Effectiveness of mind mapping in undergraduate nursing education: A quasi-experimental study

Abstract

Background

Anatomy and physiology courses are cognitively demanding and may be associated with academic difficulty and reduced motivation among undergraduate nursing students. Learner-centered strategies, including mind mapping, may enhance learning by supporting active knowledge construction, conceptual integration, and engagement.

Aim

This study evaluated the effectiveness of mind mapping on academic achievement and motivation among undergraduate nursing students enrolled in an Anatomy and Physiology I course. A secondary exploratory aim was to examine whether improved outcomes could be achieved without increased self-reported study time.

Methods

A quasi-experimental, non-randomized controlled design was conducted during the 2024–2025 academic year among undergraduate nursing students at Palestine Polytechnic University, Palestine. Participants were allocated to an experimental group receiving mind mapping-based instruction (n = 41) or a control group receiving traditional lecture-based teaching (n = 41). Academic achievement was assessed using a structured post-test aligned with course learning outcomes. Motivation was measured using a validated questionnaire at the end of the intervention only. Weekly study time was assessed using a self-reported categorical item. Independent-samples t-tests and chi-square tests were used, with effect sizes and 95% confidence intervals calculated.

Results

The experimental group achieved significantly higher academic achievement scores (M = 22.07, SD = 4.20) than the control group (M = 20.15, SD = 3.21), t (80) = 2.33, p = .022, Cohen’s d = 0.52. Motivation scores were also higher in the experimental group (M = 4.02, SD = 0.36) than the control group (M = 3.58, SD = 0.66), t (80) = 3.26, p = .002, Cohen’s d = 0.75. Weekly study time did not differ significantly, χ² (3) = 5.93, p = .205.

Conclusion

Mind mapping improved academic achievement and post-intervention motivation. However, learning-efficiency findings should be interpreted cautiously because study time was self-reported and efficiency was not directly measured.

Keywords

mind mapping nursing education academic achievement motivation learning efficiency quasi-experimental study

Introduction

Anatomy and physiology are essential components of undergraduate nursing education because they provide the scientific foundation needed for clinical reasoning, patient assessment, medication safety, and evidence-informed nursing practice. Nursing students frequently report difficulty in bioscience courses because these subjects require understanding unfamiliar terminology, integrating multiple body systems, and applying abstract biological concepts to clinical situations.^1,2 Difficulties in bioscience learning may contribute to weaker academic performance and reduced confidence during the early stages of nursing education.²

Traditional lecture-based teaching continues to be used widely in science and health professions education; however, passive learning methods may not fully support conceptual understanding in complex subjects. Evidence from undergraduate science education shows that active learning improves student performance compared with traditional lecturing, particularly when students are required to engage with, organize, and apply knowledge.³ Active learning may also reduce achievement gaps and improve engagement among students in science-related courses.⁴ Therefore, learner-centered strategies may be valuable in nursing bioscience education, where students must connect theoretical knowledge with later clinical practice.

Mind mapping is a visual learning strategy that helps students organize information hierarchically and represent relationships among concepts. Concept mapping and mind mapping approaches are grounded in the idea that meaningful learning occurs when learners actively connect new information with existing knowledge structures.⁵ From a cognitive load perspective, organizing complex information visually may reduce unnecessary mental effort and support schema formation during learning.⁶ In anatomy and physiology, this may be particularly useful because students must connect structure, function, physiological mechanisms, and clinical relevance.¹

Empirical evidence supports the educational value of mapping-based strategies. A recent meta-analysis found that concept mapping has a positive effect on academic achievement across educational settings.⁷ In undergraduate medical education, systematic review evidence showed that concept mapping supports critical thinking, knowledge integration, and meaningful learning.⁸ Similarly, physiology education research has shown that concept mapping can improve students’ understanding and performance when learning complex physiological content.⁹ In nursing education, students have reported that concept mapping helps them organize course content, understand physiological concepts, and engage more actively with learning materials.¹⁰

Motivation is also an important educational outcome because it influences students’ engagement, persistence, self-regulated learning, and willingness to invest effort in difficult academic tasks. Self-determination theory explains that learning environments supporting autonomy, competence, and active participation are more likely to enhance intrinsic motivation.¹¹ Since mind mapping allows students to construct, personalize, and revise their own learning materials, it may support both academic achievement and motivation. However, previous research has focused more strongly on academic achievement than on motivational outcomes, creating a need for studies that examine both outcomes together.

