Tag: liquid modernity

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

 

 

 

 

one reason why social change for sustainability may be difficult

Sustainability and Social change.

 

When considering social change we need to think about who are the ‘communities’ who will be involved. The Transition Towns ‘movement’ is an example of a community who are already committed to some differing vision of the future (based on building resilience to issues around peak oil). Whatever ‘community’ we work with, a principle has to be facilitating self-organising systems and not being proscriptive in offering sustainability solutions. Rather we could aim to facilitate social networking whereby the community helps to connect and offer their own solutions. Grid-group culture theory and the locking in of communities to high carbon systems both suggest that top down, education and clearer explanation do not work. Another perspective is that of Baumann’s (2001) idea of ‘liquid modernity’ in which society is characterised by atomism, individualism, fragmented social bonds and consumerism. Community movements such as ‘Transition towns’ are trying to work against this social tide. What follows is a brief discussion around high carbon systems and social lock in (Urry 2011) and grid-group culture theory. We need to understand that human behaviour change around sustainability means accepting that that this is a ‘wicked problem’ (Rittel and Webber 1973) requiring ‘fuzzy’ solutions.

 

Climate Change and Society and Social Change.

I found the following analysis helpful in getting my head around the issues of community behaviour and attitudinal change.

Sociologically, we can make the following observations about our current high carbon ‘economy-society’ (Urry 2011):

The starting point for an analysis of why a society (and hence communities within that society) engages in particular practices and habits is the observation that energy is the base commodity upon which all other commodities exist (Urry 2011). Why start with commodity? Commodity production, distribution and exchange forms the basis for the current ‘economy-society’ which has been dominated by neo-liberal economic theory since about the 1980’s and the processes of economic globalization. It is this economic infrastructure that determines in the last instance culture and behaviours.  I don’t mean to be too marxist-determinist about this but any understanding of why we do what we do has to take this into account. Thus, in the 21st century following on from the industrial revolution our community behaviours are implicitly locked into a series of interlocking clusters of high carbon systems that are taken for granted: 1) coal/gas/electric grid power 2) petrol, steel and cars 3) the carbon military-industrial complex 4) suburban housing and domestic technologies, 5) airlines/foreign tourism and 6) food/supermarkets/agribusiness. These are all high carbon systems with which we have become enchanted, entranced and encapsulated, made manifest in and by our everyday attitudes and behaviours. Some of these have become very fashionable and have become embedded into everyday practice.

 

To date we have to accept that much of social science has been ‘carbon blind’ and has analysed social practices without regard to the resource base and energy production that we now know are crucial in forming particular social practices.

 

Economics as a discipline tries to explain human behaviour, but has limits as it has an overly ‘instrumentally orientated, rational planning, utility maximizing’ model of human behaviour (‘homo economicus’). John Urry critiques modern economics for failing to address the fundamental relationship between people and the material physical world:

 

most of the time people do not behave as individually rational separate economic consumers maximising their individual utility from the basket of goods and services they purchase and use given fixed unchanging preferences…(we are) creatures of social routine and habit…fashion and fad…(we are) locked into and reproduce different social practices and institutions, including families, households, social classes, genders, work groups, schools, ethnicities, generations, nations…. (Urry 2011 p4).

 

This really muddies the waters, it requires understanding that behavior change results from myriad inputs raging from the ideological and analytical to the pragmatic availability of material resources at hand. Therefore any web 2.0 technologies will operate in this ‘economy-society’ space. 

 

So how do new habits form? What is fashion and what are the effects of this? Do we need ‘the fashionable imagination’ – is there a quality of mind that spots and encourages low carbon fashions which are supported by technologies and commodities that use less carbon based energy? The task facing us is assisting in some small way the unlocking of communities from some aspects of these high carbon systems. To do that, we also have to acknowledge, from cultural theory, the actualities of resistance and then plan accordingly. One positive about web 2.0 is that it may bypass the fatalists and allow engagement by those who seek resistance to current practices (Mason 2012).

 

 

Resistance to Change:

 

Despite ‘sustainability’ seeming to be main stream (vis the Climate Change Act 2008 and various initiatives and policies such as those of the NHS Sustainable Development Unit), the continuing existence of and adherence to the high carbon systems are implicated in the lack of progress towards a low carbon future. This will not change until enough individuals and organisations can free themselves. To do this we will need to encourage the development of perceptions that do not encourage social threat. For something (sustainability) to become fashionable is has to be non-threatening. Appealing to rationality, explaining the science, does not work because we are not rational and we have different ways of understanding the world. Social groups form around various orientations to social cohesion and the locations of solutions to social problems (Grid-Group or Cultural theory).

