From E.T.Net to Social Media: Nurses Communicating Online

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Different seas, Same boats? Column

by Dr. Peter Murray, Senior Editor


Murray, P. (February, 2011). From E.T.Net to Social Media: Nurses Communicating Online.. Different seas, same boats? Column. Online Journal of Nursing Informatics (OJNI),15 (1). Available at http://ojni.org/issues/?p=304


Different seas, same boats?While starting to write this second column for the ‘new’ OJNI, I found it useful to look back over the articles, columns and editorials written for the October 2010 issue. Without getting into too much of a reflexive analysis of the writings, I think it worth noting that there seemed to be some interesting commonality of issues and overlap with my own current and long-standing areas of interest, in particular in Sakraida, Spotanski & Skiba’s exploration of using Web 2.0 tools in research and networking, and in some of Jack Yensen’s analysis and visualisations, and the tools that he used for this work.

For this column, I want to draw on some of these issues, and on my own long-standing interest in analysis of the ways in which nurses interact online (Murray, 1997), and my use, in collaboration with changing sub-sets of colleagues, of some of the Web 2.0 tools such as blogs, and latterly Twitter (Murray, Hansen & Erdley, 2009; Kouri et al., 2009). I think that the new social media (a term that is beginning to be used by some in preference to “Web 2.0”) tools that many people are increasingly using offer potential for exploring new and interesting ways for nurses to interact, to share experience, and to compare and contrast lessons from their work experiences, whether they work in clinical areas, in education, in research, or any other area of nursing or health care. Whether the nature of the interactions facilitated by these new tools are qualitatively or quantitatively different from those facilitated by longer-established mechanisms, such as through email discussions, is an area that we need to explore, and one that I, together with some colleagues, will be researching over the coming years. In addition, we need to explore and research the potential of many of the new online and social media tools for actually conducting research; Sakraida, Spotanski & Skiba’s (2010) article offers an excellent starting point for exploring the possibilities. These new tools offer, potentially, the opportunity to reach wider cohorts of participants in our research, more quickly than previously possible; but again, we need to explore whether this potential is being translated into reality. In addition, we will need to investigate the emergence of possible new techniques that using these tools, in real-time, online collaborative ways, may offer; and reflexively use the tools themselves to research that potential.

Nurses and nurse informaticians have, for many years, exchanged and explored ideas on their practice, seeking to find answers to solutions, share experiences, and improve their areas of practice, be they within clinical work, education, research or informatics. For most nurses, paper-based local, national and international journals were, for many years, the only ways in which they could seek information and share experiences outside their immediate circles of colleagues. A fortunate few were able to attend conferences to exchange ideas and experiences, but again, outside of their immediate circle, sharing lessons derived from such events with others relied on paper publications, with their lengthy publication lead-in times.

The early years of the 1990s saw some changes, but mainly only for those working in academic settings who were fortunate enough to have email accounts and to use some of the early tools available for accessing the Internet, and then the nascent World Wide Web. Our colleagues and readers under about the age of 30, who have grown up with ubiquity of access to email and the Web, and who have never known their absence, may find it strange, or quaint, that such situations ever existed. Tools such as E.T.Net (Educational Technology Network), funded by and hosted at the National Library of Medicine and championed by Susan Sparks, allowed growing numbers of nurses to experience electronic communications and interaction with colleagues in ways that had not previously been widely available, and for the interactions and exchanges to be much more rapid (Wainwright & Sparks, 1993). The early 1990s also saw the emergence of a growing number of email discussion lists, run by and for nurses, and the growth of other online resources following the development of the World Wide Web as a system for linking documents and other materials through the Internet (Anthony, 1994). One of the first nursing email discussion lists was the nursing informatics list, nrsing-l, founded in May 1991, and  currently still maintained by OJNI Senior Editor, Scott Erdley. It was only, though, from around the mid 1990s, with the growth of commercial Internet Service Providers (ISPs), that most nurses were able to access and take advantage of the opportunities offered for communications and exchange of information and ideas. Again, it is worth noting that not too long ago, many hospitals did not allow nurses to use email from work settings, or provide them with such facilities, and so they had to rely on commercial ISPs.  As Internet access has grown, and the range of nursing-related resources has expanded, there have been many changes, which it is far beyond the scope of this column to even attempt to summarise. So, let us skip to the present day, and briefly explore some of the opportunities that currently exist for nurses to communicate and collaborate, exchange experiences and ideas, and, hopefully, learn from one another.

While definitions of what constitute ‘social media’ or ‘Web 2.0’ continue to change, one common feature is the opportunity for, and expectation of, interaction between those producing and using the materials, and not simple passive consumption of content. Online communities, collaborative projects, and social networking sites are therefore seen as key examples of social media. I want to touch on just two aspects of these within this column, to give a general introduction to the possibilities that now exist, and in future columns will return to a more in-depth exploration of some specific examples of the plethora of applications and devices that allow us to interact with our colleagues in all parts of the world.

