Nurse Education Today 107 (2021) 105160

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Nurse Education Today

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Research article

International student nurses' use of social media for learning: A cross

sectional survey
Xabi Cathala a, *, Oscar Noel Ocho b, Paul Nicholas Watts c, Calvin Moorley d
a
School of Health, Sport and Bioscience, University of East London, Stratford Campus, Water Lane, London E15 4LZ, United Kingdom of Great Britain and Northern
Ireland
b
UWISoN Faculty of Medical Sciences University of the West indies St Augustine, United Kingdom of Great Britain and Northern Ireland
c
University of East London, School of Health Sport and Bioscience, Water Lane, London E15 4LZ, United Kingdom of Great Britain and Northern Ireland
d
Diversity & Social Justice, London South Bank University Borough Rd SE1 0AA, United Kingdom of Great Britain and Northern Ireland

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Students use social media for sharing information and connecting with their friends, also for peer
Student nurses support, peer learning and student engagement. Research indicates that approximately twice the number of
Social media students were using social media for educational purposes compared to academic staff and almost all students
Teaching and learning
discuss academic issues on social media. However, little is known about how diverse cohorts of student nurses
Caribbean
Social media guidance
use social media for specific purposes at different stages of their learning.
Objectives: Identify how student nurses in each country of study use social media for learning.
Identify how each generation of student nurses use social media for learning.
Identify how student nurses use social media as their education progresses.
Design: A cross-sectional survey.
Settings: The study was undertaken across three countries Jamaica, Trinidad and Tobago and the UK.
Participants: Student nurses from each of the countries that consented to participate met the inclusion criteria.
Methods: 1050 student nurses across the three countries self-completed the cross-sectional survey between March
and September 2019. Data was analysed using descriptive and inferential statistics.
Results: WhatsApp® was the most used platform for learning amongst participants. Watching videos and
downloading articles represented two-thirds of social media usage for learning. Smart phones were the most used
device to access social media. Kruskal-Wallis tests were significant (≤0.001) for checking social media and
messaging in lecture, use of social media for studies and classroom activities by country, generation (except
classroom activities) and year of education. Use of social media for classroom activities had no significance by
generation.
Conclusion: Country, generation and year of education are factors that influence the use of social media in student
nurses' learning. These should be considered by Universities in curriculum development and in teaching and
learning delivery. From a pragmatic approach, social media is available and used by a majority of student nurses
and can be widely assimilated into the nursing curriculum.

1. Introduction
Contemporary societies increasingly use and connect to social media
SoMe (SoMe) for personal and/or professional purposes. This also ap­
plies to the nursing community's SoMe experiences in learning (Moorley
and Chinn, 2019). SoMe are open and accessible platforms available on
the internet. They allow communication, knowledge sharing, support
and discussion and can facilitate connections between nurses, educators,
academics and student nurses, which improves nursing community dy­
namics. Oducado et al. (2019) reported the use of SoMe among
millennial student nurses. SoMe are embedded in student nurses' pro­
fessional development despite the lack of guidance at national and in­
ternational levels (Cathala et al., 2021). SoMe enhances learning and
needs further integration into student nurses' curriculum (Pimmer et al.,
2018; Jones et al., 2016; Tower et al., 2014; Chugh et al., 2020). To be
able to effectively integrate SoMe into student nurses' learning it is

* Corresponding author.
E-mail addresses: x.cathala@uel.ac.uk (X. Cathala), oscar.ocho@sta.uwi.edu (O.N. Ocho), p.n.watts@uel.ac.uk (P.N. Watts), Moorleyc@lsbu.ac.uk (C. Moorley).

https://doi.org/10.1016/j.nedt.2021.105160
Received 10 April 2021; Received in revised form 14 September 2021; Accepted 26 September 2021
Available online 29 September 2021
0260-6917/© 2021 Elsevier Ltd. All rights reserved.
X. Cathala et al. Nurse Education Today 107 (2021) 105160

important to understand how they use SoMe for learning, which is the 2. Methods
aim of this study.
2.1. Population

