This document provides an introduction to sociology and its key concepts. It discusses the focus of sociology, including social interactions, organizations, and broader societal forces. It outlines the emergence of sociology in the 19th century in response to industrialization and social change. The document summarizes the perspectives of influential early sociologists like Comte, Marx, Durkheim, Spencer, and Weber. It also discusses structural functionalism and conflict theory as two major theoretical perspectives in sociology. Overall, the document concisely introduces some of the fundamental topics and thinkers in the field of sociology.

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.
©munthalinelson@outlook.com
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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
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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
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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?
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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:
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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
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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),
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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
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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.
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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.
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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.
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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
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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
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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
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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
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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
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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:
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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
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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
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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
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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.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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:
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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.
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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
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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
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40. The family is the most and first important social setting in which socialisation takes place.
Infants are almost entirely dependent on others to meet their various needs and this
responsibility almost always falls on the family. Therefore, the family is the original primary
group for most people. Socialization via the family goes from cradle to grave.
The intensive social experience that occurs within the family form the foundation of our
personalities- those relatively enduring ways that people for have dealing with others in a wide
variety of situations e.g. friendliness, generosity, and aggressiveness.
The family is largely responsible for the process of cultural transmission by which values and
norms are taught to new members of the society and incorporated into individuals’ sense of
themselves e.g. attitudes, interests; goals, beliefs and prejudice are acquired within the family.
What makes socialization in the family so important and influential?
The family is the foundation for all civilized behavior such as Language abilities (learning to
talk), body control (e.g., toilet training), emotional control (e.g., "don't hit your sister"),rules of
public conduct (e.g., "don't throw food") and Moral values (e.g., "lying is a sin").
• Access to the emotional bond between parent and child, an extremely strong and
effective socializing mechanism
• Lifetime impacts affecting the person's self-esteem, emotional health, identity, and
personality
• Origin point of gender roles (masculine and feminine behavior; fundamental division of
the social world into men and women)
• Origin point of ethnocentricism and racism (racial and ethnic prejudice)
• Source of original social capital that determines life chances
The amazing power of the family as an agent of socialization comes from a combination of two
factors:
The power of the family is strongest during infancy and toddler years. After that the media,
then peers, and finally school challenges its exclusive access to the child. By later childhood
the family's power as a socialization agent has weakened considerably. In the adolescent years
that power is further weakened by peer group influences and the predominance of the media in
teenage subculture. Overall there has been an historical trend of the family's power as an agent
of socialization being steadily eroded by the media, peer subculture, and schooling.
The family returns as a predominant agent of socialization during the adult years with the roles
of marital partner and parent.
2. Mass Media
The mass media are channels of communication directed to vast audience within a society. The
mass media includes: television, radio, movies, music, newspaper, books, magazines and
internet. Socialization also comes through from children's shows, cartoons, and, most
especially, commercials. All these constantly present us with information of all kinds and as a
result, have an enormous effect on our attitudes and behavior. Messages and values carried by
the media are powerful and seductive. Many of those messages and values challenge or directly
contradict with what parent's teach their children. Media influence continues and strengthens in
adolescence based on a merger of teen subculture, pop culture (music & movies), and corporate
marketing. Sports, increasingly a branch of marketing, become especially influential for
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41. teenage boys. The internet (web pages, e-mail, chat rooms and face books) have emerged as
another media source important to teens, again especially boys
Social learning theory suggests that much human behavior is learned from modeling others
(Bandura, 1977) and studies show that when children identify strongly with media characters,
they are most likely to be influenced by them (Williams, 1981).
The power of the media declines in adult years but still remains strong. Pop culture continues
strong but loses its subculture support. Sports and the internet continue as agents of
socialization, especially for males. News (both TV and print) emerge as new agent of
socialization in the adult years.
3. Peer Groups
Peers are people of roughly the same age (same stage of development and maturity), similar
social identity, and close social proximity. They're friends, pals, etc. Typically, children
encounter peer group influence around the age of three or so. Usually these are neighbors,
family members, or day care mates. With peers, the child begins to broaden his or her circle of
influence to people outside of the immediate family.
Often peer interaction in the earliest years is closely supervised by parents so it tends to parallel
and reinforce what is learned in the family. What is added to socialization, even in these closely
supervised situations, are social skills in group situation with social equals.
As childhood progresses, peer group interactions become more autonomous (less observed and
supervised by adults). The lessons learned also progress from basic rules of group interaction to
more complex strategies of negotiation, dominance, leadership, cooperation, compromise, etc.
These lessons are learned first in play and later through games. Peers also establish the
platform for children to begin challenging the dominant power of parents and family.
In adolescence, peer group relationships become extremely important, rising up to directly
challenge the family. In direct alliance with the media, teenage peers form their own
subculture. They learn how to navigate the complexities and nuances of group interaction
largely without adult guidance or supervision. Peer group socialization also becomes linked to
puberty and the all important role of sexuality and sexual relations in life. Peer groups are
where teens largely learn about sex and being sexual and practice the skills of sexuality.
Paralleling this, the gender role socialization begun in the family is extended, deepened, and
reinforced.
In the adult years the demands of work and family overwhelm most peer group relations and
the influence of peers seriously declines as an agent of socialization, only to return during the
elderly years.
4. School
Traditionally around six years old the child enters the school system in the first grade. Today
the process often starts earlier in Kindergarten or day care. The most widely recognized
contribution of schooling to the socialization process is teaching children a wide range of
knowledge and skills. In the early grades, these basic skills such as reading, writing and
arithmetic are learnt. Later secondary school and colleges teach highly specialized knowledge
and skills that are needed to function in a complex industrial society that has many specialized
productive roles.
