What do nurses do in professional Facebook groups and how can we explain their behaviours?

AIMTo explore and explain the causal (mechanisms) relationships between nurse’s actions and behaviours in Facebook groups.BACKGROUNDOnline Social Networks such as Facebook have rapidly diffused through the nursing profession with an estimated 60% using social media every day. There have been a range of concerns linked to unprofessional behaviours on Facebook despite professional guidance being in place. However, there is little evidence that explores the causal and influencing factors that lead to nursing behaviour and actions on Facebook.METHODBhaskarian critical realist ethnography (CRE) employing structured observation and reflective field notes of publicly accessible, groups and profiles on Facebook explicitly relevant to the nursing profession. For ethical approval reasons, these groups and pages will remain anonymous. Observations were conducted over a 6 month period during 2015-2016 by applying a selective case sampling approach to post. Observations occurred at two time points during the 6 month period by a single researcher. This allowed for a range of ‘typical’ and more extreme behaviours to be observed.CRITICAL REALISM & DATA ANALYSISCausal mechanisms are a ‘reality’ that cannot be directly observed (this is not the same as cause-effect; reality is much more complex). However, the components and outcomes of this reality can be observed and measured. Components for coding data were: morphostatic and morphogenic structures, entities, tendencies, events, behaviours and outcomes. These were then ‘mapped’ to explain how they interacted. Theories based on past research and other theoretical models were established and the maps were used to test which of these best explained nurses’ actions and behaviours in the Facebook environment.RESULTSComponents from the data were mapped (e.g. figure.1). This identified that despite having awareness of being professional and being in the domain of the professional group with other nurses a shift from professional-unprofessional seemed to occur. Indicating that awareness (self-efficacy) does not always result in professional behaviours and actions. For example, swearing would be deemed to be unprofessional but heightened emotions in response to politicians and policy changes that affect nursing created resulted in offensive language being ‘accepted’ within the group. Figure.2 provides an example framework illustrating how personal-professional-social values can create conflict and a shift in one may then affect the behaviours of an individual or group in the online environment.CONCLUSIONPersonal-professional-social values overlap in the Facebook environment and triggers in one domain may result in unprofessional or unacceptable behaviours in another. Further research needs to examine the nature of these and methods by which awareness of professionalism translates into action (i.e. the areas where conflicting values may occur)

Professionalism in Social Media: The 3Cs rule

INTRODUCTION The concept of e-professionalism or e-accountability relates to the attitudes and behaviours the reflect professional values in the online environment. Despite professional guidance and organisational policy being in place for several years, literature outlines issues associated with e-professionalism in nursing still remain. AIM To explain the complex relationships that exist between professionalism, accountability and social media and, make recommendations about how this might be managed consistently. METHOD Critical realist ethnography. Use of secondary sources of evidence: professional guidance and published research. Focus groups with registered nurses (n=8) and observation of nursing related, publicly accessible Facebook groups/pages over 3 months. A realist approach to analysis and concept mapping explained the complex interaction of components within social networks: entities, structures, tendencies, actions and events. RESULTS Issues with context, clarity and confirmability: Actions such as. breach of confidentiality, ‘friending’ patients (breach of boundaries) were unanimously ‘unprofessional’. Other behaviours were more subjective, with no consensus about whether individuals should be held to account e.g. being obviously drunk, pole dancing. Differences of opinion were best explained by background, personal values and also the difficulties with ‘confirming context’ in social media (e.g. the currency of the post, the person who actually posted it). Influencing factors: External factors changed behaviours the concept of ‘acceptability’ e.g. there was initially consensus that posting pictures at work and in uniform was unprofessional. However, in response to politician comments nurses were actually doing this publicly; accepting and promoting such behaviour. CONCLUSION Three core considerations for online behaviours and assessing incidents in social media were ‘The 3Cs’: context, clarity and confirmability. These are presented in an ‘Awareness to Action’ (A2A) tool that facilitates 1) reflection about use of social media and, 2) decisions about whether an incident is unprofessional (warranting further action) or simply, unacceptable (warranting less severe or no action)

Can the use of a Facebook group in addition to classroom teaching enhance exam success in a Drug Calculations module?

