Mind-Mapped Care Plans: Integrating

an Innovative Educational Tool as an

Alternative to Traditional Care Plans
Carolyn S. Kern, MSN, RN; Kristine L. Bush, MSN, RN; and
Joan M. McCleish, PhD, RN

ABSTRACT

Teaching nursing students how to think critically when

planning patient care is vital to their professional success.
Traditionally, the nursing care plan has been used to apply steps of the nursing process in planning patient care.
However, nursing has evolved into a more complex profession that requires expanded ways of thinking and reasoning
beyond the linear methods used in the past. Mind-mapped
care plans provide an alternative method of teaching holistic, patient-centered care. This article describes the process
used to integrate the mind-mapped care plan as an innovative educational tool, as well as formative and summative
outcomes of its use.

reating nursing care plans is a common method

of teaching nursing students how nurses think.
Generally, a nursing care plan consists of a columnar or table format that encourages nursing students to
apply the steps of the nursing process (i.e., assessment,
nursing diagnosis, planning, implementation, and evaluation) to ensure the nursing care provided is consistent
with the patients needs and progresses toward desired
outcomes. In recent years, nursing has evolved into an
increasingly complex profession that requires expanded
ways of thinking and reasoning. The linear thinking encouraged by the nursing care plan no longer accurately
Received: September 26, 2003
Accepted: December 6, 2004
Ms. Kern and Ms. Bush are Assistant Professors, and Dr. McCleish is Professor, Mercy College of Health Sciences, Division of
Nursing, Des Moines, Iowa.
Address correspondence to Carolyn S. Kern, MSN, RN,
Assistant Professor, Mercy College of Health Sciences, Division of Nursing, 928 6th Avenue, Des Moines, IA 50309; e-mail:
ckern@mercydesmoines.org.

112

depicts the thinking required for the complex needs of

nursing and patient care.
Mueller, Johnston, and Bligh (2002) identied three central issues that inhibit critical thinking when using a linear
format nursing care plan:
a) the linear nature of the tool itself, b) students copying
from care plan books when writing clinical nursing care plans,
and c) the inhibition of a holistic view of the patient. (p. 24)

In response to their concern for these issues, nurse educators have searched for more effective methods to teach critical thinking skills.
Use of mind mapping is an alternative to the traditional
nursing care plan. Developed by Tony Buzan (1995), mind
mapping is a creative way of connecting concepts and ideas to
a central subject. Mind maps provide a guide to the following
questions, How do I learn how to learn? and What is the
meaning of my thinking? These questions provide groundwork for the critical thinking process. Therefore, mind maps
are developed to provide a visual description of the thinking
process.
Mueller et al. (2002) combined the mind map with the
nursing care plan as a way to teach nursing students to view
each patient as a whole picture and to understand the relationships between the factors that affect the patient. Based
on Mueller et al.s application of the mind map to the nursing curriculum, faculty at Mercy College of Health Sciences
began using the mind-mapping method of patient care planning in the fall 2002 semester to encourage students to think
critically and creatively and to view patients holistically.
WHAT IS MIND MAPPING?
To learn more about mind mapping, the faculty sought
to dene mind mapping and determine how it differs from
other methods of planning patient care. Although not a new
concept, mind mapping has been used successfully in other
disciplines prior to its introduction in nursing. According to
Journal of Nursing Education

