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long running debate in the literature concerning the value of sociology for the discipline of nursing, beginning with Hannah Cooke’s (1993a) article Why teach Sociology? Cooke’s critical concerns can serve as the foundation for some important theoretical work regarding nursing, and more specifically nursing education. That important work, I intend to suggest, is sociological in nature. In this paper then, I argue that sociology is not only relevant to nursing education, but indeed essential precisely because of its tendency to problematize problems. I begin first with a brief overview of the discussion/debate in the nursing literature regarding the value of sociology to nursing (education). Next, I discuss the concept of assuming practice and how it relates to nursing education as well as nursing’s history of social responsibility. Following this I provide an overview of social problems theory as an example of how and what kind of sociology can be usefully taught to nursing students, and finally, I discussion how such an important sociological approach is germane to nursing education. Acknowledgements: The author would like to extend a special thank you to Dr. Dorothy Pawluch, Department of Sociology, McMaster University for encouraging me to write this paper and providing critical feedback. Introduction: There has been a rather intense and long running debate in the literature concerning the value of sociology for the discipline of nursing. Beginning with Hannah Cooke’s (1993a) article Why teach Sociology? and Sharpe’s (1994;1995; 1996) critique of both it and sociology as a value for nursing, followed by Porter’s (1995; 1996; 1997) critique of Sharpe and defence of sociology in nursing education there appeared a number of articles dealing with the issue (Balsamo & Martin, 1995a; Balsamo & Martin, 1995b; Mulholland, 1997; Williamson, 1999; Allen, 2001; Pinikahana, 2003; Holland; 2004; Aranda & Law, 2007). Cooke (1993) initiated the debate by calling for a “… more critical and theoretically informed sociology for nurses,” (p. 210) for the “the development of a new way of looking at the world – one which calls into question much that we have taken for granted,” (p. 211) and to “allow us to imagine new futures for nursing and to question the current ideological consensus within it.” (p. 215). These are certainly important questions and I will return to them shortly. Although there is certainly no intellectual or academic consensus at present in nursing (Thorne et. al., 1998), it might be argued that it does contain, with notable exceptions of course, an ideological consensus regarding; a) educational relevancy (Ironside, 2004), which is to say that all education must be directly relevant to practice and b) an antiintellectual or task/technical ideology (Bradshaw, 1995), meaning that sophisticated critique is viewed as little more than irrelevant academic speak. This is to say that, given its very recent entrance into higher education, and its long history of subjugation and task based work, nursing (both education and practice) is guilty of assuming practice (a concept I shall explain briefly). Hence, Cooke’s (1993a; 1993b) critical concerns can serve as the foundation for some important theoretical work regarding nursing, and more specifically nursing education. That important work, I intend to suggest, is sociological in nature. In this paper then, I argue that sociology is not only relevant to nursing education, but indeed
defined as it often is as the “knowledgeable doer. 391) while the latter “holds that it is the substantive subject matter of the discipline concerned which is of relevance to the problems faced by the professionals. which will be transferred to the professional setting. The majority of arguments for the teaching of sociology in nursing remain concerned.” (Balsamo & Martin. with what it can contribute to nursing practice (directly) rather than the critical attitude of nursing students.” (p. 215). 1995b). often deemphasized. sociology does not only inform nursing practice. and the lack of directly applicable knowledge gleaned from sociological research. Moreover. In other words. in addition to his use of a “knowing how” and “knowing that” binary. for the most part. Sharpe’s (1994. For those who take the former position. Contrary to this. or in Sharpe’s (1994) Ryleian view “knowledge how… [rather than] knowledge that. This epistemological confusion is the result of. In this sense sociology is an emancipatory discipline. nursing work can be seen primarily as a form of rational action. and finally. Next.” (Sharpe. I discuss the concept of assuming practice and how it relates to nursing education as well as nursing’s. I begin first with a brief overview of the discussion/debate in the nursing literature regarding the value of sociology to nursing (education). on the basis of knowledge about how these goals may most efficaciously be reached. 1995) narrow view of nursing (knowledge how rather than knowledge what) as a discipline has been. into the practice of nursing. history of social responsibility.” . 1997. and indeed must. The Sociological Debate: As Porter (1996) put it “The two basic lines of attack have been that sociology is currently not being taught properly by nursing educationalists… and. 170). Following this I provide an overview of social problems theory as an example of how and what kind of sociology can be usefully taught to nursing students. claim that not only does it not inform nursing practice. since it inculcates in the student certain general intellectual and problem-solving skills. 392). Sharpe.essential precisely because of its tendency to problematize problems. 1995a. in my view. Cooke (1993a) stated as much with reference to C. 1995. Where the former suggests that “serious study of any academic discipline is useful preparation for professional practice. also juxtaposed a personal education model with a semantic conjunction model (1994). if you will. a) nursing’s practice imperative “whatever else it may be. but it risks introducing an epistemological confusion. it also provides an emacipatory agenda. that it ought not be taught in the first place…” (p. those who subscribe to the latter. However. Indeed. the assumption is that what nursing students should be taught is how to practice nursing and anything that does not further this goal is simply moved into the category of unnecessary and irrelevant. 1999. 1997. Williamson. 2003). 53) and b) both the multiparadigmatic nature of sociology. In essence. more radically.” (p. Wright Mills “The sociological imagination shows us that existing social relations are not fixed and immutable and thus it expands our consciousness of the different possibilities for the future which are open to us. act (practice) in the world (clinical environment) sociology is. that is action which is oriented toward goals. since a nurse does. effectively dealt with (see Porter. Mulholland. the conflicting and controversial state of sociological theory reduces its utility as a repository of stable and secure knowledge from which to confidently act (practice) in the world (clinical environment). p.” (p. Pinikahana. a) of little use and/or b) unnecessarily confusing. I discussion how such an important sociological approach is germane to nursing education. 1995.
