Creative Nursing, Volume 26, Issue 1, 2020

The Effect of Concept Mapping on Critical Thinking of

Jordanian Nursing Students
Huthaifah Khrais, RN, MSN, PhD
Ali M. Saleh, RN, PhD

Aim: The aim of this study was to explore the effectiveness of concept maps in improving the critical thinking of nursing
students. Method: This quasi-experimental study was conducted using a pretest–posttest design among two groups of
a total of 115 nursing students. Participants were either exposed to concept mapping sessions or taught with traditional
lecturing; the assessment tool was a test of critical thinking completed before and after the intervention. Results: The
mean scores for critical thinking were higher in the group that engaged in mapping sessions compared to the traditional
lecture group. Conclusion: This study supports the usefulness of concept maps as a teaching strategy to promote
development of nursing students’ critical thinking abilities. These findings could provide valuable evidence for establishing
concept mapping as a promising teaching strategy for nursing students.

Keywords: concept map; critical thinking; nursing; education; Jordan

F or the last three decades, the area of nursing edu-

cation has experienced many progressive phases,
reforms, and challenges. Developing creative teach-
ing methods to improve critical thinking (CT) skills
of nursing students is one of the challenges (Daley,
Morgan, & Black, 2016). Although nursing educa-
tors carefully design the most appropriate content
to empower their students, there are many weak-
nesses in teaching strategies and methods. For exam-
ple, Ludin (2018) states that there is great emphasis on
learning outcomes, with little or no attention toward
approaches employed by students in their learning
process.
From an international point of view, educational
programs are intended to empower nurses in their
knowledge and skills (Tutticci, Lewis, & Coyer, 2016).
However, in this age of information and continu-
ing development in health-related sciences, equip-
ping graduate nurses with talents and skills such as
versatility, CT, communication, and self-confidence
is expected by nursing administrators and recipients
of care (Carter, Creedy, & Sidebotham, 2015; Swart,
2017).
Strong arguments between nursing educators
about the effectiveness of current passive teaching
pedagogies have been addressed in the nursing
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literature. Some educators claim that current
traditional lecturing does not challenge students
(Aberdeen, Leggat, & Barraclough, 2010). Others go
beyond that claim, stating that current pedagogies are
limiting students’ potential for efficient learning (Lin,
Han, Pan, & Chen, 2015).
CONCEPT MAPPING
Concept mapping (CM) was first described by Novak
and Gowin (1984), whose work was based on
Ausubel’s (1968) Theory of Meaningful Learning.
Mapping the learned material clarifies interrelations
between concepts by depicting them in a graphically
arranged way; Novak and Gowin define this as “a
schematic device for representing a set of concept
meanings in a framework of propositions” (p. 15).
Hence, a change from the current way of learning
might occur as students are able to link learned knowl-
edge meaningfully, rather than simply memorizing
concepts (Novak, 2010).
Jaafarpour, Aazami, and Mozafari (2016)
state that the advantages of CM have not been
completely confirmed in the nursing literature.
However, other authors state that, if applied

