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Social media use and critical care nursing

Implications for practice

Piscotty, Ronald J. PhD, RN-BC; Jones, Lenette M. PhD, RN

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doi: 10.1097/01.CCN.0000482513.20412.71
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Abstract

Social media use in the healthcare field has garnered significant attention as of late. The focus on the use of social media by healthcare professionals has typically centered on the benefits and drawbacks. Knowledge regarding social media use in healthcare is predominately concentrated on interactions between providers and the patient, healthcare organizations and the patient, or between patients. Given the recent frequency of interactions between healthcare professionals and social media, this relationship deserves further attention.

Current knowledge regarding nurses' use of social media is limited.1 The majority of empirical and opinion pieces that have been written are related to the education of nurses and not necessarily how social media is used in clinical practice. As there is a general deficit in knowledge regarding social media use in nursing, it is no surprise that the understanding of social media use by critical care nurses is almost absent from the literature.

Background

Social media is generally defined as applications that are used to share information among two or more people.2 According to Practical Ecommerce, over 91 social media applications exist.3 The five most popular social media applications in the United States are Facebook, YouTube, Reddit, Twitter, and Pinterest.4

When discussing social media, additional concepts must be considered. Social media in itself would not function without the ability of users to interact with each other. The use of social media to interact with others is termed social networking. The terms are often used interchangeably to describe both the software applications and the process; they are very different but intimately linked.

Additionally, it is key to highlight mobile device usage. Although social media applications, which are Internet based, may be used on office or desktop computers, the primary mode of use is via an Internet-enabled mobile device. Mobile devices such as smartphones are in the hands of most individuals in the United States. Smartphones in particular put the power of a traditional desktop computer into the pocket of many individuals, including nurses.

The high prevalence of smartphone ownership also means an Internet connection is quite often available both inside and outside of the workplace. Connecting to the Internet no longer requires users to be in a home or office; those who own smartphones can use their devices on Wi-Fi, broadband, or through a connection to a cellular network. Smartphones are one of the most popular devices due to their multiple functions, compact portability, and ability to connect to the Internet even when wired and Wi-Fi connections are unavailable.5

Conveniences such as portability, affordability, and ease of access to the Internet have made social media and mobile devices popular. Social media sites and mobile Internet devices are revolutionary tools not only in their ability to allow people to connect to one another, but also in their ability to allow access to a vast amount of the most current information.

Prevalence of social media

In society

The Pew American Life Internet Survey indicates that 65% of adults in the United States are social media users, with young adults being the most likely to use social media.6 Although there are documented racial group differences in access to broadband Internet in the home, no differences are seen in social media use.6 It is likely that mobile devices are allowing social media access to those who would not be able to access the Internet otherwise. In fact, 40% of mobile phone owners have at least one social media application on their phones, with almost a third of them accessing the application daily.6,7

Hampton and colleagues found that social network sites users were less likely to feel isolated when compared with the average individual in the United States, as they were able to use the site to establish and maintain ties to others.7 In fact, Facebook users were the most likely to have close relationships and receive support from their social connections. According to Maddock and colleagues, patients are using Internet sites to aid in decision-making and communicating through disease-specific forums, but less than 10% used a social network site to communicate with others regarding their medical condition.8 In contrast, Fisher and Clayton found that 56% of patients surveyed in a family practice clinic setting felt positively about using social media sites as a means of communicating with practitioners regarding their health information or collecting information ahead of asking general health questions.9

In the clinical setting

Due to their popularity, one can reason that many people have integrated social media and mobile devices into their lives. These tools have likely ended up in the hands of many of the 14 million nurses worldwide.10 The prevalence of social media use by nurses in the clinical setting has been examined in two seminal studies.11,12

Piscotty and colleagues reported in a descriptive survey examination of social media usage of nurses in the workplace that the majority of the nurses (90.3%) reported that they had witnessed other nurses using social media sites during a work shift.11 When the nurses were asked about their own social media use during a work shift, only half of the participants (50.7%) reported using a social media site. Piscotty and colleagues also noted that 89.3% of the nurses reported being a member of a social media site, and 85.8% reported they used social media sites “today,” indicating a high frequency of use.11 These findings are consistent with another descriptive survey study conducted by Ying and Sanghee, who reported that 93.4% of nurses in the study used social media.12 A limitation of the Ying and Sanghee study is that the majority of the participants were advanced practice nurses.

