Nursing Dx

Concept mapping is an exciting alternative format for illustrating a written plan of care. A mapped care plan will look very different from traditional plans of care, which are usually completed on linear forms.

To begin mapping a client plan of care, you must begin with the central topic—the client. Now you are thinking like a nurse. Create a shape that signifies “client” to you and place that at your map’s center. If your hand just can’t start at the center, then put the shape at the top. This will help you remember that the client is the focus of your plan, not the medical diagnosis or condition. All other pieces of the map will be connected in some manner to the client. Many different pieces of information about the client can be connected directly to the client. For example, each of the following pieces of critical client data could stem from the center:

Now, you must do a bit of thinking about how you think. To create the rest of your map, ask yourself how you plan client care. For example, which of these items do you see first orthink of first as the basis for your plan: the clustered assessment data, nursing diagnoses, oroutcomes? Whichever piece you choose becomes your first layer of connections. Supposewhen thinking about a plan of care for a female client with heart failure, you think first interms of all the nursing diagnoses about that woman and her condition. Your map would startwith the diagnoses featured as the first “branches,” each one being listed separately in someway on the map.

Completing the map then becomes a matter of adding the rest of the pieces of the plan using the nursing process and your own way of thinking/planning as your guide. If you began your map using nursing diagnoses, you might think, “What signs and symptoms or data support these diagnoses?” Then, you would connect clusters of supporting data to the related nursing diagnosis. Or you might think, “What client outcomes am I trying to achieve when I address this nursing diagnosis?” In that case, you would next connect client outcomes (or NOC labels) to the nursing diagnoses.

To keep your map clear, as suggested previously, use different colors and maybe a different shape/spoke/line for each piece of the care plan that you are adding. For example:

• Red for signs and symptoms (to signify danger)
• Yellow for nursing diagnoses (for “stop and think what this is”)
• Green for nursing interventions/NIC labels (for “go”)
• Blue (or some other color) for outcomes/NOC labels

When all the pieces of the nursing process are represented, each “branch” of the map is complete. There should be a nursing diagnosis (supported by subjective and objective assessment data), nursing interventions, desired client outcome(s), and any evaluation data, all connected in a manner that shows there is a relationship between them.
It is critical to understand that there is no preset order for the pieces, because one cluster is not more or less important than another (or one is not “subsumed” under another). It is important, however, that those pieces within a branch be in the same order in each branch.
So, you might ask, how is this different than writing out information in a linear manner? What makes mapping so special? One of the things you may have discovered about caring for clients is that the care you deliver is very interconnected. Taking care of one problem often results in the simultaneous correction of another. For example, if you resolve a fluid volume problem in a client with heart failure, you will also positively impact the client’s gas exchange and decrease his or her anxiety. These kinds of interconnections cannot be shown on linear plans of care, yet they are what practicing nurses see in their mind’s eye all the time. These interconnections can be represented on a map with arrows or dotted or dashed lines that tie related ideas together. Then, defining phrases that explain the nature of the interconnection can be added to further clarify the relationship.
In addition to the pieces of the nursing process, there are other components of care that can be illustrated on a map. Nurses have certain responsibilities when clients have diagnostic tests (such as an angiography or a bronchoscopy). These tests can be connected to the appropriate piece of your map, along with the correct nursing interventions related to those tests. Another item to be added would be potential complications (collaborative problems).
Taking your clients’ needs one step further, try asking every client you have (medical, surgical, or otherwise), “What is the most important thing to you now in relation to why you are here?” Obtaining this information builds an alliance between you and your client, and together you can work toward that desired outcome. Add it to your map and see how your plan of care becomes more client-centered.