KERN, BUSH, & MCCLEISH

Buzan (1995), mind mapping begins by identifying a central

concept or focus at the center of a page. Dening the central
focus better enables one to view the desired outcome (Wycoff,
1991). Branching from the central focus are groups of related thoughts and key words enclosed in various geometric
shapes, which are linked and colored for sorting and categorizing. Wycoff (1991) asserted that color activates the brain
(p. 52) and increases retention. After the initial brainstorming of words and ideas on the page, Wycoff suggested it may
be helpful to set the paper aside and view it later to encourage further development and insight. It is also recommended
that the entire page be used in this brainstorming technique
to better visualize the central concept.
Through mind mapping, the central concept can be viewed
more holistically. Wycoff (1991) stated that each brain hemisphere has specic traits, and the mind-mapping strategy
encourages both right-brained and left-brained thinking.
Wycoff further explained that left-brained thinking includes
language, logic, numbers, sequence, focus on details, linear,
symbolic representation, and judgment, while right-brained
thinking is nonjudgmental and includes images, rhythm,
music, imagination, color, consideration of the whole, patterns, and emotions.
Mueller, Johnston, and Bligh (2001) applied the nursing
process to the mind-mapping teaching strategy to stimulate
nursing students to think critically and holistically about patients. They believe the traditional linear nursing care plan
encourages only left-brained thinking and neglects the right
half of the brain; both halves of the brain are required for
patient care in nursing. Not only does mind mapping encourage holistic thinking, but it also allows students to see the
connections between problems and various data.
STEPS IN MIND MAPPING
To facilitate learning, it is important for students to have
working knowledge of the nursing process prior to using the
mind-mapping technique. After the nursing process has been
learned, students are able to build on it and discover how
various factors affect patients and how these factors are connected.
Because mind mapping generates a holistic view of patients and patients are central to the process, Mueller et al.
(2001) placed the patient at the center of the page. Expected
signs and symptoms, nursing diagnoses, and nursing interventions for each diagnosis stem from the patient. Each part
of the nursing process is assigned a particular shape and
color for ease of recognition by students and faculty. Optimal
functioning is identied by a heart shape and plays a signicant role in the diagram. Optimal functioning includes two
perspectives, the patients and the students, thus encouraging attainment of a common goal.
The next step is the clinical application. Students must be
able to explain their mind map as part of the learning process. In Mueller et al.s (2001) model, the night prior to the
clinical experience, students create a mini-mind map, which
is a prioritized diagram of how the student plans to care
for the patient. During the clinical experience the next day,
April 2006, Vol. 45, No. 4

students explain their maps, rationales, relationships, and

connections to peers and faculty. Then, throughout the clinical experience, students change their maps to reect actual
patient care. Mueller et al. (2001) asserted that through the
process of explaining the mind map and rationales, students
improve their critical thinking abilities.
CHALLENGES OF MIND MAPPING
Mueller et al. (2001) identied challenges to the mindmapping process. Students and faculty who have been socialized into thinking there is only one correct way to accomplish
a task may nd it difcult to accept that someone else may
have a different perspective and create a different map based
on that perspective. In addition, students who have learned
a linear approach to problem solving and decision making
may nd this method rather chaotic. For these students, we
encourage them to develop mind maps that make sense to
them and stress that these maps may look different from the
examples. As long as the connections are being made and the
students demonstrate understanding of the nursing process,
the uniqueness of each students map should be encouraged.
MIND MAPS VERSUS CONCEPT MAPS
Mind maps should not be confused with concept maps,
which are used in nursing education to assess students understanding of critical concepts (e.g., disease processes) and
promote long-term retention of material (Beitz, 1998). Concept maps are graphic presentations of a concept, presented
in a hierarchical structure of concepts and propositions, with
major ideas subsumed under one another (Novak, 1984).
Mueller et al. (2002) distinguished mind maps from concept
maps in that concept maps require a format of major ideas to
be subsumed under one another, whereas with mind maps,
all ideas coexist on an equal playing eld (p. 24). In addition, mind maps encourage a shift from the medical model to
a nursing model with the patient, rather than the disease, as
the central focus.
TRANSITIONING TO
MIND-MAPPED CARE PLANS
Development
Like many nursing faculty, faculty at Mercy College of
Health Sciences (MCHS) struggled with the benets of using the traditional care plan. They discussed the need for
innovation but were unable to identify a better alternative.
In addition, students claimed that the traditional care plan
was time consuming and only focused on a limited number
of problems.
During the 2001-2002 academic year, MCHS faculty
revised the Associate of Science in Nursing (ASN) curriculum from a four-semester to a ve-semester program. At
the same time, several faculty members read the article by
Mueller et al. (2001) describing the use of mind-mapped care
plans (MMCPs) as an educational tool for students to use
to promote critical thinking, creativity, and holistic nursing
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MIND-MAPPED CARE PLANS

Figure 1. Sample mind-mapped care plan based on the example case study. Octagon (originally in red) = assessment data; heart (blue) =
optimal functioning as identied by the patient; oval (yellow) = nursing diagnosis; triangle (black) = patient-centered outcome;
rectangle (green) = nursing intervention.
Adapted from Mueller, Johnston, and Bligh (2001) and created by Kristine L. Bush, MSN, RN, and Carolyn S. Kern, MSN, RN.

