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Sociology for Nurses LectureNotesWeek 1: IntroductionWhat is sociology for nurses? - Observes, examines, analyse, debates, critiques, theorizes – to convey the complex interrelationships of body, mind and society in the context of health and illness and health care.Why sociology for nurses? - To und...

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Sociology for Nurses Lecture Notes Week 1: Introduction What is sociology for nurses? - Observes, examines, analyse, debates, critiques, theorizes – to convey the complex interrelationships of body, mind and society in the context of health and illness and health care. Why sociology for nurses? - To understand the social forces and factors the predispose individuals and groups to particular patterns of health and illness - To shift our thinking from the individual person to the wider areas of social organisation - To understand the social forces and factors that shape the health care that we give - To contribute to social change that supports health and the wellbeing of people, communities, health care systems and the nursing profession Central Tenets - Social organisation influences health and illness, and healthcare -

In large part, illness, health, wellbeing and death are socially produced

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The forces that shape health and illness patterns are set in motion by human activities

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Illness is both a physical experience and a social experience

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Explaining social phenomena, or individual lives, should be sought first in the way that society is organised as a whole (social structure is a signpost to the questions to ask)

Each theory is a different map, highlighting particular elements…these elements are concepts. Sociological Concepts? -

They are conceived

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They are mental representations

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They act as symbols

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(e.g. the concept of “tree”)

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(Like a “coat hanger” or a “label”)

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They are used as tools for analysis

Week 2: Thinking Sociologically – A sociological imagination Sociological imagination: 4 interrelated parts -

Historical factors: how the past influenced the present?

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Cultural factors: how culture impact on our lives?

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Structural factors: how particular forms of social organisation affect our lives?

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Critical factors: How can this be different/better/changed?

Concepts: Social structure and agency -

The concept of social structure 

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The recurring patterns on social organisation (social institutions and social groups)

The concept of (human) agency 

The ability and actions of people, individually and collectively, to influence their own lives, and the society in which they live and make choices

Sociological theories – (Check week 2 lecture slides for info on theorists) -

Enable us to explain, predict and change what is happening

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Developed and refined as knowledge grows

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Maps of the social, health and healthcare worlds (within the maps are concepts)

Theorists Structural Functionalist Theory -

Emile Durkheim

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“On suicide”

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A social malaise

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Reflecting social connections and bonds

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Altruistic suicide

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Anomic suicide

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Egoistic suicide

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Talcott Parsons

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Concept of the “sick role”

Marxist Theory -

Karl Marx

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“..the goal is not just to understand the world, but to change it …..”

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“Our intellectual work can contribute to more humane social relationships, health care systems and societies...” Waitzkin, H (1989:1101)

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Concepts of social class, social inequality, social change, capitalism, ideology

Symbolic Interactionist Theory -

Erving Goffman

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Concept of stigma

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As a social blemish that discredits individuals and marks them for social isolation

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“a spoiled identity”

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Concept of deviance

Feminist Theories -

Simone de Beauvior

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The second sex (1953)

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“one is not born a woman, one becomes one”

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The concept of gender

Critical Feminist Theory -

Ann Oakley

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A sociological imagination

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Private trouble to public issues

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The connections between social relations and the health of women and their babies

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Concepts of gender, social class, social change

Critical Theory -

Michel Foucault

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Critical studies of social institutions: 

Psychiatry, medicine, the human sciences, and the prison system

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History of human sexuality (sexualities)

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Concepts of power, knowledge and discourse

Contemporary Modernism, -

Anthony Giddens

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Social structure and agency

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Fateful moments ..

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as a call to consciousness;

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as a loss of the “business as usual takes for granted life”

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as a loss of ontological security

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concept of idolisation

Contemporary Modernism -

Pierre Bourdieu

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…(sociology) revels to people what determines them…as such it can be a formidable instrument of freedom

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Concepts of habitus

Week 3: A social model of health: Understanding illness and care Intersections of social class, gender, race and ethnicity -

A complex web

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Producing and determining health, illness and health care

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The concepts of “life chances”

Social Class -

A position in a system of structured inequality based upon the unequal distribution of power, wealth, income and status

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People who share a class position share similar life chances

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Health status is one of the clearest indicators of class inequality in Australia

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Social class and health/illness gradient

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Poor living and working conditions directly influence illness and access to health care

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Social and material indicators of social class

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Class consciousness and class mobility

Australia’s health 2016 (Australian institute of health and welfare) -

Socioeconomic factors are important determinants of health and wellbeing in Australia

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The higher a person’s income, education or occupation level, the healthier they tend to be – a phenomenon often termed the ‘social gradient of health’

