The Community Nurse and the Use of the Social Media

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TECHNOLOGY

The community nurse and the use of social media
Ian Peate
Ian Peate is an Independent Consultant and Editor-In-Chief of the British Journal of Nursing  Email: [email protected]

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ocial media - the sharing of ideas using online networks and communities - has the potential to offer significant opportunities for organisations and individuals to listen and engage in conversations with the people that they wish to influence and community nurses are no exception. Managers are required to provide staff with guidance and training in what is and is not acceptable behaviour online. From a strategic perspective the next generation of community nurses will never have known a world without the internet or mobile phones. The ways in which community nurses embrace the use of social media for the benefit of patients and staff will be an essential element in creating sustainable health and social care services. Healthcare policy has moved towards the patient being empowered to make choices about their care and with the patient at the heart of all that community nurses do (Department of Health (DH), 2012a). This might regard which GP practice a patient registers with (opening GP practice boundaries), where patients elect to have surgical

operations (choose and book) or how they access their personal GP records by the time GP records go online by 2015 (NHS Employers, 2013). The way nurses work and communicate with each other is changing; nurses no longer physically (geographically) work as closely with other health professionals as they used to. Social media can offer new and different ways for nurses to engage with each other. Ofcom (2011) estimated that nearly half (48%) of UK adults used social networking sites in the first three months of 2011, up from 40% in 2010. Total time spent on social networking sites was 1.3% higher in April 2011 than it was in April 2010. Most of those using social media sites, use them for their own personal use (Arno, 2012) but community nurses can use them professionally.

What is social media?
The term social media can mean many things. It has become a term or category that includes a variety of different possibilities for a number of internet-based platforms that can enable people to communicate in various ways. Although ‘media’ is plural, it is usual to refer to ‘social media’ in the singular because of its use as an encompassing name. In Mayfield’s (2008) ebook he suggests that social media is best understood as a group of new kinds of online media, which share most or all of the following characteristics: w Participation w Openness w Conversation w Community w Connectedness There are a number of popular social media platforms (Table 1).Those platforms outlined in Table 1 are some of the more well-known ones, but are just a few of the many hundreds of social media platforms available. PwC (formerly PriceWaterhouseCoopers) Research Institute (2012), in study in the US, reported that a third of health consumers are using social media sites to seek medical information, discuss symptoms and express their opinions. Those consumers noted the information gained from the use of social media would affect their health care decisions in the following ways:

ABSTRaCT
The role and function of the community nurse has changed in a number of ways over the years; however, central to that role is the direct hands-on care that expert nurses provide to a variety of client groups. Social media can never replace that unique role yet it can help the community nurse provide safer and more effective care. The use of social media is growing and is having a significant influence on society. Social media can dictate tomorrow’s news today, provide individuals with a public voice and help to form new social connections regardless of geography. Social media has become embedded within our daily lives. For community nurses social media networks offer alternative ways in which they can share knowledge and expertise and keep up to date. This article intends to stimulate thoughts about how social media could be used positively by the community nurse and his or her organisation to help meet the future demands on the NHS and community nursing services.

KEY WORDS
Communication w social media w patient care w policy

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TECHNOLOGY
Lucie Carlier

w 45% said it would affect their decision to get a second opinion w 42% said it would affect their choice of a specific doctor, hospital or medical facility w 34% said it would affect their decision about taking a certain medication This data demonstrates that social media is changing the conversations between health systems and the communities they serve. Information found on the internet can be invaluable, inaccurate or even dangerous and there is a challenge to help patients determine what the difference is (Nelson and Joos, 2013). From an individual perspective social media is anything which allows information to be published, shared and commented on, online without interference of editors, organisations or the government. For organisations such as the NHS social media is a selection of online platforms allowing information to be published, shared and commented on online, enabling the organisation to communicate with individual stakeholders. There is a potential challenge, however, that boundaries on social media platforms become blurred with the voice of the individual becoming the voice of the organisation. Brand names such as Twitter, Facebook and YouTube are not social media. Social media refers to the technology that enables users of it to share their thoughts, the things they are working on, multimedia; it also provides a forum for commenting on content that others may have posted (NHS Employers, 2013). Social media enables an individual to become part of various networks of people who have

The term social media can mean many things. It has become a term or category that includes a variety of different possibilities for a number of internet-based platforms that can enable people to communicate in various ways.

similar interests. These networks could involve other primary health and social care providers. At the beginning of 2004, Facebook, Twitter, Flickr and YouTube did not exist, but by May 2011; Facebook had more 1 billion active users around the world (Kiss, 2012), equating to approximately one sixth of Earth’s population. In 2011, YouTube had received more than 1 trillion views, 140 views for every person on Earth (YouTube, 2012). It is evident that social media moves fast and platforms come and go overnight.Trying to keep up-to-date with the latest news and movements in the social media world can be disconcerting. Social media is invaluable in engaging nurses with the wider nursing community (Chinn, 2012). The networks (platforms) noted in Table 1 deliver content that may be of interest to an individual without that individual having to spend time finding it.