care. The faculty members were intrigued by this innovative

alternative to the traditional care plan. After reviewing the
mind-mapping process and the benets it provided, the faculty decided to implement the use of MMCPs with the start
of the new ASN curriculum in the fall 2002 semester.
Implementation
Implementation of the mind-mapping process began in
the rst semester of the program because this is the point
at which nursing process content is introduced. The faculty
developed a sample MMCP (Figure 1) using the basic format, shapes, and colors, as described by Mueller et al. (2001).
The faculty found that although Mueller et al. identied a
color for outcomes, no corresponding shape was identied.
Therefore, a triangular shape was added to the mind map as
a visual reminder to students of the need to include patient
outcomes when planning nursing care.
The nursing process and critical thinking concepts were
taught during the fth and sixth weeks of the rst semester.
During this time, mind mapping was also introduced using
a topic that students could relate to easily. An example from
Mueller et al.s (2001) article involving planning a vacation
114

was used to guide students through the steps of creating a

generic mind map. After completing this exercise, students
were able to see, via a mind map, the various factors related
to planning a vacation and how the factors affected one another.
The next step in learning the mind-mapping process was
for students to create a personal mind map using the scenario of a rst-semester student preparing for his or her rst
nursing examination. Students were asked to develop a mind
map with themselves at the center of the page and to include
a minimum of four considerations that inuence success on
the examination (e.g., work schedule, child care). These considerations were to be placed in oval shapes surrounding the
student. Next, they were asked to identify a minimum of two
solutions to address each consideration (e.g., adjusting their
work schedule prior to the examination, seeking alternative
child care arrangements). The solutions were to be placed on
the mind map in square shapes adjacent to the corresponding consideration (Figure 2).
Students shared their personal mind maps with the other
students in assigned groups. Not only did they share their
experience with developing the mind map, but they also
Journal of Nursing Education

KERN, BUSH, & MCCLEISH

Figure 2. Instructor guide for personal mind map assignment.

Created by Kristine L. Bush, MSN, RN, and Carolyn S. Kern, MSN, RN.

gained the added benet of learning study and test-taking

tips from each other.
The next step was to incorporate the mind-mapping technique into the nursing process. Students were given a health
care-specic case study to use in developing a comprehensive
MMCP, which had to include a minimum of four applicable
nursing diagnoses. Students completed this mind map as a
group project with the assistance of their clinical instructor.
Figure 1 depicts a sample MMCP for the case study given to
the clinical instructors as a guide.
The week following the case study activity, students started performing actual patient care in the clinical setting. The
use of MMCPs was implemented gradually. Initially, students were asked to gather assessment data and gain an understanding of the patients perspective of his or her optimal
level of functioning. In the weeks that followed, the students
added subsequent components of the nursing process to their
MMCPs.
As students began to develop their MMCPs, they were expected to include all pertinent assessment data, a minimum
of four nursing diagnoses, two expected outcomes for each
nursing diagnosis, and two nursing interventions for each
outcome. In addition, they were expected to verbally provide
rationales for each nursing intervention identied on the
MMCP and evaluate their MMCP.
April 2006, Vol. 45, No. 4

Evaluation
Evaluation of the MMCP takes place each week in the
clinical setting as a verbal discussion between student and
instructor. In addition, students are asked to respond in
writing to the following questions:
How do you feel about the overall care you provided
today?
How do you feel about your relationship with the patient?
What is the patient receiving from the nurse or hospital that he or she cannot provide on his or her own?
Why is the patient unable to go home?
Would you do anything differently?
FACULTY ORIENTATION
TO THE MMCP PROCESS
To facilitate the transition from the traditional care plan
to the MMCP, the faculty had to attain a thorough understanding of the MMCP as an educational tool. Two groups of
faculty requiring instruction were identied; the rst group
included seasoned faculty who were experienced with traditional care plans, and the second group included novice faculty who had never taught nursing courses or clinical experiences.
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MIND-MAPPED CARE PLANS

