Social Networking for Psychiatric-Mental Health Nurses


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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.

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  • Social networking has the ability to provide education, foster advocacy, and influence mental health policy. Developing guidelines that comply with practice acts, promote professionalism, and maintain privacy are imperative for psychiatric mental health nurses. This session presents an overview of social media outlets and impact, reviews published position statements from other disciplines, and recommends best practices for professional use. 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.
  • Prior to widespread use of the Internet, “social networking” may have conjured up images of cocktail-hour mingling, handing out business cards at professional conferences,attending association galas, playing a round of golf at the club and the like. Today, lifestreams, blogs, wikis, file sharing, micromedia, bookmarking, rating, and industry-specific media are integrating and outmoding face-to-face interactions as the primary method of communication, information dissemination, and professional contact. This preliminary definition is a adaptation from a technology perspective, namely that social networking is the use of internet based media platforms to create personal and professional profiles as a means to forge connections for real-time information sharingDiffers from web 1.0 because 2-way, not one way
  • Facebook/myspace/bebo (personal webpages shared)Blogger/wordpress/livejournalTwitter – mobile tec big in minority demo who use phones for internetWikipedia – add/edit contentiTunesFlicker,, you tubePt/prov
  • Also know as Digital Engagement
  • Popular sites such as Facebook, Twitter, and Linked-In saw an increase in usage among both men and women by 2009, claimed 34% of the display ad market share, and contributed to the rise in utilization of mobile technology By 2010, social networking accounted for 14.4% of the average American’s time spent on the internet with 9 out of 10 users visiting a social media site monthly and spending an average of 4.5 hours on networking activity“Nearly two-thirds of African-Americans (64 percent) and Latinos (63 percent) are wireless internet users, and minority Americans are significantly more likely to own a cell phone than their white counterparts (87 percent of blacks and Hispanics own a cell phone, compared with 80 percent of whites). Additionally, black and Latino cell phone owners take advantage of a much wider array of their phones’ data functions compared to white cell phone owners.
  •’s main focus for digital engagement is outreach and feedback. The goal is to increase and improve communications with the behavioral health field, public and nonprofit organizations, the recovery community, and other audiences and individuals
  • E-Patients: eqqupped, enabled, empowered, and engaged in healthcare decisions. Provide feedback on improvement of web presence and quality of serviceEducating the public on nursing and health related matters. read reviews on healthcare professionals, facilities, and institutions, register for information updates, engage with multi-media learning tools, research health plans, and read personal stories of individuals “just-in-time-just-like-me.” All of these contribute to healthcare decision making. PHRs: Google medical was the first and failed. Health vault. In developmentRecruitment & Loyalty: Meanwhile, hospitals and academic medical centers are diving into the social media mix with more than 300 YouTube channels and 500 Twitter accounts. Hospitals are moving from experimentation (Twittering from the OR to Flipcam videos) to strategic use Mobile Technology: 85% have cell phones and increasing number own tablets. Apps, MDs highest use, minority Americans are higher users of mobile Internet access, social media sites, and applications to manage or track their health. Engenders higher rates of health sharing and contribution as opposed to just consumption.Provider-Provider: APNA forum; Sermo is the largest online community of physicians, where MDs nationwide discuss drugs and devices, exchange clinical insights and collaborate on difficult cases. Through Sermo's social media platform, you can tap into unsolicited, peer-to-peer dialog and engage MDs to gain market intelligence and increase brand awarenessPatient-Patient: Online patient communities are rapidly growing through both mainstream social communities and more recently established condition-specific communities (PatientsLikeMe, QuitNet, CureTogether). Chroinic disease=higher utilizationProvider-Patient:, mercola, Dr. Oz“Social media has entered the mainstream healthcare system in several ways. Entrepreneurs who understand healthcare trends and consumer demands are leading creative business startups that are developing health-oriented social networks, health content aggregators, medical and wellness applications, and tools to enable health-related vertical searches (searches focused on a specific content area).” - . Sharp, J. “Social Media in Health Care: Barriers and Future Trends.” iHealthBeat/California Healthcare Foundation, May 6, 2010. providers, giving medical information, not advice! – medhelp.orgBut what is clear is that we can and do influence collective behavior. Social connectedness influences health, and the networks in which we are a part can spread positive and negative behaviors.Via more: -. Founded 2006. / strengthening the nurse/patient relationship; keeping patients informed/engaging in dialogue; increasing the physician's referral base; and securing job opportunities through social networking with colleagues.
