How the Nursing Practice is Interwoven with Sociology

Nursing practice without sociology is akin to sexual congress without orgasm – possible to enact, but highly unsatisfactory. It is the equivalent of entering a strange country without a map to explain the contours and pitfalls of the land. The traveller may eventually find the desired journey’s end, but the route taken will be meandering and hazardous. 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 decision making. Starting in the latter part of the twentieth century, unprecedented discoveries and ‘reshaping’ of human knowledge about the physical world have taken place.

In the fields of physics, chemistry, mathematics, molecular biology, computing, pharmacology and medicine (both in terms of diagnosis and treatment), the accumulation of and transformation in knowledge have been nothing short of incredible. Through its foundations in critical thought, it is the task of sociology to examine just how authentic these changes are. We study certain areas where Sociology and Nursing interface: Imagination to understand the changes of many personal milieux we are required to look beyond them. … To be able to do that is to possess the sociological imagination. Mills 1959:10/11) Sociologists imagine the world differently compared with the way it is viewed for example, by psychologists, and biologists, or by those who proffer ‘common sense’. In this chapter ‘the sociological imagination’ is delineated through an exploration of three major theoretical frameworks. I am using the term ‘theoretical framework’ to describe the grouping of perspectives which may have subtle differences that distinguish them, but which have similar philosophical routes, and complementary observations to make about the organisation of society and human action.

The first theoretical framework I have chosen regards society as both existing and having a set of configurations that to a greater or lesser extent induces humans to behave and think in preordained ways, including that of ‘being sick’. As an alternative to this structural understanding of human behaviour and thinking, which can be interpreted as viewing all thought and behaviour as ‘determined’ by society, the second explanatory genre projects the notion of individual volition. That is, it is argued that humans can and do direct their own lives.

The third theoretical framework has gained popularity in nursing literature in the last couple of decades, and has been extracted from a range of sociological theorising that aims to ‘deconstruct’ reality (including the actuality of ‘disease’) in one way or another. There is nothing totally ‘natural’, ‘God-given’ or inevitable about personal and social behaviour. Falling in love, committing a crime, achieving success in a career, or being ill, are all influenced by social factors.

The basis of the ‘sociological imagination’ is to look beyond the obvious, and to challenge both our own preconceived ideas and those of others. This is of particular importance when those with power in society hold prejudicial views about already vulnerable and dispossessed people. Above, all, it is to always ask the question ‘why’, and to keep on asking the question ‘why’! It was C. Wright Mills (1959) who pointed to the connection between ‘private troubles’ and ‘public issues’.

Whatever we undergo as individuals (and this applies to emotions, pain, disease and cognition) our social surroundings have either helped create, or are affected by, these experiences. For example, the private trouble of losing a loved one in a car accident is a public issue in that both the amount of money governments put into road safety, and the degree to which a society values commodities such as cars, are linked to the number of people who are killed on the roads.

The private trouble of being diagnosed as having cancer is also a public issue as either directly or indirectly it relates to health policy and health-service resources, which in turn are connected with social values. Better health promotion strategies installed by government and health agencies, a greater political will at local and national levels to improve the physical environment, more money ploughed into cancer research and treatment rather than, for example, arms technology, may have prevented that person’s malignant tumour.

The private issue of depression is a public issue in the sense that this ‘internal’ condition may have been precipitated by alienating and dehumanising social circumstances. Social events and social relationships are not taken at face value by the sociologist. Conventional wisdom is tested to see whether or not it stands up to the scrutiny of research and well-worked-out theorising. Many prevailing ideas do not. For example, it was ‘common sense’ for white imperialists and colonialists from Europe to believe that black Africans were sub-human.

Another ‘commonsense’ judgement was made by the ruling elite in the Victorian age that the mad should be locked up in asylums, the poor put in workhouses and criminals transported to Australia. The work of the American sociologist Amitai Etzioni on ‘communitarianism’ (1998), and that of the German social theorist Ulrich Beck on ‘risk society’ (1992) have also been influential in Western politics. These commentators, in different ways, have pointed to the consequences of immense social change and the need for communities and social systems to adjust in order to reduce the damage to society and its inhabitants from these changes.

Moreover, Ian Christie has argued that while the pronouncements of sociologists may still not be at the forefront of the public’s consciousness, issues affecting the lives of individuals and communities (for example, crime, the disintegration of traditional family life, poverty, unemployment, stress at work, patterns of disease) are defined in terms of their social causes and consequences, and social solutions are sought (Christie 1999). Classical sociological research techniques (i. e. he survey and interviewing) are routinely employed to assess crime rates, explore family dynamics, analyse voting habits and in assessing the health needs of communities and individuals. Nursing has incorporated social factors into most if not all of its educational programmes. Whether it be the study of childbirth, breast cancer, coronary vascular disease or schizophrenia, the inclusion of social factors in the aetiology, care and treatment of patients and their families are de rigueur.

Medicine, whilst far more resistant to the ‘contamination’ of its natural scientific foundation, has accepted sociology in its undergraduate training for decades. Furthermore, apart from the obvious case of psychiatric medicine, heavily influenced by Sigmund Freud’s sociological account of the effects of culture and the family on the unconscious psychological mechanisms of the individual (Bocock 1976), postgraduate medical education specialising purely in social science applied to disease is now not unusual. Health In our country today, too many people suffer from poor health.

Too many people are ill for much of their lives. Too many people die too young from illnesses which are preventable. But at the same time, many people realise the value of better health. (British Prime Minister, Tony Blair, 1999) What is health? Is a person healthy if she or he unknowingly has a tumour growing internally but regularly runs a marathon? At what point does that person stop being a ‘runner’ and become a ‘terminally ill patient’? If my general practitioner, on the basis of a medical examination, informs me that I am healthy, but I ‘feel’ unwell, who is right?

Can a low-caste child from the Indian subcontinent ever be described as healthy if she or he eats half the amount of food and lives for only two-thirds of the life span of a child born into a North American middle-class family? British citizens generally now live well into their seventies. Does this mean they are much healthier than British people were a hundred years ago, when most died much younger? Will it also mean that in one hundred years’ time, when the British will on average live even longer, people today will be considered to have been unhealthy?

The difficulties in establishing a definition of ‘health’ are examined in this chapter. In tackling the question of ‘what is health? ‘, definitions of ‘illness’ and ‘disease’ need also to be discerned, as does the question of ‘who is doing the defining? ‘ For centuries, people believed sickness have caused suffering to the individual concerned, incapacity in her or his daily activities, or were distressful to that person’s family or community. That is, health has been for centuries defined negatively.

Furthermore, part of this negative interpretation of health centres… elf-taught medical practitioner, was to formulate a taxonomy of diseases, delineating such conditions as syphilis, measles, gout and dysentery. In doing so, he emphasised the objectivity of disease, separate from the sufferer. That is, the trend had been… German scientist Robert Koch (1843-1910). These developments formed the foundation of scientific medicine. However, whether health is viewed as being obtained through the calming of generalised disturbances, the excision of renegade spirits, or the curing of identifiable and localized interventions by health workers.

Members of the institute’s board will offer advice to the Department of Health and Welsh Assembly on the benefits and costs of existing and new medical and surgical treatments geared to disease prevention rather than a ‘state of complete well-being’. For example, he recommends a reduction in the amount of cigarettes smoked or stopping altogether, a diet rich in fruit and vegetables, increased physical exercise, attendance at screening clinics ‘unnatural’ on the basis that the latter refer to human activity and the former everything else is erroneous.

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