Inservice for Seasoned Faculty. For the seasoned faculty, an

inservice session was conducted by two of the authors (C.S.K.
and K.L.B.) during the preparation week preceding the fall
semester. Prior to the session, the faculty were given the same
MMCP materials the students would receive, as well as a copy
of the sample MMCP that was based on the case study (Figure 1). The faculty were encouraged to read Mueller et al.s
articles (2001, 2002) prior to the inservice session.
During the session, a poster-sized copy of Figure 1 was
used for illustration. The theory of MMCP development was
presented, emphasizing the difference between mind maps
and concept maps. The faculty members were directed stepby-step through the process by which the students would be
taught to develop the MMCP using the provided case study.
The faculty requested additional clarication regarding
how students would document their rationales for nursing
interventions and evaluate the effectiveness of the MMCP,
as well as how the faculty would evaluate the MMCPs. The
facilitators emphasized that both the rationales and student
evaluations of the MMCPs should be provided through verbal exchange between the clinical instructor and student
during clinical time. In addition, faculty should evaluate the
MMCPs similar to traditional care plans by assessing that
all parts of the nursing process are included, stated correctly,
and appropriate for each patient. The faculty members were
excited about using MMCPs and anxious to try an alternative to the traditional care plan.
Inservice for Novice Faculty. A second inservice session
was conducted (using the same format) for novice clinical
faculty during their orientation to MCHS. The faculty teaching this session felt that new faculty may have different
questions and concerns related to teaching the care planning
process. The new faculty attendees were also excited about
using MMCPs.
Follow-up Meeting. Several months later, as fourthsemester and fth-semester faculty prepared to receive students into their courses, they requested a follow-up meeting
to review the MMCP process. During the follow-up session,
the faculty expressed interest in student progression and
faculty satisfaction with the tool. The facilitators of the follow-up session provided preliminary ndings of student outcomes and faculty satisfaction.
INCLUDING OTHERS IN THE CHANGE PROCESS
To further facilitate the transition to a new educational
tool, nurses at the medical center where students complete
the main portion of their clinical experience were introduced
to the use of MMCPs. In the past, the nurses have offered to
help students in planning care, so the faculty believed it was
important for nurses to become familiar with the new tool.
Two of the authors (C.S.K. and K.L.B.) attended a meeting at
the medical center to present the MMCP strategy; the clinical
nurse educators who were in attendance and are responsible
for educating staff nurses, were intrigued by the new tool.
In addition, information regarding the transition was
shared with MCHSs Nurse Advisory Council, a group
composed of nurses and individuals from the community,
116

which advises and makes recommendations to the nursing programs at MCHS. The Council indicated the MMCP
was an innovative, creative method to encourage critical
thinking.
STUDENT AND FACULTY EVALUATION
After the initial year of using MMCPs, a short evaluation survey was developed and administered to students in
the rst and second semesters of the nursing curriculum. To
avoid inuencing or biasing students responses, the survey
consisted of two open-ended statements to which students
responded anonymously:
Mind-mapped care plans helped me to __________.
I believe the following changes would enhance the use
of the MMCP: __________.
After the surveys were collected, the responses were examined. Several common themes emerged. Categories of
similar responses were identied and survey results tabulated (Table 1). Table 1 displays the student responses that
occurred most frequently but is not inclusive of every student comment. In addition, specic student comments are
included in the Discussion of Student and Faculty Evaluation section below.
A second student survey was developed based on the
themes that emerged from the rst survey and projected outcomes of the mind-mapping process as identied by Mueller
et al. (2001, 2002). The summative survey was administered
anonymously to students in a course within the nal semester of the nursing curriculum. The results, which indicate
overall satisfaction with the use of the mind-mapping tool,
are shown in Table 2.
Throughout the initiation of the mind-mapping process,
faculty feedback was solicited during individual meetings
with clinical instructors, via an e-mail survey, and during
an end-of-semester wrap-up session. Faculty feedback correlated closely with the common themes identied in the rst
student survey.
When the initial group of students using the mind-mapping tool reached the nal semester of the nursing curriculum, a summative faculty survey was developed using themes
similar to those identied in the summative student survey,
so comparisons could be made. In the summative survey, faculty with previous experience using the traditional care plan
were asked to indicate their beliefs regarding students abilities to develop a plan of patient care using the mind-mapping
technique, compared to the traditional care plan method.
Fourteen of the 29 faculty members who responded indicated having previous experience with the traditional care plan
and completed the survey. Results are shown in Table 3. For
a majority of the categories surveyed, improvement was noted. The two questions receiving the lowest scores referred to
identifying and correlating the steps of the nursing process.
After the results of the summative surveys were tabulated, a follow-up faculty forum was conducted to share results
and further evaluate the mind-mapping process. Specic
faculty feedback is included in the Discussion of Student/
Faculty Evaluations section below.
Journal of Nursing Education