Socialization in school takes the following forms:
(a). Official curriculum
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42. What the school system and its teachers announce as their content and goal. It includes the
knowledge & skills learned in English, math, history, etc. The school is the official place
where our society transmits it accumulated knowledge and skills from one generation to next.
It's also the place where we officially pass on our cultural values, tradition, and heritage, at
least the "official" heritage. This curriculum often reinforces what was learned in the family
but it can also challenge family socialization (e.g., teaching values of tolerance to a child
from a racist family)
(b). Hidden curriculum
Students learn not only from the official courses of study, but from the physical environment of
the school, the attitude teachers and pupils exhibit towards one another, the social climate, and
the bureaucratic organisation of the school for example:
1. The school activities such as sports and classroom tests teach children comprehensiveness
and the value of success.
2. The school further socializes children into culturally approved sex roles- boys are
encountered to be aggressive, athletic and dominant. Girls are expected to be feminine,
socially conscious, and submissive. Such differences related to sex continue throughout the
process of formal education. eg college women may be urged to select majors in the arts or
humanities, while college men may be encouraged to study physical Sciences.
3. The school day is based on a strict time schedule, so children experience impersonal
regimentation for the first time and learn what it is like to be part of a large organization.
4. Education plays a vital part in promoting social integration. From this point of view, school
not only helps children adjust to living within a large, impersonal world, but also teach
them knowledge and skills necessary for the successful performance of adult roles.
As preparation for the adult world of formal organization and workplace authority, the hidden
curriculum stresses such things as formalization and standardization, following instructions,
obedience to authority figures that are not Mom and Dad, learning to control behavior and fit
into the group, pleasing (even manipulating) authority figures, and working in teams.
5. Religion
Functionalists point out that an important role of religion is to contribute to the socialization of
societal members by instilling in them a sense of purpose in life and providing them with moral
instructions.
The teaching of the church may influence eating habits, dating practices, mate selection, birth
control practices, and many other elements of life style.
6. The work place
The socialization process usually follows 2 lines:
1. Formal socialization from supervisors teaching us the policies, rules and regulations, and
perhaps the technical skills needed to complete the assigned work.
2. Informal socialization from co-workers teaches us the “unofficial rules” we must abide by in
order to be fully accepted by our own peers on the job.
Assuming a work role is an important part of one’s social identity and hence is a continuation of
the process of developing “self”. Work experience during adolescence has been linked to self-
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43. esteem. E.g. when adults meet for the first time, one of the first questions they ask one another
is “what do you do?” A person’s occupation such as nurse, doctor, lawyer, garbage collectors
etc affects how he or she is perceived by others and the nature of the interaction that follow.
THEORIES OF SOCIALIZATION
(1) Social Learning Theories
We are socialized through positive and negative reinforcement by our parents, friends, and the
society and that we observe and imitate socialized behavior around us.
The two processes emphasized in social learning theory are:
(i) Conditioning
It is a form of learning in which the consequences of behavior determine the probability of its
future occurrence(Skinner,1953).Consequences of behavior that increase the chance that
behavior will occur are reinforcements; consequences that reduce probability are punishment
Observational Learning (also referred to modeling or imitation)
Occur when people reproduce the responses they observe in other people, either real or fiction.
(ii) Cognitive Development Theory
A child’s socialization occurs in step with his or her cognitive development. What and how a
person learns depends on his her ability to understand and interpret the world, something that
progresses through several stages.
Jean piaget(1926/1955) hypothesized every normal child goes through 4 stages of cognitive
development, each of which is dominated by a different scheme for handling information and
understanding how the world works:
• Sensori motor stage-young children use their senses to make discoveries eg touching;
they discover that their hands are actually a part of themselves.
• Preoperational stage-Children begin to use words and symbols to distinguish object and
ideas.
• Concrete operational stage-Children engage in more logical thinking. They learn that
even when a formless lump of clay is shaped into a snake it is still the same clay.
• Formal operational stage-adolescents are capable of sophisticated abstract though and
can deal with ideas and values in a logical manner.
(2) Symbolic interactions
Individuals monitor their own behaviour, monitor other peoples’ responses, make
interpretations, try out new ways of behaving, and come to new understanding about
themselves.
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44. (3) Generalized Other: Gorge Herbert Mead
Continued Cooley's exploration of Interactionist Theory of looking at “ glass self”.
Mead (1931/1964) contented that we gain a sense of self hold by acting towards ourselves in
much the same fashion that we act towards others. In so doing, we “take the role of the other
towards ourselves”
We mentally assume a dual perspective: We are simultaneously the subject (“I”)doing the
viewing and the object(“me”) being viewed. In our imagination, we take the position of another
person and look back on ourselves from this stand point.
Example
Think of what happens if you as a student nurse during your practical training in a hospital want
to put a question to a Chief Nursing Sister: “If I ask a question, she will think that I am stupid. I
must therefore rather keep quiet”.
In this example, you have looked at student nurses through the eyes of the Chief Nursing Sister.
By doing this you have in your imagination assumed her role and have seen yourself as the
object, the “me”. It is the “I” as subject that has decided that it would be unwise to ask the
question and therefore rather keep quiet.
Language allows us to carry on an internal conversation. We talk and reply to ourselves in much
the same manner that we carry on a conversation with others. In this fashion we judge how other
people will respond to us.
Sociologist Ralph Turner, (1968) clarified and extended Mead’s ideas on the self. Turner
pointed out that when speaking and acting, we typically adopt a state of preparedness for certain
types of responses from the other person.
Example
If we greet a patient or a friend in a friendly manner or embrace him, we expect that the other
person will react in more or less the same way. When the person reacts, we enter a phase of
testing and revision. In our imagination we test the other person’s behaviour and determine
whether it is in accordance with our expectations. By doing this we give meaning to that
behaviour. On the basis of this we then plan our next step. If the person acts “differently”, we
could either terminate the interaction or go back and follow a different approach or even follow
up the other person’s initiative, what it amounts to is that the process of self- communication is
essential for social interaction.
