Tara O’Brien, LPN BA Envt, BSN St.

Pippa Dawbney, BSc Kin., BSN St.

Leah McTaggart, BSc Kin., BSN St.

Meg Thoma, BA Psych, BSN St.

Cate Felton, Paramedic, BA Intl Studies, BSN St.

Citation: O’Brien, T., Dawbney, P., McTaggart, L., Thoma, M., & Felton, C. (2024). Podcasting in Nurse Education: Qualitative Systematic Review. Canadian Journal of Nursing Informatics, 19(2).  https://cjni.net/journal/?p=13121

Abstract

Background: Podcasts have become increasingly popular in recent years and are being used in educational settings. Nursing students and nurses must retain large amounts of knowledge, learn many different skills, and clinical competencies to perform safe, competent care.

Methods: This systematic review was conducted to understand how podcasting and digital learning objects (DLOs) impact learning in nursing education. 15 high quality research studies were chosen from the last 15 years to explore the experiences of nursing students and nurses in using podcasts in their education. A constant comparison technique and thematic analysis was used to analyze the data from the articles.

Results: Five themes were identified: flexibility of access, alternate learning styles, aid for review and revision, and increase of self-efficacy or motivation. Additionally, podcasts were deemed a useful tool for ESL students and should be used in addition to traditional lectures. Barriers were identified as digital literacy, technical difficulties, more time and technology skill required for students and faculty. Overall, podcasts and DLOs were found to be useful for nursing education and most participants from the studies reported it was a positive addition to their learning.

Discussion: Limitations in this systematic review exist as many articles did not exclusively explore the use of podcasts but also explored other DLOs. As well, a small number of studies were included, and both quantitative and qualitative data were chosen. The review suggested more qualitative-only research into the exclusive use of podcast on learning. In application, podcasts should be used in combination with other learning mediums, rather than on their own.

Background

Around the turn of the century podcasts were becoming rooted into the mainstream digital market when Apple added the form of virtual media to their library (Forbes & Hickey, 2002). Oxford American Dictionary also declared “podcast” as word of the year (Jabeer, 2021). Initially, the term was used to describe audio files which could be downloaded faster and easier than video subscriptions, while continuing to be a reliable source of mass communication (Milewski, 2022). As the years have progressed, so too have the definition of podcasts and the expanse of formats the virtual media entails. Abate (2013) defined a podcast as a “media file that is distributed over the internet” (p.182). Schlairet (2010) distinguished the word as audio files and recordings of entire lectures. Burke and William (2014) elaborated further and claimed they “can include video clips, audio clips, illustrations, and sound effects” (p. 257). Scutter et al. (2010) suggested podcasts are simply video lectures, while Strickland et al. (2010) have determined podcasts to be either audio or video digital media files. Regardless of these semantics, it is generally agreed upon that podcasts can be used as a tool for education (Forbes & Hickey, 2008).

The millennial generation (born 1980-2000) were the first to have lived most, if not all, of their lives exposed to the internet and multi-media technologies, viewing them as “a necessary tool for everyday life” (Forbes & Hickey, 2008, p. 224). With increasing pressure from this population to incorporate more virtual forms of communication and distance learning, colleges and universities jumped on the podcast bandwagon in the early 2000s (Forbes & Hickey, 2008). Indeed, it has become an important adjunct to learning in the modern educational environment, with many university students exclaiming “the availability and use of podcasting were as important as wireless Internet access and e-mail” (Forbes & Hickey, 2008, p. 224). Considering all this, researching the use of podcasts in the education of nurses would be a useful contribution to informing the future of nursing informatics.

People are presenting with more complex healthcare needs and higher acuities as modern medicine has increased life expectancies. As a result, the expectation for newly graduated registered nurses to lead and perform more complex clinical judgements and skills is increasing (Stone et al., 2020). Nursing students have committed to becoming safe, competent, and qualified registered nurses in this increasingly complex world of healthcare. Therefore, the goal of this research paper was to review healthcare related databases for all the research done on the use of podcasts by nurses and nursing students, and the effects the digital media has had on informing their education. The highest quality research studies found were reviewed and compared. The chosen studies were well documented, with the most straight-forward, clear, concise, and thorough research designs.

