Educational Innovations
Social Media in Nursing Education: Responsible Integration for Meaningful Use Jessica L. Peck, DNP, RN, CPNP-PC, CNE, CNL
ABSTRACT The astonishing popularity of social media and its emergence into the academic arena has shown tremendous potential for innovations in teaching. The appeal of using social media in the learning environment is enhanced by accessibility and affordability. However, it has also broadened the scope of consideration for protecting student privacy. This article explores the legal impact of privacy concerns when social media is used as a teaching tool. Institutions of higher learning must formulate guidelines that will govern appropriate social media use so that novel teaching modalities can be safely explored. Students must be educated by faculty regarding the standards of conduct and privacy considerations related to social media. The National Council of State Boards of Nursing has issued the White Paper: A Nurse’s Guide to the Use of Social Media, a must-read for nursing faculty in the current academic arena. [J Nurs Educ. 2014;53(3):164-169.]
Received: March 1, 2013 Accepted: October 16, 2013 Posted Online: February 19, 2014 Dr. Peck is Associate Professor, School of Nursing, University of Texas Medical Branch, Galveston, Texas. The author has disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Jessica L. Peck, DNP, RN, CPNP-PC, CNE, CNL, Associate Professor, School of Nursing, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555; e-mail: jlpeck@ utmb.edu. doi:10.3928/01484834-20140219-03
164
D
uring the past 20 years, the popularity of user-generated content such as social media, collectively referred to as Web 2.0, has grown exponentially. According to Ressler and Glazer (2011), social media is defined as “the constellation of Internet-based tools that help a user to connect, collaborate, and communicate with others in real time.” Social media applications include social networking sites such as Facebook®, MySpace, and Twitter™; media-sharing sites such as Flickr and YouTube; and blogs, wikis, and podcasts. Facebook boasted more than 500 million active users just 6 years after its inception (Viscounty & Barry, 2010), and as of 2012, that number was up to 900 million (Huang & Dunbar, 2013). In 2005, 8 million YouTube videos were viewed each day, and now, that number exceeds 2 billion. Five years ago, Twitter did not exist, and now 100 million active users send more than 65 million tweets each day (Viscounty & Barry, 2010). The cultural impact of social networking is demonstrated by the selection by the Oxford University Press of “unfriend” as its Word of the Year in 2009, referring to elimination of a friend on a social network (Skiba, 2010). Social media is changing the communication paradigm from a traditional face-to-face model to one that uses a variety of Web-based social media applications (Duncan, 2008). Several prestigious universities (i.e., Duke University, Johns Hopkins University, the University of Texas, the Mayo Medical School, Stanford University, Princeton University, and Harvard University) are becoming social media powerhouses by harnessing Web 2.0 technology to achieve tasks such as enhancing student recruitment, improving connectedness, increasing access to academic libraries, creating virtual classrooms and office hours, and creating student learning experiences to achieve desired academic outcomes (Best Colleges Online, 2011). Online interactive and social media platforms are changing the way nursing students communicate (Schaffner, 2010), and one third of faculty in academic institutions report using social media to communicate with students (Fusch, 2010). One survey found that 53% of nursing schools reported using Web 2.0 tools (Lemley & Burnham, 2009). For example, Twitter has been used in critical care simulations to enhance the clinical decision-making skills of nursing students. Students viewed videos of clinical scenarios and tweeted their observations on the patient’s evolving condition for instructor feedback (Mistry, 2011). According to the National League for Nursing (2011), more than 80% of nursing students are Millennials, or the Net Generation. These students are considered to be digital natives and Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
view new technologies as a normal part of their everyday lives. It is the role of nurse educators to harness technology and use it within an appropriate and protected scope in the learning environment. The National Council of State Boards of Nursing (NCSBN) issued the White Paper: A Nurse’s Guide to the Use of Social Media (2011), which states social media has the potential to positively impact health care in multiple ways, including providing education and information to both health care providers and consumers, increasing the speed of communication with patients, and cultivating professional networks. Many studies and articles are emerging that demonstrate the use of social media tools as an effective pedagogy to help students develop a better understanding of communication, professionalism, and ethics (Schmitt, Sims-Giddens, & Booth, 2012). While social media can enhance the educational environment, the standards guiding appropriate usage are in their infancy. There are many published works discussing the successful use of social media in levels K-12, but studies in institutions of higher learning are much more limited, with speculation that the delayed implementation may be due to faculty member apprehension (Williams & Chinn, 2009). Therefore, this article addresses issues for nursing faculty to consider when integrating social media into the classroom or curriculum, with particular consideration for the rights to privacy and confidentiality of all parties involved and the potential effects of inappropriate usage (Cronquist & Spector, 2011). This article primarily focuses on the implications for undergraduate students. Graduate students who are already practicing professionally may encounter different situations, and arguably greater risk, with improper use of social media.
Privacy Concerns Related to Social Media Usage The widespread use of social media applications has introduced new legal and ethical complexities into higher education (Duncan, 2008). It is important for institutions of higher education to create a policy for the responsible use of social media (Fusch, 2010). Many faculty are not yet fully cognizant of the complexities that will arise with widespread social media use, but a number of basic rights emanating from the U.S. Constitution can be affected by the use of social media, specifically freedom of speech, search and seizure, and the right to privacy (Cain & Fink, 2010). Health professionals in academic settings need to be informed about privacy regulations. Although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is familiar to these health care institutions, the Family Educational Rights and Privacy Act (FERPA) is more applicable in the school environment (Bergren, 2004). The purpose of FERPA is to protect private student records from disclosure without the consent of a parent until the student reaches the age of 18, which is when the right is transferred to the student (Barboza, Epps, Byington, & Keene, 2008). This law applies to all schools that receive funds from the U.S. Department of Education. Any record created and maintained for school purposes is considered part of the educational record, including transcripts, examination grades, enrollment, disciplinary actions, and health records (U.S. Department of Education, n.d.). Social media is not protected by FERPA, and any content posted in a public forum is subject to scrutiny by faculty, peers, and prospective employers. Journal of Nursing Education • Vol. 53, No. 3, 2014
However, students’ social networking accounts are not created or maintained by the school and are therefore not a part of the education record and are not protected by FERPA (Barboza et al., 2008). In fact, social networking involves sharing connections between ideas and people, whereas HIPAA and FERPA regulations protect an individual’s privacy through strict regulations about how personal information can be used and by whom.
Impact on the Academic Environment Nursing faculty may feel daunted by the ethical and legal issues associated with social media communications (Cain & Fink, 2010). One risk of using social media is posting unprofessional content that can reflect unfavorably on students, affiliated institutions, and the nursing profession in general. However, the definition of unprofessionalism in the online environment is unclear. Examples might include violation of patient privacy, use of profanity or discriminatory language, images of sexual suggestiveness or intoxication, and communication about patients or the academic institution in a negative fashion (Chretien, Greysen, Chretien, & Kind, 2009). In 2009, a U.S. District Court upheld the expulsion of a nursing student for violating the honor code of the school by making obscene remarks about the race, sex, and religion of patients for whom she had cared. The court concluded that the honor code and confidentiality agreement signed by nursing students governed the standards of acceptable behavior, and it dismissed the student’s claim that her right to freedom of speech had been violated. A similar ruling was made in a case in which a student posted pictures of herself as a drunken pirate on MySpace (Cain & Fink, 2010). Another controversial and perhaps ethical issue is using information gathered from social media sources to make admissions and employment decisions. Some argue that the way in which people choose to present themselves publicly in an online environment is an indicator of their character, and by making public posts, they have provided an open invitation for anyone to view the posted information for any purpose. Those who do not use discretion in deciding what information they post online and are not conscientious in protecting access may not have the judgment necessary to work in a professional environment (Cain & Fink, 2010).