Mead uses the term generalized others to refer to the attitudes, viewpoints, and expectations of
society as a whole that a child takes into account an entire group of people.
Children can take a more sophisticated view of people and the social environment.
IMPRESSION MANAGEMENT:ERVING GOFFMAN
Many of our daily activities involved attempts to convey impressions of who we are.
Impression Management
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45. Goffman thinks that we are constantly trying to influence others in a certain way and therefore
presents to others in such a way that they will form a favourable impression of us. In this way
we can then predict or control what will happen to us.
To create a favourable impression, people make use of concealment and of strategic disclosure.
Example
Concealment
A student nurse may spend several hours preparing and rehearsing a presentation in hopes of
appearing “knowledgeable” to other students.
Another examples is what we wear for a particular occasion eg party, job interview,
appointment with the doctor.
Strategic disclosure/revelation
A patient may place a few technical journals on his bedside table to create the impression
among nurses and visitors that he is an academician (highly educated).
To further explain social life, Goffman makes use of the dramaturgical approach.
Dramaturgical approach
He describes social life as a stage or drama. All human beings are both actors and members of
the audience, and the parts are the roles people play in the course of their lives.
According to him, the self is a product of the ongoing performances that characterize a person’s
everyday interaction with others, and of how these performances are interpreted by others.
In this view, the self is not so much something that people possess and then carry unchanged
from situation to situation, but is a “dramatic effect”.
Example
A nurse may try to appear busier than he or she is if a supervisor happens to be watching.
In accordance with this he uses terms “front stage” and “backstage”
Example
(i) Example of the waiter and the kitchen (read this example from any sociology book
or document).
(ii) Through most of the day the nurse will be “front page” where she will and must play
her assigned and expected roles of clinical competence and capability towards
colleagues, medical doctors and patients. As her home, with a good friend, she is
“back stage”, there she can literally be “herself” and kick off her shoes without
making herself ridiculous. Even the nurses’ tea room at the hospital could from time
to time be “backstage”.
However, problems could also be encountered with regard to impression management. Once
an individual has made a certain impression on others, he or she is expected to maintain that
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46. impression or behaviour. If mistakes are made, other people could form the wrong
impression about such a person. Outsiders could sometimes accidentally get glimpse of a
person’s “backstage” and consequently make the wrong assumption about such a person.
Three aspects are used to create favorable impressions:
(a) A social place
The place where personal actions and within which interactions takes place, e.g. the hospital
ward, church, pavement etc.
(b) Appearance
What a person looks like while acting his role. Human decorations such as appearance, clothes,
hairstyle, etc convey messages and play an important part in impression management.
© Attitudes
The ways in which one communicates, for example, stemly, formally, humorously etc, reflect
the general attitudes of the role-player.
SOCIALISATION IN THE HOSPITAL SOCIAL SYSTEM: BECOMING A NURSE
AND PATIENT
As nurses and patients share the same social system in the hospital, it is appropriate to consider
their socialization in the context.
A social status can create some difficult as the labeling of one individual as “nurse” with
another as “patient” tends to create stereotype ideas as to what is or should be the appropriate
behaviour for the role. This can be dysfunctional for patient care. If for example the individual
who is a nurse is perceived by the patient to be a charismatic angel of mercy and the individual
who is a patient is perceived by the nurse to be an unquestioning, subordinate and dependent
individual.
Sharing socialization processes.
Nurses and patients also share similar socialization processes in the hospital. They both undergo
a process of “role- stripping” with divests them of the symbols associated with their previous
social roles for example, adolescent girl or driver. This process is carried out during the ritual of
exchanging the clothes associated with their former social roles for those of a uniform, in the
case of the patient.
Both are also to some extent divested of their personal identities by a labeling process. The
student nurse is given the (honorary) title of the “nurse” and the sick individual labeled “patient”
and often given an index number as well.
Social distance
Both nurse and patient inevitably experience a social distance in the social system and this is a
further reason for studying the socialization of the nurse and patient in the same context.
Patients and nurses are individuals in different and distinct social groups which even though
they are geographically near in the hospital, are distinctly separate social entities; a social group
of patients and a social group of nurses separated by social distance.
It could be argued that social distance also distance also exists between nurse- students and
trained nurses who also form distinct social groups in the hospital.
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47. DEVIANCE AND SOCIAL CONTROL
DEVIANCE
In the broadest sense, deviance means not conforming to predominant norms. It refers to
behaviours that violate the folkways, mores and laws of a particular group.
The sociological definition of deviance refers to behaviours that violate group norms, exceeds
its tolerance limits and it is viewed as negative or harmful by the group or by its powerful
members.
Example
Crime- behaviours that violate laws
Also behaviours that are not criminal eg mental illness, alcoholism and homosexuality
There really is no one thing that is always called deviant and no one thing that is always called
desirable so we must be careful when we attempt to define deviance.
So we can say that deviance is any behaviour that is considered undesirable by the majority of
people at a certain time.
Complete deviance and total conformity are each extreme, ideal type of behaviour in the
society. There is always some kind of deviant behaviour in society.
It is not the act itself, but the reactions to the act, that make something deviant (Howard, 1966).
Relativity of deviance
There are no absolutes in any sociological definition or discussion of deviance. It is said that no
act or anything is automatically deviant. The definition of an act as deviant is relative to the
particular culture , subculture, time period, situational context and character of the individual
involved. E.g. killing another human being (murder) is the ultimate deviant behaviour yet there
are times when we do not label someone a murderer just because he has killed someone. We
ask, did the person kill in self defense? in war? Was he insane? Was it a case of capital
punishment?
In each case, the act of taking another’s life is the same, but the definition of the act varies.