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TECHNOLOGY
Table 1. Social Media platforms and networks
Name Twitter Example Microblogging - allows users to exchange small elements of content such as short sentences, individual images, or video links

WorldPress Tumblr

Blogging

You tube Vimeo

Video sharing

Flickr Instagram

Picture sharing

Reddit Stumbleupon

Social benchmarking - using social media to find a standard or point of reference in measuring or judging the value or success of an organisation in order to determine future plans

Facebook

Social sharing - using social media as a means of sharing experiences, news and updates

Linkedin

Professional sharing - using social media as a means of sharing career information or professional or organisational news

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Health policy and the role of social media
Health policy is moving even closer towards the patient being empowered to make healthcare choices, enabling them to participate in their healthcare and the way the NHS operates and how services are designed and reformed. There will be an even greater need for information to be provided in different online formats, information will have to be provided digitally. The Department of Health’s digital strategy was published in December 2012 (DH, 2012b). The strategy points out that those social media platforms will be critical to enable the NHS to listen and use patients’ concerns and ideas to provide a clinically excellent and sustainable NHS. So across the NHS digital is having an impact at both policy and operational levels.

Table 2. Nursing and Midwifery Council’s guidance on social media
w If you identify yourself as a nurse on Facebook, you should act responsibly at all times and uphold the reputation of the profession. Your conduct online could still jeopardise your registration if it calls your fitness to practise into question. and service users.

w Do not use social networks to build or pursue relationships with patients w Do not discuss work-related issues online; even when anonymised, these
are likely to be inappropriate. do this.

w Never post pictures of patients or service users, even if they ask you to w Social networking sites should not be used for raising and escalating
concerns (whistleblowing).

w Protect your own privacy. Think through what kinds of information you
want to share and with whom, and adjust your privacy settings. privacy settings. Once something is online, think of it as being there permanently

How community nurses can use social media to communicate
Social networking platforms can provide real opportunities for nursing. The various sites have the potential to connect millions of people to one another; they can (and in some instances do) provide an opportunity to bring nurses together in a way that has not been seen before. In other words community nurses, just like the rest of the NHS, have a responsibility to keep up to date with the numerous methods and channels of communication available to them. Social media presents nurses with new methods of communicating key health issues. Once the community nurse has established an online presence, the opportunities to engage with patients, communities and networks are endless. By using social media, nurses, organisations and communities can share information quicker; they can monitor reactions and actively engage with other users with the aim of gaining a better understanding of what healthcare staff and patients want and need.

w Remember that everything you post online is public, even with the strictest

Source: adapted from Nursing and Midwifery Council (2012)

Professional development
Social media can help community nurses with their professional development. A number of resources, such as Twitter, are effective resources for staying up to date with current issues: via @BJCommunityNurs, for example, the editorial team of BJCN regularly posts issues concerning current practice and policy. The various platforms provide an opportunity to pick up bite-sized chunks of breaking news. With the vast number of people subscribing to social media platforms there are opportunities to follow people and to use them as a useful resource. Nurses can post questions on the various sites and the advantage is that within real time a response will be made. Real-time chats can be regular, focused, topic-related debates that happen at preplanned times; each one focuses on a different topic. Contributions to these debates come from a number of areas. Meanwhile, many professional bodies and organisations are already tweeting; Department of Health (@dhgovuk) Nursing and Midwifery Council (@nmcnews) and The

King’s Fund (@TheKingsFund). The Government is already using a range of social networks as important key service delivery mechanisms for initiatives and public health campaigns that are important for community nurses and the people they care for. Healthy Start, Change4Life, SmokeFree, Live Well and NHS Flu Fighter all have an active presence on Twitter and Facebook. There are many individual nurses and organisations that are using a variety of media to communicate. YouTube videos are sometimes used to present information about a number of topics, for example, diabetes and pressure ulcers. There are so many advantages to this; for example, you can look at the videos at your own pace, in your own place, you can save them, stop them, rewind them and play them back. When participating in any external engagement, it is important that the community nurse uphold the reputation of the profession and the organisation they work for. Much of this is about using common sense when posting information and making comments online. It is essential that the community nurse consult any social media policy that should already be in place where they work and ensure that they are working within the confines of the Code of Conduct (NMC, 2008).

Social networking sites and professional conduct
As more community nurses use social media, this highlights a need for guidance regarding the appropriate use of this means of communication. There may be a lack of understanding among some staff of what is and what is not acceptable online when discussing places of work, patients and colleagues. Despite the digital voice being technically silent it has the potential to be heard by many thousands, even millions. The NMC provides information

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Lucie Carlier

Future community nurses have never known a world without the internet or mobile phones. Many of them blog, most of them have a Facebook account; all of them are likely to struggle in an organisation that has not embraced and is using social media.

that addresses the use of social networking sites by nurses and how the Code of Professional Conduct (2008) may be applied in thinking about social networking sites (NMC, 2012). This information provided is specific concerning issues about social networking sites such as Facebook, however the principles can be applied to various online communications, including personal websites and blogs, discussion boards, email groups and instant messaging. Sharing information online includes text, photographs, images, video and audio files. Nurses must:

w Use social networking sites in any way which is unlawful The list is not intended to be exhaustive. If there is any uncertainty about whether a particular activity online is acceptable, the nurse can think though what is and is not acceptable in ‘the real world’. Table 2 provides some guidance issued by the NMC.

