Use of textmessagingservices

Guidance fornurses working with children andyoung people

Acknowledgements

This guidance has been produced by the Royal College of Nursing School NursesForum with support from the RCN Informatics Forum.

Special thanks go to:

Chris Cox, Assistant Director, RCN Legal Services

Sharon Levy, RCN Informatics Adviser

Fiona Smith, RCN Adviser in Children’s and Young People's Nursing

RCN Legal Disclaimer

This publication contains information, advice and guidance to help members of the RCN. It is intended for usewithin the UK but readers are advised that practices may vary in each country and outside the UK.

The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed.Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it isimpossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to anyperson or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what iscontained in or left out of this website information and guidance.

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Nurses, midwives and healthvisitors working in a variety ofenvironments might want to use text messaging servicesfor communicating withchildren and young people.

This document aims to raiseawareness about the complexissues around using textmessaging on mobile phones.It provides guidance for writinga policy, consideration forpractice, and further reading to assist nurses to develop asafe and effective service.

Introduction

Technology is a central aspect of youngpeople’s lives and provides the newmedium of conversation. Short messageservices (SMS), such as text and email,use young people’s language and allowaccess to information or discussionabout their health problems withoutface-to-face contact.

Research has shown increasingnumbers of children and young peopleown a mobile phone and under 25 year

olds are more likely to communicate bytext message than by a telephone call(MORI, 2005).

Text messaging can provide access andsignposting to health and adviceservices for young or vulnerable peoplewho would not access services bytraditional methods.

This document is aimed at nursesworking with children and youngpeople, however its content is relevant toany health care professional setting uptext messaging services. It is importantthat nurses are familiar with and adhereto their professional guidance.

Text messaging servicesand levels of use

There are three different ways to usetext messaging and some localdiscussions need to take place aboutwhat type is suitable for your service.

✦ SIMPLE: This type of messagingservice is initiated by the serviceprovider and is usually a reminderor question about an appointment.One example of existing practice isthe oral contraceptive reminder for15 to 25 year olds in Birmingham(Nursing Times, 2004).

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✦ SPECIFIC:

Automated. A client initiates a request for information orsignposting to other services andreceives a programmed response.Examples of organisations whichuse this practice include BrookAdvisory Centres and the EatingDisorders Association.

Personal response. This service isclient-initiated and a nurse respondsto a specific question about personalhealth. It can lead to a consultationor referral to other service providers.Examples of existing practiceinclude East Kent School Nurses, andCeredigion School Nursing Services(James, 2004).

✦ SERIOUS: This describes a client-initiated disclosure of an event orcause for concern. There are noexamples of this, but could, forexample, include disclosures aboutabuse, self harm, serious drugmisuse or potentially lifethreatening situations. Localprocedures need to be in place todeal with these potential situations,and practitioners need to haveaccess to supervision.

Governance principles fortext messaging

In accordance with the NMC Code ofProfessional Conduct nurses must treatinformation about patients and clientsas confidential and use it only for thepurpose for which it was given (NMC,2004). Nurses must ensure that an up-to-date organisational confidentialitypolicy exists in their specialty whichincludes the use of mobile phones.

Issues to consider whensetting up a textmessaging service

Nurses need to reassure themselves thatthe benefits to children and youngpeople of implementing a textmessaging service outweigh the risks.For example, ask yourself if you areproviding a service because of need orbecause of current trend or youthculture.

You should also:

✦ establish client demand through aneeds assessment

✦ ensure all stakeholders enterdiscussions to agree a local policybefore implementing the service.

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Procedures need to be in place formanaging potential risks, forexample self harm, child protection,underage pregnancy, refusal offurther contact, or abuse of serviceby either service user or provider

✦ consider the possibility of increasedworkloads and the use of resourcesrequired for handling a number oftexts

✦ consider how, when and where thephone is to be used. For example, itis not acceptable to answer texts ifyou are on a break or on annualleave

✦ ensure any new service is subject toagreed audit, review andmonitoring.

Accountability

Nurses must always be accountable fortheir actions when caring forpatients/clients, and ensure that theyadhere to the following:

✦ all new, specific services should besupported by local protocols and allstaff should be appropriately trainedand have access to clinical and childprotection supervision

✦ professional reasoning andjudgement must be used whenresponding to text messages basedon the information received. It mustbe regarded as patient contact

✦ all messages should be documentedand include the followinginformation: text, telephonenumber, time, response, anyappointment made and/or referralto other agencies, date and signatureof nurse. This should then betreated as any other clientdocumentation in keeping withNMC guidelines on record keeping(NMC, 2005). Documentation maybe written, but a computer-generated system with shortmessaging service software may bepreferable (see examples on page 4)

✦ all received messages should bedeleted from the receiving handsetafter documentation to maintainhigh standards of confidentiality.

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Computer-generated and computer-recordedoptions

Computer-generated systems with shortmessaging software can be an efficientway of generating, monitoring andrecording correspondence by SMS. Twotext-messaging software systems areoutlined below as examples of possible

processes, but there are numerous other systems and options available.The e-recording option for text-basedconsultation requires development but is in a technological field that is rapidlychanging and developing. The level ofdevelopmental possibility available toany professional will vary according towhich option is being considered and thecommitment of the local practice area topurchase and support the e-options.