Despite increasing evidence supporting mapping-based strategies, several gaps remain. First, many studies have examined academic performance without giving equal attention to motivation as an affective learning outcome.^7,8 Second, some interventions have been implemented over short periods, limiting understanding of the effect of mind mapping when used throughout a full academic semester.⁹ Third, limited evidence is available on whether mind mapping can improve learning efficiency, meaning improved academic outcomes without increased study time or workload. This issue is important in nursing education because students commonly experience heavy academic demands across theoretical and clinical courses.²

Context-specific evidence is also needed because educational resources, teaching methods, curriculum structures, and student learning experiences may differ across countries and institutions. Most available evidence on mapping-based strategies comes from international educational contexts, while limited research has examined mind mapping in Palestinian undergraduate nursing education. Therefore, studying this strategy in Palestine may provide useful evidence for educators seeking low-cost, learner-centered approaches that can be integrated into routine nursing teaching.

Accordingly, this study aimed to evaluate the effectiveness of mind mapping on academic achievement and motivation among undergraduate nursing students enrolled in an Anatomy and Physiology I course at Palestine Polytechnic University in Palestine. A secondary exploratory aim was to examine whether improved outcomes could be achieved without increased self-reported study time, thereby providing preliminary evidence regarding the potential contribution of mind mapping to learning efficiency. Regarding the potential of mind mapping to support learning efficiency.

Literature review

Visual mapping strategies, including mind mapping and concept mapping, are increasingly used in health professions education to help students organize complex information into meaningful conceptual structures. Unlike linear note-taking, mapping requires students to identify key concepts, arrange ideas hierarchically, and clarify relationships between related knowledge components. This approach is consistent with meaningful learning theory, which emphasizes connecting new information with existing cognitive structures, and with cognitive load theory, which supports structured presentation of complex material to reduce unnecessary mental effort.^5,6

Evidence supports the positive effect of mapping-based strategies on learning outcomes. İzci and Akkoç reported in a meta-analysis that concept mapping significantly improved academic achievement across educational settings.⁷ In undergraduate medical education, Fonseca et al. found that concept mapping supported critical thinking, knowledge integration, and meaningful learning.⁸ These findings are relevant to nursing bioscience education because anatomy and physiology require students to connect terminology, structure, function, and clinical application rather than memorize isolated facts.

In physiology education, Kalyanasundaram et al. found that concept mapping improved learning performance among first-year medical students.⁹ Similarly, Nuuyoma and Fillipus reported that nursing students perceived concept mapping as useful for organizing physiology content, understanding relationships among concepts, and engaging actively with learning materials.¹⁰ Beyond bioscience courses, Joseph et al. found that concept mapping improved critical thinking among nursing students, while Kaddoura et al. reported that concept mapping may support clinical judgment and learning outcomes when applied as an active learning strategy.^12,13 More recent evidence also suggests that mind mapping can strengthen critical thinking by encouraging learners to analyze, categorize, and visually connect information.¹⁴

Motivation is also important in nursing education because it influences engagement, persistence, and self-regulated learning. Self-determination theory explains that learning environments supporting autonomy, competence, and active participation are more likely to enhance intrinsic motivation.¹¹ Mind mapping may support motivation because students actively construct and personalize their learning materials. However, existing studies have focused more on academic achievement and cognitive outcomes than on motivation, leaving uncertainty about its affective educational impact.

Several gaps remain. Many studies have examined academic achievement without assessing motivation, and several interventions were short-term, limiting understanding of semester-long implementation.^7–9 In addition, limited research has examined learning efficiency, particularly whether improved academic outcomes can occur without increased study time. This issue is important because nursing students often experience high academic workload.²Context-specific evidence from Palestinian undergraduate nursing education is also limited. Therefore, the present study evaluates the effectiveness of mind mapping on academic achievement and motivation among undergraduate nursing students enrolled in Anatomy and Physiology I at Palestine Polytechnic University in Palestine.

Methods

Study design

This study employed a quasi-experimental, non-randomized controlled design to evaluate the effectiveness of mind mapping on academic achievement and motivation among undergraduate nursing students enrolled in an Anatomy and Physiology I course. A quasi-experimental approach was considered appropriate because random assignment of students was not feasible within the institutional academic system, where students had already been allocated to course sections before the semester began. This design is commonly used in educational research when administrative or ethical constraints prevent randomization while still allowing meaningful comparison between naturally existing groups.¹⁰

To strengthen internal validity, both groups were taught the same syllabus, learning outcomes, academic timetable, course duration, and assessment schedule. Baseline comparability between the two groups was examined using demographic and academic variables, including age, gender, cumulative grade point average (GPA), and self-reported weekly study time.

Setting

The study was conducted during the 2024–2025 academic year in the Faculty of Nursing at a Palestine Polytechnic University, Palestine. The institution offers a four-year undergraduate nursing program, and Anatomy and Physiology I is a compulsory second-year course. The course provides foundational knowledge related to human body systems, physiological regulation, and structural-functional relationships, serving as a prerequisite for later clinical and pathophysiology courses.

