Tag: Ervin Goffman

Strict father or nurturing parent? Family metaphors and socio-political values

Ever wonder why Tories like Ian Duncan Smith are focusing on ‘welfare dependency‘ ? Smith argued:

We must be here to help people improve their lives, not just park them on long-term benefits. Aspiration, it seems, is in danger of becoming the preserve of the wealthy.

Do you wonder why politicians such as Congressman Paul Ryan talk about  “cultures of poverty” ? Ryan stated:

We have got this tailspin of culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working or learning the value and the culture of work, and so there is a real culture problem here that has to be dealt with.

Do you know why the ‘strivers v skivers‘ metaphor is being used?

David Cameron has said his party:

“…cares about the strivers, the battlers, the family-raisers, the community-builders”.

It might seem incomprehensible to those who are of the ‘progressive left’ who might feel that the the poor are being stigmatised while the 1% are wrongly lauded as ‘job and wealth’ creators?

An answer is that our much of this political positioning is down to our values rather than as a result of rational fact and argument. Tories state these things because they truly believe them and that they arise out of their values. This of course also applies to progressives. So where do these values come from and what are they?

George Lakoff in ‘Don’t think of an Elephant‘ and ‘The Political Mind’ attempts to describe the link between our values, what they are based in, and our political views.

To do that we have to go back to the beginning of our experiences as human beings and that means our experiences in a ‘Family’.

Every single one of us experienced early life in a family.  That family might be the ‘ideal type’ of the nuclear family beloved of advertisers,  or it might be a ‘reconstituted family’ including second wives/husbands. Sadly, a few grow up in social services care experiencing a ‘family’ of a very different type. The family is an ‘agent of primary socialisation’ in sociological terms – this means we learn social norms, values, behaviours and attitudes as well as a host of other things such as language and modes of dress. The family then is a foundational social experience and our experiences of families provide us with ways of thinking about how we should live together as couples, families and within wider society.

Some of us are for capital punishment, capping welfare and social security, a strong military and intervention,  using force if necessary, to secure the nation’s interests abroad. We might also consider that those who use the railways, or universities,  should be the ones to pay for them rather than taxpayers. The same goes for health in that we should learn to take responsibility and pay for services when we need them. The nanny state should be made redundant and that taxes should be ‘relieved’ or cut to the bone.

The link between our family experiences and our politics is not very clear. We may even think there is no link at all,  and that our social and political views are arrived at after some due consideration and the application of rational thought.

Lakoff however argues that the family provides us with at least two experiences which then act as unconscious metaphors for life:

1. The Strict Father.

2. The Nurturing Parent.

These two models of family life provide us with ‘frames’  – ‘mental structures that shape the way we see the world‘ (Lakoff 2004 p xv). Frames provide us with language and values, they shape our policies, the organisations we devise, what we consider is good bad, moral or immoral. Lakoff’s work follows on from Ervin Goffman who discussed our use of frames in ‘Frame Analysis: An Essay on the Organization of Experience (1974)’.

To over simplify perhaps, this is to say that we all hold both frames, strict father – nurturing parent, in our heads but one may be more dominant than the other. We then approach political and social life and use these frames to explain and give meaning to what we are experiencing and to what we value.

Right wing conservatives tend to have a ‘strict father’ frame while those on the progressive left tend to have a ‘nurturing parent’ frame.  Thus, issues such as social security will be seen by referring back to those frames, and in so doing  we will use particular language  such as ‘striver v skiver’ and invoke values that accord with those frames to explain and gain meaning for issues such as  ‘social security’.

Lakoff’s point is that over the past three decades or so the conservative right have been able to get their frame accepted in the media, by political parties and even in the general population while those of the progressive left have been unable to articulate their frame – ‘the nurturing parent’.  The right has done so by spending billions of $ in think tanks, universities, books, articles, research grants, professorships…..

So what are the features of the ‘strict father’ ?