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In general, people from lower socioeconomic groups are at greater risk of poor health, have higher rates of illness, disability and death, and live shorter lives than those from higher groups

What is racism? -

A system of structuring opportunity/disadvantage and assigning value based on the social interpretation of how we look (“race”) and who we are

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Unfairly disadvantages some individuals and communities

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Unfairly advantages other individuals and communities

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Saps the strength of the whole society through the waste of human resources

The concept of gender -

The social construction of masculinities and femininities

Explanations of gender differences and gender inequalities: -

Biological determinism (biologically determined differences)

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Social constructionism (social constructed differences)

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Sec role socialisation, “becoming masculines and feminine”

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Gender as practice (post-structuralist) – “doing masculine and feminine, as performance”- “not what we are,,,,it what we do, how we be”

Gender and sexualities -

Gender and sexuality interrelated

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Naturalisation of sexual desires and practices

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Implications for health and illness: 

Heteronormativity

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Homophobia

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Deviance

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Medicalisation

The concept of ethnicity -

Refers to a shared cultural background

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Identifies those who share a culture that is markedly different to that of Anglo Australians

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Multiculturalism: refers to the policy of equal rights, regardless of culture, language, religion and right to maintain identity and culture.

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The health/illness of refugees and seekers of asylum

The concept of culture

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The culture of a group is the peculiar and distinctive ‘way of life’…the meanings, values and ideas embodied in institution, in social relations, in systems of belief, in more and customs, in the uses of objects and material life

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Dominant and subordinate cultures….co-existence and conflict

Ethnicity and health/illness -

Different understanding of health and illness

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New migrants have high health status; this declines over time

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Disadvantaged groups have higher levels of physical and mental illness

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Transcultural nursing and cross-cultural competence

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Ethnocentrism

The concept of ideology -

Dominant systems of ideas and representations

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Ideology is the conversion of ideas into social levers that act or seek to recruit or transform us

The concept of Social Justice -

Health care should be guided by a social justice imperative. The ultimate goal is the maximisation of health status of the most disadvantaged

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A social model of health illuminates the intersections of class, gender, race and ethnicity as they shape, enable and constrain life chances (health and illness)

Week 4: Applying a sociological imagination Sociological imagination: 4 interrelated parts

- Historical factors – how the ‘Nursing’ past influences the ‘Nursing’ present? - Cultural factors – how culture/s impacts on the profession and its practice? - Structural factors – how particular forms of social organisation affect the profession -

and its practice? Critical factors – how can the profession and its practice be different/better/changed?

Historical flows of nursing?

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Charity Christianity Service Apprenticeship Professionalisation Political action

The Medical Dominance and Nursing

- The ‘power’ of the medical profession through its  Autonomy over self  Authority over others  Medical sovereignty over social life  (Evan Willis, Eliot Freidson)  Medicine is one of the key institutions in health care Australia. Structural forces and nursing?

- Gender  The sexual division of labour in healthcare  Gendered emotional labour of caring  Gender as an excluded status - Social class  Strategies of closure  Education  Working conditions - Racism and colonisation  Towards cultural safety The Health Care Professions: Sociological Perspectives 1. Functionalist/consensus perspectives: a. Trait approach 2. Marxist/conflict perspectives: a. Power approach Winds of change

Technology

Globalisation

- Disruptive technologies

- Interconnectedness

- Mobile device

- Global illness

- Cloud/big data

- Global inequalities

- To reform health care

- Global workforce

- To deliver primary health care

- To have a voice (ICN)

Sources of nursing knowledge (and power):

- Empirical - Ethical - Sociological - Personal - Oral - Experiential - Interpersonal - Intuitive - Unknowing Agency and Illness Narratives – Patient and carer knowledge

- Arthur Frank (1995) the wounded storyteller: body, illness and ethics USA California Press

- People with illness are “wounded storytellers” - A framework to reflect upon the stories, to better understand, to better care Challenges to medical dominance 1. The social model of health 2. The ‘health care consumer’ movements 3. Nursing knowledge Nursing Practice

- Upholding a social model of health and illness - Listening to illness experience - Applying sociology in nursing - Primary skill is to be sensitive to the multiple influences affecting health and illness.

Week 5: Sociology and Public Health: A case study of mental health Public Health

- Refers to the state of health of the whole population - It is an organised response and promote health and to prevent illness, injury and disability across the whole populations; with attention to specific groups. Central Concept:

- The social determinants of health are the circumstances and conditions in which people are born, grow up, live, work and play and the systems that are in place to deal with illness. The concept of medicalisation

- Defining/managing non-medical problems, or natural biological, social and living processes, as sickness, and as requiring pharmaceutical, surgical, medical, therapeutic intervention

- Birth, pregnancy, ageing, dying, ‘deviant behaviours’, abnormal bodies, grief, sexuality The Concept of Deviance

- A tool for analysis - It is not the ‘deviant’ actions/qualities of people - It is the ideas, definitions, rules, actions and sanctions applied to people labelled as ‘deviant’ The concept of Stigma

- “spoiled identity”

- “not fully human” Sociological imagination: 4 interrelated parts

- Historical factors: How does the past influence the present in perceiving, defining and responding to ‘mental illness’?