  • Physicians are by far the heaviest users of mobile devices for professional reasons among their medical colleagues; 37 percent used healthcare-related applications and 17 percent used mobile devices for healthcare-related content or jobs.Thirty-seven percent of clinicians reported using social media for professional networking; nurses had the highest use among healthcare workers at 41 percent.Sixty-four percent of the clinicians surveyed would choose Facebook, the clear favorite, if they could choose only one social networking site.
  • “Most trusted profession” means consumers expect professional behavior (Hunt, Howard, Bishop, Aldridge, & Garrett, 2010). Nurses are consistently ranked the most trusted profession in America and consumers expect we will behave accordingly whether delivering bedside care, providing telephonic health assessments, or Tweeting their latest thoughts on life. media allows new ways of getting critical information about behavioral health directly to providers of prevention and treatment services and to the public. Social media creates ways for SAMHSA to receive feedback and hear what people have to say in their own words about the behavioral health issues at hand. Litigation/Liability Self-Preservation Once it is online, it never goes away
  • 22-year-old Doyle Byrnes, was dismissed in November during her final year at Johnson County Community College in Overland Park, Kan., for putting on her Facebook page a photograph of herself with the placenta.In a lawsuit filed Dec. 23 in U.S. district court in Kansas City, Kan., Ms. Byrnes is seeking an injunction to reverse her ouster, on grounds that the photographs violated no school policy and were posted with the alleged approval of the class instructor.The most frequent social networking related violations to the ANA Nursing Code of Ethics involve the HIPPA privacy rule, unprofessional conduct, and breaches of confidentiality. Posting pictures of patients, discussing specific health issues with or about an identifiable patient in a public forum, and negative commentary on employers or peers are frequent examples that have resulted in a number of facilities using social media sites to aid hiring decisions, monitor employee networking activity, and hire social media managers. ·     November 2008, nurses at a Fargo, ND hospital used FB for unauthorized shift change updates to their co-workers.  Conversations between co-workers soon became updates.  No actual patient data was posted, but the information posted was specific to the patients and could be read by anyone who was a “friend” of these nurses. - One nurse was fired and subsequently lost his nursing license after seeking out a former patient on Facebook and commencing a romantic relationship two weeks after her hospital discharge. A patient in Pennsylvania filed a HIPPA complaint against a nurse after reading negative posts concerning office operations and pregnant clients on the nurse’s MySpace page.