Conclusion
The number of people in the UK who regularly use social media platforms continues to increase. Social media is not a fad or something that will pass over time, it is being seen by a large number of people as a different way of communicating. This information revolution will continue to impact on front line community nurses, bringing with it opportunity and risk. Health and social care organisations are now employing staff born in the 1990s. These future community nurses have never known a world without the internet or mobile phones. Many of them blog, most of them have a Facebook account; all of them are likely to struggle in an organisation that has not embraced social media. BJCN

‘...uphold the reputation of your profession at all times (NMC 2008)’
This means that conduct online and conduct in the real world should be judged in the same way, and should be at a similar high standard. The nurse’s standard of conduct online and offline, is important. The way the nurse acts online can jeopardise their ability to remain on the professional register. Nurses will put their registration at risk if they: w Share confidential information online w Post inappropriate comments about colleagues or patients w Use social networking sites to bully or intimidate colleagues w Pursue personal relationships with patients or service users w Distribute sexually explicit material

If you are interested in finding out more about BJCN on social media, follow the journal on Twitter @BJCommunityNurs, find us on facebook at www.facebook.com/community nutrsing or join our linkedin group by going to www.linkedin.com and searching British Journal of Community Nursing.

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Chinn T (2012) How nurses can use social media professionally Nursing Times 108(29):12-13 Department of Health (2012a) Equity, Excellence: Liberating the NHS. www. dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf accessed 18 March 2013 Department of Health (2012b) Digital Strategy. Leading the Culture Change in Health and Care. www.wp.dh.gov.uk/publications/files/2012/12/finalreport1.pdf accessed 18 March 2013 Kiss J (2012) Facebook hits 1 billion users a month http://www.guardian.co.uk/ technology/2012/oct/04/facebook-hits-billion-users-a-month accessed 18 March 2013 Mayfield A (2008) What is Social Media? http://www.icrossing.co.uk/fileadmin/uploads/eBooks/What_is_Social_Media_iCrossing_ebook.pdf accessed 18 March 2013 NHS Employers (2013) Briefing 87. HR and Social Media in the NHS. www. nhsemployers.org/Aboutus/Publications/Documents/HR-social-mediaNHS.pdf accessed 18 March 2013 Nelson R, Joos I (2013) Social media and the Transforming Role and Relationships in Healthcare in Nelson R, Joos I, Woolf, DM (Eds) Social Media for Nurses Ch 1 pp 1-28 Springer. New York Nursing and Midwifery Council (2008) The Code: Standards, Performance and Ethics for Nurses and Midwives http://www.nmc-uk.org/Publications/Standards/The-code/Introduction/ accessed 18 March 2013 Nursing and Midwifery Council (2012) “Social Networking Sites”. www. nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Socialnetworking-sites/accessed 18 March 2013 Ofcom (2011) “A Nation Addicted to smart phones”. media.ofcom.org. uk/2011/08/04/a-nation-addicted-to-smartphones/ accessed 18 March 2013 PWC Health Research Institute (2012) Social Media “likes”. Healthcare: From Marketing to Social Business PriceWaterhouseCoopers Health Research Institute, New York YouTube (2012) “Statistics” www.youtube.com/t/press_statistics accessed 2 April 2013

LEARNING POINTS
w The ways in which community nurses communicate are changing w Community nurses will need to embrace social media in the future not as
a channel but as a mind set

w Social media can help organisations to expand their roles and
relationships with service users and others

w Organisations have a duty to educate staff on how to effectively integrate
and use social media in their work, ensuring that they keep up to date with the pace of technological change w The thoughtful and deliberate use of social media will become an important element of any organisation’s strategic thinking

Social media enables an individual to become part of various networks of people who have similar interests. These networks could involve other primary health and social care providers.

BREAKING NEWS:
Community nurses, join in the conversation online
Keep up to date with the news, views, debate, policy and best practice ideas for district and primary care nurses through BJCN’s social media channels. Find out what’s coming up in future issues of the journal, connect with other community nurses and industry leaders and find out about BJCN events and promotions.

‘Like’ us on Facebook (www.facebook.com/communitynursing) Join our community nurses group on LinkedIn (www.linkedin.com, then search British Journal of Community Nursing) Follow us on Twitter (@BJCommunityNurs) and stay in contact with us with your views or ideas ([email protected])

Keep your ear to the ground and your finger on the pulse wherever you are in the community

www.bjcn.co.uk
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