1.1. Background
Participants were student nurses from Jamaica, Trinidad and Tobago
and the UK. The setting was chosen as a move towards working with
Most students use SoMe for sharing information and social
Caribbean nurses and students to build academic and research capacity
networking (Booth, 2015). SoMe can be used for peer support, peer
particularly in the current climate where Black researchers and aca­
learning and student engagement (Cathala et al., 2021) and also pro­
demics encounter barriers and biases in undertaking research and pub­
fessionally (Wang et al., 2019). Duke et al. (2017) surveyed Canadian
lishing. Other influencing factors include existing collaborations and the
student nurses, and identified that twice the number of students were
lack of research on Caribbean student nurses, which guided the selection
using SoMe for educational purposes compared to academic staff and
and inclusion of the countries in this study. A total of 1077 participants
almost all students discussed academic issues on SoMe. The most used
from the three countries responded from a possible pool of 63,533
SoMe for formal and informal learning were YouTube®, text messaging
participants (63,000 in the UK, 233 in Trinidad and Tobago and 340 in
and Facebook®. There was a marked difference between faculty and
Jamaica). The UK and Trinidad and Tobago met the sample size target
students regarding use of Facebook® for formal learning. Price et al.
calculated with Yamane's formula using ±5% level of precision and the
(2018) examined 1st year nursing students' educational use of SoMe
population size stated. Jamaica experienced recruitment challenges and
prior to starting their nursing programme and found that most students
did not meet the sample size requirement. Inclusion and exclusion
used at least one type of platform Facebook®, Instagram® or Twitter®.
criteria were applied (Table 1).
During their nursing education, most used Facebook®, Instagram® and
Twitter®, with an increase in Twitter® and Facebook® usage. They
2.2. Recruitment
concluded an increase in student confidence and SoMe being beneficial
in knowledge acquisition. SoMe increases cooperative learning, teacher/
To ensure recruitment consistency and ethical requirements across
student communication (Qi, 2019; Bal and Bicen, 2017) and increased
countries a flowchart was created to organise and structure the research
motivation in learning (Bal and Bicen, 2017).
linked to ethical practice. First, creation of recruitment folders per
Concerns have been expressed regarding, privacy and professional­
country including the participant information sheet (PIS) stating the
ism on SoMe (De Gagne et al., 2019), as well as the addictive nature of
ethical approval and contacts, the survey link and file, virtual learning
SoMe (Azizi et al., 2019) especially with a lack of guidance and policies
environment (VLE) invitation and a thank you email. Second, recruit­
that could impact student nurses use of SoMe (Cathala et al., 2021). The
ment folders were sent to the research lead in each country for review
literature illustrates that student nurses are using SoMe for educational
and queries. The third step outlined ethical practice regarding partici­
purposes and they are using them more than educators. Therefore, a gap
pants recruitment at each University. The VLE invitation with the survey
exists where little evidence on how and what student nurses use SoMe
link and PIS were uploaded onto the University's VLE advertising the
for, particularly those from the Caribbean where no evidence exists.
study. Students' participation was voluntary. Where possible the study
There is a lack of effective implementation and use of SoMe in higher
was advertised face to face to support the VLE invitation and on
education teaching and learning and in particularly nurse education
Twitter®, in the UK supported by @WeNurses, @WeStudentNurses and
(Greenhow and Galvin, 2020). The purpose of this research is to inves­
by a very active student nurses' community in Scotland. The fourth step
tigate student nurses use of SoMe for learning to support and guide
during the data collection involved response monitoring, weekly VLE re-
Higher Education Institutions and nursing educators to use SoMe
advertising, daily for the first week on SoMe, then weekly. Originally
effectively in teaching and learning, especially in relation to country,
planned for 3 months, however due to recruitment difficulties in the
generation and year of education settings, to help adapting SoMe use to
Caribbean sites the deadline was extended to 6 months, after which data
the student population. To address these gaps in knowledge and to
collection closed (step 5).
enhance student nurses teaching and learning through SoMe, this study
had two research questions: 1. What do student nurses use SoMe for in
their learning? 2. What are the differences in SoMe use in learning be­ 2.3. Data collection
tween generations, years of study and the 3 countries investigated?
This study is the first to investigate and compare Caribbean student A cross-sectional survey was used comprising 31 items, with 6
nurses use of SoMe for learning with UK student nurses. The findings questions on demography and 24 on SoMe use and learning utilising a 5
may offer new knowledge on how the student nurses of Trinidad and point Likert scale, yes or no responses and one open ended question. The
Tobago, Jamaica and the UK use social media for learning. The study free text comments will be reported in a subsequent paper. The survey
outcomes have potential to support the theory that SoMe is useful and was developed by the authors specifically for this study based on a
beneficial in student learning and provide guidance on the imple­ literature search and authors' knowledge and research in SoMe for ed­
mentation of SoMe use in the learning process. This provides support ucation and piloted with the student body and academic staff from the
and understanding towards the management of SoMe in the curriculum Schools and no changes were required. The pilot helped us to identify if
and delivery of education by nursing educators to improve effectiveness any modifications to questions were required and to ensure cultural
and use. congruence. Data cleaning identified anomalies in age for three

Table 1
1.2. Aim and objectives Inclusion/exclusion criteria.
Inclusion criteria Exclusion criteria
This study aimed to identify how SoMe is used for learning purposes
by student nurses across 3 countries. - Any type of student nurse enrolled on - Anyone who is not a student nurse and
a pre- registration nursing programme enrolled on a pre-registration nursing
The objectives were to:
(In England this includes Nursing programme
Associates) - Any student nurse who is not from
- Identify how student nurses in each country use SoMe for learning. - Student nurses on any year of the either of the participating countries
- Identify how each generation of student nurses use SoMe for programme
learning. - Student Nurses from United Kingdom,
Jamaica and Trinidad & Tobago
- Identify how student nurses use SoMe as education progresses.

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X. Cathala et al. Nurse Education Today 107 (2021) 105160

observations, which were excluded. (Table 2).