This frame is based on a set of assumptions:

1. The world is a dangerous place and always will be, because evil exists.

2. The world is hard and difficult because it is competitive.

3. There will always be winners and losers.

4. There are absolute right and wrongs.

5. Children are born bad, in that they only want to do that which feels good rather than that which is right.

6. Children therefore have to be made to do the right thing.

7. This world therefore needs a strong strict father who can: protect the family in a dangerous world; support the family in a dangerous world and teach children right from wrong.

These assumptions draw upon centuries of religious teaching from patriarchal Abrahamic faiths – Judaism, Christianity and Islam – that puts ‘God the (strict) Father’ at the top of the social and universal hierarchy. Early capitalist development in Europe and in the United States was founded upon these principles and found expression in the laws enacted at the time, for example the poor law in England.

Children are required to be obedient, because the strict father has moral authority – originally derived from God – as the head of the house: patriarchy. The only way to teach obedience is through punishment for wrong doing until the child can internalise discipline to do what is right.  A striver has this internal discipline while a skiver does not. Without punishment, there would be no moral authority and the social order would collapse. Moral hazard is invoked as a justification for imposing strict social policies and for not introducing supportive systems. Moral hazard arises when individuals (skivers) or institutions (e.g. trade unions) do not take on the full consequences and responsibilities of their actions. In doing so they have a tendency to act less carefully than they otherwise would.  This might result in someone else bearing responsibility for the consequences of those actions.

This idea was invoked at the inception of the NHS. It was argued that if people no longer had to pay for health care then they might take less responsibility for their health. Free at the point of delivery means people will not then take responsibility, because they don’t pay,  and the NHS i.e. taxpayers, would have to pick up the bill.

The morality of internal discipline has another affect. Discipline is required to be successful in a competitive difficult world; discipline results in self reliance and prosperity. Wealth is a result. Therefore wealth is a marker of discipline and therefore wealth and morality become linked. Those who are wealthy  – the 1% – deserve to be because of their internal discipline and self reliance. Those who are on benefits deserve their poverty because of their lack of discipline and self reliance.

The strict father frame is often supported by referring to the economic theory of Adam Smith in the ‘Wealth of Nations’ and can be seen in its modern incarnation in such conservative think tanks such as the Adam Smith Institute and the Institute of Economic Affairs.

This frame is unconscious, part of our brain structure, and is not invoked explicity in political discussions. When using the language that arise from this frame,  the frame is invoked and reinforced. Conservatives know this,  and hence do not rely on reason or facts to make their case – they invoke the language of the frame and talk about their values. In so doing, they reinforce the strict father frame.

When Andrew Lansley talked about the ‘responsibility’ deal he was invoking the requirement for all of us to exercise internal discipline towards our health, reinforcing the idea that children should learn to act in ways that are healthy and should learn to avoid ‘feel good’ but unhealthy lifestyles. If they fail to do so they should be punished by experiencing the consequences of their actions. The father’s (State’s) job is not to pick up the pieces afterwards. Corporations should be encouraged to support us in our actions but not forced to do so because in the end it is in our own hands to choose the right path.

Let’s revisit those ‘strict father’ assumptions as they apply to health:

1. The world is a dangerous place and always will be, because evil exists. ‘Evil’ in this sense is the existence of dangerous substances such as alcohol, tobacco or illegal drugs; or is sexual desire, lust and promiscuity resulting in STI’s; or high sugar, high calorie foodstuffs.  These things are ‘evil’ and pose a threat to our health.

2. The world is hard and difficult because it is competitive. Living healthily is tough, requires discipline and application above the norm of ‘soft’ living. If we don’t work hard we will not get the rewards of, for example, access to gyms, or good expensive healthy food.

3. There will always be winners and losers. In health terms, this may be that that we are born with good or bad genes that map out for us from birth our health pathways.

4. There are absolute right and wrongs. Smoking is wrong, drinking to excess is wrong, unprotected, teenage sex is wrong, illegal drug taking is wrong…we know all of this this. ‘Just say No’.

5. Children are born bad, in that they only want to do that which feels good rather than that which is right. Adults act like children when they overindulge on fatty sweet foods that they know are bad for them, when they smoke knowing it kills and when they get drunk.  they have not learned to discipline themselves and are acting out on ‘feel good’ emotions.