A wide range of literature acknowledges the use of e- and traditional learning in the health professions but further research is frequently recommended to explore perceived benefits (Lahti, Hatonen & Valimaki, 2013; Cook et al, 2010) particularly in the rapidly changing technological environment. Facebook boasts 1.11 billion users; over 61% access this via mobile ‘anytime, anywhere’ (Statistics Brain, 2013). In the United Kingdom an estimated 80% of student nurses may have a Facebook account, with a wide range of informal programme/university specific ‘groups’ available to members for support/advice. As an electronic and mobile learning tool, Facebook offers quick, easy, flexible access, complementing the ‘always on’ behaviours of nursing students today. Aim: To establish if a module specific Facebook group can improve examination success and user satisfaction in a Drug Calculations Examination. Method: Examination scores and feedback questionnaire were used to evaluate exam success and satisfaction of pre-nursing students undertaking a Drug Calculations Module. A 30 student cohort opted in or out of using a Facebook group in addition to classroom teaching. Results: A t-test to the 95% confidence level showed that students who opted in to the Facebook group were more likely to pass on first attempt with a higher mark on their exam; p=0.038. Chi-square testing showed White British students were more likely to opt-in to the Facebook group p=0.000. 90% of group users expressed that it improved their learning experience and would use it again. Conclusion: Facebook groups enhanced student success in their Drug Calculations examination and were a satisfactory option to students who chose to opt in. Students from Black/Black African groups were less likely to use this learning option. Additional research is required into student demographics and use of Facebook groups, along with more robust exploration of student use of Facebook groups for formal/informal educational support/advice

Professional socialisation, accountability and social media: what’s the relationship and should we care?

BACKGROUND: The rapid diffusion of social network sites such as Facebook have presented a wealth of challenge and opportunity for the nursing profession. A large majority of student nurses have adopted Facebook but [as developing professionals] may not understand the implications and unintended consequences of the information shared in a personal or innocent way.No studies have yet critically analysed [in depth] the underlying factors that influence and determine the relationships between professional accountability and social media or if there is actually a ‘problem’ with social media. AIM: Critically analyse the relationships between professional accountability and Facebook during the journey of professional socialisation.METHOD: Critical realist ethnography employing online observation of three cohort groups, 30 public profiles and professional group discussion topics, focus groups (academic and practicing nursing staff n=8) and semi-structured interviews with student nurses over two sites (n=16).RESULTS: Critical realist retroductive analysis (Bhaskar, 1998) was developed as part of this study. Three relationships were identified and six models were generated to explain and test proposed mechanisms within the data, which cause these relationships: 1) the concept of professional accountability 2) patterns of use 3) behaviours and activities 4) physical versus online reality 5) unacceptable, acceptable, professional or unprofessional behaviours 6) perceived knowledge and awareness versus actual behaviours.Three explanatory theoretical concepts were then confirmed and used to develop three critical realist frameworks: I) Socialisation, Professional Socialisation, Online Socialisation (SPO) II) Unacceptable, Acceptable, Unprofessional, Professional (UAPU) and III) Awareness into Action (A2A).CONCLUSION: I) SPO: This study has indicated a potential ‘tertiary’ or ‘online’ socialisation process and illustrates the factors, context and socialisation informs accountable behaviours; linking the physical and online (personal, public, professional).II, III) UAPU, A2A: The lack of physical context and presence in the online environment causes dissonance between perceived and actual behaviours and confidence versus competence in the online environment. With further research and validation these three frameworks may be used in education and practice, for personal and group assessment, reflection and/or for raising awareness of good practice online. They may also be used by organisations and professional bodies to assess scenarios or incidents

Critical realist ethnography: from philosophy to the practice of research analysis.

Background: There are few realist ethnographic studies in nursing and the majority employ traditional approaches to analysis; reflecting the principles of interpretivist or positivist research paradigms. Aim: Present the development and application of a novel approach to realist ethnographic analysis to a research project that sought to explain how student nurses become socialised into online social networks. Method: Realist ethnography sought to explain the relationship between online social networks and professional socialisation. Results: The findings show how this novel approach to analysis led to the proposition of a new and original concept of ‘online socialisation’. Conclusion: This article informs nurse and healthcare researchers how to apply an analysis approach to realist ethnographic study based on the principles of Bhaskarian philosophy

Professional Regulation In Social Media (PRISM): validation of a tool for making decisions about professional behaviours on social media

