews.Students indicated the maps requiredindepth preparation and often, in theprocess of creating the maps, they felt"lost." This lost feeling was described notin relation to the nursing content beingmapped but in trying to demonstrate theconcepts and relationships on paper.Students reported the creation of themaps was very time consuming. The fol-lowing comment was a typical evaluation:

They [concept maps] are useful in

learning to understand how manyaspects of a patient may interact. 1 thinkI leamed a lot by doing them but they

are very time consuming.A major concern of students was the

timing or introduction of concept mappingas a learning strategy. Students expressedconcern that the maps were introduced asa learning strategy in the final semester of

January 1999, Vol. 38, No. 1 45

RESEARCH BRIEFS

FAMILYHX

] procedurel \ \ \ |MEDS[--/ \ procedures \ r;̂^ ^ ; \

IIPTCAI procedures \ \ ^ - — ^ V\" ^ I \ \1 NSr, I \r

^"^ of |ANGIOPLASTY^ CARE \

SIGNIFICANTSUMMARY

HOSP STAY

JCHEST PAIN I has--»-|INC RATE||jOB

XINAOJ

HOSPITAL PROCEDURES , _,I- include

PROPOSITIONS 121HIERARCHY 25

CROSSLINKS 150

Figure 3: Final map developed by a student participating in study.

tbeir baccalaureate program. One studentcommented:

I believe that concept maps should betaught earlier in the nursing curriculum.Concept mapping is very beneficial, andI wish I learned it much earlier in mynursing program. It was hard to makethe switch this late in the game.

Anotber student responded, "If intro-duced at an earlier date, I tbink conceptmaps would not be viewed (as being] sotedious."

It appears tbat being asked to cbangelearning strategies at tbe end of tbeirnursing education program was difficultfor students. Tbey bad learned to be suc-cessful in tbeir educational program byusing certain learning strategies andresisted tbe idea of cbanging tbosestrategies so close to graduation.Students expressed tbe idea tbat tbeintroduction of mapping earlier in tbeir

educational process would bave fosteredtbeir learning.

Faculty Evaluation. Faculty articu-lated tbat concept maps as a learningstrategy were beneficial in demonstratingtbe knowledge students bad gained overtbe semester. Faculty indicated tbey couldsee tbe development of students' tbinkingprocesses. Two additional comments war-rant discussion. First, faculty indicatedtbat tbe maps belped tbem assess wbicbstudents were safe practitioners in tbeclinical experience. Faculty felt tbe mapsdemonstrated botb students' knowledge ofand plans for particular clients. Facultyindicated tbat often tbe quiet students,wbo may not verbally demonstrate tbeirknowledge, could do so in a concept map,and the clinical instructor could tell if tbeywere prepared and safe. Alternatively, tbemore verbal students, wbom facultytbougbt understood tbe information.

demonstrated on tbeir concept maps mis-perceptions and lack of fully developedknowledge bases.

Second, faculty felt tbe maps allowedtbem to correct student misperceptionswben tbe maps were discussed in postcon-ferences. Faculty indicated tbat some oftbe misperceptions were subtle enougbtbat students could bave progressedtbrougb tbeir entire nursing program, andif tbe misperception was never addressedin an examination question, it neverwould bave been corrected.

Implications for NursingEducation

Tbis study demonstrated concept mapsdo improve students' critical-tbinkingabilities. Tbe maps served tbe purpose ofproviding "reasoned consideration to evi-dence, contexts, conceptualizations, metb-

46 Journal of Nursing Education

RESEARCH BRIEFS

ods, and criteria" (APA, 1990, p. 2). Thestudy also demonstrated critical-thinkingability can change over the course of asemester.

Additionally, concept maps served bothas an education method and evaluationstrategy in this study. The authors feelthis is an important consideration. Inteaching critical-thinking abilities, thevalidity of the measurement and outcomesof the learning are important. Conceptmaps served as a tool that fostered boththe learning of critical thinking and themeasurement of those thinking abilitieswithin the context of nursing practice. Theauthors believe the students demonstrat-ed a dramatic increase in concept mapscores over one semester because themaps tied together the teaching and eval-uating of critical thinking.

The authors consider this a prelimi-nary study and would suggest replicationand further research in the area of usingconcept maps in nursing education.Future research studies need to includelarger, cross-institutional samples; com-parison of concept mapping as a strategyfor teaching critical thinking with othercritical-thinking strategies; and correla-tion of concept mapping as a measure-ment of critical thinking with other exist-ing critical-thinking measures.

Finally, the researchers suggest con-struct validity of concept maps as a mea-surement of critical thinking be estab-lished. This construct validity could beassessed using the multitrait-multi-method matrix (Campbell & Fiske,1959). This procedure would help deter-mine if convergence and discriminability

Variable

Map 1

Map 3

p = .001.

Changes in Concept

No. of Cases

18

18

(value = -5.69

TableMap Scores Over the

Mean

40.3889

135.5556

Semester

Difference

-98.1667

(Campbell & Fiske, 1959) exist betweenconcept maps and critical-thinking abil-ities.

ConclusionThis study demonstrated that concept

maps, as a metacognitive learning strate-gy, can significantly improve students'critical-thinking abilities. Additionally,when used in the clinical setting, tbe mapsserve as a strategy to assist students indrawing complex conceptual relationshipsregarding the care of their clients. Conceptmaps served as an outcome measure ofcritical thinking. Finally, when using con-cept maps as a teaching strategy, carefulconsideration needs to be given to tbemost beneficial time to introduce thistechnique in the nursing curriculum.

ReferencesAmerican Philosophical Association. (1990).

Critical thinking: A statement of expert con-sensus for purpose of educational assess-ment and instruction. Columbus, OH: Centeron Education and Training for Employment,College of Education, The Ohio State

University. (ERIC Document ReproductionNo. ED 315-4231

Ausubel. D.P., Novak, J.D., & Hanesian, H.(19861. Educational psychology: A cognitiveview (2nd ed.). New York: Werbel and Peck.

Campbell, D., & Fiske, D. (19591. Convergentand discriminant validation by the multi-trait-multimethod matrix. PsychologicalBulletin, 56, 81-105.

Ennis, R.H., Millman, J., & Tomko, T.N. (1985).Cornell Critical Thinking Test (Levels X andZ). Pacific Grove, CA: Midwest.

Facione, PA. (1992). California CriticalThinking Skills Test: Forms A and B.Millbrae, CA: California Academic Press.

Facione, N. (1995). Critical thinking and clinicaljudgment: Goals for nursing science. Paperpresented at the annual meeting of theWestern Institute of Nursing, San Diego, CA.

National League of Nursing. (1996). Criteriaguidelines of baccalaureate and higherdegree program. New York: Author

Novak, J. (1990). Concept maps and vee dia-grams: Two metacognitive tools to facilitatemeaningful learning. Instructional Science,19, 29-52.

Novak, J., & Gowin, D.B. (1984). Learning how tolearn. New York: Cambridge UniversityPress.

Watson, G., & Glaser, E.M. (1980). Watson-Olaser Critical Thinking Appraisal. Form Aand B. New York: Psychological Corporation.

Wigginton, E. (1985). Sometimes a shiningmoment: The foxfire experience. Garden City,NY: Anchor Press/Doubleday

January 1999, Vol. 38, No. 1 47