Recommendations It is essential that institutions of higher learning formulate guidelines to govern the use of social media. As the roles of social media continue to grow in educational arenas, faculty can investigate the presence of a social media policy in their particular institution that addresses the appropriate degree of disclosure on social media sites. If such a policy is not developed, faculty may opt to advocate for development of guidelines to govern social media use in the institution. In 2011, the NCSBN published the White Paper: A Nurse’s Guide to the Use of Social Media. The paper includes practical guidelines to govern the appropriate use of social media in the health care environment and is an excellent resource that can be shared with all nursing students. Many institutions have policies governing social media use, but the policies do not extend to use outside of the institution, such as clinical settings (NCSBN, 2011). Nursing faculty must be aware of institutional policies 165
EDUCATIONAL INNOVATIONS
and advise their students on the risk of committing infractions. It is also good practice for faculty to inform their students of potential consequences of violating guidelines for appropriate usage of social media because such infractions can constitute violations of state and federal laws and result in civil and criminal penalties (NCSBN, 2011).
One privacy issue related to social media is the obligation to act if information is discovered that suggests behavior contrary to published expectations or, more importantly, could potentially harm a student (Cain & Fink, 2010). For example, if a student posts complaints on a social media page about a particular course, the question is whether the instructor should respond or ignore the information. Also, if a student brings to light information obtained through social network contacts that demonstrates unprofessional behavior or comments by another student, the question is whether and how the instructor should respond (Skiba, 2010). A central principle when evaluating social media communication is whether the individual posting messages or photographs intends the post to be public or private (Cain & Fink, 2010). If the student posts information publicly, faculty may accept the information as public knowledge. If the information comes from a private post, the situation becomes more complicated, and in cases such as that, having an institutional social media policy would be a useful aide in guiding further action. Another issue facing faculty is whether to incorporate social media into curricula. The benefits are many, including the fact that both Facebook and Twitter are free applications, as are most social media tools, and they allow for easy and affordable access. In addition, students are comfortable and familiar with using these tools (Ressler & Glazer, 2011); however, faculty must consider FERPA regulations. FERPA applies only to information in the possession of the institution. Using social media sites such as Twitter and Facebook can result in an unprotected state in which students publish their assignments using public media that is not in possession of the university, thus bypassing FERPA protection. With that in mind, when students are given assignments using social media, informing them of their privacy rights is an important consideration. It is not acceptable to require students to release personal information on a public site as part of an assignment. Private posting of instructor comments or grades on assignments is an appropriate practice (Orlando, 2011).
law indicates that information from a person’s social networking page is generally discoverable, although this may depend on the context in which the information is sought (Viscounty & Barry, 2010); therefore, social media users need to be mindful that any content posted on open access sites is publicly available, and dissemination of that information is interminable. Many potential applications of social media exist within nursing education. Twitter could be used to post a “nugget of knowledge” in 140 characters or less, which can be an effective way for students to summarize important concepts and post for their fellow classmates to read as well (Skiba, 2008). Other applications of Twitter include posting a live stream of student insights during class, summarizing the “muddiest points,” or creating a class hashtag, which is a # sign used on social media sites to precede a message on a specific topic (e.g., #socialmediaassignment), to share resources such as videos, Web sites, articles, and photographs (Berta, 2012). Also, YouTube can be used in the classroom setting (either face-to-face or online) to stimulate discussion, illustrate a point, or provide further reinforcement of a concept. Students can be shown a video and asked questions to promote clinical reasoning (Agazio & Buckley, 2009). Live video feeds such as Skype™ or FaceTime® can be used to facilitate student collaboration for group projects. A live interactive online polling service provides instant feedback to gauge student knowledge on a particular subject. Many Web-based services, such as http:// www.polleverywhere.com, provide this for free or at a minimal cost and can save students the expense of having to purchase a clicker, which is expensive and unnecessary with today’s smartphone and tablet technology (Peck, 2013). Many excellent suggestions for supporting active learning experiences with social media were reported by Williams and Chinn (2009). These suggestions were the result of a study conducted to evaluate the development of an experiential learning activity and how it enhanced student engagement and learning outcomes. The use of wikis can nurture student interaction, and the social bookmarking site Delicious can be used effectively to create a personal library of relevant research articles. Teamwork and collaboration are easily generated with social media tools, which may foster interdisciplinary collaborative initiatives. George and Dellasega (2011) found that the benefits of social media in the classroom far outweighed the challenges encountered when helping students develop problem-solving skills, enhancing networking and collaboration, and promoting engagement in the course.
Classroom Theory Implications
Clinical Instruction Implications
The classroom setting creates an ideal opportunity for students and faculty to engage in discussions on the definition of professionalism in this new era of social media (Chretien et al., 2009). Relevant laws, including HIPAA and FERPA, can be easily incorporated into instruction. Raising students’ awareness that their privacy is limited on Facebook, even if they have a private profile, is an important consideration for future exploration. Further complicating privacy concerns, Facebook may retain information from deleted accounts for a period of time and cannot retract information that has been copied from the account by others (Facebook, 2013). The majority of current case
Social media is prevalent in the clinical arena and is being used by students, health care providers, patients, and institutions. Most clinical facilities have a social media presence, with the most common appearances being on Facebook and Twitter. For example, Children’s Hospital of Philadelphia (CHOP) has more than 60,000 “likes” on its Facebook page. Clinical achievements, research updates, and patient resources are just some of the many things available to consumers on the hospital’s Facebook page (CHOP, n.d.). With these readily accessible data sources provided directly by the clinical facility, the clinical faculty has a rich resource available when orienting stu-
Faculty Implications
166
Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
dents to the clinical facility. Rather than passing out handbooks or a lengthy PowerPoint® presentation, the faculty could simply point a student to the facility’s Facebook page. A recently published study (Timian, Rupcic, Kachnowski & Luisi, 2013) found that Facebook proved to be a reliable indicator of hospital quality. The number of “likes” on a hospital’s Facebook page was more predictive of mortality rates than actual patient recommendations reported through surveys conducted by the hospital. YouGov® reported that one in four consumers had expectations for a hospital to have a social media presence (Huang & Dunbar, 2013). Fifty-seven percent of consumers said that a hospital’s social media presence would strongly influence their decision about choosing to use the hospital’s services, and 81% of consumers said that a strong social media presence means that a hospital’s clinical technology is cutting edge (Huang & Dunbar, 2013). This area of study is new and needs further analysis and empirical study, but discussions with students to raise their awareness of the social media presence of their assigned institution can be a valuable learning tool (Timian et al., 2013). Another innovative application would be to allow clinical students to use social media to create patient education venues, such as YouTube videos. Green and Hope (2010) described a knowledge synthesis activity that allows students to translate health information into a 3- to 5-minute video designed for public consumption. Disseminating health information in a format readily understandable to the lay person is a critical nursing skill. Many universities have a university-branded exclusive YouTube channel (Best Colleges Online, 2011), where videos can be shared through the university’s social media site. Another effective exercise is to have students assess health information currently and readily available online in social media forums, subsequently critiquing that information for accuracy and currency. Approximately