ANSWER
Social media use can significantly impact nurses’ health, both individually and in the workplace. There are positive and negative consequences to nurses’ use of social media, including potential health consequences. This article begins with a brief overview of social media before delving into nursing health and social media risks for nurses. Social media use extends to healthcare organizations, with implications for healthcare consumers. Various emerging best practices can guide nurses’ use of social media. The authors also discuss using social media responsibly and future research directions.
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Key terms: social media, nursing, healthcare, the workplace, health, risk, and best practices.

Information and communication technology have become an integral part of everyday life… Information and communication technology have become an indispensable part of everyday life at work and home. This is especially true in nursing, where technology is essential to the job. Nurses are increasingly expected to develop informatics skills (Remus & Kennedy, 2012). The Technologies Informatics Guiding Education Reform (TIGER) Initiative is one example of how nurses are working to advance technology integration in practice (McBride, Tietze, & Fenton, 2013). Beyond enterprise technology, such as electronic charting systems, the lower cost of personal computing and internet connectivity has increased the impact of technology on nurses. Social media is one significant change in technology use. According to a 2013 study, 73% of adults in the United States use social media, and nearly half use multiple networking sites (Duggan & Smith, 2013). The impact of this technology on nurses is becoming an increasingly important issue as its use grows (Weaver, Lindsay, & Gitelman, 2013).

Social media has an impact on the health of individuals and groups, and it has the potential to have a long-term impact on nurses’ health. Social media has an impact on the health of individuals and groups (Fox & Duggan, 2013a), and it has the potential to have a long-term impact on nurses’ health. In this article, health is defined by Huber et al. as “the ability to adapt and self-manage” (2011, p. 2). Social media use may impact the health of both individual nurses and their workplaces. However, due to the variety of applications and levels of use, a discussion of social media and nurse health is highly complex. Many nurses, for example, use social media for personal and professional reasons. Employers of nurses use social media to engage and support their nursing workforce and customers. Finally, while social media use has many potential health benefits, it also has some risks. This article will provide a brief history of social media and nursing, examine the individual and workplace implications of social media and nurse health, offer selected best practices to guide usage, and conclude with research suggestions.

A Quick Overview of Social Media
A broad conceptual definition of social media is the online and mobile-accessible services that allow people to connect, collaborate, and share in real-time with others. Social media has permanently altered communication. A broad conceptual definition of social media is the online and mobile-accessible services that allow people to connect, collaborate, and share in real-time with others (Ressler & Glazer, 2010). Facebook®, Twitter®, and Google+® are common examples. The ability to easily connect, save and access content via services that enable information sharing and collaboration with others is at the heart of social media.

Social media can be used in various ways under this broad definition. The most visible impact of these technologies is the increase in social opportunities. Facebook®, a social networking service that allows users to connect with family and friends, is a prime example of social media. Facebook® has added new features since its initial launch (e.g., sending electronic gifts and planning events). An increasing number of social media tools focus on digital services (e.g., creating professional documents, uploading pictures, getting travel directions) and then incorporate social components to allow users to provide feedback, collaborate, and share.

Social media is also expanding into various health-related fields. PatientsLikeMe® (2014), for example, is a newly developed service that allows patients to track their disease, treatments, and self-reported experiences. Thanks to the social component, users can share information with other patients with the same medical condition, as well as with health researchers and healthcare providers. An increasing number of websites are dedicated to health and healthcare, such as tracking health metrics and rating healthcare providers and hospital services (Fox & Duggan, 2013b). Because people throughout the healthcare system use social media, it is prudent for nurses to discuss the benefits, risks, and best practices of social media.

Social Media and Nursing Health
Nurses can use various social media platforms to further their personal and professional objectives. Ferguson (2013) issues a call to action for nurses to step forward and become social media leaders. Nurses can access information for their work or personal lives, connect with colleagues, share best practices information, and advance health through personal and professional means. This section of the article will start a discussion about the health consequences of using social media for nurses, both individually and in the workplace.

Individual: Meeting Nurses’ Personal Health Needs

On a personal level, social media can help nurses in various ways. Moorehead et al. (2013) highlight a number of them, including increased a) the number of interactions with others, b) shared and customized health content, c) access and availability of health information, and d) peer and social support. Jensen and Sorensen (2013) discovered that social media strengthened pre-existing ties between friends and family members. As adults move away from communities where they have strong relationships, social media makes it easier to maintain contact with essential peer support. A study of 205 people discovered that using the internet was associated with lower levels of loneliness (Cotten, Anderson, & McCullough, 2013). The possibility of a good relationship between social media users to stay connected and improve mental health is growing.