2.4. Ethical consideration 3.2. Social media platforms and usage per country

Ethical approval was granted from all the participating institutions. Tables 3, 7, and 9 show the use of SoMe by country, generation and
We ensured no coercion by reminding students at every stage that for each year of nursing education. Both Caribbean countries pre-
participation was voluntary and did not impact their studies. We also registration BSc nursing programmes were over 4 year, while the UK
reiterated responses were anonymous, and that data were protected had 3 year programmes. Participants had a choice of six different SoMe
using a University password locked server ensuring General Data Pro­ platforms. The entire Jamaican sample used WhatsApp®, with most
tection Regulation and local ethical compliance. The first question of the from Trinidad and Tobago (97.5%) and the UK (86.6%) also reporting
survey was a consent question, any participants who did not consent WhatsApp® use. Instagram® use was similar in all countries ranging
were excluded. Participants were informed that once the survey was from 76.1% (UK) to 81.7% (Jamaica). Jamaica and Trinidad and Tobago
submitted, we could not withdraw them from the study. had similar use of YouTube® (93.3% and 88.6% respectively) while the
UK used it less (59.7%). Facebook® was used more in the UK (88.7%)
2.5. Data analysis compared to the Caribbean countries (69%). Twitter® was used less by
the Caribbean participants (20%) compared to the UK (60%). The least
To achieve the study's aim and objectives descriptive and inferential used platform in all countries was LinkedIn® with a use between 7.6%
statistics were performed using SPSS® statistics software version 25.0. (Trinidad and Tobago) and 13.3% (Jamaica).
Kruskal-Wallis tests and Dunn post hoc tests with Bonferroni corrections Watching videos and downloading articles represented two-thirds of
were used to test for differences in SoMe use by country, generation and SoMe uses. Knowledge concerning the Nursing Council's SoMe guidance
year of study. Statistical significance was set at p < 0.05 (two-tailed). was 15% in Jamaican participants and 22.8% of Trinidad and Tobago
participants were aware of guidance. In the UK, 86.1% of the sample
3. Results reported knowledge of the Nursing Council's guidance.
Kruskal-Wallis tests (KWT) showed statistically significant differ­
Data cleaning removed those that did not meet the eligibility criteria ences between countries in checking SoMe during lectures, (p < 0.001).
(e.g., non-consent) N = 1050. Data management involved creating a The post hoc test showed that there were no significant differences in
codebook with identified variables. The UK response was N = 832, checking SoMe in lectures between the UK and Trinidad and Tobago (p
Trinidad and Tobago N = 158 and Jamaica N = 60. = 0.261). Significant differences were observed between the UK and
Jamaica (p < 0.001) and Trinidad and Tobago and Jamaica (p = 0.002).
3.1. Demography: age, gender and ethnicity Jamaican participants checked their SoMe during lectures more than the
other countries. Messaging during lectures was analysed and KWT
Previously reported demographic data (Cathala et al., 2021) showed showed a significant difference between the 3 countries (H(2) = 29.7, p
that participants from Jamaica and Trinidad and Tobago had similar < 0.001). Dunn's test showed that messaging during lectures was
mean age of 23 yrs. (6.00) and a mean age for UK participants of 29 yrs. significantly different between the UK and Jamaica (p < 0.001) and
(9.01). Participants were predominately females for all countries. Trinidad and Tobago and Jamaica (p = 0.002). Jamaican students'
The sample included twelve ethnic groups. Jamaican student nurses message more during lectures than those in the UK and Trinidad and
identified 4 ethnicities, Trinidad and Tobago 6 and UK participants 11 Tobago. Concerning the use of SoMe for studies and SoMe in classroom
activities, a significant differences was found between counties (H(2) =
Table 2 97.7, p < 0.001; H(2) = 24.4, p < 0.001). Dunn's tests demonstrated that
Demographic data. the use of SoMe in studies was significantly different between the UK
Countries
and Trinidad and Tobago (p < 0.001) and UK and Jamaica (p < 0.001),
and no significance between Jamaica and Trinidad and Tobago. UK
Jamaica Trinidad & UK
Participants used SoMe less for studies than in Jamaica and Trinidad and
Tobago
Tobago. This same test revealed that the use of SoMe in classroom ac­
N (%) N (%) N (%)
tivities were significantly different between the UK and Trinidad and
Gender Male 3 (5.0) 8 (5.1) 92 (12.0) Tobago (p < 0.001) and the UK and Jamaica (p = 0.003), but not be­
Female 57 (95.0) 150 (94.9) 737 (88.6) tween Trinidad and Tobago and Jamaica. Participants in the UK used
Non-binary 0 (0.0) 0 (0.0) 3 (0.4)
SoMe less in classroom activities than in Jamaica and Trinidad and
Total 60 (100.0) 158 (100.0) 832 (100.0)
Ethnicity British White 0 (0.0) 0 (0.0) 593 (71.3) Tobago. (Table 4).
British Black 0 (0.0) 0 (0.0) 36 (4.3) All countries most common SoMe access mode was smart phones
British Asian 0 (0.0) 0 (0.0) 17 (2.0) followed by laptops and desktop computers. Most participants accessed
Caribbean 52 (86.7) 59 (37.3) 18 (2.2)
SoMe from multiple devices.
Black
Caribbean 0 (0.0) 8 (5.1) 1 (0.1) This analysis demonstrated how student nurses use SoMe in their
Asian learning. Students from the Caribbean countries use and integrate SoMe
Caribbean 0 (0.0) 3 (1.9) 0 (0.0) more in their studies compared to the UK. The next variable analysed in
White this study was age as a factor in student nurses using SoMe for learning.
Black African 5 (8.3) 15 (9.5) 86 (10.3)
Any Other 1 (1.7) 0 (0.0) 1 (0.1)
Black 3.3. Generational use of social media
Any Other 0 (0.0) 0 (0.0) 15 (1.8)
Asian Age was recoded into four generational groups Boomers II (BII),
Any Other 0 (0.0) 0 (0.0) 41 (4.9)
Generation X (GenX), Generation Y (GenY), and Generation Z (GenZ)
White
Mixed 2 (3.3) 57 (36.1) 17 (2.0) (Strauss and Howe, 1991) (Tables 5 and 6).
Ethnicity While the range of SoMe platforms used were similar, within group
Any Other 0 (0.0) 16 (10.1) 7 (0.8) analysis of generational use of SoMe platforms showed that BII all used
Ethnicity Facebook®, YouTube® and WhatsApp® most followed by Twitter®
Total 60 (100.0) 158 (100.0) 832 (100.0)
(25%) and Instagram® (25%). GenX used WhatsApp® (92%) the most

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X. Cathala et al. Nurse Education Today 107 (2021) 105160

Table 3
Social media usage by country.
Countries

Jamaica Trinidad & UK

Tobago

N (%) N (%) N (%)

