see attachment

OscarPerez

Ethicaltippingpoint_Nursespresenceonsocialmedia.pdf

Home >Nursing homework help >see attachment

52 l Nursing2020 l Volume 50, Number 12 www.Nursing2020.com

w a v e b

re a k m

e d

ia /S

h u

tt e rs

to c k

BY MAI-LY N. STEERS, PhD, MA, AND SARAH F. GALLUPS, PhD, MPH, RN

Ethical tipping point: Nurses’ presence on social media

A NURSE RECENTLY sparked head- lines after a controversial tweet of a video originally posted on TikTok.1,2 The video featured the poster, who is dressed as a patient in a hospital gown and clutching her chest. She appears to be short of breath. The video cuts, and, this time, she has donned scrubs and swings a stethoscope while gyrat- ing and rapping the words, “Get it! Get it! Out of breath, huh?” to mock the “patient.” The caption read, “We know when y’all are faking” fol-

lowed by two laughing emojis.1,3 The post provoked so much anger that it spawned the “#PatientsAreNotFaking” hashtag and served as the impetus for thousands of Twitter users to share stories about healthcare professionals they perceived to have dismissed their legitimate health concerns.

This is just one example of a nurse whose social media posts have inspired anger. Nurses have become increas- ingly scrutinized for social media posts, including but not limited to those

Abstract: This article discusses ethical concerns surrounding social media content posted by nurses; specifically, how these posts may violate public trust. It also sum- marizes considerations for nurses to con- template before posting to social media and provides examples of positive uses of social media.

Keywords: patient-nurse relationships, professionalism, social media, trust

www.Nursing2020.com December l Nursing2020 l 53

advocating abstinence for the preven- tion of sexually transmitted infections, deriding patients for their sexual his- tory, and mocking patients who mis- carried after vaping while pregnant.3

These cases bring into question the professional and ethical boundar- ies of nurses and other healthcare professionals on social media. For example, if these posts do not explic- itly violate confidentiality by singling out patients and, instead, provide general commentary, why has the public responded so negatively? Nurses should be allowed to post about their everyday experiences like members of other professions, but where is the line? This article dis- cusses the ethics of social media use and provides nurses with some over- arching guidelines to consider when posting on a social media platform.

Violating the public’s expectations During pinning ceremonies, new nurses from across the country often recite a version of the Florence Night- ingale Pledge. In it, they promise to “abstain from whatever is deleterious and mischievous,” “maintain and elevate the standard of [their] profes- sion,” “hold in confidence all personal matters committed to [their] keep- ing,” and “dedicate [themselves] to devoted service to human welfare.”4 The underlying principles of this oath represent a call to action for nurses to set aside their personal needs or desires and hold the welfare of their patients above all else.

According to the annual Gallup poll, nursing has been rated the most honest and ethical profession for 18 consecutive years compared with other surveyed professions in the US.5 Further, the American Nurses Association (ANA) Code of Ethics notes that the professional and personal identities of nurses are entwined. As such, nurses should embody the values of nursing even in their personal lives.6 The public

expects nurses (and healthcare pro- fessionals at large) to maintain a level of decorum and professionalism that extends beyond their working hours. Failure to live up to these expecta- tions can have serious personal and professional consequences for nurses.

Expectancy violation theory may help to explain why the public can be outraged by inappropriate posts from nurses on social media. It sug- gests that individuals can experience intense, heightened emotions such as extreme anger in response to perceived violations of their expecta- tions.7,8 Inappropriate content posted to social media undermines the trust- worthy reputation of nurses, spark- ing outrage. After experiencing these intense emotions, people may begin to ignore the message and content of the post, instead focusing their atten- tion on the source of the message.9 As

a result, people may not only think negatively about the nurse making the post, but they may also make judg- ments about nurses in general.

Ethical considerations Many ethical concerns relate to social media use among nurses, including explicit breaches of confidentiality or violations of the Health Insurance Portability and Accountability Act of 1996.10,11 In a 2020 study of nearly 400 nurses, 80% of surveyed partici- pants described posting pictures of pa- tients, even without identifiers, to social media as “never okay.”12 However, the remaining 20% of participants would not rule out the possibility, responding with “depends” or “not sure.”12

Besides protecting patient privacy, another major ethical concern is the erosion of trust in the nurse-patient relationship. According to the ANA Code of Ethics, a nurse’s primary com- mitment is to gain the trust of patients, families, and communities by practic- ing with compassion and respect.6 This includes recognizing and setting aside any personal prejudices or biases, re- specting the personal beliefs and deci- sions of patients, and maintaining pro- fessional boundaries.6 As demonstrated in the example at the beginning of this article, negative portrayals of hypotheti- cal patients, colleagues, or employers, even without any identifiable informa- tion, can erode this trust and ultimately affect nurse-patient relationships.13

Before posting to social media, nurses must consider whether they may be inadvertently exacerbating cul- tural differences and misunderstand- ings, such as perpetuating stereotypes, or enabling discriminatory behavior, such as choosing not to engage with someone for racial or socioeconomic reasons. An example is pushing the “like” button to endorse another user’s unsuitable or inappropriate content, such as inflammatory racial remarks.13

Additionally, nurses should be hesi- tant about making any impulsive posts when venting after a long day, even

Nurses should be hesitant about making

any impulsive posts when venting after a long

day, even if they lack malicious intent.