Participants and sampling

The target population consisted of all second-year undergraduate nursing students registered in Anatomy and Physiology I during the study semester. A total population sampling strategy was adopted to maximize representativeness and reduce sampling bias. All eligible students enrolled in the available course sections were invited to participate.

A final sample of 82 students agreed to participate and completed the study. Students were distributed into two intact course sections, with 41 students in the experimental group and 41 students in the control group. These sections had been established by the university administration before commencement of the study, and the researchers had no role in group allocation.

Students were eligible if they were enrolled in the undergraduate nursing program, registered in Anatomy and Physiology I during the study semester, and willing to participate voluntarily. Students who withdrew from the course, were absent during final outcome assessment, or declined participation were excluded from the final analysis.

Sample size calculation

Sample size was calculated a priori using G*Power version 3.1 for an independent-samples t-test. Assuming a medium effect size (Cohen’s d = 0.50), an alpha level of .05, and statistical power of 0.80, the minimum required sample size was 64 participants, equivalent to 32 students per group. The final sample of 82 students exceeded this threshold and was therefore considered adequate to detect meaningful differences between groups.

Intervention: Mind mapping program

The intervention was implemented across a full 12-week academic semester. It was designed in accordance with constructivist learning theory, which emphasizes active knowledge construction, and cognitive load theory, which supports the structured presentation of complex material to facilitate learning.⁴

During the first week of the semester, students in the experimental group attended a structured 90-minute orientation session introducing the principles and practical use of mind mapping. The session included explanation of the theoretical purpose of mind maps, demonstration of instructor-developed examples based on anatomy and physiology content, guided student practice, and formative feedback regarding concept hierarchy, clarity, and conceptual relationships.

Throughout the semester, mind mapping was integrated into routine classroom teaching. At the end of each major topic, students were required to construct individual mind maps summarizing key concepts, physiological mechanisms, and relationships among body systems. Topics included cellular transport, tissues, the nervous system, cardiovascular regulation, respiratory physiology, renal function, and endocrine coordination. Students submitted their maps weekly or biweekly, and the instructor provided feedback focused on scientific accuracy, logical sequencing, concept integration, and completeness. These assignments were formative in nature and did not contribute to official course grades.

To reduce instructor-related bias, the same instructor taught both the experimental and control groups. Course content, classroom time, teaching schedule, and learning objectives were standardized across sections. The principal planned difference between groups was the instructional strategy, with the experimental group receiving mind mapping activities and the control group receiving traditional lecture-based teaching.

Intervention fidelity was monitored throughout the semester using a structured observational checklist. This process ensured that planned sessions were delivered consistently, students remained engaged in mapping activities, feedback was regularly provided, and activities remained aligned with scheduled course topics. Before implementation, the observational checklist was pre-tested with 10 nursing students, representing 12.2% of the target population, to assess clarity, feasibility, and applicability in the classroom setting. Minor wording refinements were made based on pre-test feedback before the checklist was used for intervention fidelity monitoring.

Control group

Students assigned to the control group received conventional lecture-based instruction covering the same academic content, duration, learning outcomes, and assessment schedule as the experimental group. Teaching methods included verbal explanation, whiteboard illustration, and standard note-taking practices, without formal use of mind mapping strategies.

Outcome measures

Academic achievement

Academic achievement was measured using a structured post-test developed by the course teaching team and aligned with official course learning outcomes. The examination consisted of 30 items, including 20 multiple-choice questions and 10 short-answer questions. The test was designed to assess a range of cognitive levels, with approximately 60% of items measuring knowledge, comprehension, and application, while 40% measured higher-order analysis and integration.

A test blueprint was prepared before item construction to ensure balanced representation of topics and cognitive domains. Content validity was established through expert review by faculty members specializing in nursing education and biosciences. Following pilot review, item difficulty and discrimination indices were examined, and items demonstrating poor performance were revised or replaced.

Multiple-choice questions were scored dichotomously as correct or incorrect. Short-answer questions were evaluated using a standardized scoring rubric. To enhance scoring consistency, a subset of responses was independently marked by two raters. Inter-rater reliability demonstrated substantial agreement, with Cohen’s kappa of 0.87.

Motivation toward learning

Student motivation was assessed using a structured questionnaire adapted from previously validated instruments used in health professions education research. The scale measured learner engagement, interest, confidence, perceived value of learning, and willingness to invest effort. Responses were recorded using a five-point Likert-type scale ranging from strongly disagree to strongly agree, consistent with the original Likert scaling approach for measuring attitudes and perceptions.¹¹ Higher mean scores indicated greater motivation toward learning. Motivation was measured once at the end of the intervention period only; no baseline pre-intervention motivation assessment was conducted. Therefore, motivation findings reflect post-intervention between-group differences rather than within-group changes over time.

