NUR 302 Module 1 Concept Map Example

Asthma on the Line: A Concept Map of Health Beliefs, Shift Work and a Rationed Inhaler

[Student Name]

Southern New Hampshire University

NUR 302: Clinical Judgment and Holistic Assessment in Nursing

Module One Concept Map

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Asthma on the Line: A Concept Map of Health Beliefs, Shift Work and a Rationed Inhaler

Asthma control is usually discussed in terms of inhaler technique, triggers and step therapy. Those matter, but they describe the disease rather than the person who has to manage it between visits. This paper presents a concept map for a composite patient, Mr. R., a 52-year-old line cook with persistent asthma, and explains how his beliefs about the illness interact with the conditions of his work and income. The map argues that Mr. R.'s poor control is not a knowledge problem: he can describe his medications correctly, yet two beliefs and two social conditions combine to keep his controller inhaler in a drawer.

Mr. R. walked into urgent care early on a Monday with two days of chest tightness, a nighttime cough and wheezing. By his own count, the albuterol inhaler had been in use eight to ten times daily through most of the prior week. His prescribed inhaled corticosteroid, a daily controller, had last been refilled four months earlier for a 30-day supply. Oxygen saturation was 94% on room air, respiratory rate 24, and he could speak in full sentences. He said he had come in only because he could not get through Saturday's dinner service.

The Concept Map

The map is organized around a central node, uncontrolled persistent asthma, with four clusters branching from it: health perceptions, work, economic stability and access to care. Arrows show influence, and the label on each arrow states the relationship in plain language. Table 1 presents the map in text form so each link can be read and checked.

Table 1

Concept Map for Mr. R. Presented as Nodes and Links

Note. Mr. R. is a composite patient. Costs and schedule are illustrative. Arrows in the drawn map run from the node in the first column to the node in the third.

Health Perceptions

Two beliefs sit at the top of the map because every other cluster runs through them. The first is what Halm et al. (2006) called the no symptoms, no asthma belief: the idea that asthma is present only during attacks. In their cohort of 198 adults hospitalized for asthma at an inner-city hospital, 53% held this belief, and it was associated with about one-third lower odds of using inhaled corticosteroids when patients felt well. Men and people without a usual place of care were more likely to hold it. Mr. R. fits both descriptions, and his statement at triage, that he only has asthma when it flares, is almost word for word the question those authors proposed for screening.

The second belief concerns the medicine itself. Horne and Weinman (2002) found that adults with asthma weigh their sense of how necessary a preventer is against their concerns about it, and that doubts about necessity together with worries about long-term harm predicted skipped doses. Mr. R. has both: he does not see the need for a daily medicine when he feels fine, and he believes steroids will weaken his lungs over time. On the map, both beliefs point to the same node, controller inhaler use, which shows why teaching technique alone would not change his behavior.

Work and Economic Stability

The work cluster explains timing. Mr. R. works six dinner shifts a week, and a missed shift is unpaid. He described a week of worsening symptoms during which he chose to keep working, and he sought care only when he could no longer get through a service. That pattern connects the work node to the delayed care node, and delayed care connects back to the central node because each exacerbation that is allowed to build is harder to reverse. The kitchen itself is a second link from this cluster. Grill smoke, fryer vapor and cleaning products are daily irritants he cannot avoid, so his symptom burden is higher on workdays regardless of what he does at home.

The economic cluster explains the gap in refills. His employer plan carries a high deductible, and the controller inhaler costs him about $65 a month until the deductible is met. Xia et al. (2023) analyzed National Health Interview Survey data from 2013 to 2020 and found that about one in six U.S. adults with asthma reported cost-related nonadherence in the previous year, including skipping doses, taking less medication or delaying a refill to save money. Lower income and lack of insurance were among the characteristics linked to higher rates. For Mr. R., cost does not act alone. It reinforces the belief that the controller is optional, which is why the map shows two arrows arriving at the same behavior from different directions.

Access to Care

The final cluster shows why the pattern has lasted. Mr. R. has no primary care provider and has not had a routine visit in three years. Urgent care treats each exacerbation, often with a short course of oral steroids and a new albuterol prescription, and then the episode ends. Healthy People 2030 lists health care access and quality as one of five domains of social determinants, alongside economic stability and neighborhood and built environment (U.S. Department of Health and Human Services [HHS], n.d.). On the map, episodic care links back to the episodic belief: each visit that treats only the flare confirms, from the patient's point of view, that asthma is something that happens and then goes away. Current international guidance treats heavy reliance on a short-acting reliever as a marker of poor control and higher exacerbation risk (Global Initiative for Asthma, 2024), which makes the albuterol count the most urgent piece of assessment data on the page.

Nursing Priorities From the Map

Reading the map from the edges toward the center produces two nursing priorities. The first is to address the belief before the prescription. A single question, whether he thinks he has asthma all of the time or only when he has symptoms, opens a conversation about airway inflammation that continues between attacks. Pairing that explanation with his own data, eight to ten rescue puffs a day, shows him that his lungs are telling him the disease is present even on days he feels well enough to work. Teaching that respects his concern about steroids, by explaining the low dose that reaches the lungs, is more likely to change behavior than repeating the instruction to use the inhaler every day.

The second priority is to remove the cost barrier and connect him to ongoing care. The nurse can ask the provider about a lower-cost controller option or a manufacturer assistance program, and can refer him to a community health center with sliding-scale fees so that asthma is managed between flares rather than during them. A written action plan that fits a dinner shift, with a clear point at which to call rather than wait for Saturday, links the work cluster to the plan. Success can be measured at a follow-up visit two weeks later by fewer rescue puffs per day, a controller refill on time and a scheduled primary care appointment.

Conclusion

Mr. R.'s asthma looks like a nonadherence problem only if the assessment stops at the medication list. The concept map shows that two beliefs, one about the illness and one about the treatment, meet two social conditions, unpaid time off and the cost of a controller, and that episodic care keeps the whole system in place. A holistic assessment makes that structure visible, and it points the nurse toward interventions aimed at the connections rather than the symptoms.

References

Global Initiative for Asthma. (2024). Global strategy for asthma management and prevention. https://ginasthma.org/reports/

Halm, E. A., Mora, P., & Leventhal, H. (2006). No symptoms, no asthma: The acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chest, 129(3), 573-580. https://doi.org/10.1378/chest.129.3.573

Horne, R., & Weinman, J. (2002). Self-regulation and self-management in asthma: Exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychology & Health, 17(1), 17-32. https://doi.org/10.1080/08870440290001502

U.S. Department of Health and Human Services. (n.d.). Social determinants of health. Healthy People 2030. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health

Xia, T., Qiu, H., Yu, B., Bi, J., Gu, X., Wang, S., & Zhang, Y. (2023). Cost-related medication nonadherence in US adults with asthma: The National Health Interview Survey, 2013-2020. Annals of Allergy, Asthma & Immunology, 131(5), 606-613.e5. https://doi.org/10.1016/j.anai.2023.07.013