Content area
Aim
To collate existing quantitative empirical evidence on social media behavior among nursing students.
BackgroundProfessionalism in nursing, characterized by adherence to ethical principles, accountability, compassion and patient confidentiality, is vital for quality patient care and maintaining public trust. As nursing students navigate their education and clinical training, the increasing role of social media introduces new challenges to upholding these standards.
DesignA systematized review design.
MethodsThe literature search was conducted in January 2024 across four scientific databases – PubMed, ProQuest, Web of Science and Scopus. The search produced 3490, while 20 studies were included in the final analysis. Content analysis was used to analyze included studies. The review reflected the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist 2020.
ResultsFour main topics were identified, as follows: Social media usage among nursing students; Privacy awareness and patient confidentiality; Inappropriate content posted on social media; Responsible social media use. The review highlights both the educational advantages and professional risks of social media use among nursing students. While social media platforms provide access to educational resources and professional networking opportunities, they also pose significant risks, including breaches of patient confidentiality and the blurring of personal and professional identities.
ConclusionUnderstanding nursing students' social media behavior is essential for educators, policymakers and students. The findings contribute to the ongoing discourse on the role of social media in nursing education and professional development, emphasizing the need for vigilance in online behavior to maintain high standards of professionalism in the digital age.
Professionalism in nursing encompasses a commitment to ethical principles, accountability, compassion and respect for patient confidentiality ( Cao et al., 2023). These core values are essential for delivering high-quality patient care and maintaining public trust in the nursing profession ( Nursing and Midwifery Council NMC, 2018). As nursing students advance through their education and clinical training, they are expected to consistently uphold these professional standards. However, with the increasing prevalence of social media use, new challenges have emerged in maintaining professionalism, particularly in online environments ( Barker et al., 2020).
Social media platforms such as Facebook, Twitter, Instagram and TikTok have become ubiquitous, offering nursing students numerous opportunities for academic and professional development ( Moorley and Chinn, 2021). These platforms provide access to a wealth of educational resources, including research articles, instructional videos and webinars, which allow students to deepen their understanding of complex topics and stay informed about the latest advancements in healthcare ( O'Connor et al., 2022). Additionally, social media enables nursing students to connect with peers, mentors and healthcare professionals globally, thereby expanding their professional networks and fostering a sense of community (Stankovska et al., 2022). Despite these benefits, the use of social media among nursing students presents significant risks to professionalism. The potential for breaches of patient confidentiality remains one of the most pressing concerns. Regulatory frameworks such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States, the General Data Protection Regulation (GDPR) in Europe and other international guidelines impose strict standards for safeguarding patient information. Nevertheless, studies continue to document instances where nursing students inadvertently disclose patient details on social media, leading to severe consequences such as disciplinary actions or even expulsion from nursing programs (Booth et al., 2021). These incidents underscore the urgent need for heightened vigilance regarding online behavior, particularly in relation to patient confidentiality (Xie et al., 2022).
The boundary between personal and professional identities is often blurred on social media, further complicating the issue. Nursing students may post content that, while appropriate in a personal context, could be perceived as unprofessional by peers, educators, or potential employers ( Brown et al., 2020). Sharing inappropriate photos, making offensive comments, or expressing controversial opinions can damage a student’s professional reputation and career prospects ( Cain and Romanelli, 2022). Moreover, the informal communication style prevalent on social media may erode the professional communication standards expected of nursing students in clinical settings, leading to a disconnect between their online and offline professional identities ( Roberts and Farrell, 2020).
2 BackgroundThe rise of social media in nursing education has introduced significant ethical considerations. Among the most concerning is the risk of patient confidentiality breaches. Despite the presence of strict regulations like HIPAA and GDPR, research has shown that nursing students sometimes fail to recognize the boundaries of sharing sensitive information online. A study by Al-Muammar et al. (2021) found that nursing students in various countries, including the United States and the United Kingdom, had inadvertently shared patient details on social media, leading to disciplinary actions. This points to a critical gap in the education of nursing students regarding the ethical use of digital platforms and the need for more robust training ( Greenwood and Latham, 2022).
Another challenge posed by social media is the difficulty of maintaining a clear distinction between personal and professional identities. Many nursing students use social media primarily for personal purposes but may unintentionally post content that conflicts with the standards of professional conduct. Also, a study by Phillips et al. (2021) found that 35 % of nursing students had posted material that could be considered unprofessional, such as inappropriate language or comments about colleagues. Such behavior not only harms individual reputations but can also undermine public trust in the nursing profession.
Furthermore, the informal nature of communication on social media platforms may erode the communication skills nursing students are expected to develop during their education. According to Cain et al., (2018), the use of casual language and the lack of formal communication on platforms like Twitter and TikTok may hinder students’ ability to practice the clear and respectful communication required in clinical environments. This disconnect between online and offline communication standards can lead to difficulties in professional interactions with colleagues and patients.
Theoretical frameworks such as Bandura (1986) and Ajzen (1991) provide useful insights into the online behaviors of nursing students. Bandura’s model highlights the role of observational learning and peer influence in shaping behavior, suggesting that nursing students may emulate the social media behaviors they observe in their peers or mentors (Garber et al., 2020). Ajzen’s theory, meanwhile, emphasizes the importance of intention in guiding behavior, suggesting that students’ actions on social media are influenced by their perceptions of what is expected of them by peers and educators ( Garber et al., 2019). Together, these frameworks explain why nursing students may engage in both positive and negative behaviors online, depending on the influences and expectations they encounter.
Despite these theoretical insights, there is still a gap in understanding how nursing students can best be supported in developing professionalism on social media. While educational interventions focused on social media professionalism have been shown to be effective, recent studies indicate that many nursing programs still lack formal guidelines or training in this area ( Moorley and Chinn, 2021). This gap presents an opportunity for future research to explore how nursing curricula can better address the challenges posed by social media and equip students with the skills to navigate these platforms responsibly. This paper aims to provide a comprehensive literature review on nursing students’ professionalism and behavior on social media, synthesizing recent research findings and identifying key trends and challenges. By examining existing literature, this review seeks to contribute to the ongoing discourse on the role of social media in nursing education and professional development.
