Tag: Sociology in Nursing

An impact of male gender on the experience of illness

An impact of male gender on the experience of illness

 

CECIL R., McCAUGHAN E., and  PARAHOO, K. (2010) ‘It’s hard to take because I am a man’s man’: an ethnographic exploration of cancer and masculinity European Journal of Cancer Care 19, 501–509 

This paper reports on a study into male participation in cancer support groups, which elicited data on the impact of cancer on masculinities. This small qualitative pilot study, which took place in Belfast in Northern Ireland, involved semi-structured interviews with eight men with a history of cancer who were no longer being actively treated (i.e. they were not receiving chemotherapy or radiotherapy), and who were proficient in spoken

and written English. Whereas most studies into men with cancer that have looked at issues of masculinity have been on prostate and/or testicular cancer and have tended to focus upon sexual ability and activity, this study identified more sociological issues of concern that also present challenges to masculinity and to male identity.

 

Economic concerns were identified as being major issues for men, as were their changing role vis-à-vis their family, friends and colleagues, and changes to their body and to their body image.

 

The findings from this study indicate that cancer support services need to be gender sensitive in order to ensure that interventions do not undermine masculine values but address men’s concerns and foster their positive coping strategies.

 

 

 

Masculinities (and Femininities).

 

The above research indicates what being a man is and what values are held by men in Northern Ireland. Three issues seem pertinent for these men surviving cancer:

 

  • Money worries, perhaps the role of ‘breadwinner’ is undermined.
  • Their other roles in life and how cancer changes that.
  • Body image – virility and strength might be challenged.

 

These are the subjective experiences of this group of men, so that we can see that cancer not only brings about physical changes but also challenges the very idea of what it is to be a man. Are these men feeling a loss of control and power over their jobs, their lives and their women? In the context of testicular and prostate cancer the idea may be that loss of sexual function or perceived loss diminishes them both in their own eyes and in the eyes of wives and girlfriends.

 

But, what do we think being masculine actually means for other men? Are these ideas fixed in society?  Raewyn Connell discusses what being masculine means and considers that it is a dynamic concept, i.e. what it means to be a man is not fixed and can change over time and across a society. Masculinity is about where one sits in a power structure, and therefore there is more than one masculinity. So we must be careful to understand that a change in health status may be subjectively different for the metrosexual man, for example living in central London. Connell also refers to a ‘world gender order in which men continue to have power over women’.  A cancer diagnosis for a man will of course impact on his family and partner and if they are feeling challenged in the most fundamental aspect of their identity this may well impact on their on-going relationships. We might ask whether we have a set of norms and patterns for the ‘correct’ social response to these challenging issues.

 

The research paper suggests that those working with men diagnosed and treated for cancer might want to think about the values men hold , and clarifying with them their coping strategies. It clearly illustrates the psycho-social nature of a condition like cancer. A question remains though around how well equipped nurses feel they are in relation to these issues, is it easier to stick to bio-medical issues around treatment modalities, prognosis and coordinating support services.

 

Rabin (2009) also reported a US study which suggested:  “Men who strongly endorsed old-school notions of masculinity — believing the ideal man is the strong, silent type who does not complain about pain — were only half as likely as other men to seek preventive health care, like an annual physical”. This then suggest that how men  see and feel about themselves in this manner are putting themselves at risk of for example a too late diagnosis of cancer or other serious conditions such as hypertension.

 

This anonymous post form the US raises the issue of obesity, ethnicity and class in the relationship between men and their doctors, arguing that condescension, arrogance and rudeness on behalf of some doctors may also be class and racially based:

 

“The problem is, a LOT of doctors are rude, condescending assholes who may be very good scientists and diagnosticians, but are HORRIBLE at customer service!


For a lot of men – including myself – going to a 12:15 appointment but not being seen until 2 and then being told a whole lot of stuff that I already know AND having to deal with medical arrogance is insufferable!