social problems. many of the early nursing leaders (for example.” (p.(p. He further asserts that if the teaching of sociology was primarily an effort to foster intellectual skills. individuals. Indeed Nightingale herself was responding to a social problem when she headquartered her cadre of nurses at Scutari during the Crimean War in 1854. which is not say that philosophy is irrelevant) with respect to both practice and its long history. AIDS. becomes questionable. by suggesting that as nursing moved away from the medical model and began to develop a more holistic (bio-psycho-social) approach. Sharp (1994) claims that “if the rational for including sociology in the curriculum was only the development of transferable intellectual skills. 7S). public health. addiction. That is to outline a priori what nursing practice is and train (rather than education) a student to perform it. Ethel Bedford-Fenwick. Moreover. it is “sociological theory and methodology” that should be taught to nursing students. a) have some direct link to practice and b) be taught in a manner that leads to practice. 391). p. though I did not put it this way. However. Sharpe (1994) rejects the personal education argument first. Historically nursing has been viewed as a discipline that treats. 392). or desire for. A tyranny of relevance in nursing education means that whatever is taught to a nursing student must somehow. the social problem of the treatment of wounded soldiers. In essence. child abuse. cares for. It is here in fact that I think the argument for sociology in nursing education needs to be made. then philosophy would be as appropriate as sociology. or responds to. it is a receipt for a dogmatic approach to both individuals being cared for by nurses and the society nurses provide service to. Indeed. Second. rather than merely the findings of sociological research. as far back as Nightingale social problems and social responsibility have been a significant focus for nursing. 2006) used the phrase assuming practice to denote the tendency in nursing to. presumably. or should) be different and is certainly not emanciptory with respect to the student. in effect “a body of knowledge which nurses regard as legitimately their own” (p. and social problems in nursing service. Assuming Practice and Social Responsibility in Nursing Education: Elsewhere I (Betts. and political sciences. cancer.” rather.” and as well the teaching of it to nursing students. Put differently. These concerns are certainly more central to knowledge domains such as epidemiology. then the findings of sociological research. though often only on paper. Assuming practice does not allow for the possibility that nursing practice is varied. of social responsibility – particularly with reference to social problems. and very possible better…” (p. According to DeSantis and Lipson (2007) “The Committee on Curriculum for the National League for Nursing (NLN) first published a curriculum guide in 1917 that included content on psychology. teach to practice. That is. one would expect such teaching to primarily include “sociological theory and methodology. might be (as in could. if not outright irrelevant. 2003. many of the problems that nurses are faced with in practice are social problems that manifest themselves in the individual need of. not unlike the teaching to test that occurs with standardized testing. Some have gone so far as to claim that “… it is not nursing’s societal mandate to eliminate disease or redress the social determinants of health. spousal abuse and so on). Indeed. Lillian Wald. 105).” (Pilkington & Mitchell. sociology. 392) the usefulness of sociology for this “body of knowledge. What Sharpe fails to recognize is that nursing is an ineluctably social enterprise (more so than philosophical. . I was referring to a tyranny of relevance. care (cardiac disease.
