'Just a picture of her butt' — an analysis

Dr. Eleanor Barbera
Dr. Eleanor Barbera

In “A potential lawsuit in every worker's pockets?”, McKnight's Editorial Director John O'Connor describes two of many recent incidents of long-term care workers using their cell phones to record residents in embarrassing situations and post the photo or video to social media.

Despite leading to termination of employment and lawsuits, some of the employees involved appear to have no idea that this behavior is a serious ethical breach. Staff writer Emily Mongan offers the following quote in her article on this topic: “They just blew everything out of proportion,” [the offending employee] said. “It was just a picture of her butt.”

Wondering how an employee could possibly think posting a photo of a resident's behind to social media would be a reasonable action to take, I contacted psychologist and social media expert Keely Kolmes, PsyD , to find out.

Changing expectations of privacy

Dr. Kolmes notes that it's become commonplace for people to record moments from their lives and post them to social media, generally without consent from others who might be captured in the photos or videos that are shared.

For example, while I get my daughter's permission before I post anything about her to my private Facebook page, I occasionally find her featured in photos with friends on their pages without prior approval. Posting friendly pictures is considered acceptable in one's personal life (and a parent who asks permission from their child is, I suspect, unusual).

One might argue that there's a distinction between personal and professional situations, yet similar situations frequently occur in professional settings as well, such as discovering you've been featured in a photo on the website of an organization after attending their conference or on your facility website after the holiday party.

Most people are pleased to be highlighted in such photos, but if an organization expects employees to follow their social media policy, these situations are a prime opportunity to show workers that the policy is being followed at the corporate level as well. At facility events, for instance, notify staff members that photos will be taken and may be posted.

Resident/staff boundaries: Whose life/home is it?

Dr. Kolmes and I reflected on the boundaries between residents and staff in general. For instance, I frequently hear complaints from residents about staff members walking into bedrooms without knocking, or loudly chatting about their personal lives during the 11 p.m. change of shift when residents are sleeping.

In these cases, staff members may not have been trained to observe the saying: “The residents don't live where we work, we work in their homes.”

If employees have a “job” focus, then it's perfectly reasonable to walk without knocking into an area where a task needs to be performed or to bond with coworkers over weekend exploits, perhaps as a way of fostering team cohesion. If the focus instead is on working in the residents' homes, then workers naturally would knock before entering someone's personal space and they'd take their conversations to an area where the occupants aren't sleeping.

Similarly, employees might feel it's okay to share online something humorous that happened to them on the job, but if the job is in someone's home, there's a greater expectation of privacy.

Dr. Kolmes notes that privacy expectations are beginning to change in personal situations: After several years of photos and videos of social-media-savvy Silicon Valley gatherings being shared online, hosts are now putting up notices requesting that their guests refrain from online postings about their private events.

Protecting resident privacy

Dr. Kolmes and I discussed the role of staff as professionals caring for a vulnerable population. Employees have a responsibility to protect the online privacy of the residents, in addition to the efforts made to guard other personal information. Dr. Kolmes notes that it's important to be explicit that this includes posting photos of “favorite” residents and other gestures that, despite being well meaning, violate residents' privacy. Staff members may have heartwarming stories to tell about the residents they care for, but theirs are not our stories to divulge, especially without permission.

An alternative: An internal forum for staff members to share anecdotes and fond memories with each other, such as a newsletter where an editor can limit what details are being disclosed.

Social media policies and training

Another social media expert I contacted, Ed Bennett, who created the Hospital Social Media List now maintained by the Mayo Clinic, recommends the following social media policies, with the first on the list being his favorite:

• Dartmouth-Hitchcock.org

• MassGeneral.org

• McLeanHospital.org

• Crouse Hospital

Risk Control Director Betty Norman also offers helpful guidelines in her December 2015 article, “Social media: A risk analysis.”

Dr. Kolmes recommends weaving social media training into programs already in place, such as HIPAA education. If facilities need more detailed social media guidance, she provides programs that address the many ethical issues that arise: confidentiality, informed consent, “Googling” residents and their family members, “Friending” or “LinkingIn” residents and their connections, etc.

The use of social media can be quite complicated and observing appropriate decorum is not necessarily intuitive. With cell phones and Internet access ubiquitous, it's more important than ever to regularly and repeatedly teach staff how to handle it appropriately.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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