Example AHealthcare Communications: NHS text softwareProcess for using the software:

Problem: the nurse must be at a PC in order to generate/receive messages that areto be recorded

For more information about this system, see www.healthcomm.co.uk

Nurse logsonto websiteservice

Nursegenerates SMSmessage fromsite screen/facilities.Message canbe pasted intoclient notes

Client replies –message isreceived intosite websiteservice. Replycan be pastedinto clientnotes

Nurse mightwish to usestandardisedguidelineswhich can bepasted intoclient notes,might wish toreply again, ormight be endof SMSconsultation

Allinteractionsare passwordentryprotected andfull audit ispossible,includingconfirmationof receipt/non-receipt etc.All records are kept in real time

Example BTextAnywhere: text email softwareProcess for using the software:

Problem: the nurse must be at a PC in order to generate/receive messages that areto be recorded

For more information about this system, see http://ws.textanywhere.net/web

Nurse logs ontoOutlook (or other usual email service)

Has ‘SMS’ buttonin Outlook whichgenerates aroutine email.Able to sendemail message to mobilenumbers as SMStext. Email can be pasted intoclient notes

Client replies andthe text messageis received intoOutlook as email.

Email reply canbe pasted intoclient notes

This can berepeated as many times as necessary.

Passwordprotected insame way asemail.

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Principles of practice

a) Setting up the service:

✦ nurses should ensure that youngpeople understand that someinformation may be made availableto other members of the teaminvolved in the delivery of their care

✦ young people must be made awarethat confidentiality cannot beguaranteed if a disclosure is made.Nurses should refer to their NHStrust or local authority SafeguardingChildren guidelines

✦ nurses in the NHS should consultwith their appointed CaldicottGuardian (the person within anNHS Trust who is responsible forthe systems that protect patientdata, often the Medical Director)before proceeding withimplementing the service

✦ a named nurse, or nurses, should beresponsible for a specified phone tomaximise confidentiality

✦ to provide an efficient service thespecified phone should havesufficient text characters availablewhich might be more than thestandard 160-190. The equipmentmust be suitable for its use, and beupdated and maintained

✦ coded messages(encryption/security) might benecessary to protect confidentiality,for example pill reminders to under16 year olds

✦ an acceptable list of text languageshould be used in any advertising ofthe service to help preventmisunderstandings from serviceusers and providers. You should alsoconsider including hours of serviceand length of time it is likely to taketo respond to a text in anyadvertising. This is necessary toallow sufficient time in the workingday to respond to difficult orcomplex texts, and will incorporateterm-time, weekend and holidayavailability

✦ practitioners must adhere to theircode of practice at all times.

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b) Operational:

✦ the mobile phone should be lockedaway when not in use

✦ the mobile phone should have apassword known only to the namednurse/s

✦ in the event of loss or theft of themobile phone all precautions shouldbe taken to protect theconfidentiality of children andyoung people. Theft should bereported to the police and thetelephone company, andpractitioners should follow thetrust/health provider’s incidentreporting policy

✦ mobile phone numbers that arecollected in two-way messagingservices must not be used for anypurpose other than to respond tothe text. If you need to make verbalcontact with the young person, youshould obtain their consent by textmessage first.

Evaluation and audit

The text service and informationdocumented from text messagingshould be subject to rigorous andregular audit, clinical supervision,practice development and servicestandards. For example, if texts frompupils at a particular school all relate tothe same matter practitioners mightconsider implementing a schoolinitiative on that topic.

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Making children andyoung people aware ofthe service

Before introducing a text messagingservice, children and young peopleshould be given information about theservice in the form of a card or leafletwhich should include the followingdetails:

✦ the confidential text number

✦ hours and duration of the service

✦ the expected response time (forexample, within 24 hours or twodays)

✦ what confidentiality means,including keeping records of textmessages

✦ that abuse of the service will not betolerated

✦ the designated mobile is to be usedfor a ‘text only’ service

✦ meetings and phone calls from or toa different phone can be arrangedby text

✦ the procedure for complaints,comments and suggestions

✦ what to do if there is no response bythe stated time, for example contacttelephone numbers

✦ what to do if there is no responsefrom the service provider within theagreed time scale, for example, seekadvice from alternative healthprovider, or a contact telephonenumber for GP, sexual health, schoolhealth.

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References

James T (2004) School nursing serviceCeredigion NHS Trust, (unpublishedwork).

MORI (2005) Young people and mobilephones – research for the Nestlé SocialResearch Programme, London: MORI.Available from:www.mori.com/polls/2004/nestlesrp3.shtml (Accessed 6 March 2006)(Internet).

Nursing and Midwifery Council (2004)The NMC code of professional conduct,London: NMC.

Nursing and Midwifery Council (2002)Guidelines for records and recordkeeping, London: NMC.

Nursing Times (2004) Text messagingservice launched to remind youngwomen to take oral contraceptive,Nursing Times, 100 (43).

Further reading

Faculty of Family Planning andReproductive Health Care (2005)Standards of confidentiality forcontraception and sexual health services,London: FFPRHC. Available atwww.ffprhc.org.uk

Utting S (2004) How teenagers got thehealth messages, Primary Health Care,14 (2).

Useful websites

Brook Advisory Centreswww.brook.org.uk

Eating Disorders Association www.edauk.com

Wireless Healthcarewww.wirelesshealthcare.co.uk

Text 4U (Glasgow)*www.nhsgg.org.uk

Young People Nowwww.youngpeoplenow.com

*A mobile phone service which helpsyoung people living in Glasgow to accessinformation about sexual health services.See also www.caledoniayouth.org

March 2006

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