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Healthcare practice pertaining to nursing is constantly changing as a result of new knowledge, research, government policies and regulatory code of practice; therefore, it is vital that nurses maintain currency with practice guidelines, research and skills. Social media is relatively new and its full potential in terms of educational benefits is yet to be realised. In this editorial we discuss how Twitter and other forms of social media can be used for continuous professional development (CPD) in the nursing profession and explore the different ways that nurses can use Twitter to keep up to date with practice.

Twitter is an online social networking service that allows users to send a message known as a tweet using 140 characters to each other or their followers i.e. those in a person's network. Unlike Facebook, Twitter has no privacy settings and tweets can be seen by anyone, but you have to be an account holder to be able to reply to a tweet signing up for a Twitter account is free. A review of people on Twitter shows that there are a growing number of health professionals using Twitter for professional conversation and pass along value. In 2010, it was estimated that there were 19,100 nurses on Twitter (Baumann 2010), in 2014, there were, 3800 health communities, 6·6 Million Healthcare Twitter Profiles and 10,000 Provider Profiles (MD, RN etc.) (Symplur 2014). Moorley & Chinn 2014, examined creating an online nursing community using Twitter hashtags, they highlighted that the nurses who used and belonged to their nursing community (@WeNurses) reported benefits such as feeling part of a wider community and shared identity, gaining support in an online world, sharing of information, ideas, debate and challenges.

Understanding CPD & PREP

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

One way to maintain up to date practice and knowledge is through continuous professional development. Continuous professional development is an activity that can use both formal and informal approaches that lead to gain in professional knowledge, skills attitudes and behaviour (Heron & Hammond 2001). In the UK the body that governs and regulates Nurses and Midwives is the Nursing and Midwifery Council (NMC). In view of revalidation of nursing and midwifery registration, the NMC has produced a set of guidelines for post registration education and practice (Prep). There are two types of Prep: (i) the Prep (practice) standard; and (ii) the Prep (continuing professional development) standard. The practice standard states that an individual must have worked as a nurse or midwife during the previous 3 years for a minimum of 450 hours, or have successfully undertaken an approved return to practice course within the last 3 years. The continuous practice development standard, states that nurses or midwives must have undertaken and recorded continuing professional development (CPD) over the 3 years prior to the renewal of their registration. All nurses and midwives have been required to comply with this standard since April 1995. Since April 2000, all nurses and midwives must declare on their notification of practice (NoP) form that they have met this requirement when renewing their registration (NMC 2011). The Prep handbook produced by the NMC states that Prep can help to provide a high standard of practice and care, assist practitioners to keep up to date with new developments in practice; create an area for thinking and reflecting for yourself and by doing all of these demonstrate that you are keeping up to date and developing your practice.

Continuous professional development may use formal approaches to learning such as training sessions, classroom events (e.g. lectures) or education workshops. Informal learning may take the form of face to face conversations with colleagues or verbal feedback on actions or performance. As a result of the World Wide Web these approaches to knowledge sharing and transmission can extend to online environments. One such environment is social media using the platform Twitter. Twitter can be used as a learning resource; there are metrics that show healthcare conversations on Twitter. Symplur a provider of Health Care Social Media Analytics revealed there were 410 Million Healthcare Tweets. Some of these tweets were linked directly to discussions, conferences or learning resources pertaining to health. The Prep handbook (2011 pg8) states ‘The learning activity which you undertake to meet this standard must be relevant to your practice. However, there is no such thing as approved Prep (CPD) learning activity.’

Some of the communities that are listed online that hold healthcare discussions include WeNurses, Evidence Based Nursing Journal Chat, WeMidwives, PDN hour (Postal Natal Depression) Nursing Times and the Royal College of Nursing. These communities hold structured discussions on predefined topics which are often published on their webpage. The discussions have an aim and are structured in such a way that they share knowledge and information on practice or policy relevant to each community. This may be seen as a learning activity and therefore in our opinion can contribute to Prep CPD.