  • 1. Nurses must not transmit or place online individually identifiable patient information.2. Nurses must observe ethically prescribed professional patient — nurse boundaries.3. Nurses should understand that patients, colleagues, institutions, and employers may view postings.4. Nurses should take advantage of privacy settings and seek to separate personal and professional information online.5. Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities.6. Nurses should participate in developing institutional policies governing online conduct.Benefits • Networking and nurturing relationships • Exchange of knowledge and forum for collegial interchange • Dissemination and discussion of nursing and health related education, research, best practices • Educating the public on nursing and health related matters Risks • Information can take on a life of its own where inaccuracies become “fact” • Patient privacy can be breached • The public’s trust of nurses can be compromised • Individual nursing careers can be undermined
  • Recruitment: less than 21% of nurses in the psychiatric setting are under age 40 while 41% of nurses working in other areas are less than 40 years of age; Unpopularity, Few grads go into it, stigma reflectionEnvironment: ViolenceConflict: Administrative duties and maintaining patient safety often prevented them from developing therapeutic relationships with their patients even though they perceived this as the most important aspect of their role.Retention: 36 of 43 states had substantial registered nurse vacancies in hospital settingsVT: “Depression is catching”
  • Sustaining relationship with risk of patient dependency and loss of nurses self-reliance. Confiding more than reporting. Depression is catching. Need for nurturing. Time (look for comparison with other nursing diciplines). Presence/being and reassurance. Perceived distance detracts from therapeutic relationships. (look up difference in boundaries)“Human professional” intimate and distant” contradiction; recognizing vulnerabilities. Pt’s have difficulties communicating and forming relationships. The self as an instrument of care. You cant be penicillin in medical like you can be in PMH“interpersonal interaction is the core of practicemaking the therapeutic relationship a fundamental element of mental health care and associated with therapeutic outcomes across a range of clinical settings and patient populations” The 9: empathy, support, individuality, availability (presence and access), sincerity, equality, respect, clear boundaries (sm is the ultimate self-disclosure!), self-awareness. Transference/Countertransference – diagnosis through countertransference doe not work with diabetes as it does with borderlineElevated BG not the same (or as frequent) as SI/HI; CD patients on a bender?Friending patients means you may be held liable to know what they don’t tell you in the office
  • (APNA podcasts and mobile evals, #apna25)5.1 hospital and 6. 5 non-hospital 6.3 primary clinical specialty APRN
  • For example, Linda Rosenberg, M.S.W., of the National Council for Community Behavioral Healthcare in Washington, DC, said, “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.”
  • No DSM definition – not blood sugarVocal crew on reviews (another reason to be on-line, the first thing someone sees should not be yellow pages and reviews)
  • British Medical Journal – healthcare professionals should never friend patients as it “blurs the boundary" between a doctor's professional and private lives. Medial Journal of Australia - A power imbalance exists between doctors and patients, and the maintenance of clear professional boundaries protects patients from exploitation.  Doctors who allow public access to their entire online profiles introduce patients to details about their personal lives beyond what the patient would normally discover within the doctor–patient relationship. Further online interaction may constitute a violation of professional boundaries, and serious indiscretions may result in disciplinary action against the doctor. In general, doctors should avoid online relationships with current or former patients. Canadian Medical Association - The CMPA says many medical facilities are already prohibiting access to social-media sites at work because of potential legal issues. "Once even a single online friend receives information, that information is no longer within your control and may be circulated rapidly and indiscriminately," the advisory states. "This circulation of information could not only be embarrassing to you, but could also breach a patient's privacy and harm the patient emotionally."  Although there are no guidelines currently, the CMA is working on crafting guidelines for the use of social media in the medical arena. Sullivan, P. (2011). CMA developing social-media guidelines for MDs 
  • Posted on facebookcommunity psychiatric nurse, Timothy Hyde, was struck off for “conducting an inappropriate relationship with a former patient”. He had contacted the woman on Facebook two weeks after meeting her in the course of his work, but then “blocked” contact with her after they had a sexual relationship.
