Social Networks in Clinical Settings Lead to Privacy Violations

“Will hold in confidence all personal matters committed to my keeping” and “devote myself to the welfare of those committed to my care” are two principles of the Nightingale pledge that define beneficence in nursing (Nightingale, 1935). Beneficence is defined in modern terms as “refraining from maltreatment and maximizing potential benefits to patients while minimizing potential harm” (Bernstein, 2017, para. 2). Use of social media and cell phones in the clinical settings can lead to a breach in confidentiality which violates the ethical principle of beneficence.

The use of social media has exploded in today’s world. Young people today are quite dependent on cell phones and the ability to post or check social media. For nursing students, this is particularly problematic as the clinical setting is and should be a restricted area from cell phone use. Most often students want to document their clinical experiences with a picture or a social media post. Picture taking in the clinical area is quite dangerous as the potential risk for breach of confidentiality, which is usually unintentional, is quite prevalent. Posting on social media about clinical experiences can be almost as damaging as an actual picture. If a student outlines in detail the clinical setting, a procedure, or the patient, confidentiality has been breached. Once a picture or a post has been made, even if the user removes the information later, the digital imprint is still present on the Internet, thus leaving the patient or the patient’s information exposed.

Most nursing students today do not really understand how easy confidentiality can be breached. Students are excited about their clinical experiences and want to document with a picture or possibly a social media post. Innocently or not, the patient or their personal information can be exposed. “Some students do not understand that avoiding the use of patient names is not a guarantee of anonymity and complete compliance with confidentiality policies or HIPAA laws” (Edge, 2017, para. 6) Example of students violating patient’s rights to privacy or violating HIPAA (Health Insurance Portability and Accountability Act of 1996) without patient’s names are: pictures with newborn babies after a delivery or videoing in a patient care setting to document care being given and then sharing those pictures with others or posting on social media. As a nursing instructor, this nurse has experienced each of the previous examples mentioned. In the videoing incident, pre-nursing students were working with patients to complete the activities of daily living.

Three students were each assigned to a specific room with two patients. Once the students had completed the direct patient care, the room was to be cleaned. As the patients were sitting in wheelchairs while beds were being changed, one of the students decided to take her cell phone from her pocket and video the patients. Cell phones in the patient care area was a violation of clinical and facility policy. The video clearly showed each one of the patients and two of the students in uniform with the school nursing program patch. The video was later posted on Snapchat stories, which allows the story to be present and viewable for 24 hours. Posting there allowed another student to retrieve the video and forward it to the nursing instructor and to the campus dean.

Each student was easily identified and questioned about the videoing incident. The student’ s response to questioning revealed “Snapchat stories only last 24 hours and then it will disappear. Nobody we know will see it.” No accountability for their actions or empathy towards the patients and the clear breach of confidentiality. The repercussions were quite severe as the students were dismissed from the program and denied re-enrollment at that school indefinitely. Also, the facility, the families, the Department of Health and Hospitals, and the State Board of Nursing were notified of the breach. A split- second decision has now cost three students a career as a nurse. The facility graciously agreed to continue to allow students access for clinical training and the family chose not to pursue any legal action. When these events were explained to the students, each one was still in disbelief as to how a video could have caused so many problems.

Patient’s rights, HIPAA, cell phone use, and social media are all discussed in detail in the first semester of nursing school. Students are given a copy of patient’s rights and a student handbook outlining each of the regulations for clinical settings and patient privacy. Social media and the use of cell phones are reviewed at great length before any student attends a clinical rotation. Each student also signs a statement on understanding once the handbook has been reviewed with them. Do they really understand what they are signing? Do they read along and pay attention as the handbook is being reviewed? Do they really understand how posting on social media is doing harm to the patient and thus violating the ethical principle of beneficence?

Students and professionals alike have difficulty discerning what is appropriate or inappropriate to post, tweet, snap, or share. “Although there are several benefits to the use of social media for health communication, the information exchanged needs to be monitored for quality and reliability, and the users’ confidentiality and privacy need to be maintained” (Moorhead, 2013, para. 5) . When used appropriately, each of the social media platforms have allowed more exposure for breast cancer awareness, Alzheimer’s disease, Autism, and many other diseases. But as Francisco Grajales (2014, para. 39) noted “They found that maintaining ethical principles was the most difficult part of using Facebook for research. In particular, maintaining beneficence, improving knowledge and information comprehension, ensuring equity of special populations, and safeguarding confidentiality and security were the largest challenges to the study’s implementation”. Minimizing harm seems to be difficult even for professionals when posting or not posting on social media. 

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