There are also many social media applications (apps) available for nurses and patients to use to improve their health status. According to a study on the types of apps available, services like healthy eating, physical activity, and personal health and wellness are more common than apps for more complex health issues like “substance abuse, mental and emotional health, violence prevention and safety, and sexual and reproductive health” (West et al., 2012, p. e72). The early development of apps to support preventive health behaviors is a promising sign of social media’s impact on health. However, the lack of apps to support areas such as mental health shows that using apps in healthcare is still in its early stages.

Improving the Health of the Nursing Profession in the Workplace

Social media is closely related to a nurse’s professional development in four areas: clinical practice, academics, administration, and research. Social media is closely related to a nurse’s professional development in four areas: clinical practice, academics, administration, and research. In clinical practice, nurses can access information in real-time, providing unprecedented access to cutting-edge information. Some research suggests that social media can help nursing students develop their knowledge in a clinical setting (Green & Hope, 2010). Nurses can use social media to gain access to continuing education resources and tools that will help them develop their skills (Barton, 2011). The advantages may include
lowering anxiety by providing access to experts,
improving personal and professional self-image by sharing accomplishments and skills, and
developing local support networks and communities of practice.

There are numerous academic advantages to using social media in nursing. Through the implications for mentoring, Bassell (2010) demonstrated the efficacy of using social media for nursing faculty. Social media has been used to deepen and enrich the education of doctoral nursing practice students in rural settings, as well as to reduce the geographical isolation and stress that comes with it (Rutledge et al., 2011). Educators are investigating how social media can be used to assist nurses during transition periods (e.g., entry into practice, change of practice areas) and improve nurse competencies and patient outcomes.

Nurses can use social media to connect with others across organizations and borders… Social media use may also benefit nurses working in administration. The online communities #hcsm (Symplur, 2014) and #hcldr (Healthcare Leadership, 2014) bring together Twitter® users to discuss healthcare policy. When discussing national issues such as the Canada Health Accord (Health Canada, 2004) or the Patient Protection and Affordable Care Act (PPACA) in the United States. Social media can be used to hear nursing contributions from all over the country. Social media enables nurses to connect with others across organizations and borders, exchanging information and ideas in ways that were not previously possible.

There are also advantages to using social media for nurses working in research settings. The ability to share research findings is an essential factor. Archibald and Clark (2014) emphasize the ease with which Twitter® can disseminate research findings. Social media also opens up new avenues for health monitoring and data collection. According to a telephone survey of adults in the United States, 69% of adults track at least one health measure (Fox & Duggan, 2013b). More data is becoming available to nurse researchers as more social media sites allow health indicators to be tracked. Using social media, interventions can be studied at a lower cost and with a larger population.

Social media is a powerful advocacy tool… Nurses can connect and advocate for their profession and patients across all practice domains. Advocacy is essential in nursing practice (Bu & Jezewski, 2007). Social media is an effective advocacy tool that has been used in a variety of campaigns. For example, healthcare professionals banded together to support Doctors for Refugee Care, a campaign to restore refugee healthcare access in Canada (Ganesh, 2014).
Another compelling example is The Truth About Nursing (2014), a website that advocates for an accurate depiction of nursing in visual media. These advocacy tools can give individuals a strong sense of power and empower nurses who feel powerless to speak out on critical professional issues. Using social media wisely to support various aspects of nursing as a profession has the potential to contribute to a healthy workplace for nurses.

Social Media Risks for Nurses
While the various social media platforms discussed above have the potential to improve nurses’ health, it is now common knowledge that there are risks associated with the use of information and communication technology. The section will go over several risks associated with using social media.

Individual: Potential Health Risk to Nurses

Constant availability and increased social media participation may have negative consequences. Many people are unaware of social media’s impact on their sense of self (Tuten & Angermeier, 2013). Through the sharing of information, social media can perpetuate negative societal attitudes. For example, Pearl, Puhl, and Brownell (2012) discovered that participants who saw stigmatized images of obese people on social media had more negative feelings toward obese people than those who saw non-stigmatized images. Furthermore, online advertising is becoming more targeted to an individual’s browsing activity and social media use. For example, those who shop for more oversized clothing or use diet websites may see weight loss ads appear more frequently on social media websites. This targeted advertising may harm self-esteem or self-worth. Other emerging concerns include addictive and bullying behaviors, impacting sleep, productivity, and overall mental health.

