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.

Have you ever asked yourself whether you are more right-brained or left-brained? Those who naturally use their left brains are more linear in their thinking. Right-brain thinkers see more in pictures and illustrations. It is best for nurses to use the whole brain (right and left) when thinking about providing the broad scope of nursing care to clients.

No More Columns!

Traditional nursing care plans are linear—that is, they are designed in columns. They speak almost exclusively to the left brain. The traditional nursing care plan is organized according to the nursing process, which guides us in problem-solving the nursing care we give. However, the linear nature of the traditional plan does not facilitate interconnecting data from one “row” to another or between parts in a column. Concept mapping allows us to show the interconnections between various client symptoms, interventions, or problems as they impact each other.

You can keep the parts that are great about traditional care plans (problem-solving and categorizing) but change the linear/columnar nature of the plan to a design that uses the whole brain—bringing left-brained, linear problem-solving together with the freewheeling, interconnected, creative right brain. Joining concept mapping and care planning enables you to create a whole picture of a client with all the interconnections identified.

There are several diverse and innovative ways to mind map or to concept map nursing care plans. he examples in this chapter use mind mapping and require placing the client at the center, with all ideas on one page (for a whole picture); the examples also use color-coding and creative energy. When doing a large mapped plan of care, a light posterboard is often used so that all ideas fit on one page.

Components of a Concept Map

Tony Buzan developed the idea of concept mapping, a way to depict how ideas about a main subject are related. Mapping represents graphically the relationships and interrelationships of ideas and concepts. It fosters and encourages critical thinking through brainstorming about a particular subject.

Instead of starting at the top of the page, concept mapping starts in the page’s center. The main concept of our thinking goes in this center stage place.

From that central thought, simply begin thinking of other main ideas that relate to the central topic. These ideas radiate out from the central idea likes spokes of a wheel (see subsequent discussion); however, they do not have to be added in a balanced manner; the “wheel” does not have to be round.

You will generate further ideas related to each spoke (see subsequent discussion); and your mind will race with even more ideas from those thoughts, which can be represented through pictures or words.

As you think of new ideas, write them down immediately. This may require going back and forth from one area of the page to another. Writing your concept map by hand allows you to move faster. Avoid using a computer to generate a map because this hinders the fast-paced process. You can group different concepts together by color-coding or by placement on the page (see subsequent discussion).

As you see connections and interconnections between groups of ideas, use arrows or lines to connect those concepts (refer to the dotted lines). You can also add defining phrases that explain how the interconnected thoughts relate to one another, as in the following figure.

Some left-brain thinkers find it very difficult to start their ideas in the middle of a page. If you are this type of thinker, try starting at the top of the page (see subsequent discussion), but you must still represent your ideas in illustration form, not in paragraphs.

oncept maps created by different people look different. They are unique to the mind’s eye picture so don’t expect your map to be the same as someone else’s.