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Sociology Sociology Document Transcript

  • BASIC STUDIES IN NURSING SOCIOLOGY INSET BY NELSON MUNTHALI ® ( DNC/RN/2012 ) © 2012 Acknowledgement I give much thanks to Mrs. Bulambo for the fruition of this document. ©munthalinelson@outlook.com Page 1
  • GENERAL INTRODUCTION English: No man is an island. Chichewa: Mutu umodzi susenza denga Tumbuka: Munthu wangakhala yayi pa yekha We are basically social animals. We are born into human groups and derive our identities, hopes, fears, troubles and satisfaction from them. Sociologists study the influence of social factors and the behaviour e.g. how the presence of friends at a social gathering prompts beer drinking come what may. A basic premise of sociology is that human behaviour is shaped by the group to which people belong and by social interaction that take place within these groups. Individuals acquire roles, norms and cultures of the society through the process called socialization. What is sociology? It is the scientific study of social interactions and organizations (Zanden, 1988). Sociology - a disciplined approach (which is scientific in nature) to understanding society and social life. Sociologists study patterns of interaction among people with an emphasis on group contexts and broad societal forces (Chaltant and Isabell, 1988). Sociology is a social science which studies social relationship between people as individuals and as groups and the influences of social conditions on these relationships (Peil, 1979). Sociology is the study of human society (Denney, 2009) THE FOCUS OF SOCIOLOGY Sociology focuses on the factors and processes such as gender, ethnicity and social class that shape both our relationship with others and our experience and our relationship with the society. Sociology also focuses on how human lives are socially structured and organized and on the ways in which every day experiences are made meaningful. The main focus of sociology is the group and not an individual. A sociologist is interested in the interaction between people- the ways in which people act towards, respond to and influence one another. Sociology as a discipline is concerned with: • Social acts • Social relationships Page | 2
  • • Social organizations • Community and institutions in the society THE ROLE OF SOCIOLOGY WITHIN THE SOCIETY Sociology has been influential in identifying social inequalities in health. It is the role of sociology to comment on the extent to which such inequalities should be eradicated. SOCIOLOGY AND COMMON SENSE Sociology is concerned with studying many things which most people already know e.g. family life, the education system, and religion, simply by living as a member of the society. However, sociological studies will provide evidence which differs with our ‘common sense’ of understanding an issue. HOW DOES SOCIOLOGICAL THINKING DIFFER FROM COMMON SENSE? • Sociological thinking is based on and gains its credibility from the use of rational, logically structured arguments, unlike common sense. • Sociological thinking is based on and can encompass a broad vision of the social aspects of the human world whereby common sense does not. • Sociological thinking is evidence- based and can be publicly scrutinized in terms of its appeals and not common sense. • Sociological thinking always makes sense of the human world by using perspectives that begin with a collective understanding of individuals living within webs of human interdependency. • Sociological thinking therefore offers a different sort of vision or perspective on the taken- for granted, familiar aspects of human world from that offered by ‘common sense’. KEY POINTS • Be skeptical, questioning and critical. • Focus on how the social affects health and health care and social life generally. • Contest ‘individual’ expectations of health and illness experience. • Put issues into a historical perspective The role of sociology is to challenge the obvious and to assess the evidence and arguments for and against any particular position which is advanced. THE SOCIOLOGICAL IMAGINATION Sociology is a discipline that tries to place individual experience in a larger social context. Wright and Mills, (1959), called this sociological imagination the ability to see our private experience, personal difficulties and achievements as in part, a reflection of structural arrangements of the society and the times in which we live. He suggested that many of the Page | 3
  • things we experience as individuals are really beyond our control. They have to do with society as a whole, its historical development and the way it is organized. The sociological imagination allows us to see the relationship between our personal experience and broader social and historical events e.g. 1. SOCIETY AS A WHOLE. Illness is a very private trouble, and yet a very public issue, not least because of the social causes of much ill health and premature death. The individual dying of lung cancer faces a very personal tragedy, and yet this is also a public matter as the recent debates on tobacco advertising and sponsorship have emphasized. 2. THE WAY SOCIETY IS ORGANISED For sociologists, the experience of sickness and disease is an outcome of the organization of the society. Poor living and working conditions make people sicker and poorer people die earlier than their counterparts at the top of the social system. 3. HISTORICAL PERSPECTIVE The sociological imagination is historical in that it allows us to understand the distinctive nature of our present society by comparing it with the past e.g. sociologists can study how historical changes in patterns of social life can explain changes in patterns of illness. Sociology provides a window to the social world that lies outside us. It allows us to see the many social forces that shape our lives. SOCIOLOGY AND OTHER SOCIAL SCIENCES All social sciences are concerned with human action or behaviour, but they differ in the particular attribute of behaviour they study e.g. in the study of prostitution, the social sciences differ in the concepts they use, the kinds of questions they pose about the world, the methods they use to answer the questions and the kinds of solutions or explanations they provide. A rough guide to understanding the different social sciences is to look at the questions each asks in trying to comprehend human behaviour. The social science Focus The basic question asked. Sociology Relationships among humans and groups living together in society What are the functions of the various groups in a particular society? Anthropology The cultures of human societies usually non-literate communities (those without written language) What are the cultural patterns that help define these societies? Psychology The behaviour and thought process of the individual and the ways in which an individual acts and reacts to other humans and to society. What is going on inside a person’s mind? Economics The production, distribution and consumption of goods and services among individuals and groups within the society How have people organized the production and distribution of goods and services? Political Science The organizations people have developed to How are people developing? Page | 4
  • make rules and laws for their society. Geography The distribution of the features of physical environment and of the people who use those features. How has society used the land and its resources? Each of these social sciences focusses on human activity. All attempt to understand how humans function not only as individuals but also as groups. THE EMERGENCE OF SOCIOLOGY Sociology emerged as a field of inquiry during the 19th century. Between 1800 and 1900, the industrial revolution transformed society. Within a few generations, traditional rural societies were replaced by industrialized urban and scope of the change resulted in substantial social disorganization. In an important sense, the rise of sociology was a conservative reaction to the social chaos of the 19th century. Social thinkers were preoccupied with their concern for the loss of social order. The central ideas of the major pioneers of sociology, to significant extent, continue to control concerns today. 1. AUGUSTE COMTE (1798- 1857 He coined the term sociology in 1839 and is generally considered the founding father of sociology. Comte was among the first to suggest that the scientific methods would be applied to social events (positivism) POSITIVISM This is the belief that the social world can be studied with the same scientific accuracy and assurance as the natural world. This can be done through use of observation, comparison, experimentation and historical method to analyse society. Another Comte’s lasting contribution was his recognition that an understanding of the society requires concern for both the sources of order and continuity (social statics) and sources of change (social dynamics). Although sociologists no longer use the terms, Comte’s basic divisions of the society continue under the labels ‘social structure (statics) and ‘social process ‘(dynamic). 2. HERBERT SPENCER (1820- 1903) He used an organic analogy to explain social stability like humans, and society is composed of interrelated parts that work together to promote its well being and survival. An individual has a brain, a stomach, a nervous system, limbs etc and a society has an economy, a religion, a state, a family etc. Just as these parts make a essential contributions to the functioning of the human body, the social institutions are crucial for the society’s functioning. 3. KARL MARX (1881-1883) He was a philosopher, economist and social activist. Marx was born in Germany to middle- class parents. Marx was repulsed by the poverty and inequality that characterized the 19th century. Unlike other scholars of his day, he was unwilling to see poverty as either natural or God given condition of human species. Instead, he viewed poverty and inequality as man-made condition fostered by private property and capitalism. Marx predicted that all industrial societies ultimately would contain only two social classes: Page | 5
  • (i). the bourgeoisie – those who own the means for producing wealth in industrial society (the means by which the surpluses are extracted) (rich people). (ii). the proletariat – those who labour for the bourgeoisie at subsistence wages (poor people) or those who sell their labour to the rich people. CLASS CONFLICT Marx claimed that the relationship between the bourgeoisie and the proletariat was inevitably exploitative. There is a conflict between those controlling the means for producing wealth (bourgeoisie) or rich people and the proletariat (those who labour for the bourgeoisie) or poor people. Out of the conflict would emerge a classless society without exploitation of the powerless by the powerful people. For Marx, this relationship was fundamental to explaining the nurture of society. For him and his followers, the nature of the institutions and roles which make up a society can be explained with reference to those fundamental inequalities and their volatile nature. APPLICATION OF MARXIST THEORY TO THE STUDY OF HEALTH AND ILLNESS COMMODIFICATION Mcknlay, (1985), suggests that under modern capitalism, medicine like any other good and service has been modified i.e. medicine has become just another product which is bought and sold and out of which significant profits are generated for those who own the means of production (rich people). Medical practice is influenced by the activities of the large pharmaceutical companies. It can be argued that drugs are developed and marketed to medical practitioners not out of a sense of social responsibility, but as a means of making profits (huge profits) i.e. drugs are not manufactured to help in combating diseases of the poor people but drugs are developed to generate money. There is more money made from treating diseases of rich people than diseases of the poor people e.g. cancer. Drugs are discovered and made to make profits and not to improve health. 4. EMILE DURKHEIM (1858 – 1917) One of Emile Durkheim’s major concerns was social and moral order. He argued that community standards of morality, who he called the collective conscious, not only confine our behaviour but also give us a sense of belonging and integration. According to Durkheim, there is a social order because of broad consensus on values (value consensus) and institutions (family, religion, government) among members of the society. This consensus is especially a characteristic of non-literate societies based on: • MECHANICAL SOLIDALITY- social unity that comes from a consensus of values and norms, strong social pressure for conformity and depend on traditional and family. In modern society, he contended social order is based on: • ORGANIC SOLIDALITY- social unities based on a complex of highly specialized roles and make members of a society dependent on one another. E.g. in industrial society, people depend on others to provide goods and services. In this classic study- suicide, Durkheim demonstrated that suicide involves more than individuals acting alone. By showing the suicide rates, vary according to group character- the suicide rate is lower among Catholics than Protestants and lower among married men than single persons- convincingly supporting the idea that social life must be explained by social Page | 6
  • factors rather than by individualistic ones. Durkheim was among the first to stress the importance of using reliable statistics to examine theories of social life. MAX WEBER (1864- 1920) Weber believed that knowing patterns of behaviuor was less important than knowing the meaning people attach to behaviour. Webers’ emphasis was on the subjective meanings of human action which could be accomplished through a method called vesterben. VESTERBEN: understanding the behaviuor of others by putting oneself mentally in their place (empathetic). Weber said that it was not enough to say that events occur because of social structures ordain them, instead, he was concerned to understand how individuals come to see the world in such a way that they voluntarily choose a particular course of action. By being empathetic, one would gain a full understanding of an individual’s action since you are looking at the world from their point of view. Weber insisted that it is important to put oneself in other people’s shoes in order to understand them. Weber strongly counseled sociologists to conduct value free research. VALUE FREE RESEARCH: research in which personnel biases are not allowed to affect its condition and outcome. Value free sociology – concern itself with establishing what is, not what ought to be. Weber believed that knowing patterns of behaviuor was less important than knowing the meaning people attach to behaviour. Weber’s emphasis was on the subjective meanings of human action which could be accomplished through a method called vesterben. VESTERBEN: understanding the behaviuor of others by putting oneself mentally in their place (empathetic). Weber said that it was not enough to say that events occur because of social structures ordain them, instead, he was concerned to understand how individuals come to see the world in such a way that they voluntarily choose a particular course of action. By being empathetic, one would gain a full understanding of an individual’s action since you are looking at the world from their point of view. Weber insisted that it is important to put oneself in other people’s shoes in order to understand them. Weber strongly counseled sociologists to conduct value free research. VALUE FREE RESEARCH: research in which personnel biases are not allowed to affect its condition and outcome. Value free sociology – concern itself with establishing what is, not what ought to be. COMPONENTS OF STRUCTURAL FUNCTIONAL PERSPECTIVE SOCIAL STRUCTURE Social structure society is composed of social structures, the most important of which are family, religion, the economy, politics and these institutions relate to each other. SOCIAL FUNCTIONS Social institutions perform social functions that are necessary for the society to persist, at least in its present form e.g. family is for the reproduction, socialization, maintenance of children and personal fulfillment of its members. One feature of a system is the interdependence of its parts. Change in one institution has effects/implications on other institutions and for the society as a whole. E.g. the four institutions below are interlinked: education system (provide schools), Page | 7
  • family (has children), political system (government provides funding) and healthy economic (raises revenue). APPLICATION TO SOCIOLOGY OF HEALTH The various activities seen in the large, complex organization of a modern hospital can be analyzed in terms of their contribution to the survival of the hospital. Nurse- patient relationship is based on shared values e.g. health is functional and illness is dysfunctional. Because of this negative perception of illness, a patient is assigned to subordinate position in relation to a nurse, who performs a positive function in the society. An asymmetrical balance of power is operative in the system of nurse and patient. (i) CONFLICT PERSPECTIVE While functionalists apply integration and consensus in a social system, conflict theorists view society to be in a continuous state of conflict. Such conflict is presumed to be generated by the proposed interests that are inherent in the structure of society. As we look around us, we see conflict almost everywhere in society. Conflict does not necessarily imply outright violence; it includes tension, hostility, competition and disagreements over people over goals and values. We see conflicts between racial groups, ethnic groups, sexes, younger and older people, religious groups, supporters of different political ideologies ets. This conflict is not an occasional event that disrupts the generally smooth workings of the society, it is a constant process and it is an inevitable part of social life. The things that people desire such as power, wealth and prestige are always scarce and the demand for them exceeds the supply and groups and individuals fight and compete for them, this may also be a major source of conflict. (ii) CONFLICT AND CHANGE Conflict theorists do not see social conflict as a necessarily destructive force, but argue that conflict can often have positive results. Conflicts bind groups together as they pursue their own interests and the conflict between competing groups focuses attention on social problems and leads to beneficial changes that might otherwise not have occurred. The conflicts caused by social conflict prevent society from lapsing into stagnation. APPLICATION TO SOCIOLOGY OF HEALTH Page | 8
