Social Media Utilization in Undergraduate Nursing Education: An Integrative Literature Review

Citation: Reed, L. & Lee, M. (2022). Social Media Utilization in Undergraduate Nursing Education: An Integrative Literature Review. Online Journal of Nursing Informatics (OJNI), 26(2).  https://www.himss.org/resources/online-journal-nursing-informatics

Abstract

Background: Social media use has been proposed as a resource for learning in education across disciplines. The potential of social media use in nursing education programs has been highlighted since they can enhance students’ competency in the use of health information technology applications and meet the learning styles of new generations.

Method: An integrative literature review was performed to identify and describe evidence of how social media platforms have been used in undergraduate nursing education and their impact on student learning outcomes. The literature search was conducted using PubMed, CINAHL, and ERIC databases with search terms related to ‘social media’ and ‘nursing education.’

Results: The review and analytic process identified 10 studies that used the following social media platforms: Facebook, Twitter, WhatsApp, Instagram, and YouTube. These social media applications have been integrated into nursing courses as a platform for discussions, instant messaging in clinical settings, skills videos and demonstrations, and other assignments and collaborative learning.

Summary: Social media use as a teaching pedagogy within courses promoted interactivity and enhanced learning by assisting students in acquiring greater knowledge and skills in nursing-related topics. 

Background

Social media utilization has been proposed as a resource for learning in education across disciplines, including pharmacists, physicians, and nurses (Chan et al., 2020; Chen & DiVall, 2018; Duke et al., 2017). The formal integration of social media into nursing education and the influence of social media on student learning has also been broadly discussed (Alharbi et al., 2021). Despite the confidentiality and privacy concerns associated with social media use (Jones et al., 2016; Nyangeni et al., 2015), the potential of social media use in nursing education programs have been highlighted in that it can enhance students’ competency in the use of health information technology applications and meet the learning styles of new generations (Shatto & Erwin, 2016; Stegen & Sowerby, 2019).

Social media refers to electronic communication tools that create online communities for users to share information, ideas, personal knowledge, and other content (Merriam-Webster, n.d.; Nyangeni et al., 2015). The most popular social media networks worldwide include Facebook, YouTube, and WhatsApp (Statista Research Department, 2021).

Facebook, Twitter, and YouTube are considered the most popular social media platforms in nursing education (Booth, 2015; Vizcaya-Moreno & Perez-Canaveras, 2020). Millennial nursing students do not respond well to sitting in lectures and prefer to be more interactive and adapt readily to new technologies (Catalano, 2015; Stephens & Gunther, 2016). In addition, many students in current nursing pre-licensure programs are digital natives and experience instant gratification by finding answers through social media applications (Hampton et al., 2020). The changes in generational characteristics and advancements in online communication technologies trigger innovative teaching pedagogies to meet students’ learning needs.

Social media and connected health technologies can be avenues for enhancing patient-centered care (Staccini & Fernandez-Luque, 2015; Vlahos, 2019). Teaching appropriate use of these communication technologies is essential in nursing education (The National League for Nursing, 2015). It has been reported that using social media helps students put important concepts in context, maintains currency in course content, and fosters a sense of community (McGonigle & Mastrian, 2018). The use of social media is expected to enable students to interact with each other, engage with materials, and promote cooperative learning. A recent review by Ross & Myers (2017) provided an overview of social media use in pre-licensure nursing education and found that students responded positively, perceiving that social media use in nursing education was appropriate for educational and professional connection. It is beneficial to identify how nursing faculty use social media platforms to facilitate student learning in undergraduate nursing education and the effectiveness of those teaching pedagogies through a literature review. Therefore, this integrative literature review aimed to identify and describe evidence of how social media platforms have been used in undergraduate nursing education and their impact on student learning outcomes. The findings of this literature review will support nursing faculty to apply evidence-based teaching pedagogies for optimal use of social media platforms in their courses to enhance teaching. 

Methods

This review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines (Page et al., 2021). The literature search was undertaken through the following electronic databases in February 2021: PubMed, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), and the Education Resources Information Center (ERIC). Various combinations of the Medical Subject Heading (MeSH) terms, CINAHL Subject Headings, and keywords related to ‘social media’ and ‘nursing education’ were used with Boolean operators (e.g., AND, OR). The search was further limited to articles published from 2016 to 2021 in the English language in peer-reviewed journals. 