© 2020 Creative Health Care Management e19

http://dx.doi.org/10.1891/1078-4535.26.1.e19

Critical thinking is purposeful,
insightful judgment that involves
the development and effective
utilization of multiple dimensions
of cognition to analyze a
situation.
appropriately, CM is interactive; applicable in
regular classrooms and clinical areas; can initiate
many cognitive abilities; and can help educators
understand students’ learning styles and behaviors
(Chang, Sung, & Chen, 2002; Harrison & Gibbons,
2013).
CRITICAL THINKING
Promoting CT skills among students is one of the
priorities of higher education programs; Chan (2013)
calls it one of the most required competencies dur-
ing undergraduate education for professional nursing
practice. CT is “purposeful, insightful judgment that
involves the development and effective utilization of
multiple dimensions of cognition to analyze a situa-
tion” (Kaddoura, Van-Dyke, & Yang, 2016, p. 350). It
has been strongly suggested that to enhance students’
CT skills, they must be engaged in CT activities and
exercises (Jaafarpour et al., 2016; Kanbay & Okanlı,
2017). CM is a recommended pedagogical tool that
teaches students to analyze and organize data in a log-
ical manner.
In Jordan, the education system is a combina-
tion of public and private universities; most Jorda-
nian universities offer baccalaureate nursing degree
programs (Hadid, 2012). However, traditional lec-
tures are the base of education in Jordan, and the
focus of nursing education is more content-oriented
than student-oriented (Mrayyan & Acorn, 2004). In
these contexts, little is known about learning pro-
cesses and their outcomes. Issues related to students’
CT skills need to be addressed in Jordan. Therefore,
the purpose of the current study was to examine
the effect of CM on Jordanian nursing students’ CT
skills.
METHODS
Sample
A two-group, pretest–posttest, quasi-experimental
design was used to study the effectiveness of
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e20 Khrais and Saleh
CM sessions on Jordanian nursing students’ CT.
A convenience sample of 115 nursing students (from a
total of 132 potential subjects, a response rate of 87%)
enrolled in a baccalaureate program at a private uni-
versity were recruited using the following inclusion
criteria: Jordanian; completed at least 66 credit hours;
have not had previous experience with CM; willing
to participate in the study in either the intervention
or the control group; and able to complete the survey.
Seventeen students who were unable to attend the
learning sessions (most because of family or work
commitments) were excluded.
Data Collection Procedure
A total of 24 class hours over a period of 5 weeks,
as part of regular classes, were used to present the
material to the students. In order to prevent any
contamination by interaction between the interven-
tion and control groups, the investigator designed the
study over two phases: phase one, which included tra-
ditional lectures for students in the control group, and
phase two, which included teaching with CM for stu-
dents in the intervention group.
Students’ CT was measured using the Ennis–Weir
CT Test (Ennis & Weir, 1989). This test depicts a com-
plex situation; participants are required to formu-
late a rationalized justification in response to it. The
test is not intended to measure students’ language or
writing abilities, but rather to study their CT abili-
ties in dealing with a complicated situation. Validity
has been established by Ku (2009), and reliability has
been reported as 0.86 measured by Cronbach’s alpha
(Chan, 2013).
RESULTS
A quasi-experimental study was performed to assess
whether two different teaching methods produced dif-
ferent levels of CT among nursing students. Table 1
describes the demographics of the 115 students in the
study, of whom 60.9% were female. The average age
of the study participants was 24.18 years (standard
deviation [SD] = 4.35); this high average age might be
related to the presence of bridging program students.
The mean length of clinical experience was 1.93 years
(SD = 3.03).
There were four incomparable variables: stu-
dents’ age, length of clinical experience, financial
support, and study track. These variables are asso-
ciated with the outcome variable and can be statis-
tically controlled (Warner, 2008). Such nonequivalent
TABLE 1. Students’ Demographics (N = 115) DISCUSSION
Demographic M ± SD This study sought to find out if CM is an effective
Age (years) 24.18 ± 4.35 tool in improving students’ CT. The results indicated
GPA (%) 72.49 ± 7.53 significant differences between control and experi-
mental groups after applying CM. Similar to many
Number of Finished Credit Hours 92.54 ± 17.68
previous findings (Kaddoura et al., 2016; Vacek, 2009;
Clinical Experience in Years 1.93 ± 3.03 Yue, Zhang, Zhang, & Jin, 2017), this study supports
Number of Hours of Study per Day 2.80 ± 1.34 the idea that CM could stimulate students to evaluate,
N (%) analyze, and interpret information critically.
CM is an integrative process that allows students
Student’s Membership
to find out the relationships between concepts before
Control Group 57 (49.6) coming to final conclusions (Carson-Davis, 2012).
Intervention Group 58 (50.4) Consistent with the current study findings, Dear-
Gender mon, Lawson, and Hall (2011) found in their quasi-
Male 45 (39.1)
experimental study that the posttest mean scores of CT
improved significantly after CM. On the other hand,
Female 70 (60.9)
this finding was not supported by other studies in
Marital Status the literature. Kanbay, Isık, and Aslan (2011) and Kan-
Single 82 (71.3) bay and Okanlı (2017) found no significant effect of
Married 31 (27.0) CM on students’ CT. The current findings were also
inconsistent with Brune’s (2014) study, in which a 7-
Divorced 2 (1.7)
week program of CM showed no improvement in CT
Financial Support scores.
Self-Dependent 58 (50.4) CM is fairly complex and unfamiliar for students
Family 43 (37.4) (Von Colln-Appling & Giuliano, 2017). Kanbay et al.
(2011) report that students found CM time-consuming
Scholarship 14 (12.2)
and difficult, and needed more time to become famil-
Study Track iar with the process. Some students may focus on the
Regular 64 (55.7) visual product of CM rather than mastering the con-
Bridging 51 (44.3) tent itself (Khrais & Saleh, 2017).
Note. N = number of students; M = mean; SD = standard
deviation; GPA = grade point average.