 

‘Grid-Group’ Culture Theory (Douglas 1992) describes individual perceptions of societal dangers and then the response to them. Individuals tend to associate societal harms with conduct that transgresses societal norms. Sustainability practices may seem to many to be just such a transgression of norms. For example, the social norm of, say car ownership, is transgressed by those advocating active transport (walking, cycling) in a rural community. A social harm may be perceived to be lack of communication with needed services in the countryside poorly served by public transport. This tendency to equate social harm, Douglas argued, plays an indispensable role in promoting certain social structures, both by imbuing a society’s members with aversions to subversive behavior (such as ‘Transition Behaviour’) and by focusing resentment and blame on those (e.g. sustainability advocates) who defy such institutions (such as the petrol/steel/car transport system).

The second important feature of Douglas’s work is a particular account of the forms that competing structures of social organization assume. Douglas maintained that cultural ways of life and affiliated outlooks can be characterized (within and across all societies at all times) along two dimensions, which she called “group” and “grid.” A “high group” way of life exhibits a high degree of collective control, whereas a “low group” one exhibits a much lower one and a resulting emphasis on individual self-sufficiency. A “high grid” way of life is characterized by conspicuous and durable forms of stratification in roles and authority, whereas a “low grid” one reflects a more egalitarian ordering.

Douglas and Wildavsky (1982) previously had focused largely on political conflict over air pollution and nuclear power in the United States. Theyattributed political conflict over environmental and technological risks to a struggle between adherents of competing ways of life associated with the group-grid scheme: an egalitarian, collectivist (“low grid,” “high group”) one, which gravitates toward fear of environmental disaster as a justification for restricting commercial behavior productive of inequality; and individualistic (“low group”) and hierarchical (“high grid”) ones, which resist claims of environmental risk in order to shield private orderings from interference, and to defend established commercial and governmental elites from subversive rebuke.

Later works in Cultural Theory systematized this argument (see below). In these accounts, group-grid gives rise to either four or five discrete ways of life, each of which is associated with a view of nature (as robust, as fragile, as capricious, and so forth) that is congenial to its advancement in competition with the others.

 

 

The Collectivist

The Individualist

The Egalitarianist

The Fatalist

 

The Hermit

 

 

The model is a two-by-two table, though it must be emphasized that the lines are arbitrary — the two dimensions are spectra, not binary divisions.

 

 

Grid-group cultural model

Group

Weak bonds between people

Strong bonds between people

Grid

Many and varied interpersonal differences

Significant similarity between people

 

Fatalism

 

Collectivism

 

Individualism

 

Egalitarianism

(source: http://changingminds.org/explanations/culture/grid-group_culture.htm)

 

Let’s be realistic, in communities such as North Prospect in Plymouth where cultural shifts are being forced through on the back of austerity programmes many are locked into clusters of systems that will be almost impossible to break out of. This may lead to feelings of Fatalism. The fatalist culture has differences between yet limited bonding between people. A result of this is that those ‘who have’ feel little obligation towards the ‘have nots’. Individuals are left to their own fates, which may be positive or negative for them. They thus may become apathetic, neither helping others nor themselves. Those that succeed, however, feel they have done so on their own merits and effectively need those who are less successful as a contrast that proves this point.  How many ‘fatalists’ are there in North Prospect?

Neoliberalism encourages low group-high grid cultural forms manifest in the perversity of the unemployed blaming themselves for being out of work during a time of austerity and recession! In an individualistic culture, people are relatively similar yet have little obligation to one another. People enjoy their differences more than their similarities and seek to avoid central authority.Self-regulation is a critical principle here, as if one person takes advantage of others then power differences arise and a fatalistic culture would develop. Individualistic cultures favour market solutions, who accept competition, laissez faire, pragmatic materialism as answers to social and economic issues

 

In developing technologies for cultural change we will have to acknowledge the possibility of individualistic and fatalist culture which will sabotage or fear the changes. What this means for this project is the obvious point that we will not reach everybody, that social networking to address community problems will appeal to ‘high group, low grid individuals’ and that we may need to identify and target this group in the first instance to identify a quick win? Maybe this is a ‘statement of the obvious?’

