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Terri L. Schmitt, PhD, RN, FNP-BC
Susan S. Sims-Giddens, EdD, RN
Richard G. Booth, MScN, RN

As technological advances continue to expand connectivity and communication, the number of patients and nurses engaging in social media increases. Nurses play a significant role in identification, interpretation, and transmission of knowledge and information within healthcare. Social media is a platform that can assist nursing faculty in helping students to gain greater understanding of and/or skills in professional communication; health policy; patient privacy and ethics; and writing competencies. Although there are barriers to integration of social media within nursing education, there are quality resources available to assist faculty to integrate social media as a viable pedagogical method. This article discusses the background and significance of social media tools as pedagogy, and provides a brief review of literature. To assist nurse educators who may be using or considering social media tools, the article offers selected examples of sound and pedagogically functional use in course and program applications; consideration of privacy concerns and advantages and disadvantages; and tips for success.

Citation: Schmitt, T., Sims-Giddens, S., Booth, R., (September 30, 2012) "Social Media Use in Nursing Education" OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 3, Manuscript 2.

DOI: 10.3912/OJIN.Vol17No03Man02

Key words: Social media, nursing education, curriculum, informatics, TIGER initiative

Social media is more than an emerging technology platform or cultural trend, but a method of communication that is changing the way individuals and organizations throughout the world transmit and receive information. Social media is a platform that can assist nursing faculty to help students gain greater understanding of communication, professionalism, healthcare policy, and ethics. Merriam-Webster dictionary ( 2012) defines social media 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" (para. 1).Social media is more than an emerging technology platform or cultural trend, but a method of communication that is changing the way individuals and organizations throughout the world transmit and receive information. The meaning and value of social media continue to be debated among business leaders, computer science scholars, educators, and users.

The key purpose of social media is engagement of others through electronic means, most often supported through internet sites or software. These are called social networking sites and involve people who 'follow' or are 'friends' with each other, meaning that people linked to a person can see his or her information and updates. Within these sites people also share their lists of followers and interact to exchange information, knowledge, opinions, and other forms of communication ( Boyd & Ellison, 2007). Technological advances continue to fuel the development of social media as a mechanism for knowledge and information exchange within local, national, and global communities.

...nurse educators are beginning to explore sound methods of application of social media into nursing curricula. Nurses serve as significant knowledge brokers within healthcare systems, among healthcare disciplines, and with patients, families, and communities ( Robert Wood Johnson Foundation [RWJF], 2010; Schmitt & Lilly, in press); therefore, nurse educators are beginning to explore sound methods of application of social media into nursing curricula. The rapid growth of technology has kept nursing and other healthcare disciplines scrambling to keep pace. In the United States, the Technology Informatics Guiding Educational Reform (TIGER) competencies; TIGER educational initiative; American Nurses Association (ANA) social media toolkit; and nursing informatics toolkit developed by the National League for Nursing (NLN) assist educators in developing nursing informatics courses that include sound social media content such as blogging or engagement through a medium such as Facebook® ( ANA, 2011; Hebda & Calderone, 2010; The TIGER Initiative, n.d.; NLN, n.d.). Similarly in Canada, the Registered Nurses Association of Ontario (RNAO) ( 2012) recently released a faculty eHealth toolkit to help educators to embed informatics content within undergraduate education. Other resources both within and outside of nursing continue to be developed to aid nursing faculty to prepare nursing students for future demands ( Center for Disease Control, 2011; Webicina, 2012).

Roughly 80% of both Americans and Canadians currently use the Internet, and between 70 to 80% of these users seek health information data through this medium ( Pew Research Center, 2011; Statistics Canada, 2010, 2010b). Equally impressive, the number of healthcare facilities that make use of social media grew 210% between 2009 and 2011 ( Bennett, 2011). Of the millennial generation (those who will come to adulthood during this millennium), 75% use some form of social media. This generation views integration and use of technology into their lives as a defining characteristic of their generation ( Pew Research Center, 2010). Social media is not only a means of sharing social information, but also used to find employment; create a professional voice in topic areas or on professional issues; project and research collaboration; and disseminate and gather of professional information (RWJF, 2010; Schmitt & Lilly, in press).

