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SBAR  ·  NCJMM CLINICAL JUDGMENT  ·  SMART GOALS  ·  APA 7

Concept Mapping Assignment

How to pick your concept, fill in every section of the worksheet — SBAR, Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes — write proper SMART goals, and cite everything in APA 7.

13–17 min read Nightingale College / Nursing NCJMM Clinical Judgment Model 2,900+ words
Custom University Papers — Nursing Writing Team
Guidance aligned with the NCSBN Next Generation NCLEX Clinical Judgment Measurement Model (NCJMM) and standard nursing concept mapping frameworks. Written for Nightingale College DFC coursework.

The template looks simple. Six boxes, some arrows, a references page. But when you sit down to actually fill it in, it stops being simple fast. Which cues matter? What’s the difference between recognizing and analyzing? How specific does a SMART goal need to be? This guide walks through every section of the Nightingale College DFC Concept Mapping Worksheet so you know exactly what goes where — and why.

Concept Selection SBAR Format Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions SMART Goals Take Action Evaluate Outcomes APA 7 References

Step 1: Picking Your Concept from HESI

This is where you start — not with the template, but with your HESI Dashboard. Log in and pull up your performance data. You’re looking for Weak Performance Areas. Those are the concepts flagged in your results as areas where your score fell below the benchmark.

The concept you pick for your map has to come from that list. You can only use each concept once per course. That’s not just a rule — it’s the point of the assignment. You’re meant to work on what you actually struggled with, not coast on something you already know.

3

The Three Most Common Concepts for This Assignment

The assignment materials reference Glucose Regulation, Perfusion, and Gas Exchange as the primary concept examples. If all three appear in your HESI Weak Performance Areas, start with the one you feel least confident about — that’s the gap the assignment is designed to close. Each maps to a different type of patient presentation and a different set of clinical cues, so they require genuinely different maps, not just different labels on the same structure.

Don’t Skip the HESI Check

Some students pick a concept they feel comfortable with because it’s easier to write about. That defeats the purpose and risks using a concept that either isn’t in your weak areas or has already been used in a previous map. Pull the dashboard first, write down which concepts are flagged, then pick from that list.

Step 2: Choosing the Right Client

The client can be real, past, or simulated — a patient you cared for in clinical, someone from a previous encounter, or a simulated patient from your VR or skills lab. What matters is the fit between the client and your chosen concept.

Glucose Regulation

Pick a diabetic patient — ideally Type 2, with blood sugar issues and at least one complication like neuropathy, poor wound healing, or renal changes. The more concrete the clinical picture, the richer your cues.

Perfusion

Heart failure, peripheral vascular disease, or post-MI presentations work well here. Look for a patient with edema, low EF, elevated BNP, or signs of poor tissue perfusion. The cardiac and vascular cues should drive the map.

Gas Exchange

COPD exacerbation, pneumonia, or asthma are the go-to presentations. You want a patient with abnormal O2 saturation, respiratory rate changes, abnormal ABGs, or audible breath sounds like wheezing or crackles.

Keep the Client Focused on the Concept

The instructions are specific: if you pick Glucose Regulation, your entire map stays focused on diabetes-related cues and interventions. Perfusion doesn’t belong there unless it directly connects — for example, poor circulation to the feet in a diabetic patient. Don’t let the map drift into unrelated systems. The concept you chose is the lens for everything.

Filling in SBAR Client Information

SBAR stands for Situation, Background, Assessment, Recommendation. It’s a structured communication tool — widely used in actual clinical handoffs — and the assignment uses it to organize the client picture before you get into clinical judgment. Each box has a distinct scope.