Methods

This qualitative systematic review was initiated after the development of a main topic: podcast use to educate and inform nursing students. Additional questions and phrases were formulated to support the main research question and helped to identify key aspects of digital learning for nurses and nursing students. These included understanding the effectiveness of using podcasts in nursing education, nursing students’ level of satisfaction with the use of podcasts for learning, how digital learning affects the empathy of nurses and nursing students and identifying barriers to implementing podcasts in nursing education.

Search Strategy and Results

Using these questions and phrases, key terms were selected to be used singly and/or in combination when searching for articles. The inclusion criteria for our qualitative systematic review were studies examining the experiences of nurses and student nurses using podcasts for learning. Electronic keyword search terms were “qualitative”, “student nurses”, “nurses”, “podcasts”, “web-based learning” and “e-learning”. A timeframe of fifteen years was used to ensure we encompassed the initial introduction of podcasts to the mainstream market, which began around 2005 (Forbes & Hickey, 2008; Jabeer, 2021).

After excluding all meta-analyses, 28 articles in total were retrieved from either identifying key articles from the reference lists of articles from the search or from searching five different online databases. The five databases were selected for their emphasis on nursing, health-related research, and qualitative research designs; they included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, MEDLINE (EBSCO), Elsevier, and Science Direct (Anthony & Jack, 2009). The initial 28 articles we retrieved from the first pass of indexed articles were then processed through constant comparison. As explained by Streubert & Carpenter (2011), this was to identify similarities between the research articles to allow further categorization of the articles by themes and concepts. This process narrowed the results to 15 high-caliber articles (see Table 1.) All articles have detailed and exhaustive research designs, which most effectively addressed the initial focused research question: How do podcasts and digital learning contribute to the effectiveness of nurses’ education & knowledge retention?

Table 1.

Details of included studies (listed alphabetical by author)

Themes from studies

Flexibility of access

(Aase et al., 2021; Burke & William, 2014; Fenton, 2014; Marrocco et al., 2014; Meade et al., 2011; Nikpeyma et al., 2021; Rogan & San Miguel, 2013; Stone et al., 2020)

Alternate learning styles

(Marrocco et al., 2014; Meek et al., 2012; Strickland et al., 2012)

Aid for review and revision

(Abate, 2013; Burke & William, 2014; Marrocco et al., 2014; Meade et al., 2011; Mostyn et al., 2013; Rogan & San Miguel, 2013; Scutter et al., 2010; Schlairet, 2010; Stone et al, 2020)

Increase self-efficacy or motivation to engage with the material

(Burke & William, 2014; Egilsdottir et al., 2021; Fenton, 2014; Meek et al., 2012; Stone et al., 2020).

Barriers from studies

Digital literacy

(Egilsdottir et al., 2021; Fenton, 2014; Nikpeyma et al., 2021)

Technical difficulties

(Fenton, 2014; Nikpeyma et al., 2021; Marrocco et al., 2014; Strickland, 2012; Meade et al., 2011)

Faculty time & skill required

(Mostyn et al., 2013; Burke & William, 2014)

The bulk of the studies chosen were conducted in the USA (Abate, 2013; Burke & William, 2014; Marrocco et al., 2014; Meek et al., 2012; Schlairet, 2010), the UK (Fenton, 2014; Meade et al., 2011; Mostyn et al., 2013; Strickland et al., 2012), and Australia (Rogan & San Miguel, 2013; Scutter et al., 2010; Stone et al., 2010). Two additional studies were conducted in Norway (Aise et al., 2021; Egilsdottir et al., 2021), and one in Iran (Nikpeyma et al., 2021). Study designs were mostly phenomenological (Aise et al., 2021; Egilsdottir et al., 2021; Fenton, 2014; Marrocco et al., 2014; Meade et al., 2011; Scutter et al., 2010; Stone et al., 2010) and mixed methods (Abate, 2013; Burke & William, 2014; Meek et al., 2012; Mostyn et al., 2013; Rogan & San Miguel, 2013; Strickland et al., 2012). Two studies used grounded theory (Fenton, 2014; Schlariet, 2010), two used action research (Egilsdottir et al., 2021; Rogan & San Miguel, 2013), and two used generic qualitative designs (Meade et al., 2014; Nikpeyma et al. 2021). As well, there was one case study (Fenton, 2014).