Various applications exist to provide for the development of online communities based around discussion forums. Such forums seem to be replacing email discussion lists – although I say that more from a ‘gut feeling’ than systematic empirical evidence – and this may be an area for future exploration in this column and elsewhere. One good example of a vibrant online community is the Health Informatics Forum (http://www.healthinformaticsforum.com/) a ‘social network and discussion forum’ for health informatics professionals and students. With over 4,500 members, it provides for general and focused discussions on a wide variety of topics, as well as integrating other tools such as blogs, videos, and a Twitter stream. Nursing-specific examples exist, and some nursing organisations, rather than set up their own software installs to facilitate such groups, are exploring the potential of existing social networking platforms, such as Facebook, eg ANIA-CARING (https://www.facebook.com/pages/ANIA-CARING/215226257888 ) and the AMIA Nursing Informatics Working Group (https://www.facebook.com/NIWG.AMIA ). However, even here, despite the interactive possibilities, much of the communication seems to be ‘old-style’, ‘Web 1.0’ and we do not see much discussion. The ‘1% rule’ still seems to hold, that “if you get a group of 100 people online then one will create content, 10 will “interact” with it (commenting or offering improvements) and the other 89 will just view it” (Arthur, 2006). Perhaps nurses are happy with this and feel that they get enough communication and collaboration via such more passive methods.

The other area I will briefly touch on, in closing this column, is the use of blogs, and latterly micro-blogging, specifically Twitter, to provide ‘real-time’ reports on nursing and health informatics conferences, and the opportunity for other people to read, and interact with the events from a distance, for example at http://www.hi-blogs.info. We have explored our experiences in a number of papers and presentations (http://www.slideshare.net/drpeter/ni2009-web2panel-final), and believe that the experiments have been of value. However, providing blog reports on conferences is intensive work, in the same ways as is writing columns or papers for more formal publication, and my recent experience from the Medicine 2.0’10 conference (see blog post at  http://medicine20congress.blogspot.com/2010/11/is-blogging-dead-at-conferences.html) makes me wonder whether we are seeing a shift to the more immediate reporting, in short ‘bites’, that Twitter allows.

As new social media tools emerge (the current discussion in the ‘Twittersphere’ is whether Quora (http://www.quora.com) has anything new to offer), I will return to some of these issues in future columns. In the meantime, I encourage you to explore some of these collaborative areas and tools, if you have not already done so, and try them out for collaborating with colleagues and sharing your thoughts on whether we are all in the same boat, sharing similar problems and experiences, or not.


Anthony, D. (1994). Nurse: A case study. Just how useful is a subject service? Paper presented at First International WWW Conference, CERN, Geneva, 25-27 May.

Arthur, C. (2006). What is the 1% rule? Retrieved from http://www.guardian.co.uk/technology/2006/jul/20/guardianweeklytechnologysection2

Kouri, P., Saranto, K., Moen, A., Murray, P. J., & Hansen, M. (2010). Social media – new tools for personal health and wellbeing. Panel at Medinfo2010, 13th World Congress on Health and Medical Informatics, Cape Town, South Africa.

Murray, P. J. (1997). E-discourse and continuing professional education: The fusion of nursing knowledge and informatics to close the theory-practice gap. In U. Gerdin, M. Tallberg & P. Wainwright (Eds.), Nursing informatics: The impact of nursing knowledge on health care informatics. Proceedings of the Sixth International Congress on Nursing Informatics (NI97), Stockholm, Sweden. Amsterdam: IOS Press.

Murray, P. J., Hansen, M, & Erdley, S. (2009). What relevance do Web 2.0 technologies have for nursing informatics and professional development? Panel at NI2009, 10th International Congress on Nursing Informatics, Helsinki, Finland.

Sakraida, T., Spotanski, A. & Skiba, D. (October, 2010). Web 2.0 evolves to Research 2.0 post-award management. Online Journal of Nursing Informatics (OJNI), 14(3). Retrieved from http://ojni.org/14_3/Sakraida.pdf

Wainwright, P., & Sparks, S. (1993). E.T.Net – an electronic conferencing system. Information Technology in Nursing, 5(3), 10-12.


Dr. Murray is a self-employed Health Informatics/Telematics Consultant. He has taught in the MSc in Health Informatics at The University of Winchester, UK and Walter Sisulu University, Mthatha, South Africa and served as Module Leader for a Research Methods module.He is currently the CEO for the International Medical Informatics Association until 2015. He is also Adjunct faculty at University of Maryland, Baltimore, and a Founding Fellow and Director at CHIRAD. Dr Murray is a member of the American Medical Informatics Association and ANIA-CARING.

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