 

At this point he is illustrating issues around access to health services – this relates to wider social structures around employment patterns for both men and women who now make up > 50% of the UK workforce, so access issues may not be gender specific but might have socio-economic foundations. In other words people on low incomes with less freedom to leave work during the day might put off going to the doctor unless they really have to. Consider the man with prostate issues or testicular lumps which might not be painful who then does not go to the doctor because of losing a day’s pay. This applies to those who have been labelled the ‘precariat’.


Add to that that I’m fat, African American and working class and multiply the rudeness factor x 20.  I know I’m going to be accused of being a fat pig and a glutton and will be branded as a liar if I comment on what I eat – I know the doctor won’t give a damn if I give him/her an accurate description of how I got fat in the first place – and I know that I will be blamed, guilt tripped, shamed and not listened to – why would I want to subject myself to that bullshit (AND have to pay a $ 20 co pay!)


If I want to be insulted for being fat, I can find some neighborhood elementary school kids who will do it for free!

 

Here he illustrates obesity as a ‘fatphobia’, or obesity as a personal moral failing which might be the default position of some healthcare professionals. The responsibility deal initiated by Andrew Lansley emphasises taking personal responsibility for health and seeking partners to do so. Being fat could be seen as not taking that responsibility. This view downplays or challenges the idea of an obesogenic environment. It buys into the cultural/behavioural explanation for health, i.e. that illness arises because of the your cultural habits and behaviours (eating junk food and smoking for example) and it also form part of the Moral Underclass discourse which focus on the failings of people themselves and locates the origins of illness in their ignorance and fecklessness.


Like a lot of men, I would NEVER tolerate that kind of rudeness in any other type of social setting, so why would I put up with it from some douchebag wearing a white lab coat?


I suspect women are socialized to tolerate much higher levels of disrespect and verbal abuse than men are – which might explain why they have a higher tolerance level for the verbal and psychological abuse that many doctors inflict on their patients.


They’d have to – because, from what women have told me, female medical exams are not only filled with insults and rudeness but procedures that are actually physically painful (like the mammogram and the speculum).


So, if doctors want male patients to come to get routine checkups, they need to learn how to talk to their patents with courtesy and respect – especially their fat patients, who need more medical monitoring than our skinny counterparts, but are more likely to avoid the doctor’s office because of all the bullshit that many doctors put their patients through.


The same goes with African Americans – we get a double dose of condescension and rudeness, get less pain management and in general get worse medical care than our White counterparts.


I actually had a White doctor at Columbia Presbyterian Hospital accuse me of “fraud” when i came to have a knee injury treated – and he also ordered me to “go to the clinic across the street, where the neighborhood people go” (that is, CPMC’s medicaid clinic, who’s patient load is almost entirely Black and Latino, as opposed to the clinics at CPMC, that treat affluent White patients from other neighborhoods).


In short, it’s not a “masculinity” problem – it’s a medical rudeness problem – and men
are just more likely to avoid doctors to get away from the rudeness and verbal abuse!”

 

 

 

 

 

Here we have an illustration of intersectionality, i.e. how class, ethnicity and gender interact to position a person in the social hierarchy and how this then affects health.

 

So, being a man in a particular subculture can be dangerous: you take risks occupationally which you  might not be able to avoid , for example in the construction industry, and you take risks with lifestyle choices because that upholds your idea of masculinity. Not going to the doctor because a) they are a different class and b) ‘that’s not what mend do’ and c) you cannot afford the time or money further places you into a place of risk of undetected health problems. However, gender is only one aspect of health seeking behaviour, morbidly and mortality patterns. Arguably low socio-economic status is  more important in explaining health inequalities.

 

 

 

See also:

 

Stets, J., and Burke, P. Femininity/Masculinity in Edgar F. Borgatta and Rhonda J. V. Montgomery (Eds.), (2000) Encyclopedia of Sociology, Revised Edition. New York: Macmillan. pp. 997-1005

What implications do the differences between a social and medical model of health have for the nursing profession?