Discussion

The aim of this study was to examine how podcasts and digital learning objects contribute to the effectiveness of nursing education and, more specifically, knowledge retention among nurses and nursing students. The goal was to create a complete and clear picture of the phenomenological experience of nurses and nursing students interacting with podcasts or DLOs as a part of their formalized education program. Despite the original focus on effectiveness for learning, a secondary question regarding the barriers to podcast use emerged during the analysis of data. The literature review which utilized the keywords “qualitative”, “student nurses”, “nurses”, “podcasts”, “web-based learning” and “e-learning” produced an initial sample of 28 articles. A preliminary analysis truncated the sample to 16 articles, which were appraised as relevant for inclusion in this systematic review.

The content of the podcasts was varied. While many of the studies examined the delivery of traditional lecture material in podcast format, either as an adjunct or in replacement of traditional didactic lectures, others examined the use of podcasts to address specific learning needs or in a way that complimented the existing syllabus. For example, Aase et al. (2013) examined podcasts depicting an interprofessional team huddle comprised of clinical placement students and healthcare staff. Whereas Fenton (2014) examined the use of podcasts to capture and distribute an audio recording of the lived experience of a pediatric patient with a life-threatening illness. Despite the varying content of the podcasts, similar themes and topics were identified, which warranted the inclusion of all papers. As many of the studies examined were mixed methods, both quantitative and qualitative data has been included in the discussion to accurately reflect the data observed and strengthen the conclusions. Overall, podcasts were rated as useful for learning provided that some specific parameters were adhered to.

Common Themes

Five distinct themes were identified as characteristics of podcasts that led to their effectiveness for learning. Additionally, three sub-themes were identified as characteristics of podcasts which present a barrier to learning.

Firstly, the podcasts were rated positively due to their flexibility of access as students could access the information in a variety of physical spaces at a time which best suited their needs (Aase et al., 2021; Burke & William, 2014; Marrocco et al., 2014; Meade et al., 2011; Fenton, 2014; Nikpeyma et al., 2021; Rogan & San Miguel, 2013; Stone et al., 2020). For example, in the study conducted by Fenton (2014), 90% of respondents rated the DLO positively due to its flexibility and ease of access, and participants in the Aase et al. (2021) study described the podcasts as “a practical and flexible tool that was easy to use and could be listened to everywhere” (p. 5).

Secondly, the podcasts were rated favourably as the format catered to alternate learning styles, such as auditory learners (Marrocco et al., 2014; Meek et al., 2012; Strickland et al., 2012). For example, a student with learning disabilities identified the podcasts as especially helpful due to the ability to revisit content as many times as necessary (Marrocco et al., 2014). Additionally, a participant in the study conducted by Strickland et al. (2012) appreciated the auditory format: “I found it easier as someone was explaining things, reading and gaining and understanding is great but hearing someone explain points enhanced my learning” (p. 212).

The third identified theme was the ability to reuse and revisit podcasts to review challenging material, or as a refresh prior to an exam or clinical experience (Abate, 2013; Burke & William, 2014; Marrocco et al., 2014; Meade et al., 2011; Mostyn et al., 2013; Schlairet, 2010; Scutter et al., 2010, Stone et al., 2020). Burke & William (2014) found that students “indicated strongly that the podcasts facilitated their learning and allowed them time and ability to review content that was confusing or not well understood” (p. 258). 83% of respondents to a post-intervention survey distributed by Mostyn et al. (2014) agreed or strongly agreed that the podcasts were a useful revision tool (p. 1).

Lastly, the podcasts were rated favourably for learning due to their ability to bolster self-efficacy or motivation to engage with the material (Burke & William, 2014; Egilsdottir et al., 2021; Fenton, 2014; Meek et al., 2012; Stone et al., 2020). For example, one student in the study by Egilsdottir et al. (2021) stated “I would rather use my time and effort on something that gives me feedback on or an indication of my knowledge base, than on academic assignments in clinical rotation where I never get any feedback at all” (p.8). Similarly, the participants in the study by Stone et al. (2020) reported a “sense of ease” and “increase in confidence” after accessing the podcasts and stated that they felt more prepared for labs and clinical skills (p. 5).