Deviance and its definition are quite complicated. The deviance, time period, social status of
those involved, and situation all influence whether an act is deviant and how serious it is
considered to be. Eg when an enrolled nurse take the drugs, the bosses take this as a serious
matter but when the bosses take drugs, it is not taken to be a serious issue.
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48. The relevance of audience
The judgment of what is good or bad depends on those who observe and evaluate the act.
Example: In China, it is normal to abandon female children to die in preference for male
(Compare with Malawian situation).
Many different cultural groups have potentially conflicting norms of what is not deviant, even
regarding murder.
The relevance of time
Normative expectations change over time.
Example: Styles, fashions fade come and go depending on the times. People seen as sinners,
rebels and criminals in the past may be thought of as heroes and heroines in the future ,
according to Emile Durkheim in structural functionalism theory.
Relevance of the status
People will be perceived differently according to their social character. Generally, higher status
individuals are less likely to be labeled deviant or to receive harsh treatment than lower status
individuals. The dress, manner, occupation, social influence, demeanour, and family
background of an individual all help determine whether the individual’s action will be labeled
deviant.
Relevance of situation
Deviant behaviours can be relative to circumstances.
Example:
Public nudity is a behaviour condoned in an infant but condemned in an adult, killing people is
condoned in war and condemned when done for personal reasons. Drug consumption is
condoned for research and for medical treatment and condemned for enjoyment.
1. The functionalist perspective
The functional of deviance (Emile Durkheim)
• Deviance affirms cultural values and norms
• Responding to deviance clarifies moral boundaries.
• Responding to deviance promotes social unity
• Deviance encourages social change
2. Strain Theory (Robert Merton, 1938- 1968)
How social values produce deviance
Functionalists argue that crime is a natural part of society, not an aberration or some alien
element in our midst. They say some mainstream values actually generate crime.
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49. Most people have strong desires to reach cultural goals such as wealth or high status, or at
achieve whatever other objective society holds out of them.
However, not everyone has equal access to society’s institutional means, the legitimate ways of
achieving success.
Some people find their path to education and good jobs blocked. These people express strain or
frustration, which may motivate them to take a deviant path.
When a person is prevented from legitimately reaching cultural goals, there are 4 possible ways
for the person to react or adapt, according to Merton’s strain theory:
(i) Motivation
A person uses illegitimate/ deviant methods to achieve a certain socially approved goal e.g.
getting money and achieving success through theft, robbery, prostitution etc. People who
engage in these activities conform to the value of success but deviate from the norms for
acquiring success.
(ii) Retreatism
An individual simply gives up any hope of achieving the goals set out by society, he/she
feels that he/she cannot make it eg school dropouts
People can retreat into alcoholism and drug addiction or into skid row life-styles far from
mainstream society. The most extreme is suicide.
(ii) Rebellion
An individual rejects conventional culturally/socially accepted goals and hopes to estimate a
new social structure- by challenging the system.
Example:
Terrorist groups eg Hamas in Israel
(iii) Ritualism
An individual has lost sight of his/her goals altogether and become obsessed by doing things the
right way. Life becomes routine eg going to church. Conformist or deviant (people who have
lost their hope) - often not labeled as deviant.
Example:
Imagine a person who appears on the job time every working day. The person occupies a desk
and reshuffles through paper, following all rules and regulations. But the person does not care
about advancement or even how well the job is done.
3. Deviant subcultures
Cohen (1955), Cloward and Ohlin, (1960) expanded on Merton’s theory of deviance.
Focusing on juvenile delinquency, they believe the reason the lower-class may become
involved in property offences and even violent crimes is because they often find few legitimate
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50. opportunities to achieve some of the middle class goals (especially material possessions) to
which they aspire.
These blocked opportunities may lead to the formation of deviant subcultures that provide
increased social status through illegitimate means and supplement deviance eg dropping out of
school, joining gangs, stealing.
Other examples include religious cults, drug users, may feel “cut off” from larger society and
consequently find it functional to bind together for social purposes, mutual support and
protection.
4. The symbolic interactionist perspective
(a) LABELING THEORY
This is the idea that deviance and conformity result not only from what people do, but from how
others respond to those actions. It stresses the relativity of deviance.
Labeling theory does not attempt to explain the origins of deviant behaviours. It assumes
everyone commits deviant acts at some point in life. It focuses on the perpetuation of deviation
as a result of being singled out when given the stigma of deviant status.
The labeling theory places the spot light on the actors and the way in which they perceive one
another and not on the deviant behaviour itself. People are continuously rating, scaling and
labeling those around them. Some statuses override all other statuses and are given certain
priorities e.g. in USA black first, physician second.
Once an individual’s social status becomes that of deviant first, human beings second changes
are likely to occur in the individual’s self image. The deviant comes to think of self as deviant
and finds it increasingly difficult to return to a conventional status.
Primary Deviance: This is the norm violations that provoke slight reaction from others and have
little effect on a person’s self – concept eg. Skipping school and under-age drinking.
Secondary Deviance: This is when an individual repeatedly violates a norm and begins to take
on a deviant identity. Secondary deviance marks the start of a deviant career that may lead to
acquiring a stigma, a powerful negative label that greatly changes a person’s self- concept and
social identity.
Stigma operates as a master status. A deviant status can become a master status eg ex-convict,
prostitute if you redefine yourself and change your behaviour in response to how others redefine
your new status of deviance.
Retrospective Labeling
This means interpreting someone’s past in light of some future deviance eg when a priest has
sexually molested a child they rethink his past.
Projective labeling
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51. People may use a deviant identity to predict future action eg if one is a prostitute, one cannot be
employed as a house maid for fear of doing the same with the owner of the home.