WeNurses an example of Twitter discussions as Prep CPD

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

WeNurses is a nursing community on Twitter which was launched in July 2012 and currently has over 18,000 followers mainly nurses or those associated with nursing or health care. On Twitter their discussions can be located by using #WeNurses. The symbol # is used to bind the conversations that take place so all those involved can see what is being said the symbol also makes it easy to organise and find information. WeNurses hold weekly pre-determined chats that are suggested by their followers. WeNurses is one community that nurses can use for continuous professional development, their chats are archived on their webpage and they also use Facebook as an additional platform with information pertaining to health and nursing. They also attend national and international conferences and provide information that nurses can use to further research and develop practice. WeNurses uses authors of nursing texts and engages organisations such as the Nursing and Midwifery Council in discussions; this gives authenticity to the events that can be used as CPD/Prep. WeNurses reminds their followers about responsible use of social media for nurses and midwives and directs them to where they can find such information on their webpage. This community is one example that nurses can use to demonstrate as part of continuous professional development, as they provide relevant activities that can enhance nursing practice and knowledge for personal and professional development. In the flow chart below are some steps that can be followed to use social media for CPD.

When using Twitter for Prep it is important to ensure that the discussion is relevant to your practice once this has been confirmed there are a few steps that can be taken to enhance the learning opportunity. The individual should clearly document the time used on learning:

  • Be prepared to share and learn, it is most likely you are joining in a discussion because it relates to your particular nursing interest. Most discussions would have a brief on the topic; this may be in the form of a blog or a short piece on the discussion aims and objectives, some hosts may ask you to look at a video or listen to a podcast before the discussion. It is worth visiting the webpage for joining instructions; there may also be other information here such as archived chats it is advisable to look through these as they may provide further opportunity for learning. Tip Ensure you document the content, the relevance and the time you have spent researching.
  • During the discussion, you can either get involved by contributing to the discussion or just watch and listen to what others say. It is worth favourite – ing (a Twitter action that saves a particular tweet in a “Favourite” stream so you are able to refer to it at a later date) some of the tweets that resonate with you to refer to later. Tip Take a note on comments and people that got you thinking, making notes is good as some online content may move or disappear quite quickly.
  • After the discussion, you will find that some hosts may create a transcript that will allow you to go over what was said at your own pace, this is a good time to reflect on what you may have missed as an online discussion can become quite busy and you may have missed some parts of the chat. Tip By reviewing the discussion, you may identify nurses that you think you would like to continue the discussion with or maybe you share similar or different views, both are reasons to follow each other on Twitter.
  • It is clearly stated in the NMC PREP handbook that you need to document your learning “You must document, in your profile, your relevant learning activity and the way in which it has informed and influenced your practice. Although there is no approved format for the profile and you can meet the Prep (CPD) standard in many different ways” p8. It's a good idea to write your own summary of the discussion to facilitate reflection on what you have learnt. Tip You may want to blog or video blog about you reflection or simply add it to your portfolio.

Some points to consider in your reflection

  • Why did you think this discussion would be relevant to you, what did you hope to gain by participating?
  • What twists and turns did the discussion take, how did opinions from different participants vary?
  • Try to summarise the discussion in your own words or provide a link to the official transcript and summary.
  • Note any ideas you found interesting that you would use to discuss with colleagues later, or evaluate the way you perform a specific nursing task.
  • Finally, include why you found the discussion valuable and relevant to your practice.
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If you take this approach, the time spent reviewing the discussion may be more than the original length of the discussion. This approach will help you to explore and document all the value you gained from being part of the Twitter discussion.

You don't have to take part in live Twitter discussions to use them for CPD as most Twitter discussions provide transcripts after the event for people who have missed it. Archived discussions are a great resource and can be used in the almost the same way as live discussions, the only difference being that you would be unable to add your own comments to the debate.

Other forms of social media and Prep

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

Twitter discussions are valuable; however, it is important to understand that Twitter is not the only form of social media that could be used for CPD. Platforms such as Facebook, YouTube, and blogs can also provide learning opportunities.

Facebook

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

Many nurses use Facebook to connect and to share information and discuss ideas pertaining to health and nursing. A good example of this is Learning Disability Nurse Facebook page which is a vibrant community of Learning Disability Nurses who share a plethora of information about their speciality. As with Twitter the discussions that take place in forums like these are valuable learning activities which can be documented and reflected upon. Facebook unlike Twitter may operate a closed group and you may have to be a member before being able to view any information published.

