With technology advancing so rapidly within the last decade, social media has significantly changed the way many connect and communicate with the world – including medical professionals. One study done in 2011 found that around 75 percent of all Canadians currently have a Facebook account (Monk) and 261 Canadian hospitals reportedly have either a Facebook page, Twitter account, blog, or Youtuber channel (Fuller, 2011); In addition, the number of YouTube and Twitter accounts held by U.S. healthcare organization increased from zero in 2006 to about 1400 as of October 2011 (Bennett, 2011). There is so much potential for the advancing technology. If used wisely, social media technologies provide many potential benefits to nurses; they are a means to connect with old classmates and colleagues, as well as with other nurses who have similar interests and specialties that support best practices (CNA, 2012). Not only that, it’s a way to connect with patients professionally. Social media can be a great educational tool for both practicing nurses and nursing students; However, when health students and professionals combine the use of the technology and social connections, the line between “public” and “private” is blurred and the importance of teaching professional health care providers and students is highlighted.The lack of emphasis on the education on the use of social media exposes the main concern for all nurses using social media which would be breaking the confidentiality and privacy of the patient. This brings up the major ethical dilemma involving patients, health care professionals, and students. It is whether social media should be promoted and taught, or restricted to prevent the increasing risks of breaking confidentiality. To determine which choice is “right” or “wrong”, it is important to understand what is at risk for both options. Following the ethical theory of Utilitarianism, it is critical to look at whether actions are morally right or wrong depending on the outcome the actions produce. The nurse or health professional in question would determine which option will produce the most good and do the least harm.Imagine a bright young registered nurse named Joyce who has just graduated and is new to the medical field. She has begun her journey and is eager to share her stories. Without giving names or posting pictures, she has a private twitter site where she posts information about the unit she works in, including details about patients recently admitted with an unusual and interesting diagnosis. When confronted by her manager about her posts, she stated that she only intended small groups of friends and family to see her posts and purposely didn’t expose the name of the patient to try and protect patient confidentiality and privacy. Although Joyce knows she should not share this information with anyone outside the professional setting, she most likely thought that because her social media account was private, it would not be considered a public setting. However, in one study done by Lenhart and Fox (2006), most bloggers indicated that they thought their postings were at least semi-private. Unfortunately, that is not true since social media sites such as Twitter, Facebook, Blogs, and Instagram are all in a public domain. This puts private and public accounts into the same class. E-professionalism issues remain stubbornly persistent despite a plethora of warnings, guidance, commentaries, and advice about the use of social media (Jones & Hayter, 2013). According to Jones and Hayter (2013), there is advice given about the dos and don’ts of professional online behavior, but they do not advise many on what to do in various difficult situations that arise within the social media context. This can be seen in Joyce’s case as she has not been taught the proper uses of social media as a medical professional. This places health professionals to some degree of risk when there is little training given on the concept and patterns of online privacy and ‘crossing the line’ within social media. Clearly, there is a general lack of ‘boundary theory’ among many students and health professionals (Peternelj-Taylor 2002). Educators ought to be aware of the importance of educating professional health providers, medical and nursing students about these boundaries with the use of social media. In addition, nurses should advocate for the education on social media use to prevent situations like Joyce’s.Due to the lack of education based on social media, many health care providers express concerns that social media use, primarily interactions with patients, is ethically problematic (Gagnon & Sabus, 2015). However, social media engagement does not create ethical problems if best practices are taught and online communication adheres to terms of service, professional standards, and organizational policy. In fact, there are numerous positive outcomes related to the use of social media, if done properly; this includes networking, marketing, consumer engagement, and public relations (Cain, 2011). For example, Professionals primarily used LinkedIn (70.7%) and Twitter (51.2%), for communication with their colleagues and marketing reasons (Antheunis, et al., 2013); Their motives for health-related social media use were divided into five subcategories: Increasing knowledge, Efficiency, Doctor-patient communication, Marketing, and Communication with colleagues (Antheunis, et al., 2013).As a result of the ever-growing trend towards the use of social media in healthcare for information sharing, professional peer connections, and