i

Level of Knowledge, Attitudes, and Practices

on the Use of Social Media for Academic Requirements
among Nursing Students of
University of Bohol

Bongato, Jill Margarett I.

Bungabong, Gian Kayla A.

Dalapo, Sheryl B.

Lim, Trisha Elaine V.

Mumar, April Anne T.

Petersdorf, Catherine M.

Sevilla, Edsel Jim G.

COLLEGE OF NURSING
University of Bohol
City of Tagbilaran

June, 2021
Level of Knowledge, Attitudes, and Practices
on the Use of Social Media for Academic Requirements
among Nursing Students of
University of Bohol

A Thesis
Presented to the Dean and Faculty of the
College of Nursing
University of Bohol
Tagbilaran City

In Partial Fulfillment
of the Requirements for the Degree of
BACHELOR OF SCIENCE IN NURSING

by:

Bongato, Jill Margarett I.

Bungabong, Gian Kayla A.

Dalapo, Sheryl B.

Lim, Trisha Elaine V.

Mumar, April Anne T.

Petersdorf, Catherine M.

Sevilla, Edsel Jim G.

June 2021

ACKNOWLEDGEMENT
 The researchers would like to convey their heartfelt acknowledgement to the

efforts shared by everyone, who in one way or another, have contributed to the

accomplishment of this study.

Mrs. Xenita Vera P. Oracion RN, MAN, the research adviser, for introducing the

study and for sharing her knowledge and time which proved monumental towards the

improvement of this research paper.

Dr. Bonnibella Jamora and Dr. Sharon P. Lupio, the research teachers, for their

invaluable supervision, continuous encouragement and dedicated involvement

throughout the whole research process.

Sir Angelo P. Yuayan, the statistician, for lending his expertise in statistics which

was crucial for the attainment of the results in this quantitative research.

Ma’am Leah Wilfreda Pilongo, the Dean of Research, for her honest and

constructive criticism that allowed the researchers to improve the quality of this research

work.

To all the respondents who willingly sacrificed a moment of their time to

participate in the conduct of the study and in their patience in answering the tool.

To our families and friends, for their undying love, understanding, and countless

financial, moral, and emotional support that enabled the researchers to carry on despite

the difficulties.

To University of Bohol and the College of Nursing for giving their support and

permission to conduct the research study.

Above all, to God Almighty, whose fathomless grace, mercy, and guidance

enabled the researchers to stand firm amidst all the trials toward the completion of this

research.
 DEDICATION

We wholeheartedly dedicate this study to the Almighty Father who gave

us the power of mind and skills, who enlightened and guided us all throughout

the making of this research work. We offer all of these to you.

To our beloved friends and family members, our inspirations, for their love,

encouragement, and unending support which gave us motivation and sustained

us in completing this study.

To our clinical instructors who showed immense patience and

commitment in helping us achieve this milestone. This would not have been

possible without you, our dedicated professors.

Lastly, to the University of Bohol whose virtues we stand for: Scholarship,

Character and Service, for the opportunity to hone our skills in the area of

research and with the hope that our findings will be beneficial to the College of

Nursing and our fellow students.

APPROVAL SHEET
 In partial fulfillment of the requirements for the degree of Bachelor of

Science in Nursing, this study entitled “Level of Knowledge, Attitudes, and

Practices on the Use of Social Media for Academic Requirements among

Nursing Students of University of Bohol" is hereby recommended for acceptance

for Oral Examination.

Approved by the Examining Tribunal in the Oral Examination conducted

on June, 2021 with a grade of__________.

XENITA VERA P. ORACION, RN, MAN

Adviser

Approved by the Examining Tribunal in the Oral Examination conducted

on June, 2021 with a grade of__________.

THE EXAMINING TRIBUNAL

Dr. LEAH WILFREDA PILONGO

Chairman

SHARON B. LUPIO, MAN, DScN

Member

Accepted and approved in partial fulfillment of the requirements for the

degree of Bachelor of Science in Nursing (BSN)

LALAINE L. DOMAPIAS, MAEd, MAN

Dean, College of Nursing ii

TABLE OF CONTENTS
CHAPTER
I. ABSTRACT…………………………………………………………………..vii
II. PROBLEM AND ITS SCOPE
Introduction………………………….…………….……………………..……….1
Theoretical Background ……….………………..……………………….……..4
Legal Bases…………………….………………………………………………...6
Review of Related Literature….………………………………………………...8
Review of Related Studies……………………………………………………..16
The Problem
Statement of the Problem……………………………………………..……….21
Significance of the Study…………………………………………………...….22
Research Flow…………………………………………………………………..24
Research Methodology
Design……………..……………………………………………………………25
Respondents…………………………..……………………………………….25
Environment………………………..………………………..…………………26
Instrument …………………………..………………………………………….27
Data Gathering Procedures ..………………………………………………...29
Ethical Considerations………………………..………………………….……30
Statistical Treatment of data………………………………………………….31
Definition of Terms…………………………………………………………….32
III. PRESENTATION, ANALYSIS AND INTERPRETATION
Demographic Profile of the Respondents …………...……………………….34
Level of Knowledge, Attitudes, and Practices of the Respondents………..37
Relationship between the Demographic Profile and
Level of Knowledge, Attitudes, and Practices ……………………………....45
Correlation between Level of Knowledge and Attitude……………………..54
Correlation between Level of Knowledge and Practices……………….......55
Correlation between Attitudes and Practices………………………………...56 iii