...risks of policy or privacy violation, time, cost, and lack of familiarity with technology continue as barriers for nursing faculty in adoption of new technology into curricula. In general, nurses are late adopters of technology, with increasing age being an important contributing factor to this delay ( PRWeb, 2011). In 2012, the American Association of Colleges of Nursing (AACN) noted that the average age of nursing professors was over 60 years, associate professors over 57 years, and assistant professors over 51 years. In addition, risks of policy or privacy violation, time, cost, and lack of familiarity with technology continue as barriers for nursing faculty in adoption of new technology into curricula ( National Council of State Boards of Nursing [NCSBN], 2011; Schmitt & Lilly, 2012). Given the presence of social media into the lives of so many North Americans and the barriers to adoption, the purpose of this article is to review current applications of social media in nursing education by providing examples of sound and pedagogically functional use. Advantages and disadvantages of social media use will be discussed as well as suggestions for curriculum integration and future research potential.
Changing Pedagogy
As technology is rapidly changing, so is pedagogy within nursing education. Both the National League for Nursing Accrediting Commission (NLNAC) and the AACN have revised curriculum standards, encouraging nursing programs to incorporate not only nursing informatics, but technology competencies as well ( AACN, 2008; AACN, 2011; NLNAC, 2008). Similarly, the Canadian Association of Schools of Nursing (CASN) and Canada Health Infoway ( Infoway) are finalizing competencies for undergraduate nursing education to ensure graduating nurses are prepared to practice in technology-enabled clinical environments ( CASN, 2011).

Social media offers mechanisms for collaboration, networking, and learning not previously available to faculty or students. With the Institute of Medicine's critical report on the future of nursing, many nurses will return to school for further education ( IOM, 2011). Technology becomes a medium through which educators can instruct and students can learn. Through social media, students can learn outside of the traditional classroom, creating a professional voice, expanding technological abilities, and enhancing their ability to professionally and clearly communicate despite barriers of time and distance. Social media offers mechanisms for collaboration, networking, and learning not previously available to faculty or students. Social networking sites such as Twitter®, Facebook®, and LinkedIn®; blogs; and file sharing of scholarly works through entities like Mendeley are the tools through which students can learn and embrace these new opportunities.

Eighty-seven percent of students who attend a community college or university own a laptop; 62% own an iPod; and 55% own a smartphone, digital camera, or webcam ( Dahlstrom, Grunwald,deBoor, & Vockley, 2011). The primary tool used in academia is the laptop computer, essential for word processing and accessing library websites and college learning management systems. Students understand they have greater access to resources through technology, and that technology assists them to be successful and engages them in the learning process.
Student Populations
Like all classroom tools, social media as a pedagogy needs a clear purpose; an orientation; technology support; a timeframe appropriate to the course; and flexibility on the part of faculty and student.Current undergraduate and graduate nursing students are of varied backgrounds and age, from millennials to baby-boomers. Millennials multi-task personal and academic interactions daily; 58% check their Facebook® account 13 times per day; 11% of students post or read a collective of 112 times per day ( Dahlstrom, Grunwald, deBoor, & Vockley, 2011). Although technologically savvy, many millennials lack understanding of proper technology use for professional purposes. Regardless, Dahlstrom et al. ( 2011) purport that students within the Millennium generation will desire responsive and interactive faculty, and potentially evaluate classes by the effectiveness and frequency of meaningful technology integration. Many millennial and generation-X students have lived with computers and the internet all of their lives, and do not see it as an asset, but a mandatory part of their environment. These students may feel they are more adept than faculty at using technology and may not be impressed by faculty use ( Oblinger, 2003).

Baby boomers are the fasting growing age group of persons using social media tools, with over 51% using some form of social media ( Pew Research Center, 2011) and over 150% growth in use since 2009 ( Brandon, 2011). The biggest factors for non-traditional student (often of baby boomer age) withdrawal from education is family and home demands and lack of supportive services (Enseman, Coxon, Anderson, & Anae, 2006). Use of social media within the classroom can address some of these barriers and be successful with this population.

In sum, social media is appropriate to a variety of student populations. Like all classroom tools, social media as a pedagogy needs a clear purpose; an orientation; technology support; a timeframe appropriate to the course; and flexibility on the part of faculty and student.