(b) DIFFERENTIAL ASSOCIATION THEORY ( EDWIN SUNDERLAND, 1940)
A person’s tendency towards conformity or deviance depends on the amount of contact with
others who encourage or reject conventional behaviour.
If an individual has been exposed to deviant orientations with greater intensity and frequency
and for a long period of time than he has been exposed to conformist orientations, then the
individual is likely to engage in deviance.
Families
They make a big difference in whether we learn deviance or conformity
Friends, neighbourhood and subculture:
Kids with delinquent friends are likely to become delinquent too.
Bad neighbourhood, may have an influence on an individual
Some neighbours develop a subculture of violence.
The implication of the differential association theory is that the family environment,
neighbourhood, peer group, school and other socializing agents can teach a child deviant
behaviour just as easily as they can teach conforming behaviuor. Eg prostitutes tend to enter
their profession because they have a friend, or a group who encourage them to sell themselves.
HIRSCHI’S CONTROL THEORY
• Attachment
• Commitment
• Involvement
• Belief
Assignment: Read on these from any recommended and prescribed text
CONFLICT THEORIES OF DEVIANCE
Conflict Perspective
Conflict theory focuses on the inequality in which groups are singled out fro deviant statuses
and on the lack of power some groups have to fight their deviant status of the system that
labels them.
Conflict theories view deviance as arising when groups with power attempt to impose their
norms and values an less powerful groups.
Power and Deviance
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52. Those in power have the opportunity to make and enforce the norms that govern their and
others’ behaviour. Hence have power to say what and who are and are not deviant. Because
of their loftier social possession only certain people have the power to commit certain types
of deviance.
Conflict theorists insist that the criminal justice system reinforces inequality and defines as
deviance any behaviour that threatens those in power.
Elite Deviance
Only certain people in society can commit elite deviance, which include all aspects of white
collar crime as well as other deviant acts perpetrated by those in power eg environmental
pollution, insider tradings, political corruption.
SOCIAL AND CULTURAL CHANGE
Nature of social and cultural change
Most of the early studies of social factors and disease onset were concerned with the effects of
social and cultural change. They included studies of industrialization and urbanization,
migration and social occupational and geographical mobility. The major disease outcome
studied was coronary heart disease, because this is predominant a disease of industrialized
urbanized nations.
Effects of social and cultural change on health and illness
Some populations isolated from western countries have low blood pressure that does not rise
with age. However, blood pressure levels and coronary heart disease rates increase when these
populations move to urban settings. A number of studies conducted during the 1960s and early
1970s found higher rates of disease among people who changed jobs, place of residence or life
circumstances e.g. one study found that men reared on farms who moved to urban centers to
take middle class jobs had higher rates of coronary heart disease than men who continued to
work on the farms or who took labouring jobs in cities (Syme, et al, 1964). Similar observations
have been made with respect to cancer.
A number of mechanisms might be responsible for the negative effects of social and cultural
change on health. The adverse effects might be direct result of change itself, a product of the
circumstances to which individuals move or the product of personal characteristics that
predispose individuals to both mobility and poor health.
Example:
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53. One study that attempted to evaluate these explanations compared rate of heart disease among
Japanese men still living in Japan (Marmot, et al, 1975). Coronary heart disease and mortality
rates were highest among those living in California and lowest in Japan. Among those living in
California, some had become “acculturated” and had adapted Western life styles, where as
others retained traditional Japanese ways. The former had disease rates up to 5 times as high as
the later. This suggest that being mobile is not in itself, the important factor, rather it is the
change in the environment in which these people lived that explained the increases in disease
risk.
SOCIAL STRATIFICATION
Social stratification refers to the making of members of the society according to the unequal
distribution of whatever is considered valuable or the “good things” in life. In Western societies,
wealth, prestige and power are defined as the good things and are usually scarce. In African
societies, stratification may also essentially be based on age, sex, and to some extent ethnicity-
making the study more complex.
In the definition, the key word is “unequal”, for if some have more, then others must have less.
The study of stratification is thus the study of social inequality.
Social differentiation
Social stratification depends on but is not the same thing as social differentiation. Social
differentiation is the process by which the members of a society divide up activities and become
‘different” by virtue of playing distinctive roles.
Activity
1. Where do you fit in the stratification system?
2. What criterion did you use to reach this conclusion?
3. Most people would place drug dealers; no matter what their wealth, near the bottom- not
at the top of the social hierarchy; why is this so?
Dimensions of social stratification
Explain social stratification according to the following:
Marx: the inequalities of class
Weber: Inequalities of wealth, prestige and power
Socioeconomic status (SES)
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54. It is a composite social ranking that combines income, occupational prestige, level of education
and neighbourhood.
By measuring socio-economic status, we not only make distinctions among people- for example
people in different occupations-but also can demonstrate how people in the same line of work
may rank differently.
Social Class
It can be defined in a simplified manner as the level or stratum of persons who occupy similar
positions in the social hierarchy. This means that many people share similar but not exactly the
same position in that hierarchy.
For convenience social scientists generally divide the social hierarchy into three classes based
on occupation and income:
1. The upper class: those whose large income comes mainly from property.
2. The middle class: of non-propertied professionals and white collar workers.
3. The lower class: of low income manual workers
The dividing of society into these social classes is based on the socio-economic status of the
members of the society.
The lower class
The lower class is based on lack of income, poor education and low occupational prestige. The
lower class can be divided into 2 subclasses: the working poor and the underclass working poor.
Its members include unskilled laborers, those in service jobs like maids, and those in the
lowest-paying industrial jobs. They face periodic unemployment and their incomes are often at
the minimum wage or less.
They are called the working poor because their incomes do not allow them to even come close
to the mainstream style of living in Malawi.
Social Mobility
It is the movement of individuals and groups from one level (stratum) to another in the stratum’s
system- i.e. movement between social classes.