Background: There is ongoing debate around the concept of e-professionalism in the healthcare professions, with many incidents of unprofessional behaviour still reported despite policy and professional guidance having been in place for several years. A realist ethnographic study over 4 years identified inconsistent opinion across the nursing profession about what is or is not 'professional' in social media. As a result, a decision making tool was developed: Awareness to Action (A2A) 3Cs. Aim: This project aimed to evaluate and validate the A2A 3Cs decision making tool for assessing whether behaviours in social media are acceptable, unacceptable, professional or unprofessional. Method: A pre-test, post-test survey design was employed to assess the internal validity and reliability of the tool during January to November 2018. Participants were presented with five examples of behaviour in social media and used the tool to assess what action they would take (if any). A survey was also used to evaluate the usability, usefulness and relevance to nursing practice. Ethical approval was granted from two higher education institutions. Participants were recruited through social media, two higher education institutions and an NHS trust. Results: 45 nurses completed the pre-test, post-test validation component and 122 evaluated the tool. Using SPSS v24.0, Intraclass correlation showed excellent reliability 0.979 [CI 0.940, 0.997] p=0.000. Cronhbach's Kappa for each of the case examples showed high levels of internal validity. Kruskill-Wallis testing demonstrated no significant difference in decisions made based on age, nursing role, length of time registered and region of the United Kingdom. Conclusion: The A2A 3Cs tool could potentially be used to refine and develop a more aligned approach to policy and professional guidance, promote consistency in perspectives about what is deemed to be unprofessional in the nursing profession and in the education of nurses and healthcare professionals on the topic of e-professionalism

4Es of good degrees: what makes pre-registration nurses successful in achieving good degrees

Research studies examining academic attainment in Higher Education identify age, gender, disability, ethnicity and stress as possible influencing factors on a student’s ability to achieve ‘good’ honours degrees (HEA, 2008;Shanahan, 2004;Simonite, 1997;Vosper et al, 2005; Salamonson & Andrew, 2006; Pryjmachuk et al, 2008). Much of this research quantitative and mainly identifies non-modifiable factors or factors which may have further root cause e.g. stress. It is known that student nurses often leave programmes as a result of a multitude of factors leading to stress; including finances, personal commitments and placement experience (RCN, 2008) but it is also known that some still attain good academic levels suggesting that there must ‘be more to it’. This pilot project used unstructured narrative to explore the real life journey of pre-registration students [n=6] who performed at a level that indicated their ability to obtain a good honours degrees. A framework analysis identified mechanisms and interventions under the following headings; encouraging, enabling, empowering, ennobling. Results indicate that students experience a range of challenges in their lives. Academic and personal background seems to have an impact on the way in which they view and understand roles/responsibilities of students and staff. These students did not tend to use formal support systems regularly e.g. extensions for assignments and that when they were used it was seen as ‘a last resort’. Having knowledge of and effectively using mechanisms for managing stress and personal-academic-work commitments were of benefit, including: regular exercise, time management techniques, peer support, the ability to reflect on and revisit assessment feedback. These students also had very clear ideas about the requirements of academic study e.g. being widely read, and ownership of learning. A list of recommendations and advice for students and staff is available. A further longitudinal piece of research is suggested to add to this knowledge

Enhancing Nursing Student Success: A Critical Realist Framework of Modifiable Factors

There is a range of literature examining the predictors of academic success in nursing including age, entrance qualification and background. However, these are factors that cannot be changed once a student is on a programme of study. However, there is currently little or no literature that focuses only on the modifiable behaviors and environmental factors in achieving good academic success. This project aimed to explore the modifiable factors that may influence academic performance and develop a framework to guide students and academic staff. A critical realist ‘intensive’ approach employing qualitative methods was used with pre-registration 3rd year nursing students as participants. Unstructured interviews with use of academic grade documents as a point of reference. Thematic framework analysis enabled comparison on a case-by-case basis. Eight modifiable student themes were identified: time management, understanding of learning outcomes, focus on the topic and its role in the wider programme, utilization of academic team, peer support, using feedback, life management, and management of stress factors. Four themes for academic staff were found under the headings: encourage, enable, empower and ennoble. The framework presented provides focus on the factors that can be changed and influenced in order to achieve success. This framework may be used by staff and students to develop guidance documents or in design of teaching and assessment

Proposed research study into the age at death and cause of death in Gypsies & Travellers

This study will identify the age of death and the major causes of death in Gypsies and Travellers. Reliable information as to the causes of death in this population is not available. This study will provide very valuable data to those working with Gypsies and Travellers, and to the community itself, as to the predominant causes of death. This will then be used to strategically design healthcare interventions. Gypsies and Travellers have poor health status and low life expectancy compared to other English-speaking minority ethnic groups. To inform healthcare service provision and interventions it is important to accurately identify the prevalent causes of death in this population and which causes differ from the general population. Gypsy or Traveller ethnic status is generally not collected on NHS systems and ethnicity is not recorded at death; therefore age and cause of death cannot be accurately determined in this community. This study will link ethnicity and cause of death data. An appropriate funding source is currently being sought