6. Children therefore have to be made to do the right thing. Adults however, who have not learned to do the right thing, have no internal discipline and should therefore bear the consequences of their actions. The Obese are lazy, morally weak who should just eat less and exercise more. They were not made to do the right thing and have learned unhealthy behaviours. Adults are not children, it is too late and if they are protected from the consequences of their own actions what sort of example is that to give to children? Smokers, drinkers and drug takers should just take responsbility for their actions. Ill health that arises not from behaviour but from “genes” or “chance” invokes  no moral approbrium or blame and therefore health services should be provided. Illness that arises from poor choices and behaviours should really be addressed and paid for by those who make those wrong choices. Why should society pay for bad choices? Alcoholism, drug addiction, STI’s and to a lesser extent diabetes as a result of obesity, or lung cancer and vascular disease from continued smoking,  attract moral judgment and justified stigma.

The strict father knows that adults must bear responsibility, and are no longer entitled to his protection as they should have learned right from wrong.

Reflect on your view of health…what values is it based on…to what extent do you agree with the strict father assumptions?

As for IDS and Congressman Ryan, consider that they are invoking the ‘Strict Father’ frame. In focusing on the ‘parking on benefits’ he is reinforcing the idea that the State should not bail out people through overly generous benefits, this invokes ‘moral hazard’, instead people should be experiencing the discipline of the ‘real world’ – the strict father would be considering that they are adults that need to learn inner discipline which benefits rob them of so doing. Benefits robs people of aspiration, of the inner discipline to do better for themselves because they can receive enough to get by without having to work hard for it. Similarly Ryan is saying that inner city men are learning that work is not for them, they have not learned the inner discipline  to achieve. Further their poverty is proof of their lack of moral worth, they have not learned self reliance. If they act like children by not working  – and by arguing that they have a culture of poverty he invokes a lack of moral will to work – then they need punishing, not a soft cushion.

Stigma – a narrative.

“ Hello, my name is John , and I am an alcoholic”

John (aged 46) lives alone in a bedsit in a less than salubrious part of town. He looks in the mirror each morning and thinks to himself …nothing. He just feels numb. Divorced, he does not know where his children are and now isolated as his employer now reckons he can do “without his services”. His previous landlord had given him notice to quit about 3 months ago.

The landlord had stated at that time that John was not quite what he expected, his demeanour and appearance had deteriorated from when he first moved in. John had  Undesired different-ness from what I had anticipated when I first took him in as a tenant”.

John had carried his few belonging to the new place feeling that now as far as anyone else was concerned he was now “reduced from a whole and usual person to a tainted, discounted one”.

John as was drinker. When drunk his alcoholism was out there for all to see, it became a visible discrediting condition. Those around him could see and avoid him. In the mornings before his first drink he carried his alcoholism inside. He used to be able to function at work quite well, his drinking was invisible known only to John (if he thought about it) as a discreditable condition that he was able to pass off.

Throughout his life he had struggled with feelings of self hate and worthlessness. The drink was a friend. However, he knew it was not the friend it once was. He felt different, unwanted, alone. As life got more difficult he could see the stares even when pissed. Being turned down for jobs and housing when his condition became known was increasingly hard to take. Employers and landlords saw him and acted according to the label ‘alcoholic’. His wife eventually had left him unable to take the shame of having a pissed husband turn up at parties making a fool of himself. She had the courtesy of feeling the shame on his behalf.

It was not as if he had visible skin disfigurements or limbs missing, what some have called ‘abominations’ of the body’ this was not why he felt different. After all when sober he had been fairly well presented and in his younger years quite a good looking man. No, the issue now was that others thought of him as weak, unable to control himself, a laughable character, with a character blemish. It was all to do with who he was as a person, it was not his family’s fault and he could not even argue he faced ethnic discrimination living as he did among his own tribe.

His felt socially worthless life was his fault. He was seen as responsible for his drinking. If he could just put the booze down things could be better. However, some had seen him get worse over the years and though there was nothing that could be done, the drinking was progressively worse and possibility incurable. Many friends and work colleges had of course heard about alcoholism and many had drinking habits of their own which may be problematic. However, few had really understood what alcoholism actually was, how it arises, how it affects people beyond seeing the drunk, and of course being drunk was often hard to conceal.