Reason for using social media Video, short clips 47 (78.3) 112 (70.9) 473 (56.9)
Download an article or paper 37 (61.7) 98 (62.0) 530 (63.7)
Participate in an online chat or forum 18 (30.0) 63 (39.9) 360 (43.3)
Share information and ideas with other healthcare 24 (40.0) 60 (38.0) 356 (42.8)
professionals
Complete a social media learning task 13 (21.7) 46 (29.1) 198 (23.8)
Total 60 (100.0) 158 (100.0) 832 (100.0)
Have you ever checked your social media profile during a lecture? Never 2 (3.3) 18 (11.4) 155 (18.6)
Rarely 7 (11.7) 39 (24.7) 175 (21.0)
Sometimes 27 (45.0) 66 (41.8) 352 (42.3)
Most of the time 13 (21.7) 19 (12.0) 103 (12.4)
Always 11 (18.3) 16 (10.1) 47 (5.6)
Total 60 (100.0) 158 (100.0) 832 (100.0)
Have you ever used your account to post or send messages during Never 4 (6.7) 25 (15.8) 202 (24.3)
a lecture? Rarely 6 (10.0) 37 (23.4) 174 (20.9)
Sometimes 29 (48.3) 68 (43.0) 340 (40.9)
Most of the time 10 (16.7) 16 (10.1) 83 (10.0)
Always 11 (18.3) 12 (7.6) 33 (4.0)
Total 60 (100.0) 158 (100.0) 832 (100.0)
Have you ever used social media to help with your nursing Never 0 (0.0) 5 (3.2) 87 (10.5)
studies? Rarely 5 (8.3) 6 (3.8) 91 (10.9)
Sometimes 17 (28.3) 55 (34.8) 432 (51.9)
Most of the time 16 (26.7) 41 (25.9) 155 (18.6)
Always 22 (36.7) 51 (32.3) 67 (8.1)
Total 60 (100.0) 158 (100.0) 832 (100.0)
Have you ever used social media to help in a classroom activity? Never 9 (15.0) 19 (53.2) 203 (24.4)
Rarely 5 (8.3) 31 (19.6) 144 (17.3)
Sometimes 32 (53.3) 73 (46.2) 396 (47.6)
Most of the time 7 (11.7) 15 (9.5) 58 (7.0)
Always 7 (11.7) 20 (12.7) 31 (3.7)
Total 60 (100.0) 158 (100.0) 832 (100.0)
How do you access social media? Smart phone 58 (96.7) 152 (96.2) 829 (99.6)
Tablet 27 (45.0) 45 (28.5) 356 (42.8)
Desk top computer 4 (6.7) 24 (15.2) 105 (12.6)
Laptop computer 43 (71.7) 114 (72.2) 493 (59.3)
Internet café 3 (5.0) 12 (7.6) 9 (1.1)
Hospital computer 0 (0.0) 1 (0.6) 15 (1.8)
University computer 4 (6.7) 20 (12.7) 90 (10.8)
Total 60 (100.0) 158 (100.0) 832 (100.0)

Table 4
Kruskal Wallis and Post hoc test per country.
Countries

Jamaica Trinidad and United Kingdom UK – Trinidad and UK – Trinidad and Tobago –
Tobago (UK) Tobago Jamaica Jamaica

In lecture N/mean rank 60/698 158/551 832/508 42.9 189.4 146.5

Std. error 25.1 38.6 43.8
Std. test statistic (Z 1.7 4.9 3.3
score)
p value <0.001* 0.26 <0.001* <0.001*
Message in N/Mean rank 60/708 158/558 832/506 51.7 202.1 150.3
lecture Std. error 25.1 68.6 43.8
Std. test statistic (Z 2.1 5.2 3.4
score)
p value <0.001* 0.117 <0.001* 0.002*
Studies N/mean rank 60/713 158/688 832/481 206.4 231.3 24.9
Std. error 24.6 38.0 43.1
Std. test statistic (Z 8.4 6.09 0.6
score)
p value <0.001* <0.001* <0.001* 1.000
In classroom N/mean rank 60/628 158/603 832/503 99.1 124.1 24.9
Std. error 24.6 38.0 43.0
Std. test statistic (Z 4.0 3.3 0.5
score)
Adj. sig. (p value) <0.001* <0.001* 0.003* 1.000
*
Significance levels p < 0.05.

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X. Cathala et al. Nurse Education Today 107 (2021) 105160

Table 5
Generations.
Generations Date of birth between
Boomers II (BII) 1955–1965
Generation X (GenX) 1966–1976
Generation Y (GenY) 1977–1994
Generation Z (GenZ) 1995–2015
followed by Facebook® (86.7%), YouTube® (62.7%), Twitter®
(46.7%), Instagram® (44.0%) and LinkedIn® (17.3%). GenY reported
using WhatsApp® (92%) the most followed by Facebook® (84.3%),
Instagram® (68.5%), YouTube® (62.2%), Twitter® (49.5%) and Link­
edIn® (15%). GenZ's platform usage was highest for Instagram®
(88.6%) followed by WhatsApp® (86.3%), Facebook® (84.3%), You­
Tube® (69%), Twitter® (54.6%) and LinkedIn® (7.7%). Participants
were asked if they used SoMe for watching videos and short clips,
downloading articles, participating in an online chat, sharing informa­
tion and ideas or completing a SoMe learning task. All BII participants
downloaded articles, followed by shared information and ideas (75%),
watched videos (50%) and completed SoMe learning tasks (25%). In
GenX the most frequent reason for using SoMe was downloaded articles
(70.7%), followed by shared information and ideas (60%), watched
videos (58.7%), participated in online chat (54.7%) and completed
SoMe learning tasks (28%). GenY, downloaded articles (62.7%) was the
most common reason, followed by watched videos (57.7%), shared in­
formation and ideas (47.7%), participated in an online chat (46.2%) and
Age (yrs) in 2020 completed a SoMe learning task (22.3%). GenZ watched videos the most
(62.5%), followed by downloaded articles (62.4%), participated in on­
65–55
54–44 line chat (37.1%), shared information and ideas (34.5%) and completed
43–26 SoMe learning tasks (25.6%). Reporting knowledge of Nursing Council's
25–05 SoMe guidance was more common by BII (100%), GenX (86.7%), and
GenY (80.8%) than GenZ (63.8%). BII (50%) checked SoMe the least
during lectures followed by GenX (61.3%), Gen Y (77.5%) and GenZ
(91.3%).
Kruskal-Wallis tests showed significant differences between genera­
tions in SoMe checking during lectures (H(3) = 116.2, p < 0.001).
Dunn's tests showed significant differences between GenX and GenY (p
= 0.003), GenX and GenZ (p < 0.001) and GenY and Genz (p < 0.001) in
checking SoMe during lectures. There were no significant differences
between GenX and BII (p = 1.000), BII and GenY (p = 1.000) and BII and
GenZ (p = 0.440). GenZ reported checking SoMe the most, followed by
GenY, BII and GenX . Concerning messaging during lectures, KWT
demonstrated significant differences in messaging during lectures be­
tween generations (H(3) = 121.8, p < 0.001). Dunn's tests identified a
significant difference between BII and GenZ (p = 0.014), GenX and GenY
(p = 0.002), GenX and GenZ (p < 0.001) and GenY and GenZ (p < 0.001)
in messaging during lectures. No significant difference was observed
between BII and GenX (p = 1.000) and BII and GenY (p = 0.321). BII