IV. SUMMARY, CONCLUSION, RECOMMENDATION

Summary……………………………………………………………………….....57
Conclusion…………………………………………………………………….….59
Recommendation………………………………………………………………...60
V. REFERENCES CITED…………………...…………...…………………….62
VI. APPENDICES
Appendix A – Transmittal Letters ……………………………………..……….67
Appendix B – Letter to the Respondents……………………………..……….70
Appendix C – Informed Consent..……………………………………..……….71
Appendix D –
Questionnaire…………………………………………………….73
Appendix E – Ethics Endorsement Form………………………………………
76
Appendix F – Research
Clearance……………………………………………..77
Appendix G – Cronbach’s Alpha
Result………………………………………..78
Appendix H – Codebook………………………….
…………………………......81
Appendix I – Statistical Treatment Result……..
……………………………….87
Appendix J – Certificate of Passing Integrity Standard…………………….100
Appendix K – Certificate of Completion………………………………………
101
VII. CURRICULUM VITAE………….…………………………………………102

iv

LIST OF FIGURES
 I. Figure 1.Research Flow ……………………………………… 24
II. Figure 2.Vicinity Map …………………………….…………… 26

LIST OF TABLES

Table 1 – A. Distribution of Respondents………………………….……25

Table 2 – A. Dummy Table for Statistical Treatment…………….……..31

Table 1 – B. Demographic Profile of the Respondents………..............35

Table 2 – B. Level of Knowledge, Attitudes, and

Practices of the Respondents…………………….,...........37

Table 3. Level of Knowledge of the Respondents……………….……..38

Table 4. Attitude of the Respondents……………………….……………40

Table 5. Practices of the Respondents………………………….……….43

Table 6. Relationship between the Age and

Level of Knowledge of the Respondents……………….……..45

Table 7. Relationship between Sex and Level

of Knowledge of the Respondents…………………………….46

Table 8. Relationship between Religion and

Level of Knowledge of the Respondents………………….….47

Table 9. Relationship between the Year Level

and Level of Knowledge of the Respondents……….………..48

Table 10. Relationship between the Age and

Attitude of the Respondents………………….……………….48

Table 11. Relationship between the Age and

Attitude of the Respondents……………………….………….49

Table 12. Relationship between the Religion

and Attitude of the Respondents……………………………50

Table 13. Relationship between the

Year level and Attitude of the Respondents………………..51

Table 14. Relationship between the Age and

Practices of the Respondents………………………………..51

Table 15. Relationship between the Sex and

Practices of the Respondents………………………………. 52
 vi

Table 16. Relationship between the

Religion and Practices of the Respondents…………………53

Table 17. Relationship between the Year

level and Practices of the Respondents…………………….54

Table 18. Correlation between Level of

Knowledge and Attitude of the Respondents……………....54

Table 19. Correlation between Level of

Knowledge and Practices of the Respondents……………55

Table 20. Correlation between Attitude and

Practices of the Respondents……………………………….56

vii

ABSTRACT
 The adaptation towards online learning brought about questions on how

nursing students use social media in relation to their academic requirements. To

ensure safety as they partake in online classes, the researchers conducted a

descriptive research to determine the level of knowledge, attitudes, and practices

towards social media use among nursing students in the University of Bohol. The

university is a nonsectarian co-educational institution located in Dr. Cecilio

Putong Street Tagbilaran City, Bohol, Philippines. A sample of 200 nursing

students who are currently enrolled in the nursing program from level 1 to 4 of

the school year 2020-2021, were selected. The study underwent ethics review by

the Ethics Review Committee of the University of Bohol. The findings inferred

that majority of the respondents are highly knowledgeable in using social media;

have a moderately positive attitude towards social media use; and that they

practice social media frequently or often to complete their academic

requirements. Findings show no significant relationship between the

demographic profile of the respondents and their level of knowledge, attitudes,

and practices on the use of social media. A conclusion was drawn that the

respondents’ level of knowledge and attitudes, their level of knowledge and

practices, and their attitudes and practices have a vital influence on each other.
 CHAPTER I

THE PROBLEM AND ITS SCOPE

INTRODUCTION

The Philippines is considered to be among the countries with the most social

media users across Southeast Asia. As of January 2020, around 67% of Filipinos are

reported to be active in social networking sites, spending an average of four hours on

social media daily (Sanchez, 2020). As defined by Tufts University (2020), social media

refers to the medium of interaction wherein people can build, share and create, or

exchange information in a virtual setting.

Social media encompasses different online tools and Web-based technologies.

Facebook, YoutTube, Twitter, and Instagram are the foremost popular communication

systems that many students actively use. Social media sites connect people irrespective

of distance. It's generally accustomed to communicating with others by providing basic

information about oneself, including photos, videos, comments, and many more. These

platforms are getting used for all varieties of things, primarily for leisure and

entertainment purposes.

In the modern age, social media has dramatically influenced the scholar culture.

Having been integrated into the educational sector, social media has introduced

innovative teaching strategies that are pretty useful, especially in the pandemic. As a

result of the rapid transmission of Covid – 19, schools are forced to shut down across

the globe. Statistics show that approximately 1.2 billion students have been away from
their classrooms (Li and Lalani, 2020). In response to this problem, many academic

institutions have resorted to e-learning to continue students' education. Moodle, Google

Classrooms, and Edmodo are a few of the social media platforms currently utilized for

academic purposes.

Social media is of maximum importance to students. It allows them to be ready to

access information, ideas and be prepared to grasp essential details despite being

away from the four walls of a classroom. This is made possible because social media

facilitates exchanging information through chats, sending photos, videos, and voice

messaging. Therefore, instructors and students alike can communicate with each other

continuously. Moreover, social media has allowed students to access data and

researches online for the aim of reflection.