A number of nurse researchers and educators have published accounts about the potential of social media. Examples of social media reported within the nursing education literature have generally aligned thematically into three categories: expository commentaries outlining functionality or potential of social media; social media best practice recommendations and discussions of privacy, legality, and ethics within nursing education; and research studies exploring the efficacy or value of social media modalities in education. Each of these perspectives will be briefly explored.
Expository
Given the relative newness of the topic, expository commentaries outlining the functionality or potential of social media appear frequently in nursing literature. Grassley and Bartoletti ( 2009) discussed the use of blogs and wikis as part of nursing education, encouraging the use of these tools to facilitate interactive learning and engagement with learners. Billings ( 2009) summarized potential functionalities of blogs and wikis in continuing nursing education, outlining benefits within clinical settings to promote interprofessional collaboration, facilitate peer support, and assist in project management.

Twitter® functionalities make it a versatile tool for continuing nursing education... Twitter® and micro-blogging are highlighted as innovative approaches to knowledge sharing and distribution ( Bristol, 2010; Dreher, 2009; Skiba, 2007). Twitter® functionalities make it a versatile tool for continuing nursing education, including the use of hashtags within conference/workshop settings and as a framework to organize class discussions ( Bristol, 2010). Hashtags are words prefixed with the "#" symbol that identify topics or groups within social media sites (i.e., Twitter®). The more a hashtag is utilized and repeated by others to denote a specific topic/event (e.g., #NI2012; #election2012), the greater the level of 'trending (visibility of a specific topic/event) can occur ( Hashtag, n.d.). For instance, the hashtag of #nc2010 was utilized during a three day conference to assist in aggregating messages related to the event, and build a conference-wide Twitter® discussion ( Bristol, 2010). Twitter® used as a teaching tool was evaluated by Mistry ( 2011) in asynchronous and synchronous class environments. Students were asked to watch videos of clinical scenarios and then communicate via Tweeting about the evolving patient condition. Student response was positive. Tweeting allowed them to reflect, discuss, interact with classmates, review, make decisions, and reinforce learning.

Facebook® and other social networking sites hold potential for integration within education and research in safe and productive ways ( Amerson, 2011; Wink, 2011). Platforms such as podcasts and virtual reality simulators (e.g., Second Life®) have also been discussed as potential modalities from which to build further interactivity into education and facilitate various learning styles (Ahern & Wink, 2010; Delaney, Pennington, & Blankenship, 2010; Hansen, 2008; Maag, 2006; McCartney, 2006; Schmidt & Stewart, 2010; Skiba, 2005). For example, Schmidt and Stewart ( 2010) used Second Life® in an online accelerated community health nursing course to sensitize students to various public health issues. Students were provided access to a developed Second Life® environment in the form of a restaurant, and by using the virtual learning environment were able to 'inspect' the premises for potential public health infractions.
Best Practices
A number of professional and regulatory bodies offer direction through various documents related to appropriate use of social media technology A number of recent publications focus on best practices and legal/ethical considerations of social technology use. Fraser ( 2011) outlined best practices related to social media usage by nurses (and students), including various topics related to professionalism, knowledge generation, and developing a functional online reputation. Haigh ( 2010) presented a number of salient and relevant issues related to increased use of social technologies within education, focusing upon topics such as third-party material ownership and confidentiality/privacy online. A number of professional and regulatory bodies offer direction through various documents related to appropriate use of social media technology ( ANA, 2011; College of Nurses of Ontario, 2011; College of Registered Nurses of British Columbia [CRNBC], 2012). The CRNBC ( 2012) have listed nine recommendations for nurses who elect to use social media, encompassing discussion of competence, image, confidentiality, privacy, boundaries, expectations, integrity, policy, and accountability.
Research
Morley ( 2011) explored the use of wikis among 69 nursing students, 45% of whom indicated that they perceived wikis to be valuable for communication. Forbes and Hickey ( 2010) reported in a study of 170 nursing students, "students overwhelmingly perceived that podcasting had a positive impact on their learning in the course (92.4%)" (p. 226). Contrary to concerns that providing podcasts of lecture material would decrease class attendance, only 11 students (15%) reported they had opted to not attend class (at least once) because of the availability of the podcast. A survey of 644 first-year and 413 graduating health science and nursing students found that Facebook® was used by 77% of students, 18% used LinkedIn®, and only 7% used Twitter® ( Giordano & Giordano, 2011). The results of the study demonstrated that many health professional students currently utilize social media platforms during their education, and this mode of communication may provide a "unique opportunity in social networking...for universities if they are willing to think creatively" (p. 80).

