Sociological Theories in Nursing

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 13Chapter 13
Theories From the SociologicTheories From the Sociologic
SciencesSciences

Theories From Sociology
• Historically, nursing has been responsive to society’s
needs.
• Early nursing leaders (e.g., Nightingale, Barton, Wald,
Sanger) were frequently social activists.

Theories From Sociology—(cont.)
• Nursing practice and research must consider the social
factors and issues that constrain and shape health
behaviors.
• Examples of sociological theories that are used by nurses
are
– Systems Theory
– Feminist Theory
– Critical Social Theory
– Chaos Theory

General Systems Theory
• General Systems Theory was introduced in the
1930s by Ludwig von Bertalanffy.
• Presumes that there are universal principles of
organization which hold for all systems, whether
they are physical, chemical, biological, mental,
social, etc.
• Considered to be a “grand” theory because of its
universal relevancy and applicability

General Systems Theory—(cont.)
• Systems are composed of structural and functional
components.
– These interact within a boundary that filters
exchange with the environment.
– Living systems are open, and there is an ongoing
exchange of matter, energy, and information.

• All systems contain the following elements
– Input—matter, energy, and information received
from the environment
– Throughput—matter, energy, and information that
is modified or transformed within the system
– Output—matter, energy, and information that is
released from the system into the environment
– Feedback—information regarding environmental
responses used by the system (may be + or − or
neutral)

Elements of a system.

• Basic tenets of GST
– A system is composed of subsystems, each with its
own function.
– Systems contain energy and matter.
– A system may be open or closed.
– Open and closed systems reach stationary status.
• A system must achieve a balance internally and
externally (equilibrium)
– Equilibrium depends on the system’s ability to
regulate input and output to achieve balance.
– Adaptation helps maintain equilibrium.

General Systems Theory and Nursing
• Several grand theorists (e.g., Neuman, Orem, King, Roy,
Rogers) reported they used GST as one component from
which their theory was derived.
• GST was the basis of development of the nursing
process.
• Frequently used in nursing management and
administration
• Limited use in nursing research

Question
Which of the following is NOT a central concept in Systems
Theory?
A.Feedback
B.Input
C.Output
D.Reciprocation

Answer
D. Reciprocation
Rationale: The central concepts or elements of Systems
Theory are input, throughput, output, and feedback.

Feminist Theory
• Gender differences and subordination have been
viewed as natural and inevitable.
• Many believe that gender is socially constructed
and justifies the subordination and exploitation of
women.
• A core assumption in feminist theories is that
women are oppressed.

Feminist Theory—(cont.)
• Definition—an analysis of women’s subordination
(within families and all other institutions) for the
purpose of determining how to change it.

Feminist Theory—(cont.)
• Common themes in feminist theories
– Gender is a basic organizing concept—There is a
social construction and recognition of differences.
– Gender differences are used to legitimize and
perpetuate power relationships between men and
women.
– Women’s experiences are central, normal, and
valuable.
– Gender relations must be analyzed within specific
sociocultural and historical contexts.
– Social constraints and expectations contain class,
cultural, and heterosexual biases and support the
oppression of women.

Question
Which of the following is NOT a common theme in
Feminist Theories?
A. Gender is a socially constructed, organizing concept.
B. Gender differences are used to influence power
relationships between men and women.
C. Gender relations should be analyzed without regard
to sociocultural differences.
D. Social constraints and expectations contain biases
that support the oppression of women.

Answer
C. Gender relations should be analyzed without regard to
sociocultural differences.
Rationale: Gender role beliefs and expectations are highly
determined by cultural norms and values and historical
times. Therefore, understanding of feminism must
consider the specific sociocultural and historical contexts.

Feminist Theory and Nursing
• Fairly common theme in nursing literature—
focusing on:
– Advancement of the profession and education
– Practice implications in patient care
– Research in several areas (both practice and
professional)
– Administration issues

Critical Social Theory
• Jürgen Habermas is the best known of the Critical Social
Theorists.
• Habermas was part of a group of German scholars in
Frankfurt writing in the 1960s.
• He promoted critical social theory to describe “distortions
and constraints that impede free, equal, and uncoerced
participation in society.”

Critical Social Theory—(cont.)
• Critical social theory began in Marx’s argument that
oppression requires revolutionary action.
• Critical social theory uses societal awareness to expose
social inequalities that keep people from reaching their
full potential.

• Critical social theory emphasizes recognition of
oppressive behavior and emancipation for a group of
people.
• The purpose of critical social theory is to uncover an
oppressive situation and motivate victims to free
themselves from oppression.

• Critical social theory sponsors the belief that social
meaning structures events through social domination.
• The dominate group in a society has the ability to identify
its norms and values as the “right” ones in society.
• The dominate group has the power to enforce norms and
values on other groups.