  • (a) MARXIST THEORY TO THE STUDY OF HEALTH AND ILLNESS (a) COMMODIFICATION: Refer to information above: under modern capitalism, medicine like any other good and service has become commoditized and is bought and sold for huge profits by rich people. This is so especially when health care is provided by the private sector (private hospitals), although it also happens where health care is provided principally by the state. One illustration of this is the way in which medical practice is influenced by the activities of large pharmaceutical companies. It could well be argued that drugs are developed and marketed to medical practitioners not out of a sense of helping the poor but as a means of making huge profits. There is more money made from treating diseases of the rich people than diseases of poor people. (Mcknlay, 1984). (b) A social class differences in health and illness behaviour: The poor are sicker than the affluent. E.g. rich patients have the necessary means to undergo expensive methods and techniques of treatment, while poor cancer patients cannot afford this. (c) Exploitation of the weaker by the dominant group: e.g. Race- Whites tend to enjoy better health than blacks in Malawi. Sexual- There is a higher morbidity rates among women than men (male exploitation). (d) Split in authority between administration and medical staffing authority generate conflict. Also extreme division of labour in modern hospitals is conducive to inter-group antagonism. Examples between • nurses and para-medicals or doctors • Male nurses and clinical officers. (e) Solo practitioners fighting competing for patients (compare with the structural functional perspective). (f) Health practitioners fighting/ competing for prestige (insist on education). (g) Conflict between western medical system and traditional medicine. 2. INTERACTIONISM Interactionists study the processes of social interaction and their consequences for the individual. Behaviour is not assumed to be a product of adherence to normative standards as functionalists say. Instead, it is assumed that the individual interprets the situation and determine his or her behaviour accordingly. SYMBOLIC INTERACTION HERBERT MEAD (1863-1931) Symbolic interaction is the interaction that takes place between people through symbols e.g. signs, gestures dress, shared rules and most importantly, written and spoken language in social situations. The primary focus of symbolic interaction is face to face interaction through symbolic meanings. People are unique in the sense that the interaction between them does not take place automatically or instinctively, as in the case of the animal world. Interpersonal actions of reactions are carefully considered and even rehearsed before they are implemented. The individual will therefore take into consideration the other person or persons in a specific situation and their expectations and reactions will in turn influence his actions to a large extent. The interactionists also give attention to objects, events, actions, peoples’ motives and objectives, situations, circumstances etc as well as the meanings of these for individuals. Page | 9
  • Symbolic interactionism tends to reject theories which see human beings as passive pawns (creatures) in the play of wider social forces. It is concerned with the understanding how people interpret situations and how these interpretations influence their conduct. The questions that interactionists ask are: (i) What kinds of interactions are taking place between people? (ii) How do they understand and interpret what is happening to them? (iii) Why do they act towards others as they do? Sociologists using this perspective usually focus on the more minute personal aspects of everyday life. E.g. by what process does someone become drunk? APPLICATION TO SOCCIOLOGY OF HEALTH Doctor/nurse- patient relationship where clients are labeled as sick. The professional system of health care work is a network of interactions and relationships and develop thereafter. Labeling theory as applied to mental hospitalization, long term hospitalization for physical disability and chronically ill. COMPARISON OF PERSPECTIVES Each revealed something about the nature of society or the process of social interactions. Contemporary sociologists have expanded on the original versions of these theories making them more applicable to modern day issues. E.g. someone doing sociological research at a work place would ask the following questions from the three perspectives to complement each other. Structural- functional perspective- might ask how solidarity develops as workers who perform specialized tasks become independent. Conflict perspective- might ask how the social class system hinders the rise of minority group workers to positions of status and power. Interactions: ask how people in a workplace negotiate informal roles (workaholics, ideal person, mediator, leader etc) through their interaction with each other. Each social perspective looks at the same scene from a different angle and together they provide a broader understanding than any one perspective (theory) could alone. SUMMARY Sociology is described as multi-paradigmatic it can be explained using different sociological explanations. Sociological theories are divided into theories of social structure e.g. functionalism or theories of social action e.g. symbolic interactionalism. Nurses require a theoretical grounding for their actions. Nurses deal with a myriad of different people and a multiple problems. They need to use various and complex methods when making informed decisions about care and support of patients. Page | 10
  • RELEVANT SOCIOLOGICAL CONCEPTS 1. SOCIETY A society emerges only as a multitude of people interact in a patterned, recurrent ways and establish enduring relationships. WHAT IS SOCIETY? Society can ca be defined as a group of people with shared values, beliefs, symbols, patterns of behaviour and territory ( by birth or assimilation or geographical territory). A society can be as small as a tribal community of several dozen people or as large as modern nation state with 100 of millions of people. CHARACTERISTICS OF A SOCIETY A society is seen as relatively independent, self- perpetuating group of people who occupy the same territory and participate in a common culture. A society is made up of different groups of people. Society keeps on changing in terms of social attitudes, behaviour, gender relations, globalization, communication technologies, patterns of criminality and social aspects of health and illness. 2. SOCIAL STRUCTURE For the most part, people do not interact in a haphazard or random manner, rather their relationships are characterized by social ordering- the interweaving of people’s interactions and relationships in a more or less recurrent and stable patterns. It finds expression in a matrix of social positions and the distribution of people in them Social structures consist of the recurrent and orderly relationships and prevail among the members of a group or society. It gives us the feeling that life is characterized by organization and stability. Social structures provide an organized and focused quality to our group experiences and it allows us to achieve our collective purposes. By virtue of social structure, we link certain experience, terming them e.g. the family, the church, the neighborhood a business organization etc. Social life is patterned in two ways: status and role. COMPONENTS OF SOCIAL STRUCTURE (i) STATUS It is organized social position that an individual occupies within the society. Every status involves a number of rights, duties, or expectations that guide social interaction. A status serves to define the relationship between various individuals, thereby forming patterns in social structure. E.g. in a classroom situation, social interaction is based on 2 major statuses- lecturer and student. A status then is a social definition of who and what we are in relation to specific others. Page | 11
  • Statuses involve more than social positions in relation to others; they play an important part in how people define themselves. STATUS – SET It refers to all the statuses a person holds at a given time. E.g. a woman may be a mother of two, school teacher, a representative of student union etc. ASCRIBED AND ACHIEVED STATUS An ascribed status is a social position a person receives at birth or assumes involuntarily later in life. Eg being a daughter, a Malawian, a teenager or a widower. By contrast, an achieved status refers to a social position a person assumes voluntarily and that reflects personal ability and effort. eg church deacon, student nurse, lawyer etc. In general, education has been the single most important means by which individuals achieve rewarding status in life. One problem with this distinction however is that many statuses are actually the result of both ascription and achievement. More especially, people’s ascribed statuses influence the statuses they are likely to achieve. Generally, a person born in a family of high social position has numerous advantages that are likely to result in such achieved statuses as being a well paid professional etc, a status that would be far more difficult to obtain for a person born without such privileges. MASTER STATUS It is a status which outweighs and influences all other statuses. It is a key or core status that carries primary weight in a person’s interaction with others e.g. gender, males may be nurses but they are usually referred to as male nurses. A master status is a status that has exceptionally great significance for shaping a person’s entire life. Therefore it is a crucial element of a person’s self concept and social identity. Such a status can either be ascribed or mostly achieved. Some master statuses may negatively influence an individual, e.g. a mental patient or prisoner in that people view them as such for the rest of their lives and they are denied profitable occupations, shunned by former friends, suspected of suspicious behaviour when they do not conform the expectations others have on them. 3. ROLES Patterns of behaviour corresponding to a particular status one is occupying. A role is the expected behaviour we associate with a status. Role performance is the actual behaviour of the person who occupies a status. The difference between a role and status is that we occupy a status and play a role. THE NATURE OF ROLES ROLE SET A single status may have multiple roles attached to it, consisting a role set, e.g. the status of a patient involves the sick role, role as a recipient of attention from friends and family etc. ROLE STRAIN This occurs when individuals find the expectations of a single role incompatible, so that they have difficulties in performing the role. E.g. a secretary – types reports, schedules an executives meeting, making phone calls, make errands for two or more superiors. Uncorrected role strain Page | 12
  • can lead to chronic frustration, a sense of failure, feeling of insecurity, ulcers, heart disease, even death. ROLE CONFLICT Role conflict results when individuals are confronted with conflicting expectations stemming from their simultaneous occupancy of two or more statuses. E.g. if a policeman investigates a crime finds that his own son is a culprit, there may be conflict between acting as a father and as a policeman. HANDLING ROLE STRAIN AND CONFLICT We often solve role dilemmas by setting priorities. When roles clash, we decide which role is more important to us and act accordingly. One strategy for minimizing role conflict is to subdivide or “compartmentalize” our roles so that we perform roles linked to one status at one time and place and carry out roles linked to another status in a completely different settings. E.g. leave the job at work before heading home to one’s family. ROLE CONFLICTS AMONG NURSES Built into the social role of the nurse, within whatever field it may be acted, is a series of conflicts which are inherent in the role itself. A few of these conflicts will be highlighted here. INITIAL ROLE CONFLICT BETWEEN SOME OUTSIDE NORMS AND NURSING NORMS. It has been said that nursing students need to be socialized into the profession. They come from a variety of cultural backgrounds and have acquired conventional patterns of behaviour which often have to be unlearned. Intimate care necessary for treatment may conflict with the norms learned in primary socialization to regulate contact between sexes. Another area of conflict is the acceptance of death from which most students will have been protected against. Her/his role as a nurse, especially in the early stages of her socialization into the profession, may not be clearly defined, and she/he may subconsciously shrink from the very ill, the deformed and the dying. She/he must however, accept the sick or deformed person as someone in need of help, care and understanding. Impatience, undue hardness or indifference may occur as the result of the conflict between cultural conditioning regarding illness and the realities of the situation in which she/he finds him/herself. Understanding this aspect of problems encountered by nursing students can result in help and support for a student nurse confronted with role conflict situations. The student usually learns to resolve these initial conflicts in favour of the professional role, which she/he learns need not compromise her/his behaviour and activities in her/his social role. INTRAPROFESSIONAL ROLE CONFLICT Success is measured in terms of the distance one moves away from the original professional service in the direction of administration. The more advanced and skilled nurses become, and therefore the more useful to the patient, the further away they go from the patient, when they seek career development as administrators or teachers of nursing. The competent bedside nurse is promoted to a managerial position that requires knowledge and skills that she may not have. Success in nursing often lies in turning away from interaction with the patient. CONFLICT INHERENT IN THE WORK SITUATION Page | 13
  • The nurse is often faced with a conflict between the action she/he would like to take and one she/he is forced to take. S/he may be faced with decision as to whatever s/he can or should give all her care and attention to one person, and there by neglect others. This is not a case of the nurse putting her own interests before those of patients but of deciding in which area priorities lie. The nurse must ‘pt the patient first’ but which patient or patients? a potential source of inner conflict. The nursing role dictates that equal care and attention be given to all patients. In practice, this is often impossible. ROLE CONFLICT RELATED TO EMPLOYEE STATUS For so many years, nurses were exploited. They worked for ‘love of humanity’ and not for money. Working conditions, pay, rights were mentioned. This has all changed, but the old ideas die hard and can still lead to conflict. Modern nurses recognize the need for good working conditions, equitable pay and service conditions and strive for these for all members of their profession, usually by means of representations made through their professional associations. This is their right as professional people. Being paid salary is not a privilege. It is a normal condition of modern life. COMMUNICANT ROLE CONFLICT A staunch member of a religious persuasion may be called upon, by her professional role, to perform acts which are contrary to her beliefs. The nurse must realize that she/he has the right of decision regarding participation in certain procedures e.g. blood transfusion and legal abortions, provided that she/he makes her views and scruples known to the authority. NURSE- PATIENT ROLES If nurse and doctors are to serve their patients well then an understanding of the role of the patient is essential. In most cases non-clinical factors tend to receive scanty attention by both doctors and nurses in their perception of the patient. They mostly focus on physiological factors e.g. (symptoms) rather than social factors which are of equal importance. The patient role is a complete change of life style. The patient must be guided, informally and formally by nursing staff so that the transition to the patient role is accomplished with the minimum of society. Once the patient has accepted the fact that he/she require hospitalization, there begins an anticipatory period during which activities are related to the future severance from social occupational roles and to the adoption of the patient’s role. Normally the patient tries to a mass knowledge about his/her future role. THE ROLE OF A PATIENT CHANGE IN SELF- CONCEPT Illness or disability, even if it is only temporary, can bring a bout a complete change in self concept which hopefully is also temporary. Permanent disability or chronic illness changes the patient’s view of himself functioning in society. Although one remains a wife or husband, mother or father, because of illness one is prevented form fulfilling all the expectations inherent in the role itself. The person has a new role – that of a patient. How one reacts to the new role will to some extent depend on the norms and expectations of the society. In our society, a ‘man’ is expected to bear pain with fortitude, to be brave. If the man is not brave enough he may be frowned upon because he is not living up to the role expectation of being a man, a man patient. Those who feel unable to live up to it may withdraw into helplessness and even hopelessness which hampers treatment and impairs recovery. The patient Page | 14
  • must be helped to save the face so that his normal masculine self-image is not destroyed. The nursing student of sociology may find help in dealing with patients, if she/he can accept them as they are and not build up a stereotype role expectation of a patient. Illness is a crisis in the life of anyone. The fact that because of it one can no longer fulfill one’s normal role may cause worry and frustration and actually prevent or delay response to treatment and recovery. Being a patient involves accepting a state of dependence. The patient who formally was in change of himself/herself and his/her activities, is now placed in the position where he/she has to accept help even instructions. E.g. “can I go to the bathroom nurse? “Patients are not allowed to use the kitchen.”, “you should take lots of fluids fro the next few days”. However, this dependent aspect of the role of patient must also be understood. True, nursing today has changed considerably, so that independence is encouraged as much as possible. The patient is included in the administration of his own treatment. He can even participate in its planning. Thus, the dependent side of the role of patient, while still existing in many cases, is no longer dominant. This is something that nurses of the old school, who have not kept up with the modern developments, do not know and understand and from superficial observation tend to condemn as ‘poor nursing’ To them, ‘good nursing’ was that which encouraged helplessness and dependence, a concept which has long been proved erroneous. Nurses also tend to have their role expectations of patients, which are unfortunately often stereotype and which may even be dangerous. The ‘good’ patient is the one who does not complain, lies quiet and still, and is almost passive and unnoticed. However,, note that today’s nursing encourages patient involvement in planning care. CONFLICT IN THE ROLE OF PATIENT The conflict that can arise because the patient can no longer play his role as father, employer, etc, may cause irrational, lack of cooperation in treatment, dissatisfaction at hospitalization or a method of treatment prescribed. • The patient who reaches hospital has already assumed the status of sick person but in the case of an emergency situation such as a road accident, this happens involuntarily with no prior evaluation of the pros and cons. • Such a person, although in urgent needs of medical aid will often assert that he is alright; must get home because his wife will be worried; fret because he has the office keys; or become agitated because of social engagements that will be unable to undertake. • Because patients subconsciously feel this conflict, they deny that they are ill, attempt actions beyond their present capabilities, generally act in a manner that is irritating to say the least. • Doctors and nurses tend to become impatient with this attitude and dismiss the objectives as unrealistic; being concerned only with the clinical condition. • If the nurse realizes that role conflict is at the bottom of this form of behaviour, it makes it easier for her to accept it and continue to act with unfailing concern for the welfare of the patient. • It is suggested that the student of nursing, in her daily work with patients, examine her/his own attitudes and those of her colleagues within the framework of a better Page | 15
