Learning Experiences of Associate Degree in Nursing Students Using a Concept Map With Simulation

With the continuing gap in knowledge preparation and clinical nursing practice leading to errors in health care delivery, the nurse faculty remains challenged in executing innovative changes to the curriculum to improve and maintain quality and safe patient care. Graduate nurses have experienced a difficult transition as level-entry nurses to clinical practice. The use of simulation and other simulation-based experiences such as concept mapping continue to develop in nursing education. Research using the simulation with concept mapping has shown promising results in the baccalaureate nursing programs. However, the combined use of concept mapping and simulation is limited in the associate level of nursing programs. The aim of this qualitative single case study was to explore the learning experiences of seven nursing students enrolled in the beginning nursing course of a two-year program at a private college in the New England state. Study participants received a video PowerPoint presentation about creating concept maps using the nursing process with the reading assignments and information related to the simulation scenario before the actual simulation performance. In using a purposeful sampling method, data collection and content analysis originated from the study participants’ responses to a field-tested interview protocol that served as a guide to guarantee coverage of all relevant topics reflective of the research questions (Castillo-Montoya, 2016). Two field nurse experts in simulation offered comments and suggestions to the interview questions to uncover the most information acquired to understand the individual stories (Jacob & Furgerson, 2012). The research questions focused on the learning perspectives of the value in using a concept map with simulation in developing the critical thinking and reasoning skills and the appropriateness of a teaching strategy to help translate the knowledge into the clinical practice. The techniques in qualitative research used include data saturation, member checking, and triangulation. Participants received the opportunity to review the responses before performing actual data contextualization and analysis (Houghton, Casey, Shaw, & Murphy, 2013). A between-method triangulation for data collection included the study participants’ responses to the semi-structured open-ended interview questions and the concept map illustration with the corresponding explanation and reaction to the completed concept map (Delost & Nadder, 2014). In using an inductive approach to content data analysis, various themes and patterns emerged after achieving data saturation. Study findings revealed the feeling of uncertainty, confusion, and an overwhelming experience. However, the study participants thought the use of a concept map with simulation was beneficial in developing the essential nursing competencies such as the critical thinking and clinical reasoning skills to form appropriate clinical decisions if utilized in the first nursing course and consistently across the program. Moreover, as a metacognitive technique, concept mapping helped the study participants draw their understanding through a visual representation using hierarchies, labeling or drawing lines to show connectedness to communicate the relationships between concepts (Gerdeman, Lux, & Jacko, 2013; Jaafarpour, Aazami, & Mozafari, 2016). Study participants expressed the importance of knowing the facts, checking the information, reviewing the situation, figuring things out, and anticipating future events. The study participants acknowledged how the use of a concept map with simulation enhanced the learning style preferences either as a visual or kinesthetic learner. The visualization of the concept map helped the study participants to follow an order, focus, and organize their thoughts and actions in making decisions using the nursing process. The use of a concept map helped to break down broad concepts in a more concise way to minimize and avoid the overwhelming feeling. As kinesthetic learners, the study participants relied on their ability to perform the role of a nurse by feeling for the presence of pulses and listening for breath sounds displayed by the manikin. These learning activities provided meaningful experiences that the study participants can model in the next clinical rotation. Implications for nursing education based on the research findings contribute to an increased awareness of the nurse faculty on the benefits of utilizing a concept map with simulation as teaching strategies to help the students learn about the nursing practice. Nursing students need an early exposure, and consistent use of the learning strategies to gain more confidence and understanding to address the different learning styles. Consequently, the teaching practices contribute to the advancement of science in nursing education, improve the quality of instruction and faculty performance, and affect the student achievement of learning outcomes. The utilization of a concept map with simulation in the early part of the nursing program serves as a foundation for developing the critical thinking and clinical reasoning skills to make clinical decisions of a novice learner. A recommendation for future research is to broaden the understanding by following the student progress in the associate degree in nursing program. Another recommendation for future research is to acquire the learning perspectives of male nursing students in the associate degree in nursing programs and perform a comparative study with female nursing students.