Validity and reliability of instruments

The motivation questionnaire underwent content validation by three experts in nursing education and educational measurement. Minor wording revisions were introduced to improve clarity and contextual suitability. Internal consistency reliability was examined using Cronbach’s alpha, yielding a coefficient of .82, which indicates good reliability.¹¹

Construct validity was supported by theoretical consistency with established motivation frameworks and by the instrument’s ability to differentiate between intervention and control groups after completion of the program.

Study time measure

Weekly study time was measured using a self-reported categorical item asking students to estimate the average number of hours spent studying anatomy and physiology outside scheduled classroom sessions. Response categories ranged from fewer than three hours to more than eight hours per week. This variable was included as an exploratory indicator relevant to learning efficiency and was interpreted cautiously because of its subjective nature.

Ethical considerations

Ethical approval for this educational research study was obtained from the Research Ethics Committee of Palestine Polytechnic University (Approval Reference: EA/2025/45). Participation was entirely voluntary, and written informed consent was obtained from all participants prior to data collection. Students were informed that participation or non-participation would not affect their academic standing, course grades, or relationship with faculty members. Confidentiality and anonymity were maintained throughout all stages of the study, and collected data were securely stored and used solely for research purposes.

Reporting standards

The study was reported in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement to enhance methodological transparency and reporting quality.¹²

Data collection procedure

Baseline demographic and academic data were collected at the beginning of the semester. The intervention was then implemented over a 12-week period. At the end of the semester, students in both groups completed the academic achievement test and motivation questionnaire under standardized classroom conditions.

Statistical analysis

Data were analyzed using IBM SPSS Statistics version 28. Descriptive statistics, including means, standard deviations, frequencies, and percentages, were used to summarize participant characteristics and study outcomes.

Normality of continuous variables was assessed using the Kolmogorov–Smirnov test, while homogeneity of variance between groups was examined using Levene’s test before conducting parametric analyses. Independent-samples t-tests were used to compare academic achievement and motivation scores between the two groups. Chi-square tests were used to compare categorical variables such as gender, GPA categories, and weekly study time. To enhance interpretation of findings, Cohen’s d was calculated to estimate effect sizes, and 95% confidence intervals were reported for mean differences. All tests were two-tailed, and a p value of less than .05 was considered statistically significant.

Results

A total of 82 undergraduate nursing students participated in the study. Forty-one students were assigned to the experimental group and 41 students to the control group. All enrolled participants completed the study procedures and final outcome assessments. No attrition or missing data were recorded during the study period, resulting in a complete dataset for analysis.

Participants were drawn from two pre-existing course sections of the Anatomy and Physiology I course. One section received the mind mapping intervention and the other received traditional lecture-based instruction. All eligible students agreed to participate and completed baseline and post-intervention assessments. A participant flow diagram is presented in Figure 1 in accordance with TREND reporting guidance.

Figure 1.

Participant flow diagram of the study in accordance with TREND guidance.

Baseline demographic and academic characteristics of the participants are presented in Table 1. The distribution of gender was identical across the two groups, with females comprising the majority of participants in both sections (68.3%). Mean age was comparable between the control group (M = 19.0, SD = 0.69) and the experimental group (M = 19.0, SD = 0.78).

Table 1.

Baseline demographic and academic characteristics of participants (N = 82).

Variable	Category	Control n (%)	Experimental n (%)	Test statistic	p
Gender	Male	13 (31.7)	13 (31.7)	χ² = 0.00	1.000
Gender	Female	28 (68.3)	28 (68.3)
Age (years)	Mean ± SD	19.0 ± 0.69	19.0 ± 0.78	t = 0.00	1.000
GPA	<70	8 (19.5)	7 (17.1)	χ² = 0.42	.936
	70–79	18 (43.9)	17 (41.5)
	80–89	12 (29.3)	13 (31.7)
	90–100	3 (7.3)	4 (9.8)
Weekly Study Time	<3 hours	17 (41.5)	16 (39.0)	χ² = 5.93	.205
	3–5 hours	17 (41.5)	15 (36.6)
	6–8 hours	3 (7.3)	10 (24.4)
	>8 hours	4 (9.8)	0 (0.0)

Note. Percentages may not total exactly 100 due to rounding.

Most students in both groups had cumulative GPA values within the 70–89 range. Similarly, weekly study time was predominantly fewer than five hours in both groups. Chi-square analyses demonstrated no statistically significant between-group differences in gender (χ² = 0.00, p = 1.000), GPA category (χ² = 0.42, p = .936), or weekly study time category (χ² = 5.93, p = .205). These findings indicate satisfactory baseline equivalence between groups prior to implementation of the intervention.

