Critical thinking (CT), "a widely used term that includes skills in identifying, analyzing, synthesizing, making informed decisions and the disposition to apply those skills" (Shim & Walczak, 2012, p. 16), is vital to the safe and holistic delivery of nursing care. Therefore, incorporating CT education into nursing program curricula is essential. Those who develop nursing curricula strive to develop innovative interventions to maximize CT skills (Chan, 2013), which also have an impact on nursing students' success (Myrick, Caplan, Smitten, & Rusk, 2011).
Several challenges contribute to the efficacy of CT education, either as a primary subject or embedded within a course. First, CT requires the implementation of myriad components, such as gathering and seeking information; questioning and investigating; analysis, evaluation, and inference; and problem solving and application of theory (Chan, 2013). Eales-Reynolds, Gillham, Grech, Clarke, and Cornell (2012) showed that students had difficulties understanding and applying CT when traditional instruction resources were used. Multiple instruction methods, including web-based animation, clinical assignments, collaborative testing, problem-based learning, group root-cause-analysis-based projects, and simulation, have been met with mixed success. Results of a study by Shim and Walczak (2012) indicated that posing challenging questions increased the odds of students' self-reported maximum and medium CT growth by 98 percent and 44.9 percent, respectively, suggesting the importance of faculty learning how to organize, formulate, and present challenging concepts, providing clear explanations of abstract concepts and encouraging application by students.
Instructional technology (IT), such as podcasting, meshes these practical implications into a cost-effective intervention to teach CT skills. It is consistent with the National League for Nursing (NLN) research priorities: I-C, to identify and evaluate the effectiveness of emerging technologies to lead decision-making and interventions while maximizing impact (NLN, 2011), and to build the science of nursing education through the discovery and translation of innovative, evidence-based strategies (NLN, 2016).
Podcasting in education is the use of any digital media file or series of files distributed over the Internet to deliver course content or to supplement and enhance content delivery (Lonn & Teasley, 2009). Although research on the use of IT as an adjunctive learning resource has shown that it is an effective teaching method, it is generally not utilized in nursing education. Today's learners have used technology for entertainment, through social media, and within certain educational experiences, yet nursing education lags behind other academic practice disciplines in embracing the possibilities that technology has to offer (Valiga, 2012). Findings from a recent study to support nurse preceptors indicate that preceptors identified CT as an area in which senior students would benefit from the use of podcast technology (Blum, 2014). Advantages of using podcasts include designing content only once, with students having the ability to repeat its use, and a decreased sense of isolation often experienced in distance learning (Clay, 2011). Disadvantages concern the quality of the media, disruption in both social and educational settings, and absent presence, the inability of the learner and teacher to interact in real time (Traxler, 2010).
Supplementing traditional modes of education with podcast technology promises to have an impact on how nursing education is delivered. Podcasts can act as a catalyst to change how instruction occurs (Lonn & Teasley, 2009), and discipline-specific exemplars can help transform the traditional lecture format into new learning opportunities (McKinney, Dyck, & Luber, 2009). The purpose of this pilot interventional study was to determine if use of a podcast for ongoing nursing education would increase CT abilities. Three hypotheses were formulated: 1) Students who receive an educational podcast will have a greater increase in CT ability than students who receive standardized education. 2) An increased dose (number of times podcast viewed) will have a positive relationship on gains in CT ability. 3) There will be a relationship between demographic factors and changes in CT ability for students who viewed an educational podcast.
The theoretical framework for the study is the diffusion theory (Surry & Farquhar, 1997), which describes a process in which a community adopts innovative practices and products. As an adopter-based instrumentalist theory (Segal, 1994), diffusion theory guides the social function of the use of podcasts conceptualized and designed for the user (Panday, 2009). As technology infuses into the lives of student learners through distance courses, library use, and resource access and is incorporated into the social lives of most persons through social media, the social system supports podcasts as a means of diffusing information using IT.
METHOD
A comparative/correlational interventional pretest/posttest design was used to examine the relationships between nursing students' use of educational podcast technology and CT abilities. Following institutional review board approval, a convenience sample of nursing students in their final semester and clinical preceptorship in a large, urban, state college associate in science program were recruited as participants in this study. Students were not required to participate and were given the option to decline without penalties.