3 MethodsThis review aimed to collate existing quantitative empirical evidence on social media behaviour and patterns of use among nursing students. The specific research questions were formulated, as follows: What are the patterns and behaviours associated with social media use among nursing students, based on existing quantitative empirical studies?
To achieve the study's objectives, a systematized review design was used. This approach is crucial in nursing research as it offers a thorough and organized method for synthesizing existing empirical evidence. It enables researchers to systematically search for, retrieve, extract and analyze literature without excluding studies based on their methodological quality ( Grant and Booth, 2009). The systematized review reflected the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist 2020 (PRISMA) (Supplementary File 1) ( Page et al., 2021).
3.1 Search methodsThe literature search was conducted in January 2024 within four databases (PubMed, ProQuest, Web of Science and Scopus), which were selected based on their institutional availability. Different combinations of keywords referring to social media use and behaviour in nursing students ( Table 1) were used in these databases, also including Boolean operators. The literature search was restricted to sources in English, with no time constraints and included studies from any publication date in the analysis.
3.2 Inclusion and exclusion criteriaThe predefined criteria for inclusion were as follows: a) the study had to be empirical (quantitative or mixed-method, not limited to designs); b) published in a peer-reviewed journal; c) written in English (due to the widespread use of English in academic and scientific literature); d) focused on the topic of social media use and behavior of nursing students; e) involved nursing students (undergraduate or postgraduate). Conversely, studies were excluded if they: a) involved participants other than nursing students (e.g., nurses, nursing aides, other healthcare students) unless nursing student-specific data could be isolated and analyzed separately; b) were review studies, discussion articles, study protocols, editorials, expert opinions, case studies, conference papers or commentaries.
3.3 Study retrievalBased on predefined criteria, the data were systematically retrieved by two independent researchers (AA, BB) in two phases. The study selection process is documented using the PRISMA 2020 flow diagram, as shown in Fig. 1 ( Page et al., 2021). The Rayyan QCRI® program ( Ouzzani et al., 2016) facilitated the effective retrieval of studies in both phases. The search yielded 3490 studies (PubMed = 652, ProQuest = 1194, Scopus = 65, Web of Science = 1596). After removing duplicates (n = 1237), 2253 studies were assessed by title and abstract against the inclusion criteria. During this phase, 2227 studies were excluded for not directly relating to the study's objective. In the second retrieval phase, 26 studies were reviewed in full text, resulting in 20 studies being included for further analysis. Six studies were excluded for not meeting the inclusion criteria (involved also other respondents than nursing students).
To minimize subjectivity in study selection, the Rayyan QCRI® software was used to facilitate a blinded screening process by two independent reviewers (AA, BB). Each study was assessed against predefined inclusion criteria and disagreements were resolved through discussion. In cases where agreement could not be reached, a third researcher (CC) provided input to achieve a consensus. This systematic approach reduced bias and enhanced the reliability of study selection.
3.4 Quality appraisal of the studiesThe methodological quality of the retrieved studies was assessed using the Joanna Briggs Institute tool ( Moola et al., 2015), specifically designed for evaluating quantitative cross-sectional studies ( Table 2). Two independent researchers (AA, BB) performed the evaluations, resolving any disagreements through discussion until consensus was reached. Only six studies fully met the JBI criteria. Most studies (n = 11) failed to identify confounding factors or provide strategies to address them. Additionally, three studies did not employ appropriate statistical analysis methods. No studies were excluded from the final analysis based on the assessment of methodological quality.
3.5 Data extractionTwo independent researchers (AA, BB) carried out data extraction for the studies included in the systematized review. Microsoft Excel spreadsheet was used to record the following details: author, year, country, study design, sample size and target respondents, data collection methods, data analysis techniques and main results.
3.6 Data synthesisThe data were analyzed using a content analysis method, following Mayring (2004) specific approach, which facilitated a systematic categorization of data. This methodology's primary strength lies in its comprehensive and structured nature. The process consisted of eight distinct steps: familiarization with the data (1), open coding (2), abstraction (3), category formation (4), definition of categories (5), revision of categories (6), interpretation (7) and presentation of findings (8). The inductive approach was adopted within the synthesis. To provide clarity regarding the synthesis process, data from all included studies were initially organized in a data extraction matrix, capturing key elements such as study aims, methods, participant details and findings. This matrix served as the foundation for identifying recurring patterns and significant topics. For each study, findings were carefully reviewed and subjected to open coding, where meaning units were identified and labelled. These codes were then grouped into subcategories based on similarities and differences, which were subsequently abstracted into overarching categories representing broader topics. For mixed-method studies, quantitative and qualitative data were treated distinctly, with only quantitative data including in the analysis.
The research team ensured accuracy by thoroughly reviewing and double-checking 10 % of the condensed and tabulated material. The analysis prioritized preserving the exact expressions and language used by both study participants and authors to minimize interpretative bias. Findings are presented descriptively and in tabular form to enhance readability and transparency.
4 ResultsThe included studies explored the use of social media among undergraduate nursing students across various countries (Saudi Arabia, Jordan, Turkey, Canada, the USA, Spain, Hong Kong, the Philippines, Nigeria and China) focusing on its different aspects and impact on professional identity, attitudes, behaviors and ethical considerations ( Table 3). The research studies included correlational, cross-sectional, descriptive and mixed methods approaches. Sample sizes ranged from small pilot studies ( Jiménez-Rodríguez et al., 2021) to large cross-sectional surveys conducted in diverse educational and cultural contexts (e.g., Al-Shdayfat, 2018; Sadd, 2019). Data collection methods primarily involved surveys and questionnaires, interviews and content analysis.