  • understanding of the role of the patient and the conflict which can occur when the role of the patient is forced upon one. • A sensitive nurse will do everything possible to guide both patient and family over the temporally breakdown in role patterns. • A good nurse usually has the ability to see themselves in the role position of others so that the problem confronting patients are visualized, and assess how they appear to patients and clients/relatives. This will enable them play out their roles as nurses, so that the patient gains maximum benefit from them. • The nurse’s role must be flexible while maintaining professional dignity and competence. This will benefit the patient with this individual problems and his temporary patient role if the situation is handled with sympathy and care. ESCAPISM Occasionally, some people take the role of patient to escape from their role obligations. Illness is perceived by these patients as a great relief and means of escape from their day to day responsibilities. They can relax into the role of patient legitimately and expect others to care for them and they can demand services they would not normally expect to receive. E.g. a child who hates school might complain of headache so that he can exchange the role of pupil for the role of patient. 4. NORMS These are social expectations for appropriate behaviour or expectations within a given culture regarding proper behaviour or appearance. Social norms are the codes of ethics which limits behaviour of individuals. In other words, social norms are the standard by which right and wrong are judged by the society. Social norms are the products of society and culture. They lay equal pressure upon the people. B) FUNCTIONS OF SOCIAL NORMS: 1. Social norms control our behaviour by providing pattern to bring harmony in the relation of a society. 2. Social norms help to maintain order in the society. 3. Social norms safe guard our social cultural values. 4. Social norms give human beings a shape of society. C) TYPES OF NORMS: There are 03 types of norms: 1. Folk Ways. 2. Mores. 3. Laws 1) FOLK WAYS: Folk ways are the habits or tradition observed among the individuals in a group. They are the basic customs of social life. Folk ways are informal norms. Folk ways define our specific behaviour for specific situations. Folk ways are norms that arise during social interactions and Page | 16
  • are handed down from one generation to another. The peoples are punished violation of folk ways which is unwritten. Some examples of folk ways are as follows: 1. Shaking hands while meeting. 2. Respect for elders. 3. Having three meals in a day. 4. Wearing national dress. 5. Some marriage ceremonies. 2) MORES: • Mores is a Latin word for customs singular is “mos”. • Mores are the folk ways which have vital importance in the society. • Mores are compulsory behaviour. Mores are more compulsory to conform than folk ways. • Mores are more rigid and strict than the folk ways. There are definite moral supports behind mores. • Mores are more serious norms and also informal. • The violation of mores is a serious threat to the society. Some examples of mores are as follows: 1. Respect for parents. 2. Standing for national anthem. 3. Care of sick. 4. Nikah ceremony. 5. Students to attend classes regularly. 3) LAWS: • It may be defined as “Rules of modes of conduct that are recognized as binding by a supreme controlling authority”. • Law is written customs and part of law book. • Law is social or formal social norms. • Law is the guardian of highest value of the society. • Law may be: 1) Civil and 2) Criminal 5. VALUES Values are standards, ideas or things which are given importance by the people living in a society. The thing toward which are attitude is directed is called value. Values depend upon the social structure and the cultural pattern of the society. Values are the conceptions of the goodness which influence our education from available means and modes of action. Some examples of values are as under: Weather, Power, Status, Education, Truth, Affection, Respect for elders, Cleanness. B) TYPES: There are five types of values: Page | 17
  • 1) INDIVIDUAL: There are personal values which are directly related with the interests and objectives. 2) GROUPS: It is determined with a view to focus or group interest or its objectives rather then other values. 3) NATIONAL: It is those values which are shared by the people of a community. 4) CULTURAL: It is hereditary. These values are transmitted from one generation to another and form core of the culture. They provide shape of the culture. Deviation from the cultural values creates serious problems. 5) SOCIAL: They are current values. Social values are adopted by the society in their daily social life values and are direct aim of people. There values lead to the proper of the society. 6. Attitudes Attitudes are defined as an orientation (towards a person, situation, institution, or social process) that is held to be indicative of an underlying value or belief. Attitudes can only be inferred from observed behaviour, as a tendency to act in a certain (more or less consistent) way towards persons and situations. an attitude is ‘a relatively enduring organization of beliefs around an object or situation predisposing one to respond in some preferential manner Rokeach, (1976)’. 7. Ethnocentrism It can be defined as “A belief that ones own group, race, society and culture are superior to other groups, race, society and culture”. Man has a tendency to believe that his own ways are batter then those of the other and judges other cultures and societies by his own standard. ADVANTAGES & DISADVANTAGES ADVANTAGES DISADVANTAGES 1 It provides protection to group members by creating a sense of belonging among them. Ethnocentrism peoples are less educated more individual in religion and less social. 2 It promotes patriotism among member of a society. They appose the introduction of new idea and accept little social changes in their behaviour. 3 It helps in bringing about progress on national bases. It blocks the road to growth of human knowledge and mutual co-operation of human beings in social settings. 4 The individual remain loyal to their group and culture. Ethnocentrism obstructs intercultural relation. 5 It helps in preserve the original culture and separate individuality. The unity and integration of different society became difficult. Page | 18
  • 6 The people feels satisfied with their own culture. It some times takes from conflicts, wars and other types of destructive activities among two or more societies. 7 Peoples are saved from confusion to understand that what is wrong and right, good or bad in different cultures It brings frustration and restlessness among the people of different groups, and castes, and classes. 8 It brings more solidarity. It may lead to social disorganization and higher rate of crime and delinquency. RELEVANCE OF SOCIOLOGY TO NURSING PRACTICE There is a considerable controversy regarding whether nurses should study sociology. Some commentators have suggested that sociology should not be included in the nursing curriculum, arguing that it can add no value to nurse education and training. Others have suggested that sociology is vital to nurse education and to future nursing as a profession. Students often ask why de we have to study sociology? The main aim of this course is to demonstrate the practical relevance of sociology to nursing, and to explore how sociology may provide you with exciting new ways with which to understand the needs of your patients. SOCIOLOGY IN NURSING Most health professionals including nurses now study sociology as an integral part of their training. Sociology encourages us to view everyday phenomena I a different way. It is like being given anew pair of glasses. A sociological approach to nursing locates the work of individual nurses squarely within a social context, rather than considering it in isolation. In general terms, when a sociological analysis is applied to the essence of individual health care experience, whether it be that of patients or health care workers, this is termed “sociology in nursing”. Sociology can help nurses to achieve their primary objectives of good patient care. As nursing and sociology are both concerned with people and their interactions, it s likely that the theories (or material) developed in either discipline of nursing or sociology will provide insight for the other .e.g. sociolisation, deviance, family etc. There is a dynamic and fundamental role for sociological knowledge within nursing (and health care generally). Sociology demystifies the nature of health and illness, highlights the social causes of disease and death, exposes power factors and ethical dilemmas in the production of health care, and either directly or indirectly helps to create a discerning practitioner who then becomes capable of more focused and competent in decision making. The course provides foundations for a sociological understanding of health issues, which can help nursing practitioners to manage the care of their patients more effectively or at the very least more intelligently. Whilst some elements of sociological knowledge can offer immediate and direct solutions to nursing issues, what is paramount is that ‘sociological imagination’ is utilized to contextualize all nursing and health care action. Page | 19
  • A study of sociology will help a nurse to gain insight into factors in the culture and social background of patients and various groups in the society which have a direct bearing on the health and welfare of the people in the community to whom she/he must render a service. This knowledge will help her to serve more effectively. Knowledge of sociology will help nurses in their process of professional socialization, especially in the area of nurse-patient relationship for the successful interaction and outcomes they will have to be sensitive to patient’s social and emotional needs in addition to their technical (medical) competence. Because the delivery of heath care is essentially a social activity, gaining an understanding of the social processes involved would improve nurses’ social interaction with colleagues and all those with whom she deals with in her course of work. Sociological understanding should help a nurse appreciate why people respond differently to their symptoms of illness and why differences exist between individuals and groups in relations to health and illness. The study of social factors in the etiology of disease plays a significant role in causing a wide range of diseases. Some illnesses may be socially induced and can therefore be most effectively treated or prevented by action based on the understanding of cultural patterns and social actions of the people and not only on knowledge of drugs and human biology. Sociological knowledge can help towards better appreciation of the functioning of the hospital organization and the health care delivery as whole which nurse practices her/his profession. The study of sociology will help a nurse in her understanding of the social processes going on in society and show her/him how to improve her/his own image with the public. SOCIOLOGY AS A BEHAVIOURAL SCIENCE • Behavioural science courses provide some knowledge that helps us to understand the human patterns in relation to health and illness. • Examples: • Why health or illness is promoted or complicated by: • The type of food we eat • Why we accept or refuse family planning • Who determines when and where a sick person should seek medical help ( whether from hospital or traditional healer) • Why TB is common in overclouded communities. These are some of the problems which behavioural science helps to solve. Behavioural science consists of 4 main social : sociology, anthropology, psychology and social psychology. • Sociology: studies social relationships-ways people interact in a group. • Psychology: the behavioural and thought processes of an individual, the ways in which an individual acts and reacts to other human beings and the society. • Anthropology: study how peoples cultures as they affect their life patterns (usually not illiterate community) • Social psychology: an individual in a social setting and tries to explain the effects of other people on an individual’s behaviour. Page | 20
  • WHAT IS MEANT BY HEALTH, DISEASE AND ILLNESS? HEALTH Health is a concept seen in relation to disease. Thus the bio-medical definition of health may be: ‘the absence of disease or freedom from the symptoms of illness. WHO definition is a step further by describing it in a positive term as: “ state of complete physical, social and mental well- being and not merely the absence of disease infirmity.” It draws attention to the fact that positive aspects of healthiness ought to be considered and not only the negative aspects of pathology. DISEASE Disease is defined as deviations of measurable from the norm, or the presence of defined and categorized forms of pathology. Disease categories rest on description of characteristic clusters of symptoms which have been observed by doctors in their clinical practice, eg malaria symptoms. Disease, therefore, generally refers to a biological or mental condition that usually involves medically diagnosed symptoms. ILLNESS Whilst health can be defined either as an ideal state or the absence of disease (and disease is what doctors describe), illness is the subjective experience of ‘feeling’ unwell. Page | 21
  • Illness can be taken to mean the experience of disease, including the feelings relating to changes in bodily states and the consequences of having to bear that ailment; illness therefore relates to a way of being for the individual concerned (Radley, 1994:3). Illness refers primarily to an individual experience of ill health and is indicated by a person’s feelings of pain, discomfort and the like or it is the social recognition that a person is unable to fulfill his/her normal roles adequately, and that something must be done about the situation. It is thus possible to have illness without disease and disease without illness. A wide variety of subjective evidence is involved in the process of defining oneself as ill. These perceived alterations can be in physiognomy (eg loss or gain of weight), bodily emissions (eg, urinating frequently or diarrhea), the working of specific organs (eg, heart beating fast or headache), or the emotions (e.g., depression or anxiety). So what is the difference between ‘illness’ and ‘disease’?: Patients suffer ‘illness’; physicians diagnose and treat ‘disease’. Helman, (1994, p. 107), puts in this way ‘disease is something that an organ has while ‘illness’ is something a person has. What both of these explanations are doing is highlighting the difference between the objective way disease is diagnosed and the subjective way illness is defined. I.e. disease= objective while illness = subjective. THE MEDICAL AND SOCIAL MODELS OF HEALTH The medical models of health The medical model emphasizes the role of medicine in the eradication of infectious and parasitic diseases, advances in surgery, the application of technology and new drugs and lowered infant mortality rates. The biomedical methods of doctors are objective in the sense that they claim to provide ways of directly observing and measuring the signs of disease using scientific knowledge and techniques. Weitz, (2000) summarises the medical model as consisting of five main features: (i) Defines disease narrowly as a deviation from normal biological functioning. (ii) Assumes disease is both specific and universal. The model assumes that each disease has specific features recognizable through clear, objective measures that differentiate it both from other diseases and from health. (iii) Assumes each disease has a unique etiology, or cause. Modern medicine assumes, for example, that T. B., polio, AIDS, etc are each causes by a unique microorganism. (iv) Conceptualizes the body as a machine or factory and disease as a breakdown of those mechanisms. This mechanistic model encourages doctors to treat individuals in a reductionistic rather than holistic fashion. Reductionistic treatment refers to treatment refers to treatment in which doctors consider each part separately from the whole. In contrast, holistic treatment assumes that all aspects of an individual’s life and body are interconnected- that, for example, to treat an individual with cancer, health care workers must not only treat the tumor but also Page | 22
  • explore sources of illness elsewhere in the body and in an individual’s psychological and social circumstances. (v) Assumes that the definition, diagnosis and treatment of disease are neutral, scientific matters, unaffected by normal or subjective judgments or vested personal interests. The social model of health Because ‘illness’ is about how a person feels, the definition of illness is determined by the cultural context in which it occurs. Definitions of ‘illness’ rely on social definitions of ‘normality’ which itself is a relative and judgmental concept. What is considered normal may be relative to cultural and social groups and involve judgments. Illness is culturally specific. Individuals draw their ideas about illness from the group and communities in which they live. Thus illness has a social dimension to it. However, whether or not an illness is experienced in the first place, what meaning is attached to any pain or discomfort, the reaction the individual has to her or his illness, and the way in which both healer and society frame and responds to the individual, are all dependent upon the social context in which events are taking place. As Helman, (1994:107-8) notes “the same disease (such as T.B.) or symptoms (such as pain) may be interpreted completely differently by two individuals from different cultures, or social backgrounds, and in different contexts. And this will also affect their subsequent behaviour, and the sorts of treatment they will seek out. The process of becoming a patient (i.e. changing from being ill to being disease’) is not only dependent on the beliefs and actions of the individual, which in themselves are affected by social factors, but also upon the behaviour of health-care practitioners. E.g., community psychiatric nurses can decide and regulate who does not begin (or continue) a career as a ‘mentally diseased patient’. The term ‘sickness’ denotes the amalgamation of the two processes of being diagnosed as a ‘diseased’ and of feeling ‘ill’ and alludes to the existence of a social role when suffering from ill-health. It is society that confers particular behaviours on to an individual who has felt ill, and has been diagnosed as diseased by medical practitioners. The importance of recognizing social definitions of health can lead to the suggestion that the only valid measurements of health and illness are those determined subjectively. More over, policy makers and practitioners need to recognize how health and illness beliefs of individuals vary between social groups and between different cultures. That is relying on the ‘objective’ disease based criteria for measuring health and illness is unattainable. Furthermore, medical and lay beliefs are not necessarily dichotomous ways of understanding health concerns. In most medical examinations, the patient’s account of her r his illness is obtained and incorporated into the process of diagnosing disease. Meanings about the significance of the symptoms are negotiated in the doctor-patient encounter, and both condone an acceptance of the efficacy of medical science. Where non-compliance (on behalf of the patient) occurs, this is as a result of an unresolved clash between the lay and the medical perspective. The exceptions (i.e. when no negotiation can take place) are when an individual is unconscious as a result of an accident, or during surgery. Page | 23