In the ICU

The prevalence and rate of use of social media by critical care nurses is currently unknown. It can be hypothesized based on the two studies conducted by Piscotty and colleagues and Ying and Sanghee that critical care nurses most likely use social media in the work setting.11,12 Due to the untapped potential for critical care nurses to use social media to meet some of their patients' needs, findings related to how social media is used in critical care settings would be of particular interest for critical care nurses. Nurses are well positioned to use social media to support critically ill patients. Critical care nurses have excellent assessment skills and can use them to determine patient-specific needs and how social media may be used to address their needs. For example, social media can be used to link patients to a support system including providers, other patients, and family members. Further, social media may decrease feelings of isolation and allow interaction for a “shared” experience in the critical care setting.

Implications for practice

Advantages

While Facebook and YouTube were developed for social networking purposes, their ability to share information quickly and effectively has made them useful for other purposes in healthcare.13 Studies have shown that patients are interested in using Internet sites to learn more about other patients with the same health condition.14,15 Understanding what others experience is helpful for patients to understand what might happen to them during an illness or hospitalization. The Internet offers health information to patients with various illnesses and sociodemographic characteristics, which can allow for information to be tailored to meet individual needs.16 Linking these patients via social media allows an interactive and shared experience with each other. It also allows healthcare providers, such as nurses, the opportunity to participate in this experience.

According to Prgomet and colleagues, data support positive patient outcomes with the use of mobile devices in hospitals.17 Significant improvements in patients with ST-segment elevation myocardial infarctions were found when electrocardiograms were transmitted directly to cardiologists' mobile devices by nurses prior to arrival to the hospital. The cardiologists arrived to the facility with an increased awareness of each patient's current condition and could prepare to intervene immediately. This is just one possible improvement in patient outcomes regarding the use of mobile devices. Considering the thousands of health applications available, the opportunities are enormous.18

With new mobile applications being developed for personal and business use, possible benefits for healthcare providers and patients should be considered. For example, instant access to the Internet as well as a plethora of practice resource information make smartphones a valuable resource tool for nurses.5,19 A large amount of information about medications, nursing skills, professional organizations, and patient resources are placed at nurses' fingertips via social media.19 Social media also has the ability to connect nurses to one another to provide a professional resource to answer practice questions.

In a report by Cowan, the author discusses how the next generation of technology is focused and how mobile devices will become more relevant and prevalent in the healthcare setting for both providers and patients.20 In addition to devices, Cowan discusses a plethora of medically based social media sites that are already making an impact on healthcare and will continue to do so, indicating a trend for the future. For example, Microsoft Vault is already on board with mobile applications and websites offering free patient health records.20

Finally, facilitating social media use allows the nursing profession to work toward meeting technology goals outlined in Healthy People 2020. One goal of Healthy People 2020 is to increase reports of easily accessed health information among those who use the Internet for this purpose.21 Nurses have the opportunity to increase the number of those who find health information on the Internet with ease, through the use of social media.

Disadvantages

Many disadvantages have been noted in regard to social media use by nurses.1,11 Mobile devices have the potential to interrupt nurses' practice. In the study conducted by Piscotty and colleagues, 67.2% of the nurses checked their mobile device (that is, cell phone) to identify missed calls or text messages more than 2 times per shift, with 21.6% checking more than 10 times per shift.11 However, along with social media, these devices may be effective nursing tools resulting in positive patient outcomes through their ability to provide access to valuable nursing resources.1,11

Another common issue related to social media is the improper usage by nurses and other healthcare professionals. Improper usage such as posting confidential information about patients, photos of patients, or disagreements between coworkers have been noted.1,11 Freeman discusses a nurse who was fired for posting to Facebook that she was caring for a “cop killer.”22 While the posting did not relay standard protected health information, it did enable the public to identify the patient based on recent media coverage. The patient's rights were violated and negative outcomes could have arisen due to this social media post. Guidelines to address the proper usage in regard to patient confidentiality and professionalism have been developed by both the National Council of State Boards of Nursing and the American Nurses Association.23