The study synthesized data from 6080 nursing students across diverse academic years, though specific distributions by year were inconsistently reported. Some studies, like Zhu et al. (2020), included first- to third-year students, while others, like O'Connor et al. (2022), spanned all four years of a Bachelor of Nursing program. Percentages for each year were rarely provided and studies like Chan et al. (2022) focused on students with clinical placements, likely excluding first-years, without further details. Many studies emphasized other demographics or criteria, such as prior coursework or clinical experience, leaving a comprehensive academic year breakdown unavailable.
The findings underscored the influence of social media on nursing students' professional identity (e.g., Alharbi et al., 2022; Li et al., 2022), e-professionalism (e.g., Barnable et al., 2018; O'Connor et al., 2022; Smith and Knudson, 2016), ethical reasoning ( Englund et al., 2012) and the prevalence of unprofessional content ( Marnocha et al., 2015).
The systematized review identified four main topics that were further specified with several subtopics ( Table 4).
5 Social media usage among nursing studentsThe first topic related to the patterns of social media use and involved four subtopics, as follows: Time spent on social media platforms; Types of social media platforms; Purpose of using social media; Type of shared content.
5.1 Time spent on social media platformsNursing students used social media multiple times daily ( Alharbi et al., 2022; Barnable et al., 2017), with time spent ranging widely: 1–2 hours ( Zarandona et al., 2019), 2–3 hours ( Jiménez-Rodríguez et al., 2021), 2–4 hours ( Li et al., 2022; Zhu et al., 2020; Zhu et al., 2022) and 3 or more hours ( Al-Shdayfat, 2018; Barnable et al., 2017; Jiménez-Rodríguez et al., 2021; Oducado et al., 2019). Some students reported 3 and 5.5 hours ( Alharbi et al., 2022; Zarandona et al., 2019) and 6–9 hours per day ( Alharbi et al., 2022). Most students accessed social media 2–3 hours per day and checked their accounts six or more times daily (O´Connor et al., 2022). Some studies indicated that students used social media for about 5 hours ( Oducado et al., 2019). About 20.7 % spent more than 5 hours daily ( Zarandona et al., 2019) and over 70 % of students spent 0.5 – 2 hours daily ( Sadd, 2019). Nearly 79 % spent more than 1 hour daily ( Duke et al., 2017) and almost 6 % spent over 8 hours on social media daily (Zhu et al., 2020).
5.2 Types of social media platformsThe platform WhatsApp was primarily used for personal purposes and YouTube for educational purposes ( Alharbi et al., 2022; Duke et al., 2017; Jiménez-Rodríguez et al., 2021). Other platforms included Twitter, Instagram, Snapchat, Yik Yak, Pinterest, YouTube, Tumblr, Ask.fm, LinkedIn, Reddit, Facebook and TikTok ( Alharbi et al., 2022; Barnable et al., 2017; Chan et al., 2022; Duke et al., 2017; Jiménez-Rodríguez et al., 2021; O´Connor et al., 2022; Sadd, 2019). In China, nursing students used QQ, WeChat and Sina Weibo (Zhu et al., 2020). WhatsApp was the most used platform (93.4 %) ( Chan et al., 2022). Many students used multiple platforms, with nearly 50 % using 3–4 social media accounts (( O’Connor et al., 2022; Sadd, 2019; Zhu et al., 2020).
5.3 Purpose of using social mediaNursing students primarily used social media for personal, educational and professional reasons, including researching products and staying in touch with friends ( Alharbi et al., 2022; Al-Shdayfat, 2018; Duke et al., 2017; Jiménez-Rodríguez et al., 2021; Sadd, 2019; Zhu et al., 2022). Many students sed it for both personal and educational purposes (53.5 %) ( Sadd, 2019) and entertainment ( Alharbi et al., 2022; O´Connor et al., 2022; Zhu et al., 2020; Zhu et al., 2022). They used social media to connect with nursing professionals or students ( Alharbi et al., 2022; Zhu et al., 2020; Zhu et al., 2022), non-nursing healthcare providers ( Alharbi et al., 2022), family and friends ( Alharbi et al., 2022; O´Connor et al., 2022; Zhu et al., 2020; Zhu et al., 2022), teachers (Zhu et al., 2020), or strangers (Zhu et al., 2022). They primarily followed nurses and doctors ( Alharbi et al., 2022; Jiménez-Rodríguez et al., 2021), as well as institutions, educational disseminators, teachers and unqualified personnel ( Jiménez-Rodríguez et al., 2021). Social media enhance their understanding of lecture material ( Alharbi et al., 2022; Barnable et al., 2017; Chan et al., 2022), understand nursing skills taught in labs ( Alharbi et al., 2022; Jiménez-Rodríguez et al., 2021), discuss academic problems (e.g., advice on assignments) ( Alharbi et al., 2022; Duke et al., 2017; Sadd, 2019), share clinical experiences ( Chan et al., 2022), understand nursing work ( Alharbi et al., 2022) and identify job opportunities ( Alharbi et al., 2022; Jiménez-Rodríguez et al., 2021). It also served for class announcements and school events (Barnable et al., 2017).
5.4 Type of shared contentNursing students shared a wide range of the content, from general videos and news to specific posts about their professional and educational experiences ( Bacaksiz et al., 2020; Booth, 2015). While many posts reflect a commitment to their education and profession, some contain inappropriate content that undermines this professional image. In the study by Bacaksiz et al. (2020), nursing students mainly shared various videos and current news, each accounting for 30 % of their posts. A smaller portion of students shared content related to health, such as videos, photos, news, events, or other health-related topics (27 %). In contrast, higher number of nursing students in the study by Booth (2015), shared several posts on social media platform (Twitter) that related to nursing experience, education, or profession in general. Number of posts related to having too much work, problems with school assignments or general frustration related to nursing education. Nursing students frequently posted about their excitement for upcoming clinical experiences and milestones in their education, including passing courses and securing placements. Many shared achievements and personal milestones, such as the removal of a backbrace, often with hashtags like #optimism and #positiveattitude. Some posts featured humorous situations during their education, followed by witty comments ( Booth, 2015). Most students (79.8 %) agreed they maintain professional standards both on social media and in clinical placements. Additionally, 96 % took responsibility for their social media posts, including comments ( Sadd, 2019).