Limitations of Study

comparison groups are often encountered in quasi-
experimental research, therefore, analysis of covari-
ance (ANCOVA) was used.
The difference in pretest CT mean scores between
the control and intervention groups was not statis-
tically significant. However, the posttest CT mean
score for the control group was significantly lower
than the intervention group. Also, the 95% confidence
interval (CI) for the difference between sample mean,
M1 – M2, had a lower bound of 7.79 and an upper
bound of 9.79. Therefore, the researcher concluded
that the CM positively improved students’ CT scores.
See Table 2.
Paired t-tests were used to detect the difference
in students’ CT mean scores from pretest to posttest.
As shown in Table 3, it is clear that students in the
intervention group demonstrated improvement in CT
mean scores from pretest to posttest at a significance
level of 0.05, t (57) = −4.22, p > .001.
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One limitation of this study is that participants were
aware they were being observed; some students may
have answered in such a way as to support the
researcher’s findings. This potential effect may or may
not have happened and cannot be confirmed by the
researcher. A further limitation is that a sample from a
single educational setting limits the generalizability of
If applied appropriately, concept
mapping is interactive; applicable
in regular classrooms and clinical
areas; can initiate many cognitive
abilities; and can help educators
understand students’ learning
styles and behaviors.

Effect of Concept Mapping on Critical Thinking e21

TABLE 2. Comparison Between Control and Intervention Groups Regarding Mean Scores of CT Pre- and
Postlearning Sessions Using ANCOVA (N = 115)
Control Experimental Partial Eta
Dependent Variable (N = 57) (N = 58) Levene Test ANCOVA Squared (𝜂2)
M SD M SD Sig. F Sig.
CT Total Scores 5.89 3.99 7.20 4.20 0.103 4.59 0.132 .03
Pretest
CT Total Scores 6.21 3.76 11.37 6.61 0.173 20.75 0.001* 0.53
Posttest
Note. ANCOVA = analysis of covariance; CT = critical thinking.
* Significant ANCOVA at p < .005.

TABLE 3. Comparison of Pre- and Posttest Scores of CT for Intervention Group Using Paired t-Test
Dependent Variable Experimental (N = 58) Paired t-Test
M SD T Sig. 95% Confidence
Lower Upper
CT Total Scores Pretest 7.20 4.20 −4.22 0.000* −6.15 −2.19
(Intervention Group
Only)
CT Total Scores Posttest 11.37 6.61
(Intervention Group
Only)
Note. CT = critical thinking; M = mean; SD = standard deviation.
*Significant Paired t-test at p < .005.

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CONCLUSION
This quasi-experimental study using a pretest–
posttest design explored the effect of CM on the CT
skills of baccalaureate nursing students. A conve-
nience sample of 115 nursing students was assigned
randomly to the control and intervention groups. The
intervention students in this study learned with CM,
while control group students learned with traditional
lecturing. CM significantly improved students’ CT
means scores, compared to the improvement for the
control group students. However, more valid, reli-
able, and detailed nursing tools for measuring CT
are needed, as well as studies about the competen-
cies of nursing faculties in mastering the teaching of
CT skills. Also, more research is recommended in a
variety of nursing program settings, such as in the
military, governmental universities, online/hybrid
courses, and students in master’s and PhD programs.
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Disclosure. The authors report no real or perceived vested inter-
ests that relate to this article that could be construed as a conflict of
interest.
Acknowledgment. Authors acknowledge the support of Zarqa
University.
Funding. The author(s) received no specific grant or financial sup-
port for the research, authorship, and/or publication of this article.
Correspondence regarding this article should be directed to
Huthaifah Khrais at h_khrais91@yahoo.com
e23
 Huthaifah I. Khrais, RN, MSN, PhD, is
an Assistant Professor on the Faculty of
Nursing at Zarqa University in Jordan.
Ali M. Saleh, RN, PhD, is an Associate
Professor in the Community Health
Nursing Department of the School of
Nursing at The University of Jordan in
Amman, Jordan.

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