  • THE SOCIOLOGICAL PERSPECTIVE ON THE MEDICAL AND SOCIAL MODELS. Sociologists show how disease could be differently understood, treated and experienced by demonstrating how disease is produced out of social organization rather than nature of biology, or individual lifestyle choices. While sociologists make no claim to being biological scientists, they do not make the claim that biological knowledge can be sociologically explained, to show that our knowledge of health and disease is created in a political, social and cultural environment. There is no pure value-free scientific knowledge about disease. Our knowledge of health and illness, the organizations of the professions which deal with it, and our own responses to our bodily states are shaped by the history of our society and our place in society. Since sociologists do not accept the medical model of disease and illness as simply biological events, they then examine the social functions of medical knowledge. IE they examine the way medical and biological explanations of disease work in our society. Medical knowledge is produced in and reflects structural features of society. It explains as ‘natural’ what; from a sociological perspective are social phenomena. Why the working class is sicker and dies earlier, why women are diagnosed sick more than men, and why ethnic groups do not receive the services they need, requires a sociological explanation and not a biological one. Medical explanations obscure and paper over the social shaping and distribution of diseases, disease categories, and health services. SUMMARY 1. The course provides the foundations for a sociological understanding of health issues, which can help nursing practitioners to manage the care of their patients more effectively- or at the very least more intelligently. Whilst some elements of sociological knowledge can offer immediate and direct solutions to nursing issues, what is paramount is that ‘sociological imagination’ is utilized to contextualize all nursing and health care action. It is necessary for a nurse to have knowledge of sociology, so that He/She can learn and understand the human nature society and social institution. He/She can be a good and successful nurse, when He/She know Her/Him Surrounding and know how to deal with people individually and in groups. 2. The nurse is a first person who deals with the patients in emergency. If a nurse has knowledge of sociology and He/She will help her in dealing her patients in emergencies, who are usually under stress and shock. He/She will take prompt decision, and tackling them. 3. A trained nurse can help patients who are irritated during illness psychologically and help them to get over and recover from illness. 4. A nurse who has knowledge about rituals and customs of different peoples can handle patients who are superstitious have to take medicines and they believe more in which doctors and quacks. 5. As our country biggest drawbacks is illiteracy. A nurse can educate people about clean less, balance diet and also guide mother and child health and vaccination. 6. The knowledge of sociology can help nurse in a number of ways that also help in improving the society. Nursing practice consists of individual cases and each nurse has to learn how to use sociology to his or her own, and his/her patients’ advantage- just as he/she must know how to apply the other knowledge she has gained in her/his training. Sociology also provides a new way o looking at things. Page | 24
  • CULTURAL BELIEFS The professional health care provider is operating in a world peculiarly surrounded by cultural manifestations – rituals, superstitions and religious ceremonies- and he needs to understand the impact of culture on human mind for him to perform successfully in his profession. All human societies, beliefs and practices relating to ill-health are a central feature of the culture. The values and customs associated with ill-health are part of the wider culture and cannot really be studied in isolation from it. ILLNESS BEHAVIOUR Illness behaviour is about the social and cultural factors which influences the way individuals view signs and symptoms, and the kinds of actions engaged in to deal with them. Individuals may recognize symptoms and signs as a medical problem and they may go to a health facility, treat themselves or ignore the symptoms. To answer the question of why patients go to the doctor, sociologists have offered the concept of illness behaviour which describes how individual patients through a series of decisions, negotiate a ‘career’ from being a well-person to being an ill-patient. Explanation of illness behaviour To explain why individual will or will not go to the hospital with their symptoms: 1.Seriousness of symptoms Certain symptoms are classified as normal because of their wide prevalence in society. The perceived threat of the symptom must be serious for action to be taken. 2.Tolerance of symptoms The extent to which others, especially family members, tolerate the symptoms before reacting; varies; individuals also have different tolerance thresholds; it is suggested that this tolerance is made easier to adapt than those with dramatic onset. 1. Assigning of meaning Once perceived, the symptoms must be interpreted. Often people explain symptoms within normal parameters (I am just tired). For symptoms which are recognized by the medical profession as signs of disease to be taken to the doctor/ hospital, they must first be perceived as a problem and actually taken there. E.g. for students, headache might be taken to be due to over reading and therefore there is no need to go to the hospital. 2. Denial of symptoms Page | 25
  • Often, the individual or members of his/her family deny a symptom for personal or social reasons. The amount of fear and anxiety present can interfere with symptom perception. 3. Cultural variation Cultural factors determine how symptoms are interpreted and responded to between two or more cultural groups to the same symptoms. 4. Triggers Zola, (1973), found that most people tolerated their symptoms for quite a time before they went to a doctor, and that the symptoms themselves were often not sufficient to precipitate a consultation: something else had to happen to bring this about. He identified five types of triggers: • the occurrence of an interpersonal crisis eg a death in the family • perceived interference with social or personal relations “sanctioning” (pressure from others to consult) • Perceived interference with vocational or physical activity • A kind of ‘temporalizing of symptomatology’ (the setting of a deadline e.g. if I do not feel the same on Monday……….or ‘if I suffer again………’ The decision to seek professional help is then very much bound up with an individual’s personal and social circumstances. Zola (1973) also found that, when paid insufficient attention to the specific trigger that prompted an individual or that an individual used as an excuse to seek help, there was a greater chance that the patient would eventually break off treatment. 5. Lay referral and intervention It is comparatively rare for someone to decide in favour of a visit to the surgery without first discussing his or her symptoms with others e.g. relatives. It is claimed that just as doctors have a professional referral system, so potential patients have lay referral system: ‘ the whole system of seeking help involves a network of potential consultations from the intimate confines of the nuclear family through successively more select, distant and authoritative laymen until the ‘professional’ is reached (Friedson, 1970) in Scambler, (2003). Friedson has himself produced a model in terms of: (1) the degree of congruence between the subculture of the potential patient and that of doctors; and (2) the relative number of lay consultants interposed between the initial perception of symptoms and the decision whether or not to go to the doctor. Thus, for example, a situation in which a potential patient participates in a subculture that differs from that of doctor and in which there is an extended referral system would lead to the ‘lowest’ rate of utilization of medical services. Occasionally, lay persons might take it upon themselves to intervene and initiate medical consultations. This is more common when symptoms are perceived to be serious or life threatening or when the sufferer is temporarily incapable of self help. E.g. sometimes a patient is given medicine at home trying to solve the problem themselves. 6. Socio- cognitive status A person’s information about symptoms, knowledge base, and cultural values all influence his perception of illness. The actions of potential patients are also dependent on their knowledge of Page | 26
  • disease, capacity to differentiate between diseases that are threatening/non threatening and that can/cannot be effectively treated. 7. Treatment accessibility The greater the barriers to treatment whether psychological, economical, physical or social the greater the likelihood that the symptom will not be interpreted as serious or that the person will seek an alternative form of care. 8. Perceptions of cost and benefits It is assumed that if an individual regards the symptoms as threat and he believes that a visit to the doctor will be of some benefit, then he is more likely to seek medical aid than another individual who, for example, perceives a visit to the doctor or hospital to be of little value. At any given time, a person might deem obtaining treatment, which might involve hospitalization, to be less important or urgent than, for example, looking after children at home, or preparing for an examination, being at work, or going on holiday. Thus the value an individual attaches to good health varies in accordance with his or her perception of the benefits versus the costs of its accomplishments. CULTURE AND PERCEPTION OF HEALTH AND ILLNESS Cultural beliefs and ideologies about the cause and course of disease influence the ways in which different disease conditions are perceived and the subsequent actions taken. Certain patterns of behavior, which would be defined in our society as pathological and abnormal, may be considered normal in other cultures. An individual’s illness behaviour is a function of many cultural beliefs and socio economic factors as well as that of individual socialization pattern. The influence of culture on illness is more obvious in chronic disease. E.g. mental illness, T.B, hypertension, etc, than in acute clinical conditions. The values and customs associated with ill-health are part of the wider culture, which cannot really be studied in isolation from it. One cannot really understand how people react to illness, death or other misfortune without an understanding of the type of culture that they have grown up in, or acquired that is of the “lens” through which they are perceiving and interpreting their world. In addition to the study of culture, it is also necessary to examine the social organization of health and illness in that society (the health care system)- which include: the ways that they present this illness to people, the attribute of those they present this illness to, and the ways that the illness is dealt with. It is important that when studying how individuals in a particular society perceive and react to ill-health, and the types of health care that they turn to, to know the cultural and the social attributes of the society in which they live. INFLUENCE OF CULTURE ON HEALTH AND ILLNESS Page | 27
  • The health of the member of a society is closely related to the cultural practice inherent in that society. E.g. where the married woman is traditionally expected to bear many children, insisting on safer sex or refusing to engage in sexual relations is impossible and that may put her at HIV and AIDS risk. Cultural beliefs and practice can be correlated with the incidence and distribution of certain diseases. In some cases, cultural factors may protest against ill-health. Therefore, cultural factors can be casual contributory or protective in their relation to health. The following cultural patterns are some of the important determinants of the health of a community: (i) Diet • This includes how food is prepared, stored and preserved. • The utensils used in cooking and storing food, • Whether food routinely contains contaminants. • Whether food is symbolically classified into “food” and “non-food”, “sacred” or “profane”, irrespective of nutritional value. • Whether special diets are followed during pregnancy, lactation, menstruation and ill-health. • The use of western food stuffs- with high salt, high fat and refined carbohydrate levels-in non-western communities as a sign of “modernization”. (ii) Sexual Behaviour • This includes whether promiscuity, pre-or extra-marital sexual relations are encouraged or forbidden. • Whether these sexual norms apply to men, women or both. • Whether homosexuality, both male and female, is tolerated or forbidden. • Whether there are taboos on sexual intercourse during pregnancy, menstruation lactation or puerperium (after child birth). (ii) Marriage Patterns • This include whether monogamy or polygamy. • Whether the levirate (widow inheritance) or sororate (a woman is obliged to marry her diseased sister’s husband0. • Arranged marriage, bonus wife. • Whether marriage is endogamous (where the individual must marry within their family, kin-ship, clan and tribe) greater likelihood of “pooling” of recessive genes, with a higher incidence of such inheritance of such inherited diseases e.g. haemophilia, thalassaemia major cystic fibrosis – or exogamous (where you choose a partner outside those groups). (iii) Family Structure • Whether nuclear, extended or one parent families are the rule. • The degree of interaction, cohesion and mutual support among family members. • Whether responsibility for child-rearing is shared among family members. (iv) Family Size Cultural beliefs about the optimal size of the family, and gender of its children. Page | 28
  • (V) Contraceptive Pattern • Cultural attitudes towards contraception and abortion. A taboo on both-event enlarged family size and in some cases may have negative effect on maternal health. • Certain forms of contraception or abortion may also be dangerous to maternal health. • Attitude to the use of condom may influence the spread of STIs and HIV and AIDS. (Vi) Pregnancy and Child Birth Practices • Changes in diet, dress or behaviour during pregnancy. • The technique used in child birth, and the nature of birth attendants. • Care of the umbilical cord (in some cultures traditional medicine is applied as a dressing to the newly cut umbilical cord, thus increasing the risk of neonatal tetanus). • Customs relating to the puerperium, such as social isolation or the observance of specific taboos. • Whether breast or artificial infant foods (e.g. powdered milk) are preferred. (Vii) child-rearing practices • Emotional climate of child-rearing whether permissive or authoritarian. • Initiation rituals carried out after birth, and at puberty (e.g. circumcision and scarification tattooing, ear and lip piercing. (Viii) OCCUPATIONS Whether certain occupations are reserved for particular individuals, families or groups within the society. (ix) funerary customs • Concerns especially how, when and by whom the dead body are deposed of. • Whether the corpse is buried or cremated immediately, or displayed in public for sometime (which may aid the spread of infectious diseases). • The sites of burial, whether these are near to residences, food or water supplies. (x) culturogenic stress Is included, or aggravated, or sustained by the culture’s values, goals, norms, taboos or expected stress (when one reaches a certain age, stress is influenced by culture). (xi) DOMESTIC ANIMALS AND BIRDS Whether they are kept within the home or outside the home. EFFECTS OF CULTURE ON PATHWAYS TO HEALTH The pathways to health include all available sources of treatment in our society, not only the western or scientific medicine. The pathways to health can be influenced by the type of disease. Looking at any complex society, one can identify 3 overlapping, and inter-connected, sectors of health care the popular sector, the folk sector and the professional sector. Each sector has its own ways of explaining and treating ill-health, defining who the healer is and who is the patient, and specify how healer and patient should interact in their therapeutic encounter. Page | 29
  • The popular sector This is the lay, non-professional, non-specialist domain of society, where ill-health is first recognized and defined and health care activities are initiated. It includes all therapeutic options that people utilize without any payment, without consulting either folk or medical practitioners. Among these options are self treatment, and self medication. They rely on advice or treatment given by a relative, friend, neighbour or a workmate, healing with mutual care activities in a church, cult or self help group, Consultation with another lay person who has special experiences of a particular disorder, or with treatment of a physical state. In this sector the main area of health care is the family- here ill-health is identified and then treated. It is the real site of primary health care in any society. In the family, the main provider of health care are women usually mothers or grandmothers, who diagnose most common illnesses and treat them with materials at hand. People who become ill, typically follow a “hierarchy of resort” ranging from self- medication to consultation with others. The popular sector usually includes a set of beliefs in health maintenance. These are usually a series of guidelines which are special to each cultural group, about “correct” behaviour for preventing ill-health in oneself, and in others including beliefs about the “healthy” way to eat, drink, sleep, dress, work etc. In some societies, health is also maintained by the use of charms, amulets and religious medallions towards off “bad luck” including unexpected illness, and to attract “good luck” and good health. All aspects of the popular sector (and the other two) may sometimes have negative effects on peoples’ mental and physical health e.g. exclusion of family a sick members. In general, ill people move freely between the popular and the other two sectors, and back again, often using all the 3 sectors at once, especially when treatment in one sector fails to relieve physical discomfort or emotional distress. TRADITIONAL HEALTH BELIEFS AND HEALING PRACTICES Those beliefs and practices relating to disease which are the products of indigenous cultural development and are not explicitly derived from the conceptual framework of modern medicine (Hughes, 1968). The traditional study of non-western medicine registered by west as “primitive”, useless on the way out, outdated. Traditional illness “Syndromes for which members of a particular group claim to suffer and for which their culture provide aetiology, a diagnosis, preventive measure and regimens of healing. Traditional disease etiology may include: • Soul loss/ theft- the soul has either left the body on its own or been stolen leaving the body in a weakened and ill state. • Spirit possession e.g. vimbuza. • Breach of taboo- mdulo. • Object intrusion- swollen leg Page | 30