54 l Nursing2020 l Volume 50, Number 12 www.Nursing2020.com

if they lack malicious intent, as such actions can damage the public’s trust in professional caregivers. As a con- sequence, patients may decide not to disclose pertinent or important health information critical to patient care due to fear of judgment from their health- care professionals. Additionally, patients may be less likely to adhere to treat- ment recommendations and less satis- fied with care and health-related quality of life.14 Trust is the foundation of the nurse-patient relationship, and the abil- ity to cultivate and maintain it is critical for nurses as they promote health and provide patient-centered care.

Avoiding pitfalls How can nurses avoid these ethical and professional pitfalls? The ANA and the National Council for State Boards of Nursing have provided general guidelines for nurses posting to social media that include the following.15-17

• Protect privacy by refraining from mentioning, providing potentially identifying information or details on, or sharing photos or videos of patients. • Avoid participating in lateral violence, or cyberbullying, via negative com- ments about colleagues and coworkers. • Refrain from posting unprofession- al content, such as drunken antics during times out with coworkers. • Recognize that nothing is ever truly deleted; social media posts are still discoverable long after they have been removed. • Become familiar with the regula- tions of the healthcare organization. Nurses who violate their employer’s policies, even on their personal time, can be fired. • Report to a supervisor or the desig- nated organizational contact if a po- tential breach of confidentiality has been observed online. • Look for social media education opportunities and participate in con- versations about appropriate online conduct at healthcare institutions, schools of nursing, or professional organizations.

Constructive uses of social media With so much discussion on what they should refrain from posting, nurses should remember that they can also create a positive social me- dia presence. These platforms can be fun and entertaining sources to foster dialogue, disseminate research, ex- change information, and engage with patients.10 For example, nurses have posted short, fun dance or music videos featuring colorful screen cap- tions to TikTok, providing education on various health topics from osteo- porosis to COVID-19.

By sharing experiences that are also relatable to those not involved in healthcare, such as maintain- ing work-life balance or parenting young children, many healthcare professionals disseminate evidence- based information in a lighthearted way. These posts are important because they humanize healthcare professionals, which can subse- quently strengthen relationships with patients.

Additionally, social media plat- forms allow a safe space for the nursing community to bond over common experiences unique to nurses. Nurses have used social media to connect with peers and encourage future generations of colleagues and coworkers. These interactions have the potential to inspire a more diverse group of young people to pursue healthcare careers.

A positive online environment Nurses can have fun on social media, but they should always ensure that their posts maintain the integrity of the nursing profession. Overall, nurses are encouraged to harness the power of the internet to foster a posi- tive online environment in which they can share critical healthcare information, educate the public, and support and encourage other health- care professionals. ■

REFERENCES

1. D Rose. Twitter post. Nov. 19, 2019. 9:56 AM. https://twitter.com/damndrosetweets/ status/1196804341753139200.

2. Andrew S. Nurses and doctors are flocking to TikTok to crack jokes and lip sync. But are they eroding patients’ trust? CNN. 2020. www.cnn. com/2020/01/18/us/tiktok-doctors-nurses-trnd/ index.html.

3. Tait A. TikTok’s medical professionals maybe aren’t all that professional. FFWD. 2020. https:// ffwd.medium.com/tiktoks-medical-professionals- maybe-aren-t-all-that-professional-14d55a08552f.

4. Florence Nightingale pledge. J Holist Nurs. 1985;3(1):18.

5. Reinhart RJ. Nurses continue to rate highest in honesty, ethics. Gallup. 2020. https://news.gallup. com/poll/274673/nurses-continue-rate-highest- honesty-ethics.aspx.

6. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. 2015. www.nursingworld.org/practice-policy/nursing- excellence/ethics/code-of-ethics-for-nurses/coe- view-only.

7. Burgoon JK. A communication model of personal space violations: explication and an initial test. Hum Commun Res. 1978;4(2):129-142.

8. Burgoon JK. Interpersonal expectations, expectancy violations, and emotional communication. J Lang Soc Psychol. 1993;12(1-2):30-48.

9. Le Poire BA, Burgoon JK. Usefulness of differentiating arousal responses within communication theories: orienting response or defensive arousal within nonverbal theories of expectancy violation. Commun Monogr. 1996;63(3):208-230.

10. #EveryNurse. How nurses should be using social media. 2018. https://everynurse.org/blog/ how-nurses-should-be-using-social-media.

11. HIPAA Journal. HIPAA social media rules. 2018. www.hipaajournal.com/hipaa-social-media.

12. Lefebvre C, McKinney K, Glass C, et al. Social media usage among nurses: perceptions and practices. J Nurs Adm. 2020;50(3):135-141.

13. Terrasse M, Gorin M, Sisti D. Social media, e-health, and medical ethics. Hastings Cent Rep. 2019;49(1):24-33.

14. Birkhäuer J, Gaab J, Kossowsky J, et al. Trust in the health care professional and health outcome: a meta-analysis. PLoS One. 2017;12(2):e0170988.

15. American Nurses Association. ANA’s principles for social networking and the nurse: guidance for registered nurses. 2011. www.nursingworld. org/~4af4f2/globalassets/docs/ana/ethics/social- networking.pdf.

16. National Council of State Boards of Nursing. A nurse’s guide to the use of social media. 2018. www.ncsbn.org/NCSBN_SocialMedia.pdf.

17. Barry J, Hardiker NR. Advancing nursing practice through social media: a global perspective. Online J Issues Nurs. 2012;17(3):5.

Mai-Ly N. Steers and Sarah F. Gallups are assistant professors at Duquesne University in Pittsburgh, Pa.

The authors have disclosed no financial relationships related to this article.

DOI-10.1097/01.NURSE.0000694768.02007.f1