Social networking, a relatively new communication phenomenon, has the ability to provide education, foster advocacy, promote the profession, and influence mental health policy. It also has the potential to violate boundaries, infringe on privacy, create liability, and damage professional credibility. A review of the literature revealed limited research has been conducted concerning the impact and use of social networking sites in nursing practice and other healthcare disciplines. In Psychiatric/Mental Health Nursing, communication is the foundation of the therapeutic alliance. Because social networking communications have the potential to positively and negatively affect this alliance, it is imperative to develop guidelines for prudent and resourceful usage of social networking media that complies with practice acts, promotes professionalism, and maintains work-life balance for the psychiatric mental health nurse. This session will provide an overview of different types of social media outlets, review published position statements from other healthcare disciplines, and consider best practices for Psychiatric/Mental health nursing.

1. Social Networking for
Psychiatric-Mental Health
Nurses
Jaclyn Engelsher MSN, FNP-BC, DOM
Tanitha Moncier MSN, FNP-C
2nd Year PMH/DNP Students

2. Overview

3. What is Social Networking?
(in the context of healthcare)
The use of Web 2.0 based media platforms to create
personal and professional profiles as a means to
forge connections for real-time information sharing
among nursing professionals and health consumers.
Social networking is powered by social media

4. Social Media Outlets
 Lifestreams
 Blogs
 Microblogs
 Wikis
 Podcasts
 Content Communities
 Forums
(Boyd & Ellison, 2007)

5. Social Networking
is not
 Conversation  Selfish
 Commenting  Simple
 Community  Secure
 Collaboration  “Set and Forget”
 Contribution  Success by number
 Creative  Static
Understanding usage does not equate to understanding implications
(Touchette, 2010)

6. Social
Networking
in Healthcare
Treat. Teach. Learn

7. Health Information
 20% Americans use SM
 35 million in 2007; 89 million in 2010
 Average age: 41
 Household income: $75K +
 25% influence health care decisions
 32% report high level of trust
 43% “millennials” want SM communication with providers
 Mobile SM use greater with minorities and youth
 Social networking sites, video, Twitter, location services
 Importance of SM for government outreach
(Sharp, 2010) (Smith, 2010)

8. Most Popular Sites by Use
100%
94%
90%
80%
70%
60%
50%
40%
32%
30%
20% 18%
10%
2%
0%
Facebook Twitter YouTube FourSquare