Forms of Social Mobility
The most distinguish social mobility is the vertical one i.e. Horizontal mobility
SOCIAL CLASS AND HEALTH
Health and Deprivation
There is a link between economic deprivation and health. Poorer members of society tend to get
sick more and have shorter life expectancy than the more affluent.
Examples:
1. Those in the lower class of unskilled manual workers are more likely to get ill and die
earlier than those in the upper class.
2. Babies born to working class parents are twice more likely to die before their first
birthday than those born into middle class.
3. Complications in pregnancy and on delivery are more common in working class
mothers.
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55. Distribution of Health Services
Inverse Care Law
Do those who are poorest and in worst health also fail to access services and/ or obtain health
services of poorest quality.
Good medical care tends to be least available to those in greatest needs, vice versa.
The distribution of services
“Understaffed” districts in terms of health personnel are usually poor districts with high rates of
sickness and mortality and in specific need of good medical services.
Certain areas of the country are medically deprived in the sense that existing services are unable
to cope with the demand places on them, while others have relative abundance of medical
resources in relation to their needs.
Health care in hospitals according to class, e.g. paying wards providing better health care and
treatment than non-paying wards where most of those in the lower class are normally treated.
Health service expenditure by social class, e.g. dialysis machine is mostly accessible to some
middle and upper class.
The use of health services by social class; despite the services being available to all classes the
lower class does not seem to utilize certain services for their own reasons e.g. communications.
Explaining the Health Gap
Behavioral/Cultural and Materialist explanation
The behavioral/cultural and materialist types of explanation both see health as determined in
some way by social class, but they differ in the aspects of social class they see as responsible.
Behavioural/cultural explanations involve class differences in behaviors that are health
demanding or health promoting, and which, at least in principle, are subject to individual choice.
E.g. Smoking, prostitution, casual sex, unprotected sex and alcoholism.
Materialist explanations of disease, by contrast, emphasize those social, political and economic
factors beyond the control of individuals and which adversely affect their health. E.g. Diet,
housing conditions, work available and environmental conditions.
Read on cultural /behavioral and materialist explanations of health inequalities, e.g. Weltz,
(2004) and Scambler,( 2003).
Conclusion
There is abundant evidence to suggest a close association between health and social class, with
people in the higher classes enjoying on average, better health and longer lives than in the lower
social classes. It is clear that there has been no narrowing of class differentials in recent years.
Whilst it appears that none of the two approaches outlined above provide, on its own, an
adequate explanation of inequalities in health, it does seem that there is a slowly emerging
consensus amongst researchers the two approaches complement each other to a large extent in
explaining the health gap between classes.
Only by beginning to understand what causes inequality in health, can provide socially
approved services and promote health.
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56. SOCIAL INSTITUTIONS
A social institution is an organized system of social relations that embodies certain common
values and procedures and meets certain basic needs of society. Universal institutions include
the family, education, politics, religion and economy.
Social institutions are the activities and organizations by which the basic needs of society are
met. Each institution involves certain social relationships. Within social institutions, people
observe customs and organized patterns of behaviour.
An institution is a procedure, that is, an organized, formal, recognized way of doing or
performing an activity in a society. On the other hand, an association carries out institutional
norms and values e.g. church for the religious institution. Institutions are ways of doing things
while associations are groups that do them.
A persistent practice can be institutionalized or accepted.
Activity:
1. Read about the importance of/functions of institutions in recommended texts
2. Explain the manifest and latent functions of social institutions.
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57. Interaction of social institutions
Social institutions collectively contribute to the cultural fabric of the society. Actually, there is a
complex network of interrelationships that exist between institutions for a society to survive,
basic institutions must co-operate with and relate to one another. If one institution should fail to
meet the needs of the population, its failure can affect the functions of other institutions in
various ways. E.g. Economic disruptions can affect family life and the government.
The Family
The Traditional African Family
A family is a group of persons united by ties of marriage, blood or adoption, constituting a
single household, interacting and communicating with each other in their respective social rules
of husband and wife, mother, father, son and daughter, brother and sister and creating and
maintaining a common culture.
Functions of the Family
The major functions of the family are:
• For sociolisation
• Reproduction
• Regulation of sexual relations
• Care, emotional ties and protection.
The above functions seem to be the basic functions of the African and other families all over the
world to day. But some of the family’s past functions include the provision of economic
well-being, protection, recreation, education and religion. All these functions have gradually
been taken over by other social institutions.
Characteristics of an African Family Life
• Importance of the larger kin group
• Importance of children
• Lack of public display of affection
• Care for and respect for the elderly.
• Constrained communication between parents and children
• Polygamy
• Bride – worth versus bride- price
Psychosocial studies relate the health of the individual closely to the type of family in which he
or she lives, to its dynamics, functioning and quality of life.
Activity
1. Describe the terms below and apply them to Malawian society and any other African
traditional family.
Type of family Residence
Nuclear extended Neolocal patrilocal Matrilocal
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58. Authority Patriarcal Matriarchal Egalitarian
Descent
Bilineal Patrineal Matrineal
Forms of marriage Monogamy Polygamy Polyandry
Types of Marriage Customary and traditional Religious Civil
Payments Bride-price Bride wealth Bride service
Kinship Blood kinship Kinship by marriage Non-legal secondary
Or sexuality
Alternative Lifestyles Being single Cohabitation Single-parent family
Other terms Widow inheritance Endogamy Exogamy
2. Describe the changes that have taken place in an African family
For a nurse, an understanding of marriage and family forms which differ from her own can save
emotions and trauma with patients who are frowned upon for what to them is the normal pattern
of marriage and also from embarrassment when confronted with “strange” marriage and family
types.
Family and Health
Possible family reaction to an illness crisis is an affirmation of its solidarity as a social
emotional unit. If one or other member of the family has to be hospitalized a new situation
arises for all members of the family.