• Contemporary ideas from critical social theory
– Knowledge is historical and value-laden.
– Social and economic relationships shape
development and dissemination of research—
therefore, research is a political activity.

• Contemporary ideas from critical social theory—(cont.)
– Power relationships inform knowledge development.
– Language is paramount to how people comprehend
meaning and create knowledge.
– Social oppression is not natural or static; historical
and social conditions contribute to their production
and maintenance.

• Critical social theory aims to provide an environment
in which individuals can become empowered,
enlightened, and emancipated.
– Enlightenment—raising the consciousness of the
oppressed
– Empowerment encourages people to undertake
activities to improve their situation.
– Emancipation—is the goal of empowerment
through which new arrangements replace
oppressive ones

Question
Tell whether the following statement is true or false:
In critical social theory, it is posited that enlightened
people will be encouraged to engage in activities to
improve their situation.

Answer
True
Rationale: Enlightenment raises the consciousness of the
oppressed, which empowers them to undertake activities
to improve their situation and reduce or eliminate
disparities.

• Critical social theory is used fairly frequently in nursing
literature.
– Concepts from critical social theory have been
used to describe rationale for enhancing care and
eliminating disparities.
– It has also been used as a research framework to
explain health behaviors (e.g., nursing care of
adolescents with diabetes).
– Articles focusing on empowerment and
enlightenment can be found.

Chaos Theory
• Chaos theory is the science concerning nonlinearity.
• Nonlinearity is everywhere; the majority of all nature’s
phenomena are nonlinear.

Chaos Theory—(cont.)
• Problem in scientific analysis of the theory—Large data
sets with long time sequences are necessary for chaos to
become evident.
• Most science recognizes and focuses on linear
relationships, homeostasis, order equilibrium,
predictability, and control.
• The postmodern science focusing on nonlinear dynamic
systems—such as chaos theory—encourages researchers
to “think outside the box.”

• Chaos theory is the study of unstable, aperiodic behavior
in nonrandom, nonlinear, dynamical systems.
– Dynamical refers to the time-varying behavior of
the system.
– Aperiodic refers to the nonrepetitive but continuous
behavior resulting from the effects of any small
disturbance.

• Chaos theory focuses on finding the underlying order in
the apparent disorder of natural and social systems and
to understand how change occurs in nonlinear, dynamical
systems over time.
• According to chaos theory, natural and social systems
survive because of their nonlinear behavior.
– Political unrest
– Families in crisis

Concepts of Chaos Theory
• Sensitive dependence on initial conditions or the
“butterfly effect”
– Even small differences can cause dramatic changes
or divergent paths.
– Equilibrium is never reached in a dynamical system.
– Trajectories that start from “arbitrarily close” points
will diverge exponentially.

Concepts of Chaos Theory—(cont.)
• Butterfly effect illustration
– For want of a nail, the shoe was lost;
– For want of a shoe, the horse was lost;
– For want of a horse, the rider was lost;
– For want of a rider, the message was lost;
– For want of a message, the battle was lost;
– For want of a battle, the kingdom was lost.
• The small change—no nail—resulted in huge
consequences, reverberating outward indefinitely.

Three-dimensional model of a strange attractor.

• A strange attractor—(“strange” because it is unexpected)
– Exerts pull on objects to return them to their original
starting point.
– The controlling action of the attractor provides a
boundary.
– The attractor may be identified by graphing the
changing behavior of an attribute of a system.

• Bifurcation—transition from a steady state to a state
characterized by an abrupt, significant change in
behavior
– When a system is pushed so far from its steady state
that it is not able to recover, chaos or a crisis state is
reached.
– The system then is at a “fork in the road” with a
choice of two or more alternative steady states,
different from the original.
– At each crisis point, the system reaches a bifurcation
with choices.
– With each successive bifurcation, choices become
increasingly limited.

• Dissipative structures—the capacity of systems in non-
equilibrium conditions to change to a higher or more
complex level of order
• Dissipative systems may arise spontaneously out of
conditions that look chaotic but, in fact, have a hidden
order.

• Fractals—characteristics of self-similarity, a fractal
shape will look almost exactly the same no matter its
point of viewing
• Koch’s Snowflake—begin with a single triangle; at the
midpoint of each side, add a new triangle one third the
side and repeat

Chaos Theory—Application to Nursing
• Used sparingly but with increasing frequency in nursing
research and practice (see also “complex systems” or
“complexity” and “nonlinear systems” or “nonlinear
dynamics”)
– Used to develop a model of Ecological Health Nursing
– Investigation of patterns in births to adolescents in
Texas
– Describe and forecast patient census in an ICU
– Modeling for comprehensive evaluation of coronary
patients

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