- Structural Factors: How do particular forms of social organisation (social structure) influence ‘mental illness’?

- Cultural Factors: How does culture impact on ‘mental illness’? - Critical Factors: How can this be different/changed? Historical Factors

- In Australian history - The ‘moral treatment’ era - The ‘physical treatment’ era - Psychiatric hospitals - The rise of psychiatry - The ‘modern’ era - De-institutionalisation - Community mental health movement - Mental health consumers movement - ‘recovery’ movement Structural Factors

- Social class is strongly related to mental illness  Mental illness and poorer conditions of living are closely linked - Gender differences shape mental illness  Women and men experience mental illness differently

 Gendered responses to women and men with mental illness - Ethnicity and migration influence mental illness  Experiences of migration and refuge-seeking are linked to depression, anxiety and PTSD

- ‘Race’ and mental illness  Higher rates of mental health problems amongst aboriginal people - ‘Place” and mental illness  Different patterns of help-seeking and health care access between urban and rural people Mental Health and Health Inequality

- People with mental health conditions experience more illness and live shorter lives - Increases the risk of every major chronic illness - Decreases life span > 10 years - Less likely to have a stable income - More likely to be poorer - Less likely to receive health screening - More likely to receive sub-standard care for their physical illnesses Why?

- Distress - Isolation - Stigma - Neglect - Poverty - Living conditions

- Insecurity - Health knowledge - Self-worth - Trauma The dominance of the Medical Model of Mental Illness

- Focus is on biological causation with psycho-social factor; psychopharmacology as treatment; signs, symptoms = diagnosis

- Stigma

 Diminished life chances (exclusion)  Deviance and social control  Medicalisation of social life Winds of change towards public health and the social determinants of health

- Widespread public knowledge and understanding of mental health illness - Mental health care that wraps around the person - Responding to whole-of-life needs of people with illness - Team and community care at the centre of care

Week 6: Social Determinants of Health: A case study of children’s health The social determinants of health

- A global approach to understanding and responding to social inequalities and health disparities

- Health disparities are of our own making, and therefore, can be un-made - The problems and salutation lie within human society (history, structure, culture); how we live and grow Experiencing disadvantage …limiting life chances

- A child’s early years are fundamental to their life chances - Gaps appear early in life; and become cycles of disadvantage (education, health) - Childhood events (illness, injury, trauma, relationships breakdown) can trigger disadvantage Poverty in Australia

- Compared with other age groups, children are at a much higher risk of poverty, with 17.7% of all children living below the poverty line

- The high poverty risk among children reflects the higher costs facing families with children, which parents who are not in paid work or on a low wage often struggle to meet

- The high rate of poverty among children in sole parent households is the result of high rates of poverty among sole parent households overall – 33& of sole parent households being below the poverty line

Factors influencing the life chances of children (concept of personhood “childhood”

- Personality - Life experience - Social relations - Culture - Social roles - Political being (agency) - The body (embodiment) - Secret life - Perceived future - Spirit life Suffering and Childhood

- A state of distress - Personal, interpersonal and social dimensions - A loss of personhood childhood Health care as a source of suffering?

 Nurses may fail to acknowledge experience of suffering  Nurses artificially limit their care-giving  Nurses become “technicians of the body” vs “healers of the soul” Suffering and healing?

- Acknowledgment of suffering - Illness narratives of children - Resilience must be recognised - Social support as a foundation - Anti-stigma actions promote power - ‘meaning’ must be respected “New” sociology of childhood

- Children have their own culture/ a sperate life of interactions (peers/siblings/adults) - Children’s rights and children’s reciprocity - Being children vas becoming adults - Anxiety in childhood - Nomadic childhoods - Hidden histories of childhood - Working children - Children as carers

The medicalisation of childhood

- Children are diagnosed with an increasing range of conditions and are subject to a more elaborate child health and welfare monitoring and interventions

- A growing concern with mental health as well as emerging contested illnesses (ADHD - Life-style related conditions (obesity) and (allergies) or new infectious disease (Hiv/aids)

Week 8: Global Health: A Case Study of Primary Health Care The Organisation of Health Care? (Social model of health care)

- The organisation of health care in our society is the product of history (and globally), social forces and cultural values. Health care is a part of our social structure

 Does i...