one half of Americans report sharing their health care experiences on Facebook (Krowchuk, Lane, & Twaddell, 2010), and 78% of people report trusting social recommendations from family and friends for health services (Huang & Dunbar, 2013). Unfortunately, this can create the opportunity for inaccurate information to be easily shared. A specific example would be to have students post a question on their personal Facebook site, such as “Do you think vaccines or safe?” or “How often should women go in for gynecological check-ups?”, and have students evaluate responses in groups. Not only does this stimulate discussion related to evidencebased practice, but it also gives faculty the opportunity to discuss and model appropriate responses to inaccurate perceptions, thus improving professional communication. Other reported clinical uses of social media include using Twitter in surgical suites to tweet updates to a patient’s family (Krowchuk et al., 2010). One particular case involved a nurse in the operating department who tweeted more than 300 updates to the patient’s family during a 3-hour surgery, which diminished the family’s anxiety about the surgery. This type of practice could be adapted for use by clinical faculty, who could tweet updates to their clinical groups. Examples include tweeting meeting times and locations, tweeting learning opportunities (e.g., new clinical skill acquisition) available on a particular unit, or asking students to research a particular topic prior to coming to conference. Journal of Nursing Education • Vol. 53, No. 3, 2014
Smartphones have many implications for social media use in the clinical arena. They provide instant access to social media sites and search engines for health information. Students can be tasked with finding appropriate applications, or “apps,” for their patients to use (e.g., MyFitnessPal, iFitness, and Total Fitness). Many of these apps are connected to a social media presence. For instance, with the fitness apps, users can import their exercise logs to their Facebook pages, which gives them the opportunity to seek support and encouragement when embarking on a new fitness plan; however, providers need guidance on evaluating the appropriateness of these applications. As a starting point, the Robert Wood Johnson Foundation (RWJF; 2011) has suggested some criteria for judging public health care applications: (a) they should reflect evidence-based guidelines for behavior change; (b) they should offer periodic message alerts to guide behavior change; (c) they should offer the option of linking to social support resources for behavior change; and (d) they should provide links to proven services. This can be translated into assignment criteria for clinical students in which students search for relevant fitness apps appropriate for use with a diabetic patient who has received provider recommendations for more exercise. Using the RWJF criteria above, students could construct a table comparing three fitness apps for appropriateness of use with a particular patient. Conversely, the inappropriate use of social media in the clinical arena can be detrimental to students, patients, and providers. Professional standards help form the crux of quality care. Discussions between faculty and students should include the boundaries of patient confidentiality, preserving one’s professional reputation, providing accountability for colleagues’ inappropriate social media use, and maintaining appropriate patient–provider boundaries when using social media (Mansfield et al., 2011). It is easy to search for a patient and send a “friend request” on Facebook when a bond has been established during a clinical rotation, but this is not a wise course of action. A more appropriate venue would be patient Web sites such as CaringBridge, which can be followed in a more professional way. CaringBridge (2013) is a not-for-profit Web site devoted to creating a specific social media presence for patients during a health event, whether serious or minor, short-term or long-term. It creates a user-friendly, accessible venue to enhance communication on a protected site during a health event. CaringBridge creates an effective way to communicate health updates to friends and family. Supporters can post messages of encouragement, sign a guest book, and see photographs and status updates posted by the patient and his or her family (http://www. caringbridge.org). Students can be directed in the clinical arena to help patients set up a Web site specifically designed for patient posting of medical events. Even in these settings, it is not appropriate to post something that can be construed as violating confidentiality or professional boundaries. Employment Implications
Because social media is unprotected, questions exist about the access and use of information by faculty, staff, and students (Klich-Heartt, 2010). For example, surveys suggest that anywhere from 18% to 63% of employers access social media sites to look at the profiles of possible job candidates, whereas a 167
EDUCATIONAL INNOVATIONS
Microsoft survey found that only 7% of job candidates realized this possibility even existed. Furthermore, a 2011 survey found that 73% of employers do not give potential candidates the opportunity to dispute any posted information (Johnson, 2012). The classroom provides an environment in which to educate students about the distinction between a personal and professional account. It is a wise practice for students to establish both to maintain professional boundaries with faculty, patients, and colleagues (Ressler & Glazer, 2011). An option would be to have a personal Facebook page but use a professional networking site, such as LinkedIn®, for professional interactions and job seeking. Students may be unaware that online posting can reflect negatively on their professionalism and even jeopardize their careers. Students need to be educated about the potential impact of their digital footprint and should elect to use privacy settings on social networking sites. In addition, they should also conduct periodic Web searches of themselves to ensure their social media presence projects a professional image (Ressler & Glazer, 2011). One controversial application lesson to demonstrate this point is becoming increasingly popular among educators and is appearing more and more on educator blogs (Devaney, 2013). Faculty members will search social media sites such as Facebook and Twitter, with the purpose of searching for students listed on their class rosters. The faculty copy publicly posted information and, after removing student identifiers, presented the posts to the class, asking for a critique. The point is dramatically made that information searchable by faculty is easily searchable by employers and college admission departments as well (Devaney, 2013).
Conclusion For social media to be used effectively in the learning environment, it must be used purposefully. One suggestion for incorporation of social media into the classroom is to incorporate Specific, Measurable, Attainable, Results-oriented, Timely (SMART) goals. Social media should be implemented only with a desired outcome in mind, not just for the sake of keeping up with the times. Timelines should be reasonable and realistic, considering the classroom composition as well as the comfort and experience level of the faculty (Dominican University School of Education, n.d.). A starting point may simply be to investigate whether the university has a social media policy and, if so, to incorporate that into the syllabus. More advanced applications might include creating one assignment using social media that has specific goals and measurable outcomes with consideration for both short- and long-term goals as a starting point. It is also critical to ensure that any learning activity encompassing social media is in harmony with the goals and policies of the larger institution (Dominican University School of Education, n.d.). A helpful resource for faculty considering the educational use of social media is the Social Networking Principles Toolkit provided by the American Nurses Association (ANA; 2011). Elements of the toolkit include (a) a tip card for nurses using social media; (b) a social media continuing education webinar, which informs nurses of the benefits and risks of use; (c) a fact sheet on navigating social media; (d) a poster for classroom dis168
play; and (e) a discussion on social networking principles for nurses. Tip cards may be purchased in bulk for student distribution, fact sheets can be copied and distributed, and posters may be hung in the classroom to enhance awareness. The CE webinar provided on the website by the ANA could be completed as a classroom assignment. Social networking creates a community to share information, ideas, and updates (Skiba, 2010). The information provided through these sites can lead to innovative solutions and alternative perspectives, thus enhancing and transforming old patterns and ways of thinking. Nurse educators need to be innovative and engaging while educating future nursing professionals, and social media provides an excellent method to help with this; however, educators must be fully informed of their rights and students’ rights in the process, and they must take efforts to protect themselves, their students, and the public from privacy breaches (Sharoff, 2010). Social media is most effective when it is used responsibly, with faculty consenting to the significant commitment to governing responsible use in any context associated with the learning environment. The benefits have great potential, with clear evidence emerging that demonstrates the extraordinary capacity for creativity, innovation, and transformation in nursing education (Murray, 2013).