What implications do the differences between a social and medical model of health have for the nursing profession?

 

(note the hyperlinks in the text)

 

This short paper will address biomedical, social and ecological models of health.

 

Medical model:

First of all we need to be clear what we mean by these terms. A medical model (sometimes called a biomedical model) is based on knowledge about the biological causes of disease. This approach uses the sciences such as physiology, pathophysiology, pharmacology, biology, histopathology and biochemistry. A detailed knowledge of the human anatomy is required as well as detailed knowledge of:

·         Aetiology (in the United States  they spell it Etiology).

·         Epidemiology.

·         Signs and Symptoms.

·         Diagnosis.

·         Investigations and clinical examinations.

·         Treatment options and management plans

for a very wide range of conditions and diseases.

The focus is often on the individual ill patient, and it seeks to cure through the application of medications and/or surgery.

Many doctors in practice however adapt and supplement this basic approach to consider issues such as lifestyle, patient preferences and wishes in their treatment options. This might be termed a biopsychosocial model. Options for treatment also include referral to other professionals such as physiotherapists and dieticians and some doctors refer to complementary therapists.

“While disease dominates biomedical thinking, the biopsychosocial model incorporates social, psychological and emotional factors in diagnosis and treatment. It recognises that illness cannot be studied or treated in isolation from the social and cultural environment. Whereas the biomedical model prioritises professional knowledge, the biopsychosocial model expects health carers and doctors to acknowledge and take into account users’ circumstances.

Medicine practised within a biopsychosocial framework acknowledges the links between socioeconomic deprivation and adverse health. It also considers issues such as improving access to health services and reducing health inequalities as a legitimate and appropriate function of health service provision.”

(source: http://openlearn.open.ac.uk/mod/oucontent/view.php?id=398060&section=1.7)

Thus a biopsychosocial model is a link between the medical approach and the social model of health.

Box 1: This extract is taken from the Open University.

Models of healthcare delivery: the biomedical model:

Biomedicine is also known as allopathy, conventional medicine or modern western scientific medicine).  In the UK biomedicine dominates contemporary and official understandings of health and forms the basis of the NHS and other western health care systems. While the biomedical model is considered the epitome of scientific, objective, reproducible medicine, the actual delivery of health care may be somewhat different in practice. The following statements about biomedicine thus represent an idealised, necessarily artificial version of this model.

·         Health is predominantly viewed as the ‘absence of disease’ and as ‘functional fitness’.

·         Health services are geared mainly towards treating sick and disabled people.

·         A high value is put on the provision of specialist medical services, in mainly institutional settings, typically hospitals or clinics.

·         Doctors and other qualified experts diagnose illness and disease and sanction and supervise the withdrawal of service users from productive labour.

·         The main function of health services is remedial or curative – to get people back to productive labour.

·         Disease and sickness are explained within a biological framework that emphasises the physical nature of disease: that is, it is biologically reductionist.

·         Biomedicine works from a pathogenic (origins of disease) focus, emphasising risk factors and establishing abnormality (and normality).

·         A high value is put on using scientific methods of research and on scientific knowledge.

·         Qualitative evidence (given by lay people or produced through academic research) generally has a lower status as knowledge than quantitative evidence.

(Source: adapted from Jones, 1994 in http://openlearn.open.ac.uk/mod/oucontent/view.php?id=398060&section=1.6)

 

The Social Model

The social model of health focuses on the social distribution of health and illness between different groups (e.g. death rates which vary between social classes).  The social model is interested in the social causes of ill health best illustrated by the Social Determinants of Health (World Health Organisation 2008) approach.

