Psychology and Sociology in Nursing

Benny Goodman

• Publisher: Learning Matters
• Year: 2019
• ISBN:
  9781526451613
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing

This book explores sociology and psychology relevant to nursing and explains why it is so important to understand these disciplines in order to be a good nurse. It is written specifically for nursing students, and clearly explains the key concepts using nursing case studies and examples. Chapters move from individual and personal issues onto society as a whole and explore the psychological and sociological basis that underpins all aspects of nursing practice. Key features:

• All content linked to the sociological and psychological requirements in the NMCstandards of proficiency for registered nurses
• Activities to help build critical thinking, independent learning and decision-making skills
• Case studies and scenarios that link sociological and psychological theory to nursing practice

A key text for nursing students in all fields of practice

Chapter 1 The Relevance of Psychology and Sociology for Nursing

NMC Standards of Proficiency for Registered Nurses

This chapter will address the following platforms and proficiencies:

Platform 1: Being an Accountable Professional

At the point of registration, the registered nurse will be able to:

• 1.1 understand and act in accordance with The Code (2015) Professional Standards of Practice and Behaviour for Nurses and Midwives, and fulfil all registration requirements.
• 1.3 understand and apply the principles of courage, transparency and the professional duty of candour, recognising and reporting any situations, behaviours or errors that could result in poor care outcomes.
• 1.8 demonstrate the knowledge, skills and ability to think critically when applying evidence and drawing on experience to make evidence informed decisions in all situations.

Platform 2: Promoting Health and Preventing Ill Health

At the point of registration, the registered nurse will be able to:

• 2.3 understand the factors that may lead to inequalities in health outcomes.
• 2.7 understand and explain the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes.

Chapter Aims

After reading this chapter, you will be able to:

• discuss the relevance of sociology and psychology to nursing;
• outline some of the key ideas in sociology, such as the ‘sociological imagination’, and their relevance to nursing;
• outline some of the key ideas in psychology, such as ‘obedience’, and their relevance to nursing;
• appreciate how psychology and sociology are interlinked.

Introduction

This chapter discusses why social sciences are relevant for nursing practice. I begin by discussing the relevance of the sociological imagination (Wright Mills, 1959; Rolfe, 2011; Goodman, 2011b). I also use the work of Graham Scambler (2012) and Margaret Archer (1988, 2000, 2003, 2007) in an attempt to present and justify a theory of human action, known as ‘agency’, in social and cultural contexts. Theories of the ‘self’ and of ‘agency’ are important for the understanding of human behaviour regarding health, and at times throughout this book I criticise a theory held implicitly by many people. This is the concept of the ‘liberal human self’ and one of its current political manifestations ‘neoliberalism’ (Goodman, 2017; Grant and Goodman, 2018).

The ideas and theories that arise from a study of the social sciences can help us to develop a critical mind that challenges taken for granted assumptions about who we are, what we are, how we act in the world, how nursing actually operates and the context in which it works. We must think critically about what it is to be human, and why we take particular decisions.

Theory

In developing a theory of ‘agency’ in sociology, Graham Scambler (2013) suggests: We are simultaneous products of biological, psychological and social mechanisms, while retaining our agency, that are highly structured but not structurally determined.

Agency is our freedom to act on the world as individuals, but it is bound up with structures and cultures. This theory runs throughout this book.

Sociology and psychology underpin many aspects of the nursing role and your interactions with individuals, communities and populations. This is why the Nursing and Midwifery Council specifies that you must cover social and behavioural sciences (sociology and psychology) as part of your programme. Even so, some students continue to struggle to see the relevance of sociology to their experience of nursing in clinical practice (Edgley et al., 2009), and there have been critiques (Sharp, 1994, 1995). The relevance of psychology is not debated quite so strongly in the literature. Sociology’s relevance to practice will be addressed throughout this book, but a starting point is to consider what you think nursing practice is.

Sociology, Why?

Nursing is thought to be complex decision-making involving critical self-reflection based on competing philosophies and theories. It operates in power and social contexts, addressing populations and communities as well as individuals. The knowledge needed is not just for action in practical settings (‘know how’) but for personal and social transformation (‘know why’).

Concept Summary: The Case for Sociology in Nursing (Mulholland, 1997)

Mulholland maintains that sociology:

• provides an alternative to individualistic biomedical models
• supports critical and self-reflective practice
• addresses the exercise of power
• encourages a ‘quality of mind’ (Wright Mills, 1959)
• challenges the ‘taken for granted’
• involves the ‘know why’ not just the ‘know how’.

Although reflection is an important concept in nurse education and practice, you may find it difficult to achieve when you are starting out. However, concentrating on the biomedical, instrumental or practical task orientated side of nursing might make sociology seem difficult – which in turn can have a negative effect on nursing practice (see, for example, Morrall, 2001).