References Agazio, J., & Buckley, K.M. (2009). An untapped resource: Using YouTube in nursing education. Nurse Educator, 34, 23-28. American Nurses Association. (2011). Social networking principles toolkit. Retrieved from http://nursingworld.org/FunctionalMenuCategories/ AboutANA/Social-Media/Social-Networking-Principles-Toolkit Barboza, S., Epps, S., Byington, R., & Keene, S. (2008). HIPAA goes to school: Clarifying privacy laws in the education environment. The Internet Journal of Law, Healthcare and Ethics, 6(2). Retrieved from http:// ispub.com/IJLHE/6/2/3751 Bergren, M.D. (2004). HIPAA-FERPA revisited. Journal of School Nursing, 20, 107-112. Berta, M. (2012, October 12). Twitter in learning workshop recap [Web log post]. Retrieved from http://experimentalpedagogy.blogspot. com/2012/10/twitter-in-learning-workshop-recap.html Best Colleges Online. (2011, June 27). 20 colleges making good use of social media. USA Today. Retrieved from http://www.usatodayeducate. com/staging/index.php/the-20-colleges-making-the-best-use-of-socialmedia Cain, J., & Fink, J.L. (2010). Legal and ethical issues regarding social media and pharmacy education. American Journal of Pharmaceutical Education, 74, 184. CaringBridge. (2013). Your guide to discovering CaringBridge. Retrieved from http://www.caringbridge.org/what-we-offer Children’s Hospital of Philadelphia. (n.d.). In Facebook [Children’s Hospital of Philadelphia Facebook page]. Retrieved March 1, 2012, from https://www.facebook.com/ChildrensHospitalofPhiladelphia 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. Cronquist, R., & Spector, N. (2011). Nurses and social media: Regulatory concerns and guidelines. Journal of Nursing Regulation, 2(3), 37-40. Devaney, L. (2013, January 23). The benefits of using social media in the classroom. Retrieved from http://www.eschoolnews.com/2013/01/23/ the-benefits-of-using-social-media-in-the-classroom/3/ Dominican University School of Education. (n.d.). Using SMART social media in the classroom [Web log post]. Retrieved from http://www. dominicanu.com/masters-in-education-resources/social-media-classroom/ Duncan, S.H. (2008). From armbands and MySpace to cell phones: Interesting school law cases across the country. KY Bench and Bar, (72), 20-24.
Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
Facebook (2013). Statement of rights and responsibilities. Retrieved from https://www.facebook.com/legal/terms Fusch, D. (2010, June 10). Crafting a social media policy [Web log post]. Retrieved from http://www.academicimpressions.com/news/craftingsocial-media-policy George, D.R., & Dellasega, C. (2011). Use of social media in graduate-level medical humanities education: Two pilot studies from Penn State College of Medicine. Medical Teacher, 33, e429-e434. doi:10.3109/01421 59X.2011.586749 Green, B., & Hope, A. (2010). Promoting clinical competence using social media. Nurse Educator 35, 127-129. doi:10.1097/NNE.0b013e3181d9502b Huang, E., & Dunbar, C.L. (2013). Connecting to patients via social media: A hype or a reality? Journal of Medical Marketing, 13, 14-21. Johnson, S. (2012, January 17). Those party photographs could cost you a job. Chicago Tribune. Retrieved from http://www.chicagotribune.com/ features/tribu/ct-tribu-facebook-job-dangers-20120117,0,1257938. column Klich-Heartt, E.I. (2010). Social networking and HIPAA: Ethical concerns for nurses. Nurse Leader, 8(2), 56-58. Krowchuk, H.V., Lane, S.H., & Twaddell, J.W. (2010). Second opinion: Should social media be used to communicate with patients? MCN: The Journal of Maternal/Child Nursing, 35, 6-7. Lemley, T., & Burnham, J.F. (2009). Web 2.0 tools in medical and nursing school curricula. Journal of the Medical Library Association, 97, 50-52. Mansfield, S.J., Morrison, S.G., Stephens, H.O., Bonning, M.A., Wang, S.H., Withers, A.H., . . . Perry, A.W. (2011). Social media and the medical profession. The Medical Journal of Australia, 194, 642-644. Mistry, V. (2011). Critical care training: Using Twitter as a teaching tool. British Journal of Nursing, 20, 1292-1296. Murray, T.A. (2013). Innovations in nursing education: The state of the art. Journal of Nursing Regulation, 3(4), 25-31. National Council of State Boards of Nursing. (2011). White paper: A nurse’s guide to the use of social media. Retrieved from https://www. ncsbn.org/Social_Media.pdf National League for Nursing. (2011). Findings from the Annual Survey of Schools of Nursing Academic Year 2009-2010. Retrieved from http:// www.nln.org/researchgrants/slides/exec_summary_0910.pdf Orlando, J. (2011, February 7). FERPA and social media [Web log post]. Retrieved from http://www.facultyfocus.com/articles/teaching-withtechnology-articles/ferpa-and-social-media/
Journal of Nursing Education • Vol. 53, No. 3, 2014
Peck, J. (2013, January). Teaching with technology 2.0. In Faculty Development for the School of Nursing. Presented at the meeting of the University of Texas Medical Branch School of Nursing, Galveston, TX. Ressler, P.K., & Glazer, G. (2011). Legislative: Nursing’s engagement in health policy and healthcare through social media. The Online Journal of Issues in Nursing, 16(1). Retrieved from http://www.nursingworld. org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/ TableofContents/Vol-16-2011/No1-Jan-2011/Health-Policy-andHealthcare-Through-Social-Media.html Robert Wood Johnson Foundation. (2011, April 19). Public health: There’s an app for that [Web log post]. Retrieved from http://www.rwjf.org/en/ blogs/new-public-health/2011/04/public-health-theres-an-app-for-that. html Schaffner, M. (2010). Leading the way: Networking or not working? Gastroenterology Nursing, 33, 378-380. Schmitt, T.L., Sims-Giddens, S.S., & Booth, R.G. (2012). Social media use in nursing education. The Online Journal of Issues in Nursing, 17(3). Retrieved from http://nursingworld.org/MainMenuCategories/ ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-172012/No3-Sept-2012/Social-Media-in-Nursing-Education.html Sharoff, L. (2010). Stories from the field: Social networking, holistic nursing, and self-care. Holistic Nursing Practice, 24, 301-302. Skiba, J.D. (2008). Emerging technologies center: Nursing education 2.0: Twitter & tweets. Can you post a nugget of knowledge in 140 characters or less? Nursing Education Perspectives, 29, 110-112. Skiba, J.D. (2010). Nursing education 2.0: Social networking and the WOTY. Nursing Education Perspectives, 31, 44-46. Timian, A., Rupcic, S., Kachnowski, S., & Luisi, P. (2013). Do patients “like” good care? Measuring hospital quality via Facebook. American Journal of Medical Quality, 28, 374-382. doi:10.1177/1062860612474839 U.S. Department of Education. (n.d.). Family educational rights and privacy act (FERPA). Retrieved from http://www2.ed.gov/policy/gen/guid/ fpco/ferpa/index.html Viscounty, P., & Barry, J.L. (2010, December 10). Perspective: How discoverable is social media content? Los Angeles and San Francisco Daily Journal. Retrieved from http://www.lw.com/upload/pubContent/_pdf/ pub3852_1.pdf Williams, J., & Chinn, S.J. (2009). Using web 2.0 to support the active learning environment. Journal of Information Systems Education, 20, 165-174.