The Social determinants of health

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

Responding to increasing concern about these persisting and widening inequities, WHO established the Commission on Social Determinants of Health (CSDH) in 2005 to provide advice on how to reduce them. The Commission’s final report was launched in August 2008, and contained three overarching recommendations:

Responding to increasing concern about these persisting and widening inequities, WHO established the Commission on Social Determinants of Health (CSDH) in 2005 to provide advice on how to reduce them. The Commission’s final report was launched in August 2008, and contained three overarching recommendations:

1. Improve daily living conditions

2. Tackle the inequitable distribution of power, money, and resources

3. Measure and understand the problem and assess the impact of action

The WHO Conference Secretariat has now put together the full Report of the World Conference (66 pages with color pictures). A 16 page summary Report is also available. World Health Assembly adopts the Rio Political Declaration on Social Determinants of Health. A resolution endorsing the Rio Political Declaration on Social Determinants of Health was adopted in May 2012 by WHO Member States at the Sixty-fifth World Health Assembly (WHA) in Geneva, Switzerland.

http://www.who.int/social_determinants/en/

 

 

Barton and Grant (2006) have developed  a ‘health map’ which illustrates the global, environmental as well as the social antecedents for health:

 

http://eprints.uwe.ac.uk/7863/2/The_health_map_2006_JRSH_article_-_post

Barton, H. and Grant, M. (2006) A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126 (6). pp. 252-253.

 

Note that the outer ring includes the ecosystem so this firmly locates human health within the ecology of the planet. Therefore health stems from the biogeophysical environment in which humans live and are an inescapable part of. This perspective which sees no separation of humanity from ecology suggests that no one can be healthy in an unhealthy environment. This might take the position that if the oceans are increasingly acidic, resulting in fish species loss, then by definition human populations are not healthy either.

Health is then social and ecologically determined, experienced within the social relationships in a material world. No one lives alone and so it is in the coming together in communities and societies that we fashion the determinants of health. There is a biological basis for some individuals, however genetic determinants (e.g. in cystic fibrosis) operate at this individual level and are manifest in a relatively minor way. This is not to deny that for the individual the medical condition is anything but minor, but health on population levels are not determined thus. Even genetic manifestations are at times made worse or better by the social conditions in which the individual finds themselves. Poverty has a knack of making underlying biological problems much worse. Climate change may also make both poverty and the health status of populations worse.??

Social Conditions??

If health is socially determined by social relationships, what are the current forms of social relationships that give rise to certain patterns of health, illness and disease? We know from studying inequalities in health that socio-economic conditions and relative social status determine populations’ health status including measurable outcomes such as life expectancy and the under 5 mortality rate. Other social relationships such as gender and ethnicity also affect health status. I would argue that major influences upon global health are the socio-economic relationships which are based on a certain forms of political economy, i.e. capitalism.

Implications for Nursing:

The following is a gross simplification, a continuum if you like, of the two typologies. In practice a nurses will develop their own mix of the two approaches:

Biomedicine focuses on the ill individual, social models focus in healthy populations. A biomedical nurse would use mainly the medical sciences to help cure the individual , A social model nurse would draw from various disciplines (sociology, psychology) to promote health and well-being of populations. A biomedical nurse would be drawn to acute care, especially critical care while a social model nurse may be drawn to primary care and public health. A biomedical model seeks to change the individual,  A social model nurse would seek to change society. A biomedical nurse has little need for history and politics, a social model nurse understands her history and political action.  A biomedical nurse has little need to use a sociological imagination, a social model nurse needs to develop her sociological imagination.

A biomedical nurse may ignore ‘non-scientific’ approaches to cure, a social model nurse might value alternative and complementary approaches. A biomedical nurse wants to cure, a social model nurse wants to care. Biomedical nurses implicitly positively acknowledge higher stuts of medicine, a social model nurse gives no privileged status to medical practice. biomedical nursing mirrors male ways of thinking, social models open themselves up to female and post-colonial ways of thinking.

 

 

 

 

A note on ‘econursing’ or an ecological model of health.

Taking on board Barton and Grant’s health map, acknowledging for example the health impacts of climate change,  and the building upon a social determinants approach, an ecomodel would emphasise that human experience cannot be understood as separate from nature. Philosophically it critiques the dualist assumptions that see nature separate from humanity, what has been called ‘human exceptualism’. This is the position that sees us as exceptions from nature, we are separate from it, and nature is open for domination and control for the benefit of humankind. From an eco-perspective, this is extremely damaging to human health and to the health of the planet, more than that, they are the same thing.

