Blogging as an Innovative Method of Peer-to-Peer Educational Sharing

Little evidence is available on the use of blogs in health care education in general. Even fewer articles address peer-to-peer sharing of educational information. Most of the material published about the use of social media for health care education is limited to surveys, case studies, and anecdotal opinions. Nearly all the publications reviewed for this study included a call for more evidence in this area.^3–12  A brief overview of the publications reviewed follows.

The use of blogs in nursing education is well described in the literature. Multiple sources described blogs as a tool for reflective journaling^13–20  and as a component of electronic portfolios for nursing students at the undergraduate and graduate levels.^13,19  Other common themes in the nursing literature on the use of blogging in nursing included forums to share the experience of nursing,^10,15,20  support for students and practicing nurses in rural areas,⁸  and medical blogs to share information with patients or other health care professionals.⁹  Although both Grassley and Bartoletti¹⁸  and The National Student Nurses’ Association²¹  mention peer-to-peer interactions among students, we found no publications pertaining to peer-to-peer education among currently practicing nurses.

Similarly, little evidence-based research on blogging in medicine and other health care fields has been reported. Rowe et al⁶  acknowledged the limited number of available pertinent studies; however, they noted in their systematic review that clinicians from several countries in multiple fields, including nursing, medicine, social work, physical therapy, occupational therapy, pharmacy, and paramedics, reported increased clinical competence from what they termed “blended learning,” or incorporating various forms of computer-assisted technology into health care education. Articles from the United Kingdom, the United States, Canada, Australia, and South Korea were included in the review.⁶  In their exploratory case study, Ladyshewsky and Gardner²²  described blogging as a form of peer-assisted learning at the undergraduate level. They found that physiotherapy students who blogged about their fieldwork experience showed increased clinical reasoning skills and reflective practice.

A few articles in the health care literature do mention peer-to-peer blogging interactions. Paton et al⁷  presented several case studies involving use of social media in medical, biomedical, public health, and nursing education, as well as among practicing physicians. One case study described the use of peer-to-peer collaboration among medical students attending the Medicine 2.0 conference in 2009 who blogged about the presentations they attended. They reported increased sharing of information through online discussion forums and the development of a community of learners who were engaged in the conference even if not attending. Sethi et al⁴  described the use of live blogging among nephrology physicians attending scientific meetings. The blogger-physicians shared highlights from conferences with colleagues who were unable to attend. Although the authors acknowledged live blogging is not widespread in the medical community, they noted several nephrology blogs, as well as blogs from neurology, podiatry, and psychiatry, that are currently in use.

Outside of health care, the trend of limited research about blogging continues. As early as 2004, blogging was noted to be a useful tool for informal sharing of information in the business world. Cayzer²³  described blogs as a platform to share “decentralized, informal knowledge management,” a place to share articles, websites, and other information among staff at Hewlett-Packard.

In education, using student blogs to supplement classroom learning among college students has been described. To determine the benefit of blogging in higher education, Bressia and Miller²⁴  conducted a descriptive exploratory survey of experts in education who study blogging. Reflection on and application of course materials were identified as benefits of blogging, as was student engagement. Educators have also explored using blogging to support continuing professional development. As part of a research project, teachers authored weekly reflective blogs of their classroom curriculum, in addition to sharing information learned at professional conferences.²⁵  Similarly, reflection, engagement, and constructive dialogue were identified as benefits for continued professional development.

There are several advantages of blogging in general. Blogs are simple to use and inexpensive or freely available from multiple sources.^18,22,23  Blogs are available 24 hours a day from mobile devices, providing access to nurses at their convenience.^3,7,18,26  In addition, most blogging software includes metrics, providing a way to evaluate the blog’s effectiveness and influence.²⁷ 

Blogging also promotes the development of a community of learning.^{3–5,7,20,23,25,27–29}  Blogs are useful in professional networking, allowing nurses and other professionals to make connections and develop relationships with other colleagues.^4,27,30  Using a blog allows for discourse and dialogue between colleagues and educators and provides support at a peer level.^18,24,25,27  It has been suggested that contributing to a blog can facilitate the refinement of scholarly writing skills, a valuable asset for any nurse.^19,31  Finally, blogging affords nurses an opportunity to engage and connect through learning experiences.^8,28 

Lifelong learning is essential for nurses, and effective distribution is key to the success of any learning method.^3,7,8,26,31  Research shows that nurses are using social media.^3,7,11,27  In its social media toolkit, the Centers for Disease Control and Prevention (CDC) stated that 99% of American adults have some type of mobile technology.²⁷  Ying¹¹  reported that 94% of nurses responding to an online survey used social media; 32% of the media they accessed were blogs. This level of use lends support for blogging as a potentially useful format for peer-to-peer sharing among nurses. Whereas Ying¹¹  found that younger, less experienced nurses used blogs more than their older, more experienced counterparts did, the CDC stated that younger groups are using blogs less, while blogging overall has increased.²⁷  Further research is needed to evaluate the usage patterns of blogging among practicing nurses.

