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Implication of Social Media in Healthcare Practice

Submitted by on August 14, 2013 – 10:44 PM

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Technology advancements have transformed our way of living, way of working, and way of interacting. E-health can be defined as the promotion of the health, comfort, and well-being with every individual and their families to develop the proficient practice with the utilization of information and communication technology (ICT) (1). Social media (SM) is considered asthe commonly used form of e-health that consists of mobile based and web based technologies, providing an opportunity to communicate, dialogue, and exchange health related information (2).


SM seems to be the upcoming technological wave in health care because of its strong consumer edge and high accessibility (3). In today’s world,in social networking sites like My Space, Linkedin, Facebook, and Twitter, media are globally used as the most common medium for spreading health awareness. Moreover, these social networking sites are supported by multimedia contents like You Tube and Flicker. Globally, health care professionals (HCP) are using SM to improve practice and promote health by increasing access to health information and improve equity in health care (4).


In Pakistan, the use of social media is rising dramatically. The Facebook users have been doubled from 1.8 to 3.6 million over a six month period from 2010 to 2011. Also, in Pakistan, one million new Facebook accounts were createdbetween August 2011 to January 2012 (5). Even with the progression in technology and the revolution of social media, nursing profession has been dawdling to recognize the potential for application, modernization, and adoption of this technology (3).


The most important apprehensions in prevention of using these technologies in nursing practice are spelled out by Lambert et al., as risk avoidance, fear of breaching patient’s privacy and confidentiality (6). Although these issues are paramount and their importance should not be let go, SM provides nursing with multiple opportunities which must be appreciated to permit for innovation in the profession. Impact of Social Media E-health provides a variety in clinical care, health content, vast connectivity and easy accessibility through health associated internet applications(7). The utilization of information and communication technology (ICT) through SM continues to expand worldwide and is also attaining fame among health care professionals (HCP), including nursing.


It is realized that SM can be a powerful tool for educating, communicating, and influencing. Therefore, there is much to be gained in terms of its utilization in health care particularly in nursing. SM is the easy means of communication for the health care consumers. It provides a platform to consumers who can share their health issues as they arise, and get a very instant response, either from the public or from HCP.


Moreover, patients who have similar kind of health issues form the virtual communities via which they connect, communicate and share their experiences. A national survey conducted by the Pew Research Centre highlighted that in United States (US), one in three adults (30%) reported that they are people guided by health information or advice found online through SM (8). Moreover, the popularity of SM can be seen by Nursing & Midwifery Council, through their event which was conducted in February 2012: “Talking with patients online: What are the boundaries?” According to Barry and Hardikerthe event attained greater than 24,000 Twitter followers (4).


Use of Social Media within Healthcare

In order to enhance public awareness, in communities there are many nursing led initiatives globally. The wide outreach of SM can provide opportunities for the campaign of such programs (9). Furthermore, access to social media through mobile phones may prevent the need of luxurious ICT and may improve access and fairness to health care information and services in the remote areas of the world (4).Public health communication strategies are also largely promoted through SM.


In order to keep the global public aware of the outbreak of diseases and disaster, World Health Organization (WHO) utilizes SM as a source tospread and increase awareness about public health information. WHO has its own page on Facebook and Twitter. Moreover, it is significantly utilizing YouTube (11).McNab reported that during the pandemic of influenza A (H1N1), WHO used Twitter and they had more than 11,700 followers, signifying the power of SM and its rapid outreach (12).


According to Fox and Jones around 61% of Americans regularly access health related information online mainly from personal websites, blogs, and online news groups (11). Based on this, innovative health care models have been developed to connect patients and health care professionals. Hello Health model is such example initiated by Brooklyn, New York, which has established success in employing SM to communicate with health care users (13). This program aims to provide a secure social network for patients to provide health care after paying an enrollment fee.


Patients are facilitated by private web sites, instant messaging and e-mails; they are also assured to be seen by health care professionals within 24 hours. Since SM has potential to empower, educate, and engage patients, it should be used as a tool for communication between patients and health care professionals (14). HCP and physicians around the world use SM to communicate about the health related concerns. PatinetsLikeMe (Cambridge, Massachusetts) is also a podium for those patients who have similar diseases and they can advocate and explore health care options and outcomes through SM (13). Furthermore, My Health Manager (Kaiser Permanente, San Francisco, California) is a SM digital diary which is used for commentary and sharing news and patients’ experiences and it also allows patients to read physician-authored blogs (13).


In contrast, Krowchuk, Lane, and Twaddell suggest using SM with caution as there are websites like Twitter, Facebook, and MySpace which are meant for peer interaction and not for professional affiliation (14). Therefore, SM should be used with caution to communicate with patients as this could lead to the disruption of professional relationship. Moreover, building of mutual trust between HCP and patient is important to make professional relationship. This could be compromised when patients have access to the personal information of HCP that weakens that trust (15). Similarly, when on social networking sites HCP “friends” their patients, patients can get access to the personal information and this could probably affect the care they are providing and could perhaps affect the professional boundaries between patients and providers.