9. Healthcare Networking Trends
140 HEALTH CARE USES FOR TWITTER Tissue recruitment (for kidney and other organs, including blood) Epidemiological survey Disaster alerting and response
Emergency response team management Supportive care for patients and family members Diabetes management (blood glucose tracking) Maintaining a personal health diary
Adverse event reporting in the clinical setting and other pharmacovigilance functions Emitting critical laboratory values to nurses and physicians Alarming silent codes
 Engaging e-patients
(psychiatric emergencies, security incidents) Drug safety alerts from the FDA Risk management communication Augmenting telemedicine Issuing Amber alerts Issuing alerts
for missing nursing home residents Exercise management and encouragement Weight management and support Biomedical device data capture and reporting Nutritional
diary and tracking Coordinating preoperative, perioperative and postoperative care (among pharmacy, nursing and surgical services) Medical service collaboration in the
clinical setting Triage management in emergency rooms Census management/monitoring Arranging outpatient care Crowdsourcing for health care resources Shift-bidding for
nurses and other health care professionals Mood tracking (for patients with bipolar and other mood disorders) Patient care reminders in the clinical setting Prescription
management, including pharmacy refill reminders Daily health tips from authoritative sources Location awareness during crisis Occupational safety response Hazardous
 PHRs (portable/personal health records)
materials communication “Quick and dirty” diagnostic brainstorming between physicians (e.g. ‟symptom clustering‟) Clinical case education for (residents following attendings)
Physician opinion-sharing Promoting Domestic Violence awareness Raising Child Abuse awareness USMLE preparation for medical licensing NCLEX for preparation for
nursing licensing Recruitment of health care staff Alcohol and other substance abuse support Issuing doctor‟s orders Environmental alerts: pollen counts, pollution
levels, heat waves, severe weather alerts Remote wound care assistance Rural area health care communication Micro-sharing of pertinent patient information Micro-sharing
of diagnostic results (blood tests, echocardiography, radiological images) Internal facility customer service (a hospital equivalent of @Comcastcares – c‟mon hospitals!)
 Recruitment and loyalty
Publishing health-related news Psychiatric “check-ins” for patients Nursing mentoring and collaboration Publishing disease-specific tips Childcare support Fund raising for
hospitals and health-related causes Updating patient family members during procedures Live-tweeting surgical procedures for education Rare diseases tracking and and
resource connection Reporting hospital staff injuries Tracking patient trends Tracking disease-specific trends Checking hospital ratings with other health care consumers
Providing around-the-clock disease management Connecting genetic researchers with physicians Publishing the latest advances in biomedical devices Tracking antibiotic
resistance Real-time satisfaction surveys with immediate follow-up for problem resolution Issuing asthma alerts Data collection for tracking facility patterns (process-
 Mobile Technology
performance, supply-chain and staffing problems) Live-tweeting medical conferences Keyword-tracking of health-related topics via Search.Twitter Posting quick nursing
assessments that feed into electronic medical records (EMRs) Improving medical rounding systems Clinical trial awareness Hospital administration Sharing peer-to-peer
reviews of articles of interest Connecting patients with similar disease processes Enhancing health-related support groups (e.g. buddy-systems for depression) Providing
smoking cessation assistance Medical appliance support (e.g. at-home: colostomy care, infusion-pumps, wound-vacs) Reporting medical device malfunctions Tweeting
updates to facility policies and procedures Arranging appointments with health care providers Product safety alerts Food safety alerts Information on women‟s health Pain
 Real-time dissemination and discussion
management Hospital reputation monitoring Publishing hospital-sponsored events in local communities Community health outreach Bioterrorism awareness and
preparedness Issuing updates to hospital services to the public Insurance claim management Ethical, permission-based following of patients Micro-sharing consent for
surgical and other procedures Patient-sharing of health-related experiences Posting „bread crumbs‟ of facility experiences (”I had a bypass at this hospital and it went well but
the food almost killed me.”) Patient searches for others confronting similar problems Stress management Mental health awareness Posting homeless shelter needs Food
 Among providers
bank resource management Transmitting patient data to patients who are traveling abroad Generating streams of authoritative health care content online Exposing medical
quakery Micro-sharing documentation for advanced medical directives Discussing public health care policy Developing stronger patient-provider relationships Tracking the
safety and efficacy of pharmaceuticals Following health marketing Tracking influenza alerts from the CDC Exchanging/soliciting scientific validation of alternative health
 Among patients
claims Following ad-hoc conferences on eHealth like HealthCampPhila Tracking toxic diseases Tracking HIV news Issuing/exchanging dietary tips Tweeting what you eat
Comparing nursing home performance Coordinating clinical instruction Communicating with nursing supervisors Public safety announcements Tracking FDA guideline
updates Tracking the progress of developing pharmaceuticals Broadcasting infant care tips to new parents Publishing vaccination/immunization services locations, hours and
 Between providers and patients
reminders Reporting adverse events to FDA (currently not available via Twitter: why not?) Obtaining information on Medicare and Medicaid Case management functions
Clinical education coordination Facilitating patient-transfer processes Patient-information retrieval Reporting breeches of universal precautions in health care facilities Posting
daily nursing tips Exchanging physician humor (we‟re all human) Closing the digital divide with respect to health care information Coordinating allied health care services
during patient admissions Coordinating patient discharges with all services Post-discharge patient consultations and follow-up care Helping device technicians to
communicate directly with manufacturers Discussing HIPAA reform in the age of micro-sharing
(Baumann, 2009) (Fox, 2011) (Fox & Jones, 2009) (Modahl, Tompsett & Moorhead, 2011)

10. Nurses & Professional Networking
11%
LinkedIn 4%
7%
Twitter 6%
All Providers
10% Nurses
MySpace 11%
 Educators
 Clinicians
22%
YouTube 24%  Researchers
 Leaders
31%
Facebook  Entrepreneur
37%
 Policy Makers
37%  Students
Any Site 41%
(AMH Healthcare, 2010)

11. Nursing Trends & Cautions
 Most Trusted = Higher Standard
 Job search: 22%
 From 2008 to 2010
 Social networking up 4%
 Professional use up 10%
 Privacy concern up 8%
 Report of consequences grew up 11%
 Observed peer unprofessionalism up 5%
 Believe in blocking access at work fell 3%
(Anderson & Puckrin, 2011) (Hunt, Howard, Bishop, Aldridge, & Garrett, 2010)

12. Should She Have Been Expelled from
Nursing School?
(Helliker, 2010)

13. ANA Principles
for Social Networking
 Confidentiality
 Boundaries
 Access
 Presence and Privacy
 Vigilance
 Participation
(ANA, 2011)

14. Social Media
Utilization for PMH
Nursing is Unique
. . . and so are the precautions

15. PMH vs “Real” Nursing
 Recruitment
 Physical environment
 Conflict between desire and reality
 Stress-Burnout-Retention
 Vicarious Trauma
 Compensation
(Hanrahan, Aiken,, McClaine, & Hanlon, A., 2010)