John sat among the group feeling shame for his past behaviour and a little concerned about how this group would judge him. He had enough experience of how other people had treated him recently and so felt apprehensive about the value judgments they would make and actions that this group would take. He was new to AA and had no idea how this worked, he hoped that as the others had been (or still were) drinkers then maybe they would not judge him so?

His last employer, Mark Taylor, had been particularly hard on him. John’s fellow workers had felt however that Mark had some issues of his own which made the relationship between the two even more difficult. Some had even suggested that Mark was a little self obsessed and was difficult to work with. It was felt that he found it difficult to put the needs of others before his own. This only made his attitude towards John even worse. Mark’s narcissistic personality, it was felt, had just made issues worse. Mark’s stigmatization and harsh treatment of John involved dehumanization, threat, aversion and depersonalization into stereotypic caricatures. For Mark, this served to increase his own self esteem, enhanced his control and allowed “anxiety buffering”, through downward-comparison, i.e.comparing himself to John. This process increased his own subjective sense of well-being and therefore boosted his already over inflated sense of self-esteem.

 

John’s illness experience was being constructed in quite a negative way. His appearance and behaviour singled him out as socially deviant, subject to discrimination, prejudice and stereotyping. His alcoholism was a condition of societal deviance as most people accepted that this was apersonal failing, a sign of moral weakness and lack of control. This was only slightly ameliorated by it being also being seen as a disease. However Johns experience was not that of a patient with an illness that needs medical care, he felt outcast, alone and dirty. It was as if society had two definitions: alcoholism as disease for which John should play the sick role, and alcoholism as deviant behaviour that requires punishment or avoidance.

 

John thus felt ostracized, devalued, rejected, scorned and shunned. He experiences discrimination, and only thinly disguised insults. He began experience psychological distress expressing suicidal ideation as a result of viewing himself with contempt. The drink paradoxically made that feeling go away. It was both savior and nemesis.

 

John’s experiences over the past few years had an effect on his behaviour in that he often started to act in ways that others expect of them. In social situations he learned to withdraw as a result of the avoidance behavior of others. This therefore it not only changed his behavior, but it also shaped his emotions and beliefs. Thus his experiences put his social identity into threatening situations, such as low self esteem. He became more aware of the label alcoholic and thus began to act as he though alcoholics were expected to act. He had nothing to lose, people expected it anyway. He knew that he was not being treated the same way as ‘normals’ and knew he would probably be discriminated against.

 

Post script

Alcoholism – a fault with self?

Not everyone is comfortable with the term stigma or its connotations.  Critics have argued that stigma focuses too much on the characteristics of the stigmatized, and not enough on the social and structural mechanisms that create discrimination and entrench social oppression. http://stigmaj.org/announcement/view/5

To what extent is alcoholism a personal trouble? To what extent is it a public issue? What social structures are involved in ‘creating’ this as a personal and social problem? What is occurring in the 21st century in certain societies that frames the alcoholic experience in particular ways? What discourses are used to describe alcoholism – biomedical. psychiatric, criminal justice, public health, social? How does each discourse frame the issue? Is there a nursing discourse on alcoholism?

 

© Benny Goodman 2011

Goffman on Stigma

“Undesired different-ness from what we had anticipated”.

“reduced in our minds from a whole and usual person to a tainted, discounted one”

1. Medical conditions which give rise to stigma can be:

·         Discrediting conditions (visible).

·         Discreditable conditions (invisible).

2. The experience of stigma can be:

·         Felt – your subjective experience.

·         Enacted – when discrimination takes place, moral judgments made.

·         Courtesy – when friends and family are involved and feel the discrimination or stigma.

3. Sources:

·         ‘Abominations’ of the body.

·         Blemishes of character. weak will, domineering or unnatural passions, treacherous and rigid beliefs, or dishonesty. Blemishes of character are inferred from, for example, mental disorder, imprisonment, addiction, alcoholism, homosexuality, unemployment, suicidal attempts, or radical political behaviour.