KERN, BUSH, & MCCLEISH

DISCUSSION OF
STUDENT/FACULTY
EVALUATIONS
Viewing Patients
Holistically
Mueller et al. (2001) suggested that using MMCPs
helps students view patient
care more holistically. At
MCHS, as the students began using the mind-mapping
technique, they recognized
the tools holistic potential.
On the initial open-ended
student survey, one third
(33.3%) of respondents indicated the MMCP offered a
holistic view of their patient.
One student commented:

TABLE 1
Initial Open-Ended Student Survey Responses:
Common Themes about Mind Mapping (N = 168)

Helps student correlate assessment data, nursing diagnoses, and

expected outcomes appropriately (interrelationships)

101 (60.1)

Offers holistic view of patient

56 (33.3)

Creating mind maps is time consuming

40 (23.8)

Would like more examples during learning process

30 (17.9)

Helps develop problem-solving skills; incorporates both right-brained and

left-brained thinking

28 (16.7)

Mind maps are disorganized or messy

25 (14.9)

Mind maps are not used in actual nursing practice

22 (13.1)

The MMCP helped me to visualize everything that was

going on with my patients. It really forced me to think
about all the issues that might concern my patients, not
just what was affecting them medically.

Clinical faculty who taught the rst-year students also

found that students viewed patient care more holistically.
Initial clinical faculty comments included:
I prefer the MMCP over traditional care plans. I think
its easier for students to grasp the holistic piece with a
MMCP. I think students can feel more creative with
MMCPs, as well. They often think out of the box when
it comes to nursing diagnoses and plans. Also, the MMCPs
make you think of the person. Traditional care plans are
simply copying from a book.

The summative data from the second student survey

showed strong satisfaction with use of the mind map in
the areas of viewing the patient holistically (97%), using
creativity in planning care (88%), and individualizing the
plan of care (94%). In addition, on the summative faculty
survey (Table 3), faculty noted improvement in students
use of the mind map versus the traditional care plan in
the same areas: viewing the patient holistically (79%), using creativity in planning care (93%), and individualizing
the plan of care (86%). One faculty member commented:
Its encouraging to see the results of this innovative
technique. In the past, students spent hours on a traditional care plan only to have thoroughly researched and
developed one nursing diagnosis. They struggled to understand how this t into the whole picture. Now, by using
mind mapping, they can see it!

Time Needed to Complete the Care Plan

The amount of time taken to complete a care plan is a
common concern raised by students with the use of either
technique. In the initial open-ended student survey, nearly
one fourth (23.8%) of the respondents indicated they believed the MMCP is time consuming, which is not surprising as this was the students initial experience with writing
April 2006, Vol. 45, No. 4

No. of Students
(% Response)

Theme

TABLE 2
Summative Student Survey Responses (N = 34)
Statements:
The use of the mind map helped me to:

% Satised

View the patient holistically

97

Individualize the plan of care

94

Demonstrate critical thinking

91

Correlate the steps of the nursing process to

one another

88

Identify the steps of the nursing process

88

Use creativity in planning patient care

88

Articulate plan of care to instructor

85

Articulate plan of care to peers

85

any type of patient care plan. One clinical faculty member

helped the students understand the difference between the
two care-plan methods by writing a traditional care plan
based on the MMCP case study presented in the student
packet. The students compared the two care plans and realized the MMCP actually provided more information. This
activity also helped the students see that the MMCP was
not as time consuming as the traditional care plan. Regarding the time commitment, one student wrote:
I think that mind maps are easier for students [than
other types of care plans], less time consuming, and more
user-friendly in format than structured care plans. I prefer
mind maps because everything is right in front of us. There
is less time involved than typing out the old care plans.

