The purpose of this paper is to argue that the American Nurses Association’s (ANA) Code of Ethics with Interpretive Statements is sufficient to address the ethical issues raised by the nurses’ utilization of social media. Information technology is rapidly changing in all areas worldwide, creating new challenges and opportunities for different industries every day, including healthcare (Cassano, 2014). The use of social media is one of the major changes in technology (Jackson, Fraser, & Ash, 2014). A recent national survey disclosed that 70% of registered and advanced practice nurses use social media (Simpson, 2014). The paper addresses the ANA’s Code of Ethics’ guidance for two current ethical issues incited by nurses’ utilization of social media, including privacy and security, and low communication barriers.
Background for Ethical Decisions in Nursing Practice
New computer technologies compel nurses to confront new rights and responsibilities and review the standards of conduct formed prior to the advent of computers (Mohammed & El-sol, 2018). The ANA’s Nursing: Scope and Standards of Practice (2015), Standard 1, states that the “nurse applies ethical, legal, and privacy guidelines and policies to the collection, maintenance, use, and dissemination of data and information” (p. 54). The ANA’s Code of Ethics for Nurses with Interpretive Statements (2011) is a dynamic document, which provides a framework for nurses to use in ethical analysis and decision-making. It also provides guidance on the application of professional values and personal judgment in nurses’ use of social networking and media (American Nurses Association, 2011).
The ANA’s Code of Ethics for Nurses with Interpretive Statements (2015), Provision 1, Interpretive Statement 1.3, titled “The Nature of Health” guides the nurses to respect the rights and dignity of the patients regardless of the factors contributing to their health status (p. 1). The ANA’s Code of Ethics for Nurses with Interpretive Statements (2015), Provision 3, Interpretive Statement 3.1, titled “Protection of the Rights of Privacy and Confidentiality” affirms that “the nurse has a duty to maintain confidentiality of all patient information, both personal and clinical, in the work setting and off duty in all venues, including social media or any other means of communication” (p. 9). Additionally, the ANA’s Code of Ethics for Nurses with Interpretive Statements (2015), Provision 8, Interpretive Statement 8.4, titled “Collaboration for Human Rights in Complex, Extreme, or Extraordinary Practice Settings” (p. 33) addresses the nurse’s ethical responsibility to protect the public from misinformation and misinterpretation (Sewell, 2016).
Privacy and Security
As of 2017, 60 million consumers use social media to share information about their health, and there are 1200 Facebook communities that advocate for chronic illnesses (Southern Medical Association, 2017). Many nurses who use social media on a personal basis find that the platform can also be professionally useful (Simpson, 2014). 14% of nurses use their personal smartphones for application-based messaging to share patient-related clinical information (Neese, 2016). The increase utilization of social media amongst patients and health care providers is causing difficulties to protect sensitive health-related data connected to the Internet (Kotz, Gunter, Kumar, & Weiner, 2016).
A breach of privacy is the most common ethical violation of nurses using social media (Jackson et al, 2014). Many nurses are ignorant to the privacy settings of their social media accounts and do not appreciate the far-reaching nature of posts on social media (Lachman, 2010). Posting work-related information on social media heightens the risk of confidentiality breaches and allegations of unprofessional conduct (Hader & Brown, 2010).
Patient information transmitted online to other health organizations should be protected from reaching unsecured or unauthorized users (Dyer, 2001). Nurses using Facebook and other social media must understand settings and policies associated with their accounts, remain mindful of professional boundaries and patients’ privacy rights, and ensure that all postings and information sharing complies with the ANA’s Code of Ethics’ professional guidelines (Spector & Kappel, 2012). The ANA’s Code of Ethics is a foundational document for the ANA’s Principles for Social Networking and the Nurse that provides guidance to the nurses on using social media in a way that protects patients’ privacy and confidentiality and maintains the standards of professional nursing practice (American Nurses Association, 2011).
Low Communication Barriers
Use of social media to share information associated with a patient can create liability for nurses at all levels of healthcare because this information is instantly disseminated, can be forwarded by anyone to anyone, anywhere in the world without the poster’s knowledge, and can never be deleted (Simpson, 2014). Today, consumers share their general and sensitive health information in social media platforms to receive feedback from virtual community members (Denecke et al., 2015). To illustrate, a 2011 research study explored publicly available Facebook groups and found users openly sought and shared behavioral, mental, and genetic health information by publicly identifying themselves with their name, photo, and location through online postings (Denecke et al., 2015).
Communication through social media blurs the distinction between what is “private” and what is “public” in online communities (Dyer, 2001). Availability of patient’s data allows healthcare providers to conduct social media searches on patients to learn more about their behavior or social circumstances (Denecke et al., 2015). For example, healthcare providers can digitally track the patient’s personal behaviors, such as smoking habits or maintaining a healthy diet, which may strongly influence the treatment of the patient (Denecke et al., 2015).
It is crucial for providers to balance the acquired information through social media and possible misuse or misinterpretation of data (Denecke et al., 2015). Nurses must adhere to the ethical principles to respect the patient’s best interest (Sewell, 2016). Nurses should consider the intention of searching online for patient information, its potential value and risk to the patient, and the anticipated effect of gaining previously unknown information (Clinton, Silverman, & Brendel, 2010).
The ANA must periodically revise the Code of Ethics’ interpretive statements related to internet technology to assist nurses to ethically transform data into knowledge into wisdom. Nurses must remain grounded in the nursing Code of Ethics and nursing scope of practice regardless of the advancement in technology. Additionally, nurses must obtain basic knowledge in nursing informatics to make ethical decisions related to information technology. Nursing leadership must utilize ethical guidelines to create policies for nurses to function within the virtual world and to maintain nursing as the most trusted profession.