The family plays some of the following functions in relation to health:
• The family is the first emotional and social support mechanism, first teacher and first
care provider where it is usually the woman who assumes responsibility for each of these
essential functions.
• The family provides the role of keeping its members healthy and protecting them from
diseases.
• It helps in treating especially rehabilitating disease/illness (mental patients, drug addicts)
and assisting them during illness.
• “Therapeutic triangle” Collaboration in protecting or restoring health between the
patient, the family and the health care system
• The success of every cure or course of treatment of every therapeutic or health giving
prescription depends on the family.
• Consideration should be given for greater involvement of the family in health care,
where the family should be/is seen as an element of primary health with an active
response and participatory role. Unfortunately, medical practitioners tend to unload all
the patient’s problems especially in chronic or terminal illness on the family.
• They completely ignore family connections and all problems of family life leaving
health and illness within the narrow framework of the doctor-patient relationship.
• A family that depends on the sick member will have difficulty in restructuring and
adjusting to new roles of providing for themselves
Religion
Because religion deals with that which transcends everyday experience, its validity can be
assessed by neither common sense nor science. Religion is a matter of faith.
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59. From Emile Durkheim’s religion can be defined basically as a system of belief and practice built
upon the recognition of the sacred.
Religion refers to those socially shared ways of thinking, feeling and acting that have to do with
the supernatural or “beyond” (Zanden, 1988)
Activity:
Describe the role that the religion plays in society from a Functionalist and Conflict
perspectives.
RELIGION, PATIENTS AD HEALTH WORKERS
Next to the family, religion is probably the most vital and important institution in the lives of
many individuals. During periods of illness, people tend to become even more dependent on
their faith. The families too, may turn to the church more than on non-critical periods of their
illness. Both birth and death- two basic mysteries – have profound religious significance for
most people for the rites associated with them in most religious faiths.
Religious beliefs influence when and where health care is sought, who is expected to give the
care and how the care is to be given, and Sometimes Science and faith differ in their
prescriptions. For example: Jehovah Witnesses do not permit blood transfusions because they
interpret the Bible’s admonishment about drinking blood to apply also to transfusion of blood.
Other Christians believe that prayer, not medical treatment, will heal if the individual is meant
to be healed. It is of course not up to health workers to resolve conflicts between Science and
religious beliefs but anyone involved in health should be aware of and have respect for such
beliefs. It may be necessary to contact clergy of various faiths for understanding or assistance in
situations of conflict between religion and medical belief.
Economic Institution
Economic systems differ widely from society to society. They also have certain features in
common. Robert and Heilbroner, (1962) has identified two universal characteristics of economic
systems.
(I). “A society must organize a system for production of the goods and services it needs for its
own perpetuation.”
It must arrange a distribution of the fruits of its production among its own members so that more
production can take place.
When discussing the economy, there must be:
Production goods
Exchange of and
Distribution services
Health Implications of Economic Institution
• Producing of goods to be used in the health services the distribution of these goods and
the payment that must be made for them e.g. drugs.
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60. • All health planning is concerned with the economic aspect of the situation e.g. building
of health facilities to provide health services to people in need.
• It may be necessary to spend financial resources in order to obtain qualified personnel to
provide health services.
• Those working in the health services must be paid a reasonable wage or salary for their
services so that they can purchase the goods and services they need and/ or want for their
own personal lives.
Political Institution
Politics
Politics is the organized way in which power is distributed and decisions are made within the
society or the social process by which people gain, use and lose power.
The Political Institution
It is a social structure concerned with the use and distribution of power within a society.
Political organization/institution concerned with maintenance of law and order for its continuity
it must have rules and regulations. Out of this political order two concepts develop power and
authority.
Power
The likelihood of achieving desired ends in spite of possible resistance from others or the ability
to enforce compliance against the will of others.
With power, one can exercise free or coercion.
Authority
we have different authority as power widely perceived as legitimate rather than coercive.
Legitimacy - the extent to which power is organized as valid and justified by the people in a
relationship or by society at large.
Authority belongs to an office or role in society.
Those who are subject to it usually accept power that is based on authority. Power based on
coercion, however, tends to be unstable because people submit to it out of fear rather than
loyalty at some point revolt.
In practice, most politics systems rest on the exercise of both legitimate authority and coercive
power.
Political organization/institution is that which is concerned with the regulation and maintenance
of social order within a territory through legitimate use of power or force.
Types of Authority
Distinguish among the following three types of authority:
• Rational-legal authority
• Charismatic authority
• Traditional authority
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61. Uncentralized Political System
• Uncentralized political systems are mostly found in simple communities.
• Authority is mainly in the hands of elders like in the village communities, kinship
relations important societies which are based on the age set system- allocation of
functions, based on this system, seniority over younger ones.
• Power conflict.
Ethnicity and Political Organisation
• In most 3rd
World countries, in contrast to rational-legal relationships, authority is
ascribed to a person rather than an office-holder.
• The office lacks the bureaucratic separation of private and office sphere and public
authority by the ruler and officials may be used for personal interest and not for the
purpose they were intended for.
• The patron- client relationship. It is an equal relationship that involves an exchange
between a superior patron or patron group within inferior client or client group.
• Through the system of patronage and clientelism, privileged groups can have access to
state power by using their kinship, ethnic, or regional ties.
• Those in power who control the state may use their power to distribute resources in form
of jobs, development, professions and so on not according to public or universal criteria
based on justice, efficiency and need, but may do so on the basis of encouraging political
support.
• Clientelism may intensify ethnic conflicts.
Educational Institution
What is the relation between the social institution of education and health?
The obvious relationship is the formal education undergone by those preparing to become
qualified to function as health workers. Eg doctors, nurses, technicians, technologists,
supplementary health service professionals etc.
