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In this study, the use of concept mapping as a method to prepare for high fidelity simulated learning experiences was investigated. Fourth year baccalaureate nursing students were taught how to use concept maps as a way to prepare for high fidelity simulated nursing experiences. Students prepared concept maps for two simulated experiences including; 1. caring for patients with diabetes, and, 2. caring for patients with heart failure. Simulated learning experiences were video recorded and debriefing sessions were audio recorded. Following the simulation, three data analysis strategies were employed including analysis of the videos of the simulation, analysis of the audio recordings of the debriefing sessions and analysis of the concept maps. Additionally, videos from previous semesters where students did not create concept maps prior to simulations were reviewed. When comparing student behaviors to Tanner’s (2006) Clinical Judgment Model, findings indicated that students who created concept maps prior to simulation demonstrated an increase in noticing behaviors, but that interpreting, responding and reflecting behaviors did not appear to increase. Students also reported a need to have concept maps introduced earlier in their curriculum and that the maps facilitated their learning most in complex, hard to understand clinical cases. This study has implications for simulation, curriculum and the role of concept mapping in the creation of student knowledge structures. Keywords: Concept mapping, high fidelity simulations, nursing curriculum, clinical judgment Daley, Beman, Morgan, Kennedy, and Sheriff Journal of the Scholarship of Teaching and Learning, Vol. 17, No. 4, October 2017. josotl.indiana.edu 18 Providing high-quality clinical experiences is a crucial component of nursing student development and education. Clinical practice experiences help students learn not only the procedures and tasks involved in nursing care, but also the critical thinking, assessment, analysis and decision-making skills. Over the last 10-15 years, nursing education has begun using high fidelity simulations as a teaching and learning strategy that can replicate clinical practice. In recent years nursing programs have relied more extensively on simulations due to limited clinical space, shortages of faculty, patient safety concerns of clinical agencies and difficulty gaining access to electronic medical records (National Council of State Boards of Nursing, 2014). Gaba (2004) defined simulation as “... a technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (p. i2). Previous research indicates that simulations can assist students in gaining confidence, increasing knowledge and improving clinical performance. Additionally, the National Council of State Boards of Nursing in a study that replaced up to 50% of actual clinical experiences with simulated learning experiences found, “substantial evidence that substituting high-quality simulation experiences for up to half of traditional clinical hours produces comparable end-of-program educational outcomes and new graduates that are ready for clinical practice” (pg. S3).   However, what is unclear in previous research is what teaching strategies can be used with simulation to enhance learning outcomes. Additionally, there has been little investigation of which learning strategies help prepare students for simulation. The purpose of this pilot study was to investigate the role that concept mapping played in assisting nursing students to prepare for simulation. Supporting Literature To investigate the use of concept mapping and high fidelity simulation a scholarship of teaching and learning (SoTL) approach was selected (Schulman, 2005). SoTL is defined as: “problem posing about an issue of teaching or learning, study of the problem through methods appropriate to disciplinary epistemologies, application of result to practice, communication of results, selfreflection and peer review” (Hutchings & Cambridge, 1999, p.7). As pedagogical strategies concept mapping and simulation offer a unique way to foster the development of learning and the creation of meaning. This study is particularly important because the current focus in higher education has shifted to include a greater emphasis on learning. This shift from a teaching focus to a learning focus started when Barr & Tagg (1995) called on institutions of higher education to shift from being institutions that provide instruction to institutions that exist to produce learning. Concept mapping and simulation offer practical strategies to foster the development of learning potential in nursing students. Constructivist learning theory provides the overall conceptual framework for this SoTL investigation. Constructivist learning theory holds that “learners actively construct and reconstruct knowledge out of their experiences in the world” (Kafai & Resnik, 2011). Knowledge construction