Section 2: Literature Review
Implementation of Facebook in Nursing Education Programs
2.1 Introduction
The inception of various social networking sites, such as Facebook, Myspace, Orkut, Twitter, and LinkedIn, has attracted billion of users from all over the world, bridging geographical barriers by providing a seamless service of communication through which people may build and expand both their professional and personal networks. Especially, Facebook being at the peak of its success and being the most popular social networking site, various businesses have started making use of this great social platform to leverage their business operations and marketing practices. The education sector too is not left far behind. Increasingly, educators are realizing the importance of social networking sites for the promotion of both active learning and collaboration. In healthcare, as nurses play a crucial role in identifying, interpreting, and transmitting knowledge and information within the healthcare system, social media like Facebook can provide a wide-ranging scope to the nursing faculty in helping students garner greater understanding and skills in healthcare communication, patient privacy and ethics, health policy, and nursing competencies (Schmitt et al, 2012). Though there are a few barriers to the successful integration of Facebook within the scope of nursing education, the availability of quality resources will, however, assist the nursing faculty in implementing Facebook as a viable health communication tool for the nursing education program. This paper would discuss the significance of using Facebook as a pedagogical tool in great detail, touching upon the advantages, disadvantages, challenges and benefits of implementing the same within the scope of the nursing education program.
2.2 Social Networking Sites (SNSs) Definitions
Social media has been defined by the Merriam-Webster dictionary (2012) as a "form of electronic communication (as Web sites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content" (Schmitt et al, 2012). Social network sites are web-based services through which an individual can perform three primary functions; 1) create a public or semi-public profile within a restricted system, 2) form one's own group by creating a list of friends who share common interests, and 3) view and travel through the list of connections of the peer group and those made by others within the same system (Boyd and Ellison, 2007). Different social networking sites are made for different purposes. LinkedIn, for instance, caters to people for establishing professional networks. Facebook serves users to extend both the private and professional networks. Myspace, which was formed with music and entertainment in mind, emphasizes upon connections based on the preferences for music and videos. The basic look and feel and nomenclature of these sites also vary from one another.
The feature that makes all the social network sites unique is the ability of individuals to exhibit their social networks, which lead to connections between strangers and like-minded people, that otherwise would not have been possible. Though a range of technical features are made available, the backbone of social networking sites is comprised of visible profiles displaying a list of friends who are also users of the same sites. Upon joining an SNS, a user needs to fill out forms disclosing a series of personal details. Most of the sites encourage uploading a profile photo (Boyd and Ellison, 2007). The visibility of a profile varies from one site to another in accordance with the user discretion. Facebook allows the users, who share the same network, to view each other's profiles unless the permission is denied by a profile user. Though on most sites, the list of connections of an individual is visible to anyone permitted to view the profile, there are, however, exceptions (Boyd and Ellison, 2007). For example, LinkedIn extends the option to its users to opt out of showing their network.
Social networking sites are, thus, more than just an emerging technology or cultural trend, they are a form of communication and networking that has revolutionized the way individuals and organizations around the world receive and transmit information.
2.2.1 Facebook uses in Nursing Education
As per the statistics of the Pew Research Center (2012), about 80% Americans use the internet currently and seek health-related information through this medium. 50% of the US adults access the internet wirelessly. Almost half of the US population owns a smartphone device, and 17% of them seek health related information. The problems facing the healthcare system today are many. One of the biggest problems of the US healthcare system is the healthcare costs, which accounts for 16% of the country's gross domestic product (GDP), and this figure is on the rise only (CDC, 2011). Simultaneously, serious chronic health conditions and diseases, such as cancer, cardiovascular problem, diabetes, obesity, and arthritis are expensive and on the rise. The U.S. Centers for Disease Control and Prevention (CDC) give four predominant reasons for the development of these chronic ailments; poor nutrition, lack of exercise, excessive alcohol consumption and tobacco use (Weaver et al, 2012). Although there is no simple solution for these problems, if the use of electronic communication technology is imbibed in the overall approach, then it would help educating and engaging patients and monitoring their behaviors. Electronic communication would also save time and money by enabling patients to take an active role in the healthcare process (Weaver et al, 2012). Since nurses play a significant role as the communicators of knowledge within the healthcare system, with patients, their families and communities and among healthcare disciplines, nursing educators are increasingly attaching more importance to the application of social media like Facebook into the nursing curricula in order to enable the graduating nurses to understand the safe use of the communication technology and share knowledge (Schmitt et al, 2012).