Other conclusions of note included both Schlairet (2010) and Rogan & San Miguel (2013) found podcasts to be especially useful for students with English as a second language (ESL). ESL students are at a higher risk of clinical practice failure due to communication difficulties (Rogan & San Miguel, 2013). The podcasts were found to help increase confidence of ESL students and improve clinical skills. Additionally, podcasts should be based on key points or learning objectives and not simply recordings of lectures (Scutter et al., 2010). The main consensus of all participants considered in the systematic review was podcasts should be used only as an additional learning tool, and should not replace traditional didactic lectures (Abate, 2013; Burke & William, 2014, Mostyn et al., 2013; Rogan & San Miguel, 2013; Schlairet, 2010). Meade et al. (2013) went as far as to identify the use of podcasts in education as a weakness if they were provided in place of traditional face to face lectures.

Barriers

As previously mentioned, several barriers to learning were identified by students after accessing the podcasts. Firstly, the participants stated a certain level of digital literacy was required to make use of the podcasts, which some participants felt was above and beyond their current skill level (Fenton, 2014; Egilsdottir et al., 2021; Nikpeyma et al., 2021). Furthermore, many participants stated they encountered technical difficulties while trying to access the material, such as inconsistent internet access and the inability to download the material (Fenton, 2014; Nikpeyma et al., 2021, Marrocco et al., 2014; Strickland et al., 2012). The participants of the study by Marrocco et al. (2014) found this especially frustrating as troubleshooting access issues added another task to their already lengthy to do list. Mostyn et al. (2013) stated an interestingly related point: the creation of podcasts for student use creates an additional burden for faculty, who have also identified digital literacy as a barrier to their ability to create these alternative learning objects.

Research Designs

The most common research design utilized in the articles considered for this review was phenomenological design (Aise et al., 2021; Egilsdottir et al., 2021; Meade et al., 2011, Stone et al., 2020). All used phenomenological designs explored the phenomena of technology, podcasts, and learning amongst nursing students. This design is described by LoBiondo-Wood et al. (2017) as “most useful when the task is to understand an experience in the way that people having the experience understand it and is well suited to the study of phenomena important to nursing” (p.162). Learning is a subjective experience which can be properly explored using a qualitative phenomenological study design. Many of the studies considered did not explicitly state which research design they used. This was a critique of many of the studies surveyed. Designs of the selected studies have therefore been interpreted according to which best aligned. Many authors cited using an “exploratory” approach, including Aase et al., (2021) who wrote “we see the need for exploring in-depth experiences of utilizing such tools for learning” (p. 2).

Articles included in this review have varying qualitative and mixed methods research designs. There are some similarities and some differences between these designs. These high-quality articles often incorporated more than one design for their research. In the paper by Mostyn et al. (2013), the authors conducted a mixed methods approach using a survey with open and fixed questions, but additionally used focus group interviews to add another qualitative component. This is a good example of using multiple research methods in one study, utilizing both qualitative and quantitative approaches. Two of the studies used a participatory action research design focusing on a cycle of planning, acting, observing, and reflecting (Rogan & San Miguel, 2013; Egilsdottir et al., 2021). Additionally, many studies had mixed methods, collecting both quantitative and qualitative methods to collect data. Most of the articles used interviews, questionnaires and surveys to collect data from participants. The articles by Strickland et al. (2012), Scutter et al. (2010), Mostyn et al. (2013), Schlairet et al. (2010), Rogan & San Miguel (2013), and Fenton et al. (2014) used questionnaires or surveys with both open ended and closed ended questions. This allowed participants to rate their experience on a guided scale, such as a Likert scale, as well as express their own feelings in their own words about the experience.