YouTube

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

There are 100 hours of YouTube videos being uploaded every minute (YouTube 2014 https://www.youtube.com/yt/press/en-GB/statistics.html) the use of videos to aid CPD is becoming increasingly easier. TedMed is an excellent example of the use of videos for learning. It is also worthwhile exploring more low-tech examples for example wound care specialist Julie Vuolo (YouTube name julieherts) has produced a very informative series of videos around wound care. In this way, nurses using videos for Prep can produce a critical appraisal of the videos and techniques learnt and how applicable it is to their area of practice.

Blogs

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

Blogs are open access personal web pages on which an individual records opinions, thoughts, ideas and reflections and then shares this with an audience. Blogs are not peer reviewed, therefore, caution must be applied. However, blogs do encourage open and transparent discussion and debate through the comments section, and can be seen as a form of peer review. Blogs can be used to gain different insights from a variety of perspectives including the patient perspective, the student nurse/mentor relationship and learning can take place and reflected upon.

Spontaneous twitter discussion

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

Not all Twitter discussions are scheduled. Sometimes a professional conversation takes place in a spontaneous and unorganized way and learning can take place as a result of this. Capturing these discussions as proof of CPD can be problematic but there are web tools available to assist with this. Storify is an online tool that allows a user to capture a conversation via a transcript and even allows the user to make comments that link the conversation in between Tweets. This helps to create a “story” type record of the discussion. However, the use of Storify requires some skills a low-tech alternative may be to simply take a screen shot of the twitter discussion and use this as proof of CPD.

Using blogs for reflection

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

Blogs have a reflective component, which means that not only can the knowledge and information in them be used for CPD but also a blog can act as a personal log of CPD. Blogs pages are extremely versatile and free and easy to set up. Blogger and Wordpress are examples of two very popular blog sites. Blogging can be used as a tool to help develop your nursing skills through reflecting and gaining feedback from those that engage with your blog. Nurses are encouraged to reflect on their practice and how it has an impact on themselves and others therefore an advantage of blogging is that it helps the individual to develop reflective practice and structured thinking becoming more analytical of the situations that surrounds them. Blogging is a digital way to bring all your CPD into one place. Some examples of reflective blogging include:

Revalidation

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References

Revalidation will come into effect from December 2015 when it becomes the process where a nurse or midwife in the UK demonstrate that they remain fit to practice at point of registration renewal with the Nursing and Midwifery Council. Part of the demonstration would involve meeting the requirements of Prep and confirmation from a third party. Confirmation from a third party involves someone that is suitably placed to comment on the nurse or midwife's practice based on the Code. There is a revised code of practice, which is currently undergoing consultation; there are 115 points to consider which fall under various headings.

At point of revalidation, the nurse or midwife will need to demonstrate that they:

  • Continue to remain fit to practise by meeting the principles of the revised Code.
  • Have completed the required hours of practice and learning activity through continuing professional development (CPD).
  • Have used feedback to review and improve the way they work.
  • Have received confirmation from someone well placed to comment on their continuing fitness to practise (NMC 2014).

To make sure revalidation can meet the needs of an individual's scope of practice or setting, the NMC is now consulting on revising CPD requirements and what are suitable CPD activities and ways that nurses and midwives can obtain confirmation of their continuing fitness to practise. It is not clear if revalidation will lead to CPD becoming more prescriptive, our instinct is that nurses and midwives will continue to have scope but all those undergoing revalidation will have to justify the use of social media as CPD to a third party.

There is a potential for nurses and midwives to capitalise on the value of social media to meet the requirements of revalidation. Using a social media, digital space can help to develop skills and knowledge in theory and practice for example engaging in Twitter discussions, writing blogs and viewing videos. It is important that the Nursing and Midwifery Council provides clear guidance for their registrants on the applicability of social media usage to demonstrate revalidation. It is equally important that nurses document and use social media responsibly to enhance their continuous professional development. Most importantly, the Nursing and Midwifery Council and nurses and midwives acknowledge and embrace the positive benefits of using social media to assist in revalidation.

References

  1. Top of page
  2. Understanding CPD & PREP
  3. WeNurses an example of Twitter discussions as Prep CPD
  4. Other forms of social media and Prep
  5. Facebook
  6. YouTube
  7. Blogs
  8. Spontaneous twitter discussion
  9. Using blogs for reflection
  10. Revalidation
  11. References