Assumption testing

Prior to inferential analysis, assumptions for parametric testing were examined. The Kolmogorov–Smirnov test indicated that academic achievement and motivation scores were normally distributed in both groups (all p > .05). Levene’s test further showed that the assumption of homogeneity of variance was not violated for either academic achievement or motivation outcomes (all p > .05). Therefore, independent-samples t-tests were considered appropriate as in Table 2.

Table 2.

Normality and homogeneity testing for continuous outcomes.

Variable	Group	Mean	SD	K–S statistic	K–S p	Levene’s F	Levene’s p
Academic Achievement	Control	20.15	3.21	0.113	.168	1.24	.269
Academic Achievement	Experimental	22.07	4.20	0.084	.200
Motivation Score	Control	3.58	0.66	0.128	.053	2.01	.160
Motivation Score	Experimental	4.02	0.36	0.147	.062

Note. p > .05 indicates assumptions were met.

Academic achievement

Students in the experimental group achieved significantly higher post-test academic achievement scores than students in the control group. The mean score in the experimental group was 22.07 (SD = 4.20), compared with 20.15 (SD = 3.21) in the control group. This difference was statistically significant, t (80) = 2.33, p = .022.

The mean difference between groups was 1.92 points (95% CI [0.29, 3.55]). The effect size was moderate (Cohen’s d = 0.52), indicating that mind mapping had a practically meaningful positive effect on academic performance.

Motivation toward learning

Students exposed to the mind mapping intervention also reported significantly higher motivation scores than those in the control group. The experimental group obtained a mean score of 4.02 (SD = 0.36), whereas the control group obtained a mean score of 3.58 (SD = 0.66). This difference was statistically significant, t (80) = 3.26, p = .002.

The mean difference was 0.44 points (95% CI [0.17, 0.71]). The effect size was moderate-to-large (Cohen’s d = 0.75), suggesting that mind mapping was associated with substantially higher motivation toward learning as in Table 3.

Table 3.

Comparison of primary outcomes between groups (N = 82).

Outcome variable	Control mean ± SD	Experimental mean ± SD	Test	df	p	Mean difference (95% CI)	Cohen’s d
Academic Achievement	20.15 ± 3.21	22.07 ± 4.20	t = 2.33	80	.022	1.92 (0.29, 3.55)	0.52
Motivation Score	3.58 ± 0.66	4.02 ± 0.36	t = 3.26	80	.002	0.44 (0.17, 0.71)	0.75
Weekly Study Time	—	—	χ² = 5.93	3	.205	—	—

Note. Statistical significance was set at p < .05.

Weekly study time

No statistically significant difference was identified between groups in weekly study time categories (χ² = 5.93, p = .205). Although the experimental group included a greater proportion of students reporting 6–8 hours of weekly study, the overall distribution did not differ significantly. This finding suggests that improved academic achievement and motivation in the intervention group were not accompanied by a measurable increase in reported study time.

Overall, the findings demonstrate that students who received mind mapping-based instruction achieved significantly better academic outcomes and higher motivation than students receiving traditional lecture-based teaching. These improvements occurred without a statistically significant increase in reported weekly study time, suggesting that mind mapping may represent a more effective and potentially more efficient instructional approach in undergraduate nursing education.

Discussion

This quasi-experimental study evaluated the effectiveness of mind mapping as a learner-centered instructional strategy for improving academic achievement and motivation among undergraduate nursing students enrolled in an Anatomy and Physiology I course. Students exposed to mind mapping achieved significantly higher academic scores and reported greater motivation than those receiving traditional lecture-based instruction. These gains occurred without a statistically significant increase in reported weekly study time. Collectively, these findings indicate that mind mapping may represent a practical and pedagogically valuable strategy for supporting learning in cognitively demanding nursing science courses.

The improvement in academic achievement is consistent with growing evidence that mapping-based learning strategies enhance comprehension, knowledge integration, retention, and higher-order reasoning. Anatomy and physiology require students to connect terminology, structural relationships, physiological mechanisms, and clinical relevance. Conventional linear note-taking may fragment these relationships, whereas mind mapping visually organizes concepts into coherent networks that facilitate recall and deeper processing. A recent meta-analysis demonstrated that concept mapping interventions significantly improved academic achievement across educational settings.⁵ Similarly, mapping strategies have been shown to reduce cognitive load while improving student performance in anatomy education.¹ In health professions education, systematic review evidence concluded that concept mapping supports critical thinking and conceptual understanding.⁶ More recent work in health education has also shown that mind mapping can strengthen critical thinking skills and analytical learning processes.¹⁵ Therefore, the moderate effect size identified in the present study (Cohen’s d = 0.52) appears both statistically significant and educationally meaningful.

