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What is a Nursing Concept Map? Examples & Templates

What is a nursing concept map, why use a nursing concept map, types of nursing concept maps, nursing concept map templates.

A nursing concept map is a visual tool that helps nursing students strategize patient care on paper. This map allows students to organize and visualize patient care concepts in an easy-to-read diagram that highlights the relationships among various nursing concepts.

Nursing concept maps are also a self-teaching strategy that can help students pre-plan their clinical assessments and provide valuable insight for post-clinical analysis. This tool increases students' clinical reasoning and judgment while optimizing learning.

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Additional benefits of nursing concept maps include:

• Identifying patient problems and health concerns
• Helping organize assessment data
• Determining the appropriate nursing diagnoses and interventions
• Assessing outcomes

Nursing concept maps are effective learning tools for content that can be broken down into categories or when it is essential to clearly visualize the relationship between various concepts. Nursing students most commonly use them in the clinical setting. However, concept maps also benefit students who need to compare and contrast information in the classroom.

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Concept maps can help chuck significant amounts of information using many forms, including:

• Graphic organizers
• T-charts, or
• Venn Diagrams

Although there are many ways to create a concept map, most nursing concept maps are templates utilizing a graphic organizer format.

If you are a nursing student looking to study more effectively and efficiently, you have come to the right place! We’ve designed several nursing concept map templates for you to up your study game and ace your next exam. You can print these out and organize them as you need.

Medical Diagnosis Concept Map Template

SBAR (Situation, Background, Assessment, Recommendation) Concept Map Template

Body System Concept Map Template

Nursing Diagnosis Concept Care Map

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How to Create a Basic Nursing Concept Map

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A nursing concept map is a visual model outlining the relationship between various nursing concepts. The use of concept mapping has been an integral component of nursing programs for decades. Nursing schools have long relied on this method to teach critical thinking skills to nursing students and prepare them to apply their theoretical nursing education in clinical settings.

So, what exactly is a nursing concept map? How effective is it as a teaching strategy, and how should you go about creating one? This article answers these questions and shows you how to create your own concept map template in minutes.

What is a nursing concept map?

A nursing concept map is a tool that defines, organizes, and categorizes information pertaining to a nursing care plan, a medical diagnosis, nursing tasks, or nursing interventions, among many other fundamental topics. The map can follow several different structures, with the following four being the most commonly used:

• Spider maps: Spider mapping is the structure you will encounter the most in nursing. These maps feature a main topic at the center and sub-elements grouped around it.
• Hierarchical maps: These maps outline concepts from top to bottom, with the main topic at the top and more specific concepts below.
• Flow charts: These are simple diagrams that outline a workflow. Nursing flow charts represent the nursing process in sequential order.
• System maps: Just like flow charts, these maps organize the workflow in sequential order. The difference between the two is that system maps add inputs and outputs to the main diagram.

What is a nursing concept map used for?

Nursing schools use nursing concept maps as teaching tools. Concept mapping helps initiate students into the nursing workflow by distilling complex information into simple visual concepts. This approach aims to provide nurses with the relevant information needed to make the correct nursing diagnosis, apply the appropriate patient care plan, or determine outcomes for a patient.

As a learning strategy, nursing concept maps have proven effective in improving students’ decision-making, clinical judgment, and ability to see the big picture regarding the steps required to provide the best health care to the patient.

According to a study by Janet K. Garwood, Azza H. Ahmed, and Sara A. McComb, the effects of concept mapping are especially noticeable in students’ improved critical thinking skills and ability to apply theory to nursing practice.

A step-by-step guide to creating a basic nursing concept map

Now that you are familiar with nursing concept maps and their role in nurse education today, let’s break down how to create your concept map.

Step 1: Start with the main concept map topic

Choosing a main topic is the first step when using the spider-mapping structure. Depending on need and priority, your main element could be any of the following:

• Patient care plan: This patient care plan topic covers anything deemed relevant to patient care, from past medical history to risk factors. The intended purpose is to equip nurses with every piece of information that could aid in devising the right care plan for the patient.
• Medical diagnosis: Medical diagnosis maps dive into any element that pertains to the diagnosis of the disease. This includes risk factors, symptoms, medications, complications, and interventions.
• SBAR: This acronym stands for s ituation, b ackground, a ssessment, and r ecommendation. SBAR concept maps represent all the information nurses need to ensure smooth communication between them and doctors. 
• Nursing responsibilities: Nursing teams also use concept maps to delineate tasks and duties. For instance, the tasks expected from a surgical nurse will be specifically illustrated on the map. In this case, elements like prevention of infection, behavior response, and post-up care might be grouped around the main topic.

Step 2: Determine secondary subsections

Once you’ve picked your main topic, the next step is grouping a set of subsections around it. Using a patient care plan map as our example, the elements below can be used as secondary subsections for the topic:

• Diagnostic process
• Current patient history
• Risk factors
• Patient info
• Past medical history
• Medication list

Step 3: List key info for each subsection

After picking your subsections, supplement each category with key info that expands on each concept. Using the same patient care plan example, here are some possible key elements for the secondary subsections above:

• Assessment > Diagnosis
• Diagnostic process > Lab results – physical exam results
• Current patient history > Day of admission – chief complaint
• Risk factors > Use of tobacco products – dietary habits
• Patient info > Age – sex – race – marital status
• Past medical history > Childhood illnesses – major adulthood illnesses – surgical history – injury history – allergies – prior hospitalizations
• Medication list > Medication one – medication two – medication three

Nursing Concept Map Example

Nursing concept maps visually represent the relationship between points within the nursing process. They should include all (or as many as possible) key points mentioned above to get a full picture of your patient’s case.

Take a look at this nursing concept map example to help you understand how to put it all together: 

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Nursing Concept Map (FREE Template)

Nursing concept maps are dynamic tools with significant value for nurses and especially nursing students starting their educational journey.

In this article, we will learn about concept mapping in nursing and how to apply it to nursing.

Also, we will give a FREE PDF Concept Map Template.

You may also want to check out 15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

What is Concept Map?

A concept map also known as a mind map is a visual tool that represents relationships and connections between different concepts or ideas.

It is a graphical representation of information that helps to organize and understand complex topics or subjects.

Concept maps are often used to illustrate how different concepts relate to one another, showing hierarchies, connections, and dependencies.

In a concept map, concepts are represented as nodes or boxes, and the relationships between concepts are depicted using lines or arrows.

The lines connecting the nodes indicate the nature of the relationship, such as “is a part of,” “causes,” “leads to,” “is related to,” and more.

These maps can vary in complexity, from simple diagrams with a few nodes to intricate structures with numerous interconnected concepts.

Concept maps are widely used in education, brainstorming, research, and problem-solving.

They provide a visual representation that helps individuals grasp the bigger picture, understand the connections between ideas, and identify key concepts within a complex system.

Definition of Concept Map

A concept map can be defined as a visual representation that depicts the relationships and connections between various concepts or ideas in a structured and organized manner.

What is a Nursing Concept Map?

In the context of nursing, a concept map is a visual representation that illustrates the relationships between various nursing concepts and their connections within a particular patient’s care or a broader nursing context.

Concept mapping in nursing is a valuable tool for critical thinking , clinical reasoning , and effective communication among healthcare professionals.

Nursing concept maps are used to:

• Organize Information: Nursing concepts such as patient assessment, nursing diagnoses, interventions, and patient outcomes can be organized and displayed visually to help nurses and other healthcare providers better understand the care plan.
• Facilitate Care Planning: Concept maps allow nurses to create a structured plan of care for their patients. This includes identifying nursing diagnoses, selecting appropriate interventions, and predicting potential outcomes.
• Enhance Critical Thinking: Creating a concept map encourages nurses to think critically about the relationships between different aspects of patient care. It helps them identify potential issues, connections, and factors that might impact patient well-being.
• Promote Collaboration: Concept maps can be shared among healthcare professionals, fostering better communication and collaboration among nurses, doctors, therapists, and other team members involved in patient care.
• Improve Patient Education: Concept maps can be simplified and shared with patients to help them understand their medical conditions, treatment plans, and the role of nursing interventions in their care.
• Assist in Decision-Making: Nurses can use concept maps to evaluate different approaches to patient care, considering the potential outcomes of each intervention and selecting the best course of action.
• Document Patient Progress: Over time, nurses can update concept maps to reflect changes in the patient’s condition, modifications to the care plan, and progress toward desired outcomes.

A nursing concept map typically includes components such as nursing diagnoses, patient assessment data, interventions, expected outcomes, and evaluation criteria.

It visually presents the connections between these components, allowing nurses to make informed decisions and provide effective care.

It’s important to note that creating effective concept maps in nursing requires a solid understanding of nursing concepts, patient care processes, and critical thinking skills.

Concept mapping is a dynamic process that evolves as the patient’s condition changes and as the care plan is adjusted based on ongoing assessment and evaluation.

Why Use a Concept Map in Nursing?

Concept mapping is useful in nursing because it can visually represent nonlinear and linear relationships, which aids in the development of critical thinking , analytical skills, and clinical reasoning .

By linking attributes of concepts, concept maps help nurses make meaning of complex ideas, enabling them to visualize information in their own way.

Concept maps offer a way to focus on key concepts and relationships, making them quicker than note-taking and a beneficial tool for care planning, organizing nursing care, and understanding complex concepts.

They bridge existing nursing knowledge with new information and enhance critical thinking . Concept mapping also helps connect theoretical knowledge to clinical practice.