takes place when learners actively build knowledge through intellectual engagement and investment in personally meaningful tasks. Constructivists believe that individuals learn through their experience and that meaning is rooted in that experience. The key to learning, in a constructivist framework, is Daley, Beman, Morgan, Kennedy, and Sheriff Journal of the Scholarship of Teaching and Learning, Vol. 17, No. 4, October 2017. josotl.indiana.edu 19 for the learner to find multiple ways to link new information to previous knowledge and experience. Lambert et al. (1995) refer to constructivism as the epistemological processes of knowing and coming to know. Within a constructivist framework, learners create their own knowledge by how they put their worlds together. In other words, constructivists focus on the connections that the learner is making between ideas. Novak and Gowin (1984) and Novak (1998) believe that learning occurs through a process of assimilating concepts into the cognitive structures by either subsuming concepts under each other, progressively differentiating concepts from each other or reconciling the similarities between concepts. The crucial element is that the learner actively creates a knowledge base through linkages, the connections between ideas and the experiences. Novak (1998) and Novak and Gowin (1984) operationalized constructivist learning theory by creating concept maps. A concept map is a “schematic device for representing a set of concept meanings embedded in a framework of propositions” (Novak & Gowin, 1984, p. 15). Concept maps are created with the broader, more inclusive concepts at the top of the hierarchy, connecting through linking words with other concepts that can be subsumed. This tool helps facilitate understanding of conceptual relationships and the structure of knowledge. There is a rich history of concept mapping use and research in nursing education (Daley, Morgan & Beman, 2016). For example, concept maps have been used as an alternative approach to nursing care plans, (Black, Green, Chapin, & Owens, 2000), to promote critical thinking, (Daley, et al., 1999; Hicks-Moore & Pastirik, 2006; Yeo, 2014) and to advance interdisciplinary education (Bressington, Wells & Graham, 2011; Daley, Durning & Torre, 2016). A newly emerging area of research, is assessing the impact of combining concept maps with high fidelity simulations in nursing education. One study found a significant correlation between nursing student self-confidence in simulation and concept maps (Samawi, Miller & Haras, 2014). Concept maps can also help us understand how a student’s knowledge base develops and how they link theoretical understanding to practical work. Kinchin and Hay (2000, 2005) identified a qualitative classification of concept maps that included three types of maps; a spoke, a chain and a network. Each of these qualitatively different kinds of maps enhances our understanding of student learning and the development of knowledge structures leading to expertise. The “spoke” type of maps are often simple and yet, they allow the student to comfortably add new concepts to the developing knowledge base. The “chain” type of maps have many different levels and since they rely on a specific sequence the maps are hard to modify and change as the student’s knowledge base grows. As Kinchin, Cabot and Hay (2008) indicated, “Chains are indicative of procedural sequences that characterize observable clinical practice” (p. 94). Finally, the “network” type maps tend to be indicative of an advanced level of understanding that is more integrated and holistic. Kinchin, et al. (2008) believe that the hallmark of expertise may be the ability to move back and forth between a networked understanding of concepts and chain type of understanding and implementation in clinical practice. Tanner’s (2006) model of clinical judgment in nursing also informed this study. A major goal of simulated learning experiences in nursing education is to assist students in developing their ability to “think like a nurse” (Tanner, 2006, p. 209). In Tanner’s terms, this process of thinking like a nurse is sophisticated clinical judgment that includes noticing, interpreting, responding and reflecting on clinical situations. Noticing signifies that the nurse has a perceptual grasp of the situation (Tanner, 2006, p. 208). This perceptual grasp includes the context of the situation, the Daley, Beman, Morgan, Kennedy, and Sheriff Journal of the Scholarship of Teaching and Learning, Vol. 17, No. 4, October 2017. josotl.indiana.edu 20 background and the relationships that are embedded in providing nursing care. Additionally, an important component of noticing includes the expectations the nurse brings to the clinical situation. These expectations can be an understanding of the patient and the typical patient response patterns, along with the textbook k

Concept Maps: A Tool to Prepare for High Fidelity Simulation in Nursing