Blogging, Twitter®, Facebook®, and LinkedIn® are common and logical places to begin social media integration into nursing curriculum. The NLN highlights three core content areas for nursing informatics courses: computer literacy, information literacy, and informatics ( NLN, n.d.). Other key areas of curricular emphasis through the use of social media include professional communication; health policy; patient privacy and ethics; and writing competencies. Several varied examples of social media in nursing curricula follow to illustrate some typical applications. Table 1 provides additional information about selected social media software appropriate for educational use.

Table 1: Social Media Software for Classroom

Social media tool options are rapidly expanding. This table is not meant to be inclusive, but is a review of sites discussed in this article for purposes of nursing education.

Twitter® management software

Free software to assist in Twitter® management. Current topics or trends can be searched and specific hashtags followed.*

Hootsuite - http://hootsuite.com/

Tweetdeck - www.tweetdeck.com/

Free software assists users in organizing reference material. Download the software or search the website for academic research, literature, and collaboration. The downloaded software also indexes, scans, and sorts documents.*

Informatics Courses
The design of one undergraduate informatics course incorporated the three NLN nursing informatics core areas by using social media. To that end, students in this course were required to:

submit no paperwork in a Microsoft Word® document or physical paper format

create a blog in which they wrote professionally on certain topics; create a sound webliography on a healthcare topic; and keep a course journal

create a Twitter® account with a specified number of legitimate healthcare and nursing followers; a specific number of substantial interactions with others; and attendance and participation in at least one online nursing or healthcare chat within this platform

use and explore other social media and Web 2.0 tools (e.g., SlideShare®, Slide Rocket®, Glogster®, Prezi®) to engage in collaboration on group projects and presentations. (Schmitt and Lilly, 2011)

The purpose of using social media tools to facilitate such integration was to emphasize professional communication; better improve student comprehension and use of technology beyond electronic medical records (EMR) and personal computer word processing programs; and enhance student networking and collaboration with other nurses globally.

Prior to engaging in these social media platforms all students completed Health Insurance Portability and Accountability Act (HIPAA) educational training and required reading in regard to privacy, ethics, and professional communication. Students wrote about and presented through these mediums on course content issues including nursing informatics, meaningful use, the IOM report on the future of nursing, evaluation of electronic health record systems, privacy, security, and patient use of the Internet and technology as a health resource. This particular class was further revised during the 2011-2012 academic year by nurse informaticist Kezia Lilly to include student creation of electronic portfolios, podcasts, Vokis®, multimedia presentations, and LinkedIn® profiles to assist students with networking and applying for further education or future employment. The following descriptions of e-portfolio, Twitter®, and Wikipedia® assignments provide more specific details about how the undergraduate and/or graduate level informatics courses incorporated social media tools.

students are encouraged to provide a contact e-mail for prospective viewers who may have interest in their work.

E-portfolios. One assignment often used to assist students in professional communication and networking is the e-portfolio, which is assigned to undergraduates in the informatics course and carried through to their capstone course in the RN-to-BSN program. Students are instructed on how to create an e-portfolio through Google, also known as a Googlio®. A tutorial for beginning Googlio accounts is provided ( Googlios, n.d.) and several articles on e-portfolio reading are provided. Students are instructed to load specific assignments; a professional resume and photo; mission statement; and any other professional items that display involvement, community work, and knowledge. Private information is excluded, but students are encouraged to provide a contact e-mail for prospective viewers who may have interest in their work. Students add to this e-portfolio (e.g., major assignments, attendance at conferences) throughout each course. Students are free to explore other mediums for creation of their e-portfolio, such as Wordpress® and Blogger®. In our experience, the creation of e-portfolios through Google® has been particularly helpful and has allowed students to track evidence of their RN-to-BSN program learning in one centralized area. The e-portfolios are used by students after program completion as a way to easily display professional nursing and specialty knowledge to employers.

