Noted psychologists Novak andGowin1 laid the foundation foralternative teaching strategies

when they proposed concept maps asone way to create more meaningfullearning experiences. In nursing edu-cation, several descriptive and informa-tional articles have been publishedabout concept mapping.2-8 Mind map-ping, a creative alternative to conceptmaps, has received far less recognition.

Mindmapping is a human information-processing technique that uses color,images, and text in a graphical, nonlinearstyle that enhances learning and memoryrecall.8 Unlike concept maps, whichhave most often been used to explorethe components of disease, there is nohierarchical structure in mind maps.9

Knowledge is synthesized through thevisual display created by ‘‘key words’’on ‘‘branches’’ radiating outwards froma central image that represents the topicbeing considered.8 The radiant structureof mind maps, combined with the useof images, color, and text, makes theman interesting alternative for nursingstudents who are struggling to under-stand the links between their patientand the care they are providing.

Data from other disciplines showsignificant differences in knowledge

retention and memory recall amongstudy groups using mind maps as atechnique for learning. In the studyconducted by Farrand et al,10 studentswho elected to use a mind map studytechnique had better factual recall ofwritten material after 1 week than didstudents who used a ‘‘self-selected’’technique. Even though mind mapsenhanced learning, student motivationfor using them was significantly lowerthan the motivation that students hadfor using their own techniques.10

To date, only 2 studies have exam-ined variables related to student motiva-tion. One of the studies examinedcorrelations between students’ learningstyles and the grades they received on anassignment that required them to createtheir own concept maps from coursematerials; there were no significant dif-ferences between learning styles andgrades.11 In the other study, investigatorsfound that among a group of under-graduate pharmacology students, moti-vation to select and use instructor-madeconcept maps was negatively influencedby the students’ approach to learning.12

Outside these 2 studies, there are very lit-tle quantitative data describing the im-pact of either mind mapping or conceptmapping on comprehension and knowl-edge synthesis in nursing education.

PurposeMost articles written on this topicpresent strategies for teaching students

how to construct concept and/or mindmaps. We were more interested in de-veloping a mind map that communi-cated weekly topics in a consistentformat and in knowing if students’ useof the mind maps contributed to theirunderstanding, comprehension, andknowledge synthesis of course con-cepts. We hoped to convey the benefitsof mind mapping while minimizingresistance to its use.

Theoretical FrameworkBuzan mind maps use images, words,shapes, colors, and lines structured asbranches stemming from a central ideato create a radiant model of thinkingthat engages the whole brain, therebyimproving creativity, memory, and re-call.8 To create a mind map, the userstarts with a blank piece of paper inlandscape orientation. The center ofthe page is reserved for an image thatrepresents the main topic of study. Thenext step is the identification of keywords that carry major significance tothe topic. The key words are placed onlarge branches that radiate from thecentral image. As knowledge becomesmore specific, additional key words areadded to the appropriate main branchusing smaller text placed on smallerbranches. Wherever possible, users areencouraged to use color and to drawpictures that can be associated with thekey words. When connections aremade between points of information,previously thought to be unrelated, theuser draws lines and arrows to showthe relationship. According to Buzan,8

the greatest motivational obstacle tousing mind mapping is individuals’perceived beliefs that they are incapa-ble of drawing creative images.

For the past 10 years, I have usedthe Buzan mind mapping techniqueregularly for brainstorming, project man-agement, reflection, and speech writing,to name a few examples. I prefer thefree form and flexible use of space tothe rigid, linear style of traditional out-lines. Much of the learning effect con-veyed by a mind map is through its

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Vol. 33, No. 5, pp. 220-223

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Use of Premade Mind Maps toEnhance Simulation Learning

David A. Boley, MS, RN

Simulated patient care is used in nursing curriculum to facilitate the transition fromdidactic to practical learning. On the basis of the observations of nurse educators,students frequently struggle when trying to apply the nursing process to simulatedscenarios. The author discusses a study that was initiated after faculty observed his useof mind maps as a personal note-taking method.

Author Affiliation: Graduate Student, Collegeof Nursing, The Ohio State University, Columbus.Correspondence: Mr Boley, c/o Linda Daley,PhD, RN, 364 Newton Hall, 185 Neil Ave,Columbus, OH 43210 (boley.25@osu.edu).

Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

creation. The shapes and colors of thelines and images that I draw, along withthe placement of images and the sizeand style of the words, contribute to myability to recall that information later.Considering the personal nature of mindmapping and its relatively novel ap-proach to nursing education, there isno validated method for using mindmaps. My goal in writing this article isto provide you, the reader, with a de-scription of our attempt to translate thishighly personal learning method into apractical teaching strategy.

Research QuestionsAs we were designing this study, wefocused our efforts on the following2 questions:

1. Using the Buzan method, canwe design a template that canbe customized each week todepict how the stages of thenursing process are applied tocritical care scenarios?