Social scientific knowledge can help to demystify the subjective experience of illness and objective patterns of health and disease. It also brings to the fore the social nature of disease and death, shining an analytical light on the power relationships involved, and the ethical issues experienced. This will hopefully help to create a discerning nurse who becomes better at decision-making at both individual and socio-political levels. This is what Morrall (2009) calls for as moral action to complement our understanding and our practice as clean, competent and kind nurses.

Thus, sociology could encourage transformational learning which does not sit easily within the current practical and power context of much of nursing practice. However, when you engage with the wider issues, and understand that there are different ways of knowing and then you examine what it means to develop a sociological imagination (Wright Mills, 1959; Goodman, 2011b), an opportunity exists for you to develop into a knowledgeable doer (UKCC, 1986), able to transform yourself, your nursing practice and in turn society (Goodman, 2011b).

Psychology, Why?

In this section we also look at the importance of psychology in nursing. It may be simplistic to think that sociology deals with society while psychology investigates the individual mind. Wright Mills’ argument is that how we think is both shaped by society and in turn shapes society. So, the disciplines overlap.

Allport (1954) considered the goal of social psychology to be the understanding and explanation of how the presence of others influences individual cognition, affect and behaviour. Social psychology examines the unseen and powerful social ‘forces’ that shape the way we are. To a certain extent social psychology overlaps sociology in its examination of social factors, but in psychology the main focus of study is the individual. The experiments and theories of the social psychologists will be used to analyse how failure to take responsibility for our actions and misperceptions of others through stereotyping can lead to negative feeling and prejudicial behaviours. A study by the social learning theorist Albert Bandura (Bandura and Waters, 1963) will be examined to help explore how observing other people’s behaviour can influence our own actions and feelings, particularly with regard to victim blaming. The theories of the humanistic psychologists will be applied to the examination of patients’ psychological needs and how they can be met.

Case study: Critical Thinking and Evidence-Based Practice

The Replication Crisis in Social Psychology

You should know that empirical science progresses by the results of experimentation being open to ‘replication’. Some social psychology uses empirical experiments. Nosek (2015) argues:

One of the central goals in any scientific endeavor is to understand causality. Experiments that seek to demonstrate a cause/effect relation most often manipulate the postulated causal factor. Aarts et al. describe the replication of 100 experiments reported in papers published in 2008 in three high-ranking psychology journals. Assessing whether the replication and the original experiment yielded the same result according to several criteria, they find that about one-third to one-half of the original findings were also observed in the replication study.

Taken at face value, Nosek’s study suggests that any given finding in psychology is more likely to be fiction than fact. However, in 2018, some have stated this is more a ‘problem’ than a ‘crisis’. There are two extremes: those who cite one study as if it establishes a fact, and those who dismiss the findings of science as hopelessly flawed. The truth is somewhere in between.

Other psychological concepts of use to nurses include:

• Self-efficacy
• Locus of control
• Learned helplessness
• Heuristics (cognitive short cuts)
• Moral disengagement
• Dehumanisation
• Fundamental attribution error.

The Social Psychology of Obedience

Activity 1.1 Reflection

How Obedient Are You?

If your supervisor told you to leave a patient lying in a soiled bed because they needed to be taught a lesson, what would you do? How would you feel?

Can you identify a situation where you have gone along with a group decision despite feeling a little uneasy either at the time or later on?

You do not need to share this reflection with anyone unless you want to.

As this activity is based on your personal thoughts and reflections, there is no sample answer at the end of the chapter.

We can see several social psychological factors in operation here: your role as a student; your supervisor’s role as a qualified nurse; the difference in your status; the power difference; and your supervisor will also be assessing your practice and signing you off as competent.

We may like to think that our actions are always based on individual free will, clear moral codes and avoidance of actual harm. Stanley Milgram (1963) on ‘Obedience’, Albert Bandura’s (1999) ‘Moral Disengagement Theory’ and David Livingstone Smith’s (2007) ‘Dehumanisation’ theory indicate that this can be otherwise. See, for example, Francis (2013) and Darbyshire and Ion (2018).

We may also think that just being told what to do, and following orders merely because of authority, does not apply to us in clinical practice, and that we would always challenge customary practices.

Stanley Milgram (1963) studied the degree of obedience to authority. In his experiment, half of the subjects were actors, unbeknown to the rest of the group. The ‘teacher’ was required to administer a shock to a ‘learner’ when the learner gave an incorrect response to a question. Milgram ensured the teacher role fell to the naive subject and that the learner role fell to the actor. The ‘learner’ was instructed to call out in pain when receiving the imaginary shocks. The ‘teacher’ was briefed to read a series of paired words that the ‘learner’ should repeat. When the ‘learner’ answered incorrectly, the ‘teacher’ was told to give shocks of i...