6 Privacy awareness and patient confidentialityThe second topic related to the awareness and implementation of privacy setting by nursing students and patient privacy and confidentiality when using social media platforms and involved two subtopics, as follows: Awareness and implementation of privacy settings; Patient privacy and confidentiality.
6.1 Awareness and implementation of privacy settingsNursing students demonstrated high awareness of social media privacy features ( Duke et al., 2017; O'Connor et al., 2022; Sadd, 2019). However, there is a significant gap between their awareness and the actual use of these features. Many students fail to regularly use privacy settings, leaving their information potentially vulnerable ( Sadd, 2019). While students recognize that their profiles can be found online, their opinions vary on what content is appropriate to share. Most disagree with publishing content freely just because privacy settings are in place, although a subset remains ambivalent or agreeable to this practice ( Sadd, 2019; Zhu et al., 2020). The frequency of sharing personal information varies, with only a minority regularly posting details such as occupation or hobbies ( Sadd, 2019; Zhu et al., 2020).
6.2 Patient privacy and confidentialityNursing students often witnessed breaches of patient confidentiality on social media (37.6 %) (Zhu et al., 2022) and some of them admitted to sharing inappropriate content about clinical experiences and locations ( Marnocha et al., 2015; Zhu et al., 2022; Barnable et al., 2017). Despite this, many students strongly opposed posting confidential patient information ( Oducado et al., 2019) and only a small percentage shared photos from clinical settings ( Bacaksiz et al., 2020). Additionally, students believed that even vaguely worded posts that could identify patients should not be shared ( Englund et al., 2012). While many had written down patient information for study purposes, they generally practiced good patient privacy protection during clinical practicum ( Chan et al., 2022). Students emphasized the importance of thoughtful social media posts and refraining from sharing clinical cases or photos/videos taken in clinical environments ( Oducado et al., 2019; Sadd, 2019). However, a few students believed it was acceptable and even professional to post photos of themselves, colleagues, or patients at work ( O'Connor et al., 2022).
7 Inappropriate content posted on social mediaThe third topic related to the inappropriate content posted on social media by nursing students and involved four subtopics, as follows: Incidence of inappropriate content; Awareness of unprofessional content; Consequences and concerns of unprofessional behaviour; Other concerns and disciplinary actions.
7.1 Incidence of inappropriate contentInappropriate content on social media is a significant issue among nursing students. Many witnessed improper posts from schoolmates or teachers (45.7 %), complaints about them (22.2 %) and foul language (11.1 %). Specific instances included violence, sexually suggestive photos and grievances about the school. Some students shared inappropriate content themselves, such as complaints about schoolmates or teachers (9.9 %), grievances about the school or medical department (5.8 %), alcohol-related posts (0.9 %) and content containing violence, sexism, or verbal abuse (Zhu et al., 2020; Zhu et al., 2022).
7.2 Awareness of unprofessional contentIn the study by Marnocha et al. (2015), most nursing students were aware of unprofessional online content posted by peers, such as negative comments about patients, peers, the work environment, or the profession (58 %); profanity (37 %); and discriminatory language (29 %). Intoxication and sexually suggestive content were reported by fewer than 20 % of respondents. Sexting was also noted as a regular occurrence among nursing students, more frequently reported by women ( Gutiérrez-Puertas et al., 2017). Booth (2015) found students posted vulgar, derogatory, or overly critical messages, often in reaction to immediate stressors or unpleasant experiences.
7.3 Consequences and concerns of unprofessional behaviorNursing students were concerned about reputational damage, emotional distress and academic repercussions due to unprofessional behavior on social media. They believed that public viewing of their social network activities could negatively affect their reputation ( Sadd, 2019). Additionally, 38.8 % worried about future job prospects being influenced by their social media posts ( Al-Shdayfat, 2018). Many admitted to posting content they would not want a prospective employer or academic staff member to see ( Duke et al., 2017; O'Connor et al., 2022; Sadd, 2019). Opinions were mixed about the fairness of employers using social network information to judge professionalism, reflecting ambivalence about privacy and professional boundaries ( Sadd, 2019). However, most students reported that patients never found them on social media ( O'Connor et al., 2022).
7.4 Other concerns and disciplinary actionsOther concerns included distractions, lack of privacy and issues with e-professionalism ( Duke et al., 2017). Over 10 % noticed distractions caused by the smartphone use of others during clinical practicum ( Zarandona et al., 2019). Inappropriate social media use led to miscommunication, reduced face-to-face interaction, unprofessional language, misinterpretation of information, risk of confidentiality breaches and the easy spread of inappropriate information ( Duke et al., 2017). When aware of online unprofessionalism, nursing students often issued informal warnings (58 %) or reported formal disciplinary meetings (31 %). Other disciplinary actions included dismissal (11 %) and remedial assignments or academic penalties (18 %) ( Marnocha et al., 2015).
8 Responsible social media useThe fourth topic related to the responsible use of social media by nursing students and involved three subtopics, as follows: Awareness of professional behavior on social media platforms; Attitudes towards social media content and use; Opinions in smartphone use policies.
8.1 Awareness of professional behavior on social media platformsMost nursing students did not receive explicit guidance on professional social media use ( Alharbi et al., 2022; Zhu et al., 2022). Those who did were advised by various sources, including family, friends, university staff and healthcare professionals, to use social media responsibly and maintain professionalism ( Alharbi et al., 2022). In the study by Marnocha et al. (2015), most students indicated their school's policies included guidelines for online content, with 89 % addressing blogs and social media specifically.
Overall, most nursing students felt sufficiently informed about professional social media behavior ( Al-Shdayfat, 2018; Duke et al., 2017; Sadd, 2019; Zhu et al., 2020). However, about 48.1 % of respondents in Zhu et al. (2022) were unfamiliar with social media regulations and over half were unaware of online professional standards specific to healthcare providers (Zhu et al., 2020).