·         Tribal, e.g. arising from race, nation and religion. beliefs that are transmitted through lineages and equally contaminate all members of a family.

4. According to Goffman, diseases associated with the highest degree of stigma share common attributes:

·         The person with the disease is seen as responsible for having the illness.

  • The disease is progressive and incurable.
  • The disease is not well understood among the public.
  • The symptoms cannot be concealed.

Goffman, E. (1963) Stigma: Notes on the management of spoiled identity. Englewood Cliffs, Prentice Hall.

Society, Socialisation and Culture

Sociology in Nursing

 

This short paper discusses the meaning of three key words:

 

·         Society

·         Socialisation

·         Culture

 

There will be other words in blue and bold which also have specific meanings. These are hyperlinks to Wikipedia which is a useful introduction, however you will have to access books and journals if you wish to discuss these terms in academic writing.

 

 

What does the terms ‘society’ mean?

 

A large group of people who relate to each other. That is to say they work, interact, live in a shared ‘space’ be that geographical, occupational or recreational. They of course are not all in kin or family relationships, with the nature of the relationship often being transactional (‘for a purpose’) rather than emotional. Therefore human societies can be characterized by a shared and distinctive culture and institutions.  A society may be described as the sum total of such relationships among its members. A society can be a particular ethnic group, such as for example those who grandparents may have been from the Indian subcontinent; a nation state, such as Scotland; or a broader cultural group, such as a Western (Anglo-American) society.

From a sociological perspective, a larger society often manifests stratification and/or dominancepatterns among the groups that make it up. For feminist thinkers, many societies are dominated by men and male ways of thinking (Patriarchy), for those of a marxist persuasion societies are dominated by ruling class elites and their ideologies.

In nursing, there is discussion that society is patriarchal. This results in male values and ways of doing things becoming to be seen as more important than female. Also because nursing is female dominated and medicine male dominated these male values often result in nursing being understood as an inferior profession (Goodman and Ley 2012 p36-41).

If it is a collaborative society, the members can benefit in ways that would not otherwise be possible if they remained as individuals. British society since 1948 generally agreed on the social funding, out of personal taxation, of a health care system we call the NHS. Currently British society is showing less cohesiveness (what Zygmunt Bauman calls ‘liquid modernity’) and arguments now arise on how the NHS should be funded or delivered. 

A society can also consist of like-minded people governed by their own norms and valueswithin a dominant, larger society. This is sometimes referred to as a subculture. For nursing we can think of subgroups, especially our professional subgroups, who may have shared norms and values and who may develop quite distinct views, knowledge and attitudes towards health. This means we need to examine our relationship as professionals to our patients and clients and to other professional groups.

In sociology a key issue for understanding how societies work was whether societies arise from the collection of individual actions of ‘free agents’ and therefore if this is the case we need to investigate these social actions at the small group and individual level; or whether societies are characterised as having groups and institutions within them all fulfilling various functions such as child rearing and therefore we need to investigate the functioning of society; or whether societies are riven with group conflict (be they class or gender conflicts) and therefore we need to investigate the nature of this conflict.

From the first viewpoint we could investigate the ‘presentation of self in everyday life’, (see the work of Ervin Goffman) that is to say, how do we go about our daily business ensuring we know what ‘actions’ we need to undertake, for example as a nurse, and how do we manage the impression people have of us? This involves the wearing of uniforms and ways of speaking so as to play the role of ‘professional’. From the second viewpoint we might want to investigate what being sick means for the functioning of society and thus what role should be played by a sick person (see the work of Talcott Parsons). What are the rights and responsibilities of the sick person in a proper functioning society? From the last viewpoint we would want to investigate if health care professionals really serve society as they say they do or whether they actually serve themselves and are in conflict with other groups in society. We would look at the structure of rewards and status in society of, for example, doctors and/or men as doctors (see the work of Ivan Illich).

