Atherton and Richard Kyle explain how nurses can use the social sciences to deepen ... >Sociology, which focuses on social behaviour ... Downloaded from rcnpublishing.com by Richard Kyle on Aug 13, 2014. .... Books (including.
LEARN TO SEE PATIENTS IN THEIR OWN WORLD In the first of an occasional series of articles, nursing lecturers Iain Atherton and Richard Kyle explain how nurses can use the social sciences to deepen understanding of their patients and improve care
SUMMARY
Two children are born 3,000 miles apart: one in the UK, the other in Sierra Leone. One is likely to live to 80, the other a little over half that age. It is a scandalous statistic. But similar social injustice can also be found closer to home. Take a ride east on London’s Jubilee Line from Westminster to Canning Town and over one year of male life expectancy is lost at every stop. These contrasts are stark – and they shock us. Yet they also demonstrate that where people live influences their health. Think about two people you cared for during your last shift. Each is likely to die at a different age, probably from a different cause, in very different situations. These different deaths will reflect decisions they have made: whether to smoke; what to eat; how much to exercise. But their deaths reflect more than this. Their choices have
been constrained or enabled by circumstance and, conversely, their circumstances are shaped by those choices. And that is why the social sciences matter. Insights from the social sciences help us appreciate people’s lives and the wider influences that shape them. In so doing they encourage us, as nurses, to become more empathetic, more holistic in our care, and more committed to social justice.
Social sciences
Insights from the social sciences can help nurses understand the influences that shaped their patients and the decisions they make. This can develop empathy and encourage better care. Nurses are passionate about their patients’ wellbeing. They can use the social sciences to improve the care they deliver and improve their patients’ lives. Authors Iain Atherton and Richard Kyle are lecturers in nursing in the School of Nursing, Midwifery and Health at the University of Stirling’s Highland Campus, Inverness
A range of different academic disciplines make up what is called the social sciences. Like nursing, each has people at its heart, attempting to understand society at large and the lives, relationships, attitudes, behaviour and experiences of the people who make up society. These include: Geography, which puts place at centre stage and reveals the lottery of life expectancy and the processes that perpetuate and explain differences between one place and another. Sociology, which focuses on social behaviour, relationships and the ways in which society influences individuals, and provides insights into how processes such as sexism, ageism and racism shape everyday experiences of prejudice. Anthropology, which traditionally embedded
researchers in societies to understand the world from their perspective. It provides accounts of how individuals create cultures, such as those of the ward, that shape and are shaped by individual interactions. The list goes on. Politics can inform our understanding of healthcare policy; linguistics helps us understand how nurses are socialised into their role through the words we use and the way we talk; economics reveals how market forces influence service delivery and organisation. Social scientists achieve understanding through a variety of different research methods. Some research employs large-scale surveys or the census, with thousands of people analysed using sophisticated statistical techniques. Other work is much smaller in scale, involving detailed one-to-one interviews or focus groups. But regardless of methods, we believe that the social sciences can bring new colour to nursing practice by adding depth to the picture we paint of our patients’ lives.
Empathy, care and justice
Insights from the social sciences enable us to see individuals from a different perspective, to understand both the circumstances in which lives are lived and the ways through
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result in greater appreciation of the decisions that patients take – perhaps contrary to advice – about their care. Social justice is encouraged through a recognition of wider society and the ways it influences individuals’ everyday experiences and health outcomes, attitudes and behaviours. This might stir a passion not only to recognise such structures, but to strive towards social justice, with a desire to actively change social structures whether on an institutional, local or global scale.
Practice
Deeper engagement with insights from the social sciences might elevate the unique skills and knowledge that nurses bring to patient care by highlighting the importance of non-medical perspectives. Nurses are all too aware that non-medical issues may be as important to a patient’s
wellbeing as medication, surgery or dressings. Recognition of these issues may reduce the likelihood of readmissions, given the importance of supporting informal and family care. A nurse may alter his or her priorities for a shift to ensure there is opportunity to talk with patients about their lives beyond the immediate and more obvious aspects of the reason for admission (see case study over page).