8.2 Attitudes toward social media content and useNearly half of the nursing students understood digital professionalism and were aware of social media guidelines, most of them rejecting friend requests from unknown individuals. Students emphasized avoiding offensive or confidential posts and had varied views on the professionalism of different social media scenarios ( O'Connor et al., 2022). Students generally disagreed with posting photos smoking, racism, illegal drug use, hate speech, or sexually suggestive content ( Oducado et al., 2019). However, some third-year students found it acceptable to post pictures with alcohol or of themselves intoxicated, while a few first-year students were okay with content involving illegal substances ( O'Connor et al., 2022). Additionally, nursing students generally had a positive attitude towards responsible social media use, particularly for educational and professional purposes ( Oducado et al., 2019; Al-Shdayfat, 2018). They appreciated social media for its convenience, broad reach and academic support ( Duke et al., 2017).
8.3 Opinions on smartphone use policiesOpinions on restricting smartphone use during clinical practice were divided, with 28.7 % agreeing that students should not use smartphones, but only 22.4 % supporting a policy to limit smartphone use in healthcare settings ( Zarandona et al., 2019). Despite this, students reported using smartphones professionally during practicums, primarily for looking up medication information (49.6 %), accessing university resources (42.3 %), communicating with team members (19.4 %) and using patient care apps (13.4 %) ( Zarandona et al., 2019). Pimmer et al. (2018) found frequent use of WhatsApp for personal reasons during placements correlated positively with professional identity and placement satisfaction and negatively with professional isolation.
9 DiscussionWith the findings of this systematized review, we bring to the existing quantitative empirical evidence on the behavior and patterns of social media use among nursing students. In total, four topics were identified, and 13 subtopics were described within these topics.
The findings on the first topic regarding social media usage reveal that nursing students are active users, engaging across multiple platforms for personal, educational and professional purposes. The reviewed studies consistently highlight significant time spent on platforms such as WhatsApp, YouTube, Facebook and Instagram, with usage often exceeding several hours daily ( Zarandona et al., 2019; Alharbi et al., 2022). This aligns with broader trends observed in university student populations globally ( Dehghani et al., 2019). However, social media usage patterns are influenced by cultural and social contexts, as well as the digitization and regulatory environments of specific regions, leading to variations in platform preferences and online behaviors ( Kim et al., 2015; Rouleau et al., 2017). For instance, platforms like QQ and WeChat are more popular in China, reflecting regional digital ecosystems (Zhu et al., 2020).
The integration of social media into nursing education, while offering potential benefits, remains inconsistent. Platforms such as YouTube are often used for educational purposes, including understanding nursing skills, accessing supplementary materials and reviewing lecture content ( Alharbi et al., 2022; Jiménez-Rodríguez et al., 2021). Social media also facilitates peer collaboration, professional networking and access to job opportunities, demonstrating its versatility as an educational tool. However, a limited proportion of shared content directly addresses health topics or public health advocacy, highlighting a missed opportunity to engage students in meaningful professional discourse ( Bacaksiz et al., 2020; Giroux, and Moreau, 2022).
To address these gaps, structured guidelines are essential for leveraging social media in nursing education and professional development ( Borgmann et al., 2015). Educators should integrate comprehensive digital literacy training into curricula, emphasizing ethical online behavior, maintaining professional boundaries and using social media as a tool for career advancement ( Rouleau et al., 2017). Institutions can foster responsible usage by encouraging the sharing of credible health-related content and facilitating professional networking opportunities through platforms like LinkedIn. Collaborative learning initiatives, such as virtual study groups and cross-institutional exchanges, could further enhance the educational value of social media ( Nyangeni et al., 2015; Pizzuti et al., 2020).
Second topic was focused on nursing students' awareness and implementation of privacy settings, patients' privacy and confidentiality on social media platforms. Students are aware of privacy setting’ and patient privacy and confidentiality ( Duke et al., 2017; O'Connor et al., 2022; Sadd, 2019), but they do not regularly use these settings ( Sadd, 2019). Nursing students who are future professionals must be informed of the ethical, regulatory and legal risks that may arise from their actions. Their level of awareness and adherence to privacy and security principles when using social media may vary by country, generation and year of nursing program ( Cathala et al., 2021). Education about the importance of privacy and security when using social media, including the protection of personal data and shared content, should be part of the education of nursing students, as it includes working with sensitive information about patients and compliance with ethical standards is essential ( The ICN Code of Ethics for Nurses, 2021). The content of the education should include patient privacy, safe use of social media, ethical online behavior and risks of sharing personal information. In the area of patient privacy, nursing students are mainly trained in the principles of privacy protection and GDPR compliance (in the EU), where emphasis is placed on not publishing any personal data of patients on social media and respecting confidentiality ( Crowhurst et al., 2019; Xiang, and Cai, 2021).
The third topic represents findings regarding ‘Inappropriate content posted on social media’ by nursing students. Inappropriate and unprofessional content on social media is a significant problem among nursing students and is diverse, with the impact of violating patient privacy, damaging professional reputation, for example sharing alcohol-related posts, containing violence, sexism (Zhu et al., 2020; Zhu et al., 2022), or various comments that are discriminatory in any way. In addition, the publication of inappropriate and unprofessional personal photos or videos can negatively affect the reputation of the students themselves as a future health professional. Most students reported sharing unprofessional online content posted by peers ( Marnocha et al., 2015). At the same time, nursing students are aware of the consequences of unprofessional behavior and recognize protecting patient privacy as an ethical basis and professional duty. Nursing students must already during their studies fully understand the importance of patient privacy and the impact of its violation ( Fallahmortezanejad et al., 2021).
Other consequences of sharing inappropriate content on social media include concerns about reputational damage in academic or professional development for nursing students ( Sadd, 2019). Offenses of unprofessional behavior on social media for nursing students are handled in a variety of ways depending on the seriousness of the offense, internal policies of the educational institution and local or national regulations. Most students expressed that a common step is mainly warning and additional education about professional behavior and ethics as well as about the correct use of social media ( Marnocha et al., 2015), so that they understand the consequences of their behavior and avoid similar mistakes in the future. For more serious offenses, disciplinary measures can include admonition or expulsion from school, or legal consequences ( Marnocha et al., 2015).