2. Do instructor-made mind mapshelp students achieve measur-able improvements in learning?

Setting and SampleThe study was conducted at the largest,public, land-grant institution in theUnited States. The convenience sampleincluded 14 graduate students enrolledin the critical care nursing course ofan accelerated graduate nursing pro-gram. The course consisted of a 4-hourlecture once a week and a weeklysimulation laboratory where studentsparticipated in interactive patient care

scenarios built around the conditionsthat were discussed in the lecture. Stu-dents electively chose simulation labo-ratory days based on convenience withtheir schedule. Students electing tohave laboratories on either Mondayor Tuesday were chosen for this studybecause the same instructor led bothsections. The mind map group (MMG)consisted of 9 students in the Tuesdaysection, whereas the control group (CG)consisted of 5 students in the Mondaysection.

ProcessI collaborated with faculty to create abasic mind map that served as a templatefor all of the mind maps used in thestudy. As illustrated in Figure 1, 7 keywords were chosen, namely, (1) knowl-edge of the patient, (2) 5 key points ofthe central topic, (3) special skills re-quired for care of the patient, (4) assess,

(5) plan, (6) act, and (7) reevaluation;the main ideas of nursing knowledgewere placed along the bottom of themap, and the components of the nurs-ing process were placed across the top.For each subsequent week, a centralimage that represented the core conceptof the scenario was added, and largebranches were drawn to connect thekey words to the image. Off of each keyword, specific details were placed onsmaller branches, and free space wasleft for students to write their own notes(Figure 2).

As a class, all students received thesame assignments, exposure to lecturecontent, and simulated learning expe-rience. At the start of each simulationlaboratory, instructors held a 15- to 20-minute preconference for explana-tion and discussion of the day’s topic.The preconference provided a naturalperiod for the introduction of new teach-ing strategies. During the preconfer-ence, I was invited to explain how thecentral image represented the simula-tion topic and how each key word wasrelated. The group’s clinical instructorfacilitated further discussion, questions,and answers. The simulation laboratorystarted at the end of the preconference,and I was able to observe the studentsin action.

We conducted the study in 2 phases.Phase 1 lasted until all students com-pleted the midterm examination, andphase 2 took place after the midtermand lasted until the final examination.During phase 1, only the MMG receivedthe mind map during the preconference.During phase 2, we presented the mindmaps to both the MMG and the CG.Figure 1. The mind map template with key words.

Figure 2. A completed mind map, read from the bottom right to left.

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Once the CG crossed over into the MMG,we used the remaining students enrolledin the course for comparison. All stu-dents completed weekly quizzes anda midterm and final examination. Atthe end of the quarter, study partici-pants completed the Mind Map Evalua-tion Survey. We evaluated outcomesby tracking the average quiz and testscores for the MMG and CG, as individ-ual groups and with the remainder of theclass as a whole.

InstrumentsThe entire class completed seven 10-question quizzes. Questions were de-signed to test students’ comprehensionand application of clinical decisionmaking when given a specific patientscenario. On weeks 5 and 10, studentswere given a 50-question midterm andfinal examination, respectively. On thelast day of simulation laboratory, stu-dents in the MMG and CG were askedto complete a survey designed to as-sess their opinions regarding the mindmaps. The survey included a total of8 items. The first 6 items were state-ments that asked students to indicatethe strength of their agreement using ascale of 1 to 5. The last 2 items wereopen-ended questions aimed at solicit-ing the students’ attitudes toward themind maps.

Data CollectionWe began the data collection pro-cess after obtaining exemption statusfrom the university institutional reviewboard. At the first meeting with theMMG, I explained the study and madeit clear that participation was voluntaryand that students’ personal data wouldbe kept confidential. I assured themof confidentiality and impunity if theydecided to withdraw at any time. I ob-tained a signed consent from each stu-dent who agreed to participate. At thebeginning of the quarter, we used theindividual grade point average (GPA)of each student to calculate the groupGPA in order to establish similarity be-tween the MMG and the CG. At thebeginning of the study, the MMG GPAwas 3.76; the CG GPA was 3.72. Eachweek, we tracked quiz scores by cal-culating the group average just as wedid with the GPAs; the same was donefor the midterm and final examination

scores. At the end of the quarter, wereviewed information from the surveysfor common patterns.

ResultsFor research question 1, I initiallythought that creating a template formind maps that would be used byother people for teaching and learningwas too much of a divergence from therules of Buzan mind mapping. Aftercreating the template and beginningthe work on the weekly maps, I be-came more comfortable with the idea.In the end, we were able to success-fully answer this question. The mindmap template was important for thefollowing reasons:

& Improved validity: because we ex-plored the feasibility of using atechnique that is not well studiedand because we analyzed the re-sults of quiz and test scores, it wasimportant to minimize the numberof variables under consideration.

& Timely creation of new mind maps:after reaching an agreement on theformat of the template, each sub-sequent mind map took less thanan hour to create.