Although other disciplines have described a lack of guidelines on social media in their respective fields,^4,22  numerous nursing agencies have published guidelines for social media use in the health care field. Both the American Nurses Association^32,33  and the CDC²⁷  have social media toolkits available. In 2011, the National Council of State Boards of Nursing issued its “White Paper: A Nurse’s Guide to the Use of Social Media,”¹⁵  and the National Student Nurses’ Association has published recommendations on social media use for student nurses.²¹  In general, these guidelines caution nurses to respect patients’ privacy and confidentiality, and refrain from photographing or recording patients in any form.^3,11,16–18  Nurses are also reminded to uphold their professional standards and boundaries and to be mindful of the privacy settings of the social media sites they use.^{15,21,32–34}  Finally, of course, nurses must strictly adhere to the regulations set forth in the Health Insurance Portability and Accountability Act (HIPAA) and any hospital-specific policies when using any form of social media.^{12,14,15,21,27,30,32–34}  These are only a sampling of the recommendations, policies, and position statements put forth by professional nursing organizations.

A blog (or weblog) is an online website with entries about a specific subject posted by community members.²  Posts are listed in reverse chronological order (ie, the newest appears first).^8,19,35  The CCU NPC designed its blog using freely available blogging software from Google’s Blogger (http://www.blogger.com).³⁶  The blog was designed as a filter-style blog, in which contributors submit a synthesis or synopsis of educational information or share topics relevant to a chosen topic.^8,19  Blogger provides blog templates, allows photos and links to other websites, and interfaces with other social media platforms for sharing blog posts.³⁶  Blogger also offers comprehensive privacy settings, allowing the CCU blog to be private, preventing it from being visible to search engines or Blogger’s listing of blogs.³⁶  To maintain HIPAA compliance, no patient information is shared on the blog. The hospital’s public relations department includes a social media specialist, who was consulted to ensure that the blog was developed in accordance with hospital policy. The CCU blog is a closed environment, where content must be screened before posting.⁸  Two nurses from the NPC are blog administrators; they have permission to post content and make changes to the blog template, layout, and privacy settings. Blog posts and reader comments require administrator approval to become public, ensuring that the content is professional in topic and tone and is compliant with both HIPAA and hospital policy.

The blog includes a section called “Other Places to Get Your Learn On,” which features other professional education websites (Figure 1). Hyperlinks to professional organizations and vendor-specific education pages are available to provide additional educational opportunities and resources to CCU staff. Additional blog features include links to previous posts, an option to receive e-mail notifications when there are new posts, and a total-page-views counter. Administrators have access to additional metrics, including views per post, operating system, and browsers.

Initially, the NPC members attending the local conference agreed to blog about their educational experiences to share with staff (Figure 2). Later, the blog was expanded, and all staff nurses are now encouraged to contribute. Any CCU staff nurse can submit a post reviewing an educational conference, presentation, grand rounds, webcast, or speaker presentation. Several of the CCU staff have presented at various forums and have shared their presentations via the blog. Staff receive links to new blog posts via hospital e-mail, SharePoint, and the CCU Facebook page.

To determine nurses’ perception of the utility of the blog for sharing educational information, an online survey was administered to the CCU nursing staff 15 months after the blog was implemented. The NPC developed an 11-question electronic survey tool using Research Electronic Data Capture (REDCap; https://catalyst.harvard.edu/services/redcap/) electronic data capture tools hosted by BWH (Figure 3).³⁷  REDCap is a secure, web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry, (2) audit trails for tracking data manipulation and export procedures, (3) automated export procedures for seamless data downloads to common statistical packages, and (4) the ability to obtain and maintain anonymous survey answers.³⁷  All respondent identifiers are restricted from data reporting within REDCap to protect the confidentiality of the data.³⁷ 

All CCU staff received an invitation to participate in the survey through hospital e-mail. The invitation indicated that participation in the study was voluntary and anonymous, and it contained a link to the survey. By clicking the link, participants provided consent. Only 1 response per invitation was allowed. Participants had 1 month to complete the survey, and weekly reminder e-mails were sent to staff who had not yet responded. The survey was designed as a quality improvement project, so approval was not sought from the institutional review board.