Several theoretical mechanisms may explain these findings. Constructivist learning theory proposes that students learn more effectively when actively reorganizing and integrating information rather than passively receiving content.^16,17 In the present study, students generated individualized maps linking major concepts across body systems, which likely promoted elaboration, reflection, and meaningful learning. Concept mapping theory similarly suggests that durable learning occurs when learners connect new knowledge to existing cognitive structures through hierarchical associations.¹⁸ Cognitive load theory offers an additional explanation. Complex scientific subjects can overwhelm working memory when information is poorly structured. Visual mapping may reduce extraneous cognitive load by clarifying hierarchies and relationships, thereby allowing students to allocate greater mental resources to essential learning tasks.⁴ This mechanism is especially relevant because physiology has long been recognized by educators as a difficult subject due to its conceptual complexity and need for system-level integration.¹⁹

The present study also demonstrated significantly higher motivation among students receiving the intervention, with a moderate-to-large effect size (Cohen’s d = 0.75). Motivation is a central determinant of persistence, attention, engagement, and academic resilience in nursing education. Students frequently experience stress during foundational bioscience courses, and reduced motivation may contribute to avoidance behaviors and lower performance. Mind mapping may improve motivation by increasing autonomy, creativity, and active participation. Rather than functioning as passive recipients of information, students become active creators of their own learning materials. This interpretation aligns with self-determination theory, which emphasizes autonomy, competence, and relatedness as key drivers of intrinsic motivation.³ Contemporary studies in higher education have similarly shown that active learning approaches enhance student engagement, satisfaction, and perceived competence.^9,13

A notable feature of this study was the exploratory examination of learning efficiency. Students in the experimental group achieved superior academic and motivational outcomes without a statistically significant increase in reported study time. This pattern may suggest that mind mapping supported more efficient learning through better organization of information, quicker revision, and stronger conceptual encoding. For nursing students facing heavy curricular demands, strategies that improve outcomes without increasing workload are especially valuable. Nevertheless, this interpretation should remain cautious. Weekly study time was self-reported rather than objectively measured, and learning efficiency was not directly assessed as a predefined primary outcome. Consequently, these findings should be interpreted as preliminary rather than conclusive evidence of improved efficiency. Future research should incorporate objective measures such as time-on-task analytics, workload inventories, learning management system activity logs, or repeated diary methods.

The findings also extend the literature in several important ways. First, many previous studies have concentrated primarily on academic achievement, whereas the current study simultaneously examined cognitive and motivational outcomes. Second, several earlier investigations evaluated short-term interventions or isolated classroom sessions. By contrast, the present intervention was delivered across an entire academic semester, thereby increasing ecological validity and demonstrating feasibility under routine teaching conditions. Third, evidence from nursing education settings in low- and middle-income regions remains comparatively limited. Contextual research is important because curriculum structure, student workload, class size, and educational resources vary substantially across institutions. The present findings therefore contribute relevant evidence for nursing programs seeking low-cost and scalable teaching innovations.

Comparison with prior nursing education research further supports the present results. Nursing students have previously reported that concept mapping helps them understand human physiology and organize course content more effectively.⁸ In broader nursing education, concept mapping has been associated with improvements in critical thinking, care planning, and clinical judgment, particularly when used repeatedly rather than as a one-time activity.¹⁴ These findings suggest that visual mapping strategies may have utility beyond bioscience education and could support integrated nursing competencies across theoretical and clinical domains.

From a methodological perspective, although randomization was not feasible, quasi-experimental studies remain valuable for evaluating educational interventions in authentic academic environments where administrative structures may prevent true random assignment.²⁰ When supported by baseline equivalence testing, standardized teaching conditions, and transparent reporting, such designs can generate meaningful evidence for practice-based educational improvement.

The acceptable internal consistency of the motivation instrument is consistent with psychometric guidance indicating that reliability coefficients above .80 are generally suitable for applied educational research.^21,22

Implications

The present findings have several practical implications. First, integrating mind mapping into anatomy and physiology teaching may help reduce learning difficulties commonly encountered in early nursing education. Strengthening understanding in these gateway subjects may support progression into later clinical courses. Second, mind mapping represents a relatively low-cost instructional innovation requiring minimal technological infrastructure, making it feasible in resource-constrained settings. Third, educators may incorporate mind mapping into lectures, tutorials, revision sessions, peer learning activities, and formative assessment tasks. Fourth, faculty development initiatives may be beneficial to train educators in designing effective mapping activities aligned with learning outcomes. Finally, mind mapping may be transferable to other complex nursing subjects, including pharmacology, pathophysiology, critical care, and clinical reasoning.