SBAR Component What to Include What Does NOT Belong Here
Situation (S) Chief complaint — why is the patient here right now? One to three sentences. “56-year-old male presenting with blood glucose of 380 mg/dL, polyuria, and fatigue. Reports not taking metformin for two weeks.” Full medical history, your assessment findings, lab details — those go in B and A
Background (B) Past medical history, relevant diagnoses, current medications, allergies, significant social history. “PMH: Type 2 DM diagnosed 2018. Medications: metformin 1000mg BID (non-adherent), lisinopril 10mg. A1C 9.5% at last visit.” Today’s vital signs or lab results — those are Assessment data, not background
Assessment (A) Your clinical findings right now — vitals, lab values, physical exam findings. “BP 148/92, HR 98, RR 18, Temp 98.8°F, SpO2 98%. BMP: glucose 380 mg/dL, BUN 22, Cr 1.1. Skin dry and warm. Bilateral lower extremity paresthesia reported.” Interventions, recommendations, or treatment plans
Recommendation (R) What needs to happen — the immediate plan or what you’re requesting. “Initiate insulin sliding scale, IV fluid replacement, dietary consult, diabetes education, and endocrinology referral.” Detailed SMART goals or nursing interventions — those are for the lower sections of the map

The “Concept of the Map” Box

This small box sits next to the SBAR section. It’s asking for one thing: the name of the concept you chose from your HESI weak performance areas. Just write it clearly — “Glucose Regulation,” “Perfusion,” or “Gas Exchange.” That’s it. It anchors the whole map and tells the reader what lens you’re using to interpret everything else.

Keep it Aligned All the Way Through

Whatever concept you write in that box has to show up consistently throughout every section of the map. If you wrote “Gas Exchange” but your cues, hypotheses, and interventions are all about heart failure without a respiratory connection, that’s a mismatch your instructor will catch. The concept is not just a label — it’s the filter for every clinical decision you describe below it.

Recognize Cues vs. Analyze Cues

These two boxes are connected by an arrow on the template for a reason. One feeds the other. But students consistently mix them up or treat them as the same thing. They’re not.

Recognize Cues

This is observation only. You’re listing the data points from your SBAR that stand out as clinically significant — the findings that catch your attention as a nurse. You’re not interpreting yet. Just naming what you see.

  • Abnormal lab values (glucose 380 mg/dL, A1C 9.5%)
  • Vital sign deviations (HR 98, BP 148/92)
  • Patient-reported symptoms (polyuria, fatigue, paresthesia)
  • Physical assessment findings (dry skin, warm to touch)
  • Medication non-adherence (metformin not taken x2 weeks)

Analyze Cues

Now you interpret what those cues mean. What condition do they point to? What is the pathophysiology? What is the clinical significance of each abnormal finding? You’re moving from “here’s what I see” to “here’s what it means.”

  • Glucose 380 mg/dL + non-adherence → hyperglycemia from missed doses
  • Polyuria, fatigue → classic hyperglycemia symptoms (osmotic diuresis)
  • A1C 9.5% → chronic poor glycemic control over past 3 months
  • Paresthesia → early diabetic peripheral neuropathy
  • Elevated BP → hypertension common in T2DM; increases complication risk

A good test: if you’re writing something in Recognize Cues that includes a “because” or “suggests,” you’ve crossed into analysis. Move it to Analyze Cues. Keep Recognize Cues purely observational.

Prioritize Hypotheses and Generate Solutions

By the time you reach these boxes, you’ve identified what’s happening. Now you’re ranking the problems and planning responses.

Prioritize Hypotheses

What Is the Primary Problem — and What Comes After?

Your hypotheses are your clinical nursing diagnoses or problem statements, ranked by urgency. List up to three. The first one should be the most immediate and life-threatening or most acutely impactful. For a hyperglycemic diabetic patient: Hypothesis 1 might be impaired glucose regulation related to medication non-adherence, evidenced by glucose 380 mg/dL. Hypothesis 2 could be risk for fluid volume deficit related to osmotic diuresis. Hypothesis 3 might be deficient knowledge related to diabetes self-management. The ranking isn’t arbitrary — it reflects your clinical judgment about what to tackle first.