& Acceptance and use: students onlyneeded orientation to the first mindmap, and by our second meeting, Iobserved several of them using themind maps for note taking and as areference tool during the simula-tion exercise.

On the evaluation survey, studentsagreed that the mind maps were easyto read, helped them prepare for thesimulation laboratory, and helped themunderstand the concepts of critical carenursing. In addition, most studentsindicated that they would like to havemind maps for other topics in nursing.Based on the catalog of 7 mind mapsthat was created using the template andthe overall positive response of stu-dents, creating a template was a suc-cessful approach to incorporating mindmaps into simulation exercises.

For research question 2, theinstructor-made mind maps seemed topositively impact the learning experi-ence. During phase 1 of the study, theMMG consistently outperformed theCG on weekly quiz scores, indicat-ing a positive impact from the mind

maps. However, an even better indica-tor was seen during phase 2, when theCG started receiving the mind maps.Before phase 2, the CG’s cumulativegrade on quizzes was 84.82%. After re-ceiving mind maps during the simulationlaboratory preconference, the group’squiz grades increased to 98.3% in week7 and 95.0% in week 8.

There were 2 exceptions to thegenerally positive impression seen inthe quiz scores. In week 4, the quizwas administered on Friday eventhough the midterm examination wasscheduled for the following Monday.We believe that the drop in scoreswas likely because students were plac-ing more emphasis on studying forthe midterm than the quiz. In week 9,the simulation laboratory was can-celled and the groups received themind maps after they had taken thequiz. Although it was neither plannednor expected, the drop in quiz scoresactually substantiates the benefit thatstudents received from the mind mapseven further.

Unfortunately, students might notrecognize the benefits, or see them assignificant enough, to adopt mind map-ping as a learning strategy. Responseson the evaluation survey revealed thatthe overwhelming majority of studentsdisagreed with the statement ‘‘I willuse mind maps in my future studies.’’Answers to the open-ended questionsindicated that some students believethat the mind maps would be ‘‘toodifficult or time consuming to make,’’whereas others indicated that mindmapping ‘‘is not my style of learning.’’As mentioned earlier, we knew fromour literature review that learning styleand perceived abilities were 2 knownfactors that negatively affect motiva-tion to use mind mapping. This findingactually confirms our reason for pro-viding the students with mind maps inthe first place, to benefit those studentswho might otherwise never use thisbeneficial strategy.

ConclusionWe were successful in creating a tem-plate and 7 unique mind maps that wereused by nursing students during simu-lated patient care scenarios. Our samplesize was too small to make highly ac-curate statements about the effective-ness of instructor-made mind maps as a

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teaching strategy in nursing education.Still, we found that students who re-ceived the instructor-made mind mapshad better quiz scores than did studentswho did not receive them. Furthermore,when the students who had been re-ceiving the mind maps did not get them,their quiz scores dropped. Buzan’s8

theory emphasizes that learning occursduring the creation of mind maps, yetthis study shows that these students ben-efited from our instructor-made mindmaps. Future studies with larger cohortsare needed to verify our results and es-tablish reliability.

Even though most students indicatedthat they would not use mind maps in thefuture, there were some who indicatedthat they would. Maybe those are thestudents on whom faculty can have thegreatest impact by making mind mapsthat show the big picture of nursingcare in a creative and meaningful way.

Acknowledgments

The author graciously thanks MelissaPopovich, MS, RN, for her encourage-

ment, guidance, assistance, and for theuse of her office. Her willingness toprovide access to students, and supportduring presentations, data collectionsand drafting this article made this proj-ect possible. Thanks also to advisorLinda Daley, PhD, RN, for her continu-ing support and help to define thisproject by serving as the principalinvestigator.

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4. Ferrario CG. Developing nurses’ criticalthinking skills with concept mapping.J Nurses Staff Dev. 2004;20(6):261-267.

5. Abel WM, Freeze M. Evaluation of con-cept mapping in an associate degreenursing program. J Nurs Educ. 2004;45(9):356-364.

6. Harpaz I, Balik C, Ehrenfeld M. Conceptmapping: an educational strategy for ad-vancing nursing education. Nurs Forum.2004;39(2):27-36.

7. Wilgis M, McConnell J. Concept map-ping: an educational strategy to im-prove graduate nurses’ critical thinkingskills during a hospital orientation pro-gram. J Contin Educ Nurs. 2008;39(3):119-126.

8. Buzan T. The Mind Map Book: How toUse Radiant Thinking to Maximize YourBrain’s Untapped Potential. New York,NY: Penguin Group; 1994.

9. Mueller A, Johnston M, Bligh D. View-point. Joining mind mapping and careplanning to enhance student criticalthinking and achieve holistic nursingcare. Nurs Diagn. 2002;13(1):24-27.

10. Farrand P, Hussain F, Hennessy E. Theefficacy of the ‘mind map’ study tech-nique. Med Educ. 2002;36(5):426-431.

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