Strengths and limitations

This study has several strengths. It used a controlled quasi-experimental design, allowing comparison between intervention and control groups under authentic educational conditions. The intervention was implemented over a full academic semester rather than a brief session, which strengthens practical relevance. Baseline equivalence between groups was assessed and demonstrated across key demographic and academic variables. The study also examined both academic achievement and motivation, providing a more comprehensive evaluation of educational effectiveness. Furthermore, psychometric and methodological rigor was enhanced through structured outcome measures, effect size reporting, confidence intervals, and transparent reporting principles.

Because participants in both groups were recruited from the same institution and academic level, contamination between groups may have occurred through informal peer communication outside the classroom. Students in the experimental group may have shared mind mapping techniques, examples, or study strategies with students in the control group during regular academic or social interactions. Although the intervention was delivered separately by course section, complete prevention of information exchange was not feasible in this natural educational setting. This possibility may have reduced the observed difference between groups and should be considered when interpreting the intervention effect.

Future research

Future studies should employ randomized controlled or multicenter designs to strengthen causal inference and generalizability. Longitudinal research is needed to examine retention of anatomical knowledge and transfer into clinical reasoning or patient care performance. Comparative studies of paper-based versus digital mind mapping platforms may also be valuable. Research should further explore whether particular learner characteristics, such as prior academic performance, learning style preferences, or digital literacy, moderate intervention effectiveness.

Conclusion

This study provides evidence that mind mapping is a promising instructional strategy for undergraduate nursing education. Students who received mind mapping-based instruction demonstrated higher academic achievement and stronger motivation than peers receiving traditional lecture-based teaching. These improvements were achieved without evidence of increased study burden, suggesting potential benefits for learning effectiveness and efficiency. Given its low cost, theoretical grounding, and practical adaptability, mind mapping may be a valuable addition to contemporary nursing curricula. Further rigorous multicenter studies are warranted to confirm these findings and determine long-term educational and clinical benefits.

Supplemental material

Supplemental material - Effectiveness of mind mapping in undergraduate nursing education: A quasi-experimental study

Supplemental material for Effectiveness of mind mapping in undergraduate nursing education: A quasi-experimental study by Zeenat Mesk, Mohammad Qtait, Nesreen Alqaissi, Ahmad Amro, Mahmood Asafrah, Fayez zeedat, Hasan zeedat, Mohammad Daoud, Dana Asafrah, and Nour hmedat in Sage Open Medicine.

Footnotes

Author note

The study was reported in accordance with the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) guidelines for quasi-experimental educational interventions to ensure transparency, methodological clarity, and reproducibility (Des Jarlais et al., 2004).

Acknowledgements

The authors would like to thank all undergraduate nursing students who participated in this study for their valuable time and cooperation. The authors also acknowledge the support of the Palestine Polytechnic University College of Nursing for facilitating the implementation of this research. Appreciation is also extended to colleagues who provided academic and administrative assistance throughout the study process.

ORCID iDs

Zeenat Mesk

Mohammad Qtait

Ethical considerations

Ethical approval for this educational research study was obtained from the Palestine Polytechnic University Research Ethics Committee (Approval Reference: EA/2025/45). Participation was voluntary, and written informed consent was obtained from all participants. Confidentiality and anonymity were maintained throughout the study.

Author contributions

Zeenat Mesk: Conceptualization, study design, supervision of data collection, manuscript drafting, and final approval of the manuscript. Mohammad Qtait: Methodology development, statistical analysis, interpretation of findings, manuscript writing, correspondence, and final approval of the manuscript. Nesreen Alqaissi: Literature review, critical revision of the manuscript, and final approval. Ahmad Amro: Data collection, participant coordination, manuscript review, and final approval. Mahmood Asafrah: Data management, quality assurance, manuscript review, and final approval. Fayez Zeedat: Intervention support, data collection, manuscript review, and final approval. Hasan Zeedat: Data entry, data verification, manuscript review, and final approval. Mohammad Daoud: Literature support, participant follow-up, manuscript review, and final approval. Dana Asafrah: Administrative coordination, data organization, manuscript review, and final approval. Nour Hmedat: Data collection assistance, manuscript review, and final approval. All authors contributed substantially to the study, reviewed the final manuscript, approved the submitted version, and agree to be accountable for all aspects of the work.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Correspondence and requests for materials should be addressed to M.Q.*

Trial registration

This study was not a clinical trial and therefore was not registered in a clinical trial registry. No clinical interventions or patient-related outcomes were involved.