The survey included 2 questions about the respondent’s age and experience level, 2 yes/no questions related to blog use, and 1 multiple-choice question on means of accessing the blog. The remaining 6 questions asked participants to rate the perceived influence of the blog using a 5-item Likert scale, ranging from strongly disagree to strongly agree (Figure 3).

Of 55 CCU nursing staff members, 37 responded to the survey—a response rate of 67%. The majority of respondents were 51 to 60 years of age, with percentages increasing incrementally with each age group from youngest to oldest. Nearly 11% of respondents were male, which is representative of the staff as a whole (9% male). The experience level of the respondents covered a broad range, from fewer than 5 years to more than 20 years of nursing experience, with most respondents indicating the latter. These demographic data are listed in Table 1. Most of the respondents accessed the blog through a hyperlink provided in their hospital e-mail, and links on the CCU Facebook page were the second most common way to access the blog (Table 2).

Positive response data (ie, strongly agree, agree) have been aggregated for the discussion of the results. Complete response data are listed in Table 3. All respondents indicated they were aware of the blog, 84% stated that they had read the blog, and 88% of those who responded (3 respondents did not answer that question) reported that they would continue to read the blog (Table 4). Most (86%) of those who responded agreed that the blog is an effective tool for learning and sharing professional education information (Table 3). Eighty-one percent felt the blog helped keep them up to date with evidence-based practice, and 59% indicated their practice had changed or would change on the basis of information shared on the blog (Table 3). The majority of respondents (78%) reported they were more likely to attend a professional conference after reading the blog and 62% would be willing to submit a post to the blog (Table 3). Currently, the blog has nearly 4000 page views.

The goals of the survey were to assess staff perception of the utility of the blog for educational peer-to-peer sharing, the potential influence of blogging on future continuing educational efforts, and the usage patterns among the staff. The survey results suggest that use of a blog might have a positive influence on nursing practice. Staff perceived the blog to be an effective tool for learning and sharing professional education information, and they thought that it helped keep them up-to-date about evidence-based practice. The results also reveal a potentially beneficial influence on staff continuing-education patterns.

These survey results are consistent with findings in the literature from other disciplines, particularly regarding the development of a community of learning, engagement in continuing-education practices, and peer-to-peer sharing of educational information. This study adds new information to the sparse literature highlighting blogging for peer-to-peer education among currently practicing nurses.

Most survey respondents were senior staff who were more than 40 years old. Of the 37% of responding staff who access the blog via posts on the CCU Facebook page, 62% have more than 16 years of nursing experience, and 71% are more than 40 years old. These results are the opposite of Ying’s finding that younger, less experienced nurses were more likely to use social media than their older, more experienced counterparts were.¹¹  This difference may be related to the age and experience level of this particular survey sample.

The survey tool was newly designed by the authors and not validated. Additionally, the survey responses represent subjective opinions of the staff in the CCU. The survey was conducted using a small convenience sample from a single unit in one hospital. Therefore, results may not be generalizable. The respondents were also very experienced and most were 40 years of age or older, which may not be typical of all units. Finally, authoring blog posts can also be perceived as difficult and time-consuming, and this perception may deter staff from contributing.^10,31  Survey responses support this concept. Although 62% of respondents to the survey indicated that they would be willing to contribute posts to the blog, only 23% of staff have contributed to date.

Little research has addressed the effectiveness of blogging for peer-to-peer education in nursing, and health care in general, and that research is largely limited to surveys and case studies. Rigorous research is needed to measure and evaluate the effectiveness of blogging for peer-to-peer education. Research in other settings may suggest additional findings to support the use of blogging as a potentially effective method of peer-to-peer educational sharing in nursing. Further research on blogs and other forms of social media may highlight use patterns specific to nurses’ age and experience level.

Lifelong learning is essential for nurses at all levels of practice. Peer-to-peer education among currently practicing nurses can be challenging owing to varying staffing patterns. Patient acuity and care may limit time for peer-to-peer educational sharing during work hours. Blogging has been identified as a potentially useful method of peer-to-peer sharing of educational information in formal nursing education as well as among practicing providers in other health care disciplines. The results of this survey suggest that blogging may provide currently practicing nurses with a way to learn at their convenience on their computers, smartphones, and tablets³  and may foster interest in future professional development opportunities. These findings add to the body of knowledge on blogging for peer-to-peer education in nursing and may help inform the practice of others seeking to implement novel strategies for continuing nursing education and professional development.