This approach enables nurses to plan care for patients and families effectively while addressing multiple complex problems, ultimately improving clinical reasoning .

What are the Types of Concept Maps?

Concept maps come in various types, each tailored to specific purposes and contexts. Some common types of concept maps include:

Hierarchical Concept Maps:

These show a main concept at the top, with related sub-concepts branching out beneath it, emphasizing relationships and hierarchy.

Spider Concept Maps:

Radiating from a central concept, these maps explore related ideas, making them useful for brainstorming and idea generation.

Flowchart Concept Maps:

Illustrating processes and workflows, they depict sequential steps and decisions in a clear, linear manner.

Systematic Concept Maps:

These demonstrate the components and interactions of a complex system, useful for understanding system dynamics.

Comparative Concept Maps:

Used for analysis, they highlight similarities and differences between concepts, objects, or ideas.

Storyline Concept Maps:

Showing relationships in a narrative format, they’re used for plotting stories, historical events, or case studies.

Venn Diagram Concept Maps:

They display overlapping relationships among sets of concepts, helping to identify commonalities and distinctions.

Although not concept maps per se, mind maps start with a central idea and branch out with associated thoughts, fostering creativity and idea exploration.

Network Concept Maps:

Emphasizing connections without hierarchy, they reveal complex relationships and dependencies.

Tree Concept Maps:

Organizing concepts in a hierarchical tree structure, they’re suitable for classification and categorization.

Cross-Linking Concept Maps:

Linking concepts based on shared attributes, they offer a multidimensional view of relationships.

These diverse types of concept maps cater to different learning styles, communication needs, and information structures, allowing users to select the most suitable format for their specific purposes.

How Do You Create a Nursing Care Plan Concept Map?

Creating a nursing care plan concept map involves visually representing the relationships between various nursing concepts, patient assessment data, nursing diagnoses, interventions, and expected outcomes.

Here’s a step-by-step guide to creating a nursing care plan concept map:

Step 1: choose a patient scenario:.

Select a specific patient scenario or case for which you want to create a nursing care plan concept map.

This could be a patient with a specific medical condition or a set of nursing diagnoses.

Step 2: Gather Patient Data:

Collect relevant patient data, including medical history, physical assessment findings, lab results, and any other information that informs the nursing care plan.

Step 3: Identify Nursing Diagnoses:

Based on the patient data, identify relevant nursing diagnoses. These are clinical judgments about actual or potential health problems that nurses are licensed to treat.

Each nursing diagnosis represents a specific problem or need that requires nursing interventions.

Step 4: Organize Diagnoses Hierarchically:

Place the identified nursing diagnoses at the center of your concept map. Branch out from each diagnosis with lines to represent related concepts such as assessment data, interventions, and expected outcomes.

Step 5: Add Assessment Data:

Connect assessment data relevant to each nursing diagnosis. This could include physical assessment findings, patient history, and any other data that contributes to the identification of the diagnosis.

Step 6: Include Interventions:

Add nursing interventions associated with each nursing diagnosis.

These interventions should be evidence-based and targeted toward addressing the specific patient needs and diagnoses.

Step 7: Predict Expected Outcomes:

Predict the desired outcomes that result from implementing the nursing interventions.

These outcomes should reflect the improvement, stabilization, or prevention of the patient’s health problem.

Step 8: Define Relationships:

Draw lines or arrows to show the relationships between nursing diagnoses, assessment data, interventions, and outcomes.

Use labels to describe the nature of these relationships, such as “supports,” “leads to,” or “addresses.”

Step 9: Evaluate and Refine:

Review your nursing care plan concept map to ensure that the relationships make sense, interventions are appropriate, and outcomes are achievable. Make revisions as needed.

Step 10: Share and Implement:

Share the nursing care plan concept map with other healthcare professionals involved in the patient’s care.

Use it as a guide to communicate the planned interventions and outcomes, and update it as the patient’s condition changes.

Creating a nursing care plan concept map helps you visualize the comprehensive care plan for your patient, ensuring that you consider all relevant aspects of their condition and tailor your interventions accordingly.

Nursing Concept Map Examples

Sample of nursing care plan concept map.

Sample Hypertension Nursing Concept Map

Download FREE Nursing Concept Map Template

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In conclusion, nursing concept maps offer nursing students an invaluable means to comprehend intricate healthcare concepts, promoting the development of critical thinking and clinical reasoning skills.

By visually representing relationships and care plans, these maps aid students in translating theoretical knowledge into practical patient care scenarios, fostering a holistic approach to nursing education.

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5 Effective Nursing Concept Map Templates and Examples

Nursing concept maps are essential tools that aid healthcare workers in organizing complex patient data, connecting different facets of patient care, and creating all-encompassing patient management plans. Understanding and using various forms of nursing concept maps can significantly improve your capacity to deliver comprehensive and effective patient care, regardless of whether you are a nursing student or an experienced nurse. To get you started, here are six nursing concept map templates and examples:

Basic Nursing Concept Map

A basic nursing concept map serves the fundamentals of patient care. Patient data like demographics, medical history, and present medical problems are frequently included in the Nursing concept map. Here is an example of how a basic nursing concept map looks like:

• Ready to use
• Fully customizable template
• Get Started in seconds

Mood and Affect - Nursing Concept Map

This type of concept map focuses on a patient’s emotional well-being and psychological state. It helps nurses assess and address mood-related issues that may impact the patient’s overall health. The below template shows the example of Mood and affect of a patient:

Pneumonia Nursing Concept Map

A pneumonia nursing concept map aids in understanding the complexities of treating patients with pneumonia. It covers aspects such as assessment, interventions, and potential complications. Here’s an example of a pneumonia nursing concept map:

Medical Diagnosis Nursing Concept Map

This concept map revolves around a specific medical diagnosis and its related care strategies. The below example would be helpful for a nursing student or professional to record a medical diagnosis in a concept map:

Nursing Care Plan Concept Map

A nursing care plan concept map is all-encompassing, outlining a patient’s entire care journey. It includes assessments, diagnoses, interventions, evaluations, and ongoing adjustments. Here’s an example of what a nursing care plan concept map might include:

Try Creately to Create Nursing Concept Map Templates

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Making Concept Map for Nursing School : A Nursing Student's guide

As a nursing student, you will be assigned to write a concept map either as a stand-alone assignment or as part of your nursing coursework.

A nursing concept map is a visual model that outlines the relationship between different nursing concepts. Clinical concept mapping improves critical thinking and decision-making among nursing students. Concept mapping also fosters long-term learning among nursing students and is preferred by nursing educators as a content delivery mechanism or part of assignments.

Using concept maps, nursing students can break down large topics into smaller sections to help them understand concepts and relationships. This means that you can use them when revising your nursing notes in preparation for exams (NCLEX or nursing school exams), especially if you are a kinesthetic/tactile learner . Doing concept maps in nursing school additionally promotes higher-level thinking, which helps grasp nursing theories and concepts.

The gist of this article is to help you create a basic concept map, which you can do using Microsoft Word. But even before, if you need help with your nursing class, you can get it ASAP.

Steps for Creating a Nursing Concept Map

There are many types of nursing concept maps that nursing students can draw. They include charts, tables, spider maps, hierarchical maps, flow charts, graphic organizers, mind maps, timelines, Venn diagrams, timelines, system maps, or T-charts. However, the key focus of this guide is to draw a basic concept map for your nursing coursework or revision.

Given the understanding of what nursing concept maps are, you now need to know how to create a concept map. Here are the steps to take.

1. Note down the main subject or topic

At the core of making a nursing concept map is the main topic or subject; everything else is about it. When you choose the main topic or subject, you get to brainstorm about the other concepts connected to it. Your main subject can be many things among them being medical diagnosis, SBAR, nursing responsibilities, or patient care plan, which translates to different types of common nursing concept maps in nursing school.

A patient care plan concept map focuses on the aspects that are relevant to patient care from medical history to risk factors and management or interventions. These concept maps are meant to help nurses make clinical judgments and adopt the right care plan given the patient's condition.

The nursing responsibilities concept map is meant to delineate the duties and tasks of nurses and other members of an Interprofessional care team. It could focus on the tasks of a specific nurse or a healthcare practitioner or a group of nurses or healthcare practitioners. It helps group elements like post-op care, behavior response, prevention of infection, management of wounds, etc.

A medical diagnosis concept map looks at all the elements of the diagnosis of a condition or a disease. It focuses mostly on the etiology, risk factors, pathophysiology, pathology, medications, symptoms, complications, and interventions.

You can also be asked to make an SBAR concept map , which entails a representation of all the information that nurses need to communicate smoothly in clinical settings, specifically focusing on communications between nurses and doctors.

2. Determine the secondary subsection

After you have decided on the topic or subject, you have to come up with the subsections related to it. You will group them around the subject and draw arrows showing the relationship they have to the subject. For instance, if you are drawing a medical diagnosis concept map, the disease or condition will be the subject. Aspects such as etiology, risk factors, pathophysiology, interventions, complications, symptoms, nursing implications, and medication and management. You can use text boxes in the word processor for the respective subsections and the subject/main topic.

3. List the main information for the subsections

After mapping out the subsections, you need to fill in the information for the respective section.

A good approach is to research and take shorthand notes. Mostly, instructors or professors prefer that you cite the source of information. If that is the case, ensure that you use peer-reviewed nursing journals and other scholarly sources written within the last 5 years.