Inclusion/Exclusion Criteria

This literature review included studies focused on undergraduate nursing students and examined faculty use of social media to facilitate student learning. Exclusion criteria were as follows: articles that assessed social media utilization in graduate and professional nursing populations, systematic reviews, instrument evaluations, and commentaries. The initial search yielded 118 articles, of which 60 were identified from PubMed, 52 from CINAHL, and six from ERIC. After seven duplicates were removed, 111 titles and abstracts were screened according to the inclusion criteria. After this initial screening, 85 studies were excluded. The full-texts of the remaining 26 articles were carefully reviewed, and 16 articles were further excluded for the following reasons: studies did not investigate specific social media applications, did not measure student perceptions of social media use in facilitating student learning, did not implement social media applications in a course by faculty, or did not explicitly articulate the methodology of social media use. Thus, after the full-text review, a total of 10 articles were included in this literature review. Figure 1 shows the article selection process. 

Literature Review Process

The following information was extracted from the included studies and presented in Table 1: study purpose, study design, sample, social media platforms used, teaching pedagogies in using social media, and findings. Key findings from the selected articles were synthesized according to the specific social media application utilized.

Table 1: Literature Review Summary

Evidence Level and Quality Assessment

The evidence and quality of each study were evaluated using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) tools (Dang & Dearholt, 2017). The criteria of JHNEBP rating included adequate sample sizes, clear research aims, and research aim and design congruency. Four articles were rated as Level III – Nonexperimental Study, four as Level V – Experiential and Non-research Evidence, and two as Level I – Randomized Control Trial. As for the quality of the articles, most articles were evaluated as ‘B – Good quality’ except for two rated as ‘C – Low quality or major flaws.’

Results

Study Characteristics

There were two randomized control trials (Bayram et al., 2020; Vicdan, 2020), two cross-sectional, descriptive studies (Pimmer et al., 2018; Price et al., 2018), a single group pre-and post-test study (Tubaishat, 2018), one qualitative (Gazza, 2019), three mixed methods teaching quality improvement projects (Morales, 2017; Johnston et al., 2018; Theron et al., 2017), and one case study (Jones et al., 2016). The countries where the studies were conducted included the United Kingdom (Jones et al., 2016; Price et al., 2018), the United States (Gazza, 2019; Morales, 2017), Turkey (Bayram et al., 2020; Vicdan, 2020), Nigeria (Pimmer et al., 2018), Canada (Theron et al., 2017), Australia (Johnston et al., 2018), and Jordan (Tubaishat, 2018). 

The majority of the studies included a sample of first-year nursing students (Bayram et al., 2020; Jones et al., 2016; Morales, 2017; Price et al., 2018; Vicdan, 2020); other studies were conducted with first and second-year nursing and paramedicine students (Johnston et al., 2018), first and third-year nursing students (Tubaishat, 2018), RN to BSN students (Gazza, 2019), second-year BSN students (Theron et al., 2017), and senior nursing students (Pimmer et al., 2018). The largest sample size was comprised of 2,500 nursing and paramedicine students in Johnston et al.’s (2018) study. In the remaining studies, sample sizes ranged from 47 to 547 nursing students.

Social Media Platform Use in Courses and Their Impacts on Student Learning

Five social media platforms have been used in undergraduate nursing student education: Facebook, Twitter, WhatsApp, Instagram, and YouTube.  

Facebook 

Three studies reported faculty use of Facebook in undergraduate nursing program courses. Morales (2017) explored the use of social media in a pharmacology course to facilitate student engagement in learning and developing test-taking skills by posting daily National Council Licensure Examination (NCLEX) questions on Facebook. Facebook posts were monitored to measure student engagement. Students reported that the Facebook platform for discussing NCLEX questions was helpful and described the platform as a safe environment for promoting faculty/student interactions and faculty responses as caring, encouraging, and supportive. Benchmark testing scores improved, and student engagement with the class social media was correlated with higher grades. Theron et al. (2017) used Facebook as the assignment platform for students to appraise social media health information and measured student learning experiences.

Students praised the use of Facebook for social interaction in their comments. However, 32% of 47 nursing student participants rated they were  ‘greatly dissatisfied’ regarding the statement “using Facebook as a learning platform” on a scale; and students commented about difficulties of posting documents on Facebook. Tubaishat (2018) created a Facebook course page for adult health nursing and advanced health courses and provided course notifications and updates by posting at least 4-5 times every week through the term. These posts incorporated updates about course lectures, presentations, notes, summaries, or reminders about exams and quizzes, as well as links to extra learning resources. Students were encouraged to participate in the page by posting comments, questions, and discussions. Most students perceived Facebook as an effective tool for nursing education since the platform can facilitate communication, provide easy access to course materials, and provide support.