 

 

 

Case study: Mid Staffordshire NHS Foundation Trust Inquiry March 2010

 

In 2010, Emily Cook (a health correspondent for a daily paper) reported that up to 1,200 patients may have died as a result of “shocking” treatment at Stafford Hospital. This story was based on a report by the Healthcare Commission which stated that Mid Staffordshire NHS Foundation Trust had an appalling and chaotic system of patient care.

The Healthcare commission (now the Care Quality Commission) had a role in examining the quality of care delivered by NHS organisations. The Commissions’ report argued that between 400 and 1,200 more people died than would have been expected during 2005 to 2008.

According to Cook, families described ‘Third World’ conditions in the hospital with some patients resorting to drinking water from flower vases because they were so thirsty.  Some of the conditions reported included filthy, blood and excrement crusted wards and bathrooms, patients being left in pain and needing the toilet, and being left sat in soiled bedding for hours and not given their regular medication. In one ward, 55 per cent of patients had pressure sores when only 10 per cent had sores on arrival.

The health minister at the time was concerned enough to order an inquiry. In a 452 page report, Robert Francis QC outlined the shortcomings in care in and argued “It was striking how many (patient’s) accounts related to basic nursing care as opposed to clinical errors leading to injury or death”. The conclusion was that patients were ‘routinely neglected’ in the context of cost cutting, targets and processes that lost sight of the basic need to provide safe care.

 

Many patients had their basic needs neglected:

 

·      Calls for help to use the bathroom were ignored.

·      Patients were left lying in soiled sheets.

·      Patients were left sat on commodes for hours.

·      Patients were left unwashed – at times for up to a month.

·      Food and drink was left out of reach.

·      Family members had to feed patients.

·      There was a failure to make basic observations.

·      Pain relief was given late.

·      Patients were discharged inappropriately.

·      There were poor standards of hygiene.

·      Families removed dressings and had to clean toilets.

 

 

 

The reasons outlined in the report for these deficiencies in care were as follows:

·      A chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care.

·      Morale at the Trust was low.

·      Many staff did their best in difficult circumstances, others showed a disturbing lack of compassion (my emphasis) towards their patients.

·      Staff who spoke out felt ignored and there is strong evidence that many were deterred from doing so through fear or bullying.

 

The Trust’s board was found to be:

 

“ disconnected from what was actually happening in the hospital and chose to rely on apparently favourable performance reports by outside bodies such as the Healthcare Commission, rather than effective internal assessment and feedback from staff and patients.

The Trust “failed to listen to patients’ concerns”, the Board did not “review the substance of complaints and incident reports were not given the necessary attention”.

 

Quotes are from   http://www.midstaffsinquiry.com/news.php?id=30

See http://www.midstaffsinquiry.com/ for the report into Mid Staffordshire NHS Trust.

 

 

 

Please read the case study above and then think about what this says about our society, how we are socialised and what a culture may mean.

 

Next I will address two key concepts in sociology – socialisation and culture – and relate them to what was going on at Mid Staffordshire and how they apply to your own nursing practice.

 

 

 

What is socialisation?

 

Staff at the Mid Staffordshire NHS FoundationTrust may have been socialised into a particular culture that was detrimental to good care. But what is meant by ‘socialisation’? 

One possible definition is as follows:

We may understand the idea that we are born into a society that has certain rules of behaviour and we, as human beings, learn these rules through a process of socialisation. Socialisation simply means the various ways we learn how to be a human being and are taught the basic rules of society we live in. (Goodman and Clemow, 2008, page 78).

 

Therefore socialisation is the process by which we learn the customs, norms, values, attitudes, beliefs, mores and behaviours of our society, i.e. how we acquire our culture. However, socialisation provides only a partial explanation for the acquisition of culture. People are not blank slates to be written on by our society. We are not robotic social actors blindly learning culture. Scientific research provides strong evidence that people are shaped by both social influences and their hard-wired biological makeup Genetic studies have shown that a person’s environment (socialisation) interacts with their genotype to influence their behavioural outcomes. So, society shapes us through socialisation and we also act as agents to socialise others. Our genes do not determine our behaviour and are in fact affected by the social environment.  

The following activity asks you to consider your own socialisation.

