Use of Social Media and Web 2.0 Technologies to Increase Knowledge and Skills of British Columbia Nurses Noreen C. Frisch, RN PhD1, Elizabeth M. Borycki, RN PhD1, Grace Mickelson RN MA2, Pat Atherton, MPA3; Helen Novak-Lauscher, PhD4, Daniel Hooker, MLIS,4 Kendall Ho, MD FRCPC4 1 University of Victoria, Victoria, British Columbia; 2Provincial Health Services Authority, Vancouver, British Columbia, 3InspireNet, http://www.inspirenet.ca/ 4University of British Columbia, Vancouver, British Columbia, Canada Abstract Health professionals’ use of social media and Web 2.0 technologies are emerging as a new area of research. We present the experiences of a province-wide network in Canada that was developed using such technologies as a means to increase nurses’ capacity in nursing health services research. Our network is based on a model of electronic communities of practice (eCoPs). Network evaluation affirms that nurses do respond to social media, as membership has grown to over 1,400 members in two years. Approaches used for network development and implementation are discussed, and the network’s eHealth eCoP is presented as a case of network activities and directions. Introduction Published research on the use of social media and Web 2.0 technologies in health care is growing. Much of this work focuses on the use of social media and other technologies as tools that can be used by individuals to support the self-management of their health issues and to support communication between patients/clients and their health care providers.1,2,3 Along these lines, a new area of research has emerged at the intersection of social media, Web 2.0 and health professional practice. The focus of this emerging area of research is two-fold: (1) it attempts to better understand how healthcare professionals, including nurses, are using social media to connect with one another professionally, and (2) it attempts to determine the impacts of these professional practice connections on health research and practice outcomes. The aim of this paper is to present the initial findings of a project that is evaluating the impacts of social media in their support of nursing professional practice and health services research. Specifically, we report on our experiences using virtual technologies in a province-wide network in British Columbia (BC), Canada, called InspireNet. InspireNet was formed to increase capacity among BC nurses to conduct and use nursing health services research. The project is a professional network called Innovative Nursing Services and Practice Informed by Research and Evaluation Network (InspireNet). As part of a larger suite of programs in BC supported by the BC Nursing Research Initiative (BCNRI), InspireNet was funded for four years through the Michael Smith Foundation for Health Research. The network has a mission to serve nurses in diverse settings addressing those in both urban and rural/remote areas who are separated by a vast geography. It was clear from the beginning that InspireNet could only accomplish its goals by becoming virtual and making full use of social networking and Web 2.0 capabilities for bringing people together. To our knowledge, InspireNet is the first professional nursing network in Canada that has attempted to conduct its work almost exclusively using social media through the establishment of electronic communities of practice (eCoPs). Review of the Literature Social media, or Web 2.0 as it is often called, are electronic forms of media that support ‘many-to-many’ communications (rather than individual-to-individual), thereby providing a means for individuals to enter into discussions (synchronous or asynchronous) with groups of like-minded people. The term Web 2.0 indicates the evolution of World Wide Web sites from static pages with content merely provided to be read, into active spaces that allow and encourage active participation from the sites’ users. Social media and Web 2.0 technologies offer people opportunities to meet and network virtually as well as provide ability for collaboration among people who have similar professional practice and research interests. To date, social media researchers in healthcare have identified a number of benefits associated with the use of this