patient education, many health organizations such as hospitals and pharmacies have taken advantages of social media tools such as Twitter, Facebook, YouTube, LinkedIn, and other social networking systems to promote the efforts of the organizations and its members and improve communications (Cain, 2011). Social media is a great way for health care providers to assist, reach out to, and offer support to their patients as is a beneficial vehicle to convey information or opportunities for better health and keeping patients up to date on health-related information (Eschenbrenner & Nah, 2015). It also represents the beginning of a new era of communications for health promotion and interventions. For example, there is a free counseling service provides on Twitter for people thinking about suicide called Suicide Call Back Service (@SuicideCallBack) (Eschenbrenner & Nah, 2015). In addition, health students who use social media have a unique opportunity to learn from field leaders to keep up with the increasingly fast pace of the change in their discipline (Rhonda et al., 2014).Nearly every hospital in the United States has a website that supports interactive social media features; for example, Mayo Clinic reported that in 2012, more than 1,500 United State hospitals manage 6,500 social media accounts on site (Gagnon & Sabus, 2015). In addition, a recent study in the American Journal of Medical Quality showed that “for a group of New York hospitals, there was a one percentage point decrease in 30-day mortality rate for every 93 “Likes” on the hospitals’ Facebook pages. Facebook “Likes” were more closely related to mortality than patient satisfaction surveys” (Gagnon & Sabus, 2015).Given the universality of social media in society, it is likely that a large proportion of healthcare providers use social media, at least for personal purposes. This furthers the importance of educating rather than restricting the use of social media. Standards of Conduct in the Use of Social Media, propose that users consider creating separate personal and professional identities on social media platforms; this is commonly referred to as “dual citizenship” (Gagnon & Sabus, 2015). This decreases the risk of breaking confidentiality and privacy for patients. Furthermore, since social media is such a new concept within the last decade, many practicing health professionals are new to social media and may not be comfortable or understand how to use social media.  Professionals in practice should continuously seek educational opportunities including education workshops, webinars, and informal lunch and learn sessions to develop their comfort and knowledge of professional health care in social media.Organizations such as The Ottawa Hospital have already started to incorporate social media into their system ever since feedback from health professionals addressed how printed newsletters and internal websites are not effective nowadays (Jackson & Kennedy, 2015). They recognized these challenges with communication and found social media represented a solution with their new social media platform: TOH Nurses, a social media platform that shares information about nursing education, recognition, and professional practice issues in a venue that is accessible to nurses 24 hours a day (Jackson & Kennedy, 2015). The goal of implementing TOH Nurses was to communicate effectively with clinical nurses in a large, multi-site teaching hospital with the aim of achieving higher attendance at nursing events (Jackson & Kennedy, 2015). With bigger organizations such as The Ottawa Hospital incorporating social media into their system, it is more beneficial to educate health professionals and students the use and productivities of social media.Even though there are many organizations understanding the benefits of implementing social media into their system and promoting the education of their use, concerns about social media are still present. Organizations concerns fall into three classifications: reputation issues, privacy issues, and productivity issues (Cain, 2011). Although social media allow more interactions with clients, it allows more opportunities for controversial or negative dialogue to be posted, which has the potential to reflect poorly on the organizations. Privacy issues are now more at risk with social media and more employees are now disciplined for ill-advised social media posts as seen in Joyce’s case. Finally, there are productivity concerns; The use of social media applications can divert the employee’s attention and consume a significant amount of time, even if that time is in small increments. In one study, organizations who allowed office workers to have access to Facebook during working hours experienced, on average, 1.47% drop in productivity across the employee population (Cain, 2011). These factors must be considered when making such big ethical decision regarding whether the use of social media should be promoted and taught versus prevented and prohibited.Considering the laws of Utilitarianism and factoring in the fact that the age of technology is current, the benefits of promoting and educating the use of social media outweigh the liabilities compared to restricting and preventing. Therefore, by prioritizing beneficence, working health professionals and learning student should be educated on the use of social media as it provides great opportunities to increase knowledge, Efficiency, Doctor-patient communication, Marketing, and Communication with colleagues.


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