  • Disease etiology The dualist theory of traditional medicine recognizes both a natural and supernatural set of conditions. Natural causes of illness This is called ‘common or ordinary sickness- germ theory. Explanations of disease are based entirely on observable cause- and- effect relationship. Supernatural /causation of disease Supernatural etiological categories refer to those explanations that place the origin of disease in supersensible forces, agents, or acts that cannot be directly observable. This is the theoretical construction made use of to explain the “uncommon or out of the ordinary” type if sickness. It is made use of at a point where ordinary knowledge empirical methods of treatment and explains how they have failed. Supernatural causation of disease is the basic fundamental theory of African traditional medicine. In varying degrees, most African beliefs that it explains all complexes of extraordinary diseases. Traditional Healers These healers are not part of the “official” medicine system and occupy an intermediate position between the popular and professional sectors. Most traditional healers share the basic cultural values, and world of view, of the communities in which they live, include beliefs, cultural origin, significant and treatment of ill-health. Why consult a traditional healer? • Failure to respond to western medicine • Need to gain specific knowledge of the real etiology and problem • Belief that the solution to the problem was only through the sing’anga. • Influence of other members of the family. Advantages of traditional medicine over modern scientific medicine • There is frequent involvement of the family in the diagnosis and treatment. The healer himself/herself is usually surrounded by the “helpers”, who take part in the ceremony, give explanation to the patient and his family, and answer any other queries. From the modern perspective, this type of healer with helpers, together with the patients’ family provides an effective primary health care team, especially in dealing with psychosocial problems. • This healing takes place in a familiar setting such as the home, or a religious shrine. Because traditional healers articulate and reinforce the cultural values of the communities in which they live, they have advantage over western doctors, who are often separated from their patients by social class, economic position, gender, specialized education, and social cultural background. • In particular, these healers are better able to define and treat “illness”- i.e. the social, psychological and moral dimensions associated with ill-health, as well as with other forms of misfortune. Page | 31
  • • They also provide a culturally familiar ways of exploring the causes and timing of ill- health, and its relation to the social and supernatural words. Limitations of traditional healers • They have no common practice and hence it becomes difficult to ascertain whether one is getting the right treatment or not, or whether the traditional healer has the required competency. • The traditional healer could intentionally or otherwise give a patient wrong medicine • There are fears of overdose or under dose. • Most of the traditional healers have no right facilities, especially training on how to handle certain kinds of diseases, yet they assist to treat merely for economic gains. • Accommodation and hygiene may not meet the required standards. These may have the effect of spreading diseases instead of preventing them • Some patients who could have otherwise got cured in hospital are delayed and this may be dangerous. Professionalisation of traditional healers • The relationship between traditional and professional sector has usually been marked by mutual distrust and suspension. Most doctors have tended to view traditional healers as quacks, charlatans or “medicine men” who pose a danger to their patient’s health. • Increasingly (and often reluctantly) however, the medical authorities have recognized that despite their short comings – traditional healers do have some obvious advantages to their family especially when dealing with psychosocial problems. • In 1978, WHO recommended that traditional medicine be promoted, developed and integrated wherever possible with scientific medicine, but stressed the necessity “to ensure respect, recognition and collaboration among practitioners of the various systems concerned. • There has been a rapid growth in the number of practitioners especially in Africa and also in Malawi. By creating a professional association, traditional healers’ hope to advance their interests and those of their clients, improve their standards, raises their prestige and earning power, gain official support and defend an area of health care that only they can provide. Page | 32
  • On a practical level, knowledge of medical beliefs and practice is important in planning health programs for, and in delivering health services to traditional people. Traditional healers have a place in Malawian society in their own right as well as a complement and supplement to the overall medical and nursing concerns of the population. Transcultural nursing care. Transcultural nursing care is concerned with the provision of nursing care in a manner that is sensitive to the needs of individuals, families, and groups who represent diverse cultural populations within a society. Page | 33
  • Cultural awareness The deliberate and cognitive process in which the nurse becomes appreciative to the values, beliefs, life, ways, practices and problem solving strategies of a client’s culture. During this process a nurse must examine his/her biases and prejudices towards other cultures as well as explore his/her own cultural background to avoid the tendency to be ethnocentric regarding one’s own values, beliefs and practice. Without becoming aware of the influence of one’s own cultural values, a risk exists for nurses to engage in cultural imposition i.e. the tendency of an individual to impose his/her beliefs, values and patterns of behaviour upon another culture (ethnosensitivity). Cultural knowledge This is a process in which the nurse seeks out and obtains a sound educational foundation concerning the various world views of different cultures. The goal of cultural knowledge is to become familiar with culturally/ethically diverse groups world views, beliefs, values, practices, life styles and problem-solving strategies. Cultural knowledge can be acquired e.g. from fields of transcultural, studies, sociology, psychiatry, medical, anthropology, etc. Cultural skills It involves the process of learning how to conduct a cultural assessment. This skill allows the nurse to individually assess the clients’ cultural values, beliefs, and practices, without depending solely on written “facts” about that specific cultural group. The nurse learns about the client’s perception regarding his health and illness, as well as the client’s perception of treatment that should be rendered. It is important that every client needs cultural assessment many factors other than ethnicity, e.g. geographical location, gender, religious affiliation, occupation and socio-economic status. Page | 34
  • A cultural assessment is needed for every client, has values, beliefs, and practices that must be considered when rendering health care services. Two guiding principles which can help the nurse in making an accurate culturological assessment are: (a) Maintain a broad objective and open attitude of individuals and their culture. (b) Avoid seeing all individuals alike. The data obtained from cultural assessment will assist the client and nurse to formulate a mutually acceptable, culturally responsible treatment plan. Cultural encounter This is the process that allows the nurse to directly engage in cross-cultural interactions with clients from culturally diverse backgrounds. Cultural encounter can be important to refine or re-modify existing knowledge about a specific cultural group (this may negate and contract academic knowledge about a cultural group). Failure to directly interact with another cultural group will only serve to stereotype that culture. Page | 35
  • SOCIALISATION PROCESS It is a process of social interaction by which people acquire the knowledge, attitudes, values and behaviour essential for effective participation in society. It is the process of becoming a social being, a process that continues throughout one’s life. The process of “making our own” the norms of the groups is known as internalization. The socialisation of a human being into the family and into the community is an important aspect of sociology. Failure of the socialisation process can lead to many problems in the personality of the individual in the community. Human Nature and Nurture People are not born human (Biological inheritance). We become human through the process of social interaction (environment). Relate human nature and human nurture. For many years a controversy has existed having to do with human nature and human nurture. Human nurture has to do with one’s environment and socialization. Human nature has to do with one’s heredity. Which is more important: environment or heredity? Activity: Recount the findings of a study you learnt in the first topic of this course on the influence of social factors on identical twins. The factors of heredity and environment combine to produce a human being. Sociologists tend to play down the significance of heredity and to emphasize the significance of environment and socialization. They characterize the individual as moulded and shaped by the social factors of the culture, family, neighbourhood, peers, education, institutions and life experiences. Sociologists study human nurture and not human nature. Nevertheless, biological and hereditary influences also must be considered if one seeks to understand human behaviour. THE SELF AND SOCIALISATION The looking glass “self”: Charles Horton Cooley This is a process by which we imaginatively assume the stance of other people and view ourselves as we believe they see us. Research suggests that the looking glass “self” functions as a “magnifying glass” during self-perception, so that people see in themselves while others are present has an extra powerful impact on their “self images”. Examples: Page | 36
  • The feeling that a nurse has of and about herself, namely that she is pretty, competent, organized, pleasant and intelligent, depends to a larger extent on what she thinks about how other people perceive her. This ability to “take over” the perspective of another person forms the basis on which the person models his/her behavior. The process of developing a self identity or self-concept has 3 stages: 1. The imagination of our appearance to others 2. The imagination of their judgment of that appearance 3. The development of feelings about and responses to these judgments Examples If you approach a group of college classmates, you are immediately aware that you are giving off an impression. Generally you want that impression to be as favourable as possible, and you view yourself as being friendly, witty, and charming. As you interact with members of the group, you “read” both their verbal and nonverbal reactions to assess whether they view you in the way you imagine you appear to them. If their feedback is positive and they eagerly include you in the group, you most likely will have your positive concept of self reaffirmed. On the other hand, if they suddenly stop talking, seem to feel ill at ease, look away, or make a hasty retreat, you most likely will assess your feelings about yourself and wonder if maybe you are less friendly, witty and charming than you thought. It must be stressed that what this approach concentrates on is the “self “is the product of the individual’s imagination of how others see him or her. As a result, we can develop self-identities based on incorrect perceptions of how others see us. Example A Matron may criticize a professional nurse for being passive and uninterested; the later (Nurse) could decide (perhaps wrongly) that she is incompetent. This could give her a negative self-image and affect the way in which she/he performs her/his roles. In fact, the truth may be that the Nurse Manager had worked long hours’ overtime and was simply short tempered at that time. Cooley therefore points out that even though our perceptions are not always true and correct, what we believe others think of us frequently forms a more important basis for further action than is justified by what is really the case. If the nurse could therefore understand how people, including patients, perceive reality, they would also show understanding for the social behavior of other people. Preconditions for socialization (i) The child must have an adequate biological inheritance. Socialisation is a matter of learning how to think, feel and behave. In order to learn, the child must have adequate biological equipment. If a child is born with brain damage or is deaf or blind or with any other serious hereditary disadvantage, the process of sociolisation becomes more difficult, although not impossible. Our heredity provides us with the potential ability to experience socialization. Page | 37
  • (ii) There must be an ongoing society from which the child learns. Functions of socialization 1. It helps in the transmission of values, attitudes, languages, customs and skills of the society from one generation to another. 2. It serves as a means of social control by instilling a sense of morality in those growing up. By this mechanism it prevents us from committing serious violations against society and each other. Without this social control mechanism duling socialization societies would need to have an enforcement agent on every corner. 3. Every society has a social structure and socialization helps us to know where we fit into the structure, for example, into the upper, middle or lower class. 4. During socialization human beings develop their personalities or their sense of self. Such personality development include learning how to perceive things, to criticize, differentiate between good and bad, to do things as well as possible to have emotions. TYPES OF SOCIALIZATION Because socialization begins at birth and continues throughout the life cycle, it is a process that takes different forms, depending on the stage of life and the specific environmental and situational problem that may arise. (1) Primary socialization The most crucial phase of learning for an individual occur in the first years of life. Primary socialization therefore refers to the childhood socialization. It is called primary because it supplies the foundation for all other learning, and it must come first. In primary socialization, the child must learn the basic skills necessary to function in society. These include table manners, respect for elders, toileting, language and so on. The mother is usually the first socialization agent who spends the most time with the baby. Primary socialization is usually carried out by those with strong emotional ties with the children. Children learn many things by watching and imitating their parents (gender roles). (2) Secondary socialization It is the next phase of socialization that involves the learning that builds on and modifies primary socialization as an individual/child moves into new stages of life and faces a challenging environment. An individual has to learn a new set of skills in order to meet the expectations of his new role. As children grow older, relatives and peer group members become social agents in addition to parents. Socialisation takes place in school and other institutions apart from home. Adult socialization focuses on realism rather than idealism. Primary socialization centres on impacting societal values and motives; adult socialization usually considers satisfying what one says and does is acceptable. (3) Anticipatory socialisation It refers to learning roles by practicing those we anticipate playing in the future. This is readily observed in young children who engage in games of mothers and fathers with their dolls. In role Page | 38
  • socialization- you think about, experience with, and try on the behaviours associated with a new role. Similarly, during training student nurses and medical students will anticipate their future roles by acting out that role during training. They will at first “play nurse” or “play doctor” rather than be a “real nurse” or “real doctor” and hope that those watching will approve the performance. Through time and with practice students gain the conviction that the practices are authentic because others respond in ways indicating that they are as competent and legitimate in the role. Anticipatory socialization serves as a means of preparation by which people gain some certainty and confidence regarding their performance before others. The socialization of the student nurse into the world of nursing is vital to the achievement of success in the professional chosen. The student nurse, who is not socialized into the nursing profession, is not likely to drop out and not complete the course. The student nurse, coming from school, has to learn a whole set of values and norms related to her new role otherwise it is a waste. (4) Resocialisation The process of unlearning past behaviour and learning how to live in a very different way. It is the learning of new patterns of behaviour that run counter to previously acquired patterns e.g. born again Christians. However, resocialisation takes place in mainly in total institutions such as a prison, the defense force and the hospital (particularly at institutions for mentally disordered patients). Here the individual is physically and socially isolated from the rest of society for an appreciable period of time and where their behaviour is tightly regimented and their way of life extremely supervised. Here “inmates” or “recruits” are exposed to resocialisation. (5) Occupational socialization It is the process of aligning the norms, values and beliefs of a new worker with those of the organization or occupation. The organization socializes employees to its core norms, values and practices. The individual acquires the knowledge and skills needed to get along and get ahead. Employees are expected to personify the organisation’s image every minute of the day. But most companies and organizations demand much less, expecting only that workers do their jobs well AGENTS OF SOCIALIZATION According to agents of socialization definition, it is the people like parents, peers, social institutions like schools and religious institutions that help in integration of an individual with society. The four major agents of socialization in society are family, school, community culture and peers (friends). The other agents of socialization include mass media, gender and work. The agents of socialization are divided into socialization groups. These socialization groupings are as follows: 1. The family Page | 39