technology. For example, social media applications have been used as teaching tools to increase the knowledge and skill level of nurses and other health care professionals.4,5,6 These authors report positive outcomes in establishing mentoring relationships, building best practices by teaching through social media, and supporting nurses to maintain currency in practice. There is also an emerging literature on how social media is changing the practice of healthcare professionals. One author describes a ‘new age’ primary care practice where the provider and patient connect regularly through technology.2 There are new opportunities for social media in healthcare identified almost daily: from individuals finding health information online, to participation in online support groups, to being able to track the spread of pandemic information and public reaction.7,8,9 Additional examples of social media use by healthcare professionals include medical blogs (e.g., http://casesblog.blogspot.com/), a twitter journal club established by a group of students (e.g., http://www.twitjc.com/), and many online health care social media groups (e.g., http://healthsocmed.com/). Social media has been used by nursing organizations to broaden their scope of work and increase numbers of participants in organizational activities as well.10,11,12 Social media use has been explored in relation to the development of communities of practice (CoPs). CoPs were initially described by authors influenced by social learning theory who suggested that learning takes place within social relationships, rather than through the simple acquisition of knowledge.13 It has been argued that people form CoPs because they share a passion for a topic. Thus, consistent with the notions of social learning theory, when people share a concern or wish to solve a set of problems, they deepen their knowledge and expertise by interacting with each other on an ongoing basis.14 CoPs take time to develop and those following the process of CoP work described ‘life-cycle phases’ of such communities showing a progression from being an informal group to an actively-committed and engaged community. There are five CoP life cycles phases describing the actions and focus of the group at each point: Potential (an informal network); Coalescing (people are beginning to establish a group identity); Maturing (members clarify their focus and actively work together for a shared goal); Stewardship (members sustain momentum for their work); and Transformation (having accomplished a goal, members of the community either reestablish their purpose or disband the CoP). Once web-based technologies became available, people began using such technologies to form these CoPs and now refer to them as electronic CoPs, or simply, eCoPs. Additional success factors for achieving eCoPs include: problem focused; voluntary involvement and self-organization, distributed leadership, transparency and public accountability; shared identity; sustainability; and accessibility.15 It is important to note that in social media applications there are always two levels of members: the ‘core’ members and the ‘peripheral’ members. Core members are those who are actively and consistently engaged. Peripheral members are those who ‘lurk’, who enter into the website sporadically and who keep a watchful eye on discussions without entering into those discussions themselves. In our network, both are welcomed and important members. The core members accomplish the ‘work’ and goals of their eCoP team. Peripheral members learn something, exchange information on the member database and participate from a distance. These two levels of members make it difficult for network managers to interpret membership numbers as it becomes possible to only estimate the number of core members out of the full membership numbers. Our network is providing a living laboratory to understand the development of virtual networks for healthcare professionals and to learn about nurses’ needs, behaviours, and thoughts around a new way of coming together for a common purpose. Thus, we developed a comprehensive evaluation plan. Background on InspireNet Launched in 2009, InspireNet operates with a philosophy committed to creating collaborative advantages by bringing people together. Operating though a virtual office, the network was established as an academic-practice partnership. InspireNet is managed by a team of three individuals: one from academia, one from clinical practice and a network manager hired to support operations. The network is ‘open’ for membership such that any nurse or health professional may join at no fee. The network management team collaborates with others groups to enhance the knowledge and expertise that are brought to its work. To make full use of social media and Web 2.0 technology, the website was designed to be interactive and engaging (see www.InspireNet.ca). The website was developed using Drupal, an open source content

management system that provides full Web 2.0 functionality and has both public and private areas. Publically-accessible areas provide general information about InspireNet as well as allowing individuals to review a blog, use links to various resources and view upcoming conference listings. Those who use the publically-accessible portions of the website can also listen to pod/webcasts for skill-development, review a news archive of relevant nursing health services-related content and link to InspireNet’s Twitter feed, Facebook account, Flickr account and access YouTube links. Private areas of the website (for members only) provide users with a discussion board, and access to eCoPs which are open for any member to join. These eCoPs support topic-specific Action Teams. Each Action Team has a blog, discussion boards, an event calendar, a shared document repository, a wiki and the ability to write to a static webpage. In addition, the Action Teams have access to web-based conferencing technologies (webinars), allowing them to schedule virtual meetings at no cost to members who connect to the meeting over their personal computing device. Currently, there are active teams addressing topics of: eHealth; First Nations health; healthy workplace climate; nurse educators’ scholarship; utilization of advanced practice nurses; practicebased research and a “Nursing Education and Research Rounds” team. A significant portion of the management support goes to maintaining the website and all of its functions. Evaluation Methods Several types of data were collected so that InspireNet could be evaluated: memberships and user tracking data; a survey of users; and information about eCoP development. Procedures Membership numbers are kept by the network manager and reported out weekly. Google Analytics are used to track website activity. A 40-item web-based survey was conducted to ascertain members’ demographics, interests, reasons for joining, activities on Action Teams, and level of satisfaction with the network. Actions teams are evaluated by tracking numbers of team members, member activities, and correlating Action Team members’ responses in the aggregate with the team’s responses to the survey items related to each Action Team development. While not reported in this paper, eCoP member interviews are in process at the time of this writing to provide additional information. Results Memberships and User Tracking: Over 1,400 people have become members of InspireNet, and membership numbers have continued to increase since the initial website launch (See Table 1). These membership numbers do not indicate the actual numbers of core versus peripheral members; they indicate the number of individuals who have signed on to become part of the database and who have attended at least one member activity. The InspireNet site has been visited 1,925 times per month on average, resulting in an average 9,145 page views per month. Members retrieve information from the member database 350 times per month; the blog posts have each been read 275 to 510 times; and there are over 206 Twitter followers and 23 Facebook ‘likes’. Notably, almost all of the Twitter and Facebook followers have not formally joined. Table 1: InspireNet member growth over two years End of time period 6 months 1 year 2 years