Technology is increasingly becoming a daily part of one's lifetime and all in

modern society. It is increasingly noticeable that social networking sites and their

applications have tremendous advantages for university students. However, along with

the benefits come the risks associated with the use of social media. Considering that

social media is a platform that is open to all, students become susceptible to different

threats.

Misuse of social media may have negative repercussions. Online activities need

elaborate planning because they pose a risk to the reputation of universities and

teaching programs. If deemed ineffective, students will have difficulty learning and may

also develop hostility towards education itself. Students should be made acquainted

with the hazards when using social media. Nursing students, above all, must be guided
and educated about the problems of professionalism in social media usage concerning

the emerging concerns within the field of medical and allied health.

Nursing students should remember that many social media platforms and tools

can be utilized within the healthcare field to enhance the standard of education and

patient care. Nevertheless, along with these advantages are the risks that must be

taken into consideration. Nursing students' problems may come across social media,

including the distribution of poor-quality information, damage to a knowledgeable image,

breaches of patient privacy, violation of personal–professional boundaries, and licensing

or legal issues. But there are, fortunately, organizations that have issued guidelines to

avoid these possibilities (Edge W., 2017).

Studies conducted previously have shown documentation of scholars engaging

in unprofessional behaviors. One survey records a complete of 293 nursing schools;

77% experienced a minimum of one occurrence of scholars posting or sharing amateur

content on social media. There have also been reports of misconduct in African

countries. In a very study conducted in Canada, nursing students have admitted to

posting information on social media platforms that they would not have any desire to be

discovered by a future employer or tutorial staff member (Sims – Giddens et al., 2012).

The University of Bohol, College of Nursing has adapted to the shift towards

online learning. Nursing students now engage in social media activities on Facebook,

Messenger, Google classroom, and Zoom to complete their academic requirements. To

ensure that students are safe as they take part in online classes, the researchers

deemed it necessary to conduct the study to determine the level of knowledge,

attitudes, and practices towards social media use among University of Bohol nursing

students. The study also intends to answer questions about how the respondents use

social media for academic purposes and assess the respondent's perceived risks and

benefits of social media use. The results will then give an insight into whether there are

probabilities of online misconduct and a need for awareness regarding legal issues

associated with social media use. Lastly, the study will serve as baseline data for future

related studies.

Theoretical Background

This study was anchored on Social Learning Theory by Albert Bandura and the

Theory of Planned Behavior by Icek Ajzen. Social Learning Theory describes the

accession of skills that are developed primarily within a grouping. Bandura's Social

Learning Theory will facilitate the knowledge, attitude, and practices towards

understanding social media usage for nursing students' educational purposes. The

Social Learning Theory essentially describes how the environmental and cognitive

constituents work together to change the behavior and learning pattern. Social Learning

theory views learning as a human process that individuals will self-initiate, control

learning and make a determined effort to create knowledge by their efforts, creating and

connecting information.

In line with the idea, nursing students' skills through their frequent use of social

media for educational purposes are acquired exclusively within their environment.

Following the Social Learning Theory of Bandura, students' use of social media for

educational purposes will allow amassing skills and information to enhance their
academic performance. The idea of self-efficacy is the critical argument of Bandura's

Social Learning Theory. Self-efficacy is the belief in a person's abilities to rearrange and

perform courses of action needed to cause given achievements. It is recommended that

students' use of social media is positively linked to their academic self-efficacy, which

positively impacts their awareness and academic success without interruption.

Therefore, academic self-efficacy is hypothesized as a mediator to social media usage

and knowledge of academic nursing students.

Analyses of those models offer an understanding of social media usage and

academic self-efficacy and their combined effects on the scholars' knowledge and

principle. As the media and its different forms have increasingly penetrated most

homes, social learning theories have recognized the role of the media in influencing

nursing students' social actions. Social networking sites are virtual worlds for net users.

Spending most time within the virtual worlds affects young minds' educational learning

abilities and the behavior of the scholars. Students obtain much of their characteristics

through continuous exposure to and participation within the virtual world, such as

chatting and video sharing. Throughout adulthood, their behavioral characteristics

acquired as young adults continue. There are possible social learning pattern factors

seen in grown-ups.

Theory of Planned Behavior by Icek Ajzen describes that attitude is believed to

influence behavior. One's beliefs, emotions, and perceptions are considered as a vital

and cognitive component of attitude. With this theory, it is the determinant of behavioral

intention in which nursing students' attitude towards social media usage may influence

their behaviors. As nursing schools still produce nursing professionals, there's an

immense need to explore the nursing students' perspectives regarding the responsible

use of social media accounts to avoid the probabilities of online misconduct and stop

legal and ethical issues.

Legal Bases

Similar to the use of technologies, legal and ethical issues with social media use.

According to Kenny & Johnson (2016), social media may impact an individual's

professional fitness to practice. Therefore as aspiring nurses, the nursing students from

the University of Bohol must be cautious about their social media activities. Being a

platform accessible to all, social media challenges nursing students' capability to adhere

to the nursing profession's ethical responsibilities, which is to maintain the privacy and

confidentiality of their patients (Nyangeni et al., 2015).

The Code of Ethics for Nurses by the International Council of Nurses (2012) and

the Philippine Board of Nursing (2004) clearly states that nurses must keep confidential

information about the patients' privacy. As nursing students, they need to keep the

patients' information confidential, mainly because most nursing students do their duties

online.

House Bill No.5021, "Social Media Regulation Act of 2017," is the act that

protects and upholds the public interest and regulates the use and flow of social media,

and gives unbiased information to the public. This act protects the nursing students,

especially during online classes covering their identity online, prohibiting someone from

stealing his/her identity presenting himself/herself to the social media and online world

as the person whom he/she is not.