Opinions on the fairness of employers using social media information to assess professionalism have been mixed ( Sadd, 2019). In many countries, it is common that employers check public social media profiles of applicants, their behavior and values ( Davison et al., 2016) for the recruitment purposes. Such an assessment can be important for the employer, as nursing requires a high level of professionalism, ethical behavior and trustworthiness. However, the employer must ensure that there is no violation of privacy rights or biased assessment of the applicant ( Davison et al., 2016).
The last topic is connected to the ‘Responsible use of social media’ by nursing students. According to the findings, most nursing students expressed that they did not receive information about the professional use of social media ( Alharbi et al., 2022; Zhu et al., 2022). Those who had, reported different sources ( Alharbi et al., 2022). Nursing students should be informed about the professional use of social media. Education programs play critical role in instilling understanding of the importance of confidentiality and the potential consequences of privacy violence. By incorporating comprehensive patient privacy training into the nursing curriculum, educators can better equip students with the knowledge and skills needed to effectively navigate malpractice ( Wiles et al., 2018). National and international professional nursing organizations also play an important role in providing guidelines and recommendations regarding the use of social media ( Cronquist, and Spector, 2011; Spector, and Kappel, 2012).
According to Zhu et al. (2020), nearly half of nursing students reported being unfamiliar with social media regulations and more than half were unaware of online professional standards specific to healthcare providers. In some countries, regulatory bodies responsible the professional use of social media can issue directives that set rules and standards for the use of social media in the health profession. Another lesser-known source for raising awareness on the social media use are student organizations, which can provide advice in this area in the form of workshops or discussion panels ( Spector, and Kappel, 2012).
Nursing students commonly use social media for academic purposes ( Duke et al., 2017). Almost half of the students understand digital professionalism ( O'Connor et al., 2022) and generally showed a positive attitude towards the responsible use of social media, especially for educational and professional purposes ( Oducado et al., 2019; Al-Shdayfat, 2018). An attitude of high professionalism and ethics is extremely important for personal and professional development as well as for the protection and improvement of the nursing profession.
Opinions on using smartphones during clinical practice vary and only a few students perceive that their use should be limited. Smartphones during clinical practice are especially helpful in searching for drugs and less for patient care ( Zarandona et al., 2019). According to the findings of Pimmer et al. (2018) use of WhatsApp for personal reasons during placements was positively correlated with nursing students' professional identity and placement satisfaction. This perception and attitude are also crucial for personal and professional satisfaction of students.
9.1 Study limitationsThe systematized review design, while thorough, has limitations. It does not exclude studies based on methodological quality, potentially affecting robustness. Restricting the search to English-language sources may have omitted relevant non-English studies and reliance on institutional database availability could limit comprehensiveness. Content analysis, though systematic, may introduce subjective interpretations despite efforts to reduce bias. Additionally, the study was not registered in PROSPERO, as its focus on broader research questions, rather than clinical interventions or health outcomes, does not meet PROSPERO's criteria ( PROSPERO, 2023). Finally, the study does not incorporate advanced statistical methods to systematically control for bias, such as meta-regression or sensitivity analysis, as it focuses on descriptive and content synthesis rather than inferential statistical modeling.
10 Implications for practice and future researchTo foster responsible social media use among nursing students, curricula should include training on digital professionalism, emphasizing ethical behavior, patient confidentiality and avoiding inappropriate content. Universities and healthcare institutions must establish clear policies and promote educational tools for professional development. Workshops, self-audits and feedback can help students manage their digital presence, while clinical practice guidelines ensure smartphones are used professionally. Future research should examine social media’s impact on professional identity, the effectiveness of educational interventions, cross-cultural differences and its potential for public health advocacy, while identifying risks for unprofessional behaviour to guide interventions.
11 ConclusionThis review highlights the dual nature of social media as both a valuable educational tool and a potential risk for nursing students' professional development. The findings underscore the need for nursing curricula to integrate comprehensive digital professionalism training, emphasizing the ethical use of social media and patient confidentiality. By fostering greater awareness and providing clear guidelines, nursing educators and policymakers can better equip students to maintain the high standards of professionalism required in both digital and clinical environments. As social media continues to play an increasing role in healthcare, nursing students must be prepared to navigate the digital landscape responsibly, ensuring that their online activities align with the ethical standards of their profession.
Funding statementSupported by the project UGA IX/1/2024: Competencies of nursing students in patient safety.
Declaration of Competing InterestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Appendix A Supporting informationSupplementary data associated with this article can be found in the online version at doi:10.1016/j.nepr.2025.104277.