16. Therapeutic Alliance
 HIPAA2
 Transference/Countertransference
 Compliance, continuity, transition
 Communication/Relationship skill of pt. population
 Stalking your patients
 Reportable findings
 Non/therapeutic use of self
(Dziopa & Ahern, 2009) (Hem & Heggen, 2003) (Moyle, 2003)

17. Networking PMH Nurses
 Service Outreach and Follow-Up
 Instant Messaging for TBI
 Mobile CBT
 Facebook for Grief Processing
 Psych/Primary Care Integration and Collaboration
 Clinical Insights
 Tailored Treatment Plans
 Feedback
(Pond, 2011)

18. “If we truly want to educate the public to understand that treatment for mental
illnesses and addictions are effective and recovery is possible, we must be
where our audience is—on Facebook, Twitter, and whatever the next wave
is.” - Linda Rosenberg, M.S.W
“Veterans should have consistent and convenient access to reliable VA
information real time using social media —whether on a smartphone or a
computer. They also should be able to communicate directly with appropriate
VA employees electronically.”
Secretary of Veterans Affairs Eric K. Shinseki on VA Directive 6515: Use of
Web-Based Collaboration Technologies
(Pond, 2011) (U.S. Department of Veteran Affairs, 2011)

19. Networking PMH Patients
 Decrease Stigma and Isolation
 Camaraderie Inspires Advocacy
 PatientsLikeMe
 Twitter #mhsm
 Finding the Elusive Normal
 “e-patient” Education and Empowerment
SAMHSA
@samhsagov
Official Twitter account of
SAMHSA.gov - Following
does not imply
endorsement.
http://www.samhsa.gov/

20. Peer Pointers for Policy
 British Medical Association (2011) - healthcare professionals
should never friend patients as it “blurs the boundary"
 Canadian Medical Association (2011) - avoid online relationships
with current or former patients.
 American Psychological Association (2010) - How does this
particular relationship fit with the treatment relationship?
 Nursing and Midwifery Council (2011) - Nurses should decline
friend requests from patients or clients on Facebook, even if they
are no longer under their care, but should also avoid discussing
work or colleagues.

21. In what situation
is this Facebook
post a problem?

22. Guidelines

23. What Goes Where?
Public Private
 Business contact  Home contact
 Resume information  Family/Friend information
 Thoughts on health  Religious, political, social
news, research, advocacy commentary
 Professional photos  Social photos
 Complements  Complaints

24. Mind Your Mind
 Know the Technology You Are Using
 Keep Up With Future Trends
 Office Boundaries/Hours and Web 2.0
 Don‟t go there if you wouldn‟t go there
 Know what you know from the office
 Social Media Policy/Disclaimer Statement
 Venting Online? Find Better Coping Skills!

25. Avoid Unintended Disclosure
 Do Not “Friend” Patients, Their Family, Unknown People
 Perform Routine Self-Audits
 Internet Background Checks
 Peer Review
 Internet Reputation Management
 Maximize Privacy and Access Settings
 There is No Such Thing as Anonymity

26. Professional Utilization
 Know Your “Who” and “Why”
 Establish a Professional Identity
 Avoid Communication on 3rd Party Platforms
 Document Social Media Interactions
 Patient Update Options
 Mobile reminders
 Trusted sources for news, information (not advice!), referrals
 Consents forms

27. . . . and now for a little more networking . . .
www.Twitter.com/OneDNP
www.Facebook.com/OneDNP
http://gplus.to/onednp
http://www.linkedin.com/profile/view?id=19012160&trk=tab_pro
http://onednp.blogspot.com/ Click “APNA” for a resource list!

28. But what about . . . . . ?

29. Share Your Thoughts:
Take the Survey
https://www.surveymonkey.com/s/OneDNP

30. References
AMH Healthcare (2010). 2010 social media survey of healthcare professionals: The use of social media and other online resources for
professional networking and job searches. San Diego, CA: AMH Healthcare
American Nurses Association (2011). Social networking principles toolkit. Retrieved from http://www.nursingworld.org/socialnetworkingtoolkit
American Nurses Association (2010b). ANA on social media. Retrieved from
http://www.nursingworld.org/FunctionalMenuCategories/AboutANA/Social-Media.aspx
American Medical Association. (2010). AMA Policy: Professionalism in the Use of Social Media.
Anderson, J., & Puckrin, K. (2011). Social network use: A test of self-regulation. Journal of Nursing Regulation, 2 (1), 36-41.
Baumann, P. (2009). 140 health care uses for Twitter. eBook
Boyd, D. M., & Ellison, N. B. (2007). Social network sites: Definition, history, and scholarship. Journal of Computer-Mediated
Communication, 13(1).
CDC Social Media Tools Guidelines & Best Practices. (2010, 2011). Retrieved from http://www.cdc.gov/SocialMedia/Tools/guidelines/
Chretien, K. C., Azar, J., & Kind, T. (2011). Physicians on Twitter. JAMA: Journal of the American Medical Association, 305(6), 566-568.
Cruickshank, J. (2010). Legal advisor. Social media: Know the law. Provider, 36(10), 91-93.
Dallest, K., Strachan, H., & Flett, G. (2009). The online Managed Knowledge Network that shares knowledge for eHealth in NHS Scotland.
Studies in Health Technology and Informatics, 146:49-53.
Dziopa, F., & Ahern, K. (2009). What makes a quality therapeutic relationship in psychiatric/mental health nursing: a review of the research
literature. Internet Journal of Advanced Nursing Practice, 10(1): 1-19.
Fox, S (2011). What really works in mobile healthcare? Washington, DC: Pew Internet & American Life Project

