Deborah Boschini, MSN, RNFresno State University

April 2, 2014

Guidelines for Social Media Usefor Nursing Students:Learning to Balance

Freedom of Expression with Professional Boundaries

Overview of Topic*We invite everyone viewing this presentation to complete a feedback form. Here is the link to this presentation feedback form.

Inappropriate use of

social media by nursing students

Nurses must meet professional expectations:• Protect patient privacy &

confidentiality• Maintain boundaries• Follow laws & policies

Knowledge & attitudes of

nursing students: Under

Construction

Use of social media increasing

& evolving

The Illusion of Privacy & the

Online Disinhibition

Effect

• What are the best practices that nursing programs should follow to help students avoid inappropriate social media use?

Research Question

• Posting photos, patient names, other identifying info

• Posting info that is harmful to a program, employer, or the profession

• Accessing social media on the job• Contacting patients through social media

• The “Placenta Incident”

Examples of Inappropriate Use

• Violations may result in criminal and/or civil penalties

• Other consequences:– Students: disciplinary action up to expulsion

– Nursing programs: loss of clinical sites, damage to reputation, increased attrition, lawsuits

– Nurses: loss of job (or offer), suspension or revocation of license

– Profession: damage to reputation, loss of trust in nurse-patient relationships

Importance of Topic:Boundary Violations Have Serious Consequences

• Comparison of Facebook profiles of medical students & residents for privacy violations (2007 vs. 2009).– Most common violation: photos– Increased over time– Newer students more likely to have violations

» (Thompson et al., 2011)

• Analysis of 813 Facebook profiles of medical students & residents for inappropriate material.– 70% had photos with alcohol– 30% had privacy violations, foul language, or explicit

sexual content– 2/3 accounts not private

» (Thompson et al., 2008)

Research: Types of Inappropriate Use (1)

• In a survey of 46 U.S. medical schools 60% reported violations

» (Chretien, Greysen, Chretien, & Kind, 2009)

Research: Types of Inappropriate Use (2)

Patien

t Con

fident

iality

Expli

cit S

exua

l Con

tent

Intox

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n

Discrim

inato

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ngua

ge

Profa

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0%20%40%60%

Types of Social Media Violations

• 439 perfusionists were surveyed regarding cell phone use during cardiopulmonary bypass (CPB)

» (Smith, Darling, & Sceales, 2011)

– 93% “never distracted,” but 35% witnessed other distracted providers (compared to distraction during driving)

Research: Types of Inappropriate Use (3)

Social Media

Internet Email Texting0%

10%20%30%40%50%

Activities Reported during CPB

• Analysis of 132 websites of medical schools:– 95% (126) associated with Facebook– 10% (13) featured guidelines for social media use

• 5/13 clearly defined inappropriate use• 7/13 encouraged responsible use

» (Kind, Gerrich, Sodhi, & Chetien, 2010)

• Analysis of state boards of nursing (BONs)– Proportion of BONs with social networking guidelines

rose from 7% (2010) to 17% (2012)– 72% of BONs had received complaints about RNs

who posted inappropriate content» (NCSBN, 2012)

Research: Social Media Policy Establishment

• Survey of 895 healthcare students after a training session on professionalism (including social media use):

» (Hatch, Bates, Khera, & Walton, 2013)

Research: Barriers to Student Learning

Information Resistance

Social media is “common sense” & doesn’t need to be formally addressed

21% reported social media

session as the “least liked”

“It is condescending to assume that we all post inappropriate things online and need to be told

otherwise.”

• Reflective practice through use of case studies & discussion can increase awareness regarding appropriate social media use, enhance professional growth.

» (Kung, Eisenberg,& Slanetz, 2012)

Research: Effective Strategies

• Strengths– Interdisciplinary– Observational– Formed a basis for

guidelines

• Weaknesses– Lack of longitudinal

studies– Lack of

experimental studies

– Fewer recent studies

Analysis of Research

• Include stakeholders in policy creation• Cover ethical and legal obligations• Address social media myths• Discuss effects of social media use on

organizations & teams• Don’t be restrictive or negative• Teach appropriate use & boundaries• Have clear statements of expected

behaviors & consequences• Be proactive, not reactive

Best Practices for Social Media Policy Development(ANA, 2011; NCSBN, 2012)

• Professional programs are responsible for addressing social media use– Conveying standards– Establishing policies– Enforcing policies, standards, & laws

• Educational leaders must be knowledgeable about boundaries– Personal vs. professional lives– Freedom of expression vs. ethical duties & legal

restrictions– Focus on the possibilities, not challenges

Implications for Educational Leadership

American Nurses Association (ANA). (2011). ANA’s principles for social networking and the nurse. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards/ANAPrinciples.aspx

Chretien, K.C., Greysen, S.R., Chretien, J.P., & Kind, T. (2009). Online posting of unprofessional content by medical students. Journal of the American Medical Association, 302, 1309-1315.

Hatch, T., Bates, H., Khera, S., & Walton, J. (2013). Professionalism and social media: An interprofessional learning activity. Medical Education 2013, 47. 1119-1146. doi: 10.1111/medu.12334

Kind, T., Genrich, G., Sodhi, A., & Cretien, K. (2010). Social media policies at U.S. medical schools. Medical Education Online. doi: 10.3402/meo.v15i0.5324. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20859533

Kung, J.W., Eisenber, R.L., & Slanetz, P.J. (2012). Reflective practice as a tool to teach digital professionalism. Academic Radiology, 19(11), 1408-1414. doi: 10.1016/j.acra.2012.08.008

National Council State Boards of Nursing (NCSBN). (2012). White paper: A nurse’s guide to the use of social media. Retrieved from https://www.ncsbn.org/Social_Media.pdf

Skiba, D.J. (2011). Nursing education 2.0: The need for social media policies for schools of nursing. Nursing Education Perspectives, 32(2), 126-127.

Smith, T., Darling, E., & Searles, B. (2011). 2010 survey on cell phone use while performing cardiopulmonary bypass. Perfusion, 26(5), 375-380. doi: 10.1177/0267659111409969. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21593081

Thompson, L.A., Black, E., Duff, W.P., Paradise Black, N., Saliba, H., & Dawson, K. (2011). Protected health information on social networking sites: Ethical and legal considerations. Journal of Medical Internet Research. Retrieved from http://www.jmir.org/2011/1/e8/

Thompson, L.A., Dawson, K., Ferdig, R., Black, E.W., Boyer, J., Coutts, J., & Black, N.P. (2008). The intersection of online social networking with medical professionalism. Journal of General Internal Medicine, 23(7), 954-957. doi: 10.1007/s11606-008-0538-8 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18612723

Presentation References