Because you had just listed the main sub-topics of the subsections, in this step you populate the subsection with information. For instance, if you are talking about the risk factors of CHF, you need to list the risk factors and give the exact citation.

4. Make a Connection between Concepts

After including all the main sections and subsections in your concept map and designing the shapes, you need to show the relationships between the concepts. You should use the arrows or lines that begin from the main point to a subsection. You will see this shortly in the template examples included in this article. In many cases, an instructor might require you to accompany your concept map with a few paragraphs that expound on the concepts and information you have visually presented. You will find yourself writing a nursing essay or research paper with detailed information such as pathophysiology, etiology, epidemiology, management and treatment (interventions), patient education, etc.

Some instructors and professors prefer that the concept maps are created in Microsoft Word, MS Publisher, or PowerPoint Slides . However, some also allow the use of third-party concept mapping tools such as GitMind, MindMeister, and Draw.Io, among others .

Nursing Concept Map Template & Examples

We have included templates and examples below to help synthesize the information about creating nursing concept maps.

Here is a concept map example for Covid-19. Note that there is no designated way of presenting concept maps. You can use any shape or styles if your map visually details the clinical or nursing concepts.

Below are two examples of nursing student concept map templates. We can send you a downloadable free nursing concept map template for Microsoft word that you can fill in and use.

Care Plan Concept Map Example

To make it even simpler, below is a video that demonstrates how to create a concept map for nursing school, be it for revision or coursework fulfillment purposes.

Parting Shot

Nursing concept maps can come in handy during revising concepts that are hard to capture in one reading. Breaking down such topics into smaller chunks that are visually represented helps you to master the concepts. Concept mapping also helps in improving clinical decision-making and clinical judgment. It also helps you to see the big picture as regards the steps needed to achieve high-quality patient care.

Related Reading:

• Nursing term paper topics.
• List of nursing theories and theorists.
• How to formulate good PICOT questions
• PICOT Question examples for nursing capstones and research papers

If you need help designing a concept map, we have well-informed and qualified writers to help. You can take advantage of our concept map writing services . Someone specialized in your field of study will handle your order. Do not struggle with designing concept maps when someone can help you. Our charges are flexible and affordable.

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Case Study: Evidence-Based Patient-Centered Concept Map

Assessment Case Study: Evidence-Based Patient-Centered Concept Map

Create a concept map graphic and write a 2-4 page narrative on the patient scenario presented in Assessment Case Study: Evidence-Based Patient-Centered Concept Map. Base your report on the information provided in the case study and your own research of 3-5 evidence-based resources.

Evidence-based practice is a key skill in the tool kit of the master’s-prepared nurse. Its goal is to ensure that health care practitioners are using the best available evidence to ensure that patients are receiving the best care possible (Godshall, 2015). In essence, evidence-based practice is all about ensuring quality care.

In this assessment, you will apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient. The concept map that you will create is an example of a visual tool that you can use for patient and family education.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Apply evidence-based practice to plan patient-centered care. Analyze the needs of a patient, and those of their family, to make sure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs. Competency 3: Evaluate outcomes of evidence-based interventions. Proposerelevant and measurable criteria for evaluating the outcomes the patient needs to achieve. Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision. Determine the value and relevance of evidence used as the basis of a patient-centered concept map. Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions. Develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way. Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style. Reference

Godshall, M. (2015). Fast facts for evidence-based practice in nursing: Implementing EBP in a nutshell (2nd ed.). New York, NY: Springer Publishing Company.

The charge nurse at the wellness center has sent you an email to request that you review a patient file before the patient arrives at the clinic. She has asked you to put together a concept map for your patient’s care plan. The concept map is intended to help you think through the best strategy for your patient’s care and for subsequent use for patient education. In addition, the nurse needs a narrative report that describes your patient with up to five diagnoses, in order of urgency.

You are a nurse at a community wellness center who has received a request for patient case review and preparation for an upcoming appointment.

Instructions

Review the Assessment Case Study: Evidence-Based Patient-Centered Concept Map media activity.

Create your concept map and narrative as separate parts of your document. Be sure to note where you must include your evidence-based support and clarify your strategies for communicating information to the patient and the patient’s family.

Integrate relevant evidence from 3–5 current scholarly or professional sources to support your assertions.

Part 1: Concept Map

Develop a graphical concept map for the patient based on the best available evidence for treating your patient’s health, economic, and cultural needs. Many organizations use the spider style of concept maps (see the Taylor and Littleton-Kearney article for an example). The Assessment Case Study: Evidence-Based Patient-Centered Concept Map, which includesan example of a concept map, may help you prepare your assessment. If a particular style of concept map is used in your current care setting, you may use it in this assessment. Part 2: Narrative Report

Develop a narrative (2–4 pages) for your concept map. Analyze the needs of a patient and his or her family to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Consider how your patient’s economic situation and relevant environmental factors may have contributed to your patient’s current condition or could affect future health. Consider how your patient’s culture or family should inform your concept map. Determine the value and relevance of the evidence you used as the basis of your concept map. Explain why your evidence is valuable and relevant to your patient’s case. Explain why each piece of evidence is appropriate for the health issue you are addressing and for the unique situation of your patient and the family. Propose relevant and measurable criteria for evaluating the outcomes the patient needs to achieve. Explain why your proposed criteria are appropriate and useful measures of success. Explain how you will communicate specific aspects of the concept map to your patient and the family in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies: Promote honest communications. Facilitate sharing only the information you are required and permitted to share. Are mindful of your patient’s culture. Enable you to make complex medical terms and concepts understandable to your patient and his or her family, regardless of language, abilities, or educational level. Additional Requirements

Organization:Use the following headings for your Diabetes Patient Concept Map assessment: Concept Map. Patient Needs Analysis. Value and Relevance of the Evidence. Proposed Criteria for Patient Outcome Evaluation. Patient and Family Communication Plan. Length:Your concept map should fit on one page (possibly a horizontal layout) and your narrative report will be 2–4 double-spaced pages, not including title and reference pages. Font:Times New Roman, 12 points. APA Format:Your title and reference pages must follow current APA format and style guidelines. The body of your paper does not need to conform to APA guidelines.Do make sure that it is clear, persuasive, organized, and well written, without grammatical, punctuation, or spelling errors. You also must cite your sources according to APA guidelines. Scoring Guide:Please review this assessment’s scoring guide. The requirements outlined above correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance-level descriptions for each criterion to see how your work will be assessed. ACTIVITY DETAILS FROM LINK:

Patient Profiles

From: Janie Poole

To: Alexander Ruche

Good morning,

We have a new patient coming in today.

Her name is Carole Lund. Carole is a new mother who had gestational diabetes during her pregnancy. She has continued to track her blood glucose postpartum, and is worried that it does not appear to be stabilizing.

It probably will be helpful to create a concept map for Carole to show her this care plan in a visual way. Talk to your patient and start planning her care. Thanks!

— Janie Poole

Uptown Wellness Clinic

Diabetes Patient

Reason for Referral:

Carole Lund is a 44–year–old woman of mixed Native American and European descent, and a new mother. She is concerned that she is not recovering from gestational diabetes.

Carole is here with her daughter, Kassandra, who is 10 weeks old. Carole was diagnosed with gestational diabetes at week 30 of her pregnancy. She has carefully logged her blood glucose since the diagnosis, and it shows 150–200 fasting, over 200 following meals.

Carole Lund Diabetes Patient Interview:

What diabetes treatments did you receive during your pregnancy?

Well, they gave me a glucometer, so I started using that. I could see right away that the way I was eating was a problem; I would usually work straight through the day and then have one big meal in the evening, and that was making my numbers bounce all over. So I set alarms on my laptop, so three times a day I would get interrupted, have a small meal, take a short walk, and then test my blood sugar. That helped. And then I stopped drinking juice and soda, which I should have done years ago, and that helped too. But I don’t think my numbers improved as much as my OB/GYN wanted them to, but she said my blood sugar should return to normal after delivery.

Did your obstetrician advise you to take insulin during your pregnancy?

She did, yeah, and we talked about it. I don’t like the idea of being dependent on a drug. I called my mother. She’s still on the reservation, so she called the elders, and we all agreed that injecting my body with an animal hormone was a bad idea. But then the doctor told me that they make synthetic insulin now, but that means it’s made in a laboratory somewhere, and I’m not sure that’s any better.

By then I was in my third trimester, and all the tests said Kassandra was big but healthy, so I thought we would just ride it out. It was supposed to clear up after she was born. But it hasn’t, and I know you have to be careful having a baby at my age. I want to do what’s best, but I don’t want to believe that insulin is my only option.

Are there any challenges in your life which you think may be interfering with your ability to follow a treatment plan?

It’s harder now than it was before she was born. It’s just the two of us in the apartment, which is wonderful, but I don’t remember the last time I had a good night’s sleep. A lot of my work is freelance, so I make my own hours, but that also means if I’m not working I don’t get paid. I had family help while I was recovering from the C-section, and they helped cook healthy meals for me, and kept me on my schedule. Now it’s all on me — work, caring for my daughter, and managing my blood sugar. If I fall behind on anything, it will be looking after my health.

Do you have any other concerns you’d like to have addressed?

I worry about Kassandra. She’s healthy and perfect, but I know that she’s at a greater risk for developing Type 2 Diabetes. I want to do whatever I can to reduce that risk, to care for her, and as she grows, to teach her how to care for herself.