Workplace Professionalism: Ensure It Transmits to Social Media

Nurses must be aware of and follow published professional guidelines for using social media… Social media use in the workplace has its drawbacks. Patient privacy is one of the most frequently discussed issues (Spector & Kappel, 2012). Patient privacy violations are a serious concern for nurses because they violate professional standards and can result in termination or suspension. As self-regulating healthcare professionals, privacy concerns are paramount (College of Nurses of Ontario, 2009). The most common ethical violations of nurses using social media are breaches of privacy or failure to report another nurse’s breach of privacy (Spector & Kappel, 2012). According to Lachman (2013), many nurses need to be aware of the privacy settings on their social media accounts and unaware of the broad reach of social media posts. When misused and without consideration, social media can harm health, such as the mental anguish associated with a professional, ethical violation. Nurses must be aware of and follow published professional guidelines for using social media (Spector & Kappel, 2012) and understand the settings and policies associated with the media they use.

There have also been reports of social media being used as a tool for workplace cyberbullying. This is concerning because there have been reports of lateral violence in nursing (Lachman, 2014). Cyberbullying is risky because it is widespread and can occur anywhere there is internet access. Nurses may be victims of cyberbullying directly or through social media tools. Exclusion from workplace social media programs can also indirectly impact nurses. Cellphone use is also associated with other cyberbullying risks. Because most cell phones can take pictures and videos, there is a chance that images will be shared on social media to harass colleagues (Hall & Lewis, 2014). Nurses and nurse managers must be aware of the risks associated with bullying and social media and actively promote the positive use of social media tools. The consequences of using social media at work should be clearly defined in an appropriate organizational policy.

Social Media to Promote a Positive Organizational Culture
There are numerous ways in which social media can benefit an organization. TOH Nurses, a nursing social media campaign aimed at clinical nurses at The Ottawa Hospital (TOH), is one example (TOH Nurses, 2014). This campaign employs several social media tools to foster a positive workplace culture and professional self-image in its nurses. TOH Nurses inform nurses about hospital events, educational opportunities, and wellness programs. However, social media is more than just newsletter distribution. TOH Nurses enables these nurses to ask questions and provide real-time feedback to the corporate office. It also allows nurses to be recognized; photos shared on Facebook® and Instagram® allow each nurse to be the face of TOH Nurses for a day. Spreading positive images and recognizing clinical nurses through photographs is intended to be a key component in increasing nurse engagement in this facility. This example shows how a social media campaign can help with branding at a hospital, recruiting nurses, and role modeling to other healthcare professionals and the general public, resulting in a healthier workplace environment.

As social media continues to evolve as a tool for impacting the workplace, it can influence organizational commitment and the sense of community among nurses. This can positively impact nurses’ local professional culture; a positive culture has been shown to influence nurse satisfaction and patient safety (Liang & Lin, 2007). Gonzalez, Leidner, Riemenschneider, and Koch (2013) investigated the various ways social media can be used for this purpose. They claimed that social media could be used to connect newly hired nurses with organizational resources as well as additional information about the nursing role and organizational policies. Nurses can also find job-related educational material on social media, such as videos and wikis. This promotes self-directed learning and can help new and experienced nurses understand and feel more confident in their roles. According to Gonzalez et al. (2013), social media can help nurses feel more connected to their peers in terms of socialization. For example, a new nurse is “friended” (connecting with people you know via an online social networking site) by a colleague can aid in the development of relationships and a support network within the organization.

Social Media and Healthcare Delivery Consumers
Social media can help people adapt and self-manage their health by providing timely and accurate information. Social media can help people adapt and self-manage their health by providing timely and accurate information. Because nurses are responsible for both their patients and their health, they must learn how to be wise consumers of Internet-based healthcare information, including that found on social media platforms. The ability to make patient connections (with peers and providers) and the importance of obtaining trustworthy information are two areas critical to consumers of healthcare delivery in the context of social media.