Passion
Nurses care. Their patients matter to them. We know this through talking with our students and their mentors out in clinical practice. Nurses are passionate advocates for their patients. They want to act to improve lives. The extent to which lives can be improved just by treating disease is marginal. For many people, even treating their conditions is going to be limited by their circumstances. Rest might be advised, but the extent to which a patient can realistically do so could be constrained by, for example, caring responsibilities to a close family member or neighbour.
IAN DODDS
which those circumstances have shaped, and are shaped by, choices and life chances. Looking at patients’ lives through this lens potentially enhances our nursing practice in at least three ways: Empathy is engendered through reflection on the circumstances that have shaped our own lives and the choices we have made. This may trigger a deeper realisation and appreciation for the ways in which people’s lives and choices have also been shaped by circumstances, potentially promoting us to confront and challenge our own preconceptions and prejudices, however subconsciously held, and help us to make closer emotional connections with others. Holistic care is enabled through a greater appreciation of the importance of the relationships through which individuals live their lives and the multiple dimensions of their lives. This emphasises the importance of family, work, social life, sports and leisure activities to a patient’s wellbeing. Understanding relationships can
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Taking the next step
We hope that we may have convinced you to find out more about the social sciences. There are lots of ways through which your interest might be taken further. Books (including Psychology and Sociology in Nursing by Benny Goodman and Tim Ley, 2012, Sage Publications) have been specifically written to introduce nurses to the social sciences. Many universities run relevant courses and modules. More general textbooks are also an excellent way to get started, and you could pick up one of the many social science journals that publish research on health and health care.
Find out more More details of the ESRC seminars and other resources that may stir up your passion for the social sciences can be found at www. socialscienceandnursing.com
SCIENCE PHOTO LIBRARY
Nurses’ passion for the profession makes studying the social sciences exciting. We live in a colourful, constantly changing world, chock full of diversity. Learning about the different lives of others can appeal to the core interests of nurses. The social sciences enable us to paint vibrant pictures of patients’ lives to enhance our care. Nurses have to continually develop educationally to maintain registration with the Nursing and Midwifery Council (NMC). Choosing what to study can be far from straightforward. Reflecting on the different groups in society and the implications for nursing care is important. Studying the social sciences can therefore meet NMC requirements while also engaging nurses in something that motivates their desire to care and tap into the heart of their passion for their patients’ lives.
Case study: care informed by the social sciences Bill is admitted into your care with an exacerbation of his chronic obstructive pulmonary disease (COPD) and heart failure. He has a number of other health problems and a long history of hospital admissions. Nursing care will focus on the treatment of his COPD. Awareness of the social sciences enables more holistic care, enabling a caring relationship and potentially reducing the likelihood of future admissions. In planning Bill’s care you might think about the following issues: What is Bill’s life story? Learning about Bill’s life can help a nurse to understand what has led to Bill’s experience of health and make the connection that enables empathy. Who are the important people in Bill’s life? How are they coping? We know that much of the care provided today is from family members, not nurses. Explicit exploration of these relationships may enable formal care to complement this informal care. What is Bill’s financial situation? Is he accessing all the benefits he is entitled to? The focus on health needs might overlook important social needs, which may have a considerable effect on wellbeing. Hospital admission provides an opportunity to put Bill in touch with others to support these issues, such as a social worker or make him aware of services offered by the Citizens Advice. Again, this is holistic care that enables social justice. Does Bill understand what is being said to him? Abilities to understand the language used by healthcare workers varies markedly. A low level of literacy might further limit his ability to find out about his health condition or treatment. Such needs are not easily or quickly addressed. Recognition of such issues encourages empathy and may alter a nurse’s workload priorities, enabling holistic care. What does Bill want? Understanding Bill’s life helps us to understand and support his own decisions, such as those around treatment options. Knowing the place of family, of friends, of social activities to his sense of wellbeing enables us to be more empathetic and deliver holistic care. The aim is to learn and kindle interest. So dip in, look at the abstract of the article, get a sense of what is being said. If it stimulates your interest, read on. The language used can initially appear difficult, but over time it will become less obscure. Our belief in the importance of the social sciences for nursing
led us to move forward a seminar series funded by the Economic and Social Research Council (ESRC), an organisation that funds and promotes the social sciences in the UK. This seminar series has nurse education and the potential links with the social sciences at its heart NS
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