# of members 134 449 1,484

Table 2: Membership work settings Member workplace Clinical Practice Post-secondary, educational Government, NGO or other

68% 21% 11%

Survey: Once InspireNet was in operation for 16 months, all members were asked to complete the webbased survey that was ‘open’ for a period of one month. Members were reminded through broadcast emails and through information in a biweekly newsletter to complete the survey form. Eighteen percent of the full membership completed the survey. Results indicated that a majority were nurses from clinical practice (see Table 2). These data match well to the distributions of workplace in the full database, indicating that the survey respondents appear to represent the membership at large. Further, the 18% response rate may be an indicator of the actual number of core members. Seventy per cent of the

respondents thought of themselves as being ‘average’ or ‘proficient’ computer users; 94% reported that use of the Internet is useful or very useful in helping to support their work. Over seventy per cent of the respondents indicated they had a clear understanding of the meaning of “Communities of Practice”; 35% of the respondents joined one or more of the Action Teams, and were looking for networking, collaborating and learning opportunities. eCoP Development -- The eHealth Action Team: The eHealth Action Team is presented as an example of the development of an action team. The team was founded to bring nurses together who were interested in eHealth and technologies who were working in diverse areas such as IT departments, professional practice offices, quality improvement, education, and nursing management, with an open invitation to students. In the first year of operation, the team grew to having 45 members. Except during a summer break, the members met for web-conferenced meetings at least once per month. Sessions included topics such as nurse-sensitive outcome measures, nursing documentation in electronic health records, development of information systems, an introduction to a national nursing informatics organization, and participation in a journal club. Presenters ranged from individuals in local facilities to nationally/ internationally known speakers. Presenters were readily able to connect through their computers, share their desktops, present themselves over webcams, and have a conversation “face-to-face” with team members, about half of whom connect via webcam and others through audio only. They met in real time and had question/answer periods for discussion. The website permits posting recordings of these web conferences for members to access anytime they wish. Review of data from past web conferencing sessions indicates that 9 to 10 people attend on the average, and that an equal or greater number of people access the recording after the session takes place. During the time period of speaker activity for presentations, the Action Team’s website was accessed 101 – 243 times per month. The Action Team website also includes discussion groups, event postings, information on open access journals and books in the field, and opportunity for members to alert one another of interesting issues or events. One such posting came from a member illustrating two views of an electronic ‘power chart’ that was being developed at a regional centre. This posting provided information and permitted reaction and discussion about the plan. On survey responses, the eHealth Action Team members differed from the general membership in that 100% identified themselves as proficient users of computers and technologies. In other regards, however, their responses were similar. Given a description of the life-cycle phases of eCoPs, most placed their team at the coalescing phase. They logged onto the site two times a month or more and used the event calendar more than other area. They very clearly joined for collaboration, networking and knowledge development. Members agreed that research collaborations are developing as a result of the network and 66% indicated they are actively planning nursing health services research education at their place of work. They indicated very positive satisfaction as network members. We have observed other activities of these Action Team members: individuals who have met through the eCoP have sought each other out when visiting distant parts of the province so that they can meet face-toface (perhaps much like what is reported in other social media activities); some individuals have been contacted by others to collaborate on educational and/or research project proposals; at least two individuals have applied for graduate programs having learned about opportunities through the eCoP; and one member of the eCoP joined on after having attended a web-based session of another Action Team where he learned about the eHealth team (i.e. an “eCoP to eCoP referral”). Discussion/Conclusions The experience of InspireNet demonstrates that nurses do respond to the use of Web 2.0 technologies to become part of a community of practice. Membership growth documents interest and enthusiasm, but also is a response to considerable recruitment efforts, not the least of which seems to be the ‘draw’ from the web conferencing sessions and the support provided by the network manager to assist members with unfamiliar technology. The rate of accessing the website also indicates members and non-members are finding something of interest there. The fact that most members indicated that they joined for networking, collaboration, and learning opportunities, suggests that they came together with values consistent with the notions of social learning theory – perhaps they believed that they could accomplish something together when working within relationships. We note that working through relationships is an expressed value of

