Nurses' Representation in Health News Media: The Woodhull Study Revisited

1. The Woodhull Study Revisited: Nurses’ Representation in Health News Media Diana J. Mason, PhD, RN, FAAN, Principal Investigator Barbara Glickstein, MPH, RN, Co-Investigator

2. Funders Gordon and Betty Moore Foundation Robert Wood Johnson Foundation Beatrice Renfield Foundation Sigma Theta Tau International American Association of Critical-Care Nurses Donald and Barbara Jonas Foundation National League for Nursing Wolters Kluwer Health On Course Learning American Association of Colleges of Nursing American Organization of Nurse Executives

3. Background • Diversity in journalism: newsrooms, topics and sources • Women’s Media Center and Global Media Monitoring Project: women in journalism • 24% of newsroom • 36% of sources in news stories • 48% of sources for health news stories

4. Background • To what extent are nurses used as sources for health-related news stories?

5. The Woodhull Study On Nursing And The Media: HealthCare’s Invisible Partner • Published in 1998 by Sigma Theta Tau International Nursing Honorary Society • Designed and co-directed by Junior Bridge, Unabridged Communications; co-directed by Jane Kirschling, PhD, RN, Sheila Ryan, PhD, RN, then at the University of Rochester, School of Nursing • Named after Nancy Woodhull, a founding editor of USA Today

6. The Woodhull Study On Nursing And The Media: HealthCare’s Invisible Partner • Analysis of health news stories in September 1997 • 2 leading national and 5 metro daily newspapers • 3 general interest weeklies and 1 business weekly • 5 health industry publications • Nurses were quoted in 4% of quotations in newspapers and 1% in weeklies and industry publications. • Nurses never cited in health news stories on policy and rarely identified in photos accompanying the articles.

7. Twenty Years Later… • Phase 1. Are nurses represented as sources and identified in photos in health news stories in public and trade print publications with greater frequency than in 1997? • Phase 2. What do health journalists perceive to be the barriers and facilitators to using nurses as sources in new stories? • Phase 3. Are schools of nursing using social media to highlight the expertise of their faculty?

8. Phase 1. Replication Of Original Woodhull Study • Diana J. Mason, PhD, RN, FAAN, Senior Policy Service Professor, GW School of Nursing Center for Health Policy and Media Engagement • Laura Nixon, MPH, Senior Media Researcher, Berkeley Media Studies Group • Barbara Glickstein, MPH, RN, Director of Communications and Media Projects, GW School of Nursing Center for Health Policy and media Engagement • Sarah Han, BA, Research Associate, Berkeley Media Studies Group • Kristi Westphaln, PhD, RN, Senior Fellow, GW School of Nursing Center for Health Policy and Media Engagement

9. Print News Analysis Methods • Sources • Newspapers (7), weeklies (3), healthcare industry publications (3) • September 1997 • 2,234 articles • September 2017 • 537 articles (random sample)

10. Nurses Rarely Quoted In Healthcare News* In 1997, • 4% in newspapers • 1% in weeklies and industry publications • In 2017, • 2% in newspapers • 1% in weeklies and industry publications *Difference is not statistically significant

11. Nurses Primarily Quoted About Nursing Profession ”There has been an erosion of respect. We have to dispel that notion that being assaulted is just ‘part of the job.’ It is not.” ~Pam Cipriano, President of the American Nurses Association Massachusetts Nurses Association Nurse Elise Wilson was stabbed multiple times in July by a patient unhappy with his medical care.

12. Where Nurses Do Appear Stories about health care quality and public health “…Pairing a primary-care physician with a registered nurse, two medical assistants and a nurse practitioner or a resident physician has led to better management of chronic conditions and reduced reliance on the emergency department.…”

13. Nurses Absent From Stories About Policy

14. Female Sources Are Underrepresented 1997 2017 • Women: 25% • Men: 75% • Women: 34% • Men: 65%

15. Photo Content Analysis Methods • Subject: people or person • Gender • Role • Nurses, Physicians/Dentists, Paraprofessionals, Unidentified Clinicians, Policymakers, Educators, Non-medical healthcare, CEOs/Administrators, Researchers, Celebrities, Patients/Families, Other

17. Nurses And Women Underrepresented In Images Politicians, white males, patients and families, and unidentified clinicians in white coats or scrubs

18. Limitations • Nurses are likely represented as sources at a higher level than reported here because editorial styles remain a barrier to identifying nurses. • Nonetheless, editorial styles have not changed much in 20 years, so comparisons with the original study are likely valid. • This study examined only the print sources used in the original Woodhull study. Future research should examine online health news media.

19. ConclusionNurses remain invisible in health news stories.

20. Phase 2. Health Journalists’ Experiences With Using Nurses As Sources • Diana J. Mason, PhD, RN, FAAN, Senior Policy Service Professor, GW School of Nursing Center for Health Policy and Media Engagement • Barbara Glickstein, MPH, RN, Director of Communications and Media Projects, GW School of Nursing Center for Health Policy and Media Engagement • Kristi Westphaln, PhD, RN, Senior Fellow, GW School of Nursing Center for Health Policy and Media Engagement

21. What do health journalists perceive to be the barriers and facilitators to using nurses as sources in new stories?

22. Methods • Qualitative; semi-structured interviews • Snowballing technique • 10 health news journalists; 2 were men • Telephone interviews recorded, 30 to 60 minutes • Transcribed • Individual researcher analysis, discussion and consensus on themes

23. Findings: High-level ThemeBiases about women, nurses, and positions of power in the health care system can get in the way of journalists using diverse sources in health reporting.

