Informatics has been identified as a necessary component of undergraduate nursing education to prepare nursing students to practice in an increasingly technological health care environment (National League for Nursing, 2008). Because of social media's pervasiveness in 21st century society, millennial students' preference for technology-rich teaching strategies and the call for informatics education in undergraduate nursing programs, it is imperative that nurse educators consider the influence of social media on nursing students and nursing education today. As the most popular social media platform, Facebook specifically warrants attention.

Although various forms of social media have been documented as teaching strategies in collegiate education, there is limited research exploring the use of social media in nursing education (Ross & Myers, 2017). The limited nursing education literature suggests that students enjoy using social media in the educational environment (Morley, 2014; Stephens & Gunther, 2016); however, there is no existing nursing education literature that explores student perceptions or outcomes with the use of Facebook as a platform to present patient case study data. The purpose of this descriptive, qualitative study was to understand baccalaureate nursing students' perceptions of the use of Facebook as a platform to present patient case study data.

METHOD

Nineteen baccalaureate nursing students enrolled in an Introduction to Professional Nursing Practice course in a private, Catholic university participated in the study. Seventeen participants were female; all but one identified as Caucasian. Ages ranged from 19 to 38 years; the mean age was 21.7; the mode was 20 (n = 11).

After standard teaching and learning content presentation (including textbook readings, lecture, class discussion, and review questions), students traditionally applied the content by creating a teaching plan based on a written patient case study. For this study, the case study information was used to create a Facebook page featuring a simulated 20-year-old college student with diabetes. Patient data, previously presented in paragraph form, were disseminated on the Facebook page through status updates, photos, and private messages that were managed by a graduate research assistant (RA). For example, one of the patient's cognitive learning needs related to eating a diabetic diet. To illustrate this learning need, one status update announced that she was visiting a local ice cream shop; a photo post showed her desk with candy and sugary soda.

At the end of the didactic portion of the teaching and learning unit, students were instructed to become Facebook friends with the simulated patient and follow her posts until the next class session. Students were encouraged to interact with the patient by replying to or "liking" her posts, photos, and private messages. As an important consideration in all online interactions, especially social media, privacy was addressed as part of the activity instructions. The instructor facilitated a discussion about the Health Insurance Portability and Accountability Act and what behaviors constitute appropriate or inappropriate professional social media use. It was critical to emphasize that Facebook was being utilized as an alternative to traditional case studies. Although students were instructed to interact with the simulated patient, they were informed that communicating with an actual patient on social media is not appropriate. The instructor also addressed the personal privacy of students and faculty during the activity; students were assured that their Facebook pages would not be viewed by faculty or the RA and that they were expected to respect the privacy of the faculty, RA, and each other.

During the next session, the instructor facilitated a discussion about the information collected from the patient's Facebook page. All students, even those without a personal Facebook account, had access to the information needed to complete the associated teaching plan. One week later, subjects were recruited by the RA for participation in the study; institutional review board approval was obtained prior to recruitment. Participants provided a written informed consent and completed an anonymous online survey that included demographic data and responses to nine Likert-style questions and five open-ended questions.

Descriptive statistics were used to analyze results of the Likert-style survey questions. Conventional content analysis was used to analyze the qualitative responses of the open-ended survey questions. Conventional content analysis is appropriate when there is limited existing research on a topic because it allows the researcher to develop categories directly from the data without preconceived themes to allow for a deep understanding and subsequent description of the phenomenon (Hseih & Shannon, 2005).

RESULTS

Quantitative

The results were overwhelmingly positive. All but one participant (95 percent) either agreed or strongly agreed with the following statements: "The Facebook case study was an effective way to apply the principles of teaching and learning"; "The Facebook case study enabled me to create an individualized care plan"; "The Facebook case study helped me learn the teaching and learning content."

Eighty-nine percent agreed or strongly agreed that the Facebook case study encouraged them to engage in the course material outside of class; 84 percent agreed or strongly agreed that it increased their competence in applying teaching and learning principles; 83 percent agreed or strongly agreed that it increased their confidence in applying teaching and learning principles; 78 percent agreed or strongly agreed that it would help with the application of teaching and learning content in clinical. The vast majority (94 percent) felt the Facebook case study provided more realism than a written case study and was an overall positive experience.

Qualitative

Conventional content analysis of the open-ended survey questions yielded five categories: realism, relatability, engagement, uniqueness, and desire for expansion.

REALISM

A major category that resulted from this study was that information presented through Facebook was a more realistic way to learn. By using social media to obtain information instead of being handed a static case study in class, participants reported that "it seemed more realistic to see an actual patient and problems than just reading a paragraph."

RELATABILITY

Participants found that information presented through social media was relatable to modern day society and, therefore, their own experiences, which made participants feel able to connect with the patient more effectively. Participants identified that using social media was "relatable to our daily lives." "It was worthwhile because it helped us relate to the patient more and gather information."

ENGAGEMENT

Participants indicated that using social media made it easier to engage in learning and complete associated assignments. One stated, "It got me more involved and excited about the topic." Participants were also more engaged in the learning process. One commented that (s)he "felt like it makes me pay attention and think while I was outside of class."

UNIQUENESS

The overall consensus was that a Facebook case study is a unique way to engage in patient data collection for care planning both inside and outside the classroom. One participant commented that this teaching method "was a creative way to incorporate teaching materials outside the classroom." Participants appreciated that it was "a different approach to teaching lecture" that provided "a good break from regular class activities."

DESIRE FOR EXPANSION

The survey offered an opportunity to recommend changes to the activity. A repeated recommendation was to expand the experience by increasing the amount of online interactions between students and the case study patient and extending the duration of the experience, for example, structuring the activity as an unfolding case study that would span the semester with various assignments. One student commented, "It would be fun for assignments to be attached to it and it be ongoing throughout the semester."

DISCUSSION

As the demographics, preferences, and learning styles of undergraduate nursing students change, nursing education strategies must likewise evolve to meet the learners' needs. One teaching strategy that shows promise for undergraduate nursing education is the incorporation of social media as a platform to actively engage students outside the classroom. The results from this study suggest that students enjoy and react positively to the use of Facebook as an active teaching strategy. Students found the activity engaging, which is a critical component of learning, understanding, and application of content. Moreover, engaging in learning activities that more closely mimic reality promotes application of content. The positive perceptions are consistent with existing nursing education literature, in which undergraduate nursing students respond positively to the incorporation of social media as a teaching strategy (Morley, 2014; Stephens & Gunther, 2016).

Because of the dearth of evidence supporting the use of social media as a teaching strategy, this remains an important area for nursing education research. The current study was designed as an initial step to address this gap in the nursing education literature. Limitations include the use of a small, homogeneous convenience sample, which limits generalizability. More empirical evidence is needed to describe this phenomenon more thoroughly and support the use of social media as an evidence-based teaching strategy in undergraduate nursing education, specifically, to explore the perceptions among various types of prelicensure nursing programs and among more varied populations of nursing students.

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