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  1. 1. 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. © Page 1
  2. 2. 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
  3. 3. • 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
  4. 4. 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
  5. 5. 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
  6. 6. (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
  7. 7. 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
  8. 8. 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
  9. 9. (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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. (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
  30. 30. 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
  31. 31. 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
  32. 32. • 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
  33. 33. 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
  34. 34. 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
  35. 35. 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
  36. 36. 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
  37. 37. 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
  38. 38. (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
  39. 39. 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