 Republic Act 10173, known as the Data Privacy Act, implements rules and

regulations to ensure the security and protection of human rights and privacy (National

Privacy Commission of Philippines, 2012). Under the said act, information is to be kept

accurate and relevant and must be only used for the stated purpose, to be retained only

for as long as it is reasonably needed. A social media is used chiefly by nursing

students as a source of education and schooling. This law helps to protect students to

their data and privacy.

Social media is used to educate nursing students, showing how their knowledge

relates to the laws mentioned above. However, aspiring and licensed professionals are

bound to their legal responsibilities and refrain from posting offensive, sensitive, or

confidential information about their patients. Lastly, student nurses need to familiarize

themselves and abide by nursing's ethical practices, mainly because, according to

Smith and Knudson (2016), social media can jeopardize the nurse-patient relationship.

REVIEW OF RELATED LITERATURE

Social media has uses in medical education for training, learning, and patient

engagement. It's the power to abolish hierarchies in educational experiences, allowing

patients to attach, collaborate, and exchange information with learners. This statement

indicates that patients should be considered experts who are open on social media sites

and may play a job in medical education. It illustrates how patients in social media-
based medical education can function as teachers and how the narratives and

experiences of patients who volunteer in online environments can help cultivate patient-

centered care practices (Giroux, C. M., & Moreau, K. A 2020).

Boyd and Ellison (2007) explicated that social network sites are public web-

based applications that allow people to develop a personal profile. This would also

enable them to identify other users ("friends") to connect or relate with, read and react

to posts by other users, and publicly or privately send and receive messages. However,

users can set limits on what information they would like to share publicly with others.

Based on Peck, J.L. (2014) in nursing, social media has the proper use. It is meant

primarily for nurses because it gives them affordability and access to easy use of the

learning environment with social nurses. It would be able to have more expounded use

of their learning's. It is easy for them to have an accessible and affordable source of

knowledge. It enhances their skills as nurses social media that appeals to a more

affordable and accessible learning environment, especially in nurses, to improve their

craft and have meaningful use in social media.

Vanwynsberghe and Verdegem (2013) looked at factors that may affect social

media integration in education and have identified students' knowledge about social

media use (social media literacy) as one of the barriers. They defined social media

literacy as the competency in accessing, analyzing, evaluating, and creating social

media content through different contexts. Access is said to be the first pre-requisite to

achieve social media literacy. Access mainly refers to the capacity to obtain materials

using media technologies; financial constraints, support of social networks, family

composition, and peer pressure are some of the factors that are said to influence
access. Through analysis and evaluation, you know how to assess the information

presented to the viewer critically. To be considered knowledgeable, one has to screen

the data for reliability, bias, accuracy, and errors and determine which information is

relevant and valuable among the abundant numbers of materials provided online. In a

period where social media enables individuals to be both consumers and producers of

content, it is deemed necessary that people, particularly students, can utilize social

media to create content that can effectively deliver the message they want to convey.

Social media have become more mainstream, and their impact has extended to the

health domain (Anderson and Speed 2010). Social media in health care provides a

means for getting alternative views, personal experiences, and tacit knowledge on

diagnoses and treatments. It also contributes to a viral effect of public health

messaging, enabling people to spread their health experiences to others, resulting in

desirable behavior changes, and allowing health professionals and organizations to

quickly disseminate accurate and authentic information (Christakis and Fowler, 2008).

Therefore, health professionals and institutes have utilized social media to reach broad

audiences in social marketing campaigns and empower consumers in their health-

related interactions (Thackeray, Neiger, Hanson, and McKenzie, 2008).

Recently, social technologies have been widely used by students daily. It was

then perceived as a type of technology used merely for social and entertainment

purposes. Gradually, it has been adapted for use in education (Top, 2012). The use of

these applications helps create a social-media-focused culture that influences how

people communicate, teach, and learn (Mao, 2014). These applications contribute to

developing culture shaping, how people interact, teach, and learn (Mao, 2014).
According to Lau (2012), online social networks assist students in initiating learning

practices. Students who use online social networks may expand their awareness

through comprehensive communication and knowledge sharing on the sites. High

school students' affordances for social media, their views and opinions regarding these

emerging technologies, and related challenges and problems in using social media

were all explored by Mao (2014). According to the findings, students have optimistic

perceptions and views regarding the use of social media in education. Students, in

particular, assumed that using social media could help them learn better and that they

would enjoy using it for an assignment or diversional activity after school. However,

some students thought that social media would create a distraction and were time-

consuming.

In terms of literature, there are separate definitions for attitudes and beliefs.

Attitude is the term used to refer to the feeling which indicates favor or disfavor,

whereas belief is the premise about something that is felt to be true (Wesely, 2012).

Gall and Borg (2013) provided a more comprehensive definition that states that attitude

is the person's point of view or disposition regarding the affective, cognitive, and

behavioral components. On the other hand, the mental part refers to the belief or

knowledge about the attitude object. According to Bodur, Brinberg, and Coupey (2000),

attitude research has been focused on understanding the relationship between cognitive

structure, affect, and attitude. They suggested that as a non-cognitive determinant, the

effect can directly impact attitude, resulting in the inconsistency between attitude and

behavior. They have also stated that the interaction between the user and a tool should

also be considered a potential determinant when looking at forming an attitude toward

the use of technology. Researches have undertaken surrounding attitude, and attitude

formation shows that attitudes can be associated with beliefs, and the same can be said

about attitudes and behaviors (Siragusa and Dixon, 2008). Attitudes are further

classified into likes and dislikes. As stated by Gasaymeh (2009); Mishra & Panda

(2007); Wen and Shih (2008), the broad expansion of ICT in the field of education within

the past decade led to many research studies exploring the attitudes of users (both

educators and students) towards the assimilation of ICT in education.