Articles by Stone et al. (2010), Nikpeyma et al. (2021), Mostyn et al. (2013), Meade et al. (2011), Egilsdottir et al. (2021), and Aisle et al. (2021) used interviews with participants to collect data. Several of these studies conducted semi-structured interviews, two conducted focus group interviews and two conducted feedback interviews. These types of interviews allowed for more free-flowing thoughts from the participants, whereas structured interviews may limit people’s answers. All these articles collected similar information after the implementation of the podcast or digital learning system. Two articles were not part of this as they collected data differently. The article by Burke & William (2014) used two surveys, one implemented pre-intervention and one post-intervention. This was to understand the change in perception on digital learning throughout the study. Abate (2013) collected data on the participants’ knowledge retention from the podcast by using a quiz and case study about the information learned on it. This is different as the other articles inquired with the participants about their experience with digital learning, how they liked it and the advantages or disadvantages they found rather than testing one’s knowledge about a subject.

Research Design Strengths

Many of the articles chosen for this review exercised different methods. It allowed the researchers to see the larger picture and how the findings were represented through different lenses. LoBiondo-Wood et al. (2017) identified two types of mixed methods: mixing of different methodologies that underly the research and the mixing of different research methods to collect and analyze data. These articles showed strength when rooted in qualitative research, such as phenomenology and then utilized qualitative and quantitative tools to collect data. Using a mixed methods approach is beneficial as it allows the researcher to obtain generalizable and externally valid quantitative data, as well as in depth contextualized qualitative data (George, 2021). When both qualitative and quantitative methods are used it can strengthen the conclusions and findings. Also, the data collection methods are important in the strength of the design. Interviews and surveys collected individual narratives describing the phenomena being studied. This allowed researchers to understand the thoughts and feelings of each participant in regard to the digital learning and podcast implementation.

Limitations

This review included several strengths such as having high qualification standards for the studies selected and using a robust analytic approach to review selected articles. Furthermore, the topic investigated is relevant to nursing students as online and digital resources are becoming more commonplace in education settings. There were, however, some limitations present in this study. One of these limitations was that this review included articles that did not exclusively explore the use of podcasts but additionally, explored digital learning resources and objects, such as online courses (Aase et al., 2021; Egilsdottir et al., 2021; Fenton, 2014; Nikpeyma et al., 2021). All these studies did include podcasts as part of their listed DLOs. These studies were ultimately included in the review as their scope was aligned with the research question, even if they were not specific to only podcasts.

Another limitation with this literature review was the relatively small number of studies, since only fifteen were included. Originally, 28 articles from five different databases were chosen. Many of these articles did not meet the demanding standards or scope desired to maintain for this study. A final limitation with this review was the decision to include studies which used mixed data collection methods (Burke & William, 2012; Mostyn et al., 2013; Rogan & San Miguel, 2013; Strickland et al., 2012). Some articles using quantitative as well as qualitative data were ultimately included because had they been excluded, the number of studies discussed in the review would have been very small and relevant data would have been excluded. This review should be read with these considerations in mind.

Recommendations

Podcasting and DLOs are quickly becoming more commonplace in educational settings. These tools allow students to access course materials remotely and have changed perceptions of what learning can look like. These resources are particularly useful for nursing students who must learn a lot of material in a short time span. It is recommended for further qualitative research to be conducted investigating specifically the relationship between learning, podcasts, and nursing students. Future researchers could also investigate the practical applications of podcasts with other learning methods such as video and other DLOs.

Conclusion

This qualitative systematic literature review provided a rigorous synthesis and analysis of articles investigating the phenomena of podcasts, technology, and learning among nurses and nursing students. The review identified various ways podcasts could be incorporated to promote learning. Evidence was found to suggest podcasts could improve learning amongst nursing students. However, podcasts are best used as an additional learning resource and not as the only source of information. Podcasts were considered useful by participants because they were accessible at any time and allowed information to be listened to multiple times. Constant comparison and thematic analysis were used to draw these conclusions. Further research is required to better understand how podcasts, which types, and perhaps how DLOs may influence learning. Studies utilizing a qualitative research design are particularly needed. This would allow for a better understanding of the phenomena and clarify what aspects of technology best promote learning amongst nursing students.

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ABOUT THE AUTHORS

This paper was collaboratively done by five Critical Inquiry: Qualitative Research students in the Fall of 2022 during their course work in the BSN-AE Nursing Program at Kwantlen Polytechnic University in British Columbia, Canada.