 

However, as part of argument to explain global political unrest and cultural change, Mason (2011) suggests it is the coming together of ‘the graduate with no future’ and technology, e.g. web 2.0. Guy Standing’s ‘precariat’ are another group, fearful of change and riddled with insecurities (Standing 2011). These are the social realities we have to deal with. I think we just have to be realistic about who we are dealing with when designing interventions for social change.

The attraction of web 2.0 is that it gets ‘out there’, bypassing those who are just not interested and is readily available for those who wish to use it. However we may need social marketing techniques and skills in getting the message out and engagement up.

 

 

 

Refs:

Bauman, Z. (2000) Liquid Modernity. Cambridge. Polity

Douglas, M., Wildavsky, A.B. (1982) Risk and Culture: An Essay on the Selection of Technical and Environmental Dangers. Berkley, University of California Press.

Douglas, M. (1992). Risk and Blame: Essays in Cultural Theory. London: New York: Routledge

Mason, P. (2012) Why its kicking off everywhere. The New Global Revolutions. London. Verso.

Urry, J. (2011) Climate Change and Society. Cambridge. Polity Press.

Rittel, H, and Webber, M. (1973) Dilemmas in a General Theory of Planning  pp. 155–169, Policy Sciences, Vol. 4, Elsevier Scientific Publishing Company, Inc., Amsterdam [Reprinted in N. Cross (ed.), Developments in Design Methodology, J. Wiley & Sons, Chichester, 1984, pp. 135–144

Standing, G. (2012). The Precariat: The new dangerous class. Bloomsbury. London.

Nursing, Care scares and Moral Panic.

Moral Panic

The number and tone of reports of poor quality care (e.g. Simmons 2011) especially, since the Mid Staffs NHS trust inquiry but by no means is defined by it, may be described as a moral panic and has been described as a crisis in care (Hari 2011, Phillips 2011a, 2011b) and “reveal a moral sickness in the professional ethic of nursing, and more particularly nurse training…” (Phillips 2011b) . These media reports over poor quality care (Marrin 2009, 2011, Shields et al 2011) and the identification of graduate nurses as folk devils who are “too posh to wash”, lead us to ask why this moral panic over graduate nursing has arisen?

A ‘moral panic’ is when a population feels the ‘social order’ is threatened, and that this threat is felt intensely, it is a certain reaction to a perceived social problem. A moral panic may be characterized by irrational, inappropriate overreactions to problems. Stanley Cohen (1972) applied the term to press reports and establishment reaction to the phenomenon of ‘Mods and Rockers’, a moral panic arises when:

“a condition, episode, person or group of persons emerges to become defined as a threat to societal values and interests” (Cohen 1973 p9). The scathing criticism of graduate nursing in the press looks very similar to this sort of description. So, what societal values and interests are thought to be threatened by graduates?

The first aspect is that some feel a loss of ‘the proper place of women/nurses as mother archetypes’ which is part of the longer term process of female entry into the labour market and the break from domestic duties. Feminism has been blamed for this process (however the requirements of consumer capitalism and the need for labour has also had its effects).

The second is the ambiguities felt over the care of elderly people which increasingly has been seen to be the State’s proper role since the introduction of the Welfare State. Although the expressed social order demands that care of the elderly be done within families, the economy demands labour mobility resulting in geographically fragmented families unable to care for elderly relatives. The loss of the family wage and the rise of consumer culture also affects our abilities to care for both children and the elderly as both parents work. The actual social order is that elderly people are, en masse, in institutions and that allows us to abrogate our responsibilities. Although no one expresses a wish to be in a nursing home, no-one either wants (or is able) to take responsibility for elder care.

The third aspect is that bodywork which involves intimacy, closeness as well as dirt and disgust, is again seen as female caring work which does not attract any social value or support beyond expressions of stoic heroism on behalf of carers.

Graduate nurses challenge these conceptions by being women who are educated, who work and expect like any other professional to be rewarded for their efforts, there is then a cognitive dissonance between on the one hand a vision of nursing as self-sacrificial angels and as professionals requiring proper education and reward as professionals. One way to solve this dissonance is to reframe professional nursing, i.e. ‘train’ them in hospitals (putting them in their ‘proper place’).

