الفهرس 
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Abstract
The primary goal of nursing education is to help nursing students learn how to integrate
information, think critically, reason effectively, and use clinical evidence to take the most
accurate and suitable decisions . Nursing students are significant decision-makers in any
developed healthcare system, and evidence suggests sound clinical judgment is important
because the judgments made by nurses in practice, influence patient outcomes.
Clinical judgment is the relationship between nursing knowledge and how that
knowledge applied through intervention, management, and evaluation. As a result, there is a
need in nursing education to improve nursing students’ critical thinking, clinical reasoning,
and clinical judgment skills on a national and global scale.
Clinical judgment skills can be improved by many strategies, Mind mapping is one of
them. It has been incorporated with teaching and learning in recent years. It is a method of
creating memory links between a topic keyword and an image, color, or other link by
combining drawings and words. It highlights the contents’ important points and allowing
learners to successfully store and extract information.
Mind mapping is also an effective teaching and learning strategy in linking theory and
practice and making the nursing process easier for students to learn. The purpose of mapping
nursing practice is to help students develop clinical judgment skills; that is through, assessing
the patient, gathering information from various literatures, identify relevant points, relate all
of the collected information to the care of the patient, and illustrate the information
graphically.
The aim of this study is to determine the effect of utilizing electronic mind map on
nursing students’ clinical judgment skills.
Research hypothesis: Nursing students who utilize electronic mind map exhibit higher
clinical judgment skills levels than those who do not.
Setting: This study was carried out at Medical-Surgical Nursing Department at the
Faculty of Nursing, Damanhour University, in addition to the Damanhour Medical National
Institute in which the nursing students spent their clinical training.
Subjects: The participants consisted of 60 nursing students out of 150 students who
were enrolled in the urology rotation during the second semester of the academic year 2021-
2022.The study subjects were randomly allocated into two equal groups the control and the
study group, (30) students for each.
To accomplish the aim of the current study; two tools were used for data collection;
Tool I: Clinical Judgment Skills Rubric: It was adapted by the researcher based on
Lasater clinical judgment skills rubric LCJSR (2007) after approval for modifications from
the original author. The tool was used to assess the four aspects of clinical judgment: noticing,
interpreting, responding, and reflecting. In addition to asheet that contains students‘ personal
and academic characteristics such as name, code, age, sex, academic achievement in the first
academic year.
Tool II: Electronic Mind Map Scoring Rubric: the researcher developed this tool
after an extensive review of the literatures (Cañas & Novak, 2014; Coutinho, 2014; Abd-
Elhalem, 2016)to measure the performance of nursing students in constructing the electronic
mind map. It included organization, comprehensiveness, links, accuracy, and attractiveness.
Before conducting the study and after explaining the study aim, approvals were
obtained from the Research Ethics Committee (REC) of the Faculty of Nursing, Alexandria
University, the Dean and head of the ”Medical-Surgical Nursing Department,” and the head of
the ”Information Technology Unit” of the Faculty of Nursing, Damanhur University.
Five experts in nursing education and medical-surgical departments from Damanhour
and Alexandria universities evaluated the study tools for content validity, and the necessary
modifications were made.A pilot study was carried out on six nursing students to assess the
clarity and applicability of the tools, the necessary modifications were made and they were
excluded from the study subjects.
The Cronbach’s Alpha test was used to assess the reliability of study instruments. The
tools were dependable, with test scores of 0.76 and 0.71, respectively.
This research was carried out in three stages: preparation, implementation, and evalustion.
Phase I: Preparation Phase:
- During this phase, the researcher prepared herself, content including PowerPoint
presentation, Small videos and a case study for the study group training on writing a
nursing care plan in the form of an E-mind map, learning environment (IT lap) and
student’ channel on the Microsoft team and Whats-App group were created.
Phase II: Implementation Phase:
- On the first hospital day both groups were distributed randomly to dialysis patients
and were instructed to write their first nursing care plan individually by paper- based
method (Pretest) and evaluated by using tool I for both groups.
- First, the researcher presented the PowerPoint presentation, the small videos for the
study group and provided them with the case study data and teach them how to
construct a mind map.
- Then, on hospital days, both groups were distributed to the urology department
patients randomly.
- The researcher observed and asked the study group during their interaction with the
patients and collection of data by using tool I that contains ten items which are
focused observation and information seeking; identify deviations from expected
patterns; prioritizing data; making sense of data; calm, confident manner; clear
communication, well-planned intervention/flexibility; being skillful; evaluation /selfanalysis;
commitment to improvement.
- Every student constructed one EMM per week pertaining to the assigned patients (five
electronic MMs) in addition to one for posttest.
- The contact were established between the researcher and the study group for any
question or interpretation via face to face on the day of the hospital, the day of the
clinical conference, and the students send the maps on the Microsoft team channel or
WhatsApp group and shared them with each other.
4. Evaluation Phase:
- Every hospital day the study group received oral and written feedback about their
performance and suggestions for improvement based on researcher evaluation of their
MM content, their progress and the students’ score in tool II.
- On the last hospital day posttest were done for both groups by the evaluation of the
last nursing care plan by using tool I for both groups and tool II for study group only.
Main results of the current study: There was a high statistical significant difference
between the study and the control group after using the E-mind map in relation to their
clinical judgment skills (p = 0.000). In addition to the mean change and standard deviation of
clinical judgment skills in the study group were reported as 18.17±2.49, while in the control
group, it was 3.43±2.11. This substantial difference highlights the effectiveness of the
intervention (application of EMM) in the study group. There was a high positive correlation
between the mean score of the mind map and the clinical judgment skills among the study
group over the course of the intervention.
The study findings show that throughout the application of EMMs, there was a
significant difference in mean score of the four aspects of clinical judgment in the study group
before and after the intervention and consequently in the CJS totally mean score and EMM
scores which increased progressively from the first week to the last week.
Concerning the control group, the results show that there were no significant changes in
the mean scores of the noticing and interpreting aspects over the course of the study.
However, the mean scores of the responding and reflecting aspects progressed slightly which
may be due to that nursing students exposure to various patients or settings ,made them more
experienced, promote their ability to respond appropriately and encourage them to engage in
self-reflection.
The following recommendations are made based on the current study findings:
- EMM strategy should be integrated into the curriculum and online courses.
- Nurse educators should use EMM in combination with traditional teaching methods.
- Nurse educators should use EMM in constructing courses outline and objectives.
- Appropriate infrastructure and updated resources to support the successful EMM
strategy implementation and educational process.
- Specific time during the clinical rotation to take the opportunities for applying the new
technologies that improve clinical judgment skills as EMM strategy.
- Determine the effect of EMM strategy on students‘ knowledge retention and academic
achievement.
- Replication of this study on other nursing specialties to ensure results can widely be
generalizable.