24. Subthemes • Nurses can bring important perspectives to health reporting.

25. Subthemes • Nurses can bring important perspectives to health reporting. • Journalists don’t fully understand the range of nurses’ roles, work, and education.

26. Subthemes • Nurses can bring important perspectives to health reporting. • Journalists don’t fully understand the range of nurses’ roles, work, and education. • Journalists may value diverse sources, but often don’t know how to find nurses to interview and have limited time to track them down.

27. Subthemes • Nurses can bring important perspectives to health reporting. • Journalists don’t fully understand the range of nurses’ roles, work, and education. • Journalists may value diverse sources, but often don’t know how to find nurses to interview and have limited time to track them down. • Communications staff of health care organizations and universities aren’t offering nurses as sources unless journalists ask for them.

28. Subthemes • Nurses can bring important perspectives to health reporting. • Journalists don’t fully understand the range of nurses’ roles, work, and education. • Journalists may value diverse sources, but often don’t know how to find nurses to interview and have limited time to track them down. • Communications staff of health care organizations and universities aren’t offering nurses as sources unless journalists ask for them. • Editorial biases, policies and processes can get in the way of using nurses as sources.

29. Subthemes • Nurses can bring important perspectives to health reporting. • Journalists don’t fully understand the range of nurses’ roles, work, and education. • Journalists may value diverse sources, but often don’t know how to find nurses to interview and have limited time to track them down. • Communications staff of health care organizations and universities aren’t offering nurses as sources unless journalists ask for them. • Editorial biases, policies and processes can get in the way of using nurses as sources. • Nurses and their associations aren’t strategic about engaging journalists.

30. Phase 3. Use of Twitter by Schools of Nursing Kimberly D. Acquaviva, PhD, MSW, CSE, Professor, GWU School of Nursing

31. Research Questions • To what extent are the top 50 schools of nursing using hashtags that could attract/invite attention from journalists and media outlets on Twitter? • To what extent are the top 50 schools of nursing being followed on Twitter by journalists and media outlets?

32. Methods • 47 of the top 50 schools of nursing had public Twitter accounts • Analyzed most recent 3,200 tweets 9/29/2016 – 2/22/2018 • Collectively, the 47 schools of nursing had 101,544 Twitter followers • Hashtags and followers were coded and analyzed using R version 3.4.3, R Studio Version 1.1.423, and Microsoft Excel for Mac Version 15.38

33. Hashtag Analysis • 31,762 tweets met the date inclusion criteria • 15,119 of those tweets contained hashtags • 11,143 tweets contained one of 84 hashtags that had been used 40 or more times across the corpus of tweets  “most frequently used hashtags” • Most frequently used hashtags appeared in 73.7% of the tweets in which hashtags were used • Thematic analysis of most frequently used hashtags  6 categories of hashtags, further divided into inward- and outward- facing hashtags

34. Hashtag Findings • Among 11,143 tweets containing at least one of the most frequently used hashtags, only 20.17% of hashtags used were outward-facing: • Inward-Facing Hashtag Categories • Nursing-Specific hashtags were present in 35.37% of tweets. • School-Specific hashtags were present in 36.77% of tweets. • Conference or Twitter Chat hashtags were present in 7.69% of tweets. • Outward-Facing Hashtag Categories • Illness/Disease/Condition hashtags were present in 5.46% of tweets. • Health hashtags were present in 5.22% of tweets. • Something Else hashtags were present in 9.49% of tweets.

35. Follower Analysis • 101,544 total Twitter followers • 58,184 of these were unduplicated user accounts • Ran an R script to detect journalists, reporters, and other members of the media in the dataset of followers. Yielded list of 1,718 accounts. • Manually coded 1,718 follower accounts into categories and grouped them as member of the media or NOT member of the media

36. Followers Of The Top 47 Nursing Schools

37. Woodhull Revisited: Conclusion • Nurses remain invisible in health news stories, with no progress being made during the past 20 years. • Improving health reporting is dependent upon addressing the barriers to using nurses as sources. • Doing so requires actions by newsrooms, journalists, communications/PR staff in health care organizations and universities, and nursing organizations. • Future research should examine nurses’ representation in online health news media.

38. Reaction Panel • Cristal Williams ChancellorDirector of Marketing, Women’s Media Center • Yanick Rice LambChair, Department of Media Journalism and Film, Howard University • Ivan OranskyPresident, Association for Health Care Journalists

39. National Advisory Committee • CrestaArchuletta, National Hispanic Nurses Association • Connie Barden, American Association of Critical-Care Nurses • Mary Boyle, AARP Center for Championing Nursing in America • M. Junior Bridge, Media Consultant • Sheree Crute, Communications/Journalist • Katti Gray, Journalist • Jane Kirschling, University of Maryland • Elizabeth Madigan, Sigma Theta Tau International • Ivan Oransky, Retraction Watch • Sheila Ryan, University of Nebraska • Liz Seegert, Journalist • William Watson, Media Consultant • Tennessee Watson, Journalist • Louise Woerner, HCR Home Care

40. Contact Information Diana J. Mason djmasonrn@gwu.edu Barbara Glicksteinbglickstein@gwu.edu Laura Nixon nixon@bmsg.org Kristi Westphalnk_westphaln@yahoo.com Kimberly D. Acquavivaacqua@gwu.edu