169
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Social Media in Nursing Education: Responsible Integration for Meaningful Use Jessica L. Peck, DNP, RN, CPNP-PC, CNE, CNL
ABSTRACT The astonishing popularity of social media and its emergence into the academic arena has shown tremendous potential for innovations in teaching. The appeal of using social media in the learning environment is enhanced by accessibility and affordability. However, it has also broadened the scope of consideration for protecting student privacy. This article explores the legal impact of privacy concerns when social media is used as a teaching tool. Institutions of higher learning must formulate guidelines that will govern appropriate social media use so that novel teaching modalities can be safely explored. Students must be educated by faculty regarding the standards of conduct and privacy considerations related to social media. The National Council of State Boards of Nursing has issued the White Paper: A Nurse’s Guide to the Use of Social Media, a must-read for nursing faculty in the current academic arena. [J Nurs Educ. 2014;53(3):164-169.]
Received: March 1, 2013 Accepted: October 16, 2013 Posted Online: February 19, 2014 Dr. Peck is Associate Professor, School of Nursing, University of Texas Medical Branch, Galveston, Texas. The author has disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Jessica L. Peck, DNP, RN, CPNP-PC, CNE, CNL, Associate Professor, School of Nursing, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555; e-mail: jlpeck@ utmb.edu. doi:10.3928/01484834-20140219-03
164
D
uring the past 20 years, the popularity of user-generated content such as social media, collectively referred to as Web 2.0, has grown exponentially. According to Ressler and Glazer (2011), social media is defined as “the constellation of Internet-based tools that help a user to connect, collaborate, and communicate with others in real time.” Social media applications include social networking sites such as Facebook®, MySpace, and Twitter™; media-sharing sites such as Flickr and YouTube; and blogs, wikis, and podcasts. Facebook boasted more than 500 million active users just 6 years after its inception (Viscounty & Barry, 2010), and as of 2012, that number was up to 900 million (Huang & Dunbar, 2013). In 2005, 8 million YouTube videos were viewed each day, and now, that number exceeds 2 billion. Five years ago, Twitter did not exist, and now 100 million active users send more than 65 million tweets each day (Viscounty & Barry, 2010). The cultural impact of social networking is demonstrated by the selection by the Oxford University Press of “unfriend” as its Word of the Year in 2009, referring to elimination of a friend on a social network (Skiba, 2010). Social media is changing the communication paradigm from a traditional face-to-face model to one that uses a variety of Web-based social media applications (Duncan, 2008). Several prestigious universities (i.e., Duke University, Johns Hopkins University, the University of Texas, the Mayo Medical School, Stanford University, Princeton University, and Harvard University) are becoming social media powerhouses by harnessing Web 2.0 technology to achieve tasks such as enhancing student recruitment, improving connectedness, increasing access to academic libraries, creating virtual classrooms and office hours, and creating student learning experiences to achieve desired academic outcomes (Best Colleges Online, 2011). Online interactive and social media platforms are changing the way nursing students communicate (Schaffner, 2010), and one third of faculty in academic institutions report using social media to communicate with students (Fusch, 2010). One survey found that 53% of nursing schools reported using Web 2.0 tools (Lemley & Burnham, 2009). For example, Twitter has been used in critical care simulations to enhance the clinical decision-making skills of nursing students. Students viewed videos of clinical scenarios and tweeted their observations on the patient’s evolving condition for instructor feedback (Mistry, 2011). According to the National League for Nursing (2011), more than 80% of nursing students are Millennials, or the Net Generation. These students are considered to be digital natives and Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
view new technologies as a normal part of their everyday lives. It is the role of nurse educators to harness technology and use it within an appropriate and protected scope in the learning environment. The National Council of State Boards of Nursing (NCSBN) issued the White Paper: A Nurse’s Guide to the Use of Social Media (2011), which states social media has the potential to positively impact health care in multiple ways, including providing education and information to both health care providers and consumers, increasing the speed of communication with patients, and cultivating professional networks. Many studies and articles are emerging that demonstrate the use of social media tools as an effective pedagogy to help students develop a better understanding of communication, professionalism, and ethics (Schmitt, Sims-Giddens, & Booth, 2012). While social media can enhance the educational environment, the standards guiding appropriate usage are in their infancy. There are many published works discussing the successful use of social media in levels K-12, but studies in institutions of higher learning are much more limited, with speculation that the delayed implementation may be due to faculty member apprehension (Williams & Chinn, 2009). Therefore, this article addresses issues for nursing faculty to consider when integrating social media into the classroom or curriculum, with particular consideration for the rights to privacy and confidentiality of all parties involved and the potential effects of inappropriate usage (Cronquist & Spector, 2011). This article primarily focuses on the implications for undergraduate students. Graduate students who are already practicing professionally may encounter different situations, and arguably greater risk, with improper use of social media.
Privacy Concerns Related to Social Media Usage The widespread use of social media applications has introduced new legal and ethical complexities into higher education (Duncan, 2008). It is important for institutions of higher education to create a policy for the responsible use of social media (Fusch, 2010). Many faculty are not yet fully cognizant of the complexities that will arise with widespread social media use, but a number of basic rights emanating from the U.S. Constitution can be affected by the use of social media, specifically freedom of speech, search and seizure, and the right to privacy (Cain & Fink, 2010). Health professionals in academic settings need to be informed about privacy regulations. Although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is familiar to these health care institutions, the Family Educational Rights and Privacy Act (FERPA) is more applicable in the school environment (Bergren, 2004). The purpose of FERPA is to protect private student records from disclosure without the consent of a parent until the student reaches the age of 18, which is when the right is transferred to the student (Barboza, Epps, Byington, & Keene, 2008). This law applies to all schools that receive funds from the U.S. Department of Education. Any record created and maintained for school purposes is considered part of the educational record, including transcripts, examination grades, enrollment, disciplinary actions, and health records (U.S. Department of Education, n.d.). Social media is not protected by FERPA, and any content posted in a public forum is subject to scrutiny by faculty, peers, and prospective employers. Journal of Nursing Education • Vol. 53, No. 3, 2014
However, students’ social networking accounts are not created or maintained by the school and are therefore not a part of the education record and are not protected by FERPA (Barboza et al., 2008). In fact, social networking involves sharing connections between ideas and people, whereas HIPAA and FERPA regulations protect an individual’s privacy through strict regulations about how personal information can be used and by whom.
Impact on the Academic Environment Nursing faculty may feel daunted by the ethical and legal issues associated with social media communications (Cain & Fink, 2010). One risk of using social media is posting unprofessional content that can reflect unfavorably on students, affiliated institutions, and the nursing profession in general. However, the definition of unprofessionalism in the online environment is unclear. Examples might include violation of patient privacy, use of profanity or discriminatory language, images of sexual suggestiveness or intoxication, and communication about patients or the academic institution in a negative fashion (Chretien, Greysen, Chretien, & Kind, 2009). In 2009, a U.S. District Court upheld the expulsion of a nursing student for violating the honor code of the school by making obscene remarks about the race, sex, and religion of patients for whom she had cared. The court concluded that the honor code and confidentiality agreement signed by nursing students governed the standards of acceptable behavior, and it dismissed the student’s claim that her right to freedom of speech had been violated. A similar ruling was made in a case in which a student posted pictures of herself as a drunken pirate on MySpace (Cain & Fink, 2010). Another controversial and perhaps ethical issue is using information gathered from social media sources to make admissions and employment decisions. Some argue that the way in which people choose to present themselves publicly in an online environment is an indicator of their character, and by making public posts, they have provided an open invitation for anyone to view the posted information for any purpose. Those who do not use discretion in deciding what information they post online and are not conscientious in protecting access may not have the judgment necessary to work in a professional environment (Cain & Fink, 2010).