The continous in-service education/training, which is deliberation planned for the purpose of
updating and maintaining a competence among health workers is an essential part of the social
institution.
Provisional health education aimed at improving health as related to the preventive and
promotive aspects of the health service- health education teaches nutrition, hygiene, child care-
budgeting.
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62. DEMOGRAPHY
Demography studies describe the physical and social characteristics of human population and
the changes which occur in these characteristics. It includes the study of the changes in the
number as well as type of persons in a particular geographic area over a period of time. This
means that the statistics of births, deaths, diseases, age, sex and other characteristics of the
people comprising the population are collected and studied.
Relevance of Demography and Population Figures for the health Care
The collection and study of statistics of births, deaths, diseases, age, sex, etc are very important
in the health field as they illustrate conditions prevailing in communities which are vital to the
planning of health services as well as the determination as to whether health services are
meeting the needs of the community for which they are designed.
Determinants of Population Size
Three factors directly influence population size: births, deaths and migration of people out of or
into the population.
Changes in birth rate, mortality (or death rate) and migration will directly affect the size of a
population.
Explain how the following influence population size and pay attention to the subtitles under
each one of them.
Births- birth rate, crude birth rate, general fertility rate
Deaths- crude death rate, infant mortality, life expectancy
Migration- immigration and emigration
Determinants and measurement of population composition
This is measured by counting the number of people in it who share certain biological or social
characteristics, such as sex, race, education, occupation, ethnic background etc.
Importance of knowing composition of population of a country
Government can plan for the public facilities such as schools institutions, water, employment
opportunities, health facilities, etc
The sex ration and age composition of a population are important in determining the future
growth of population.
State the importance of the following in demographic studies:
Sex ration
Age composition.
Determinants of population distribution
Geography
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63. People are distributed over only part of the of earth’s surface which is naturally habitable.
Urbanisation andIndustrialisation
As a country becomes more industrially developed, people move from rural areas to urban cities
and this has an important effect on the distribution of a population.
Effects of Urbanisation and Industrialisation
• The growth of cites can contribute to economic progress- usually increasing amount and
variety of goods and services available to people.
• Increase peoples’ awareness and size of the group with which a person can form
friendships
Consequences of rapid Population Growth
Mention the consequences of rapid population growth in the following areas:
Land and natural resources
Food security
The labour market
Social services
Current Demographic Trends
Causes of Population Growth
Most important factor of population growth has been declined in death rate combined with high
birth rates in DC.
• Increase in food production and distribution
• Improvement in water and sanitation
• Introduction of medical technology such as vaccines and antibiotics
• Advances in health care
The Demographic Transition
The surge in population growth rates can be explained by what is called “Demographic
Transition”.
Population grows slowly, or not at all, at the beginning and end of the demographic transition
because births are counter- balanced by deaths. During the transition, however, population
growth can soar because death rates usually fall than birth rates and there is a large excess of
birth over deaths.
The theory of demographic transition is used to explain this result between births and deaths.
The following representation shows the result of:
The Old Balance
With its very high death rate, high birth rate and consequent slow growth or stability in the total
population increases.
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64. The Transitional Period
This is characterized by its declining death rate, high birth rate and consequent high rate of
natural increase, leading to an explosion in the population numbers.
The New Balance
This will hopefully have not only a low death rate, but also a controlled, low birth rate so that
there is only limited population increase.
The aim of most demographic health planners is ultimately to achieve a nil population growth.
The overall goal of the policy is to improve the standard of living and quality of life of the
Malawian people.
In order to attain this goal, the policy proposes to lower fertility and infant, child and maternal
mortality rates. As early pregnancy has been identified as a major contributing factor to high
infant and maternal mortality, the policy focuses on reducing adolescent marriages and teenage
pregnancies. It also seeks to reduce the high rate of urbanization, enhance labour force
absorption and increase opportunities of productive employment for the labour force. Other
objectives of the policy include ensuring food security and improving the status of women with
youth in all spheres of development.
Explaining the strategies that must be implemented in order to achieve the goal of the
policy.
The overall goal of this national population policy is to improve the standard of living and
quality of life of the Malawian people. The policy’s central feature is to ensure that the future
growth of the country’s population is kept under manageable and sustainable boundaries, while
still maintaining the right of each individual and couple to decide the number of children they
wish to bear.
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65. Sociology Sample Questions
• Discuss 3 ways how sociological thinking differs from common sense.
• Define the following;
• Positivism
• empathy
• Explain why value free research is important when studying nurse patient
Interaction.
• With clear examples, describe four ways in which conflicts is resolved
• Differentiate between the two terms:
• Ascribed status from achieved status
• Differentiate status from role.
• Differentiate the medical model of health from the social model of Health.
• with relevant examples, discuss how the following factors can make patient
to decide whether to go to the hospital or not:
• Tolerance of symptoms
• Denial of symptoms
• Cultural variations
• with relevant examples, discuss five limitations of traditional healers
• Explain the factors that can make a patient to consult a traditional healer.
• Differentiate human nature from human nurture
• With relevant examples discuss two /many preconditions forsocialization
• Discuss the functions of socialization to an individual
• With clear examples, differentiate primary socialization from occupational
Socialization.
• Explain how nurses and patients share socialization process.
• Discuss the relevance of Demography and Health care
• With examples, discuss the three consequences of rapid population growth
in a country.
• With examples, discuss the causes of population growth.
• Explain how symbolic interactionism is applied in the sociology of health.
• Differentiate between role set from role strain(role over load)
• Facing with conflicting roles at your working place, describe how you can
handled the (two) 2 roles conflict.
• Give three advantages and disadvantages of the term ‘Ethnocentrism’
• Explain 2 (two) ways how sociology is relevant in nursing practices
• Describe three (3) types of norms
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