  • The family is the most and first important social setting in which socialisation takes place. Infants are almost entirely dependent on others to meet their various needs and this responsibility almost always falls on the family. Therefore, the family is the original primary group for most people. Socialization via the family goes from cradle to grave. The intensive social experience that occurs within the family form the foundation of our personalities- those relatively enduring ways that people for have dealing with others in a wide variety of situations e.g. friendliness, generosity, and aggressiveness. The family is largely responsible for the process of cultural transmission by which values and norms are taught to new members of the society and incorporated into individuals’ sense of themselves e.g. attitudes, interests; goals, beliefs and prejudice are acquired within the family. What makes socialization in the family so important and influential? The family is the foundation for all civilized behavior such as Language abilities (learning to talk), body control (e.g., toilet training), emotional control (e.g., "don't hit your sister"),rules of public conduct (e.g., "don't throw food") and Moral values (e.g., "lying is a sin"). • Access to the emotional bond between parent and child, an extremely strong and effective socializing mechanism • Lifetime impacts affecting the person's self-esteem, emotional health, identity, and personality • Origin point of gender roles (masculine and feminine behavior; fundamental division of the social world into men and women) • Origin point of ethnocentricism and racism (racial and ethnic prejudice) • Source of original social capital that determines life chances The amazing power of the family as an agent of socialization comes from a combination of two factors: The power of the family is strongest during infancy and toddler years. After that the media, then peers, and finally school challenges its exclusive access to the child. By later childhood the family's power as a socialization agent has weakened considerably. In the adolescent years that power is further weakened by peer group influences and the predominance of the media in teenage subculture. Overall there has been an historical trend of the family's power as an agent of socialization being steadily eroded by the media, peer subculture, and schooling. The family returns as a predominant agent of socialization during the adult years with the roles of marital partner and parent. 2. Mass Media The mass media are channels of communication directed to vast audience within a society. The mass media includes: television, radio, movies, music, newspaper, books, magazines and internet. Socialization also comes through from children's shows, cartoons, and, most especially, commercials. All these constantly present us with information of all kinds and as a result, have an enormous effect on our attitudes and behavior. Messages and values carried by the media are powerful and seductive. Many of those messages and values challenge or directly contradict with what parent's teach their children. Media influence continues and strengthens in adolescence based on a merger of teen subculture, pop culture (music & movies), and corporate marketing. Sports, increasingly a branch of marketing, become especially influential for Page | 40
  • teenage boys. The internet (web pages, e-mail, chat rooms and face books) have emerged as another media source important to teens, again especially boys Social learning theory suggests that much human behavior is learned from modeling others (Bandura, 1977) and studies show that when children identify strongly with media characters, they are most likely to be influenced by them (Williams, 1981). The power of the media declines in adult years but still remains strong. Pop culture continues strong but loses its subculture support. Sports and the internet continue as agents of socialization, especially for males. News (both TV and print) emerge as new agent of socialization in the adult years. 3. Peer Groups Peers are people of roughly the same age (same stage of development and maturity), similar social identity, and close social proximity. They're friends, pals, etc. Typically, children encounter peer group influence around the age of three or so. Usually these are neighbors, family members, or day care mates. With peers, the child begins to broaden his or her circle of influence to people outside of the immediate family. Often peer interaction in the earliest years is closely supervised by parents so it tends to parallel and reinforce what is learned in the family. What is added to socialization, even in these closely supervised situations, are social skills in group situation with social equals. As childhood progresses, peer group interactions become more autonomous (less observed and supervised by adults). The lessons learned also progress from basic rules of group interaction to more complex strategies of negotiation, dominance, leadership, cooperation, compromise, etc. These lessons are learned first in play and later through games. Peers also establish the platform for children to begin challenging the dominant power of parents and family. In adolescence, peer group relationships become extremely important, rising up to directly challenge the family. In direct alliance with the media, teenage peers form their own subculture. They learn how to navigate the complexities and nuances of group interaction largely without adult guidance or supervision. Peer group socialization also becomes linked to puberty and the all important role of sexuality and sexual relations in life. Peer groups are where teens largely learn about sex and being sexual and practice the skills of sexuality. Paralleling this, the gender role socialization begun in the family is extended, deepened, and reinforced. In the adult years the demands of work and family overwhelm most peer group relations and the influence of peers seriously declines as an agent of socialization, only to return during the elderly years. 4. School Traditionally around six years old the child enters the school system in the first grade. Today the process often starts earlier in Kindergarten or day care. The most widely recognized contribution of schooling to the socialization process is teaching children a wide range of knowledge and skills. In the early grades, these basic skills such as reading, writing and arithmetic are learnt. Later secondary school and colleges teach highly specialized knowledge and skills that are needed to function in a complex industrial society that has many specialized productive roles. Socialization in school takes the following forms: (a). Official curriculum Page | 41
  • What the school system and its teachers announce as their content and goal. It includes the knowledge & skills learned in English, math, history, etc. The school is the official place where our society transmits it accumulated knowledge and skills from one generation to next. It's also the place where we officially pass on our cultural values, tradition, and heritage, at least the "official" heritage. This curriculum often reinforces what was learned in the family but it can also challenge family socialization (e.g., teaching values of tolerance to a child from a racist family) (b). Hidden curriculum Students learn not only from the official courses of study, but from the physical environment of the school, the attitude teachers and pupils exhibit towards one another, the social climate, and the bureaucratic organisation of the school for example: 1. The school activities such as sports and classroom tests teach children comprehensiveness and the value of success. 2. The school further socializes children into culturally approved sex roles- boys are encountered to be aggressive, athletic and dominant. Girls are expected to be feminine, socially conscious, and submissive. Such differences related to sex continue throughout the process of formal education. eg college women may be urged to select majors in the arts or humanities, while college men may be encouraged to study physical Sciences. 3. The school day is based on a strict time schedule, so children experience impersonal regimentation for the first time and learn what it is like to be part of a large organization. 4. Education plays a vital part in promoting social integration. From this point of view, school not only helps children adjust to living within a large, impersonal world, but also teach them knowledge and skills necessary for the successful performance of adult roles. As preparation for the adult world of formal organization and workplace authority, the hidden curriculum stresses such things as formalization and standardization, following instructions, obedience to authority figures that are not Mom and Dad, learning to control behavior and fit into the group, pleasing (even manipulating) authority figures, and working in teams. 5. Religion Functionalists point out that an important role of religion is to contribute to the socialization of societal members by instilling in them a sense of purpose in life and providing them with moral instructions. The teaching of the church may influence eating habits, dating practices, mate selection, birth control practices, and many other elements of life style. 6. The work place The socialization process usually follows 2 lines: 1. Formal socialization from supervisors teaching us the policies, rules and regulations, and perhaps the technical skills needed to complete the assigned work. 2. Informal socialization from co-workers teaches us the “unofficial rules” we must abide by in order to be fully accepted by our own peers on the job. Assuming a work role is an important part of one’s social identity and hence is a continuation of the process of developing “self”. Work experience during adolescence has been linked to self- Page | 42
  • esteem. E.g. when adults meet for the first time, one of the first questions they ask one another is “what do you do?” A person’s occupation such as nurse, doctor, lawyer, garbage collectors etc affects how he or she is perceived by others and the nature of the interaction that follow. THEORIES OF SOCIALIZATION (1) Social Learning Theories We are socialized through positive and negative reinforcement by our parents, friends, and the society and that we observe and imitate socialized behavior around us. The two processes emphasized in social learning theory are: (i) Conditioning It is a form of learning in which the consequences of behavior determine the probability of its future occurrence(Skinner,1953).Consequences of behavior that increase the chance that behavior will occur are reinforcements; consequences that reduce probability are punishment Observational Learning (also referred to modeling or imitation) Occur when people reproduce the responses they observe in other people, either real or fiction. (ii) Cognitive Development Theory A child’s socialization occurs in step with his or her cognitive development. What and how a person learns depends on his her ability to understand and interpret the world, something that progresses through several stages. Jean piaget(1926/1955) hypothesized every normal child goes through 4 stages of cognitive development, each of which is dominated by a different scheme for handling information and understanding how the world works: • Sensori motor stage-young children use their senses to make discoveries eg touching; they discover that their hands are actually a part of themselves. • Preoperational stage-Children begin to use words and symbols to distinguish object and ideas. • Concrete operational stage-Children engage in more logical thinking. They learn that even when a formless lump of clay is shaped into a snake it is still the same clay. • Formal operational stage-adolescents are capable of sophisticated abstract though and can deal with ideas and values in a logical manner. (2) Symbolic interactions Individuals monitor their own behaviour, monitor other peoples’ responses, make interpretations, try out new ways of behaving, and come to new understanding about themselves. Page | 43
  • (3) Generalized Other: Gorge Herbert Mead Continued Cooley's exploration of Interactionist Theory of looking at “ glass self”. Mead (1931/1964) contented that we gain a sense of self hold by acting towards ourselves in much the same fashion that we act towards others. In so doing, we “take the role of the other towards ourselves” We mentally assume a dual perspective: We are simultaneously the subject (“I”)doing the viewing and the object(“me”) being viewed. In our imagination, we take the position of another person and look back on ourselves from this stand point. Example Think of what happens if you as a student nurse during your practical training in a hospital want to put a question to a Chief Nursing Sister: “If I ask a question, she will think that I am stupid. I must therefore rather keep quiet”. In this example, you have looked at student nurses through the eyes of the Chief Nursing Sister. By doing this you have in your imagination assumed her role and have seen yourself as the object, the “me”. It is the “I” as subject that has decided that it would be unwise to ask the question and therefore rather keep quiet. Language allows us to carry on an internal conversation. We talk and reply to ourselves in much the same manner that we carry on a conversation with others. In this fashion we judge how other people will respond to us. Sociologist Ralph Turner, (1968) clarified and extended Mead’s ideas on the self. Turner pointed out that when speaking and acting, we typically adopt a state of preparedness for certain types of responses from the other person. Example If we greet a patient or a friend in a friendly manner or embrace him, we expect that the other person will react in more or less the same way. When the person reacts, we enter a phase of testing and revision. In our imagination we test the other person’s behaviour and determine whether it is in accordance with our expectations. By doing this we give meaning to that behaviour. On the basis of this we then plan our next step. If the person acts “differently”, we could either terminate the interaction or go back and follow a different approach or even follow up the other person’s initiative, what it amounts to is that the process of self- communication is essential for social interaction. Mead uses the term generalized others to refer to the attitudes, viewpoints, and expectations of society as a whole that a child takes into account an entire group of people. Children can take a more sophisticated view of people and the social environment. IMPRESSION MANAGEMENT:ERVING GOFFMAN Many of our daily activities involved attempts to convey impressions of who we are. Impression Management Page | 44
  • Goffman thinks that we are constantly trying to influence others in a certain way and therefore presents to others in such a way that they will form a favourable impression of us. In this way we can then predict or control what will happen to us. To create a favourable impression, people make use of concealment and of strategic disclosure. Example Concealment A student nurse may spend several hours preparing and rehearsing a presentation in hopes of appearing “knowledgeable” to other students. Another examples is what we wear for a particular occasion eg party, job interview, appointment with the doctor. Strategic disclosure/revelation A patient may place a few technical journals on his bedside table to create the impression among nurses and visitors that he is an academician (highly educated). To further explain social life, Goffman makes use of the dramaturgical approach. Dramaturgical approach He describes social life as a stage or drama. All human beings are both actors and members of the audience, and the parts are the roles people play in the course of their lives. According to him, the self is a product of the ongoing performances that characterize a person’s everyday interaction with others, and of how these performances are interpreted by others. In this view, the self is not so much something that people possess and then carry unchanged from situation to situation, but is a “dramatic effect”. Example A nurse may try to appear busier than he or she is if a supervisor happens to be watching. In accordance with this he uses terms “front stage” and “backstage” Example (i) Example of the waiter and the kitchen (read this example from any sociology book or document). (ii) Through most of the day the nurse will be “front page” where she will and must play her assigned and expected roles of clinical competence and capability towards colleagues, medical doctors and patients. As her home, with a good friend, she is “back stage”, there she can literally be “herself” and kick off her shoes without making herself ridiculous. Even the nurses’ tea room at the hospital could from time to time be “backstage”. However, problems could also be encountered with regard to impression management. Once an individual has made a certain impression on others, he or she is expected to maintain that Page | 45
  • impression or behaviour. If mistakes are made, other people could form the wrong impression about such a person. Outsiders could sometimes accidentally get glimpse of a person’s “backstage” and consequently make the wrong assumption about such a person. Three aspects are used to create favorable impressions: (a) A social place The place where personal actions and within which interactions takes place, e.g. the hospital ward, church, pavement etc. (b) Appearance What a person looks like while acting his role. Human decorations such as appearance, clothes, hairstyle, etc convey messages and play an important part in impression management. © Attitudes The ways in which one communicates, for example, stemly, formally, humorously etc, reflect the general attitudes of the role-player. SOCIALISATION IN THE HOSPITAL SOCIAL SYSTEM: BECOMING A NURSE AND PATIENT As nurses and patients share the same social system in the hospital, it is appropriate to consider their socialization in the context. A social status can create some difficult as the labeling of one individual as “nurse” with another as “patient” tends to create stereotype ideas as to what is or should be the appropriate behaviour for the role. This can be dysfunctional for patient care. If for example the individual who is a nurse is perceived by the patient to be a charismatic angel of mercy and the individual who is a patient is perceived by the nurse to be an unquestioning, subordinate and dependent individual. Sharing socialization processes. Nurses and patients also share similar socialization processes in the hospital. They both undergo a process of “role- stripping” with divests them of the symbols associated with their previous social roles for example, adolescent girl or driver. This process is carried out during the ritual of exchanging the clothes associated with their former social roles for those of a uniform, in the case of the patient. Both are also to some extent divested of their personal identities by a labeling process. The student nurse is given the (honorary) title of the “nurse” and the sick individual labeled “patient” and often given an index number as well. Social distance Both nurse and patient inevitably experience a social distance in the social system and this is a further reason for studying the socialization of the nurse and patient in the same context. Patients and nurses are individuals in different and distinct social groups which even though they are geographically near in the hospital, are distinctly separate social entities; a social group of patients and a social group of nurses separated by social distance. It could be argued that social distance also distance also exists between nurse- students and trained nurses who also form distinct social groups in the hospital. Page | 46