2.3 Prevalence of Using SNSs (e.g. Facebook) in Nursing Education
In modern times, 87% students attending a community college or university have a laptop, 62% students have an iPod, and 55% students have a digital camera, smartphone or webcam. Laptop is the primary tool used in the education system (Jones and Wolf, 2010). Laptop and other mobile devices help students in their education process outside the traditional classroom in conducting research online by flipping through various scholarly journals and magazines and accessing library websites. With such rapid growth and use of technology, it has become necessary for the nursing educators as well as the educators of other healthcare disciplines to keep pace. In the USA, the number of healthcare operations using social media like Facebook has grown by 210% between the period of 2009 and 2011. The social media toolkit developed by the American Nurses Association (ANA), the Technology Informatics Guiding Educational Reform (TIGER) competencies and TIGER educational initiative, and the nursing informatics toolkit developed by the National League for Nursing (NLN) provide assistance to the nursing educators to incorporate the use of social media such as Facebook in the nursing competency programs (Hebda, and Calderone, 2010). The nursing educators understand that the use of social media like Facebook in the process of nursing competency program will not only will enable students to learn outside the boundary of classroom, but will also help them develop professionalism, expand technological abilities and improve their ability to clearly and professionally communicate, overcoming the physical barriers of time and distance.
2.4 Implementing Facebook in Nursing Education
The Pew Internet Study has categorized those born in the period between 1981 and 2000 as the Millennials, because this generation of youth remains constantly connected to the web through social media like Facebook (Pew Research Center, 2012). If they lack the knowledge of using social media safety, then their inadvertent action of leaking sensitive news can lead them and the associated hospitals into problem. Current graduate and undergraduate nurses are of mixed backgrounds and age, right from millennials to baby-boomers. Millennials are tech-savvy. 58% of the millennials check their account in Facebook at least 13 times a day, and 11% of them either read or post a collective of 112 times a day (Dahlstrom et al, 2011). Despite being tech-savvy, millennials, however, lack the understanding of using technology for professional reasons. Baby boomers, on the other hand, are the fast growing age group of people 51% whom use social media, especially Facebook. Their use of social media has increased by 150% in the last few years. The biggest reason for the students of baby boomers' age to quit education midway is due to the demands of family and the lack of supportive services (Schmitt et al, 2012). The use of Facebook within the perimeter of classroom can be useful in addressing these barriers.
Facebook with its significant others LinkedIn and Twitter are common and logical places to initiate social media integration into the curriculum of nursing. The purpose of implementing Facebook in the nursing education program would be to improve professional communication, improve the students' comprehension and use of the technology and enhance the students' ability to network and collaborate with other nurses globally. The three core content areas for nursing recognized by the NLN include computer literacy, informatics, and information literacy. Other areas crucial for setting the curriculum through the use of social media include health policy, professional communication, writing competencies, and patient privacy and ethics (Schmitt et al, 2012). The implementation of Facebook in the nursing curricula should be made in such a way as to take care of these factors that by incorporating Facebook, the students nurses are not only taught the effective use of communication technology, but also learn about the areas related to privacy and professional ethics that are otherwise ignored by most of the Facebook users.
Before student nurses engage themselves in the use of the social media platforms in clinical environments, it is important for all the students to complete the training on Health Insurance Portability and Accountability Act (HIPAA) and other necessary reading with regard to ethics, privacy and professional communication (NCSBN, 2011). The federal laws related to confidentiality and privacy of patients are defined by HIPAA, and students must learn about them to understand the gravity of situations that may arise from the breach of confidentiality and trust. The student nurses must learn that any information related to the patients must be kept confidential as a professional ethics and must not be disclosed to any outside party. Only with the patients' informed consent can only be those information shared, or else it is the nurse's obligation to keep patients' information confidential (NCSBN, 2011). Since the relationship between nurse and patient is based on trust, nurses must safeguard the privacy of the patients so that the patients feel confident in sharing personal details with the nurses. Any breach of this trust would rupture not only the particular patient-nurse relationship, but would also damage the trustworthiness of the entire nursing community.