Grading Rubric:

1. Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.

Passing Grade: Designs an individualized, patient-centered concept map based on the best available evidence for treating a patient’s specific health, economic, and cultural needs, and identifies. Outcomes for each diagnosis are aligned and complementary.

2. Analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.

Passing Grade: Analyzes the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Identifies unanswered questions or areas of uncertainty where further information could improve the analysis.

3. Determine the value and relevance of evidence used as the basis of a patient-centered concept map.

Passing Grade: Justifies the value and relevance of evidence used as the basis of a patient-centered concept map, and impartially considers conflicting data and other perspectives.

4. Propose relevant and measurable criteria for evaluating the outcomes the patient needs to achieve.

Passing Grade: Proposes relevant and measurable criteria for evaluating the outcomes the patient needs to achieve and acknowledges challenges specific to such an evaluation process.

5. Develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.

Passing Grade: Develops a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way, and identifies assumptions on which the strategy is based.

6. Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

Passing Grade: Integrates relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style. Citations are error-free.

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assessment Case Study: Evidence-Based Patient-Centered Concept Map

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• Iran J Nurs Midwifery Res
• v.19(1); Jan-Feb 2014

Clinical concept mapping: Does it improve discipline-based critical thinking of nursing students?

Marzieh moattari.

1 School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

Sara Soleimani

Neda jamali moghaddam, farkhondeh mehbodi, background:.

Enhancing nursing students’ critical thinking is a challenge faced by nurse educators. This study aimed at determining the effect of clinical concept mapping on discipline-based critical thinking of nursing students.

Materials and Methods:

In this quasi-experimental post-test only design, a convenient sample of 4 th year nursing students ( N = 32) participated. They were randomly divided into two groups. The experimental group participated in a 1-day workshop on clinical concept mapping. They were also assigned to use at least two clinical concepts mapping during their clinical practice. Post-test was done using a specially designed package consisting of vignettes for measurement of 17 dimensions of critical thinking in nursing under two categories of cognitive critical thinking skills and habits of mind. They were required to write about how they would use a designated critical thinking skills or habits of mind to accomplish the nursing actions. The students’ responses were evaluated based on identification of critical thinking, justification, and quality of the student's response. The mean score of both groups was compared by Mann-Whitney test using SPSS version 16.5.

The results of the study revealed a significant difference between the two groups’ critical thinking regarding identification, justification, and quality of responses, and overall critical thinking scores, cognitive thinking skills, and habits of mind. The two groups also differed significantly from each other in 11 out of 17 dimensions of critical thinking.

Conclusion:

Clinical concept mapping is a valuable strategy for improvement of critical thinking of nursing students. However, further studies are recommended to generalize this result to nursing students in their earlier stage of education.

I NTRODUCTION

Contemporary explosive nature of today's knowledge has created a situation in which our nursing students’ achievement in meeting their learning needs is quite difficult.[ 1 ] Therefore, the importance of critical thinking has been increasingly emphasized in the last decades and nursing educators are challenged to determine appropriate methods of teaching and evaluating critical thinking among nursing students.[ 2 ]

Critical thinking has been defined by many philosophers in different ways indicating the multifaceted nature of critical thinking as a process or outcome. However, consideration of the context has been highlighted in John Dewey's definition of critical thinking. According to Dewey, critical thinking is active, persistent, and careful consideration of a belief or supposed form of knowledge in the light of the grounds which support it and the further conclusions to which it tends (Dewey, 1909, page 9).[ 3 ] Also, context is highlighted in a definition provided by Facion.[ 4 ] Therefore, it should be considered that definition of critical thinking in different academic disciplines may vary as each discipline has its own specific knowledge. In an attempt to describe critical thinking in nursing, many models have been developed.[ 5 , 6 ]

To define critical thinking in the context of nursing, Schefer and Rubenfeld (2000) conducted a five-round Delphi study in which 55 nurse educators were involved. Based on their study, a consensus was made on 17 dimensions of critical thinking under two categories of thinking (cognitive) skills and habits of mind[ 7 ] [Box 1].

Different strategies have been developed to teach critical thinking. Concept mapping is one example proposed for improvement of critical thinking. Using this strategy, the students draw the map of contents, and therefore use their cognitive skills of analysis, evaluation, and reasoning.[ 8 ] Also, they will be able to summarize the content while preserving the meaning. This strategy was developed by Novak during the years 1972-1992 based on Ausoble's learning theory.[ 2 ]

The effectiveness of using concept mapping in student's achievement and interest[ 9 ] and self-efficacy[ 10 ] has been shown previously. Its efficacy in learning and evaluation of critical thinking in music, mathematics, and engineering has led nurses to use this learning strategy.[ 2 ] Use of concept mapping in clinical learning activities improves critical thinking and encourages students to comprehensively observe the patients, and organize and process the complex information. Furthermore, it enables the students to evaluate what they have learned and what they need to learn.[ 1 , 8 ] In a recent research, concept mapping was used as a teaching strategy in the development of critical thinking skills of eight undergraduate nursing students. The researchers designed a concept mapping rubric using Tanner's Clinical Judgment Model to help students construct clinical cases for the development of appropriate clinical judgment skills. Qualitative evaluation of concept mapping activity and rubric revealed that the students positively approached this experience and evaluated it as a means for better clinical decision making and enhancement of clinical judgment.[ 11 ]

Despite the potential benefit of concept mapping in the clinical context, nursing students are encouraged to write nursing care plan for their patients while they see the nursing process as time-consuming paperwork not leading to critical thinking. The more use of nursing process might be due to the fact that clinical instructors, nursing students, and even nursing staff are more familiar with traditional nursing process comparing to concept mapping. However, the use of nursing process (care plan) as the instrument for problem-solving or enhancing the art and creativity of nursing, and also as a method of providing individualized care has been challenged.[ 12 ] Furthermore, it was recognized that the students prefer reflection compared to written nursing care planning.[ 13 ]

Admitting the distinction between nursing process and concept mapping, some researchers compared the effects of these two strategies on critical thinking skills of nursing students.[ 8 , 14 ] The findings of these researches provide no significant difference between these two methods of care planning in promoting critical thinking. It seems that concept mapping should not be seen as a separate strategy for care planning. To use concept mapping, students need to comprehensively understand nursing process. Therefore, concept mapping based on nursing process might possibly add some benefit to traditional nursing process.

Another point worth mentioning is the approach used in measurement of critical thinking. Critical thinking skills tests used in most studies are more appropriate for measurement of critical thinking in a general context, while measurement of discipline (nursing)-based critical thinking needs appropriate planning and careful implementation. Complexities of clinical teaching and the difficulties in measurement of domain-specific critical thinking might be the reason for the insufficient evidence in this regard. Therefore, the aim of this study was to determine the effects of concept mapping using nursing process on nursing-specific critical thinking, and its components of cognitive skills and habits of mind.

Box 1: Critical thinking skills and habits of the mind for nursing

Critical thinking skills.

• Analyzing: Separating or breaking a whole into parts to discover their nature, function, and relationships
• Applying standards: Judging according to established personal, professional, or social rules or criteria
• Discriminating: Recognizing differences and similarities among things or situations and distinguishing carefully as to category or rank
• Information seeking: Searching for evidence, facts, or knowledge by identifying relevant sources and gathering objectives, subjective, historical, and current data from those sources
• Logical reasoning: Drawing inferences or conclusions that are supported or justified by evidence
• Predicting: Envisioning a plan and its consequences
• Transforming knowledge: Changing or converting the condition, nature, form, or function of concepts among contexts.

Critical thinking habits of the mind

• Confidence: Assurance of one's reasoning abilities
• Contextual perspective: Consideration of the whole situation, including relationships, background, and environment, relevant to some happening
• Creativity: Intellectual inventiveness used to generate, discover, or restructure ideas; imaging alternatives
• Flexibility: Capacity to adapt, accommodate, modify, or change thoughts, ideas, and behavior
• Inquisitiveness: Eagerness to know by seeking knowledge and understanding through observation and thoughtful questioning in order to explore possibilities and alternatives
• Intellectual integrity: Seeking the truth through the sincere, honest processes, even if the results are contrary to one's assumptions and beliefs
• Intuition: Insightful sense of knowing without conscious use of reason
• Open-mindedness: A viewpoint characterized by being receptive to divergent views and sensitive to one's biases
• Perseverance: Pursuit of a course with determination to overcome obstacles
• Reflection: Contemplation upon a subject, especially one's assumptions, and thinking for the purposes of deeper understanding and self-evaluation.

Adapted from: Rubenfeld M, Scheffer B. Critical Thinking Tactics for Nurses. Canada: Jones and Bartlett publishers. 2006;p: 16-17[ 15 ]

M ATERIALS AND M ETHODS

In this quasi-experimental study (post-test only design), a convenient sample of 4 th year nursing students ( N = 32) who were involved in clinical learning experiences participated giving their consent. They were randomly divided into two experimental and control groups. The intervention of the study was conducted for the experimental group during their usual clinical learning experiences in medical surgical and pediatric wards. Both groups had a similar clinical rotation during the study.

The intervention of the study started with a 1-day workshop. In this workshop, the students in the experimental group were introduced with the use of concept maps based on the nursing process.[ 16 ] They used concept mapping for application of nursing process in a given scenario specifically designed for this intervention.

The students worked individually and then in groups to illustrate the relevant information from the presented case and provide the concept mapping. They were instructed to do the following:

Identify the patient and his/her medical diagnosis as the central concept in a box in the middle of the page.