Recommendations It is essential that institutions of higher learning formulate guidelines to govern the use of social media. As the roles of social media continue to grow in educational arenas, faculty can investigate the presence of a social media policy in their particular institution that addresses the appropriate degree of disclosure on social media sites. If such a policy is not developed, faculty may opt to advocate for development of guidelines to govern social media use in the institution. In 2011, the NCSBN published the White Paper: A Nurse’s Guide to the Use of Social Media. The paper includes practical guidelines to govern the appropriate use of social media in the health care environment and is an excellent resource that can be shared with all nursing students. Many institutions have policies governing social media use, but the policies do not extend to use outside of the institution, such as clinical settings (NCSBN, 2011). Nursing faculty must be aware of institutional policies 165
EDUCATIONAL INNOVATIONS
and advise their students on the risk of committing infractions. It is also good practice for faculty to inform their students of potential consequences of violating guidelines for appropriate usage of social media because such infractions can constitute violations of state and federal laws and result in civil and criminal penalties (NCSBN, 2011).
One privacy issue related to social media is the obligation to act if information is discovered that suggests behavior contrary to published expectations or, more importantly, could potentially harm a student (Cain & Fink, 2010). For example, if a student posts complaints on a social media page about a particular course, the question is whether the instructor should respond or ignore the information. Also, if a student brings to light information obtained through social network contacts that demonstrates unprofessional behavior or comments by another student, the question is whether and how the instructor should respond (Skiba, 2010). A central principle when evaluating social media communication is whether the individual posting messages or photographs intends the post to be public or private (Cain & Fink, 2010). If the student posts information publicly, faculty may accept the information as public knowledge. If the information comes from a private post, the situation becomes more complicated, and in cases such as that, having an institutional social media policy would be a useful aide in guiding further action. Another issue facing faculty is whether to incorporate social media into curricula. The benefits are many, including the fact that both Facebook and Twitter are free applications, as are most social media tools, and they allow for easy and affordable access. In addition, students are comfortable and familiar with using these tools (Ressler & Glazer, 2011); however, faculty must consider FERPA regulations. FERPA applies only to information in the possession of the institution. Using social media sites such as Twitter and Facebook can result in an unprotected state in which students publish their assignments using public media that is not in possession of the university, thus bypassing FERPA protection. With that in mind, when students are given assignments using social media, informing them of their privacy rights is an important consideration. It is not acceptable to require students to release personal information on a public site as part of an assignment. Private posting of instructor comments or grades on assignments is an appropriate practice (Orlando, 2011).
law indicates that information from a person’s social networking page is generally discoverable, although this may depend on the context in which the information is sought (Viscounty & Barry, 2010); therefore, social media users need to be mindful that any content posted on open access sites is publicly available, and dissemination of that information is interminable. Many potential applications of social media exist within nursing education. Twitter could be used to post a “nugget of knowledge” in 140 characters or less, which can be an effective way for students to summarize important concepts and post for their fellow classmates to read as well (Skiba, 2008). Other applications of Twitter include posting a live stream of student insights during class, summarizing the “muddiest points,” or creating a class hashtag, which is a # sign used on social media sites to precede a message on a specific topic (e.g., #socialmediaassignment), to share resources such as videos, Web sites, articles, and photographs (Berta, 2012). Also, YouTube can be used in the classroom setting (either face-to-face or online) to stimulate discussion, illustrate a point, or provide further reinforcement of a concept. Students can be shown a video and asked questions to promote clinical reasoning (Agazio & Buckley, 2009). Live video feeds such as Skype™ or FaceTime® can be used to facilitate student collaboration for group projects. A live interactive online polling service provides instant feedback to gauge student knowledge on a particular subject. Many Web-based services, such as http:// www.polleverywhere.com, provide this for free or at a minimal cost and can save students the expense of having to purchase a clicker, which is expensive and unnecessary with today’s smartphone and tablet technology (Peck, 2013). Many excellent suggestions for supporting active learning experiences with social media were reported by Williams and Chinn (2009). These suggestions were the result of a study conducted to evaluate the development of an experiential learning activity and how it enhanced student engagement and learning outcomes. The use of wikis can nurture student interaction, and the social bookmarking site Delicious can be used effectively to create a personal library of relevant research articles. Teamwork and collaboration are easily generated with social media tools, which may foster interdisciplinary collaborative initiatives. George and Dellasega (2011) found that the benefits of social media in the classroom far outweighed the challenges encountered when helping students develop problem-solving skills, enhancing networking and collaboration, and promoting engagement in the course.
Classroom Theory Implications
Clinical Instruction Implications
The classroom setting creates an ideal opportunity for students and faculty to engage in discussions on the definition of professionalism in this new era of social media (Chretien et al., 2009). Relevant laws, including HIPAA and FERPA, can be easily incorporated into instruction. Raising students’ awareness that their privacy is limited on Facebook, even if they have a private profile, is an important consideration for future exploration. Further complicating privacy concerns, Facebook may retain information from deleted accounts for a period of time and cannot retract information that has been copied from the account by others (Facebook, 2013). The majority of current case
Social media is prevalent in the clinical arena and is being used by students, health care providers, patients, and institutions. Most clinical facilities have a social media presence, with the most common appearances being on Facebook and Twitter. For example, Children’s Hospital of Philadelphia (CHOP) has more than 60,000 “likes” on its Facebook page. Clinical achievements, research updates, and patient resources are just some of the many things available to consumers on the hospital’s Facebook page (CHOP, n.d.). With these readily accessible data sources provided directly by the clinical facility, the clinical faculty has a rich resource available when orienting stu-
Faculty Implications
166
Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
dents to the clinical facility. Rather than passing out handbooks or a lengthy PowerPoint® presentation, the faculty could simply point a student to the facility’s Facebook page. A recently published study (Timian, Rupcic, Kachnowski & Luisi, 2013) found that Facebook proved to be a reliable indicator of hospital quality. The number of “likes” on a hospital’s Facebook page was more predictive of mortality rates than actual patient recommendations reported through surveys conducted by the hospital. YouGov® reported that one in four consumers had expectations for a hospital to have a social media presence (Huang & Dunbar, 2013). Fifty-seven percent of consumers said that a hospital’s social media presence would strongly influence their decision about choosing to use the hospital’s services, and 81% of consumers said that a strong social media presence means that a hospital’s clinical technology is cutting edge (Huang & Dunbar, 2013). This area of study is new and needs further analysis and empirical study, but discussions with students to raise their awareness of the social media presence of their assigned institution can be a valuable learning tool (Timian et al., 2013). Another innovative application would be to allow clinical students to use social media to create patient education venues, such as YouTube videos. Green and Hope (2010) described a knowledge synthesis activity that allows students to translate health information into a 3- to 5-minute video designed for public consumption. Disseminating health information in a format readily understandable to the lay person is a critical nursing skill. Many universities have a university-branded exclusive YouTube channel (Best Colleges Online, 2011), where videos can be shared through the university’s social media site. Another effective exercise is to have students assess health information currently and readily available online in social media forums, subsequently critiquing that information for accuracy and currency. Approximately