Researchers have become increasingly interested that social media's growth as

new Internet networking platforms would add value and benefit to existing distance

education methods. Social media's versatility as networking platforms is beneficial for

students in tertiary education institutions. The student does not have to attend class but

can communicate with classmates and lecturers from home or work. Social networking

can promote online learning, enabling versatility through the convenience of time and

place to accommodate adult learning. Social media are seen as enabling technologies

that facilitate blended learning solutions and, through peer-to-peer engagement, can

promote active learning and information construction (Nyangeni, T., Du Rand, S., & Van

Rooyen, D., 2015). Most nursing students nowadays have their smartphones, which is

technically the most popular gadget to communicate. This new technology has both

negative and positive impacts on the consumer's psychosocial behavior. To make

effective and essential use of social media, nurses should engage themselves in

developing new and alternative methods and policies in sharing information,

collaboration on projects, education, and patient care( Alsayed, S., Bano, N., & Alnajjar,

H., 2020).
 In a period of rapidly changing digital technologies, Ricciardelli et al. (2020)

explore potentially rich ethical consequences for communication norms, social well-

being, and individual mental health to disseminate social media. The objectives of the

there study were to identify and explore variables of interest and their ethical

implications within the data relating to the use and awareness of social media by

students of social work and attitudes towards social media; and to make

recommendations for follow-up research studies aimed at more profoundly determining

the intersection of social media, ethical, social work practices. Overall, results show that

social work students appear to have contradictory attitudes towards social media that

are often contrary to their self-reported experience and social media use. Westrick, S. J.

(2016) stated that social media misuse could lead to disciplinary actions and program

dismissal for students and legal actions and lawsuits for nursing programs. It analyzes

recent court proceedings involving patients expelled from nursing programs because of

social media abuse. Schools need policies that explicitly set standards and the

implications of social media site abuse.

As we go along our journey in the health profession, wherein technology is also

evolving; we can experience many things that help us deal with our patients. Nurses

should embrace this evolving technology to keep up with the demands and changing

needs of patients. There are potent developments and tons of projects worldwide in

using social media to enhance healthcare for patients and the community (Thompson,

T. L. C., Emrich, K., & Moore, G., 2003). Moreover, Lee, R. B., Baring, R., Maria, M. S.,

& Reysen, S., (2017) reveals that the analysis effect on global citizenship identity

histories and outcomes of a positive attitude towards technology, the amount of social
media network memberships, and grade point average (GPA) on global citizenship

identity. Students at a university in the Philippines have established a survey examining

the above constructs. The results showed that attitude towards technology, number of

social network site memberships, and GPA-anticipated global citizenship recognition

and subsequent pro-social perceived perception of the troubling environment. The

results show the relations with a worldwide identity and associated ideals between

technology and academic success.

In nursing education, social media's widespread use remains prevalent, and

nursing students have vital cognitive assessments of social media's responsible use.

Nonetheless, students must constantly be reminded to consider the possible

consequences of their use of social media. In the undergraduate nursing program,

continuous instruction and commitment to improve social media awareness and avoid

cyber-incivility are crucial. Nursing schools must have specific standards of appropriate

online student behavior, such as the concept of social behavior media practices that

could relate to disciplinary action. Also, precise and up-to-date policies about what

constitutes unprofessional, immoral, and inappropriate social media activity must affect

academic nursing institutions. Without adequate guidelines and knowledge of social

media professional conduct, it is possible to predict a future increase in the amount of

unprofessional social media activities that may contribute to ethical and legal

consequences (Edge W., 2017).

As aspiring professionals, nursing students are expected to display professional

online behavior and be responsible social media consumers. However, with the

instantaneous exchange of multiple information on social media, nursing students are

put at risk and in danger of performing several behaviors that may go against their

professions, such as breaching the ethical rule of privacy and confidentiality. In light of

Hoffman, D. L., & Novak, T. (2012), people use social media to motivate them to drive in

social pursuit. Moreover, to help them with the different goals to know the relationship

between the users' social media behaviors and the effects of social media in the various

goal pursuit, knowing their well-being and knowing their motives needs. Many parents,

activists, and policymakers have raised concerns about social media user's possible

adverse effects in recent years. Some research has shown that social media can be

related to adverse mental health effects, including suicidality, loneliness, and reduced

empathy (Berryman, C., Ferguson, C. J., & Negy, C., 2018).

Ayar et al. (2018) suggest that social networking sites, Facebook, in particular,

offer students the chance to engage in peer learning, promoting self-efficacy. With the

use of Facebook groups, students can share their experiences (i.e., mastery and

modeling), verbally convince others to reframe challenges and help alleviate several

physiological responses attributed to stress. Based on the above premise, it is believed

that social networking sites can be used as a tool to resolve the "sophomore slump" and

influence nursing students' decisions to continue pursuing the profession and refrain

from dropping out of nursing programs.

According to Price, A. M., Devis, K., LeMoine, G., Crouch, S., South, N., &

Hossain, R. (2018), social media have been widely used worldwide as a medium for

communication. Many nurses have successfully incorporated social media into their

practice and actively use it to enhance the quality of care and health. The internet

possesses the quality of ubiquity, allowing social media to bring enormous benefits,
including the accessibility of information and services and bringing equity to health care.