Add the patient's medical diagnosis/chief complaints or reason for hospitalization.

From the patient's medical diagnosis/chief complaints or reason for hospitalization, add as many relevant nursing diagnoses as possible in the boxes related to the main box (categorize all the information presented in scenario).

For each nursing diagnosis, list the subjective and objective data, identified from the case study, that are associated with the diagnosis.

List the current information about medical diagnosis, patient's medical history, risk factors and etiologies, diagnostic tests, treatments, and medications under the relevant nursing diagnoses.

Draw lines between concepts to indicate the relationships. Link the relevant data using different types of lines (e.g. arrows, bolded lines, direct lines, or broken lines), based on the nature of the relationship. On each line, use words (such as related to, lead to, associated with) to explain the relationship between the related concepts.

Draw red lines to connect the related nursing diagnosis.

List the nursing interventions such as assessment, monitoring, procedures, therapeutic interventions (therapeutic communication and or teaching) for each diagnosis.

Add the expected outcomes associated with the nursing interventions for each nursing diagnosis.

Update the concept map based on the new information and patient's possible responses.

The students in the experimental group were required to apply concept mapping at least on two patients during their 10-week clinical practice. The first author provided a weekly 2-h counseling session for the students to present their concept mapping and receive feedback. For ethical considerations, they were told that their attendance in these activities dose not influence their clinical evaluation.

Demographic data including age and grade point average (GPA) were reported by the students on the first page of the instrument used in the study. The instrument for measuring critical thinking was developed based on the instruction provided in another study[ 17 ] in which 17 dimensions of critical thinking under two categories of cognitive skills and habits of mind were considered. Therefore, 14 scenarios were developed to measure analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, transforming knowledge, contextual perspective, creativity, inquisitiveness, intuition, open-mindedness, perseverance, and self-reflection. The first draft of scenarios was developed by a group of medical surgical and pediatric nursing instructors based on their lived experiences in relation to each critical thinking dimension. The scenarios then were examined in a group of students to ensure that they are thought provoking. Ultimately a panel of experts consisting of experienced faculty members from different nursing specialties confirmed the appropriateness of scenarios for the measurement of the above-mentioned critical thinking dimensions. For the dimensions of confidence, flexibility, and intellectual integrity, the students were offered a free response opportunity to select their own appropriate clinical experiences to illustrate the use of critical thinking.

To develop the test format, each of the 17 critical thinking skills or habits of mind was defined in a square on top of the page specific to that critical thinking. Scenarios developed for 14 critical thinking dimensions were inserted in any of its associated definitions. For the three other mental habits or critical thinking skills, we provided only the definitions. The students were instructed to read the definitions carefully and then try to analyze their related scenarios and/or their own experience. They were asked to carefully explain how they used that critical thinking in a given scenario or their own selected experience. For this purpose, they should write their own analysis based on the two tips given below.

• Write in detail what you will do. Explain in detail so that someone reading your content would be able to realize that you have used that critical thinking
• Explain why you believe your actions illustrate the designated habits or skill.

As the methodology of the study was post-test only design, the tests were given to the students at the end of the 10 th week of their clinical course and they were required to return them in the next 2 weeks. The students were instructed not to share their responses with other students.

All the test packages received from the students were copied and evaluated anonymously by two different evaluators who were blind to the groups. They were instructed to evaluate the students’ responses based on the guideline for evaluation of critical thinking provided elsewhere.[ 17 ] Therefore, the students’ responses were assessed based on three criteria: Identification of critical thinking, justification, and quality of responses. Identification includes a 3-point scale (2, 1 and 0) for clear illustration of the skill or habit, partial identification/misidentification, and no evidence of understanding of the related critical thinking dimension, respectively. Justification was based on a 2-point scale (2, 1) for either adequate or inadequate/absence of reasoning for the actions each student described as an exemplar for the related critical thinking dimensions. Quality or level of the response was scored based on a 3-point scale: 3 for clear and appropriate, 2 for unclear or inadequate description, and 1 for below the student's academic level. Inter-rater agreement on scoring between the two evaluators was measured to maintain reliability. The result showed an agreement between the two evaluators in scoring of more than 80% of the responses. However, a consensus was made between the two evaluators on the scoring of the remained responses. The agreed upon scores in the three criteria for evaluation of critical thinking including identification, justification, and quality of responses were used in data analysis. Data were analyzed by Chi-square, t -test, and Mann-Whitney U test using SPSS, version 16.5.

No statistically significant demographic differences were found between the students of the two groups. Chi-square analysis revealed that the groups were similar in terms of age and overall cumulative GPA. Dimensions to which most of the students did not respond were confidence, flexibility, and intellectual integrity. These dimensions were free choice responses for which no vignettes were provided. Next, the scores from each of the 17 subscales for both groups were analyzed. Table 1 reveals the two groups’ scores related to evaluation criteria in all areas of critical thinking. The experimental group was significantly better in identification ( P = 0.002), justification ( P = 0.001), and quality of responses ( P = 0.003). Table 2 reports the scores related to each dimension of cognitive critical thinking skills. The experimental group performed significantly better in 5 out of 7 areas related to cognitive thinking skills, including analysis ( P = 0.008), logical reasoning ( P = 0.01), discriminating ( P = 0.03), applying standards ( P = 0.001), transforming of knowledge ( P = 0.001). As it is shown in Table 3 , 6 out of 10 areas of habits of mind including perseverance ( P = 0.02), contextual perspective ( P = 0.003), open-mindedness ( P = 0.008), confidence ( P = 0.01), intuition ( P = 0.008), and intellectual integrity ( P = 0.01) were improved.

Mean score of both groups post-test in evaluation criteria for measurement of critical thinking

Mean scores for dimensions of cognitive critical thinking skills in two experimental and control groups

Mean scores for dimensions of habits of mind in two experimental and control groups

D ISCUSSION

This study examined the impact of concept mapping in the clinical context on discipline-based critical thinking skills of nursing students. Based on the results of this study, application of concept mapping resulted in an increase in students’ ability to identify dimensions of critical thinking, justify their reasoning, and provide appropriate explanation. The results also support the effectiveness of concept mapping in the improvement of both cognitive critical thinking skills and habits of mind. Cognitive critical thinking skills improved in this study are analyzing, applying standards, discrimination, logical reasoning, and knowledge transformation, and the improved habits of mind are perseverance, contextual perspectives, open-mindedness, confidence, intuition, and intellectual integrity. This improvement can be attributed to the structure of concept mapping which was implemented based on the nursing process. Although nursing process as a systematic approach to care planning is widely accepted, its relation to critical thinking has been criticized. According to Jones and Brown, nursing process is a linear problem-solving approach which prevents the development of critical thinking in students.[ 18 ] In contrast, development of reasoning map leads to the improvement of interpretation, analysis, evaluation, inference, explanation, self-regulation, and self-evaluation.[ 19 ]

Habits of mind also have been improved as a result of the intervention of the study. According to Costa, a habit of mind is knowing how to behave intelligently when someone does not know the answer.[ 20 ] He developed 16 habits of mind useful for everyday life. However, in this study, we used habits of mind as defined in the context of nursing. These dispositions or attributes/attitudes or habits of mind could be considered as the elements of a process of reasoning in an individual's character that propels or stimulates an individual toward using critical thinking. The engagement of critical thinking will not occur without these dispositions.[ 21 ] In one study, concept or mind mapping is introduced as a nonlinear teaching strategy that helps students evaluate how they think.[ 22 ] The result of this study is not in agreement with that of the study conducted by Samawi et al . (2006). They concluded that concept mapping does not improve critical thinking skills and dispositions.[ 23 ] However, there are some evidences supporting the effect of concept mapping on critical thinking and critical thinking disposition. One example is the research conducted by Wheeler and Collins using a pre-test – post-test design with control group to figure out the effect of concept mapping on critical thinking skills of nursing students. Although they did not find any significant difference between experimental and control groups, their within-group results showed that concept mapping is effective in helping students develop critical thinking skills.[ 8 ] In another study performed by Atay and Karabacak (2012), the effects of care plans prepared using concept maps on the critical thinking dispositions of students were investigated in a pre-test – post-test control group design. The critical thinking dispositions of the groups were measured using the California Critical Thinking Disposition Inventory. They found a significant difference in the total and sub-scale post-test scores between the experimental and control groups.[ 24 ]

There is one study conducted in Iran in which the effectiveness of concept mapping on critical thinking was confirmed.[ 25 ] Other studies mostly focused on determining the effects of concept mapping as compared to other strategies. In a study conducted in Iran, concept mapping was compared with integrated method of learning. Researchers concluded that concept mapping is a better strategy in developing meaningful (deep) learning.[ 26 ] In another study, concept mapping was compared with lecture to find out its effectiveness on learning, wherein no significant difference was found between the two groups of the study.[ 27 ] However, a different finding was revealed in another study in which concept mapping was found to be better than lecture in producing meaningful learning.[ 28 ]

The present study is different from the other studies mentioned. In the current study, concept mapping based on nursing process was used in the context of clinical experience, which is more appropriate to nursing as a practical field. Also, critical thinking was measured using scenarios or real clinical experience. Nonetheless, the students did not respond completely to all the critical thinking dimensions. In another study aiming at determining the reliability of vignettes for measurement of critical thinking also, the students did not respond to all dimensions.[ 17 ] But there is an important difference between these two studies. In the current study, the students’ response to the vignettes was more than that to their own clinical experiences, while the opposite was true about that study. This difference may be attributed to the different contexts of these two studies. It appears that in the context of the present study, the students prefer the structured situations for thinking and have low motivation to reflect on their own experiences. These findings could be considered as the hints to produce a more motivating environment in which the students have more contribution. Such a motivating and supportive atmosphere is more important when we consider that concept mapping as well as other strategies known to be effective in the improvement of critical thinking (e.g. reflection) are time consuming compared to conventional strategies.[ 16 , 29 ]

In most studies, critical thinking has been measured by context-free tests such as California Critical Thinking Skill Test (CCTST) and the Watson Glaser Critical Thinking Appraisal (WGCTA).[ 30 , 31 ] In a study, National League for Nursing (NLN) Critical Thinking in Clinical Nursing Practice/PN Examination (NLNCT exam) was used to measure the students’ critical thinking abilities of interpretation, analysis, evaluation, inference, and explanation. The researchers found that using concept mapping method is not better than or even equal to the traditional care planning in improvement of critical thinking.[ 32 ] Although measurement of discipline-based critical thinking is a challenging issue, the test developed in our study as a nursing-specific test of critical thinking showed acceptable inter-evaluator agreement as a sign of reliability.