Using Case Studies

Faculty at MCHS believe the case study approach used to
teach the mind map method of care planning was effective.
Because nearly 18% of the students who responded to the
initial open-ended survey believed having more examples
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MIND-MAPPED CARE PLANS

been creative in developing alternative styles of

MMCPs. For example, one
Summative Faculty Survey Responses Regarding Students Ability to Plan Care
student positioned the nursUsing Mind-Mapped Care Plans Compared to Traditional Care Plans (N = 14)
ing diagnosis shapes in the
No
Compromised
corners of the page, while
Improvement
Difference
Ability
another placed the patient
Criteria
n (%)
n (%)
n (%)
on the left-hand side of the
Use creativity in planning patient care
13 (93)
1 (7)

page and used a owchart

style emerging from the
Articulate plan of care to instructor
12 (86)
2 (14)

patient, and another develArticulate plan of care to peers

12 (86)
2 (14)

oped a computer program

Individualize the plan of care
12 (86)
2 (14)

to organize patient information into the appropriate

Demonstrate critical thinking
11 (79)
3 (21)

mind map shapes.

View the patient holistically
11 (79)
2 (14)
1 (7)
By the end of the proCorrelate the steps of the nursing process
8 (57)
3 (21)
3 (21)
gram, a few comments
to one another
on the summative faculty
Identify the steps of the nursing process
7 (50)
3 (21)
4 (29)
survey expressed faculty
members preferences for
the linear design and use of
computer templates. Comments also suggested that the colors
would be helpful, the faculty offered more case studies to
and shapes were, at times, either not being used consistently
facilitate student learning. In addition, clinical faculty were
or not being required by some faculty. These issues became a
encouraged to create their own MMCPs to share with the
focal point of discussion during the follow-up faculty forum.
students.
Wycoff (1991) indicated that color activates the brain
(p. 52) and increases retention, while Mueller et al. (2001)
Critical Thinking
stressed the signicance of allowing students to develop
According to Mueller et al. (2001), the mind-mapping techmind maps that make sense to them, realizing they may look
nique is designed to promote students ability to think criticaldifferent from the examples. Mueller et al. also warned of
ly when planning patient care. Nearly 17% of the respondents
the potential difculty for linear-thinking faculty to adapt
in the initial open-ended student survey indicated that the
to the non-linear style of mind mapping. During the forum,
MMCP helps develop problem-solving skills and incorporates
the faculty came to a consensus that the use of a standardboth right-brained and left-brained thinking. By the end of the
program, 91% of the students surveyed reported they were
ized template limits students creativity and does not foster
satised that using the mind map helped them demonstrate
individualized care. Faculty also agreed on the importance of
critical thinking. Faculty throughout the program agreed that
allowing students to use a style that makes sense to them,
MMCPs encourage students to think critically. One clinical
as long as the interconnections are being made and students
faculty member stated:
demonstrate understanding of the nursing process. The
uniqueness of each students map should be encouraged, reI like the mind map [over the traditional care plan]. A mind
gardless of faculty preference.
map allows students to visualize their critical thinking.
By the end of the program, 79% of the faculty surveyed
Faculty Orientation
reported that the students abilities to demonstrate critical
An additional need voiced by faculty at the forum, and supthinking had improved using mind maps versus traditional
care plans. One faculty member commented:
ported by students in the summative survey, was for a more
detailed and consistent faculty orientation to mind mapping
I believe mind mapping is a very useful tool for students.
throughout the program, with ongoing follow up and evaluaIt gives a process to thinking about the nursing process. The
tion. This will be an area of emphasis in the future.
area that students nd frustrating is the mess that they
TABLE 3

oftentimes end up with on their paper.

Appearance of MMCPs
In the initial open-ended survey, some students (14.9%)
expressed concern that the mind maps appear disorganized
or messy. Mueller et al. (2001) identied students perception
of disorganization as a pitfall with MMCPs, particularly
with students who prefer linear thinking. These students,
according to Mueller et al., should be allowed to develop different styles of maps, as long as their interconnectedness is
correct. The faculty have noticed that several students have
118

Knowledge of the Nursing Process

Mueller et al. (2001) identied that to successfully develop MMCPs, it is critical for students rst to have a working
knowledge of the nursing process. The initial open-ended student survey results indicated that nearly two thirds (60.1%)
of the respondents believed MMCPs helped them correlate
the assessment data with nursing diagnoses and expected
outcomes. The students also indicated that using MMCPs
helped them see interrelationships when planning patient
care. One student commented:
Journal of Nursing Education

KERN, BUSH, & MCCLEISH

Mind-mapped care plans helped me to correlate nursing

diagnoses together and see how they interrelate, possibly using one nursing intervention to solve several problems simultaneously.

