Abstract

The use of social media in nursing is accelerating rapidly after its relatively recent

commencement in 1989. These continuing enhancements have led to the social media platforms

available today including Facebook, Blackboard, and YouTube among many others. Even with

the organizations such as The Truth About Nursing and The World Health Organization set in

place, predators still lurk within the realm, and unaccredited sources are taking the forefront and

potentially providing harmful information to the public. Maintaining an open forum environment

that is safe for users is a major obstacle currently faced. Misconstrued public images of nurses

related to personal posts, untrustworthy information, and pitfalls of web-based educational

systems all play a role in the risks related to this professional issue. Decisions to abstain from

using social media are often made to avoid all consequences; however, it is a disservice to the

nursing community and public to boycott all social media because the potential benefits

including public support, professional networking and accredited information outweigh the risks

involved. Nurses possess the potential to have a positive impact on this matter. Nurses can

educate patients on safe practices and apply those practices themselves. In conjunction with

professional organizations, nursing professionals and students have the ability to impose safe

practices, visit monitored internet pages while reporting prospective threats, and coach patients

on deciphering accredited information from misleading data. Further research to improve current

standards is necessary to develop secure platforms for the public and professionals. Secure

platforms and accessible outreach will provide a better experience for the public as well as

healthcare professionals.
Introduction: why is this subject important

The social media arena of nursing continually evolves as a result of worldly social media

and technological advancements. When connecting social media to nursing, many health care

professionals, nursing students, and the public have a negative connotation. However, with this

influx of social media use related to healthcare, safer, more efficient ways of using social media

are being established from previous mistakes and shortcomings. The patient experience, nursing

professionals, academic references, and web-based nursing education systems are all affected by

social media trends. Gorea et al. explain, "Social media is defined as a constellation of internet-

based tools that help users to connect, collaborate and communicate with other users in real-

time" (2016, p. 2). With social media proliferating, it is now considered the mainstream

communication method for the population (Gorea et al., 2016). Identifying social media issues is

integral in providing the best patient experience, maintaining nursing professionals' safety, and

accelerating web-based nursing education systems. There are multiple factors on social media

issues in nursing, including but not limited to; patient privacy, unfavorable representation of the

nursing profession, the anonymity social media allows, accuracy concerns, unpredictability, and

digital divides (Huston 2020). Social media’s focus population has mainly been younger adults

who have the most access and most remarkable ability to use technological techniques for

information. With this revolution of social media, including access to patient charts online, web-

based meetings, and education systems along with continuing education credits for nursing

becoming more web-based, clearly, the focus needs to shift to a more general population of

middle-aged to even elderly adults. The known risks of internet scams, false information from

people posing to be health care professionals, and consequences of professionals using social
media influence consumer usage of social media. With the negative factors preventing patients

and health care professionals from getting quality usage, nursing committees, internet boards,

and information technology groups are all working to give the best experience possible.

Historical Aspects

Engineers used the revolution of the internet and Web 2.0, founded in approximately 1989, as an

advantage to help design a platform for virtual interaction. Furthermore, social media is a newer

platform first utilized by internet users in the late 1990s and early 2000s. One of the first social

media platforms was instant messenger designed to communicate and share thoughts with others

(Mohamed 2018). Although functional, this is where the issues began; intended for personal

communication between friends and family, the internet allowed users to remain anonymous and

claim to be anyone in chatrooms while communicating with others. This anonymity matter is

prevalent today. As stated by Korda & Itani, "The nurse or patient may believe they are

interacting with a highly trained medical professional or caring friend and find the individuals

are not whom they say they are" (2020, p.189). The first web-based learning education systems

were adapted in 1996 and have developed tremendously since that time. Additionally, Schmitt et

al. (2012) explain, "Social media is more than an emerging technology platform or cultural trend,

but a method of communication that is changing the way individuals and organizations

throughout the world transmit and receive information" (p.1). New platforms adapted by schools

such as Blackboard and real-time lectures in Zoom make the online world of learning easier.

Another platform worth mentioning is YouTube, which includes procedure walk-throughs,

learning channels like Osmosis, and lectures from various colleges that play an integral part in

continuing education. Huston states, "For the practicing clinical nurse, there are thousands of
videos devoted to nursing skills and the management of illness. Nurse educators can use

YouTube to store and distribute videos to students or the nursing profession in general" (2020, p.

193). Shortly after, web-based social media learning got its start, Wikis form in 2001. These

wikis allow an open platform where multiple users can post new content, edit other’s content,

and create online communities (Huston 2020). One of the most popular wikis is Wikipedia.

Cross-referencing is vital while using Wikipedia because a non-accredited source can edit

material to portray inaccurate data. Ventola states, "The main limitation of health information

found on social media and other online sources is a lack of quality and credibility" (2014, p.

496). However, a study evaluating nursing students' contributions to a Wikipedia subject shines a

light on the positive side of an open forum. The results inspired the students, explaining they

were impressed with how quickly their work was edited and corrected (Schmitt, 2012). "Thanks

to the evolution of social media, a new paradigm was formed that enabled a basis for information

access, connecting information, ideas and content" (Mohamed 2018, p.6). Although problems

arise, social media is continually developing by improving the quality of overall content.