one half of Americans report sharing their health care experiences on Facebook (Krowchuk, Lane, & Twaddell, 2010), and 78% of people report trusting social recommendations from family and friends for health services (Huang & Dunbar, 2013). Unfortunately, this can create the opportunity for inaccurate information to be easily shared. A specific example would be to have students post a question on their personal Facebook site, such as “Do you think vaccines or safe?” or “How often should women go in for gynecological check-ups?”, and have students evaluate responses in groups. Not only does this stimulate discussion related to evidencebased practice, but it also gives faculty the opportunity to discuss and model appropriate responses to inaccurate perceptions, thus improving professional communication. Other reported clinical uses of social media include using Twitter in surgical suites to tweet updates to a patient’s family (Krowchuk et al., 2010). One particular case involved a nurse in the operating department who tweeted more than 300 updates to the patient’s family during a 3-hour surgery, which diminished the family’s anxiety about the surgery. This type of practice could be adapted for use by clinical faculty, who could tweet updates to their clinical groups. Examples include tweeting meeting times and locations, tweeting learning opportunities (e.g., new clinical skill acquisition) available on a particular unit, or asking students to research a particular topic prior to coming to conference. Journal of Nursing Education • Vol. 53, No. 3, 2014
Smartphones have many implications for social media use in the clinical arena. They provide instant access to social media sites and search engines for health information. Students can be tasked with finding appropriate applications, or “apps,” for their patients to use (e.g., MyFitnessPal, iFitness, and Total Fitness). Many of these apps are connected to a social media presence. For instance, with the fitness apps, users can import their exercise logs to their Facebook pages, which gives them the opportunity to seek support and encouragement when embarking on a new fitness plan; however, providers need guidance on evaluating the appropriateness of these applications. As a starting point, the Robert Wood Johnson Foundation (RWJF; 2011) has suggested some criteria for judging public health care applications: (a) they should reflect evidence-based guidelines for behavior change; (b) they should offer periodic message alerts to guide behavior change; (c) they should offer the option of linking to social support resources for behavior change; and (d) they should provide links to proven services. This can be translated into assignment criteria for clinical students in which students search for relevant fitness apps appropriate for use with a diabetic patient who has received provider recommendations for more exercise. Using the RWJF criteria above, students could construct a table comparing three fitness apps for appropriateness of use with a particular patient. Conversely, the inappropriate use of social media in the clinical arena can be detrimental to students, patients, and providers. Professional standards help form the crux of quality care. Discussions between faculty and students should include the boundaries of patient confidentiality, preserving one’s professional reputation, providing accountability for colleagues’ inappropriate social media use, and maintaining appropriate patient–provider boundaries when using social media (Mansfield et al., 2011). It is easy to search for a patient and send a “friend request” on Facebook when a bond has been established during a clinical rotation, but this is not a wise course of action. A more appropriate venue would be patient Web sites such as CaringBridge, which can be followed in a more professional way. CaringBridge (2013) is a not-for-profit Web site devoted to creating a specific social media presence for patients during a health event, whether serious or minor, short-term or long-term. It creates a user-friendly, accessible venue to enhance communication on a protected site during a health event. CaringBridge creates an effective way to communicate health updates to friends and family. Supporters can post messages of encouragement, sign a guest book, and see photographs and status updates posted by the patient and his or her family (http://www. caringbridge.org). Students can be directed in the clinical arena to help patients set up a Web site specifically designed for patient posting of medical events. Even in these settings, it is not appropriate to post something that can be construed as violating confidentiality or professional boundaries. Employment Implications
Because social media is unprotected, questions exist about the access and use of information by faculty, staff, and students (Klich-Heartt, 2010). For example, surveys suggest that anywhere from 18% to 63% of employers access social media sites to look at the profiles of possible job candidates, whereas a 167
EDUCATIONAL INNOVATIONS
Microsoft survey found that only 7% of job candidates realized this possibility even existed. Furthermore, a 2011 survey found that 73% of employers do not give potential candidates the opportunity to dispute any posted information (Johnson, 2012). The classroom provides an environment in which to educate students about the distinction between a personal and professional account. It is a wise practice for students to establish both to maintain professional boundaries with faculty, patients, and colleagues (Ressler & Glazer, 2011). An option would be to have a personal Facebook page but use a professional networking site, such as LinkedIn®, for professional interactions and job seeking. Students may be unaware that online posting can reflect negatively on their professionalism and even jeopardize their careers. Students need to be educated about the potential impact of their digital footprint and should elect to use privacy settings on social networking sites. In addition, they should also conduct periodic Web searches of themselves to ensure their social media presence projects a professional image (Ressler & Glazer, 2011). One controversial application lesson to demonstrate this point is becoming increasingly popular among educators and is appearing more and more on educator blogs (Devaney, 2013). Faculty members will search social media sites such as Facebook and Twitter, with the purpose of searching for students listed on their class rosters. The faculty copy publicly posted information and, after removing student identifiers, presented the posts to the class, asking for a critique. The point is dramatically made that information searchable by faculty is easily searchable by employers and college admission departments as well (Devaney, 2013).
Conclusion For social media to be used effectively in the learning environment, it must be used purposefully. One suggestion for incorporation of social media into the classroom is to incorporate Specific, Measurable, Attainable, Results-oriented, Timely (SMART) goals. Social media should be implemented only with a desired outcome in mind, not just for the sake of keeping up with the times. Timelines should be reasonable and realistic, considering the classroom composition as well as the comfort and experience level of the faculty (Dominican University School of Education, n.d.). A starting point may simply be to investigate whether the university has a social media policy and, if so, to incorporate that into the syllabus. More advanced applications might include creating one assignment using social media that has specific goals and measurable outcomes with consideration for both short- and long-term goals as a starting point. It is also critical to ensure that any learning activity encompassing social media is in harmony with the goals and policies of the larger institution (Dominican University School of Education, n.d.). A helpful resource for faculty considering the educational use of social media is the Social Networking Principles Toolkit provided by the American Nurses Association (ANA; 2011). Elements of the toolkit include (a) a tip card for nurses using social media; (b) a social media continuing education webinar, which informs nurses of the benefits and risks of use; (c) a fact sheet on navigating social media; (d) a poster for classroom dis168
play; and (e) a discussion on social networking principles for nurses. Tip cards may be purchased in bulk for student distribution, fact sheets can be copied and distributed, and posters may be hung in the classroom to enhance awareness. The CE webinar provided on the website by the ANA could be completed as a classroom assignment. Social networking creates a community to share information, ideas, and updates (Skiba, 2010). The information provided through these sites can lead to innovative solutions and alternative perspectives, thus enhancing and transforming old patterns and ways of thinking. Nurse educators need to be innovative and engaging while educating future nursing professionals, and social media provides an excellent method to help with this; however, educators must be fully informed of their rights and students’ rights in the process, and they must take efforts to protect themselves, their students, and the public from privacy breaches (Sharoff, 2010). Social media is most effective when it is used responsibly, with faculty consenting to the significant commitment to governing responsible use in any context associated with the learning environment. The benefits have great potential, with clear evidence emerging that demonstrates the extraordinary capacity for creativity, innovation, and transformation in nursing education (Murray, 2013).