  • If off hours,Self-careWhen a friend becomes a patient; duel/multiple relationships
  • Dictating behavior – just ignore friend requests not going to work in MHMisuseSMNursesMDTwitterJAMASee what they see
  • Why are you using SMSM interacions . . . You are doing this with email, right?When friends become patients?What are your thoughts on responsibility and liability for a patient report of SI/HI or abuse allagations
  • Social Networking for Psychiatric-Mental Health Nurses

    1. 1. Social Networking forPsychiatric-Mental Health Nurses Jaclyn Engelsher MSN, FNP-BC, DOM Tanitha Moncier MSN, FNP-C 2nd Year PMH/DNP Students
    2. 2. Overview
    3. 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 sharingamong nursing professionals and health consumers. Social networking is powered by social media
    4. 4. Social Media Outlets  Lifestreams  Blogs  Microblogs  Wikis  Podcasts  Content Communities  Forums(Boyd & Ellison, 2007)
    5. 5. Social Networking is not Conversation  Selfish Commenting  Simple Community  Secure Collaboration  “Set and Forget” Contribution  Success by number Creative  StaticUnderstanding usage does not equate to understanding implications (Touchette, 2010)
    6. 6. Social Networkingin HealthcareTreat. Teach. Learn
    7. 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. 8. Most Popular Sites by Use100% 94%90%80%70%60%50%40% 32%30%20% 18%10% 2% 0% Facebook Twitter YouTube FourSquare
    9. 9. Healthcare Networking Trends140 HEALTH CARE USES FOR TWITTER Tissue recruitment (for kidney and other organs, including blood) Epidemiological survey Disaster alerting and responseEmergency response team management Supportive care for patients and family members Diabetes management (blood glucose tracking) Maintaining a personal health diaryAdverse 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 alertsfor missing nursing home residents Exercise management and encouragement Weight management and support Biomedical device data capture and reporting Nutritionaldiary and tracking Coordinating preoperative, perioperative and postoperative care (among pharmacy, nursing and surgical services) Medical service collaboration in theclinical setting Triage management in emergency rooms Census management/monitoring Arranging outpatient care Crowdsourcing for health care resources Shift-bidding fornurses and other health care professionals Mood tracking (for patients with bipolar and other mood disorders) Patient care reminders in the clinical setting Prescriptionmanagement, 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 fornursing licensing Recruitment of health care staff Alcohol and other substance abuse support Issuing doctor‟s orders Environmental alerts: pollen counts, pollutionlevels, heat waves, severe weather alerts Remote wound care assistance Rural area health care communication Micro-sharing of pertinent patient information Micro-sharingof diagnostic results (blood tests, echocardiography, radiological images) Internal facility customer service (a hospital equivalent of @Comcastcares – c‟mon hospitals!) Recruitment and loyaltyPublishing health-related news Psychiatric “check-ins” for patients Nursing mentoring and collaboration Publishing disease-specific tips Childcare support Fund raising forhospitals and health-related causes Updating patient family members during procedures Live-tweeting surgical procedures for education Rare diseases tracking and andresource connection Reporting hospital staff injuries Tracking patient trends Tracking disease-specific trends Checking hospital ratings with other health care consumersProviding around-the-clock disease management Connecting genetic researchers with physicians Publishing the latest advances in biomedical devices Tracking antibioticresistance Real-time satisfaction surveys with immediate follow-up for problem resolution Issuing asthma alerts Data collection for tracking facility patterns (process- Mobile Technologyperformance, supply-chain and staffing problems) Live-tweeting medical conferences Keyword-tracking of health-related topics via Search.Twitter Posting quick nursingassessments that feed into electronic medical records (EMRs) Improving medical rounding systems Clinical trial awareness Hospital administration Sharing peer-to-peerreviews of articles of interest Connecting patients with similar disease processes Enhancing health-related support groups (e.g. buddy-systems for depression) Providingsmoking cessation assistance Medical appliance support (e.g. at-home: colostomy care, infusion-pumps, wound-vacs) Reporting medical device malfunctions Tweetingupdates 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 discussionmanagement Hospital reputation monitoring Publishing hospital-sponsored events in local communities Community health outreach Bioterrorism awareness andpreparedness Issuing updates to hospital services to the public Insurance claim management Ethical, permission-based following of patients Micro-sharing consent forsurgical 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 butthe food almost killed me.”) Patient searches for others confronting similar problems Stress management Mental health awareness Posting homeless shelter needs Food  Among providersbank resource management Transmitting patient data to patients who are traveling abroad Generating streams of authoritative health care content online Exposing medicalquakery Micro-sharing