Twitter®. Another required activity in the undergraduate informatics course helps students to better understand why people engage in social media; how people seek health information there; and how social media can be used as a networking and information gathering tool. Undergraduate students participate in a "Twitter®" assignment and are required to do the following:

create a Twitter® account at the beginning of the course

learn how to use a secondary platform to manage the Twitter® account such as Tweetdeck® or Hootsuite®

begin following at least 60 legitimate nursing and health care Twitter® resources

have 40 legitimate followers in nursing and health care to their account by the end of the course

engage in a set number of substantial of microblog updates which must be related to current information in healthcare but follow all privacy guidelines

demonstrate the use and understanding of hashtags

engage in at least one health care related 'chat' during the duration of the course.

Assignments are graded based on a rubric and each student shares their account with faculty and others in the course. Faculty also use the course number as a hashtag and hold weekly class "chats" to discuss current topics in nursing and course information or issues.

...students either generated a new article for Wikipedia® or updated an existing article into a scholarly, lay-language, encyclopedia entry. Wikipedia®. An activity within graduate informatics courses required students to write Wikipedia® articles on topics related to health and/or informatics ( Booth, Stern, & Tkac, 2012). Students were requested to search Wikipedia® for articles or subjects that were either poorly written or missing from the encyclopedia. Working in small groups, students presented and verbally defended the importance of their proposed Wikipedia® topic/article to the course instructor. Upon ratification by the instructor, students either generated a new article for Wikipedia® or updated an existing article into a scholarly, lay-language, encyclopedia entry. Very quickly, a number of students found their additions challenged by Wikipedia® editors or modified by other users of Wikipedia®, teaching them the importance of accuracy and the peer review process. In one case, students had to defend and justify the uniqueness of their article, as it had been flagged for merger with another topic of similar underpinning. The Wikipedia® criteria for a good article [Available: http://en.wikipedia.org/wiki/Wikipedia:Good_article_criteria] were operationalized into a rubric for the students, and their updates/revisions were graded accordingly. ...students demonstrated comprehension of privacy, health care policy issues, ethics, and an improvement in both professional writing and engagement. Overall, students commented that they were impressed with the rapidity with which information was shared, critiqued, and modified on Wikipedia®. Similarly, most students reflected that they felt attached to their newly revised or created articles, leading a few to state they planned to follow and update their pages beyond the duration of the course.

Through these activities, students demonstrated comprehension of privacy, health care policy issues, ethics, and an improvement in both professional writing and engagement. Integration of technology throughout this course helped students demonstrate attainment of TIGER competencies along with achieving better understanding of computer science, library science, information management, and professional conduct in online environments. Qualitative and quantitative responses from students in course evaluations showed initial trepidation but ended with enthusiasm for the many new skills and understandings they had gained.
Graduate Nurse Educator Programs
To actively engage and prepare graduate nurse educator students, we developed a graduate course, Technology for Healthcare Education ( Sims-Giddens, 2011). This course prepares future faculty to assess the variety of generations and learning styles in classrooms and to go beyond PowerPoint presentations. By exploring strategies to utilize technology and digitally enhance course content, nurse educator graduate students learn the significance and process of incorporating social media (e.g., class social media sites), YouTube productions, and podcasts.

Graduate students are encouraged to pilot social media strategies in practicum courses. One graduate student incorporated a private blog in place of a reflective journal so undergraduate nursing students could share successful clinical experiences or procedures with peers, as well as express any frustrations encountered. Another student incorporated a class wiki for undergraduates to complete a group assignment, providing them opportunity to learn the importance of teamwork and group dynamics.

Before learning to use technology for a classroom application, many graduate students used Facebook® to connect with friends and family but had not explored other social networking sites nor considered use of social media in graduate education. Brainstorming sessions allowed students to identify new applications to actively engage undergraduates in the classroom. Students became excited thinking of faculty research and collaborative opportunities within and across nursing programs, as well as across colleges and universities.
Using Social Media beyond Informatics Courses
A different approach was to embed the use of social media technologies alongside traditional teaching methods in a senior-level nursing theory course. The author screen-recorded and narrated animated Prezi® slideshows of both clinical and professional situations. The videos were then subsequently uploaded to the author's personal Vimeo® account and the link shared through the university's learning management system. Discussion of the video narrative and preparatory readings for the class were completed online and further extended during the face-to-face element of the class. Overall, students found the teaching approach to be engaging. This approach allowed for a more complex situation to be presented, given the audiovisual nature of the case scenarios.