However, the place of women, and women as nurses, the ambivalence towards care and its meaning, the increasing marginalisation of the elderly and their devaluing may be manifestations of society’s turn from solid to ‘liquid modernity’ (Baumann 2000). Social values, aspirations and expectations are played out within the themes of globalization, individualization, marginalisation, poverty and consumerism. These are the actual social threats that this moral panic cannot actually name and identify. ‘Folk devils’ have to be found to explain these new forms of alienation. Poor care has been around as long as there have been carers, and so we need to be careful not to argue that liquidity causes poor care, rather it may the case that liquid social conditions predispose individuals to perform in particular ways and for their actions to be interpreted in particular ways. The folk devils are, in this instance, graduate nurses. However, blaming nurses refocuses attention away from more difficult problems and gives easy solutions (‘return training to hospitals and all will be well’).

Liquid modernity, according to Baumann, involves community fragmentation, eroding social bonds, atomized relationships and individualistic expectations all in the context of the globalization of capital and markets which dislocate communities. Workers have to respond to calls for mobility and flexibility or face redundancy. Communities struggle to reconcile competing demands especially with the increasing numbers of elderly people and costs of care. Nurses and midwives find themselves caught between all of these competing demands unable to make the links between their individual experiences and larger social conditions,

If only one nurse abuses a patient we should properly look to the character of the individual nurse for reasons.  When cases of reported abuse become legion then the personal troubles of the patients should be seen in the context of the public issues of society. To fully comprehend the position of the abuser we need to address their personal biography and history and the relationship between the two in society. Anyone wishing to analyze why there is poor care needs to avoid simplistic knee-jerk moral panic type reactions and grab the idea that nurses can understand their experiences and gauge their fates only by locating themselves within their period, that they can know their  own lives only by becoming aware of all those nurses in the same circumstances. Focusing on the personal accountability of care staff without addressing the structural conditions in which they work simply will not do.

So what then is the answer?

Care has to be really valued, and in current society, the main way value is ascribed is to place a monetary value on it and bring it centrally into business planning. Therefore the cost of care has to be brought into all accounting. Capitalist production currently does not take into account the care (and environmental) costs that society bears for that production. However caring still has to be done or else production cannot continue in its current form. This is not a new argument, feminists and environmentalists have been arguing this for years. If society wishes to value care then it has to pay for it. That means increasing the number of staff and paying them a competitive wage so that good quality staff are educated, retained, supervised, developed and valued. Or, as Sue Gerhardt (2010a) argues we should refocus on caring as a real social value and perhaps introduce a ‘caring wage’ (2010b) say £12,000-£16,000 per year? Society has to value care with more than lip service and the stoic angels tag, but in the current economic setting social values are not strong enough to ensure we will do this.

Bauman Z. (2000) Liquid Modernity. Polity. Cambridge.

Cohen, S. (1973). Folk Devils and Moral Panics. St Albans: Paladin, p.9

Gerhardt S. (2010a) The Selfish Society. How we all forgot to love one another and made money instead. Simon and Shuster. London.

Gerhardt S.(2010b) The Selfish Society. RSA events. 22nd April. http://www.thersa.org/events/audio-and-past-events/2010/the-selfish-society

Hari, J. (2011) The plan to resolve our care home crisis. The Independent January 26th http://tinyurl.com/5ugyond

Hawken P (1994) The Ecology of Commerce. Harper Collins. London

Marrin, M. (2009) Oh Nurse, Your degree is a symptom of equality disease. The Sunday Times. November 15th

Marrin, M. (2011) Our flawed uncaring NHS is a self-inflicted wound. The Sunday Times. May 29th

Phillips, M (2011) The moral crisis in nursing, voices from the wards. Daily Mail. October 21. http://melaniephillips.com/the-moral-crisis-in-nursing-voices-from-the-wards

Phillips, M. (2011) How feminism made so many nurses to grand to care. Daily Mail. October 17. http://melaniephillips.com/how-feminism-made-so-many-nurses-too-grand-to-care

Shields, L., Morrall, P., Goodman, B., Purcell, C. and Watson, R. (2011) Care to be a nurse? Reflections on a radio broadcast and its ramifications for nursing today. Nurse Education Today. doi:10.1016/jnedt.2011.09.001

Simmons, M. (2011) Poor Nursing care. NursingTimes.net. 4th July. http://www.nursingtimes.net/poor-nursing-care/398.thread

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