many nurses in our province and forms the basis of several of our province’s nursing educational programs. It would be an interesting question to explore in further study if nurses are more likely to join such a network than other professionals. Our knowledge of the eHealth Action Team suggests that this team is currently at the coalescing life-cycle phase of an eCoP. We project that it will take another year for this team to fully engage at the maturing and stewardship stage and that we will be able to document outcomes of this team’s work only after the third year of operation. We have experienced a few challenges. While no members considered themselves to be novice computerusers, the management team noted that many members required assistance (some a great deal of assistance) in using Web 2.0 and webconferencing systems. We need to develop a sustainable strategy to meet the evolving technology needs of our members while incorporating new Web 2.0 and social media tactics. At this point, we believe that nurses will become engaged in new technologies only if there is sufficient support for them to work through their real and imagined barriers to full technology use. Continued evaluation of InspireNet’s activities is being done. We are encouraged to learn that a majority of members indicated interest in both learning about and participating in nursing health services research. We know that nurses throughout our province have responded by joining and participating and that some of these nurses are very active, core members. Several hundred nurses (the peripheral members) have attended at least one educational session on health services research topics. Many members are forming teams focusing on educational and research projects together. Without access to the technologies, coupled with significant managerial support, we would certainly not have a network of over 1,400 members. References 1. Ressler PK, Glazer G. Nursing’s engagement in health policy and healthcare through social media. OJIN. 2010; 16 1. 2. Hawn C. Take two aspirin and tweet me in the morning: How Twitter, Facebook and other social media are reshaping healthcare today. Health Affairs. 2009; 28 2: 361-8. 3. Shea L. Using social media to get health care messages out. Patient Education Management. 2009; 16 7: 76-7. 4. Bassell K. Social media and the implications for nursing faculty mentoring: A review of the literature. Teaching and Learning in Nursing. 2010; 5:143-8. 5. Billings DM, Kowalski K, Briston T. Twitter: Consider the use for continuing nursing education. J Continuing Ed in Nursing. 2010; 41 5: 199-200. 6. Saver C. Tweeting, posting and yammering: The role of social media in the OR. OR Manager. 2009; 26 2:1, 12-4. 7. Scanfeld, D., Scanfeld, V., & Larson, E. L. (2010). Dissemination of health information through social networks: twitter and antibiotics. American journal of infection control, 38(3), 182-8. doi:10.1016/j.ajic.2009.11.004 8. Signorini, A., Segre, A. M., & Polgreen, P. M. (2011). The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. during the Influenza A H1N1 Pandemic. (A. P. Galvani, Ed.)PloS one, 6(5), e19467. Public Library of Science. doi:10.1371/journal.pone.0019467 9. Bender, J. L., Jimenez-Marroquin, M.-C., & Jadad, A. R. (2011). Seeking support on Facebook: a content analysis of breast cancer groups. Journal of Medical Internet Research, 13(1), e16. doi:10.2196/jmir.1560 10. Bell J. Social media and family nursing. J Family Nursing. 2010; 16:251-55. 11. Brown C. Keep the connection through social media. ONS Connect. 2010; 25 7: 18. 12 Fraser R. Social media: An innovative way to share nursing ideas. Reflections on Nursing Leadership. 2010; 36 1: 5 13. Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Evolution of Wenger’s concept of community of practice. Implementation Science. 2009; 4 1:11. 14 Wenger E, McDermott R, Snyder W. Cultivating Communities of Practice. 2002. Boston: Harvard Business School Press. 15. Ho K, Jarvis-Selinger S, Norman CD, Li LC, Olatunbosun T, Cressman C, Nguyen A. Electronic CoP: Guidelines from a project. Journal of Continuing Education in the Health Professions. 30(2);139-143. 2010.

Use of social media and web 2.0 technologies to increase knowledge and skills of british columbia nurses.

Health professionals' use of social media and Web 2.0 technologies are emerging as a new area of research. We present the experiences of a province-wi...
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