Another collaborative application was piloted between nursing programs in America, Finland, and the Philippines. Faculty established a private wiki and students in community health classes were invited to participate in a global health perspectives assignment. Students introduced themselves by creating personal, narrated Power Point presentations; wrote and shared essays about health promotion and prevention and the relationship between health and the environment; and developed Power Point presentations about health care delivery systems and community health services in their countries. This exchange encountered challenges, such as faculty time to develop the collaborative group and how best to include and evaluate the assignments for a particular course. The logistics of university calendars and time zone delays presented scheduling problems. Benefits of the collaborative assignment included student exposure to international cultures and health care delivery systems, and trying new technology (Finnish students narrated using Power Point for the first time). Student comments from this exchange were very positive and encouraged faculty to continue the collaborative effort. Faculty learned about educational and curricular differences, and negotiated assignments and evaluation so the learning experience would benefit students. This virtual collaborative was an exciting adventure, one that will be discussed, refined, and repeated.
Teaching Privacy
The use of social media in the classroom assists in conveying professional communication standards. Prior to use, students should complete HIPAA education and be required to read the ANA Social Networking Principles Toolkit ( ANA, 2011). Students should also be instructed to intentionally consider the following:

everything typed may be publicly accessed

who is the audience and who can see each posting

whether postings will add to or detract from the profession of nursing and their professional reputation

the need to establish professional boundaries even between friends and family

at all times to keep patient information private including their assigned work unit and minor information (e.g., patient census or their shift)

the need to keep privacy settings reviewed and updated

( Schmitt & Lilly, 2012). With careful use and preparation, social media tools can provide exciting new strategies for students and teachers.
Advantages and Disadvantages
As illustrated in the examples above, social media venues offer connectivity and a mechanism for teaching technology, communication management, information management, privacy, ethics, and professionalism. Considering the following advantages and disadvantages can be helpful to determine if, or how, social media tools might enhance in a given nursing course or program.
Advantages:

New innovations in technology offer alternate mechanisms to engage students with a variety of learning styles and help them succeed.

Online learning options continue to increase with over 6.1 million U.S. college students currently taking some form of online course work (Allen & Seaman, 2011). Social media offers a way to overcome boundaries of distance and constraints of synchronous classrooms, offering a tangible option for interacting with distance students.

Incorporating social media into the curriculum may foster excitement and learning by faculty, management of information in a way that can be recorded and researched, and creative group project work (Sakraida, Spotanski, & Skiba, 2010).

Disadvantages/Barriers:

Nursing programs may not be providing enough technological training to adequately meet student needs, desires, or the TIGER competencies (McDowell & Xiping, 2007).

Barriers may restrict the use of or enthusiasm for incorporating social media tools. Examples of barriers include lack of knowledge in technology use; fear; cost; time; the rapid nature of technology change; multiple demands and outside distractions; an unwillingness by faculty or students to engage in social media use; restrictive organizational policies; and reprimand or ostracism for misuse or mistakes within social media (Schmitt & Lilly, in press).

Social media use poses a real risk to patient and student privacy, with a larger reach and documentable evidence (NCSBN, 2011). However, many infractions are not intentional and could be overcome with clear education for both students and faculty prior to use, creating practice environments where mistakes can safely be made just as is done in physical clinical environments, and faculty development of know-how and education mechanisms for sound use of social media.

Know the institution and/or department social media policy. Several sound resources exist to assist faculty in the use of social media (see Table 2). All nursing faculty are encouraged to thoroughly examine these resources when contemplating use of social media tools. Faculty engaging in online education might also benefit from the yearly statistical report of the Sloan Consortium [Available: http://sloanconsortium.org/publications/survey/going_distance_2011]about online learning within the United States. Other tips for success include:

Know the institution and/or department social media policy. If a social media policy does not exist, strongly consider developing one through examination of published guidelines (e.g., ANA, NCSBN) and/or other institutions.

Know the educational background of students entering a course. Have students had a basic computer science course? Have they had a program introduction course where policies or HIPAA education occurs or does this need included? Ensure that students have adequate opportunity for learning about privacy, policy, ethics, and safety prior to introducing social media projects.

Choose no more than one or two types of social media to begin, then expand into other areas once those areas are understood and mastered by faculty and students.

Seek assistance from the university librarians, computer support services, and other technology-savvy faculty.

