Understanding Sociology in Nursing

Helen Allan, Michael Traynor, Daniel Kelly, Pam Smith, Author

• Publisher: SAGE Publications Ltd
• Year: 2016
• Print ISBN: 9781473913592, 9781473913585
• eBook ISBN: 9781473965638
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Provides students with insights into key contemporary debates and events to demonstrate the relevance of sociology and its practical application to modern nursing. This textbook helps student nurses make the leap from a narrow focus on the physical problems of their patients to a broader understanding of the whole person and the contexts of care which will help them succeed as compassionate nurses. Written directly for nurses, it focuses on the individuals and families in their care, the organisations they work in, and the factors which affect their practice.

Key features include:

• Case studies and scenarios to help students relate sociology to real-life examples
• Reflection points to help students critically engage with the discussion
• Learning outcomes and chapter summaries for revision
• Definitions of key terms in each chapter

1 Becoming a patient

Helen Allan

Issue

The sociological issue that is the focus of this chapter is what happens when you – or your parent, child or friend – become a patient.

Read the following scenario and reflect on your responses.

While it may be necessary to prepare patients for surgery in the way described above, nevertheless becoming a patient may not just involve a loss of dignity but the gradual erosion of your identity as you conform to the expectations of those who are caring for you. Does being a patient mean that you suddenly become subject to the hospital’s rules and regulations? Do you have to have your temperature taken every four hours? Are you treated as if you make the decisions? What happens if you disagree with your doctor, nurse or physiotherapist? Can you complain and what happens to complaints anyway? Sometimes as nurses we expect patients to behave in ways which aren’t always necessary and may involve a loss of rights to autonomy or dignity.

It is also worth noting that while the example above is a hospital-based one, the issues we discuss in this chapter, and indeed throughout the book, apply to all patients in a range of contexts such as mental health settings and community settings as well as learning disability.

How people learn to become patients (Revans, 1964) has interested sociologists for a long time and is a good illustration of macro and micro sociology. Some of the theories, such as the sick role, you might have come across; others won’t be so well known. The chapter finishes with a discussion of patient-centred care which is, in our view, a logical development from macro to micro sociological approaches to understanding how people become patients.

Scenario 1.1

Imagine you are admitted to hospital to a day surgery ward for an investigation. It is early in the morning; you have not had breakfast, a cup of tea or even a drink of water. You are worried, even scared, of what is going to happen as you have heard the procedure is uncomfortable.

You have been asked to leave any valuables at home which includes your wedding ring, earrings and other jewellery. You are asked to change into a hospital gown and given a pair of rather horrid paper knickers. And then you wait … for ages it seems although it might only be 15 minutes before someone comes over to say they will be back to ask you some questions. You’re not sure who they are as they’re wearing an ill-fitting blue top and trousers which you suppose is what they wear in theatres but it doesn’t help you understand who they are.

How could you be made to feel more at ease? Do you have to be stripped of all your personal possessions?

What could the staff do to reduce your anxiety and make you feel less scared?

Chapter outline

The chapter is divided into three broad sections:

• Macro sociology
  • The sick role and the social system
• Micro sociology
  • When the patient encounters the doctor
  • The subjective experience of being a patient
  • Narratives/patient stories
• Patient-centred care
  • What do patients want?
  • Patient surveys

Macro sociology

Structural functionalism: the sick role as a social process and healthcare as a social system