Participants were assigned a numerical code to match pre- and postdata. Spring 2014 nursing students were the control group (n = 17); fall 2014 nursing students were the intervention group (n = 21). Both groups were provided with traditional CT education in the classroom and had the same didactic and clinical instructors who supported the study and used the same teaching resources and methods. However, the intervention group was given unrestricted access to view supplemental CT podcast media developed by the researcher.
The 34-item Health Sciences Reasoning Test (HSRT; Cronbach's alpha = .72 and .82) was the instrument used for measuring CT abilities. The HSRT measures overall CT abilities and the five core reasoning skills needed for reflective decision-making: induction, deduction, analysis, inference, and evaluation (Insight Assessment, 2013). Both groups' CT abilities were assessed twice, at the beginning and end of the semester.
Demographic information was collected with the post-HSRT and used to identify the possibility of differences between specific demographic factors of age and native language for those who viewed the podcasts. A Likert scale was included to indicate the student's level of agreement with the following statement: Podcasts, depicting common content areas important to nurses such as CT solutions, are a supportive tool for student nurses.
RESULTS
A total of 59 nursing students participated initially. Some students did not return for the posttest, resulting in a total sample of 38 students (control group = 17, intervention group = 21).
Hypothesis 1
It was hypothesized that students who receive an educational podcast will have a greater increase in CT ability than students who receive standardized education only. Repeated-measures analysis of variance, used to analyze this hypothesis, showed results that approach statistical significance, F(1, 36) = 1.91, p = .088, [eta]2 = .050. Results for the individual core reasoning skills showed no statistical significance.
Hypothesis 2
It was hypothesized that increased dose will have a positive relationship on gains in CT ability. Students reported that podcasts were viewed a mean of 1.8 times. Multiple linear regression (full and restricted models) showed no statistical significance for overall HSRT scores, [DELTA]F(1, 18) = 1.35, [DELTA]R2 = .037, p = .261. Results for the individual core reasoning skills showed no statistical significance, with the exception of analysis, [DELTA]F(1, 23) = 5.27, [DELTA]R2 = .161, p = .031.
Hypothesis 3
It was hypothesized that there will be a relationship between demographic factors and changes in CT ability for students who viewed an educational podcast. Multiple linear regression (full and restricted models) showed no statistical significance for overall HSRT scores, [DELTA]F(2, 17) = .218, [DELTA]R2 = .013, p = .806. Results for the individual core reasoning skills showed no statistical significance with the exception of inference, [DELTA]F(2, 34) = 2.85, [DELTA]R2 = .135, p = .072, which approached statistical significance.
This pilot study had limited power or relationship to demographic factors, such as native language or age, or to the number of times the podcasts were viewed. Changes in CT ability for these criteria could not be identified and should be a priority of study in future investigations. However, a Likert-scale assessment on nursing students' perceptions of instructional podcasts showed that they were highly valued. This finding, in addition to the findings in literature, indicates the need for further research with larger samples to determine statistical significance of podcast viewing on overall CT abilities and whether a relationship exists with demographic factors.
DISCUSSION
CT is a fundamental part of the nursing process (Chan, 2013). Learning this skill is crucial to nursing students' success in their education and in the future as practicing professional nurses. Studies have shown the efficacy and usefulness of IT in education and learning, yet it is largely lacking in nursing education programs (Axley, 2008; Valiga, 2012). Recognizing the social process inherent in learning, providing resources and skill development using social software, such as podcasts, recognizes the digital culture of today's learner (Panday, 2009). This study sought to integrate technology in the form of podcasts to teach CT to nursing students. Diffusion theory (Surry & Farquhar, 1997) effectively guided the dissemination of podcast materials.
Using podcasts as the form of technology to reinforce CT skills, study results approached significance for those receiving the intervention, although the dose was only significant with the core reasoning skill of analysis as measured using the HSRT. Analysis, a common core component across CT definitions in nursing (Chan, 2013), indicates the ability to compare and contrast and integrate ideas (Shim & Walczak, 2012), as was demonstrated in the interventional podcast.
Although Greenfield (2011) recognized a benefit in using podcasts as a teaching modality for non-native English speakers to learn and retain knowledge and to improve language comprehension and clinical skills through repetition, limitations of demographic factors and sample size resulted in a decrease in observed power, affecting the ability of this pilot study to validate this finding. Future investigation of nursing students' CT scores is recommended with the following considerations: larger sample size with diversification of demographic factors.
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