2.5 Impact of using Facebook in nursing education
While the use of Facebook can be extremely valuable for the nursing profession, inappropriate use of the social media tools, however, may create devastating outcome. If one is not careful enough, the implementation of Facebook in the nursing curricula may invite troubles, as what happened with a student nurse, who in her enthusiasm to share the picture of 3 year old leukemia patient on Facebook, got expelled from the nursing program (Spector and Kappel, 2012). Some of the advantages and disadvantages of implementing Facebook are described below:
2.5.1 Advantage of using Facebook in nursing education
If Facebook can be implemented successfully in the nursing education program, it will lead to a lot of benefits. First of all, since Facebook encourages people to express and communicate in a written format, it will help students develop their writing competencies. Secondly, Facebook will help students develop their interpersonal communication and their collaboration in a group. Since in healthcare practices, it is important for nurses and the physicians to collaborate effectively with each other, learning the art of collaboration through Facebook while working on projects would enable the students to be collaborative in the professional clinical environments (Weaver et al, 2012). Thirdly, the implementation of Facebook will help students nurses interact with each other, overcome the physical boundaries of distance and classrooms. It will especially be useful for those taking distance learning courses. Finally, incorporation of Facebook into the nursing curricula may also foster excitement in the learning activity in a way that can be used for preparing creative group project work (Schmitt et al, 2012).
2.5.2 Disadvantage of using Facebook in nursing education
Different barriers, such as the lack of technological knowledge, cost, time, the rapidly changing technologies, outside distractions, restrictive policies of organization, the reluctance of the students and teaching faculty to use Facebook, and the rebuke or social ostracism resulting from the misuse or mistakes committed with the system of Facebook, may impede the students nurses from effectively utilizing the education program through Facebook (Amerson, 2011).
The use of Facebook in nursing education also poses the risk of student and patient privacy as students gain an access to a larger base of documental evidences. Since many violations are unintentional, through the use of proper education provided to both the faculty and students, such challenges can be overcome (NCSBN, 2011).
2.6. Social Networking Guideline in Nursing Education
Firstly, the social media policy of the department or the institution should be known. If in case, such policy does not exist, developing a policy by consulting the published guidelines of NCSBN and ANA or other institutions should be considered (Schmitt et al, 2012).
Secondly, the educational background of the students entering the nursing course should be checked. Whether or not the students have basic knowledge in computer science or whether or not they were ever introduced to any program that outlined the HIPAA policies should be verified. It needs to be ensured that students have sufficient opportunity to learn about healthcare policies, privacy, professional ethics, and safety before they initiate social media projects (NCSBN, 2011).
Thirdly, assistance from the technology-savvy faculty, librarians, and computer support services should be sought, when necessary.
Fourthly, prior to the implementation of Facebook in the nursing curricula, conducting a pilot test of the project, involving a small group of students and faculty, is necessary.
Fifthly, students should be allowed sufficient time to grow their technological skill. They should be encouraged to conform to ethical online behaviors and not to post at the heat of the moment (Schmitt et al, 2012).
Sixthly, no more than one or two types of social networking sites should be introduced to the students to begin with, and then gradually, they would be guided into other areas.
Finally, examples of both the correct and incorrect use of social networking sites should be presented to the students and they should be encouraged to think and discuss what constitutes professional communication in a healthcare context (Amerson, 2011).
2.7. Challenges and Limitation of Implementing Facebook in Nursing Education
The main challenge in the implementation of Facebook in the nursing education may come from restrictive organizational policies. Some organizations in order to safeguard itself go overboard in chalking out policies (Amerson, 2011). For instance, if the organization implements a policy that restricts the freedom of speech and reasons that the administrators and the faculty members can be fired or suspended if any social media post is against the best interests of the employer, then it will impose a severe restriction on the educators as they will not be able to educate their students freely or organize projects creatively out of the fear of implications.
Another challenge may come from the students’ attitude towards learning. If the students are not careful about the implications of their violation of an organizational policy or the violation of confidentiality and privacy policy, then they may engage in unethical activity such as leaking out confidential information outside the classroom intentionally to gain publicity.
The main limitation in the implementation of Facebook in the nursing education program comes from the fact that Facebook, after all, is a third party software, and hence, the projects cannot be customized freely according to the needs of the students. For example, if the educator wishes to conduct a survey among the students in the Facebook portal in order to garner information related to a group activity, he needs to do it in within the scope of services offered by Facebook. He cannot design and customize the survey according to his own ideas.
2.8. Conclusion
The prevalence of social networking sites has not only affected the personal lives of people, but has also entered the professional sphere when people readily build and expand professional network using the social media platforms. The popularity of the social networking sites has made way into the educational sector too, with various universities and colleges developing programs to educate students about the effective use of the social media and the internet. In the context of healthcare, nurses are the main communicators of knowledge, and if the implementation of social media like Facebook can be made in the nursing education programs, then nurses will be able to communicate and share their knowledge among the patients, their families and healthcare disciplines as a whole more effectively. However, taking into account that unintentional leakage of sensitive information can put nurses into trouble, they should be educated about the HIPAA policies on privacy and confidentiality before being engaged in projects through Facebook.
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