Ethical Decision-Making Among Nurses Participating in Social Media: A Grounded Theory Study

Abstract

Background: Nurses use social media for both professional and personal purposes, but even personal posts that can be misconstrued or violate patient privacy can lead to severe consequences for nurses. To help nurses in preventing such social media errors, it is essential to understand how nurses make ethical choices when posting on various social media platforms. Purpose: The objective was to uncover nurses’ decision-making process in evaluating ethical choices when participating in social media through the identification of influencing situational factors, their consideration of professional boundaries, and their current understanding of professional expectations. Methods: A qualitative grounded theory approach was utilized. The organizing theory was Schwartz's Integrated Ethical Decision Making. Participants were recruited through Facebook, X (formerly Twitter), and LinkedIn. After completing a short survey to verify that participants met inclusion criteria, 21 participants were interviewed via video conferencing or telephone using a semi-structured interview technique. All participants reported that they were registered nurses currently practicing in an inpatient hospital setting in the United States. Results: Nurses are multidimensional individuals with different personalities and motivations for participating in social media. Professional obligations, employer policies, and Health Insurance Portability and Accountability Act regulations trigger fear of repercussions or ramifications for content included in social media. Knowledge of social media expectations helps elicit a healthy balance between motivations for interacting with others via social media and fearing any negative outcomes. Experiencing outcomes, whether personal or observed, impacts how the nurse continues to make decisions about interacting on social media. Conclusion: Nurses have different levels of understanding of what is acceptable and not acceptable, and this study emphasizes the need to educate nurses regarding professional guidelines, expectations, laws, and employer policies.