Connections with patients. Social media alters how patients interact with healthcare providers and the healthcare system. Individuals no longer passively receive health information and interventions, assuming that a provider has all the answers. Patients increasingly turn to the internet to find resources and additional information. PatientsLikeMe® (2014), a website, allows people to connect with others dealing with a similar diagnosis. Patients can also use this website to contact healthcare providers, track personal data, and share their stories. Creating effective patient connections among peers and providers through social media sites may benefit health by providing emotional support and assisting patients in maintaining relationships with providers.

Information that can be relied on. With the internet providing potentially dangerous false information, patients must receive accurate information from reliable source. Credible health information is critical for public health and can help with outbreaks, as it did with H1N1 and disease prevention (McNab, 2009). Reliable sources, such as Health Canada (2014) or the Centers for Disease Control (n.d.), can provide trustworthy information to healthcare professionals and the general public, as well as help counteract inaccurate and potentially harmful health information from other sources (Greysen, Kind, & Chretien, 2010).

There are numerous online resources that promote self-care and provide reliable health information. However, there are sources of questionable quality that may be providing inaccurate information to people who lack the education to distinguish between good and bad (Silversides & Sullivan, 2012). The most shocking example is anti-vaccination campaigns (adherents are known as “anti-vaxers”). Following the (now debunked) claims that vaccines cause autism, anti-vaxers began using social media to disseminate information about the perceived dangers of vaccines and to encourage parents not to vaccinate their children. The consequences of this effort have been disastrous. Across North America, there have been outbreaks of preventable diseases, and some areas have seen a resurgence of previously eradicated diseases, such as measles (Maki & Barton, 2014). Nurses must remember that they may need to review evidence with patients and recommend credible resources to promote health.

Best Practices for Safe Social Media Usage
Nurses must stay informed of the changing landscape as social media use evolves and becomes more integrated into health-related apps. Nurses can gain a better understanding of social media and maximize its positive impact on their own health. It is also critical that nurses are informed about the risks of participating in social media. As previously discussed, there are numerous ways for nurses to use social media effectively, both individually and in the workplace, but social media can also have potentially negative effects on both emotional and physical health. The best practices for using social media at both the individual and organizational levels are listed below.

Individual: Examine the Effects of Social Media on Health

Be deliberate. Nurses are trained to assess the effectiveness of clinical interventions on patients. This can be applied to the use of social media. When nurses approach social media with an outcome-oriented mindset, the focus shifts to the consequences of using social media. It is critical that nurses take the time to develop a proactive, strategic, and intentional approach to social media use. Prior to using social media, consider the desired outcomes. This can be a useful guide when evaluating the impact of this technology.

Use analytics and reflective practice. Reflective practice is a popular method for lifelong learning that can be used with social media. Reflective practice is the active intentional exploration of experiences in order to learn (Mann, Gordon & MacLeod, 2009). It is a simple and effective method for nurses to track how their use of social media affects them. Inquiring about how social media is personally meaningful, distracting, relaxing, energizing, stressful, or supportive can yield valuable information. Doing so on a regular basis can help nurses reinforce positive social media participation. Nurses can determine how much time is spent using a particular service and whether or not an account should be closed.

Social media accounts have built-in measures, known as analytics, that are related to the service. SlideShare, for example, allows you to upload presentation slides and informs users how many times a specific presentation has been viewed and downloaded. Social networks provide metrics such as the number of professional contacts or friends added. These analytics can be used to collect quantitative data for use in a nurse’s reflective practice. This feedback can be used to evaluate social media use and outcomes critically.

Think about health-related apps. Social media sites with health metrics can provide immediate feedback on health-related goals. There are numerous fitness-related apps and services available that can track various metrics, create a program, provide reminders, and reinforce the adoption of healthy behaviors. Personal tracking devices, such as Fitbit® trackers and Jawbone’s Up®, can measure criteria such as total daily steps or hours and sleep quality. Individuals can share their goals, progress, and accountability with others thanks to the social features of these tools. Services such as MyFitnessPal® make it easier to track calories and weight loss. These apps make it easier to see how one’s behavior affects one’s health. Other social media apps, such as RunKeeper®, can combine social and goal-setting features with programming. Social media platforms are increasingly attempting to provide fitness advice to users. When nurses have specific health goals, these apps can help them track, adapt, and achieve personal milestones.
QUESTION

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.