The results of this study support the effectiveness of concept mapping on cognitive critical thinking skills and habits of mind. This post-test only design study was conducted on a small sample size. Therefore, further studies on larger sample size and with more rigorous design, such as randomized controlled trials, are needed to generalize the findings. Furthermore, it is suggested that clinical instructors be trained to apply this strategy on their students and its effectiveness on critical thinking be evaluated.

C ONCLUSION

Overall, it can be concluded that concept mapping based on nursing process is effective in the improvement of critical thinking skills and habits of mind. Nursing-specific measurement of critical thinking is feasible and application of concept mapping in clinical context is suggested. However further studies are needed to generalize the finding of this study.

A CKNOWLEDGMENTS

The authors thank the Vice-Chancellery of research in Shiraz University of Medical Sciences for the financial support provided for this study (3551). Authors are thankful to instructors and their students for their sincere contribution to this research. Also, the authors would like to thank Dr. Nasrin Shokrpour at Center for Development of Clinical Research of Nemazee Hospital for editorial assistance.

Source of Support: This manuscript is financially supported by Shiraz University of Medical Sciences

Conflict of Interest: Nil.

R EFERENCES

• Open access
• Published: 27 August 2024

Mindfulness intervention, homogeneous medical concept, and concentrated solution nursing for colorectal cancer patients: a retrospective study

• Yaning Feng 1   na1 ,
• Kuanlei Wang 2 ,
• Jianchun Fan 3   na1 ,
• Xueliang Wu 4 , 5 ,
• Tian Li 6 &
• Zhili Yang 4 , 7  

BMC Cancer volume  24 , Article number:  1055 ( 2024 ) Cite this article

27 Accesses

Metrics details

We aim to explore the differences of the psychological distress of postoperative chemotherapy patients with colorectal cancer between mindfulness intervention combined with homogeneous medical concepts and mindfulness intervention only.

One hundred patients with colorectal cancer undergoing chemotherapy after surgery from Sep 2020 to Sep 2022 were enrolled and divided into active control group (Solution centered nursing interventions; homogenized medical and nursing professional teams; dedicated personnel responsible for “admission notices”; Regular follow-up after discharge) and mindfulness group (homogeneous medical concept + and concentrated solution + Mindfulness intervention) with 50 cases in each group according to different nursing methods.

After nursing, the physical function, emotional function, cognitive function, and social function of the patients in the mindfulness group were significantly higher than those in the active control group. However, the overall life and economic difficulties of the patients in the mindfulness group were significantly lower than those in the active control group ( P  < 0.05). After nursing, the observation score, description score, action score, intrinsic experience score, non-judgment score and non-reaction score of the mindfulness group were significantly higher than those of the active control group ( P  < 0.05).

The implementation of mindfulness intervention in colorectal cancer patients undergoing chemotherapy can alleviate the patients’ negative emotions, improve the level of mindfulness, and improve the quality of life of patients.

Peer Review reports

Introduction

Colorectal cancer is one of the common tumor diseases caused by the digestive tract system, which mainly presents symptoms such as local abdominal pain, blood in the stool, anemia and weight loss [ 1 ]. According to relevant research reports, the morbidity and mortality of colorectal cancer patients in my country rank third and fourth among many cancer diseases, and the patients are obviously younger [ 2 , 3 ]. At present, radiotherapy and chemotherapy are an important auxiliary means for the treatment of colorectal cancer. They can lead to increased physical and psychological stress, and cause patients The quality of sleep decreases, and the difficult emotions such as fear, depression, and anxiety are aggravated [ 4 ].

In recent years, the homogeneous medical concept nursing model has been widely advocated by hospitals. Homogeneous healthcare refers to a group of individuals who have identified similar patterns of medical resource utilization, treatment sequences, prognosis, and care trajectories [ 5 ]. The solution-focused mode is characterized by fully respecting individual resources and potential, and emphasizing that the focus of problem-solving is on the positive aspects of people [ 6 ]. Previous studies have found that the solution-focused model can help improve the psychological function and quality of life of patients [ 7 ]. The concentrated nursing model is a rehabilitation nursing measure covering the patient’s psychology, sports and life, and its starting point is health education. However, the current clinical nursing mode of homogeneous medical concept combined with focused solution mode lacks the ability to perceive the patient’s physiological state and enhance the patient’s sense of self-control [ 8 ]. As research progresses, positive thinking interventions can be used to increase the level of positive thinking in patients. It is a meditation practice that evaluates the subconscious mind to find out the level of stress that the patient perceives, thus ensuring that the patient remains in a more normal state under stress. Positive thinking intervention therapy can significantly reduce patients’ fear of disease and a series of difficult emotions after gastrointestinal surgery. Subsequently, it has been shown to reduce patients’ psychological and physical health, thereby improving their quality of life and significantly increasing their sense of well-being. Positive thinking therapy can help patients to increase their level of positive thinking and thus continuously improve their physical and psychological health.

According to related studies, colorectal cancer patients have obvious anxiety and depression, and the severity of the disease is increasing [ 9 ]. The contradiction between the disease and the psychological problems caused by colorectal cancer is becoming more and more tense, which in turn leads to the lower level of mindfulness and quality of life in patients with colorectal cancer, which gradually affects their living standards [ 10 ]. The mindfulness intervention is a stress reduction therapy that originated from meditation and is guided by Zen concepts to help patients relieve pain and anxiety. Studies have shown that in addition to conventional care and psychological care measures, mindfulness interventions can effectively reduce difficult emotions and improve quality of life in patients with colorectal pain [ 11 ].

Materials and methods

Research subject.

The medical records of 100 patients with colorectal cancer undergoing chemotherapy after surgery from Sep 2020 to Sep 2022 were selected as the retrospective research objects, and divided into an active control group and an mindfulness group with 50 cases in each group according to different nursing methods. All patients underwent the intervention during hospitalization and discharge, over a period of 5 weeks. Patients were followed up weekly after discharge from hospital for the intervention. We have de-identified all patient details. All authors have signed informed consent forms. The reporting of this study conforms to CONSORT guidelines [ 12 ].

Inclusion criteria: (1) Patients were informed about this study and agreed to participate in this research; (2) 70 ≥ Age ≥ 18 years; (3) Patients were diagnosed with colorectal cancer by pathological examination; (4) There were no organ lesions in patients with stage I and Stage II partial colorectal resection; (5) Have a certain ability to read and write, and have a certain understanding of colorectal cancer. (6) Be able to understand the essence of this experiment and actively cooperate with it.

Exclusion criteria: (1) Those who refused to accept the questionnaire; (2) Those with other primary cancers, or those with other serious diseases who could not be treated by radical surgery; (3) Those with a history of mental illness or mental retardation: (4) The family requested that the patient not be informed of the actual condition.

Homogeneous medical concept combined with focused solution nursing

Among them, the active control group implemented the concept of homogeneous medical care combined with solution-focused nursing, namely: (1) Solution-focused nursing intervention: Describe the problem: The responsible nurse guides the patient to describe the main problems at present. Build feasible goals: Encourage patients to think about the goals they want to achieve in the treatment process. Discuss success stories: Discuss past success stories with patients, let patients realize that stoma is not so scary. Implement feedback: Encourage and praise the daily changes of the beneficiaries. Evaluate the effect: Evaluate the patient’s results and actively improve in the next step. (2) Form a homogeneous medical and nursing professional team: members include medical staff in colorectal surgery and oncology surgery, and the selected personnel are senior nurses and physicians in the department. Before the nursing work is carried out, conduct unified training. After hospitalization, activate the homogeneous medical mode immediately, inform the patient of the precautions for dietary activities, and inform the patient that a series of encouragement measures after admission will be the responsibility of the attending physician. (3) In-hospital stage: After the patient is admitted to the hospital, the responsible nurse informs them of the “Admission Notice”.