Use NANDA-I language if your course requires it. Some Nightingale instructors expect formal nursing diagnoses in this box. If yours does, use the three-part format: Problem + Related to (etiology) + As evidenced by (signs/symptoms). Check your rubric.
Generate Solutions

This Is Where SMART Goals Live

Each solution you generate should be a SMART goal — a specific, measurable, achievable, relevant, time-bound patient outcome statement. The solutions box is not for nursing interventions. Those come in “Take Action.” The solution box answers: what do you want the patient to achieve, and how will you know it happened? Write one SMART goal per prioritized hypothesis, so your solutions map back to your hypotheses in a logical sequence.

Solutions map to hypotheses by number. Solution 1 addresses Hypothesis 1, Solution 2 addresses Hypothesis 2, and so on. If your three hypotheses don’t have matching solutions, the map looks incomplete. The arrows on the template show this flow intentionally.

Writing Proper SMART Goals

This is the section students rush — and it shows. Vague goals don’t earn points. Here’s what each letter of SMART actually demands in a nursing context:

S — Specific

Names the exact outcome

Not “the patient will improve.” Specific: “The patient will maintain blood glucose levels between 140–180 mg/dL.” The outcome has to be named precisely.

M — Measurable

Has a number or observable indicator

You need something you can actually measure. A glucose range, a pain score, an O2 sat percentage, a weight in pounds. “Feeling better” is not measurable.

A — Achievable

Realistic for this patient

Setting a goal of “A1C below 6.5% by discharge” for a patient with A1C 9.5% admitted for two days is not achievable. Match the goal to what’s actually possible in the timeframe.

R — Relevant

Tied to the identified problem

The goal must directly address the nursing diagnosis or hypothesis. A glucose goal for a hypothermia problem is not relevant. Stay focused on the concept of your map.

T — Time-bound

States when the outcome should occur

“Within 24 hours,” “by discharge,” “within 30 minutes of intervention.” Without a time element, the goal has no accountability structure.

Full Example

What a complete SMART goal looks like

“The patient will demonstrate correct insulin self-injection technique on at least two return demonstrations before hospital discharge.” Every SMART element is present.

Weak SMART Goal — Fails Multiple Criteria The patient will have better blood sugar control during their stay. // Not specific (what does “better” mean?), not measurable (no number), not time-bound (when exactly?). This will not earn marks. Strong SMART Goal — Glucose Regulation The patient will maintain blood glucose between 140–180 mg/dL as evidenced by fingerstick readings every 4 hours within 24 hours of initiating insulin therapy. // Specific target range. Measurable (fingerstick values). Achievable (realistic reduction from 380 in 24hrs). Relevant (glucose regulation concept). Time-bound (within 24 hours). Strong SMART Goal — Gas Exchange The patient will maintain SpO2 ≥ 92% on supplemental oxygen ≤ 2L/min via nasal cannula within 4 hours of initiating bronchodilator therapy, as evidenced by continuous pulse oximetry monitoring. // Same structure. Specific (SpO2 ≥ 92% on ≤ 2L). Measurable (pulse oximetry). Achievable. Relevant (gas exchange concept). Time-bound (4 hours).

Take Action: Nursing Interventions

This section lists what you — the nurse — will actually do to help the patient reach the goals from Generate Solutions. Each action should be specific, evidence-based, and connected to at least one of your prioritized hypotheses. Four actions are listed on the template. Don’t pad with generic tasks.

1

Make Each Action Clinically Specific

“Monitor blood glucose” is weak. “Monitor fingerstick blood glucose every 4 hours and prior to meals; report values above 250 mg/dL or below 70 mg/dL to the provider per protocol” is an action. The specificity shows clinical judgment, not just a task list.

2

Include Patient Education as an Action

Teaching is a nursing intervention. For glucose regulation, an education action might be: “Educate patient on the importance of medication adherence for metformin and review proper timing with meals.” For perfusion: “Teach patient to monitor and record daily weight, reporting gains of more than 2 pounds in one day to the provider.” Education is evidence-based and maps to your knowledge-deficit hypothesis.

3

Tie Actions Back to Your Solutions

Each action should logically support at least one of the SMART goals you wrote in Generate Solutions. If you have a goal about glucose range, your actions should include glucose monitoring, insulin administration, dietary modifications — things that actually move the glucose toward that range. Actions disconnected from goals make the map look fragmented.