Student satisfaction in this area continued throughout

the program. By the completion of the curriculum, 88% of the
students surveyed reported that using mind maps helped
them identify and correlate the steps of the nursing process.
From initial feedback, the clinical faculty also indicated
that using MMCPs helped students more easily correlate the
steps of the nursing process when planning patient care. One
clinical faculty member stated:
The visual map portrays all the patients problems at
once. I like how it shows that patient assessment data ts
all of the problems, not just one diagnosis at a time. I have
observed that students are able to come up with outcomes
and interventions that are much more individualized for the
patient; it doesnt appear like a textbook plan.

By the end of the program, 57% of respondents on the

summative faculty survey indicated that using mind maps,
compared to using the traditional care plan, improved students ability to correlate the steps of the nursing process,
and 50% indicated that using mind maps, compared to using
the traditional care plan, improved students ability to identify the steps of the nursing process (Table 3). This disparity
in responses between reported student satisfaction and faculty assessment of student improvement related to the nursing process was explored further at the faculty forum. One
faculty member expressed concern that students were not
writing measurable goals nor including an adequate amount
of assessment data on their mind maps. It was suggested
that the faculty return these maps to the students for revision, as these are errors in technique and not the fault of the
mind-mapping tool. As identied above, not all instructors
required the use of color on the maps. One faculty member
asserted that color coding facilitates quick identication of
the various parts of the nursing process on the map.
Use in Nursing Practice
One surprising theme in the initial student survey comments was the concern that MMCPs are not used in actual
nursing practice. The faculty have since stressed that the
mind map is an educational tool for learning to plan nursing care and that students will only see mind maps in the
academic setting, not the clinical setting. The mind map
represents a picture of the way nurses think, which would
not be seen in written form on the clinical unit. However,
parts of the mind map will be seen and used in the clinical
setting in various formats (e.g., nursing diagnoses, expected outcomes, assessment data). The faculty will continue to
dialogue with nurses in the practice setting to keep them
apprised of the use of MMCPs in the educational setting.
Rationales and Evaluation
An initial concern raised by nursing faculty was related to
methods of identifying rationales for nursing interventions
and evaluation of the effectiveness of the MMCP. As suggested by Mueller et al. (2001), faculty were encouraged to
April 2006, Vol. 45, No. 4

discuss rationale and evaluation with students in the clinical

setting, as this exchange enhances students critical thinking
abilities. In addition, faculty in several courses have added
an evaluation component, which students include in a reective journal.
In the nal semester of the program, 85% of the students
surveyed reported that using the mind map helped them articulate their plan of care to their instructor and peers. In
comparison, 86% of the faculty surveyed reported that the
students abilities to articulate their plan of care to the instructor and students peers had improved using the mind
map versus the traditional care plan. One faculty member
explained that in the critical care course in the nal semester, the mind map was incorporated into a multiple organ
dysfunction syndrome (MODS) presentation, saying that:
Students were assigned to complete a mind map on a patient with MODS using at least eight nursing diagnoses. In a
presentation, the students had to explain their map to their
peers, relating the concepts to MODS. The students were all
able to produce and explain a comprehensive, holistic map
with ease on a very complicated patient. The students explanations of their mind maps actually became a review of the
course in preparation for the nal exam.

CONCLUSION
Overall, the rst program cycle of using the MMCP
as an innovative teaching strategy in the nursing curriculum at MCHS has received a positive response from
both students and faculty. As use of the mind-mapping
process continues, emphasis will be placed on continued
faculty orientation to the process. In addition, follow up
and evaluation of the process will be ongoing. The following instructors comment expresses the faculty members
enthusiasm for the change from the traditional care plan
method to mind-mapped care plans:
I prefer mind-mapped care plans over traditional care
plans. They are just easier for students to grasp and not as
threatening as the traditional plans. Theyre much easier to
grade and clearer to see if the student gets the concepts and
overall plan. Its refreshing to have a change in this area after so many years of the other way, which was tedious for
everyone.

REFERENCES
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Mueller, A., Johnston, M., & Bligh, D. (2001). Mind-mapped care
plans: A remarkable alternative to traditional nursing care plans.
Nurse Educator, 26(2), 75-80.
Mueller, A., Johnston, M., & Bligh, D. (2002). Viewpoint: Joining
mind mapping and care planning to enhance student critical
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Novak, J., & Gowin, D. (1984). Learning how to learn. New York:
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Wycoff, J. (1991). Mindmapping: Your personal guide to exploring
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