The responsible nurse and the attending doctor participate in the ward round, Consultation, treatment plan formulation, surgical arrangement, pathological discussion and other medical activities, comprehensively understand the actual condition of the patients in charge, give timely feedback on difficult problems in the treatment process, and improve the implementation. In addition, pay attention to ease the patient’s psychological state, continuously encourage the patient, help enhance their confidence in treatment, and establish a correct attitude towards the disease. Take behavioral interventions for the bad mood of the thinker, such as arranging the thinker to do progressive muscle relaxation training in the recovery room with light music, and gradually relax the muscles of the whole body through deep breathing, once a day in the morning and evening, 20 min/time, the training time can be appropriately extended 3 days before the operation. During the operation, the vital indicators of the patients were strictly observed and anti-infection measures were taken. On the first day after the operation, the responsible nurse asked the stoma specialist nurse to conduct on-site teaching during the consultation, so that they could master the skills of cutting, pasting and replacing the ostomy bag, and observe the main points of the stoma. Learn to observe the color change of the stoma mucosa, manage and prevent stoma complications; during the nursing process, the medical staff should give enough respect and encouragement to the patients, so as to reduce the patient’s postoperative stigma and enhance the confidence in treatment 3 to 14 days after operation, according to the patient’s recovery, give corresponding dietary guidance, supplement nutrition, encourage patients to get out of bed early, and increase the time and scope of activities. (4) After discharge: within 48 h after the patient is discharged from the hospital, the responsible nurse and the attending doctor will complete the telephone follow-up of the patient. Provide professional guidance. One month after discharge from the hospital to the stoma outpatient follow-up, targeted re-interventions were carried out. The nursing time of patients in both groups was 6 months after the confirmed enrollment.

• Mindfulness intervention

The mindfulness group implemented mindfulness intervention, namely: mindfulness intervention therapy is a group training therapy on the first coupling of cancer and psychology, which in turn continuously improves the physical and psychological condition of the patient, thus continuously rebuilding the patient’s perception of the disease and its management. The 50 patients in the mindfulness group were divided into 7 groups, 6 of which had 7 patients in each group and the remaining group had 8 patients. The patients in each group were given mindfulness intervention care sequentially from Monday to Monday for 2.5 to 3 h each time, once a week for 5 weeks. In our study, the administration process was mainly influenced by the new crown epidemic, which was adjusted to a weekly group therapy session and a different theme each week, with a continuous intervention for patients for 5 weeks, with the weekly intervention taking place on Tuesdays at 4 p.m. The main intervention length was 2–2.5 h. It was conducted in two groups, and the next cycle of rehabilitation was generally not allowed until the end of the previous cycle, for a total intervention time of 2 months. In our study, instructional manuals and teaching videos were distributed to the administered patients before the start of the sessions, mainly to facilitate the patients to be able to perform white me training by learning, and the frequency and duration of weekly training were recorded on the memo sheet. To be able to keep the patients with colorectal cancer able to continue their rehabilitation training, we studied the use of online and offline instruction to educate the patients. In addition, the health care staff will distribute group training homework to patients with colorectal cancer online every week, and will follow up on the patients’ training results and provide one-on-one professional answers to their feelings and questions.

Week 1: the background, current situation and attitude of mindfulness colorectal cancer rehabilitation were introduced, and instruction manuals and exercise record cards were issued. Introduce yourself, set up a WeChat group, and introduce mindfulness breathing to learn and cultivate mindfulness. Week 2: Discuss mindfulness breathing, the group exchanged experiences from last week’s practice, and shared knowledge about cancer and stress, as well as the psychological problems caused by changes in the personal image and orientation of colorectal cancer patients. Week 3: Discuss new findings in body scan assignments, the impact of colorectal cancer patients on physical fatigue and pain; stretching teaching of gentle yoga, taking into account the patient’s physical disability, the practice follows the principle of moderation Week 4: Discuss the problems of yoga practice and Experience, tell the typical jade stress response and conscious stress response to cancer stress events. Tell stories in life, troubled stories in your mind and mental state, introduce mindfulness walking, and explore the relationship between walking movement and emotions. Week 5: Discuss the problem of mindfulness walking, share relevant experiences, explain the relationship between sleep, fatigue, physical pain, and emotions, and discuss experiences and findings in cancer coping. Review, discuss the mindfulness journey, how to deal with fear of cancer recurrence, emphasize mindfulness healing as a means of having health, and provide online resources.

Observation indicators

Quality of life score: EORTCQLQ-C30 V3.0 Chinese version developed by European Organization for Research and Treatment of Cancer, EORTC. The scale contains 30 items in 15 areas, including 5 functional areas: physical function (items 1–5), cognitive function (items 20, 25), emotional function (items 21–24) and social function (questions 26–27), three symptom areas, fatigue, nausea and vomiting, pain, 6 individual symptoms (including dyspnea, loss of appetite, quality of life, constipation, diarrhea, and financial difficulties), and 1 general health area. The overall health status is divided into 7 grades from 1 to 7. 1 means “very poor”, 7 means “very good”, and the rest of the items are divided into 4 grades, 1 means “never”, 2 means “somewhat”, 3 for “something” and 4 for “very much”. The scoring method of the scale: the scores of the items included in each field are added up and divided by the number of items included to obtain the rough score of the field. And the better the quality of life, the higher the symptom domain score, indicating that the more symptoms or problems, the worse the patient’s quality of life. At present, the scale has been translated into 43 languages, including Chinese, and is widely used in various countries and regions in the world. The Five-Factor Mindfulness Scale (FFMQ) [ 13 ]: measures the level of mindfulness of patients. The scale has 39 items, and each item is scored on a five-point scale (1 = not at all, 2 = less, 3 = somewhat), 4 = very agree, 5 = complete agreement), the score interval is [39,195], the higher the score, the higher the level of mindfulness. The severity of difficult emotions mainly evaluates two kinds of difficult emotions, namely anxiety and depression, and the evaluation time is before and after nursing. The scale used to assess anxiety is the Hamilton Anxiety Scale (HAMA) [ 14 ], with a cut-off value of 7 points. A score below 7 indicates that the patient has no anxiety, while a score over 7 indicates that the patient has anxiety, and the higher the score. High indicates more severe anxiety. The Hamilton Depression Scale (HAMD) [ 15 ] was used to evaluate depression. A score below 7 indicates that the patient does not have depression, while a score over 7 indicates that the patient has depression, and the higher the score, the more severe the patient’s depression.

Statistical analysis

The sample size calculation formula for multiple rate comparisons was used. The sample size was calculated according to the formula: N = Z 2 ×[P× (1-P)]/E 2 . Where N is the sample size; Z is the statistic, and when the confidence is 95%, Z = 1.96; When the confidence is 90%, Z = 1.64; E is the error value; P is the probability value; Thirty samples is the minimum sample size for a quantitative study. All data were entered using Epidata, and SPSS 28.0 was used for statistical processing. Independent samples t test was used for measurement data expressed as mean ± standard deviation (X ± SD), and χ 2 test was used for count data expressed as percentage (%). Statistical P  < 0.05 is significant.

General data analysis

The gender, average age, body mass index and educational level of the two groups of patients were compared by t test and chi-square test, and there was no statistical significance ( P  > 0.05). See Table  1 .

Quality of life score comparison

Before nursing, there was no significant difference in the quality of life scores between the two groups ( P  > 0.05). After nursing, the physical function score, emotional function score, cognitive function score, and social function score of the mindfulness group were significantly higher than those of the active control group, but the economic difficulty score of the mindfulness group was significantly lower than that of the active control group, which was statistically significant. ( P  < 0.05). See Fig.  1 .

Comparison of quality of life scores. For the quality of life score data in our study, all data were entered using Epidata, and SPSS 28.0 was used for statistical processing of the data, and the measurement data expressed as mean ± standard deviation (± SD) were tested by independent samples t test The results showed that before nursing, there was no significant difference in the quality of life scores between the two groups ( P  > 0.05). ( A ) The physical function score of the mindfulness group and the active control group after nursing. ( B ) The emotional function score of the mindfulness group and the active control group after nursing. ( C ) The cognitive function score of the mindfulness group and the active control group after nursing. ( D ) The social function scores of the mindfulness group and the active control group after nursing. ( E ) The Financial Hardship scores of the mindfulness group and the active control group after nursing. There were statistical significance (* P  < 0.05)

Comparison of mindfulness levels

Before nursing, there was no significant difference in the level of mindfulness between the two groups ( P  > 0.05). After nursing, the observation score, descriptive score, action score, intrinsic experience score, non-judgment score, and non-reaction score of the mindfulness group were significantly higher than those of the active control group, and the difference was statistically significant ( P  < 0.05). See Fig.  2 .

Comparison of mindfulness levels. For the mindfulness level data in our study, Epidata was used to enter all data, SPSS 28.0 was used to perform statistical processing, and the measurement data expressed as mean ± standard deviation (± SD) was tested by independent samples t test. Results It was found that before nursing, there was no significant difference in the level of mindfulness between the two groups ( P  > 0.05). The sex score was significantly higher than that of the active control group, and the difference was statistically significant ( P  < 0.05). ( A ) The observation score of the mindfulness group and the active control group after nursing. ( B ) The descriptive score of the mindfulness group and the active control group after nursing. ( C ) The action score of the mindfulness group and the active control group after nursing. ( D ) The non-judgmental scores of the mindfulness group and the active control group after nursing. ( E ) The non-responsiveness scores of the mindfulness group and the active control group after nursing. There were statistical significance (** P  < 0.05)

Bad mood comparison

The independent sample t-test analysis of the two groups of patients showed that there was no significant difference in the difficult emotions between the two groups before nursing ( P  > 0.05). After nursing, the HAMA score and HAMD score of the mindfulness group were significantly lower than those of the active control group, and statistics showed that the difference was statistically significant ( P  < 0.05). See Fig.  3 .