Appendix A Supplementary materialSupplementary material
| Search words | Hits |
| | PubMed: 652 |
| | ProQuest: 1194
Web of Science: 1596 Scopus: 65 |
| Total | 3490 |
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| Alharbi et al. (2022) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Al-Shdayfat (2018) | Y | Y | Y | Y | Y | Y | Y | Y | 8/8 |
| Bacaksiz et al. (2020) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Barnable et al. (2017) | Y | Y | Y | Y | Y | Y | Y | Y | 8/8 |
| Booth (2015) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Duke et al. (2017) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Englund et al. (2012) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Gutiérrez-Puertas et al. (2017) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Chan et al. (2022) | Y | Y | Y | Y | Y | Y | Y | Y | 8/8 |
| Jiménez-Rodríguez et al. (2021) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Li et al. (2022) * | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Marnocha et al. (2015) * | Y | Y | Y | Y | N | N | Y | N | 5/8 |
| O´Connor et al. (2022) | Y | Y | Y | Y | N | N | Y | N | 5/8 |
| Oducado et al. (2019) | Y | Y | Y | Y | N | N | Y | N | 5/8 |
| Pimmer et al. (2018) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Sadd (2019) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Smith and Knudson (2016) * | Y | Y | Y | Y | Y | Y | Y | Y | 8/8 |
| Zarandona et al. (2019) | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
| Zhu et al. (2020) | Y | Y | Y | Y | Y | Y | Y | Y | 8/8 |
| Zhu et al. (2022) | Y | Y | Y | Y | Y | Y | Y | Y | 8/8 |
| Author, year | | | Study Design | Sampling method | Sample Size & Target Respondents | Data Collection Methods | Data Analysis Techniques | Main Results |
| Alharbi et al. (2022) | Saudi Arabia | To investigate the relationship between social media usage by undergraduate nursing students and the development of their professional identity. | Descriptive, correlational, cross-sectional study | Convenience | 484 undergraduate nursing students | Survey on social media usage
Nursing professional identity scale | Descriptive and inferential statistics | The study found a positive correlation between social media use and the development of professional identity among nursing students. Increased social media engagement contributed to students' understanding of professional norms and expectations, though excessive use was linked to potential risks like unprofessional behavior. |
| Al-Shdayfat (2018) | Jordan | To explore the attitudes of undergraduate nursing students in Jordan toward using social media websites. | Descriptive, cross-sectional study | Stratified random | 395 undergraduate nursing students | Students Nurses' Use and Views of Social Media survey | Descriptive and inferential statistics | The study revealed that most students viewed social media positively as a tool for communication and education. However, concerns were raised about the potential negative impact on professionalism, with a need for education on appropriate social media use. |
| Bacaksiz et al. (2020) | Turkey | To examine the content nursing students share on Facebook, focusing on Timeline, Photos, Friends and About sections. | Descriptive, cross-sectional study | | 100 nursing students | Analysis of Facebook profiles | Descriptive statistics | The study showed that nursing students often share personal content on Facebook, some of which may be considered unprofessional. There is a need for greater awareness and guidance on maintaining professionalism on social media. |
| Barnable et al. (2017) | Canada | To examine nursing students' perceptions of confidentiality, accountability and e-professionalism in relation to Facebook usage. | Descriptive, cross-sectional study | | 97 nursing students | Cain Survey, Pharmacy Students Use of and Attitudes toward Facebook | Descriptive and inferential statistics | Nursing students displayed varied understandings of confidentiality and professionalism on Facebook. The study highlighted the importance of integrating e-professionalism into nursing curricula to ensure students are aware of the ethical implications of social media use. |
| Booth (2015) | Canada | To analyze nursing students' tweets about nursing education to understand their views on stress, happiness and professional challenges. | | | 189 tweets | Analysis of tweets | Qualitative thematic analysis | The pilot study revealed that nursing students use Twitter to express both positive and negative emotions related to their education. Tweets often included discussions on stress, peer interactions and professional identity, indicating that social media can be a reflection of their educational experience. |
| Duke et al. (2017) | Canada | To explore the usation of social media in nurse education and its impact on e-professionalism. | Cross-sectional study | Convenience | 337 nursing students | Pharmacy Students´ Use and Views on Social Networking (adapted for nursing) | Descriptive and inferential statistics | Social media was widely used for learning, but concerns about e-professionalism were prevalent. The study suggested the need for structured guidelines to ensure that social media use enhances professionalism rather than undermining it. |
| Englund et al. (2012) | USA | To investigate ethical reasoning among nursing students in relation to online social media use. | Descriptive study | | 69 sophomore nursing students
56 senior nursing students | Survey of own structure | Descriptive and inferential statistics | The study found that nursing students often lack awareness of ethical boundaries on social media. It emphasized the need for ethical training in nursing programs to foster responsible social media usage. |
| Gutiérrez-Puertas et al. (2017) | Spain | To explore the sexting phenomenon among Spanish nursing students. | Descriptive, cross-sectional study | | 105 nursing students | Sexuality and Technology Questionnaire | Descriptive and inferential statistics | The study found that sexting is a prevalent issue among nursing students, which raises concerns about e-professionalism and the potential for unprofessional conduct to affect their future careers. |
| Chan et al. (2022) | Hong Kong | To examine nursing students' behaviors regarding patient privacy protection in a digital context. | Cross-sectional, descriptive correlational study | Convenience | 319 nursing students | Practice of Patient Privacy | Descriptive and inferential statistics | The study highlighted gaps in nursing students' understanding and practices related to protecting patient privacy online. This suggests the need for enhanced training on digital privacy within nursing programs. |
| Jiménez-Rodríguez et al. (2021) | Spain | To develop and validate a social media questionnaire for use in nursing training. | Cross-sectional study | Convenience | 107 nursing students | Use and Views of the Social Media Questionnaire | Descriptive statistics, content validity and reliability analysis | The study successfully developed and validated a tool to assess nursing students' use of social media for professional purposes. The questionnaire can help educators evaluate students' social media behavior and guide them toward more responsible usage. |
| Li et al. (2022) | China | To investigate how social media use has an impact on the professional identity of undergraduate nursing students. | Mixed-methods study | | 698 nursing students (quantitative phase)