Earlier in the last century, sociologists, in particular American sociologist Talcott Parsons (1902–79), called this learning process taking on ‘the sick role’; that is, a person who is unwell or ill is allowed to adopt a role and concomitant behaviours that might temporarily excuse them from certain expectations such as turning up for work. Note I say allowed – this is important because Parsons was interested in how individuals functioned in society and contributed to the functioning of that society; in the main their roles as employees and in the family. He was therefore interested in what mechanisms existed to allow them time off from work. So adults are expected to work until retirement unless there are very good reasons why not. Illness was one of those mechanisms that allowed the individual to take time off work; other mechanisms are paid holidays or retirement. But illness was also not normal behaviour, rather a sort of deviance, as, by being ill, individuals did not conform to society’s expectations, albeit temporarily. Of course this model depends on the patient presenting with recognisable symptoms and signs that the doctor then diagnoses. At this point the doctor can refer the patient for tests or to a specialist. However, sometimes the doctor doesn’t recognise the illness, mistrusts the patient’s story, and irrespective of whether the patient continues to experience symptoms, there is then a possibility that the patient will not be signed off and not be validated as being sick. In other words, diagnosing illness is not straightforward.

Read Reflection 1.1 in the box below and reflect on your thoughts about the doctor’s role in legitimating the sick role.

The idea of society functioning as a system dependent on its parts was very much a feature of the USA and the UK in the 1950s. Illness was one way for an adult to get sanctioned time off work as long as it was certified by a doctor. Therefore the doctor becomes an agent of social control; in fact, ‘The sick role is, for Parsons, one of the most important mechanisms of social control in capitalist societies’ (Varul, 2010: 76).

Reflection 1.1

Think of how people suffering from myalgic encephalomyelitis (ME) struggled to have their symptoms recognised as a legitimate illness – it is often referred to as chronic fatigue syndrome, which patients believe underplays how serious an illness it is and the effects on lives it can have.

Have a look at the website of the ME Association: www.meassociation.org.uk/2007/01/overview/.

What do you think the note on the website signifies? ‘PLEASE NOTE – before considering prognosis, it is important to obtain a positive diagnosis, which should be determined only by a suitably qualified medical professional.’

I think this statement is a good example of the power of the doctor to diagnose. It upholds the idea of the sick role and the expectation that an individual should not self-diagnose as diagnosis remains in the hands of doctors.

The social system

In The Social System (1951), Parsons said that the doctor–patient relationship was functional for society because it meant that people could be off sick, diagnosed by a doctor and then cured (or if they had a chronic disease, be managed by a doctor over a longer period). This concern with function or roles within society is described in sociology as structural functionalism.

Parsons believed that individuals’ behaviours need to be understood as social behaviours rather than as determined by individuals’ internal processes or cognitions (which is what psychologists study). He advocated the study of the social systems in which people lived; in other words, the social structures and cultural values that both constrained and facilitated action and behaviours.

Concern among sociologists about the nature of social structures and individual agency, the collective perspective or the individual, was first written about by nineteenth-century sociologists. Karl Marx (1818–1883), Emile Durkheim (1858–1917) and Max Weber (1864–1920) were all writing about this topic at roughly the same time, the mid to late nineteenth century and the early twentieth century. They all took different views of how strong either structure or the individual (agency) was in reproducing social norms, values and behaviours; in producing society.

Durkheim was interested in the functioning of specific social structures, such as crime and religion, while Weber studied the social actions of individuals that were influenced by their values and the economic system in which they lived (capitalism essentially). Parsons, born after Marx, Durkheim and Weber, but drawing on their work and the work of Freud, a psychologist, was more interested in social structures: in the social system (society), social institutions such as universities and social structures such as healthcare, and their functional roles in maintaining the equilibrium of society, the social order or the status quo.

The doctor–patient relationship

The doctor–patient relationship is part of a social sub-system that kicks into action when there is a ‘disturbance of normal functioning of the total human individual’ (Parsons, 1951: 431–432), as Parsons called illness or disease. So when an individual is fu...

Table of contents

• Cover
• Half Title
• Publisher Note
• Title Page
• Copyright Page
• Contents
• About the Authors
• Foreword
• Introduction
• 1 Becoming a patient
• 2 Who is the patient?
• 3 Becoming a nurse
• 4 Nursing as women’s work
• 5 Caring, face-work and nursing
• 6 Nursing the body
• 7 When things go wrong
• 8 Leadership and management
• 9 Using a sociological framework to understand nursing
• Index