Negotiate within faculty contracts or teaching loads to provide time and/or compensation for making these changes in courses and the curriculum.

Keep course outcomes, program outcomes, and accrediting body standards as a priority and begin a project to meet specific outcomes and standards.

Investigate systematic approaches and theoretical frameworks for technology integration in curriculum.

Know your audience. Evaluate your student population's perception and attitude about technology, and their knowledge, preference, and abilities. Be prepared to create tutorials or provide assistance in areas where students may need more knowledge. Do not make assumptions about a group's technology skills based on a demographic (e.g. being a millennial).

Pilot test your project with a small group of co-faculty or students prior to implementation.

Be creative, have fun, think outside the box, and help students connect with reputable organizations and nurses.

Allow students time to grow. Encourage netiquette (respectful online behaviors) and forgiveness of others' mistakes. Caution students to not post when angry.

Provide students with privacy settings checklists for various platforms.

Finally, provide examples of both incorrect and correct use of social media, and encourage students to begin to think, discuss, and define what professional communication in a healthcare context means in social media platforms.

As future applications of technology in nursing education continue to expand, nurse educators must become early adopters and disseminators of the feasibility, acceptability, and outcomes of technology integration. One area of need is a larger body of sound research on student outcomes and abilities with technology integration and social media use within nursing curriculum. Social media is a viable option for conducting nursing education and practice research, data gathering, or interventions ( Bate & Cannon, 2011; Crilly, Keefe, & Volpe, 2011; Galer-Uti, 2010).

As nurse educators prepare student nurses to safely administer medications or perform health assessments, so must educators play an active role in teaching students to engage in safe and professional communication within a globally connected society. Social media offers a mechanism for enhancing the education and expanding the knowledge base of students in regard to privacy, ethics, health policy, professionalism, and communication. It may also assist nurses in building an earlier professional identity and connection with the profession. Barriers in the use of social media in nursing curricula continue to be related to possible breaches in patient information and unprofessional conduct by nursing students. These risks exist for professional nurses no matter the medium of communication. As nurse educators prepare student nurses to safely administer medications or perform health assessments, so must educators play an active role in teaching students to engage in safe and professional communication within a globally connected society. Active engagement in social media may help nurses identify false information; provide new sources of accurate information; encourage preventive care; participate in discussions about how to improve the future of the profession; find answers to key issues in nursing; engage in interdisciplinary learning; and begin to disarm environments of lateral violence by finding peers and platforms for positive influence. With a clear purpose; some caution and education; support from administration; resolution of barriers; and an idea of available platforms that will meet outcomes, nurse educators can successfully integrate social media into nursing curricula.

Terri L. Schmitt, PhD, RN, FNP-BC
E-mail: Tschmitt2002@gmail.com

Dr. Terri Schmitt is an Assistant Professor in the Christine E. Lynn College of Nursing at Florida Atlantic University. She has previously worked with Southwest Baptist University and Chamberlain College of Nursing. She received her diploma degree in nursing from St. John's College of Nursing, BSN from Missouri State University, MSN with an emphasis as a Family Nurse Practitioner from Missouri State University, and her PhD in nursing science from the University of Missouri, Kansas City. She runs the blog nursestory.com and has previously facilitated online nursing discussions through Twitter. Her research interests include adolescent female health, body image, type I diabetes, social media, and student learning.

Susan S. Sims-Giddens, EdD, RN
E-mail: susansims-giddens@missouristate.edu

Dr. Sims-Giddens is an Associate Professor in the Department of Nursing, Missouri State University. She received her BSN from West Texas A&M, Canyon, Texas; MSN from the University of Texas El Paso, El Paso, Texas; MEd in Bilingual Multicultural Education from Northern Arizona University, Flagstaff, Arizona; and EdD in Educational Leadership from Northern Arizona University, Flagstaff, Arizona. Research interests include technology in healthcare education; academic achievement and educational access for at-risk students; community engagement of nursing students through service learning; student peer-mentoring; nurses' and nursing students' attitudes and beliefs about poverty; vulnerable population access to healthcare, Dr. Sims-Giddens teaches in undergraduate generic BSN and BSN-Completion programs; a MSN Nurse Educator program; and is the Program Director for the BSN-Completion and Nurse Educator Programs.