4

Use Active, Nurse-Centric Language

Actions are what the nurse does, not what the patient does. “Administer prescribed bronchodilator therapy via nebulizer and assess respiratory response within 20 minutes of administration” is nurse-centric. “The patient will use their inhaler” is a goal, not an action. Keep the subject of every action sentence as “nurse” or implied “I.”

Evaluate Outcomes

The last box on the map asks whether the interventions worked. This is where you close the loop. Each evaluation statement should directly reference one of your SMART goals and say what actually happened — or what you would look for if this were a real ongoing patient situation.

What a Good Evaluation Looks Like

  • References the specific measurable goal: “Patient’s fingerstick glucose readings remained between 140–180 mg/dL for 18 consecutive hours following insulin initiation.”
  • States whether the goal was met, partially met, or not met
  • Describes observed patient response to interventions: “Patient demonstrated correct insulin injection technique on two return demonstrations prior to discharge.”
  • Includes a plan if the goal was not met: “If SpO2 remains below 92% after bronchodilator therapy, escalate oxygen delivery method and reassess in 30 minutes.”

What to Avoid

  • Repeating the intervention: “The patient received insulin.” That’s an action, not an evaluation.
  • Vague outcomes: “Patient improved.” Improved how? To what value? By when?
  • Evaluating something you never set as a goal — if you didn’t write a goal for it, you can’t evaluate it here
  • Using future tense: evaluation is about what happened or what you would observe, not what you hope will happen

The Three Common Concepts Explained

Each concept pulls a different clinical picture. Here’s what to keep in mind when building your map around each one.

Concept 1

Glucose Regulation

The core physiological problem is insulin deficiency or resistance leading to hyperglycemia. Your cues will center on blood glucose values, A1C, polyuria, polydipsia, fatigue, and complications like neuropathy or nephropathy. Interventions focus on glycemic monitoring, insulin or oral agent management, dietary teaching, foot care, and self-management education. The concept stays narrow — don’t map every diabetic complication, just the ones directly related to glucose dysregulation in your specific patient.

Key lab to anchor your map: blood glucose and A1C. Everything else (BUN, creatinine, UA) is supporting context — include it in SBAR Assessment but only reference it in the map if it directly connects to glucose regulation.
Concept 2

Perfusion

Perfusion is about adequate blood flow delivering oxygen and nutrients to tissues. Heart failure is the most common patient presentation for this concept — reduced EF means reduced cardiac output, which means poor perfusion to organs and periphery. Your cues will include low SpO2, elevated BNP, pedal edema, JVD, fatigue, and dyspnea. Interventions center on diuretics, fluid restriction, daily weights, activity modification, sodium restriction, and oxygen support.

Key lab to anchor your map: BNP (brain natriuretic peptide) and ejection fraction. An EF of 30% is a critical finding that drives every intervention in a heart failure map. Don’t ignore it.
Concept 3

Gas Exchange

Gas exchange means the movement of oxygen into the bloodstream and carbon dioxide out, occurring in the alveoli. COPD exacerbation is the classic presentation — airway inflammation and mucus obstruction reduce effective alveolar ventilation. Your cues include SpO2, respiratory rate, breath sounds (wheezing, diminished), ABG values (low PaO2, elevated PaCO2 in retention), use of accessory muscles, and pursed-lip breathing. Interventions focus on bronchodilators, controlled oxygen delivery (critical in COPD — too much O2 blunts hypoxic drive), positioning, and breathing techniques.

Important nuance for COPD: oxygen targets in COPD patients are typically SpO2 88–92%, not 95%+. If you’re mapping a COPD exacerbation, your SMART goal for oxygen saturation should reflect this range. Instructors who know pulmonary nursing will look for it.

APA 7 References for This Assignment

The second page of the template gives you two placeholder citations — one for an ebook, one for a textbook. You replace those with your actual sources. The assignment says to cite everything you used: your textbook, credible websites, or journal articles.