Table 6
Generation in the sample.
Countries

Jamaica Trinidad & Tobago UK

N (%) N (%) N (%)

Age by generation Boomers II 0 (0.0) 0 (0.0) 4 (0.5)

Generation X 0 (0.0) 3 (1.9) 72 (8.7)
Generation Y 10 (16.9) 34 (21.5) 382 (46.0)
Generation Z 49 (83.1) 121 (76.6) 372 (44.8)
Total 59 (100.0) 158 (100.0) 830 (100.0)

Table 7
Social media usage by generation.
Generations

Boomers II Generation X Generation Y Generation Z

N (%) N (%) N (%) N (%)

Have you ever used your account to post or send messages during a lecture? Never 3 (75.0) 35 (46.7) 125 (29.3) 67 (12.4)
Rarely 1 (25.0) 21 (28.0) 96 (22.5) 99 (18.3)
Sometimes 0 (0.0) 18 (24.0) 176 (41.3) 243 (44.8)
Most of the time 0 (0.0) 1 (1.3) 22 (5.2) 86 (15.9)
Always 0 (0.0) 0 (0.0) 7 (1.6) 47 (8.7)
Total 4 (100.0) 75 (100.0) 426 (100.0) 542 (100.0)
Have you ever used social media to help with your nursing studies? Never 1 (25.0) 6 (8.0) 45 (10.6) 40 (7.4)
Rarely 1 (25.0) 7 (9.3) 44 (10.3) 50 (9.3)
Sometimes 0 (0.0) 34 (45.3) 226 (53.1) 243 (44.8)
Most of the time 1 (25.0) 19 (25.3) 77 (18.1) 115 (21.2)
Always 1 (25.0) 9 (12.0) 34 (8.0) 94 (17.3)
Total 4 (100.0) 75 (100.0) 426 (100.0) 542 (100.0)
Have you ever used social media to help in a classroom activity? Never 1 (25.0) 26 (34.7) 96 (22.5) 107 (19.7)
Rarely 0 (0.0) 10 (13.3) 76 (17.8) 94 (17.3)
Sometimes 1 (25.0) 30 (10.0) 209 (49.1) 260 (48.0)
Most of the time 1 (25.0) 6 (8.0) 25 (5.9) 48 (8.9)
Always 1 (25.0) 3 (4.0) 20 (4.7) 33 (6.1)
Total 4 (100.0) 75 (100.0) 426 (100.0) 542 (100.0)
How do you access social media? Smart phone 4 (100.0) 75 (100.0) 423 (99.3) 534 (98.5)
Tablet 4 (100.0) 38 (50.7) 187 (43.9) 197 (36.3)
Desk top computer 0 (0.0) 23 (30.7) 62 (14.6) 47 (8.7)
Laptop computer 3 (75.0) 47 (62.7) 245 (57.5) 352 (64.9)
Internet café 0 (0.0) 1 (1.3) 7 (1.6) 15 (2.8)
Hospital computer 0 (0.0) 3 (4.0) 9 (2.1) 4 (0.7)
University computer 1 (25.0) 15 (20.0) 55 (12.9) 43 (7.9)
Total 4 (100.0) 75 (100.0) 426 (100.0) 542 (100.0)

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X. Cathala et al. Nurse Education Today 107 (2021) 105160

Table 8
Kruskal Wallis test and Post hoc test per generation.
Generation

BII GenX GenY GenZ GenX- GenX – GenX – BII – BII – GenZ GenY –
BII GenY GenZ GenZ GenZ

In lecture N/mean rank 4/ 75/ 426/ 542/

353 324 450 512
Std. error 147.8 36.1 35.5 144.6 144.5 18.6
Std. test statistic (Z − 0.2 3.5 8.1 0.7 1.8 8.7
score)
p value <0.001* 1.000 0.003* <0.001* 1.000 0.440 <0.001*
Message in N/mean rank 4/ 75/ 426/ 542/
lecture 171 321 451 612
Std. error 147.7 144.6 144.5 36.0 35.5 18.6
Std. test statistic (Z 1.0 1.9 3.0 3.6 8.2 8.7
score)
p value <0.001* 1.000 0.321 0.014* 0.002* <0.001* <0.001*
Studies N/mean rank 4/ 75/ 426/ 542/
493 540 480 557
Std. error 142.3 35.5 18.3 145.3 142.1 34.8
Std. test statistic (Z − 0.1 − 1.7 4.2 0.3 0.0.4 0.5
score)
p value <0.001* 1.000 0.525 <0.001* 1.000 1.000 1.000
In classroom N/Mean rank 4/NA 75/NA 426/NA 542/NA
p value 0.053 No post hoc test Kruskal Wallis test not significant
*
Significance levels p < 0.05.