Therefore, there are many successful nurse-led initiatives. However, social media is a

double-edged sword and can also bring about multiple individual and organizational

risks. With this, student nurses must be educated about the professional and ethical

practices of social media use. Their attitude and practices as student nurses may

impact their credibility to practice in the future.

Review of Related Studies

Social media offers an effective mechanism in enhancing nursing education.

Expanding the students' knowledge base regarding their privacy, ethics, health policy,

professionalism, and communication as technology continues to grow, as illustrated by

Terri L. Schmitt et al., in the study "Social Media Use in Nursing Education." It can also

help nurses to build an early identity and specific connection with this profession in

healthcare. Barriers in social media use in the nursing field continue to be related to

possible inpatient data breaches and unprofessional conduct by nursing students.

These risks exist even for a professional nurse, no matter the medium of

communication is used. As nurse educators train their student nurses to administer

medications to patients or perform health assessments safely, the educators must play

an active role in teaching their students to engage in safe, pleasant, and professional

communication within a globally connected society. Active engagement in social media

may help nurses identify false information.

Moreover, provide new and improved sources of accurate data information,

encourage preventive care, participate in discussions on improving and enhancing the

future of their profession. Find clues and answers to critical problems and issues in

nursing, engage in some interdisciplinary learning, and begin to disarm lateral violence

environments by finding peers and platforms for positive and significant influence. With

a clear purpose with some caution and education, support from administration,

resolution of barriers, and an idea of available platforms that will meet good outcomes,

nurse educators can successfully integrate social media into the nursing field.

Regarding the uses of social media, a study to identify how social media and

mobile technology can be helpful for undergraduate nurses. Their studies entitled "I am

Ready to Learn: Undergraduate Nursing Students Knowledge, Preferences and

Practice of Mobile Technology and Social Media by Hay et al., 2017. The study had 386

nursing students from the University of Notre Dame Australia as participants. The

method of research was done with the use of questionnaires. The study's design was a

quantitative descriptive survey, an adaptation of the starting pilot survey created by the

authors. The sample population was asked to answer questions related to their present

knowledge, their preferences, and their practices towards social media and mobile

technology as they undergo their undergraduate nursing course. The study's findings

revealed that students are more likely to show support for social media and mobile

technology in theory than in practice. The research also indicates that the students who

often use mobile technologies are more inclined to print out their output, highlight the

hard copy, and annotate the material used in lectures. The research study suggests that

at the moment, students are interested in learning with the aid of mobile technology and

social media. Hence, academic institutions must promote the correct usage of social
media and mobile technology in the undergraduate curriculum to develop responsible

use of these technologies and bring out its potential benefits to the nursing workforce.

On the other hand, social interactions of college students across was studied in

all media. Results have shown that 64% prefer face-to-face interaction, 18.4% favor cell

phone use, and only 16.1% prefer the internet for setting social contacts. Many studies

have also shown the type of platforms and mode of communication and what nursing

students use or do with gadgets daily. The internet interactions reported that E-mail was

by far the most dominant form of contact, followed by chat and instant messaging,

according to the finding of Baym et al., 2004. Of the 51 participants in the study, 49

reported conducting their social life contacts using two and often three methods on any

given day. Similarly, the findings of Lenhart et al. (2010), in their study, reported that

over 27% of young adults use a social networking site every day in 2009.

Social media has different uses and importance. For Urista, Dong, & Day, 2009,

social network sites help fulfill communication needs and wants. It is a convenient

communication method and provides the ability to stay connected with friends and

family, but at the user's rate and time. Users can manage their interactions within their

schedule by choosing when they want to read and respond. Internet communication is a

solitary activity. This means that it could be done alone. However, it is efficient because

it is a one-to-many communication method that allows users to spread information

quickly.

Nursing students, as potential practitioners, are supposed to be responsible

social media users. However, the rapid exchange of social media information exposes
them to the risk of transmitting unprofessional practices, such as privacy and

confidentiality violations. Social media messages should be carefully considered, and

that patients' clinical cases should not be posted on social media. Repeated cursing,

liking a disrespectful post or comment about a fellow student or an organization, using

false names or someone's identity, and sharing photographs or videos while intoxicated

with alcohol were the most commonly seen unprofessional activities on social media.

Without adequate guidance and understanding of social media professional conduct, it

is possible to predict a future increase in unprofessional social media activities that can

contribute to ethical and legal consequences. Academic nursing institutions should

consider developing approaches to resolve this issue, such as developing policies that

define social media actions that could lead to disciplinary action. (Edge W. 2017).

Meanwhile, Gikas, J., & Grant (2013) investigated the utilization of social media

use. The research is focused on finding the characteristics of social media use and the

productive use of social media. The study aims to determine undergraduate students'

reasons for using social media in their daily lives and know the different practices in

social media. There is a phenomenon known as "sophomore slump" wherein students

who are in their second year of nursing study develop low self-efficacy, which to a great

degree determines academic success. One strategy to help build up self-efficacy is peer

learning.

Nursing students, as future nurses, must display good practices on social media.

Students need to adhere to the codes of e-professionalism. According to Duke et al.

(2017), social media shows can be an effective tool in the healthcare profession,

especially in communication and collaboration. Communication through social media

has been a way of life for us nurses. There is excessive reported usage of smartphones

among nursing students nowadays, which can be very beneficial and helpful but can

also cause implications if not appropriately used in personal and academic use.

Furthermore, Kim et al. (2016) tackle the relationship between social engagement and

digital social media, showing a positive correlation between the students' sense of

belonging and social media and smartphone usage, thus encouraging students'

participation in online activities. The study provides empirical evidence regarding the

positive impacts of digital devices on student behaviors and how it plays a part in

understanding how their sense of belonging may result in social engagement using

social media and smartphone devices.