References Agazio, J., & Buckley, K.M. (2009). An untapped resource: Using YouTube in nursing education. Nurse Educator, 34, 23-28. American Nurses Association. (2011). Social networking principles toolkit. Retrieved from http://nursingworld.org/FunctionalMenuCategories/ AboutANA/Social-Media/Social-Networking-Principles-Toolkit Barboza, S., Epps, S., Byington, R., & Keene, S. (2008). HIPAA goes to school: Clarifying privacy laws in the education environment. The Internet Journal of Law, Healthcare and Ethics, 6(2). Retrieved from http:// ispub.com/IJLHE/6/2/3751 Bergren, M.D. (2004). HIPAA-FERPA revisited. Journal of School Nursing, 20, 107-112. Berta, M. (2012, October 12). Twitter in learning workshop recap [Web log post]. Retrieved from http://experimentalpedagogy.blogspot. com/2012/10/twitter-in-learning-workshop-recap.html Best Colleges Online. (2011, June 27). 20 colleges making good use of social media. USA Today. Retrieved from http://www.usatodayeducate. com/staging/index.php/the-20-colleges-making-the-best-use-of-socialmedia Cain, J., & Fink, J.L. (2010). Legal and ethical issues regarding social media and pharmacy education. American Journal of Pharmaceutical Education, 74, 184. CaringBridge. (2013). Your guide to discovering CaringBridge. Retrieved from http://www.caringbridge.org/what-we-offer Children’s Hospital of Philadelphia. (n.d.). In Facebook [Children’s Hospital of Philadelphia Facebook page]. Retrieved March 1, 2012, from https://www.facebook.com/ChildrensHospitalofPhiladelphia 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. Cronquist, R., & Spector, N. (2011). Nurses and social media: Regulatory concerns and guidelines. Journal of Nursing Regulation, 2(3), 37-40. Devaney, L. (2013, January 23). The benefits of using social media in the classroom. Retrieved from http://www.eschoolnews.com/2013/01/23/ the-benefits-of-using-social-media-in-the-classroom/3/ Dominican University School of Education. (n.d.). Using SMART social media in the classroom [Web log post]. Retrieved from http://www. dominicanu.com/masters-in-education-resources/social-media-classroom/ Duncan, S.H. (2008). From armbands and MySpace to cell phones: Interesting school law cases across the country. KY Bench and Bar, (72), 20-24.
Copyright © SLACK Incorporated
EDUCATIONAL INNOVATIONS
Facebook (2013). Statement of rights and responsibilities. Retrieved from https://www.facebook.com/legal/terms Fusch, D. (2010, June 10). Crafting a social media policy [Web log post]. Retrieved from http://www.academicimpressions.com/news/craftingsocial-media-policy George, D.R., & Dellasega, C. (2011). Use of social media in graduate-level medical humanities education: Two pilot studies from Penn State College of Medicine. Medical Teacher, 33, e429-e434. doi:10.3109/01421 59X.2011.586749 Green, B., & Hope, A. (2010). Promoting clinical competence using social media. Nurse Educator 35, 127-129. doi:10.1097/NNE.0b013e3181d9502b Huang, E., & Dunbar, C.L. (2013). Connecting to patients via social media: A hype or a reality? Journal of Medical Marketing, 13, 14-21. Johnson, S. (2012, January 17). Those party photographs could cost you a job. Chicago Tribune. Retrieved from http://www.chicagotribune.com/ features/tribu/ct-tribu-facebook-job-dangers-20120117,0,1257938. column Klich-Heartt, E.I. (2010). Social networking and HIPAA: Ethical concerns for nurses. Nurse Leader, 8(2), 56-58. Krowchuk, H.V., Lane, S.H., & Twaddell, J.W. (2010). Second opinion: Should social media be used to communicate with patients? MCN: The Journal of Maternal/Child Nursing, 35, 6-7. Lemley, T., & Burnham, J.F. (2009). Web 2.0 tools in medical and nursing school curricula. Journal of the Medical Library Association, 97, 50-52. Mansfield, S.J., Morrison, S.G., Stephens, H.O., Bonning, M.A., Wang, S.H., Withers, A.H., . . . Perry, A.W. (2011). Social media and the medical profession. The Medical Journal of Australia, 194, 642-644. Mistry, V. (2011). Critical care training: Using Twitter as a teaching tool. British Journal of Nursing, 20, 1292-1296. Murray, T.A. (2013). Innovations in nursing education: The state of the art. Journal of Nursing Regulation, 3(4), 25-31. National Council of State Boards of Nursing. (2011). White paper: A nurse’s guide to the use of social media. Retrieved from https://www. ncsbn.org/Social_Media.pdf National League for Nursing. (2011). Findings from the Annual Survey of Schools of Nursing Academic Year 2009-2010. Retrieved from http:// www.nln.org/researchgrants/slides/exec_summary_0910.pdf Orlando, J. (2011, February 7). FERPA and social media [Web log post]. Retrieved from http://www.facultyfocus.com/articles/teaching-withtechnology-articles/ferpa-and-social-media/
Journal of Nursing Education • Vol. 53, No. 3, 2014
Peck, J. (2013, January). Teaching with technology 2.0. In Faculty Development for the School of Nursing. Presented at the meeting of the University of Texas Medical Branch School of Nursing, Galveston, TX. Ressler, P.K., & Glazer, G. (2011). Legislative: Nursing’s engagement in health policy and healthcare through social media. The Online Journal of Issues in Nursing, 16(1). Retrieved from http://www.nursingworld. org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/ TableofContents/Vol-16-2011/No1-Jan-2011/Health-Policy-andHealthcare-Through-Social-Media.html Robert Wood Johnson Foundation. (2011, April 19). Public health: There’s an app for that [Web log post]. Retrieved from http://www.rwjf.org/en/ blogs/new-public-health/2011/04/public-health-theres-an-app-for-that. html Schaffner, M. (2010). Leading the way: Networking or not working? Gastroenterology Nursing, 33, 378-380. Schmitt, T.L., Sims-Giddens, S.S., & Booth, R.G. (2012). Social media use in nursing education. The Online Journal of Issues in Nursing, 17(3). Retrieved from http://nursingworld.org/MainMenuCategories/ ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-172012/No3-Sept-2012/Social-Media-in-Nursing-Education.html Sharoff, L. (2010). Stories from the field: Social networking, holistic nursing, and self-care. Holistic Nursing Practice, 24, 301-302. Skiba, J.D. (2008). Emerging technologies center: Nursing education 2.0: Twitter & tweets. Can you post a nugget of knowledge in 140 characters or less? Nursing Education Perspectives, 29, 110-112. Skiba, J.D. (2010). Nursing education 2.0: Social networking and the WOTY. Nursing Education Perspectives, 31, 44-46. Timian, A., Rupcic, S., Kachnowski, S., & Luisi, P. (2013). Do patients “like” good care? Measuring hospital quality via Facebook. American Journal of Medical Quality, 28, 374-382. doi:10.1177/1062860612474839 U.S. Department of Education. (n.d.). Family educational rights and privacy act (FERPA). Retrieved from http://www2.ed.gov/policy/gen/guid/ fpco/ferpa/index.html Viscounty, P., & Barry, J.L. (2010, December 10). Perspective: How discoverable is social media content? Los Angeles and San Francisco Daily Journal. Retrieved from http://www.lw.com/upload/pubContent/_pdf/ pub3852_1.pdf Williams, J., & Chinn, S.J. (2009). Using web 2.0 to support the active learning environment. Journal of Information Systems Education, 20, 165-174.
169
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