Comparison of bad mood. For the bad mood data in our study, Epidata was used to input all the data, SPSS 28.0 was used to perform statistical processing on the data, and the measurement data expressed as mean ± standard deviation used an independent sample t test. The results showed that the two groups of the independent sample t-test analysis showed that there was no significant difference in the difficult emotions of the two groups of patients before nursing ( P  > 0.05). ( A ) The HAMA score of the mindfulness group and the active control group after nursing. ( B ) The HAMD score of the mindfulness group and the active control group after nursing. There were statistical significance (*** P  < 0.05)

Main interpretation

Mindfulness therapy is a meditation method founded by Zen Buddhism that pays attention to the moment, does not judge, and is aware [ 16 ].Mindfulness therapy mainly allows patients to use various mindfulness trainings such as sitting, scanning, meditation, etc., so that the patient can achieve emotional regulation through making people more conscious about their emotions and reactivity when facing stress and be able to choose a more conscious response [ 17 ]. Mindfulness does never talk about control emotions. Mindfulness therapy is a kind of psychotherapy and a meditation method, which has become one of the main methods for the treatment of mental illness in China [ 18 ]. The subsequent development of this technology has fallen into a bottleneck period due to insufficient theoretical basis for exposure and unclear therapeutic mechanism. But with the deepening of research [ 19 ]. By introducing the etiology theory, method and technical theoretical basis of mindfulness therapy, it is found that attachment and breaking of attachment can keep the body away from mental illness and achieve true health and happiness, which significantly improves the precision and science of mindfulness therapy [ 20 ]. At present, mindfulness therapy is widely used in many fields, such as psychological efficacy, physiological efficacy, clinical efficacy and so on. Therefore, our study aims to provide a theoretical basis for our research through the discussion of mindfulness therapy.

Neoplasms remain the main cause of death worldwide [ 21 , 22 , 23 , 24 ]. The quality of life of colorectal cancer patients undergoing chemotherapy has an important relationship with adverse factors such as anxiety and depression, and the adverse factors and quality of life also affect each other. The main reasons for the occurrence of difficult emotions in colorectal cancer chemotherapy patients include: colorectal cancer chemotherapy patients need to face the threat of individual life, and at the same time need to accept the reality of self-image damage, especially younger patients are particularly prone to anxiety, depression, difficult emotions such as anxiety [ 25 ]. Chemotherapy requires a lot of costs for patients, and the beneficiaries are worried that the excessive treatment costs will increase the financial burden of the family, and they will also worry that their own disease will affect the harmony of the family [ 26 ].

Clinical implications

Our study found that after nursing, the physical function, emotional function, cognitive function, and social function of the patients in the mindfulness group were significantly higher than those in the active control group. However, the overall life and economic difficulties of the patients in the mindfulness group were significantly lower than those in the active control group. Statistical significance. After nursing, the HAMA score and HAMD score of the mindfulness group were significantly lower than those of the active control group, and statistics showed that the difference was statistically significant. We found that mindfulness intervention can reduce negative emotions, improve level of mindfulness, and quality of life of patients undergoing chemotherapy after colorectal cancer. It shows that mindfulness intervention can effectively reduce postoperative anxiety and depression in patients with colorectal cancer, which may be because mindfulness intervention improves patients’ concentration and ability to resist stressful events through specific methods such as breathing awareness, sitting meditation and walking meditation, increase patient tolerance for adverse events and reduce patient sensitivity to difficult emotions. The reasons for the analysis are as follows: mindfulness intervention does not allow patients to avoid difficult emotions, but allows patients to truly perceive the existence of difficult emotions and accept their own difficult emotions, and then people become more able to tolerant of difficult emotions and the negative reactions when they appear [ 27 ]. This has positive implications for alleviating the automatic emotional responses generated by negative beliefs, thereby improving patients’ sleep quality and solving physiological problems [ 28 ]. Long-term mental awareness connections can even alter the parenchymal structure of the brain, improving the cortical areas of the right anterior lobe and right anterior limbic system, which are important for regulating mood and memory in patients, reducing the automated emotions generated by negative beliefs reaction [ 29 ]. This also shows that mindfulness intervention is of great significance for affecting the physiological susceptibility of individuals to difficult emotions, thereby improving the negative emotions in patients with colorectal cancer chemotherapy, and improving the quality of sleep and life of patients [ 30 ]. Mindfulness intervention is more in line with the trend of modern medical development, focusing on cultivating patients’ awareness of correct cognition of diseases, and cultivating patients to use scientific methods to regulate their own emotions and behavior [ 31 ]. In order to improve the patient’s psychological coping ability, cultivate the patient’s health awareness and healthy behavior, improve the patient’s coping ability and psychological status, and improve the patient’s quality of life as a whole [ 32 ].

Our study found that the observation score, descriptive score, action score, intrinsic experience score, non-judgment score, and non-reactivity score of the mindfulness group after nursing were significantly higher than those of the active control group, and statistics showed that the difference was statistically significant. The main reason is that colorectal cancer patients have a certain fear of their disease, and feel very helpless about the gradual decline in their living standards and quality in the future. The high economic burden caused by the family, etc., eventually leads the patient to be in a state of mental stress with high tension and excessive anxiety, which gradually makes the mindfulness of colorectal cancer patients in a lower state [ 33 ]. The awareness-action score in the mindfulness level is the highest, while the non-judgmental score for inner experience is the lowest, mainly because colorectal cancer patients are more cooperative with medical staff in the treatment process [ 34 ]. Moreover, this cognitive behavior will have a higher positive effect on the patients in the next stage of treatment, thus making the colorectal cancer patients’ awareness behavior at a higher level [ 35 ]. Andrew et al. [ 36 ] conducted a 4-week randomized controlled study on 68 patients and found that compared with the active control group, the increase in awkward symptoms in the mindfulness group was significantly reduced at week 8. Although the results suggested that mindfulness was not superior to the active control group in alleviating psychological distress, both treatments had partial improvement in depression. Mindfulness intervention is reliable and acceptable. Compared to our study, different populations included in the study, varying levels of acceptance of mindfulness interventions by patients, and cultural differences will lead to varying degrees of bias in the results. The clinical sample size of this study is small, and the region and patient population are relatively limited. We will need to conduct large sample multicenter clinical studies for verification in the future. However, after the colorectal cancer patients came forward, they recurred, mainly because the patients lacked effective medical care during the actual healing process, and the patients failed to effectively implement the rehabilitation-related methods explained by the medical staff after being discharged from the hospital. In the actual operation process, there will be a certain degree of fear and resistance, which leads to a low level of the patient’s non-judgmental dimension score [ 37 ].

Study limitations

Our study is affected by objective conditions, and our study has certain shortcomings that need to be further improved and supplemented. In addition, our study only conducted a preliminary qualitative and quantitative study on the level of positive thinking, health beliefs and self-management efficacy of some patients before and after the intervention. The study explored the effect of positive self-management efficacy of colorectal cancer patients, with the aim of bridging the lack of systematic and rigorous theoretical support for positive thinking therapy, so as to provide healing tools for clinical treatment of colorectal cancer patients, and then better provide treatment services for colorectal cancer patients.

In conclusion, mindfulness intervention in patients undergoing chemotherapy after colorectal cancer can reduce their negative emotions, improve the level of mindfulness, and improve the quality of life of patients.

Data availability

https://www.jianguoyun.com/p/Dazb6xoQuaiFChjXs5YFIAA.

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Acknowledgements

This project was supported by the Medjaden Academy & Research Foundation for Young Scientists (Grant No. MJA202306056).

Hebei Provincial Health and Family Planning Commission medical science research project (20200597).

Author information

Yaning Feng and Jianchun Fan contributed equally to this work.

Authors and Affiliations

Physical Examination Center, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China

Yaning Feng

Hospital Office, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China

Kuanlei Wang

Graduate School, Hebei North University, Zhangjiakou, 075000, China

Jianchun Fan

Department of General Surgery, The First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou, 075000, China

Xueliang Wu & Zhili Yang

Tumor Research Institute, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China

Xueliang Wu

School of Basic Medicine, Fourth Military Medical University, Xi’an, 710032, China

Department of Anorectal Surgery, Xinchang Country People’s Hospital, 117 Gushan Middle Road, Xinchang, Zhejiang Province, 312500, China

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Contributions

Yaning Feng performed the statistical analyses and wrote the manuscript. Kuanlei Wang, Jianchun Fan completed all the data entry and provided assistance for the data analysis. Xueliang Wu designed and wrote the study protocol and reviewed the manuscript. Yaning Feng participated the revision of this manuscript. Xueliang Wu participated in manuscript revision. Tian Li offered many constructive opinions on this study and provided a critical revision of the manuscript for important intellectual content. All authors contributed to and approved the final manuscript.

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Correspondence to Xueliang Wu , Tian Li or Zhili Yang .

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Feng, Y., Wang, K., Fan, J. et al. Mindfulness intervention, homogeneous medical concept, and concentrated solution nursing for colorectal cancer patients: a retrospective study. BMC Cancer 24 , 1055 (2024). https://doi.org/10.1186/s12885-024-12508-y

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Received : 09 February 2024

Accepted : 12 June 2024

Published : 27 August 2024

DOI : https://doi.org/10.1186/s12885-024-12508-y

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