Table 9
Social media usage by year of education.
Years of education

1st year 2nd year 3rd year 4th year

N (%) N (%) N (%) N (%)

Country Jamaica 13 (3.9) 12 (3.2) 16 (5.5) 19 (35.2)

Trinidad and Tobago 75 (22.7) 40 (10.7) 18 (6.2) 25 (46.3)
UK 243 (73.4) 323 (86.1) 256 (88.3) 10 (18.5)
Total 331 (100.0) 375 (100.0) 290 (100.0) 54 (100.0)
Have you ever checked your social media profile during a lecture? Never 71 (21.5) 70 (18.7) 30 (10.3) 4 (7.4)
Rarely 87 (26.3) 69 (18.4) 54 (18.6) 11 (20.4)
Sometimes 123 (37.2) 168 (44.8) 125 (43.1) 29 (53.7)
Most of the time 28 (8.5) 45 (12.0) 58 (20.0) 4 (7.4)
Always 22 (6.6) 23 (6.1) 23 (7.9) 6 (11.1)
Total 331 (100.0) 375 (100.0) 290 (100.0) 54 (100.0)
Have you ever used your account to post or send messages during a lecture? Never 98 (29.6) 79 (21.1) 47 (16.2) 7 (13.0)
Rarely 76 (23.0) 86 (22.9) 46 (15.9) 9 (16.7)
Sometimes 121 (36.6) 154 (41.1) 135 (46.6) 27 (50.0)
Most of the time 22 (6.6) 38 (10.1) 45 (15.5) 4 (7.4)
Always 14 (4.2) 18 (4.8) 17 (5.9) 7 (13.0)
Total 331 (100.0) 375 (100.0) 290 (100.0) 54 (100.0)
Have you ever used social media to help with your nursing studies? Never 41 (12.4) 36 (9.6) 15 (5.2) 0 (0.0)
Rarely 29 (8.8) 40 (10.7) 29 (10.0) 4 (7.4)
Sometimes 161 (48.6) 177 (47.2) 144 (49.7) 22 (40.7)
Most of the time 55 (16.6) 84 (22.4) 62 (21.4) 11 (20.4)
Always 45 (13.6) 38 (10.1) 40 (13.8) 17 (31.5)
Total 331 (100.0) 375 (100.0) 290 (100.0) 54 (100.0)
Have you ever used social media to help in a classroom activity? Never 83 (25.1) 87 (23.2) 55 (19.0) 6 (11.1)
Rarely 66 (19.9) 62 (16.5) 44 (15.2) 8 (14.8)
Sometimes 150 (45.3) 176 (46.9) 148 (51.0) 27 (50.0)
Most of the time 18 (5.4) 30 (8.0) 25 (8.6) 7 (13.0)
Always 14 (4.2) 20 (5.3) 18 (6.2) 6 (11.1)
Total 331 (100.0) 375 (100.0) 290 (100.0) 54 (100.0)

texted the least, followed by GenX, GenY and GenZ. Generational use of
SoMe for studies was investigated and KWT showed statistically signif­
icant differences (H(3) = 18.0, p < 0.001) between generations in SoMe
use for studies. Dunn's test was significant for GenY and GenZ (p <
0.001) but not significant between the other generations. GenZ used
SoMe the most in their studies, followed by GenX, GenY and BII. There
were no significant differences between SoMe use in classroom activities
by generations (H(3) = 7.7, p = 0.053) (Table 8).
3.4. Social media usage by year of education
In Jamaica and Trinidad and Tobago, a nursing degree is 4 years,
while in England, Ireland and Scotland the programme is 3 years, with
an optional 4th year in Scotland to obtain a Master of Science. SoMe use
was analysed by different cohorts (years) of the nursing programme, the
mean age for each year of study in the entire sample was similar 28 yrs.
(8.77). Regarding the distribution of countries, apart from the 4th year
the UK was the most represented for each year of study followed by
Trinidad and Tobago and Jamaica (Table 9).

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X. Cathala et al. Nurse Education Today 107 (2021) 105160

Table 10
Kruskal Wallis test and Post hoc test per year of education.
Year of education

1 2 3 4 1–2 1–3 1–4 2–3 2–4 3–4

In lecture N/Mean rank 331/468 375/518 290/591 54/577

Std. error 21.8 42.4 23.2 42.0 22.6 42.8
Std. test statistic (Z score) − 2.3 − 2.6 − 5.3 − 1.4 − 3.3 0.332
p value <0.001* 0.142 0.062 <0.001* 0.940 0.007* 1.000
Message in lecture N/mean rank 331/462 375/521 290/589 54/607
Std. error 21.8 23.2 42.4 22.6 42.0 42.8
Std. test statistic (Z score) − 8.7 − 5.5 − 3.4 − 3.0 − 2.1 − 0.4
p value <0.001* 0.042* <0.001* 0.004* 0.015* 0.235 1.000
Studies N/mean rank 331/502 375/510 290/545 54/665
Std. error 21.4 22.8 41.7 22.2 41.3 42.1
Std. test statistic (Z score) − 0.3 − 1.9 − 3.9 − 1.6 − 3.8 − 2.8
p value <0.001* 1.000 0.351 0.001* 0.653 0.001* 0.027*
In classroom N/mean rank 331/488 375/521 290/554 54/628
Std. error 21.4 22.8 41.6 22.2 41.3 42.0
Std. test statistic (Z score) − 1.6 − 2.9 − 3.4 − 1.5 − 2.6 − 1.8
p value 0.001* 0.721 0.023* 0.005* 0.843 0.057 0.462
*
Significance levels p < 0.05.