For this reason, (Oducado et al., 2019) conducted a study that tackles the

student nurses' perception and attitude towards responsible social media use. The

findings of the study revealed that nursing students are indeed wide users of social

media. Nursing students also had good perceptions and attitudes concerning

responsible social media usage. Social media is continuously gaining interest among

the students. Hence, responsible use must be upheld. The researchers suggest that

Academic nursing institutions must formulate approaches that promote social media

literacy in nursing education.

THE PROBLEM

STATEMENT OF THE PROBLEM

The study aimed to determine the level of knowledge, attitudes, and practices on

social media use among nursing students at the University of Bohol. Specifically, it

sought to answer the following questions:

 1. What is the demographic profile of the respondents in terms of:

1.1 Age;

1.2 Sex;

1.3 Religion; and

1.4 Year level?

2. What are the respondents' levels of knowledge, attitudes, and practices on social
media use?

3. Is there a significant relationship between the respondents' profile and the following:

3.1 Level of knowledge;

3.2 Attitudes; and,

3.3 Practices?

4. Is there a significant correlation between the following:

4.1 Level of knowledge and attitude;

4.2 Level of knowledge and practices; and

4.3 Level of attitude and practices?

5. What recommendations can be drawn based on the findings of the study?

Null Hypotheses

1. There is no significant relationship between the respondents' profile and their

level of knowledge, attitudes, and practices.
2. There is no significant correlation between the respondents’ level of knowledge
and attitude, level of knowledge and practices, and attitudes and practices.
Significance of the Study

The researchers believe that the findings of this study will serve as a benefit of

the following:

Nursing students. The study is significant because this will provide new

information, knowledge, and awareness about social media use.

Family/Significant Others. This study provides new information about social

media and the different practices in social media.

Persons using social media. This study is significant to people using social

media to give them ideas about the different knowledge, attitudes, and practices giving

them awareness about their social media uses.

School Administrators. This study will raise the concern of knowing how the

University of Bohol-College Nursing Students render and perform the specific task in

social media's proper practice.

Future researchers. This study will be a source of reference to future

researchers who will attempt to tackle large-scale research studies about the

knowledge, attitude, and practices towards social media.

 Legal Basis
THEORIES
The Code of Ethics for Nurses
Albert Bandura’s Social
Social Media Regulation Act
Learning Theory of 2017
Theory of Planned Behavior by RA 10173 Data Privacy Act
Icek Ajzen

Input
 Demographic profile of the respondents
 Level of knowledge, attitudes, and
practices on the use of social media

Process
Data Gathering
Data Analysis
Data Interpretation
Conclusion

FIGURE 1
Research Flow
 Research Methodology

Design

This study utilized quantitative research, which used a descriptive design to

explore the level of knowledge, attitudes, and practices on social media use among

nursing students of the University of Bohol. This study employed a simple random

sampling technique. The quantitative approach arises from the belief that human

behavior and phenomena can be studied objectively.

Respondents

The study's targeted respondents were two hundred (200) nursing students of

the University of Bohol. The inclusion criteria included those students who are officially

enrolled in the nursing department from Level 1 to Level 4 of the school year 2020-

2021, regardless of age and gender. Exclusion criteria included students from the

University of Bohol outside the Nursing Department. The respondents were chosen

utilizing random sampling. Table 1 presents the distribution of tables for respondents.

Table 1 - A

Distribution of Respondents
N= 200
Percentage of
Year level Total population Target respondents
Distribution
Level I 160 82 41%
Level II 111 56 28%
Level III 88 45 22.5%
Level IV 33 17 8.5%

Environment
 The locale of the study was the University of Bohol, located in Dr.Cecilio Putong

Street Tagbilaran City, 6300 Bohol, Philippines. It is a private non-sectarian co-

educational institution of higher learning in its 74 th year, established as the Rafael Palma

College in 1946. The main building is located along Maria Clara Street with some

departments in the vicinity. It is the first university to be established in the province of

Bohol.

As a premier university, the University of Bohol envisions transforming lives for a

great future. Its mission is to provide a holistic education anchored on virtues:

Scholarship, Character, and Service. Specifically, the University of Bohol has the

following goals: Developing self-reliant, self-sufficient, and globally competent students

equipped with relevant knowledge and skills. The University of Bohol has an offered

course of College of Nursing, composed of levels I, II, III, and Level IV. The researchers

wisely chose the environment for they know that they can gain active respondents, and

the place is easy to access.

FIGURE 2
Instrument Vicinity Map
 The study utilized a researcher-made questionnaire to answer questions

regarding the level of knowledge, attitudes, and practices towards social media use

among nursing students in the University of Bohol. Some of the questions were

formulated based on the tool of Oducado et al (2019) entitled “Perceptions and Attitudes

Toward Responsible Use of Social Media”. The questionnaire played a crucial role in

gathering data for the completion of the study.