1Citing Your Course Nursing Textbook

Standard APA 7 book format: Author, A. A., & Author, B. B. (Year). Title of the book (Xth ed.). Publisher. — For example, a common Nightingale text: Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer. Capitalize only the first word of the title and proper nouns. Italicize the full title.

2Citing an Ebook with a DOI

The template shows the DOI format: Author, A. A. (Year). Title of the ebook (Xth ed.). Publisher. https://doi.org/xxxxx — If your ebook has a DOI (most do when accessed through your library), include it at the end without a period after the URL. If there’s no DOI, use the URL of the library database homepage, not the full retrieval URL (those expire).

3Citing a Clinical Website (CDC, ADA, AHA)

Organization Name. (Year, Month Day). Title of the specific page. URL — Example: American Diabetes Association. (2024). Standards of care in diabetes — 2024. https://diabetesjournals.org/care/issue/47/Supplement_1 — Use the page-level URL, not the homepage. If no individual author is listed, the organization name serves as author. Use (n.d.) if no date is available.

4In-Text Citations Within Your Map

The assignment says to use both in-text citations and a reference list. That means when you write something in your Take Action or Generate Solutions boxes that comes from a source, you need to tag it: (Hinkle & Cheever, 2022). If it’s a direct quote (rare in a concept map, but possible), include the page number: (Hinkle & Cheever, 2022, p. 145). Most of what you write in a concept map will be paraphrased — no quotes needed, but the author and year still go in parentheses.

How Many References Do You Need?

The assignment doesn’t specify a minimum. Two to four references is a realistic and adequate range for this type of document — your textbook, one clinical guideline or ebook, and potentially one journal article if you used one. Don’t list sources you didn’t actually draw on. Every reference in the list should correspond to at least one in-text citation somewhere in the map.

Mistakes That Cost Points

Mixing Up Recognize and Analyze Cues

Writing “glucose 380 suggests uncontrolled diabetes” in the Recognize Cues box crosses into analysis. Recognition is pure observation. “Blood glucose 380 mg/dL” is a cue. What it means goes in Analyze Cues. Keep the boxes conceptually separate.

List Raw Findings in Recognize, Interpret in Analyze

Recognize Cues: “Blood glucose 380 mg/dL. Polyuria. Reports missing metformin x14 days. A1C 9.5%.” Analyze Cues: “Elevated glucose and missed doses indicate acute hyperglycemia from medication non-adherence. Polyuria is consistent with osmotic diuresis. A1C indicates chronic poor control.”

Writing Goals That Aren’t Measurable

“The patient will understand diabetes management by discharge.” Understanding is not measurable. What observable behavior proves understanding? A return demonstration. A verbal quiz. A teach-back. Name the evidence, not the internal state.

Use Observable Outcomes in Every SMART Goal

“The patient will verbalize three signs of hypoglycemia and the appropriate self-treatment steps by the end of the education session, as evidenced by teach-back.” Observable. Measurable. Time-bound. Your instructor can grade this because it’s concrete.

Letting the Map Drift Off-Concept

Picking Gas Exchange but filling the Take Action box with interventions for fluid management, daily weights, and diuretics. Those belong in a Perfusion map. When in doubt, ask: does this intervention directly address how oxygen moves in and out of the alveoli? If not, it doesn’t belong here.

Run Every Entry Through the Concept Filter

Before writing anything in any box, ask: “Does this connect to my chosen concept?” For Gas Exchange, every cue, hypothesis, goal, action, and evaluation should trace back to oxygenation and ventilation. If it doesn’t, cut it or find the connection explicitly.

Putting Nursing Actions in the Solutions Box

“Administer insulin as ordered” is an action, not a solution. The Generate Solutions box is for patient outcome goals — what the patient will do or achieve, not what the nurse will do. Putting interventions in the wrong box scrambles the clinical judgment sequence the assignment is testing.

Solutions = Patient Goals, Actions = Nurse Interventions

Generate Solutions: “Patient will maintain blood glucose 140–180 mg/dL within 24 hours.” Take Action: “Administer insulin per sliding scale protocol. Monitor fingerstick glucose every 4 hours.” The patient is the subject of goals. The nurse is the subject of actions. Keep them in the right boxes.