Cross tabulation by year of study was performed to investigate the
use of SoMe, starting with the platform used. The 1st year students used
WhatsApp® (88.5%) the most, followed by Facebook® (80.7%), Insta­
gram® (77.6%), YouTube® (65%), Twitter® (47.4%) and LinkedIn®
(8.8%). The 2nd year had similar usage. For the 3rd year students, the
distribution differed slightly, Facebook® (88.3%) was the most used
then WhatsApp® (85.9%), Instagram® (77.2%), Twitter® (64.8%),
YouTube® (57.6%) and LinkedIn® (15.5%). The 4th year used What­
sApp® most (96.3%) then YouTube® (88.9%) followed by Instagram®
and Facebook® equally used (83.3%), Twitter® (20.4%) and finally
LinkedIn® (13.0%). The main uses of SoMe for the 1st year were
watching videos (61.9%), downloading articles (59.5%), online chat
(40.5%), sharing information (34.7%) and completing a SoMe learning
task (25.7%). The 2nd year mostly used SoMe for downloading articles
(65.1%) followed by watching videos (61.9%), online chat (42.7%),
sharing information (40.3%) and completing SoMe tasks (26.1%). 3rd
year students mainly used SoMe for downloading articles (66.6%),
watching videos (53.8%), sharing information (52.1%), online chat
(46.6%) and completing SoMe learning tasks (23.4%). The 4th year
students mostly watched videos (72.2%), downloaded articles (57.4%),
shared information (42.6%), online chat (22.2%) and completed SoMe
learning tasks (11.1%). Knowledge of Nursing Council SoMe guidance
was reported most by 2nd year students (80.8%), followed by 3rd year
(75.5%), 1St year (67.1%) and 4th year students (31.5%).
There were significant differences in checking SoMe during lectures
by year of nursing study (H(3) = 30.0, p < 0.001). Dunn's tests showed
significant differences between 1st and 3rd year (p < 0.001) and 2nd and
3rd year students (p = 0.007) but there were no significant differences
between other years regarding checking SoMe during lectures. 1st years
reported checking SoMe the least during lectures, followed by 2nd year,
3rd year and 4th year students. There was significance between years of
study and messaging in lectures (H(3) = 34.5, p < 0.001). Dunn's tests
showed significant differences between 1st and 2nd year (p = 0.042), 1st
and 3rd year (p < 0.001), 1st and 4th year (p = 0.004) and 2nd and 3rd
year students (p = 0.015), but no significant difference between 2nd and
4th year and 3rd and 4th year in messaging during lectures. 4th year
students reported messaging during lectures the most, followed by 3rd
year, 2nd year and 1st year students. A significant difference between
the use of SoMe for studies by year of study was observed (H(3) = 17.8,
p < 0.001). Dunn's tests showed significant differences between 1st and
4th year students (p < 0.001), 2nd and 4th year students (p < 0.001) and
3rd and 4th year students (p = 0.027) in SoMe use for studies. 1st years
reported using SoMe in their studies least, followed by 2nd year, 3rd
year and 4th year students. There was a significant difference in the use
of SoMe in the classroom by year of study (H(3) = 15.9, p < 0.001).
Dunn's tests showed significant differences between 1st and 3rd year
students (p = 0.023) and 1st and 4th year students (p = 0.005) in the use
of SoMe in the classroom. 1st year students reported using SoMe in the
classroom the least, followed by 2nd year students, 3rd year students
and 4th year students (Table 10).
4. Discussion
Types of SoMe platforms used across our sample was aligned with
those identified in the study by Price et al. (2018). However, uses of
SoMe were different and could reflect distinctive uses of SoMe by nurse
educators in teaching and learning material and approaches as well as
reflecting different learning styles. YouTube® video and short clips are
particularly suitable in supporting behaviourist teaching especially in
skills learning. In our study, all students regardless of country of origin,
reported checking SoMe in lectures. It was not established if these were
for professional or personal reasons. Furthermore, participants in
Caribbean countries used SoMe more for messaging during lectures, in
their studies, and in classroom activity than those from in UK. This is an
important observation considering that Caribbean participants reported
limited internet access. The majority of the student nurses a study by
Duke et al. (2017) discussed academic issues on SoMe. Similarly, the
majority of respondents in a study by Alsayed, Bano, and Alnajjar (2020)
reported accessing SoMe platforms for academic purposes. Students
from Caribbean countries clearly use and integrate more SoMe in their
learning than their counterparts in the UK. The relatively low use of
SoMe for learning in the UK could reflect: (i) educators' lack of knowl­
edge; (ii) reluctance to adopt SoMe in teaching & learning practices; (iii)
acknowledgement related to older generations learning style; and (iv)
the educator's generation.
Older generations (BII) appeared to use fewer platforms than
younger generations (Delello and McWhorter, 2017). Generational
characteristic had an impact on students' learning style. Younger gen­
erations used more video and short clips and appeared to be visual
learners whereas older generations seem to be reading learners. This
could be related to their primary education, for example, BII were
probably taught by reading compared to GenZ who may have been
taught with videos and online technology. This can have an important
impact on learning organisation and acquisition. The significant differ­
ence observed between generations regarding using SoMe during a
lecture could be attributed to how technology has changed the way we
communicate. Almost all SoMe platforms have a direct messaging
function, making it easy to send messages over the internet. It may also
be perceived as being less disruptive in a lecture. This data was inter­
esting to contrast with (Cathala et al., 2021) study that showed BII were

