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Abstract
EBN engages readers through a range of Online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.
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This article summarises a recent EBN Twitter chat on the use of social media as way to support student nurses. The Twitter chat was led by Daniel Gooding (@DannGooding) as a representative of the Student Nurse Project (@StNurseProject) and Alison Twycross (@alitwy), a Professor of Children’s Nursing, Deputy Dean and Lead Nurse at London South Bank University, on behalf of the Evidence-Based Nursing Journal. A Wakelet version of the Twitter chat can be found online (https://wakelet.com/wake/f8cb3d3b-e4e1-4f7a-9613-3cf7fc1439f5). The prechat blog can be found online (https://blogs.bmj.com/ebn/2018/09/03/how-can-we-use-social-media-to-support-student-nurses/).
Background
The use of social media among students is well documented. A UK survey1 conducted in 2016 of 121 nursing students (a response rate of 32%) found that 77% were using Facebook before starting University, which rose only slightly after starting the programme. Twitter was used by 12% before the course and rose to 24% after. The students in this survey used Twitter to engage with professional forums and exchange information and ideas. Nurse lecturers could be ‘uniquely placed to incorporate the use of social media to enhance students’ learning experiences and support students to develop competency in the use of social media for patient benefit’ (p 188).2
The idea for the Twitter chat emerged from a discussion about whether it was feasible or desirable to host part of the nursing curriculum on social media. We students speculated that it might increase engagement and possibly improve student outcomes. There is no doubt collaborative learning and an emphasis on engagement with subject matter is essential in nursing education3: student engagement is ‘positively correlated with student achievement’ (p 326). Stephens and Gunther4 note that in order to ‘meet the generational needs [of the] millennial student and to engage that student in learning, it is imperative for the educator to adapt teaching and learning methods that will optimise the probability of success’. Millennial students are said to prefer teaching that is ‘fast, relative and succinct’ (p 183).5 Social media platforms offer plausible and logical adjuncts to traditional curriculum delivery and a Twitter chat is a logical way to explore what the students think of this idea.
Key messages from the Twitter chat
The Twitter chat focused around three themes: organisational encouragement and discouragement; barriers to getting started or continuing to use Twitter; and Pros and Cons of Social Media use. Twitter was the main focus of discussion but Facebook was also mentioned. The chat explored perceptions of individuals and also organisations; organisations included in the discussions were Higher Education Institutes (HEIs) (Universities), departments within an HEI (eg, a School of Nursing), programmes within a department (eg, bachelors level nursing course), and acute secondary and tertiary services (eg, hospitals).
Organisational encouragement or discouragement
The participants identified a dichotomous approach to social media, especially Twitter, with individual lecturers and departments/programmes of study either encouraging or discouraging its use. Programmes reportedly varied in their engagement with the platform but more HEIs and departments have begun to use Twitter, which gives tacit permission for students to do the same. Several HEIs and programmes were mentioned in the chat as making effective use of Twitter (figure 1) and this was often led by individual members of staff with @nurselecturer from Plymouth University being a noticeable leader in this.
#PUNC Plymouth University and University of West of England are keen users.
However, even when an organisation has one or more active accounts there were departments within that organisation that eschew the use of social media. (figure 2).
Different attitude by organisation and department.
One of the reasons postulated for the reluctance of both individuals and organisations to sanction or use social media was historical reports of inappropriate use of social media by nurses, which has led to disciplinary action.6 7 Some students might be concerned about how to use social media safely and professionally (figure 3). However, regulators, organisations and professional bodies have begun to develop social media guidelines (eg, the UK Nursing and Midwifery Council 2015)8 and this can promote safe professional use. In the UK, new standards for education require programmes to ensure their students are supported to be demonstrate digital and technological skills and increasingly social media is being used as an integrated course component to achieve this.9 Use of social media as part of education, use by organisations and guidelines should all serve to reduce students’ fear. Plymouth University (and others) has a module on digital professionalism and HEIs use twitter as an optional assessment and for engagement with learning material.10 We are seeing the gap close between more traditional teaching and learning strategies eg, lectures) which can lead to a lack of student engagement11 and better use of technologies such as Twitter.
Concerns about ‘appropriate’ use of Twitter.
Students in the chat pointed out that they were trusted to abide by their professional code while in practice, and therefore, it did not make much sense for a lack of trust in their use of social media (figure 4).
Trust is an essential component of social media use.
Barriers to getting started or continuing use of twitter
Students and HEI staff both valued being ‘walked through’ how to use Twitter as initial anxiety about it was often high (figure 5). Support to do this came from a variety of places—the HEI, friends and peers.
Support to get started on twitter.
Many users felt that once they got started they gradually became more proficient and could make better use of Twitter (figure 6) but there can be challenges to overcome. One of the main barriers to ‘effective’ use of Twitter was having the time to engage.
Gaining confidence in use of Twitter.
The chat demonstrated this technology for learning has been embraced by lecturers and students of all ages (figure 7)—suggesting that the ‘generational gap’11 between the two might be less of a problem than some suggest.
Age is no barrier to use of social media.
Pros and Cons of social media use
Twitter has the potential to facilitate the exchange of a broad range of information. Students share their experiences with each and with other healthcare professionals. Twitter is a platform to share and discover good practice that can enhance patient care and ultimately we can learn from each other to create better care provision. The students in the chat felt that they made contact with people outside of the circle that would influence them in ‘real life’ (figure 8).
Learning through networking.
Despite its time consuming nature many people felt that Twitter was a learning tool, it helped expand their horizons, and alerted them to new ideas (figure 9).
Twitter provides access to new and different ideas.
The potential downside of social media use is that there is an overwhelming amount of information out there which makes it difficult for readers to judge what is reliable and trustworthy.12 However, one of the hallmarks of current student nurse education is attention to critical appraisal skills including the evaluation of the veracity, rigour and bias of digital resources.13 14
Students can feel pressured into creating an account and being an active tweeter. While it is possible to do this anonymously the encouragement to tweet as part of a module, or to use a name that affiliates you to a particular course, can raise serious issues for some students. It is vital to have an alternative for those students who do not wish to or cannot engage with Twitter (figure 10).
Students autonomously decide whether to engage.
There is also the fear that there are unrealistic expectations promoted by the use of Twitter: it is very easy to only share the great things that you have done (figure 11). This attitude has the potential to make other students feel like they are not good enough.
Skewed view offered by twitter.
Twitter is also used to provide support for student nurses, by their peers and by a wider circle. Practical help, encouragement and reassurance are given. For example, the second-year slump or ‘sophomore slump’—a period of low self-efficacy during the middle of the nursing course that is thought to contribute to attrition (figure 12). Tower et al 15 identified that students share mastery experiences, provide modelling experiences and used verbal persuasion to reframe problems via Facebook, helping to build self-efficacy and alleviating ‘sophomore slump’.
Providing support via Twitter.
Conclusions
Perhaps unsurprisingly the twitter chat participants were very positive about the benefits of making use of Twitter. Support was provided in a variety of ways educationally and psychologically. Guidelines were referenced by the group who demonstrated an awareness of the potential risks and the need to be aware of maintaining professionalism. While some HEIs promote the use of social media, there are others who actively discourage it. The participants felt that this discouragement indicated a lack of trust, which is at odds with their regard for students on practice placements for example.
Generally, benefits were perceived to outweigh risks but participants also recognised that social media is not for everyone and fairness requires alternatives are made available if social media is being used as part of a course requirement.
Footnotes
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.