  • DEVIANCE AND SOCIAL CONTROL DEVIANCE In the broadest sense, deviance means not conforming to predominant norms. It refers to behaviours that violate the folkways, mores and laws of a particular group. The sociological definition of deviance refers to behaviours that violate group norms, exceeds its tolerance limits and it is viewed as negative or harmful by the group or by its powerful members. Example Crime- behaviours that violate laws Also behaviours that are not criminal eg mental illness, alcoholism and homosexuality There really is no one thing that is always called deviant and no one thing that is always called desirable so we must be careful when we attempt to define deviance. So we can say that deviance is any behaviour that is considered undesirable by the majority of people at a certain time. Complete deviance and total conformity are each extreme, ideal type of behaviour in the society. There is always some kind of deviant behaviour in society. It is not the act itself, but the reactions to the act, that make something deviant (Howard, 1966). Relativity of deviance There are no absolutes in any sociological definition or discussion of deviance. It is said that no act or anything is automatically deviant. The definition of an act as deviant is relative to the particular culture , subculture, time period, situational context and character of the individual involved. E.g. killing another human being (murder) is the ultimate deviant behaviour yet there are times when we do not label someone a murderer just because he has killed someone. We ask, did the person kill in self defense? in war? Was he insane? Was it a case of capital punishment? In each case, the act of taking another’s life is the same, but the definition of the act varies. Deviance and its definition are quite complicated. The deviance, time period, social status of those involved, and situation all influence whether an act is deviant and how serious it is considered to be. Eg when an enrolled nurse take the drugs, the bosses take this as a serious matter but when the bosses take drugs, it is not taken to be a serious issue. Page | 47
  • The relevance of audience The judgment of what is good or bad depends on those who observe and evaluate the act. Example: In China, it is normal to abandon female children to die in preference for male (Compare with Malawian situation). Many different cultural groups have potentially conflicting norms of what is not deviant, even regarding murder. The relevance of time Normative expectations change over time. Example: Styles, fashions fade come and go depending on the times. People seen as sinners, rebels and criminals in the past may be thought of as heroes and heroines in the future , according to Emile Durkheim in structural functionalism theory. Relevance of the status People will be perceived differently according to their social character. Generally, higher status individuals are less likely to be labeled deviant or to receive harsh treatment than lower status individuals. The dress, manner, occupation, social influence, demeanour, and family background of an individual all help determine whether the individual’s action will be labeled deviant. Relevance of situation Deviant behaviours can be relative to circumstances. Example: Public nudity is a behaviour condoned in an infant but condemned in an adult, killing people is condoned in war and condemned when done for personal reasons. Drug consumption is condoned for research and for medical treatment and condemned for enjoyment. 1. The functionalist perspective The functional of deviance (Emile Durkheim) • Deviance affirms cultural values and norms • Responding to deviance clarifies moral boundaries. • Responding to deviance promotes social unity • Deviance encourages social change 2. Strain Theory (Robert Merton, 1938- 1968) How social values produce deviance Functionalists argue that crime is a natural part of society, not an aberration or some alien element in our midst. They say some mainstream values actually generate crime. Page | 48
  • Most people have strong desires to reach cultural goals such as wealth or high status, or at achieve whatever other objective society holds out of them. However, not everyone has equal access to society’s institutional means, the legitimate ways of achieving success. Some people find their path to education and good jobs blocked. These people express strain or frustration, which may motivate them to take a deviant path. When a person is prevented from legitimately reaching cultural goals, there are 4 possible ways for the person to react or adapt, according to Merton’s strain theory: (i) Motivation A person uses illegitimate/ deviant methods to achieve a certain socially approved goal e.g. getting money and achieving success through theft, robbery, prostitution etc. People who engage in these activities conform to the value of success but deviate from the norms for acquiring success. (ii) Retreatism An individual simply gives up any hope of achieving the goals set out by society, he/she feels that he/she cannot make it eg school dropouts People can retreat into alcoholism and drug addiction or into skid row life-styles far from mainstream society. The most extreme is suicide. (ii) Rebellion An individual rejects conventional culturally/socially accepted goals and hopes to estimate a new social structure- by challenging the system. Example: Terrorist groups eg Hamas in Israel (iii) Ritualism An individual has lost sight of his/her goals altogether and become obsessed by doing things the right way. Life becomes routine eg going to church. Conformist or deviant (people who have lost their hope) - often not labeled as deviant. Example: Imagine a person who appears on the job time every working day. The person occupies a desk and reshuffles through paper, following all rules and regulations. But the person does not care about advancement or even how well the job is done. 3. Deviant subcultures Cohen (1955), Cloward and Ohlin, (1960) expanded on Merton’s theory of deviance. Focusing on juvenile delinquency, they believe the reason the lower-class may become involved in property offences and even violent crimes is because they often find few legitimate Page | 49
  • opportunities to achieve some of the middle class goals (especially material possessions) to which they aspire. These blocked opportunities may lead to the formation of deviant subcultures that provide increased social status through illegitimate means and supplement deviance eg dropping out of school, joining gangs, stealing. Other examples include religious cults, drug users, may feel “cut off” from larger society and consequently find it functional to bind together for social purposes, mutual support and protection. 4. The symbolic interactionist perspective (a) LABELING THEORY This is the idea that deviance and conformity result not only from what people do, but from how others respond to those actions. It stresses the relativity of deviance. Labeling theory does not attempt to explain the origins of deviant behaviours. It assumes everyone commits deviant acts at some point in life. It focuses on the perpetuation of deviation as a result of being singled out when given the stigma of deviant status. The labeling theory places the spot light on the actors and the way in which they perceive one another and not on the deviant behaviour itself. People are continuously rating, scaling and labeling those around them. Some statuses override all other statuses and are given certain priorities e.g. in USA black first, physician second. Once an individual’s social status becomes that of deviant first, human beings second changes are likely to occur in the individual’s self image. The deviant comes to think of self as deviant and finds it increasingly difficult to return to a conventional status. Primary Deviance: This is the norm violations that provoke slight reaction from others and have little effect on a person’s self – concept eg. Skipping school and under-age drinking. Secondary Deviance: This is when an individual repeatedly violates a norm and begins to take on a deviant identity. Secondary deviance marks the start of a deviant career that may lead to acquiring a stigma, a powerful negative label that greatly changes a person’s self- concept and social identity. Stigma operates as a master status. A deviant status can become a master status eg ex-convict, prostitute if you redefine yourself and change your behaviour in response to how others redefine your new status of deviance. Retrospective Labeling This means interpreting someone’s past in light of some future deviance eg when a priest has sexually molested a child they rethink his past. Projective labeling Page | 50
  • People may use a deviant identity to predict future action eg if one is a prostitute, one cannot be employed as a house maid for fear of doing the same with the owner of the home. (b) DIFFERENTIAL ASSOCIATION THEORY ( EDWIN SUNDERLAND, 1940) A person’s tendency towards conformity or deviance depends on the amount of contact with others who encourage or reject conventional behaviour. If an individual has been exposed to deviant orientations with greater intensity and frequency and for a long period of time than he has been exposed to conformist orientations, then the individual is likely to engage in deviance. Families They make a big difference in whether we learn deviance or conformity Friends, neighbourhood and subculture: Kids with delinquent friends are likely to become delinquent too. Bad neighbourhood, may have an influence on an individual Some neighbours develop a subculture of violence. The implication of the differential association theory is that the family environment, neighbourhood, peer group, school and other socializing agents can teach a child deviant behaviour just as easily as they can teach conforming behaviuor. Eg prostitutes tend to enter their profession because they have a friend, or a group who encourage them to sell themselves. HIRSCHI’S CONTROL THEORY • Attachment • Commitment • Involvement • Belief Assignment: Read on these from any recommended and prescribed text CONFLICT THEORIES OF DEVIANCE Conflict Perspective Conflict theory focuses on the inequality in which groups are singled out fro deviant statuses and on the lack of power some groups have to fight their deviant status of the system that labels them. Conflict theories view deviance as arising when groups with power attempt to impose their norms and values an less powerful groups. Power and Deviance Page | 51
  • Those in power have the opportunity to make and enforce the norms that govern their and others’ behaviour. Hence have power to say what and who are and are not deviant. Because of their loftier social possession only certain people have the power to commit certain types of deviance. Conflict theorists insist that the criminal justice system reinforces inequality and defines as deviance any behaviour that threatens those in power. Elite Deviance Only certain people in society can commit elite deviance, which include all aspects of white collar crime as well as other deviant acts perpetrated by those in power eg environmental pollution, insider tradings, political corruption. SOCIAL AND CULTURAL CHANGE Nature of social and cultural change Most of the early studies of social factors and disease onset were concerned with the effects of social and cultural change. They included studies of industrialization and urbanization, migration and social occupational and geographical mobility. The major disease outcome studied was coronary heart disease, because this is predominant a disease of industrialized urbanized nations. Effects of social and cultural change on health and illness Some populations isolated from western countries have low blood pressure that does not rise with age. However, blood pressure levels and coronary heart disease rates increase when these populations move to urban settings. A number of studies conducted during the 1960s and early 1970s found higher rates of disease among people who changed jobs, place of residence or life circumstances e.g. one study found that men reared on farms who moved to urban centers to take middle class jobs had higher rates of coronary heart disease than men who continued to work on the farms or who took labouring jobs in cities (Syme, et al, 1964). Similar observations have been made with respect to cancer. A number of mechanisms might be responsible for the negative effects of social and cultural change on health. The adverse effects might be direct result of change itself, a product of the circumstances to which individuals move or the product of personal characteristics that predispose individuals to both mobility and poor health. Example: Page | 52
  • One study that attempted to evaluate these explanations compared rate of heart disease among Japanese men still living in Japan (Marmot, et al, 1975). Coronary heart disease and mortality rates were highest among those living in California and lowest in Japan. Among those living in California, some had become “acculturated” and had adapted Western life styles, where as others retained traditional Japanese ways. The former had disease rates up to 5 times as high as the later. This suggest that being mobile is not in itself, the important factor, rather it is the change in the environment in which these people lived that explained the increases in disease risk. SOCIAL STRATIFICATION Social stratification refers to the making of members of the society according to the unequal distribution of whatever is considered valuable or the “good things” in life. In Western societies, wealth, prestige and power are defined as the good things and are usually scarce. In African societies, stratification may also essentially be based on age, sex, and to some extent ethnicity- making the study more complex. In the definition, the key word is “unequal”, for if some have more, then others must have less. The study of stratification is thus the study of social inequality. Social differentiation Social stratification depends on but is not the same thing as social differentiation. Social differentiation is the process by which the members of a society divide up activities and become ‘different” by virtue of playing distinctive roles. Activity 1. Where do you fit in the stratification system? 2. What criterion did you use to reach this conclusion? 3. Most people would place drug dealers; no matter what their wealth, near the bottom- not at the top of the social hierarchy; why is this so? Dimensions of social stratification Explain social stratification according to the following: Marx: the inequalities of class Weber: Inequalities of wealth, prestige and power Socioeconomic status (SES) Page | 53
  • It is a composite social ranking that combines income, occupational prestige, level of education and neighbourhood. By measuring socio-economic status, we not only make distinctions among people- for example people in different occupations-but also can demonstrate how people in the same line of work may rank differently. Social Class It can be defined in a simplified manner as the level or stratum of persons who occupy similar positions in the social hierarchy. This means that many people share similar but not exactly the same position in that hierarchy. For convenience social scientists generally divide the social hierarchy into three classes based on occupation and income: 1. The upper class: those whose large income comes mainly from property. 2. The middle class: of non-propertied professionals and white collar workers. 3. The lower class: of low income manual workers The dividing of society into these social classes is based on the socio-economic status of the members of the society. The lower class The lower class is based on lack of income, poor education and low occupational prestige. The lower class can be divided into 2 subclasses: the working poor and the underclass working poor. Its members include unskilled laborers, those in service jobs like maids, and those in the lowest-paying industrial jobs. They face periodic unemployment and their incomes are often at the minimum wage or less. They are called the working poor because their incomes do not allow them to even come close to the mainstream style of living in Malawi. Social Mobility It is the movement of individuals and groups from one level (stratum) to another in the stratum’s system- i.e. movement between social classes. Forms of Social Mobility The most distinguish social mobility is the vertical one i.e. Horizontal mobility SOCIAL CLASS AND HEALTH Health and Deprivation There is a link between economic deprivation and health. Poorer members of society tend to get sick more and have shorter life expectancy than the more affluent. Examples: 1. Those in the lower class of unskilled manual workers are more likely to get ill and die earlier than those in the upper class. 2. Babies born to working class parents are twice more likely to die before their first birthday than those born into middle class. 3. Complications in pregnancy and on delivery are more common in working class mothers. Page | 54
  • Distribution of Health Services Inverse Care Law Do those who are poorest and in worst health also fail to access services and/ or obtain health services of poorest quality. Good medical care tends to be least available to those in greatest needs, vice versa. The distribution of services “Understaffed” districts in terms of health personnel are usually poor districts with high rates of sickness and mortality and in specific need of good medical services. Certain areas of the country are medically deprived in the sense that existing services are unable to cope with the demand places on them, while others have relative abundance of medical resources in relation to their needs. Health care in hospitals according to class, e.g. paying wards providing better health care and treatment than non-paying wards where most of those in the lower class are normally treated. Health service expenditure by social class, e.g. dialysis machine is mostly accessible to some middle and upper class. The use of health services by social class; despite the services being available to all classes the lower class does not seem to utilize certain services for their own reasons e.g. communications. Explaining the Health Gap Behavioral/Cultural and Materialist explanation The behavioral/cultural and materialist types of explanation both see health as determined in some way by social class, but they differ in the aspects of social class they see as responsible. Behavioural/cultural explanations involve class differences in behaviors that are health demanding or health promoting, and which, at least in principle, are subject to individual choice. E.g. Smoking, prostitution, casual sex, unprotected sex and alcoholism. Materialist explanations of disease, by contrast, emphasize those social, political and economic factors beyond the control of individuals and which adversely affect their health. E.g. Diet, housing conditions, work available and environmental conditions. Read on cultural /behavioral and materialist explanations of health inequalities, e.g. Weltz, (2004) and Scambler,( 2003). Conclusion There is abundant evidence to suggest a close association between health and social class, with people in the higher classes enjoying on average, better health and longer lives than in the lower social classes. It is clear that there has been no narrowing of class differentials in recent years. Whilst it appears that none of the two approaches outlined above provide, on its own, an adequate explanation of inequalities in health, it does seem that there is a slowly emerging consensus amongst researchers the two approaches complement each other to a large extent in explaining the health gap between classes. Only by beginning to understand what causes inequality in health, can provide socially approved services and promote health. Page | 55