Twitter

Three studies explored the use of Twitter in nursing education. Gazza (2019) created a Twitter account for use in a health policy course and asked students to complete learning activities in addition to Twitter activities, including a review of evidence on a health policy topic, reading assignments, engaging in an online debate, and writing a scholarly paper about a selected policy issue. On average, individual students followed 13.2 policy-related individuals and groups, totaling 645 in 49 nursing students. Two themes emerged from the students’ responses: Students described how using Twitter could provide easy access to a variety of current health care policy-related information (Staying up to date) and how Twitter could be used to realize students’ potential contributions to health policy (Opening my eyes). In addition, the students indicated that microblogging with Twitter was helpful for student engagement relative to healthcare policy initiatives.

Jones et al. (2016) used Twitter as an assignment platform to pilot an introduction to digital professionalism as an element of nursing curricula. Students were required to engage in Twitter activities by following at least 30 nursing or health-related accounts and tweeting on topics to contribute to a web forum. Twitter accounts were monitored to measure student engagement. The majority of students indicated that Twitter was worthwhile and acknowledged that learning was enhanced through Twitter. Price et al. (2018) evaluated the use of Twitter and perceptions of students in adult, child, and mental health nursing courses by implementing a module with Twitter as an option to discuss ‘what is nursing.’ Students were asked to engage in a discussion using Twitter. Student engagement was assessed using an online self-report questionnaire. The nursing students reported positively about using Twitter to engage, promote discussion, and share nursing information during the program's first year. The students also indicated that Twitter use was beneficial to increase awareness of nursing issues and recommended the use of social media in nursing schools. The online interactions were found to create a more collaborative learning approach.

WhatsApp

Two studies investigated the use of WhatsApp. Pimmer et al. (2018) examined the extent of WhatsApp use by students during clinical placement. The students perceived WhatsApp to be useful in clinical settings due to its ease of use. Students also reported the app contributed to placement satisfaction, identity development, and social capital with peers. Bayram et al. (2020) conducted a randomized control trial to examine the effect of WhatsApp-supported training on students’ knowledge and skills for safe ventrogluteal site injections. Students who received additional videos and pictures from WhatsApp scored significantly higher on tests of knowledge and skills for the proper administration of intramuscular injection into the ventrogluteal area compared to the control group of students who did not receive them. 

Instagram

Vicdan (2020) created a teaching web page in the Instagram application and evaluated its effect on student learning of intramuscular injections in the ventrogluteal area. Teaching materials included subject-related images, PowerPoint presentations, handwritten notes, questionnaires, videos, and live webcasts. A knowledge evaluation form regarding ventrogluteal injections and a skills application checklist was used to evaluate and measure student learning. There were no statistically significant differences in the knowledge and skill level scores between the intervention and control groups, but knowledge and skill levels increased within each group. The author considered that utilizing social media was just as effective as teaching the skill in the face-to-face modality.

YouTube

Johnston et al. (2018) created a ‘Biological Sciences’ YouTube channel and uploaded 149 evidence-based educational videos for students to the channel. Over 90% of students agreed that the videos in the course assisted their learning. Students’ comments were positive regarding content quality, learning goal alignment, motivation, presentation design, interaction usability, accessibility, and reusability. Student confidence and subsequent access to the YouTube videos were enhanced by their familiarity and the breadth of information available.

Discussion

This literature review identified that various teaching pedagogies with social media have been used in undergraduate nursing courses and impacted student learning outcomes. Five social media platforms utilized in the reviewed studies included Facebook, Twitter, WhatsApp, Instagram, and YouTube. In fact, these platforms have been the most predominantly used ones by college students in general (Nagel et al., 2018; Wang et al., 2015); according to a report from the Pew Research Center (2021), the usage rate of these social media platforms range from 42-95% in the age group of 18-29 as of 2021. The wide use of social media has impacted students’ college life and learning patterns (Wang et al., 2015). Thus, harnessing social media platforms for teaching and learning in nursing courses is a good teaching strategy to meet the learning styles and needs of the Millennial generation.