documentation for advanced medical directives Discussing public health care policy Developing stronger patient-provider relationships Tracking thesafety and efficacy of pharmaceuticals Following health marketing Tracking influenza alerts from the CDC Exchanging/soliciting scientific validation of alternative health  Among patientsclaims Following ad-hoc conferences on eHealth like HealthCampPhila Tracking toxic diseases Tracking HIV news Issuing/exchanging dietary tips Tweeting what you eatComparing nursing home performance Coordinating clinical instruction Communicating with nursing supervisors Public safety announcements Tracking FDA guidelineupdates Tracking the progress of developing pharmaceuticals Broadcasting infant care tips to new parents Publishing vaccination/immunization services locations, hours and  Between providers and patientsreminders Reporting adverse events to FDA (currently not available via Twitter: why not?) Obtaining information on Medicare and Medicaid Case management functionsClinical education coordination Facilitating patient-transfer processes Patient-information retrieval Reporting breeches of universal precautions in health care facilities Postingdaily nursing tips Exchanging physician humor (we‟re all human) Closing the digital divide with respect to health care information Coordinating allied health care servicesduring patient admissions Coordinating patient discharges with all services Post-discharge patient consultations and follow-up care Helping device technicians tocommunicate directly with manufacturers Discussing HIPAA reform in the age of micro-sharing (Baumann, 2009) (Fox, 2011) (Fox & Jones, 2009) (Modahl, Tompsett & Moorhead, 2011)
    10. 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. 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. 12. Should She Have Been Expelled from Nursing School? (Helliker, 2010)
    13. 13. ANA Principles for Social Networking Confidentiality Boundaries Access Presence and Privacy Vigilance Participation (ANA, 2011)
    14. 14. Social MediaUtilization for PMHNursing is Unique . . . and so are the precautions
    15. 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. 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. 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. 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. 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 - Following does not imply endorsement.
    20. 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. 21. In what situationis this Facebookpost a problem?
    22. 22. Guidelines
    23. 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. 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. 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. 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. 27. . . . and now for a little more networking . . . Click “APNA” for a resource list!
    28. 28. But what about . . . . . ?
    29. 29. Share Your Thoughts: Take the Survey
    30. 30. ReferencesAMH Healthcare (2010). 2010 social media survey of healthcare professionals: The use of social media and other online resources forprofessional networking and job searches. San Diego, CA: AMH HealthcareAmerican Nurses Association (2011). Social networking principles toolkit. Retrieved from Nurses Association (2010b). ANA on social media. Retrieved from 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. eBookBoyd, D. M., & Ellison, N. B. (2007). Social network sites: Definition, history, and scholarship. Journal of Computer-MediatedCommunication, 13(1).CDC Social Media Tools Guidelines & Best Practices. (2010, 2011). Retrieved from, 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 researchliterature. 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. 31. References ContinuedFox, S. & Jones, S. (2009). The social life of health information: Americans pursuit of health takes place within a widening network of both onlineand offline sources. Washington, DC: Pew Internet & American Life ProjectGreysen, S. R., Kind, T., & Chretien, K. C. (2010). Online professionalism and the mirror of social media. Journal Of General InternalMedicine, 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 acutecare 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 nurses relationship with a psychiatric patient. Journal of AdvancedNursing, 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, 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: QuantiaMDMoyle, W. (2003). Nurse-patient relationship: a dichotomy of expectations. International Journal of Mental Health Nursing, 12(2): 103-109.
    32. 32. References ContinuedNursing and Midwifery Council, (2011). Social networking sites. Retrieved from, C. (2009). The history of social networking. Retrieved from, 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, P. K., & Glazer, G. (2010). Legislative: Nursing‟s Engagement in Health Policy and Healthcare Through Social Media. The Online Journalof Issues in Nursing, 16(1).Shaw, G. (2010). Five Tips to Guide Your Hospitals Social Media Policy. Retrieved from, A. (2010) Mobile Access 2010. Washington, DC: Pew Internet & American Life ProjectTariman, J. D. (2010). Where to draw the line: Professional boundaries in social networking. ONS Connect. 25(2):10-3Touchette, 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), 6-7U.S. Department of Veteran Affairs (2011). VA publishes social media policy. Retrieved from