In order to access health information, there are numerous patients who are using internet and other SM website (13). Interestingly, it is also found out by some researchers that to access health information, up to 75% of patients use the web search with the increase in the population between the age of 70 and 75 years (16). SM users which were once confined to young adults and teenagers are shifting towards population of older adults. Whereas, it is also argued by Skiba that the availability of SM tool is not a possibility for many patients, particularly those with low income brackets (16).


Besides, accessibility is an issue with many health receivers. Wireless technology has made it possible to communicate with patients and access information just about anywhere and engage more individuals (11). Nurses can use SM technology to improve the quality of care provided to clients and their families. Crumb reported that in one of the studies, the patient undergoing surgery approved to have a hospital staff use Twitter to continuously inform her family about her progress during surgery (17).


The staff was in operating room, and during 3 hours surgery he “tweeted” about 300 progress reports to the patient’s family. It was concluded that informing the patient’s attendants rapidly with patient’s progress during surgery can reduce family’s anxiety.


Risks Associated With Social Media:

Privacy Concerns

Preserving patient’s confidentiality and ethical practices have been a challenge in traditional nursing practice. As increasing patients are participating in venue of SM in seeking health care, the risk of patients’ record being compromised is increasing exponentially. Health care through SM poses a huge challenge like privacy issues. According to Krowchuk, Lane, and Twaddell, while providing nursing care to the patient on SM, patients post a question on HCPs’ Facebook wall related to their health (14).


The question posted by patient and responses by the provider can be viewed by other friends in the provider’s network. These wall posts are then made accessible by “friends” to their other “friends”. This is how patient’s information can become accessible to many people which can violate the right to privacy of patients.


Confidentiality and ethical aspects should be foundational module of nursing curricula. Due to the marked growth in the SM used by HCP and patients, there is an urgent need for the inclusion of “social media in nursing practice’ in nursing curriculum (3). Moreover, the perceived benefits of SM in nursing is meaningful, thus the secure social networks should be formed in order to overcome privacy issues.


Legal Issues

Initiating new technology entails a watchful assessment and judgment of “fit for purpose” (3). Legal issues need to be well thought-out when executing SM into nursing practice. Hawn and McBride & Cohen affirmed that it has been reported in the literature that due to leakage of the patients’ private information on the social networking sites, blogs, and public websites, lawsuits have occurred against HCP (13, 15). Legal issues can occur when the patient’s personal information is shared. Therefore, it is significant that all HCP should comply with the Health Insurance Portability and Accountability Act (HIPPA) (14). HIPPA is designed to guard the confidentiality of patient’s medical records (18).


Practice Implications for Healthcare

Regardless of the advancement in technology, Google and other social websites remain blocked on the desktop computers of nursing stations by the hospital server administrators. Selected websites are unblocked for senior management staff during the office timings from 9 AM to 5 PM as they may need referring to vital information on the web (3). However, these search tools like Google scholar could prove effective in the enhancement of evidence based care and up-to-date researches for the nursing profession. This is a thought provoking matter, as nurses are trusted to access highly confidential patient data and in administrating controlled drugs to save patients but they are not trusted to access searching engines at the time of delivering nursing care (3).



There are certain challenges for the implementations of SM in health care program. Krowchuk, Lane, and Twaddell are of view that use of SM for routine health cannot replace the traditional, face-to-face communication with patients (14). They further argue that the list of emailed symptoms of patients cannot substitute the inspection, auscultation, and palpation performed by HCP. Similarly, the caring touch from nurse, the listening ears and the welcoming smile cannot be replaced by emails, websites and other SM tools.


This makes the effectiveness of promoting health through SM questionable. Therefore, there is an urgent need of studies to be conducted in order to evaluate the effectiveness of SM in nursing practices (14). Also, nursing needs to carefully harness the power of SM to avail unprecedented opportunities for wide reaching communication globally. Gap Analysis, an in-depth critical review of literature to the best of my knowledge, shows that very limited research has been done on this topic in Asian/Pakistani context.


Moreover, there is a scarcity of research from the perspective of E-health through SM. In Pakistan, most of the population has access to SM and those in remote areas can have access to healthcare through SM in near future. However, there is a need to initiate access to health care benefits through SM. Thus, there is a gap in study of the SM for health care in order to improve the quality of care provided through SM.



Like any other technology, use of SM for spreading health awareness and increasing patient satisfaction has also its own merits and demerits. While it helps in improving effectiveness of communication, easy dissemination, better accessibility and potential for decision making, there are issues of privacy, confidentiality and sensitivity. It is, however, evident that merits prevail over demerits. Nurses as health care professionals, need to learn the boundaries within which one must utilize SM to increase patient satisfaction. A conscious effort needs to be made at all levels, starting from thoughtful policy making to actual utilization of this mode on daily basis by healthcare professionals.




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About the Author: Neelam Saleem Punjani is a first year student in Masters of Nursing program at the Aga Kahn University School of Nursing and Midwifery. Pakistan. She had two years of experience of working in Surgical unit as a Special care nurse at the Aga Khan University Hospital. Neelam can be reached at  [email protected]

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