  • SOCIAL INSTITUTIONS A social institution is an organized system of social relations that embodies certain common values and procedures and meets certain basic needs of society. Universal institutions include the family, education, politics, religion and economy. Social institutions are the activities and organizations by which the basic needs of society are met. Each institution involves certain social relationships. Within social institutions, people observe customs and organized patterns of behaviour. An institution is a procedure, that is, an organized, formal, recognized way of doing or performing an activity in a society. On the other hand, an association carries out institutional norms and values e.g. church for the religious institution. Institutions are ways of doing things while associations are groups that do them. A persistent practice can be institutionalized or accepted. Activity: 1. Read about the importance of/functions of institutions in recommended texts 2. Explain the manifest and latent functions of social institutions. Page | 56
  • Interaction of social institutions Social institutions collectively contribute to the cultural fabric of the society. Actually, there is a complex network of interrelationships that exist between institutions for a society to survive, basic institutions must co-operate with and relate to one another. If one institution should fail to meet the needs of the population, its failure can affect the functions of other institutions in various ways. E.g. Economic disruptions can affect family life and the government. The Family The Traditional African Family A family is a group of persons united by ties of marriage, blood or adoption, constituting a single household, interacting and communicating with each other in their respective social rules of husband and wife, mother, father, son and daughter, brother and sister and creating and maintaining a common culture. Functions of the Family The major functions of the family are: • For sociolisation • Reproduction • Regulation of sexual relations • Care, emotional ties and protection. The above functions seem to be the basic functions of the African and other families all over the world to day. But some of the family’s past functions include the provision of economic well-being, protection, recreation, education and religion. All these functions have gradually been taken over by other social institutions. Characteristics of an African Family Life • Importance of the larger kin group • Importance of children • Lack of public display of affection • Care for and respect for the elderly. • Constrained communication between parents and children • Polygamy • Bride – worth versus bride- price Psychosocial studies relate the health of the individual closely to the type of family in which he or she lives, to its dynamics, functioning and quality of life. Activity 1. Describe the terms below and apply them to Malawian society and any other African traditional family. Type of family Residence Nuclear extended Neolocal patrilocal Matrilocal Page | 57
  • Authority Patriarcal Matriarchal Egalitarian Descent Bilineal Patrineal Matrineal Forms of marriage Monogamy Polygamy Polyandry Types of Marriage Customary and traditional Religious Civil Payments Bride-price Bride wealth Bride service Kinship Blood kinship Kinship by marriage Non-legal secondary Or sexuality Alternative Lifestyles Being single Cohabitation Single-parent family Other terms Widow inheritance Endogamy Exogamy 2. Describe the changes that have taken place in an African family For a nurse, an understanding of marriage and family forms which differ from her own can save emotions and trauma with patients who are frowned upon for what to them is the normal pattern of marriage and also from embarrassment when confronted with “strange” marriage and family types. Family and Health Possible family reaction to an illness crisis is an affirmation of its solidarity as a social emotional unit. If one or other member of the family has to be hospitalized a new situation arises for all members of the family. The family plays some of the following functions in relation to health: • The family is the first emotional and social support mechanism, first teacher and first care provider where it is usually the woman who assumes responsibility for each of these essential functions. • The family provides the role of keeping its members healthy and protecting them from diseases. • It helps in treating especially rehabilitating disease/illness (mental patients, drug addicts) and assisting them during illness. • “Therapeutic triangle” Collaboration in protecting or restoring health between the patient, the family and the health care system • The success of every cure or course of treatment of every therapeutic or health giving prescription depends on the family. • Consideration should be given for greater involvement of the family in health care, where the family should be/is seen as an element of primary health with an active response and participatory role. Unfortunately, medical practitioners tend to unload all the patient’s problems especially in chronic or terminal illness on the family. • They completely ignore family connections and all problems of family life leaving health and illness within the narrow framework of the doctor-patient relationship. • A family that depends on the sick member will have difficulty in restructuring and adjusting to new roles of providing for themselves Religion Because religion deals with that which transcends everyday experience, its validity can be assessed by neither common sense nor science. Religion is a matter of faith. Page | 58
  • From Emile Durkheim’s religion can be defined basically as a system of belief and practice built upon the recognition of the sacred. Religion refers to those socially shared ways of thinking, feeling and acting that have to do with the supernatural or “beyond” (Zanden, 1988) Activity: Describe the role that the religion plays in society from a Functionalist and Conflict perspectives. RELIGION, PATIENTS AD HEALTH WORKERS Next to the family, religion is probably the most vital and important institution in the lives of many individuals. During periods of illness, people tend to become even more dependent on their faith. The families too, may turn to the church more than on non-critical periods of their illness. Both birth and death- two basic mysteries – have profound religious significance for most people for the rites associated with them in most religious faiths. Religious beliefs influence when and where health care is sought, who is expected to give the care and how the care is to be given, and Sometimes Science and faith differ in their prescriptions. For example: Jehovah Witnesses do not permit blood transfusions because they interpret the Bible’s admonishment about drinking blood to apply also to transfusion of blood. Other Christians believe that prayer, not medical treatment, will heal if the individual is meant to be healed. It is of course not up to health workers to resolve conflicts between Science and religious beliefs but anyone involved in health should be aware of and have respect for such beliefs. It may be necessary to contact clergy of various faiths for understanding or assistance in situations of conflict between religion and medical belief. Economic Institution Economic systems differ widely from society to society. They also have certain features in common. Robert and Heilbroner, (1962) has identified two universal characteristics of economic systems. (I). “A society must organize a system for production of the goods and services it needs for its own perpetuation.” It must arrange a distribution of the fruits of its production among its own members so that more production can take place. When discussing the economy, there must be: Production goods Exchange of and Distribution services Health Implications of Economic Institution • Producing of goods to be used in the health services the distribution of these goods and the payment that must be made for them e.g. drugs. Page | 59
  • • All health planning is concerned with the economic aspect of the situation e.g. building of health facilities to provide health services to people in need. • It may be necessary to spend financial resources in order to obtain qualified personnel to provide health services. • Those working in the health services must be paid a reasonable wage or salary for their services so that they can purchase the goods and services they need and/ or want for their own personal lives. Political Institution Politics Politics is the organized way in which power is distributed and decisions are made within the society or the social process by which people gain, use and lose power. The Political Institution It is a social structure concerned with the use and distribution of power within a society. Political organization/institution concerned with maintenance of law and order for its continuity it must have rules and regulations. Out of this political order two concepts develop power and authority. Power The likelihood of achieving desired ends in spite of possible resistance from others or the ability to enforce compliance against the will of others. With power, one can exercise free or coercion. Authority we have different authority as power widely perceived as legitimate rather than coercive. Legitimacy - the extent to which power is organized as valid and justified by the people in a relationship or by society at large. Authority belongs to an office or role in society. Those who are subject to it usually accept power that is based on authority. Power based on coercion, however, tends to be unstable because people submit to it out of fear rather than loyalty at some point revolt. In practice, most politics systems rest on the exercise of both legitimate authority and coercive power. Political organization/institution is that which is concerned with the regulation and maintenance of social order within a territory through legitimate use of power or force. Types of Authority Distinguish among the following three types of authority: • Rational-legal authority • Charismatic authority • Traditional authority Page | 60
  • Uncentralized Political System • Uncentralized political systems are mostly found in simple communities. • Authority is mainly in the hands of elders like in the village communities, kinship relations important societies which are based on the age set system- allocation of functions, based on this system, seniority over younger ones. • Power conflict. Ethnicity and Political Organisation • In most 3rd World countries, in contrast to rational-legal relationships, authority is ascribed to a person rather than an office-holder. • The office lacks the bureaucratic separation of private and office sphere and public authority by the ruler and officials may be used for personal interest and not for the purpose they were intended for. • The patron- client relationship. It is an equal relationship that involves an exchange between a superior patron or patron group within inferior client or client group. • Through the system of patronage and clientelism, privileged groups can have access to state power by using their kinship, ethnic, or regional ties. • Those in power who control the state may use their power to distribute resources in form of jobs, development, professions and so on not according to public or universal criteria based on justice, efficiency and need, but may do so on the basis of encouraging political support. • Clientelism may intensify ethnic conflicts. Educational Institution What is the relation between the social institution of education and health? The obvious relationship is the formal education undergone by those preparing to become qualified to function as health workers. Eg doctors, nurses, technicians, technologists, supplementary health service professionals etc. The continous in-service education/training, which is deliberation planned for the purpose of updating and maintaining a competence among health workers is an essential part of the social institution. Provisional health education aimed at improving health as related to the preventive and promotive aspects of the health service- health education teaches nutrition, hygiene, child care- budgeting. Page | 61
  • DEMOGRAPHY Demography studies describe the physical and social characteristics of human population and the changes which occur in these characteristics. It includes the study of the changes in the number as well as type of persons in a particular geographic area over a period of time. This means that the statistics of births, deaths, diseases, age, sex and other characteristics of the people comprising the population are collected and studied. Relevance of Demography and Population Figures for the health Care The collection and study of statistics of births, deaths, diseases, age, sex, etc are very important in the health field as they illustrate conditions prevailing in communities which are vital to the planning of health services as well as the determination as to whether health services are meeting the needs of the community for which they are designed. Determinants of Population Size Three factors directly influence population size: births, deaths and migration of people out of or into the population. Changes in birth rate, mortality (or death rate) and migration will directly affect the size of a population. Explain how the following influence population size and pay attention to the subtitles under each one of them. Births- birth rate, crude birth rate, general fertility rate Deaths- crude death rate, infant mortality, life expectancy Migration- immigration and emigration Determinants and measurement of population composition This is measured by counting the number of people in it who share certain biological or social characteristics, such as sex, race, education, occupation, ethnic background etc. Importance of knowing composition of population of a country Government can plan for the public facilities such as schools institutions, water, employment opportunities, health facilities, etc The sex ration and age composition of a population are important in determining the future growth of population. State the importance of the following in demographic studies: Sex ration Age composition. Determinants of population distribution Geography Page | 62
  • People are distributed over only part of the of earth’s surface which is naturally habitable. Urbanisation andIndustrialisation As a country becomes more industrially developed, people move from rural areas to urban cities and this has an important effect on the distribution of a population. Effects of Urbanisation and Industrialisation • The growth of cites can contribute to economic progress- usually increasing amount and variety of goods and services available to people. • Increase peoples’ awareness and size of the group with which a person can form friendships Consequences of rapid Population Growth Mention the consequences of rapid population growth in the following areas: Land and natural resources Food security The labour market Social services Current Demographic Trends Causes of Population Growth Most important factor of population growth has been declined in death rate combined with high birth rates in DC. • Increase in food production and distribution • Improvement in water and sanitation • Introduction of medical technology such as vaccines and antibiotics • Advances in health care The Demographic Transition The surge in population growth rates can be explained by what is called “Demographic Transition”. Population grows slowly, or not at all, at the beginning and end of the demographic transition because births are counter- balanced by deaths. During the transition, however, population growth can soar because death rates usually fall than birth rates and there is a large excess of birth over deaths. The theory of demographic transition is used to explain this result between births and deaths. The following representation shows the result of: The Old Balance With its very high death rate, high birth rate and consequent slow growth or stability in the total population increases. Page | 63
  • The Transitional Period This is characterized by its declining death rate, high birth rate and consequent high rate of natural increase, leading to an explosion in the population numbers. The New Balance This will hopefully have not only a low death rate, but also a controlled, low birth rate so that there is only limited population increase. The aim of most demographic health planners is ultimately to achieve a nil population growth. The overall goal of the policy is to improve the standard of living and quality of life of the Malawian people. In order to attain this goal, the policy proposes to lower fertility and infant, child and maternal mortality rates. As early pregnancy has been identified as a major contributing factor to high infant and maternal mortality, the policy focuses on reducing adolescent marriages and teenage pregnancies. It also seeks to reduce the high rate of urbanization, enhance labour force absorption and increase opportunities of productive employment for the labour force. Other objectives of the policy include ensuring food security and improving the status of women with youth in all spheres of development. Explaining the strategies that must be implemented in order to achieve the goal of the policy. The overall goal of this national population policy is to improve the standard of living and quality of life of the Malawian people. The policy’s central feature is to ensure that the future growth of the country’s population is kept under manageable and sustainable boundaries, while still maintaining the right of each individual and couple to decide the number of children they wish to bear. Page | 64
  • Sociology Sample Questions • Discuss 3 ways how sociological thinking differs from common sense. • Define the following; • Positivism • empathy • Explain why value free research is important when studying nurse patient Interaction. • With clear examples, describe four ways in which conflicts is resolved • Differentiate between the two terms: • Ascribed status from achieved status • Differentiate status from role. • Differentiate the medical model of health from the social model of Health. • with relevant examples, discuss how the following factors can make patient to decide whether to go to the hospital or not: • Tolerance of symptoms • Denial of symptoms • Cultural variations • with relevant examples, discuss five limitations of traditional healers • Explain the factors that can make a patient to consult a traditional healer. • Differentiate human nature from human nurture • With relevant examples discuss two /many preconditions forsocialization • Discuss the functions of socialization to an individual • With clear examples, differentiate primary socialization from occupational Socialization. • Explain how nurses and patients share socialization process. • Discuss the relevance of Demography and Health care • With examples, discuss the three consequences of rapid population growth in a country. • With examples, discuss the causes of population growth. • Explain how symbolic interactionism is applied in the sociology of health. • Differentiate between role set from role strain(role over load) • Facing with conflicting roles at your working place, describe how you can handled the (two) 2 roles conflict. • Give three advantages and disadvantages of the term ‘Ethnocentrism’ • Explain 2 (two) ways how sociology is relevant in nursing practices • Describe three (3) types of norms Page | 65