 

Activity

 

a. Think back to your first day at secondary school. How did you know how to behave with other pupils and with the teachers. How did you learn the formal (and informal rules) for being a pupil in class (i.e. how were you socialised as a pupil)?  

 

b. Think about right now and what is happening to socialise you first as a student and secondly as a nurse.

 

c. Now identify just one aspect of your health and how it has been shaped by your socialisation. Consider, for example, your alcohol consumption and the likelihood of developing problems with alcohol.

 

 

Socialisation shapes our behaviour in quite fundamental ways to the extent that we begin to feel that we could not behave in any other way. Take a common student pastime: drinking.  The use of alcohol in western society is seen very differently from that in a Muslim society. People living in Muslim families, in the UK as well as abroad, may well be socialised into very different views on drinking. Young westerners ‘feel’ that going to the pub is very normal and to be expected, whereas their counterparts from a devout Islamic background may not feel the same way. However as this example indicates socialisation is not so strong that behaviour never changes as young British Muslims may feel themselves being socialized into two different cultures and this results in a tension that has to be resolved.

 

A related idea is that of ‘Occupational’ socialisation i.e. how one learns the customs of an occupation. The suggestion here is that many occupations (and professions) have their own ways of speaking, dressing and acceptable modes of behaviour. Melia (1987) described the occupational socialisation of student nurses, while over 30 years old, this study sheds light on how we become the nurses we are and illustrated the tension felt by students as they juggle the demands of education and the service needs of the NHS. The clinical area demands a certain behaviour (doing the work) while the University expects another (studying).

 

As student your focus may be on learning about medications; their administration, prescription, side effects and contra indications and so you may wish to spend time asking about drugs or reading the British National Formulary while you are in practice. Your University may highly value this activity. Your clinical practice setting may also value this knowledge but what may be of more immediate importance is that you assist the qualified staff in actually administering the drugs themselves, time being too short to look up every single one. The university may value knowledge, the practice setting may value ‘getting the work done’.  Of value also is that knowing how to find out a piece of information that is specific to a particular patient or situation is perhaps more important than carrying the complete contents of the BNF around in your head.

 

What is culture?

 

The shared beliefs, norms values, attitudes, mores and behaviours of a society is its culture. This involves language use, the way we dress, the food we eat, what leisure we like, whether work is valued …even what sports we value. Into this mix are ideas about dominant and subordinate cultures, or sub-cultures, within wider culture. Culture is dynamic and subjective. It changes over time (sometimes rapidly). It is defined by those who are experiencing it and will mean different things to different people. Therefore, and from an understanding of how we become socialised into a culture as described above, we may see that culture affects how we behave, our attitudes and our values. At Mid Staffs the organizational culture was described as having elements of:

 

·      Bullying

·      Target driven priorities

·      Disengagement from management

·      Low staff morale

·      Isolation

·      Lack of candour

·      Acceptance of poor behaviours

·      Reliance on external assessment

·      Denial

 

So it can be hypothesised that despite professional codes of conduct some nursing staff were or socialised into accepting poor practice. Although staff did raise concerns, the culture was such that not enough was done to prevent poor quality care.

 

Socialisation and culture can be viewed as strong social ‘forces’ that shape how we go about our business in an organization. We may think we are completely free agents making free choices, but the experiences of nurses at Mid Staffs shows that the culture can very seriously affect behaviour, in this case the reporting of and delivery of inadequate care. Sociology moves us on from blaming individuals as the sole reason for poor care. Instead it asks us to investigate the social processes that affect individuals in an attempt to devise solutions which go beyond the individual and focus as well on the nature and culture of organisations in which people have to work.

 

Benny Goodman. 2012

 

 

 

 

 

Goodman, B. and Clemow, R. (2008) Nursing and Working with other people. p78. Learning Matters. Exeter.

 

Goodman, B., and Ley, T. (2012) Psychology and Sociology in Nursing. Learning Matters. Exeter.

 

Melia K (1984) Student nurses’ construction of occupational socialisation. Sociology of Health and Illness 6 (2) pp 132-151

 

 

 

 

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