In approximately 2010, the e-Patient emerged. An e-Patient is a consumer of health care

who actively uses social media to enhance their experience. Specifically, Huston reports, "People

who are empowered, engaged, educated, and informed are sometimes known as e-Patients"

(2020, p.186). Because the e-Patient exhibits these qualities, it is no surprise they also; seek out

the most up-to-date, well-rounded evidence-based practice. They also engage in social media

platforms with peers who are also affected by the same diagnosis and use social media's

collective wisdom to their benefit. For example, these super users are using Facebook, a platform

created in 2004 for a support group and information center for many different conditions; one

well-known condition that has been taken to many social media platforms for support and
information is diabetes. In the fairly short time that social media has been in the prospects of

nursing major strides have already taken place. Regarding the nursing profession, patient

experience and education, social media is predicted to continue the fast-track development as

seen since 1990; with that being said, creators work every day to improve kinks and negative

influences.

Nursing Implications

Health care professionals, including nurses and students, have a responsibility to explain,

enhance, and refrain from misusing social media. This responsibility is climbing in severity due

to the significant rise usage. Greenwood et al. notes there has been a significant rise in

multiplatform social media use from 2013 pertaining to online adults (2016). The rules of HIPPA

apply in the realm of social media, which plays a major role in the discipline of healthcare

professionals that use social media to vent about work or post protected patient information

(Huston, 2020). It is the nurses' responsibility to protect patients-rights to privacy, educate about

new platforms that may be beneficial to patients, and portray a positive image of themselves and

the company they represent. Even in a protected group on social media such as a nursing school

chat or private web page, patient information should never be posted or spoken about.

Specifically, there is a scenario of a nursing student that had been perused by a patient, where the

patient adds the student on Facebook and messaged the student. The student posted this in a

private blog for students in their class, but the post included the patient's full name. When this

was copied to social media, the students were reprimanded for breaching patient-rights privacy

(Huston 2020). It is the duty of the health care professional to refrain from posting information

about patients or anything that can be linked to patients, in addition to not giving medical advice
through social media. Unprofessional behaviors, foul or discriminatory language, sexually

suggestive images, the portrayal of intoxication, and unfavorable comments about employers,

nursing schools, or patients themselves may reflect negatively on individuals (Ventola, 2014).

Huston wrote in her examination of social media in the professional nursing practice; "Although

the social media environment does contain some risks, carefully utilized Web-based platforms

can potentially enhance practice, education, and research" (2020, p. 191). It is the nursing

professionals' obligation to keep the safety of themselves and the patients first.

Proposal to solve the issue

Organizations, committees, leaders, and nursing professionals are working non-stop to

proactively change social media into a more usable, predictable source. Specifically, The World

Health Organization is currently working on a solution to manage accredited health care

information. This solution includes a request to establish a new social domain that would solely

be used for accredited health care professionals (Ventola 2014). The World Health

Organization's fight to give the public the most accurate information is admirable and will bring

trustworthy information to the public as long as it is easily accessible. The nurse may not always

be to blame or unfavorable portrayals regarding the image. The Truth About Nursing is an

organization that addresses the media's negative stereotypical portrayal of nursing professionals.

This group's ultimate goal is to address the media's disrespectful nursing stereotypes by starting

petitions and bringing issues to the companies themselves when an issue arises. Huston's

example is the Heart Attack Grill, a restaurant with waitresses dressed up as "naughty nurses."

This particular restaurant depicts nurses as female sexual objects and not well-educated people

that include both genders. The Truth About Nursing advocated for the image of nursing and
ultimately had the restaurant change the menu and merchandise by the owner using asterisks to

clarify the women working there were not of the health care profession. Although a small step,

The Truth About Nursing organization was at the forefront of that issue, standing up for the

nursing profession (2020). Groups such as these are integral in keeping the public's outlook on

nurses as close to true as possible. It is important to support these groups by donating or

subscribing to making strides in social media issues. At a more individual level, the nurse must

take on responsibility themselves to teach patients the importance of knowing what to look for

when finding accredited sources and to explain the various types of scams, including but not

limited to requesting money and falsifying credentials. Personal standards must be upheld by

nursing professionals and students regarding social media, by not posting profanity or derogatory

statements and upholding a professional representation. Issues regarding social media in nursing

will never subside completely; there will always be new technology and new hurdles to face.

With the nursing community's support, students, and the public working on the problems, new

and old, the social media benefits will always outweigh the risks.

Conclusion

Communication, furthering education, and accessibility are the primary reasons social media is

on the rise despite having negative issues such as scams, personal use downfalls, non-accredited

works, untrustworthy information, and digital divides. Leaders are working continuously to

making safer platforms for health care professionals, students, and the public. As an integral part

of the health care team, nurses’ responsibility for themselves and the public is of grave

importance. Approaches that nurses can take in aiding in the fight against social media

downfalls, including; supporting organizations such as The World Health Organization and The
Truth About Nursing and educating patients on not only the risks involved with social media but

all of the benefits available. Nursing professionals must also represent themselves and the

profession in a favorable way that attracts respect. The risks and benefits of social media in

nursing have been thoroughly examined regarding personal and professional use from healthcare

professionals and the public, academic references, and web-based nursing education. There are

many positive and negative factors with the subject at hand. Social media in nursing will only

become more prevalent in years to come, so for change to happen, these obstacles need to be

overcome by teamwork and positive attitudes.