The studies included in this literature review demonstrated well how to use social media in nursing courses. The social media platforms were used as a course site (Johnston et al., 2018; Tubaishat, 2018; Vicdan, 2020), part of course assignments and activities (Gazza, 2019; Jones et al., 2016; Morales, 2017; Price et al., 2018; Theron et al., 2017), a communication channel during clinical placement (Pimmer et al., 2018), or a training module (Bayram et al., 2020). In the studies included in this literature review, the use of social media promoted student engagements through enhanced interactions and discussions with peers and instructors (Morales, 2017; Pimmer et al., 2018; Price et al., 2018; Theron et al., 2017; Tubaishat, 2018), easy access to course materials (Johnston et al., 2018; Tubaishat, 2018; Vicdan, 2020), and knowledge and skills on the targeted nursing topics (Bayram et al., 2020; Morales, 2017; Vicdan, 2020).

Student engagement is a significant contributor to student success. Previous studies exploring social media use with college students reported that more interaction with teachers and peers, student engagement, perceived collaborative learning, and students' academic performance were all positively interrelated (Ansari & Khan, 2020). The interactions between learners and instructors and among peers also influenced student satisfaction and the intention of continuous use of social media (Chou & Pi, 2015). So, the results of the reviewed nursing studies support the positive potential of social media to improve the academic engagement and performance of nursing students.

It is also notable that social media use in the reviewed studies facilitated student engagement in health professional activities inside and outside the classroom. For example, students with social media platforms with instructions could have opportunities to appraise the quality of social media health information (Theron et al., 2017) and expand their network and engagement related to course topics beyond classrooms, such as following or retweeting health policy individuals/ groups or nursing/health-related initiatives (Gazza, 2019; Jones et al., 2016). These results supported that integrating social media into coursework could inspire students to find new ways to collaborate and engage a broader audience in their work (Chapman and Greenhow, 2019) and build relationships by weaving the coursework to make it meaningful to them (Greenhow & Galvin, 2020). 

Although social media platforms provide many advantages to enhance student engagement, it is necessary for instructors to consider possible challenges, such as maintaining quality of interactions with large-size classes while preventing burdens and boundaries of students’ use of social media inside and outside the class network (Lopez & Cleary, 2018). Instructors need to clarify expectations and boundaries of the coursework to prevent confusion or risks of exposing students’ private lives to classmates or external users; this will create a conducive and safe learning environment (Thalluri & Penman, 2015). Social media, only if thoughtfully integrated into coursework, can help students and instructors stay connected and enhance student engagement; this will make the remote online learning approach less remote (Greenhow & Galvin, 2020). 

During clinical nursing placement, Pimmer et al. (2018) examined the extent of WhatsApp use by nursing students; they found that students perceived the app contributed to placement satisfaction and reducing feelings of isolation in professional situations. In general, undergraduate nursing students felt disorganized, anxious, and fragmented in clinical practicums (Arkan et al., 2018; Wang, et al., 2019). So, Pimmer et al.’s (2018) study result highlights social media’s potential to reduce students’ anxiety and peer support during clinical placement. However, nursing faculty should discuss patient confidentiality, privacy, and other ethical issues when using social media in clinical training (Vizcaya-Moreno & Perez-Canaveras, 2020).

Therefore, it is important for instructors to talk openly with students about the potentials and pitfalls of social media integration and to set shared expectations and ground rules (Krutka et al., 2019). Furthermore, before implementing social media in courses, educators should consider the technical features of social media platforms (e.g., privacy safeguards of how data is used and shared) and how they can be used in ethical ways (Krutka et al., 2019).

Implications for Future Research

Further education research in a systematic manner using validated measurement tools is encouraged to determine the usefulness and impact of social media on the learning outcomes of nursing students in both classrooms and clinical placements. Simultaneously, it is necessary to collect reasons for dissatisfaction and concerns with social media use in courses from the students’ point of view. In our review, only one study (Johnston et al., 2018) was conducted with nursing and other disciplinary students. It would be worth investigating how social media can improve interprofessional education or international nursing partnership programs, overcoming barriers of face-to-face learning. 

Limitations of This Literature Review

Despite a comprehensive literature search, some studies examining social media use in undergraduate nursing education may have been excluded. In addition, the search was limited to only English articles, and relevant articles may have been excluded. As a result, future searches could possibly include articles in a variety of languages. 

Conclusion

The social media platforms that have been utilized most frequently in undergraduate nursing education within the past five years were elucidated in this review. The findings of this literature review support nursing faculty to apply teaching pedagogies for optimal use of social media platforms in their courses to enhance students’ knowledge and skills and student engagement in professional communication and engagement, health policy, and nursing-related topics. However, clear expectations, boundaries of social media use in the coursework, and rules of privacy protections need to be established. More educational research is recommended to determine the impact of social media utilization in undergraduate nursing programs on student learning outcomes.