7
X. Cathala et al.
messaging mostly when on duty in clinical practice. However, Usher
et al. (2014) showed that participants' preferred primary source of in­
formation was online media. A generational difference was identified in
SoMe use while studying, with younger generations using SoMe the most
for this purpose. However, there was no significant difference in the
generational use of SoMe in classroom activities. This could be explained
by educational materials and resources embedded in SoMe platforms
(Price et al. (2018); Männistö et al., 2019; Alsayed et al., 2020). SoMe
use in classroom activities is mainly directed by the educator who plans
the learning activity and can incorporate SoMe to meet the learning
outcomes. This approach can minimise, generational differences on the
use of SoMe for learning and enhance individual learning outside
classroom activities and lectures.
During the 4th year of education, half of the SoMe platforms were
used consistently but 2 had increased usage, Twitter® and LinkedIn®.
This was represented mostly by Caribbean countries with an initial low
use of Twitter®. This could be explained by Twitter® being linked with
searching for clinical resources and materials, sharing and exchanging
professional ideas (Kung and Oh, 2014), and LinkedIn® known for job
prospects (Huang et al., 2014). Our study clearly identified that the use
of SoMe differs between the years of education. 1st year student nurses
used mostly YouTube®, which is an efficient teaching resource for
behaviourism, which is known as an effective teaching theory in skill
learning and resonated with some skills of “watch and repeat” (Stewart,
2012). 1st year student nurses were from younger generations who
seemed to be more visual learners and comfortable in SoMe use for
learning. During the 2nd year of education YouTube® use decreased,
while the use of SoMe for downloading articles, chat and discussion such
as Twitter® increased. This phenomenon could be related to the increase
of underpinning theories and academic skills teaching, older generations
could have become more comfortable with the theoretical stage of
“enlightenment” (Stewart, 2012) potentially involving more construc­
tivist methods (reading, peer discussion). The 3rd and 4th year of edu­
cation can be seen as “consolidation and going further” where theories
of connectivism and constructivism can be applied to student nurses'
autonomies and prepare them for their new career. These stages in
learning can support understanding of student nurses' behaviour in
relation to SoMe learning use. Since its inception SoMe has not only
gained importance as a resource but also as teaching material which can
explain its increased use in lectures, messaging in lectures, in studies and
in classroom activities. Our study showed that SoMe use for learning
increased as the course progressed, at an individual and group level,
which could demonstrate a growth in confidence to use SoMe toward the
final year (Price et al., 2018) but also by an augmentation of the inte­
gration of SoMe in the classroom. Across the study, the smartphone was
the most common device used to access SoMe, followed by laptops and
tablets. Student nurses' use of social media through the various years of
education can be linked to elements of VARK (visual, auditory, reading/
writing, and kinaesthetic) pedagogical theory (Prithishkumar and
Michael, 2014). Importantly educators should not use VARK and social
media to label student learning styles but use the knowledge to improve
the way students learn, augmenting social media learning with class­
room activities and incorporating it into the curriculum. In our experi­
ence of VARK and social media learning, students tend to sit in the
middle between visual and auditory learning styles. Therefore, social
media can be a way of helping students to identify learning styles and
help educators to meet learning needs (Idrizi and Filiposka, 2018).
This study has limitations, it focussed on student nurses' SoMe use in
learning and not in the general use of SoMe or qualified nurses' use. The
survey was a self- assessment, developed by the authors and was used for
the first time. Jamaica did not meet the sample size, but UK and Trinidad
and Tobago did. The survey sample was not random and therefore may
not be representative of the wider student nurse populations in these
countries. The results may be applicable to other countries with a similar
nursing education system. However, further research in a wider range of
countries would be necessary to demonstrate this empirically.
8
Nurse Education Today 107 (2021) 105160
5. Conclusion and recommendation
Understanding SoMe usage by student nurses for learning is funda­
mental. Country, generation and year of education are factors that in­
fluence the use of SoMe in learning and should be taken into
consideration by educational institutions in curriculum development
and teaching and learning delivery. The knowledge generated from this
study can be linked with learning theories facilitating transferability
into practice and present important information to effectively use SoMe
to tailor teaching and learning to the student population. SoMe should
be incorporated into the nursing curriculum as a learning tool and
guidance and support offered to student nurses on its appropriate use.
From a pragmatic approach, SoMe is already available and used by a
majority of student nurses and can be widely assimilated into the
nursing curriculum and teaching and learning processes. A wider choice
of teaching and learning approaches as well as a more individual
learning experience by using SoMe can increase inclusivity and equity.
Funding
There is no funding for this research project.
CRediT authorship contribution statement
All authors meet the criteria for authorship, have approved the final
article and all those entitled to authorship are listed as authors. This
work is original and has not previously been published or in the process
of being considered for publication in any other journal. This article is
from of a larger programme of research, in which we are investigating an
international comparison of student nurses' use of social media for
learning.
Credit author statement:
Xabi Cathala: Conceptualization, Methodology, Validation, Formal
analysis, Investigation, Resources, Data Curation, Writing - Original
Draft, Writing - Review & Editing, Visualization, Supervision, Project
administration. Oscar Ocho: Conceptualization, Methodology, Valida­
tion, Formal analysis, Investigation, Resources, Data Curation, Writing -
Original Draft, Writing - Review & Editing, Visualization. Paul Watts:
Conceptualization, Methodology, Validation, Formal analysis, Investi­
gation, Resources, Data Curation, Writing - Original Draft, Writing -
Review & Editing, Visualization. Calvin Moorley: Conceptualization,
Methodology, Validation, Formal analysis, Investigation, Resources,
Data Curation, Writing - Original Draft, Writing - Review & Editing,
Visualization.
Declaration of competing interest
None.
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