Frequently Asked Questions

How do I pick which concept to use for the concept map?
Log into your HESI Dashboard and check your performance scores. Find your Weak Performance Areas — those are the concepts flagged with low scores. Pick one from that list. The assignment is designed around improving areas you struggled with, so you can’t just choose any topic you find interesting. And remember: you can only use each concept once per course, so if you used Glucose Regulation last time, pick Perfusion or Gas Exchange this time.
What goes in each SBAR box?
Situation is the chief complaint — the short answer to “why is this patient here right now?” Background is past medical history, current medications, and relevant context. Assessment is your clinical data from today — vital signs, lab values, physical exam findings. Recommendation is the immediate plan: what needs to happen, what you’re requesting. Each section has a distinct scope. Don’t put assessment data in Background or treatment plans in Situation.
What is the difference between Recognize Cues and Analyze Cues?
Recognize Cues is pure observation — you’re listing the data points that stand out as abnormal or significant. Analyze Cues is interpretation — you’re explaining what those findings mean clinically, what condition they point to, and why they matter. An easy test: if you’re writing a “because” or “suggests” or “indicates,” that belongs in Analyze Cues, not Recognize Cues. Recognition comes first, analysis follows.
How many hypotheses and solutions do I need?
The template shows three slots for Prioritize Hypotheses and four for Generate Solutions. You should aim to fill at least three hypotheses and match each one with a corresponding SMART goal in the solutions box. The fourth solutions slot allows for an additional goal if your patient situation warrants it. Hypotheses should be ranked by clinical urgency — most immediate, life-threatening, or acutely impactful problem first.
Can I use a simulated patient from VR or class?
Yes. The assignment explicitly allows real patients, past encounters, and simulated patients from class or VR. The key is that the clinical picture — the SBAR data, the cues, the assessment findings — needs to be specific enough to build a realistic map from. A well-constructed simulated case works just as well as a real patient encounter if you have enough clinical detail to fill every section meaningfully.
Do I need in-text citations inside the concept map itself?
Yes. The instructions specify both in-text citations and a reference list. That means anywhere in your map where you draw on a source — an intervention protocol, a clinical fact about the disease process, a medication mechanism — you should add a parenthetical citation: (Author, Year). The reference list on page 2 of the template is where those full citations live. If you cite it in the map, it has to appear in the reference list, and vice versa.
What’s the difference between Take Action and Generate Solutions?
Generate Solutions contains patient outcome goals — what the patient will achieve (your SMART goals). Take Action contains nursing interventions — what the nurse will do to help the patient reach those goals. The patient is the subject of solutions. The nurse is the subject of actions. Mixing them up is the most common structural error on this assignment. If you catch yourself writing “the patient will…” in the Take Action box, it belongs in Generate Solutions instead.
How specific does the Evaluate Outcomes section need to be?
Each evaluation statement should directly reference one of your SMART goals and state whether it was met, partially met, or not met — with clinical evidence. “Patient’s SpO2 readings remained 90–92% on 2L nasal cannula throughout the shift, meeting the established goal” is a solid evaluation. It names the metric, states the value, and draws a conclusion. If the goal wasn’t met, include what your next step would be: reassess, escalate, or modify the intervention. Evaluation without a decision is incomplete.

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Putting the Map Together

The concept map isn’t busy work. It’s a structured clinical reasoning exercise — the same sequence a nurse runs through mentally at the bedside, just made visible on paper. Recognize, analyze, hypothesize, plan, act, evaluate. That’s the loop.

The students who struggle with this assignment usually do so because they treat the boxes as separate tasks rather than a connected sequence. Your cues should drive your analysis. Your analysis should drive your hypotheses. Your hypotheses should drive your goals. Your goals should drive your actions. And your actions should be measurable enough that you can evaluate them at the end. When that chain holds together, the map works.

Get the concept right, keep the focus tight, write SMART goals with real numbers, and cite your sources. That’s the whole assignment.

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