31. References Continued
Fox, S. & Jones, S. (2009). The social life of health information: Americans' pursuit of health takes place within a widening network of both online
and offline sources. Washington, DC: Pew Internet & American Life Project
Greysen, S. R., Kind, T., & Chretien, K. C. (2010). Online professionalism and the mirror of social media. Journal Of General Internal
Medicine, 25(11), 1227-1229.
Hader, A. L., & Brown, E. D. (2010). LEGAL BRIEFS. Patient Privacy and Social Media. AANA Journal, 78(4), 270-274.
Hanrahan, N., Aiken, L., McClaine, L., & Hanlon, A. (2010). Relationship between psychiatric nurse work environments and nurse burnout in acute
care general hospitals. Issues in Mental Health Nursing, 31(3), 198-207.
Helliker, K. (2011). Odd facebook post leads to student‟s ouster, suit. The Wall Street Journal (Online ed.)
Hem, M. H., & Heggen, K., (2003). Being professional and being human: One nurse's relationship with a psychiatric patient. Journal of Advanced
Nursing, 43(1): 101-108.
Hunt, E., Howard, J., Bishop, C., Aldridge, D., & Garrett, C. (2010). Social networking and nursing. Tar Heel Nurse, 72(4), 14.
Jain, S. H. (2009). Practicing medicine in the age of Facebook. New England Journal of Medicine, 361(7), 649-651.
Kientz, E., & Kupperschmidt, B. (2011). Social networking & students: Implications for professional nursing. Oklahoma Nurse, 56(1), 1-7.
Mayo Clinic, (2011). The Mayo Clinic Center for Social Media Retrieved from http://socialmedia.mayoclinic.org/about-3/
McBride, D., & Cohen, E. (2009). A closer look. Misuse of social networking may have ethical implications for nurses. ONS Connect, 24(7), 17-17.
Modahl, M., Tompsett, L., Moorhead, T. (2011). Doctors, patients, and social media. Waltham, MA: QuantiaMD
Moyle, W. (2003). Nurse-patient relationship: a dichotomy of expectations. International Journal of Mental Health Nursing, 12(2): 103-109.

32. References Continued
Nursing and Midwifery Council, (2011). Social networking sites. Retrieved from http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-
topic/A/Advice/Social-networking-sites/
Nickson, C. (2009). The history of social networking. Retrieved from http://www.digitaltrends.com/features/the-history-of-social-networking/
Pond, M. H. (2011). Behavioral health and social media: Increasing outreach, feedback, and virtual communities. SAMHSA News, 19(1), 1, 4-6.
Radwanick, S. (2011). The 2010 U.S. Digital Year in Review. Retrieved from
http://www.comscore.com/Press_Events/Presentations_Whitepapers/2011/2010_US_Digital_Year_in_Review
Ressler, P. K., & Glazer, G. (2010). Legislative: Nursing‟s Engagement in Health Policy and Healthcare Through Social Media. The Online Journal
of Issues in Nursing, 16(1).
Shaw, G. (2010). Five Tips to Guide Your Hospital's Social Media Policy. Retrieved from http://www.healthleadersmedia.com/content/TEC-
250829/Five-Tips-to-Guide-Your-Hospitals-Social-Media-Policy#%23
Smith, A. (2010) Mobile Access 2010. Washington, DC: Pew Internet & American Life Project
Tariman, J. D. (2010). Where to draw the line: Professional boundaries in social networking. ONS Connect. 25(2):10-3
Touchette, F. (2010). Avoid social networking poison. Health Management Technology, 31(11), 32.
Trautner, K. (2011). Workplace wisdom: Social networking and the workplace: Think before you post. Ohio Nurses Review, 86(1), 6-7
U.S. Department of Veteran Affairs (2011). VA publishes social media policy. Retrieved from
http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2150