Social media interaction is not a substitute for patient-provider interaction. Previous studies have shown that patients still valued face-to-face interaction with healthcare providers. In fact, these studies found that participants identified healthcare providers as the most important source of information.24 Therefore, use of social media must be viewed as a tool, not a replacement, for interactions with healthcare providers. Because nurses have frequent interactions with critically ill patients and their families, they may direct them to social media sites for additional emotional support from those who have a similar or shared experience. One issue is that critically ill patients may be too sick to utilize social media, but their families or caregivers may use social media to learn more about diagnosis, treatment, and psychosocial support. (See Issues related to social media use by critically ill patients.)

Additionally, it is important to consider that although a patient may be a very experienced social media user in his or her private life, it may be difficult for him or her to navigate as a social media “patient.” Therefore, nurses can facilitate patients' use of social media by helping them organize health information and by providing education on terms the patient may not understand.25 Nurses have designed social media platforms that meet patients' specific needs, sparing patients from becoming frustrated due to Internet information overload. Nurses can help prevent patients' anxiety and frustration by directing them to reliable, well-organized sites or applications.25

Studies have reported that some nurses struggle with technology and may be intimidated by using technology themselves, directing patients on its use, and/or discussing information patients have obtained using the Internet.26 Nurses must therefore work to achieve technologic competency in preparation for assisting the critically ill patient to successfully navigate the Internet as a resource.27 In addition, nurses could partner with social media professionals to offer joint educational programs and collaboratively develop appropriate and useful Internet resources.

Balancing the positive and negative

Mobile devices have made it into the hands of nurses at the bedside. This can potentially lead to both positive and negative outcomes for the patient, yet current trends indicate social media and mobile device policies restrict the use of all social media and, to some extent, mobile devices in patient care.1 While current organizational policy attempts to prevent negative outcomes, no research has been conducted to fully understand the impact these restrictive policies have on the potential positive patient outcomes related to the use of social media and mobile devices in nursing care.

As technology continues to create more useful social media and mobile devices with innovative applications and instantaneous search abilities, the current policies that restrict social media and mobile devices are also inhibiting the use of a possibly highly effective nursing tool. Although there are risks associated with the inappropriate use of social media devices in practice settings, innovative policy development and staff education could be the key to harnessing social media devices in a manner that can positively affect patient outcomes.

Future investigation

Future research needs to be conducted to expand and develop the understanding of the use of social media and mobile devices as a nursing practice tool and the patient outcomes that may be improved with the proper use. Positive outcomes may come from using social media and mobile devices, thus further research is needed to determine if the currently known risks outweigh the potential benefits. These findings will guide future policy development by establishing if more permissive institutional policies that allow social media as a clinical tool would benefit patients. Correlation between nurses' inpatient use of mobile devices and social media in improving patient outcomes still requires research, but the current data available already support positive outcomes for outpatient care and community health.28

Conclusions

In summary, there is untapped potential for providing support to patients via social media, especially by nurses. It provides flexibility and availability because a patient can access social information whenever desired. Mobile applications can be easily updated to ensure that information is current, and it is a cost-effective medium to deliver health information compared with other methods of health information delivery, such as printed materials. Digital information sources can also be more readily tailored to individual needs and issues.29 Additionally, social media has been understudied for its potential use for health information delivery. Given that 73% of Internet users are members of one or more social networking sites,30 social media could be an effective channel for reaching critically ill patients.

Issues related to social media use by critically ill patients

  • Hospitals may restrict the use of mobile devices by patients.
  • Critically ill patients may be too sick to utilize social media, but their families or caregivers may use social media to learn more about diagnosis, treatment, and psychosocial support.
  • If the patient's condition permits, the critical care nurse may use social media as an interactive educational tool with the patient; however, there should be time limits for each session, based on the patient's condition.

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Keywords:

critical care; critical care nurses; critically ill patients; healthcare; social media

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