16 nursing students (qualitative phase) | Survey (on social media use; own structure); Questionnaire for Baccalaureate Nursing Students; interviews | Thematic analysis and statistical analysis (descriptive and inferential statistics) | The study found that positive exposure to nurse-related content on social media enhances the professional identity of nursing students, while negative content can have the opposite effect. The study underscores the importance of curating professional content on social media platforms. |
| Marnocha et al. (2015) | USA | To examine the prevalence of unprofessional online content posted by nursing students. | Cross-sectional study | | 293 nursing students | Survey (own structure) and content analysis of open-ended question | Descriptive and inferential statistics | A significant proportion of nursing students posted unprofessional content online, including inappropriate language and behavior. The study called for stricter social media policies in nursing programs. |
| O´Connor et al. (2022) | UK | To explore the opinions of undergraduate nursing students on digital professionalism on social media. | Descriptive, cross-sectional study | Purposive | 112 nursing students | Survey (adapted from digital professionalism on social media) | Descriptive statistics | The study found that while most nursing students recognize the importance of digital professionalism, there is variability in their adherence to professional standards. Educational interventions were recommended to address this gap. |
| Oducado et al. (2019) | Philippines | To assess nursing students' perceptions and attitudes toward responsible social media use in nursing education. | Descriptive, cross-sectional study | | 298 nursing students | Responsible Use of Social Media Attitude Scale | Descriptive and inferential statistics | Students showed a general understanding of responsible social media use but lacked specific knowledge of its implications in nursing. The study called for increased social media literacy in nursing education. |
| Pimmer et al. (2018) | Nigeria | To assess the impact of instant messaging on nursing students' clinical learning experiences. | | | 196 nursing students | Set of questionnaires (WhatsApp Use, Social Capital, Isolation from the Professional Community, Professional Identity, Placement Satisfaction, Determinants of WhatsApp Use) | Descriptive and inferential statistics | Instant messaging was found to facilitate clinical learning by enhancing communication and support among nursing students. However, concerns were raised about distractions and potential breaches of professionalism. |
| Sadd (2019) | Not specified | To investigate student nurse attitudes and behaviors on social media. | Descriptive study | | 228 nursing students | Online self-reporting questionnaire on behaviours and attitudes when engaging with social network | Descriptive and inferential statistics | The study revealed that many nursing students engage in unprofessional behavior on social media, underscoring the need for formal education on responsible social media usage. |
| Smith and Knudson (2016) | USA | To explore unethical behavior among nursing students on social media, with a focus on generational differences. | Mixed-method study | Convenience | 55 nursing students (quantitative phase)
8 nursing students (qualitative phase) | Hilbert Unethical Behaviour Survey-Modified, interviews | Descriptive and inferential statistics, thematic analysis | The study found that younger nursing students are more likely to engage in unethical behavior online. The findings suggest that social media ethics should be an integral part of nursing education. |
| Zarandona et al. (2019) | Spain | To assess the use of smartphones among nursing students and the impact of distraction and restriction policies. | Descriptive, cross-sectional study | | 234 nursing students | Questionnaire of own structure | Descriptive and inferential statistics | The study found that smartphones are widely used among nursing students, often leading to distractions during clinical placements. It suggested implementing restriction policies to improve focus and professional behavior. |
| Zhu et al. (2020) | China | To explore the professionalism and use of social media among undergraduate nursing students. | Cross-sectional study | | 654 nursing students | Students´ Use and Views of Social Media; Self-Rating Scale of Self-Directed Learning; General Self-efficacy Scale | Descriptive and inferential statistics | The study revealed that while students extensively use social media, their understanding of professionalism on these platforms is often inadequate. Educational interventions were recommended to improve digital professionalism. |
| Zhu et al. (2022) | China | To examine the attitudes, motivations and mental health effects of social media usage among Chinese nursing students. | Cross-sectional study | | 1054 nursing students | Students´ Use and View of Social Media; Fear of Missing Out; Social Media Fatigue; Self-disclosure in social media; Social media use; Professionalism towards social media | Descriptive and inferential statistics | The study found that social media usage was linked to both positive motivations, like social connection and negative outcomes, such as mental health issues. It highlighted the need for mental health support and responsible social media use education. |
| | | Key References |
| 1. Social Media Usage Among Nursing Students | Time Spent on Social Media Platforms | Alharbi et al., (2022); Al-Shdayfat, (2018); Barnable et al., 2017; Duke et al., (2017); Jiménez-Rodríguez et al., (2021); Li et al., (2022); Oducado et al., (2019); Sadd, (2019); Zarandona et al., (2019); Zhu et al., 2020; Zhu et al., 2022 |
| Types of Social Media Platforms | Alharbi et al., (2022); Barnable et al., 2017; Chan et al., (2022); Duke et al., (2017); Jiménez-Rodríguez et al., (2021); O´Connor et al., 2022; Sadd, (2019); Zhu et al., 2020 | |
| Purpose of Using Social Media | Alharbi et al., (2022); Al-Shdayfat, (2018); Barnable et al., 2017; Chan et al., (2022); Duke et al., (2017); Jiménez-Rodríguez et al., (2021); O´Connor et al., 2022; Sadd, (2019); Zhu et al., 2020; Zhu et al., 2022 | |
| Type of Shared Content | Bacaksiz et al., (2020); Booth, (2015); Sadd, (2019) | |
| 2. Privacy Awareness and Patient Confidentiality | Awareness and Implementation of Privacy Settings | Duke et al., (2017); O'Connor et al., (2022); Sadd, (2019); Zhu et al., 2020 |
| Patient Privacy and Confidentiality | Bacaksiz et al., (2020); Barnable et al., 2017; Chan et al., (2022); Englund et al., (2012); Marnocha et al., (2015); O'Connor et al., (2022); Oducado et al., (2019); Sadd, (2019); Zhu et al., 2022 | |
| 3. Inappropriate Content Posted on Social Media | Incidence of Inappropriate Content | Zhu et al., 2020; Zhu et al., 2022 |
| Awareness of Unprofessional Content | Booth, (2015); Gutiérrez-Puertas et al., (2017); Marnocha et al., (2015) | |
| Consequences and Concerns of Unprofessional Behavior | Al-Shdayfat, (2018); Duke et al., (2017); O'Connor et al., (2022); Sadd, (2019) | |
| Other Concerns and Disciplinary Actions | Duke et al., (2017); Marnocha et al., (2015); Zarandona et al., (2019) | |
| 4. Responsible Social Media Use | Awareness of Professional Behavior on Social Media Platforms | Alharbi et al., (2022); Al-Shdayfat, (2018); Marnocha et al., (2015); Sadd, (2019); Zhu et al., 2020; Zhu et al., 2022 |
| Attitudes Toward Social Media Content and Use | Al-Shdayfat, (2018); Duke et al., (2017); O'Connor et al., (2022); Oducado et al., (2019) | |
| Opinions on Smartphone Use Policies | Pimmer et al., (2018); Zarandona et al., (2019) |
©2025. The Authors