Supplemental material

Supplemental material for this article is available online.

References

Bolatli

. The Effect of Concept Map Technique on Students' Cognitive Load and Academic Success in Anatomy Course. Med Sci Educ 2024; 34(6): 1487–1496, Published 2024 Aug 14. https://doi.org/10.1007/s40670-024-02143-4

McVicar

Andrew

Kemble

. The ‘bioscience problem’ for nursing students: an integrative review of published evaluations of year 1 bioscience courses. Nurse Educ Today 2015; 35(3): 497–504. https://doi.org/10.1016/j.nedt.2014.11.005

Ryan

Deci

. Intrinsic and extrinsic motivation from a self-determination theory perspective: definitions, theory, practices, and future directions. Contemp Educ Psychol 2020; 61: 101860. https://doi.org/10.1016/j.cedpsych.2020.101860

Sweller

Ayres

Kalyuga

. Cognitive Load Theory. Springer, 2019. https://doi.org/10.1007/978-1-4419-8126-4

İzci

Akkoç

. The impact of concept maps on academic achievement: a meta-analysis. Heliyon 2024; 10(2): e23290. https://doi.org/10.1016/j.heliyon.2023.e23290

Fonseca

Marvão

Oliveira

, et al. The effectiveness of concept mapping as a tool for developing critical thinking in undergraduate medical education - a BEME systematic review: BEME Guide No. 81. Med Teach 2024; 46(9): 1120–1133. https://doi.org/10.1080/0142159X.2023.2281248

Kalyanasundaram

Abraham

Ramachandran

, et al. Effectiveness of concept mapping in learning physiology among first-year medical students. Adv Physiol Educ 2021; 45(2): 201–207. https://doi.org/10.1152/advan.00143.2020

Nuuyoma

Fillipus

. Nursing students’ perceptions and experiences of concept mapping as a learning tool in a human physiology course. Afr J Health Prof Educ 2020; 12(3): 98–102. https://doi.org/10.7196/AJHPE.2020.v12i3.1330

Freeman

Eddy

McDonough

, et al. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A 2014; 111(23): 8410–8415. https://doi.org/10.1073/pnas.1319030111

10.

Shadish

Cook

Campbell

. Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Houghton Mifflin, 2002.

11.

Likert

. A technique for the measurement of attitudes. Archives of Psychology 1932; 22(140): 1–55.

12.

Polit

Beck

. Nursing Research: Generating and Assessing Evidence for Nursing Practice. 11th ed. Wolters Kluwer, 2021.

13.

Des Jarlais

Lyles

Crepaz

, et al. TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 2004; 94(3): 361–366. https://doi.org/10.2105/AJPH.94.3.361

14.

Theobald

Hill

Tran

, et al. Active learning narrows achievement gaps for underrepresented students in undergraduate science, technology, engineering, and math. Proc Natl Acad Sci U S A 2020; 117(12): 6476–6483. https://doi.org/10.1073/pnas.1916903117

15.

Joseph

Thomas

Varghese

. Effectiveness of concept mapping in improving critical thinking among nursing students: a quasi-experimental study. Nurse Educ Pract 2022; 62: 103356. https://doi.org/10.1016/j.nepr.2022.103356

16.

Harris

McGregor

Perencevich

, et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc 2006; 13(1): 16–23. https://doi.org/10.1197/jamia.M1749

17.

DeVellis

. Scale Development: Theory and Applications. 4th ed. Sage Publications, 2017.

18.

Turkestani

Zipp

Nufaiei

, et al. Mind mapping to enhance critical thinking skills in respiratory therapy education. J Educ Health Promot 2024; 13: 198, Published 2024 Jul 5. https://doi.org/10.4103/jehp.jehp_1816_23

19.

Kaddoura

Van-Dyke

Yang

. Impact of a concept map teaching approach on nursing students' critical thinking skills. Nurs Health Sci 2016; 18(3): 350–354. https://doi.org/10.1111/nhs.12277

20.

Michael

. What makes physiology hard for students to learn? Results of a faculty survey. Adv Physiol Educ 2007; 31(1): 34–40. https://doi.org/10.1152/advan.00057.2006

21.

Novak

Cañas

. The theory underlying concept maps and how to construct and use them. Technical Report IHMC CmapTools 2006-01 Rev 01-2008. Pensacola (FL): Florida Institute for Human and Machine Cognition 2008, Available from. https://cmap.ihmc.us/Publications/ResearchPapers/TheoryUnderlyingConceptMaps.pdf

22.

Gil

Lee

. Effectiveness of using concept mapping by dental students in the radiographic interpretation of jaw diseases. J Dent Educ 2024–1425. https://doi.org/10.1002/jdd.13590

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.18 MB