Richard G. Booth, MScN, RN
E-mail: rbooth5@uwo.ca

Richard Booth is a doctoral candidate and lecturer at Western University (London, Canada), studying clinician learning and adoption of health technology. He works clinically as a psychiatric-mental health nurse in the adult psychosis program at St. Joseph's Health Care London. Currently, he teaches in the undergraduate program at the Arthur Labatt Family School of Nursing at Western University, and holds an adjunct professor position at the Institute of Health Policy, Management & Evaluation, University of Toronto. His current research interests include nursing education, social media, health informatics, and socio-technical perspectives.

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© 2012 OJIN: The Online Journal of Issues in Nursing
Article published September 30, 2012

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social media and communication technology: new “friends” in healthcare

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Terri L. Schmitt, PhD, RN, FNP-BC Susan S. Sims-Giddens, EdD, RN Richard G. Booth, MScN, RN As technological advances continue to expand connectivity and communication, the number of patients and nurses engaging in social media increases. Nurses play a significant role in identification, interpretation, and transmission of knowledge and information within healthcare.

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This VoiceThread will be used as part of the welcome and introduction to the course.  We will have  four contributors:
a. Course Mentor - Discusses expectations for the student and the levels of support that are available in the course
b. Subject Matter Expert - Discusses the content and importance of the content for real-world applicability
c. Graduated student working in the field - Discusses how the course is directly tied to job relevance and performance
d. Instructional Designer of the course - Discusses a bit about the course design and a few features

Each individual will provide a short video and slide as their part of the collaborative VoiceThread.

The student will gain from the social, cognitive and teaching presence delivered in one feature.

Here is a sample of the design of this activity. It is preferable for each 'character' to make a video rather than an audio presented here: https://voicethread.com/share/8471151/

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As an alternative idea, an Animoto video could be used with the same intention as the VoiceThread learning object. The disadvantage in using this tool is that it lacks audio features for each speaker.

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A. Present to internal team
B. Get buy in from leadership
C.  Organize course mentors, IDs, SMEs, and former students working in the field to make a collaborative VT with video input

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1." Social media is a platform that can assist nursing faculty to help students gain greater understanding of communication, professionalism, healthcare policy, and ethics."
2."Nurses serve as significant knowledge brokers within healthcare systems, among healthcare disciplines, and with patients, families, and communities (Robert Wood Johnson Foundation [RWJF], 2010; Schmitt & Lilly, in press); therefore, nurse educators are beginning to explore sound methods of application of social media into nursing curricula."
3."As technology is rapidly changing, so is pedagogy within nursing education. Both the National League for Nursing Accrediting Commission (NLNAC) and the AACN have revised curriculum standards, encouraging nursing programs to incorporate not only nursing informatics, but technology competencies as well (AACN, 2008; AACN, 2011; NLNAC, 2008)
4.The purpose of using social media tools to facilitate such integration was to emphasize professional communication; better improve student comprehension and use of technology beyond electronic medical records (EMR) and personal computer word processing programs; and enhance student networking and collaboration with other nurses globally."

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This tool in the way it is designed offers multiple creative uses. For our purposes, we can introduce several individuals who can each speak to the course from several different perspectives: a former student now working in the field, the course mentor , a SME who helped design the course and the instructional designer who was responsible for the design. The tool allows students to see, hear and engage with the content as their learning preference dictates.  The virtual presence of these individuals will deliver a sense of connection, understanding of the course and a delivery of relevance for the future.

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Create a method for large rolling enrollments to experience the value of social, cognitive and teaching presence.

To design a method that is manageable for our existing resources and that provides a continuous seamless environment where privacy and student needs are protected and respected.

To create a learning object that will provide an enriched look at the course through the lens of several contributors and stakeholders.

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Because we have such large rolling enrollments (20,000+students currently enrolled in our program), we cannot use social media tools in traditional ways as we don't have resources to monitor the sites nor do we have ways of clearing posts periodically after a certain period of time. We are working on this idea as we understand the high value of peer-to-peer contact and also ongoing dialogue with the course mentors.  For the time being, I am planning to use VoiceThread as an introductory piece at the beginning of a course.  It will afford opportunities for course mentors, former students, SMEs and others to paint a picture of the course and the relevance of the content to real world practice. This will introduce social, cognitive and teaching presence in one exposure.