Concept Maps Boost Nursing Students’ Knowledge of Intravenous Catheterization in Randomized Trial

Teaching a first-year nursing student how to insert a peripheral intravenous catheter sounds straightforward: explain the anatomy, demonstrate the technique, supervise the practice. Yet a new randomized trial from Türkiye suggests that the traditional lecture-and-demonstration formula leaves a striking amount of knowledge on the table. When researchers added a structured round of concept map–based reflective learning to standard instruction, students’ post-test knowledge scores jumped by nearly thirty points compared with classmates who received conventional teaching alone. The study, published in BMC Nursing, offers some of the clearest quantitative evidence yet that how students organize what they learn may matter as much as what they are taught.

The trial was conducted between May and July 2024 and enrolled 66 first-year nursing students, split evenly into an intervention group of 33 and a control group of 33. Because the study used a cluster-randomized design, students were randomized in groups rather than as individuals, a choice that helps prevent contamination between participants who might otherwise share notes or study together. Both groups received the same standard instruction in peripheral intravenous catheterization, one of the most frequently performed and most consequential bedside procedures in nursing practice. The intervention group, however, additionally took part in concept map–based reflective learning sessions layered on top of that standard curriculum.

Concept mapping is a learning technique rooted in the educational psychology of meaningful learning. Students construct visual diagrams in which key concepts appear as nodes and are connected by labeled links that articulate the relationships between them. In the context of intravenous catheterization, building such a map forces a learner to connect, for example, vein anatomy and site selection to aseptic technique, equipment preparation, patient communication, and the recognition of complications. Rather than memorizing a checklist of steps, the student must actively reason about why each step exists and how it depends on the others. Reflective learning adds a second layer: after constructing or working with the map, students deliberately examine their own understanding, identify gaps, and reorganize their mental model accordingly.

The theoretical appeal is easy to see. Procedural skills like catheterization are typically taught as sequences, but safe practice demands integration across domains — theoretical knowledge, psychomotor skill, and clinical judgment. Traditional teaching methods, the study’s authors note, may not effectively integrate theory and practice, leaving students able to recite steps without grasping the underlying logic. Concept maps are designed to expose that logic explicitly. When a student draws a link between two nodes, the link label must state the relationship, and a wrong or missing link reveals a misconception that a lecturer’s slide deck might never surface. Reflection then converts that exposure into corrected understanding.

To measure whether the technique actually delivered, the researchers collected data using a demographic form and knowledge tests administered before and after the educational period. The analysis plan was appropriately rigorous for a trial of this size: independent-samples t-tests to compare groups, paired-samples t-tests to track within-group change, and — most importantly — analysis of covariance, or ANCOVA, to adjust the final comparison for differences in baseline knowledge. Effect sizes were reported as Cohen’s d and partial eta squared, allowing readers to judge not just statistical significance but practical magnitude.

The results were emphatic. After adjustment for baseline knowledge scores, post-test knowledge remained significantly higher in the intervention group than in the control group, with an adjusted mean difference of 29.3 points and a 95 percent confidence interval of 23.9 to 34.7. The corresponding test statistic was F(1,63) = 117.43, with p < 0.001, and a partial eta squared of 0.651. In educational research, where effect sizes above 0.14 for partial eta squared are conventionally considered large, a value of 0.651 is remarkable — it indicates that roughly two-thirds of the variance in post-test knowledge, after accounting for baseline differences, was associated with the teaching method itself. Few instructional interventions in health professions education report effects of this magnitude.

The authors conclude that concept map–based reflective learning may be an effective educational strategy for improving knowledge acquisition in undergraduate nursing education. That conclusion carries practical weight because peripheral intravenous catheterization is a gateway skill: it is among the first invasive procedures nursing students learn, and competence with it shapes patient comfort, infection risk, and the success of intravenous therapy more broadly. Knowledge deficits at this stage can propagate into clinical placements, where supervision is thinner and the cost of error is borne by patients. A low-cost, low-tech addition to the curriculum that reliably deepens understanding is therefore attractive to nursing schools operating with limited faculty time and simulation resources.

The study is not without caveats that readers should keep in view. The sample was drawn from a single institution and consisted of 66 students, so generalization to other curricula, cultures, and class sizes remains to be demonstrated. The trial was registered retrospectively on ClinicalTrials.gov under number NCT07674849 on 26 June 2026, meaning the registration occurred after data collection rather than before enrollment — a limitation common in educational research but one that trial-methods specialists typically flag. The published outcome concerns knowledge acquisition measured by tests; the study did not report whether the intervention improved actual psychomotor performance at the bedside, which is the ultimate clinical endpoint. The authors received no external financial support for the research, and the work received ethics approval from the Atatürk University Faculty of Medicine Ethics Committee on 4 January 2024, with all participants providing written informed consent.

Even with those constraints, the findings land at a moment when nursing educators worldwide are rethinking how to prepare students for increasingly complex clinical environments. The intervention requires no expensive equipment — paper, pens, and structured facilitation are largely sufficient — which makes it unusually scalable for low-resource settings. The effect size suggests that the mechanism, forcing learners to externalize and interrogate the structure of their knowledge, addresses a genuine bottleneck in skills education rather than producing a marginal gain. For educators, the actionable lesson is that reflection should not be an afterthought tacked onto skills labs but a designed component of them. For students, the message is perhaps more personal: the struggle to explain, on a map, why one concept connects to another is not busywork but the very process by which fragile memorization becomes durable, clinically usable understanding. Future trials extending this design to psychomotor outcomes, retention over time, and other procedural skills will determine how broadly the approach can be deployed, but the evidence so far makes a compelling case that drawing the connections is how students learn to draw the needle.

Subject of Research: Concept map–based reflective learning for teaching peripheral intravenous catheterization to first-year nursing students

Article Title: Effectiveness of concept map–based reflective learning for teaching peripheral intravenous catheterization to first-year nursing students: a cluster-randomized controlled trial

Article References: Nacak, U. A., Karakaş, E., Bozkurt, T., & Çiftçi, B. (2026). Effectiveness of concept map–based reflective learning for teaching peripheral intravenous catheterization to first-year nursing students: a cluster-randomized controlled trial. BMC Nursing. https://doi.org/10.1186/s12912-026-05244-0

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05244-0

Keywords: nursing education, concept mapping, reflective learning, peripheral intravenous catheterization, cluster-randomized controlled trial, knowledge acquisition, ANCOVA, undergraduate nursing, instructional design, meaningful learning, clinical skills, BMC Nursing