Benny Goodman 2012

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

 

 

 

 

why study sociology in nursing?

The NMC (2004, 2010) has published standards for education programmes (Diplomas/Degrees in Nursing) and requires all student nurses to meet these standards and competencies during their education and before registering. This is one reason why you are studying the social context of care. If you read the standards you will understand why a wider knowledge of the context of care is required for nurses at the point of registration.

 Some students continue to struggle to see the relevance of sociology to their experience of nursing in clinical practice. The debate over sociology has been reflected in the literature especially in the late 1990’s but is still current. Does sociology have any relevance to nursing?’ The answer is partly based on what one thinks nursing practiceis.

 The case for sociology in nursing (Mulholland 1997):

1) It provides an alternative to individualistic biomedical models.

2) Supports critical and self reflective practice.

3) Addresses exercise of power.

4) Encourages a ‘quality of mind’ (Mills 1959).

5) Challenges the ‘taken for granted’.

6) Involves the ‘know why’ not just the ‘know how’.

One view is that nursing uses a science based biomedical model, is individually focussed involving concrete (evidence based) guidance for practical action. The knowledge needed for action is instrumental knowledge – knowledge for a purpose, ‘know how’.

The case against sociology in nursing:  (Sharp 1994, 1995):

1) Nursing is rational action directed to achieving measurable outcomes.

2) Nursing needs ‘know how’ not ‘know why’.

3) Nursing needs concrete knowledge based on certainty and unambiguous guidance for action.

4) Nursing is not about complex decision making and is thus non reflexive.

5) Sociology is multi paradigmatic and so cannot offer guidance for action.

6) Sociology is endlessly self reflective and questions all claims and assumptions and thus it is practically useless as it fails to meet the instrumental requirements of the nursing profession.

Another view is that nursing is complex decision making involving critical self reflection based on competing philosophies and theories. Nursing operates in power and social contexts, addressing populations as well as individuals. The knowledge needed is not just for action in practical settings (‘know how’) but for personal and social transformation (‘know why’).

Undergraduate students in practice may not engage much in analytical, critical, self reflective learning. They often describe what they see and read about. They learn task orientated, ‘correctly sequenced psycho-motor movements’ in an instrumental fashion to achieve essential skills and competencies. They often operate in a biomedically dominated frame of reference in chronic and acute illness and disease management with individual patients often in a hospital setting. They also often operate in a context where ‘getting the work done’ is paramount (Melia 1984). This work is often instrumental in nature: giving direct ‘hands on’ patient care. The emphasis is on the ‘doing’ not the ‘knowing’. The cultural view they bring into nursing is dominated by a hospital/medical frame of reference.

 

This makes sociology ‘difficult.’

 

Sociology encourages and requires transformational learning which does not sit easily within the current practical and power context of much of nursing practice. However, when students engage with the wider issues, and understand that there are different ways of knowing and examine what it means to develop a sociological imagination (Mills 1959), an opportunity exists for them to develop into ‘knowledgeable doers’ (UKCC 1986) who may transform both themselves, nursing practice and in turn society.

 

Melia, K. (1984) Student nurses’ construction of occupational socialisation   Sociology of Health and Illness6 (2) pp 132-151

 

Mulholland, J. (1997) The sociology in nursing debate. Journal of Advanced Nursing. 25 p 844-852.

 

Sharp, K. (1994) Sociology and the nursing curriculum: a note of caution. Journal of Advanced Nursing. 20 pp 391-395

 

Sharp, K. (1995) Sociology in nurse education: help or hindrance? Nursing Times. 91 (20) pp 34-35

 

UKCC (1986) Project 2000: A new preparation for practice. UKCC.  London

 

Wright Mills, C. (1959) The Sociological Imagination. Penguin. London 40th ed.

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