Pilot testing of the tool was conducted on ten (10) respondents within the

inclusion criteria. It was subjected to Cronbach’s alpha analysis, where the statistician

measured the tool's reliability or internal consistency. The results were within acceptable

values (≥ .70) as shown below:

Level of Knowledge, Attitudes and Practices Cronbach’s Alpha Values

on the Use of Social Media among
Nursing Students
University of Bohol

Knowledge .847
Attitudes .712
Practices .800

The instrument has four parts. Part I contains the demographic profile of the

Respondents, including their age, sex, religion, and year level. Part II includes ten (10)

statements, all of which aims to assess the respondents' level of knowledge on social

media use and can be answered using a scale below:

KNOWLEDGE

SCALE SYMBOL DESCRIPTION MEANING INTERPRETATION

Extremely Knows how to do Highly
4 EK Knowledgeable independently with knowledgeable
ease
Moderately Knows how to do Average
3 MK Knowledgeable independently with
little difficulty
Slightly Knows how to do Somewhat
2 SK Knowledgeable with help or knowledgeable
assistance
Not Does not know how Not knowledgeable
1
NK Knowledgeable to do it at all at all

Part III, which is designed to assess the respondents' attitudes, consists of five

(5) statements wherein the respondents can choose to check the column that

corresponds to their answer using the scale below:

ATTITUDE
SCALE SYMBOL DESCRIPTION MEANING INTERPRETATION
Extremely Positive
4 SA Strongly Agree Very true
Attitude
Moderately Positive
3 A Agree Mostly true
Attitude
Slightly Negative
2 D Disagree Not very true
Attitude
Strongly
1 SD Not true at all Negative Attitude
Disagree

Part IV is created to determine the social media practices of the participants. It

has a total of ten (10) statements, which the respondents can answer by utilizing a

scaling of:
PRACTICES

SCALE SYMBOL DESCRIPTION MEANING INTERPRETATION

4 A Always Practiced all the Highly practiced
time
3 O Often Frequently Moderately
practiced practiced
2 S Sometimes Rarely practiced Slightly practiced
1 N Never Not practiced at all Not practiced

There were items in the tool that were reversed and re-coded in the responses,

whereby a high score is transformed into its corresponding low score on the scale. This

is because the items were negatively stated and must be reversed in scoring. The

items included under attitude are items 4 (Safe when sharing private information about

myself and the patients on different platforms) and 5 (It is convenient to ask patients for

information by messaging them on their social media accounts to help with RLE

requirements). The items reversed under practices are items 9 (Share patients clinical

information with classmates) and 10 (Voice out concerns towards the clinical instructors

and oter staff members in the College of Nursing).

Data Gathering Procedures

The researchers selected 200 respondents from the University of Bohol College

of Nursing through simple random sampling. The researchers used a self-made

questionnaire as a tool to get accurate data and responses from the respondents.

Transmittal letters were sent to the Dean of the College of Nursing, as well as the VP of

Academics for approval. The questionnaire was then given to the respondents as

Google form, an online platform for conducting a survey. The researchers stated the
purpose of the research study, gave proper instructions to the respondents, provided

the researchers’ contact information, and asked them through Messenger application to

directly answer questions or concerns from the respondents. Privacy and confidentiality

were strictly observed throughout the study's conduct as the respondents were assured

that the data gathered would be used for research purposes only. The respondents will

be given a copy of the results of the said study for their future reference.

Ethical Considerations

Primary ethical concerns were observed and considered throughout the conduct

of the study. The study underwent an ethics review by the Ethics Review Committee of

the University of Bohol. The study encouraged the respondents' voluntary participation.

It was emphasized that the participants had the option to withdraw from the study at any

stage if they wished to do so. Informed consent was collected from the respondents

after the purpose of the study was presented to them. Since the survey was conducted

online, privacy and confidentiality were strictly followed throughout the study's conduct.

The respondents were assured that the gathered data would only be used for research

purposes.

Statistical Treatment

The gathered data underwent a normality test to determine the appropriate

statistical tests to be used. Results revealed that the distribution of the data was

skewed. Hence, nonparametric tests were employed in testing the hypotheses of the
research. Below is the summary table of the statistical treatment of data utilized in this

research:

Table 2 - A
Dummy Table for Statistical Treatment

Statement of the Variables Statistical Treatment of

Problem Data
1. What is the Age Frequencies and
demographic profile of the Sex Percentages
respondents in terms of: Religion
1.1 Age; Year level
1.2 Sex;
1.3 Religion; and
1.4 Year level?

2. What are the respondents' Levels of Knowledge Weighted Mean

levels of knowledge, Level of Attitudes
attitudes, and practices on Level of Practices
social media use?

3. Is there a significant Age Spearman Rank Correlation,

relationship between Sex and Chi-Square Tests
respondents’ profile and the Religion
following: Year level
3.1. knowledge; Levels of knowledge,
3.2 attitude; and, attitudes, and practices on
3.3 practices? social media use

4. Is there a significant Levels of Knowledge Spearman Rank Correlation

correlation between the Level of Attitudes Test
following: Level of Practices
4.1 knowledge and attitude;
4.2 knowledge and practices;
and,
4.3 attitude and practices?

Operational Definition of Terms

Attitude

It refers to beliefs, feelings, and manners of action toward using social media

among nursing students.

e- professionalism

Refers to nursing students' attitudes or behaviors as they engage in social media

activities and their adherence to the ethical codes relevant to the nursing profession.

Knowledge

Refers to one's ideas or facts that he/she acquired through experience; it is not

necessarily true or untrue since one's knowledge could be practical or theoretical. It

measures or identifies how much the respondent is aware on using social media.

Media Literacy

Refers to students' ability to distinguish one type of media from the other, analyze

information, and correctly receive or create messages through media.

Practices

Refers to applying nursing students’ knowledge on using social media; it is the

actual performance or use of a belief or understanding; practices are the things being

done, may it be habitually or unusually. Practices would tell how the respondent acted

upon a particular topic based on the respondent's knowledge.

Social Media

A platform where students and teachers can create online communities facilitates

exchanging information by sharing documents, photos, or videos relevant to their

studies.

Technology
 It is defined as a purposeful application of knowledge, skills, and experiences in

using resources to create products or systems to meet human needs.