criticism. proves perhaps more strikingly than any other that a new conception of human society has arisen and that a new ideal is to be pursued for the future. Dock (1907) wrote. this. As Chopoorian (1990) put it “Without a critical analysis of the social forces. 2004) view. 899) In 1931 Alice C. to make democratic politics and public commitments central to their lives… that obligation does not simply rest on expanding the boundaries of knowledge for students. Maxine Greene. emanciptory. That is: … nurturing those capacities that enable [students] to take risks. 329). higher education agenda (National League for Nursing Board of Governors. economic. the nursing profession may collapse… We need to ask how social. its social responsibility must come foremost in the conception of its duties.Lavinia Dock. to inculcate a single moral standard. Lloyd (1931) wrote. that nursing students be schooled in a true higher education model. radical form of critique for nursing education. Clara Barton and numerous others of course) spoke often of social problems and nurses responsibility for them. Indeed the curriculum revolution emphasized a. and the recent movement to teach sexual hygiene.” (Bevis & Murray. Mary Adelaide Nutting.” (p. and political climate influencing nursing. in Some Urgent Social Claims: But now the day has come when we might here decide on our place. In short then. and meaning making. Moreover. nearly. or perhaps demanded (it was after all a revolution). our share. caring. political. (p. p. in the mid-80’s such social responsibility and social problems in nursing became a central position in the curriculum revolution’s attempt to shift the paradigm of nursing education from a Tylerian training model to a critical. and nurturers of curiosity. responsibility for social problems is nothing new in nursing despite its often marginalized status. in 1907 Lavinia L. Yet. Rather. its iniquities and dangers… prostitution and the white slave traffic with its trail of disease and death. intellectual. 24). consultants. and theoretical resource… It means using knowledge in more than a narrowly instrumental way – such as preparing for a . and cultural structures and fundamental societal processes and human relations produce the problems we see in our daily work. problem-posers. society. they recommended. For example. – industry and the industrial situation – especially as it relates to women-child-labor. Michael Apple and so on. inquiry. 1990. in 1941 Gladys Sellew (1941) wrote a book specifically titled Sociology and Social Problems in Nursing Service. one of the newest reform and educational movements. It also rests on making students more aware of how knowledge can be used as a social. One perhaps similar to Giroux’s (as cited by Rahmani. 2005). 911).” (p. that “To place the nursing profession on a high level. Although the original participates of the curriculum revolution did not ignore nursing practice (indeed they addressed is all to well. albeit rather abstractly at times) neither did they assume practice. citing such critical pedagogy theorists as Paulo Freire. The curriculum revolution then proposed a liberal education for nurses with an emancipatory programme that “requires teachers to be meta-strategists. in an article entitled Social Responsibility: An Aim of Nursing Education. and our policy toward the great social claims of education and educational reforms.. and health care. and to combat venereal disease of which we make so melancholy an acquaintance – not only in the wards of city hospitals but even among our private patients. Henry Giroux. economic conditions.
We might just as well label this the commonsense model in that. this is how it will invariably be presented to them. that is future professionals vested with authority. to think about practice rather then simply for practice (Betts. (p. According to Best (2003a) there are two mutually exclusive approaches to (the sociology of) social problems. self referring (homelessness refers to the problem of homelessness). homelessness) has little to do with other social problems (say AIDS. Porter (1998) claims that. 2006). epistemological confusion and diverse research agendas become invaluable. . rape. development and controversies. to those modes of moral witnessing necessary to transform the underlying systemic conditions that produce human suffering… to prepare students for a very complex and contradictory world. “sociology’s emphasis on critical reflection can encourage nurses to be more questioning and self aware… ” (p. when nursing students encounter social problems in their course of their study. if I have done it justice. trust and autonomy by society. 647) In other words. educating nursing students. and a direct line of decent runs from them to their modern counterparts. Social Problems Theory and Nursing Education: I now wish to use Social Problems Theory (the sociology of social problems). a multiparadigmatic view of. Finally. It is here that sociology’s multi-paradigmatic nature. equality. The first is the traditional model (what Best refers to as the “mainstream approach”). that is. in her well know feminist critique of the hegemony of the natural science model in nursing. In effect. in which they are going to learn how to govern and not simply be governed. crime and/or poverty. in addition to sociological research findings contributing to practice. both the individual’s nurses care for and the greater society they serve has important value in-itself. poverty. to Cooke’s (1993a) initial concerns. in his text for nursing students Social Theory and Nursing Practice. rather for a traditional perspective social problems are discrete entities that are. It is also the answer. Indeed. Add to this Hagell’s (1989) comments. x). its history. it is the personal education model that Sharpe (1994) too easily rejects that ends up being of great value for nursing education. feminism and critical theory.” (p. As Best (2003a) explains “… the mainstream approach to the sociology of social problems is more than a century old… [and] as sociologists began to identify many social problems… soon. that social problems exist as objective conditions of the world which require solutions and moreover that one social problem (for example.” (p. crime… etc). again. 231). even if the results of this view do not directly apply to nursing practice. This is not to say that one cannot be homeless as a result of AIDS. rape. “Perhaps the most important area for change should take place in nursing education… [which] should incorporate… courses that are aimed at critically evaluating nursing theories and other theories… [including] alternative thought such as… Marxism. In other words. in a sense. there were books and courses titled Social Problems. to provide an example of the value that sociology may well have for nursing education. 134).job – it also means critically embracing knowledge as a means of self development tied to modes of learning and intellectual work that address matters of human freedom. nearly everyone (except a group of sociologist I will mention in a moment) holds this position. and social justice… to social change.
original emphasis). that is the combination of objective and subjective components has been referred to as the value-conflict theory of social problems. if they do indeed exist.” (p. it is concerned with how social problems are subjectively (that is by individuals referring to social problems) defined. Although. 463). Although Fuller and Myers did indeed admit to important subjectivist (definitional) characteristics of social problems.The second approach to social problems (the one taken by those sociologists I just mentioned) is concerned with the definition of social problems. 1973. 1941b) later suggested that “Every social problem has both an objective and a subjective aspect. then.” (p. definition of social problems “… we define social problems as the activities of individuals or groups making assertions of grievance and claims with respect to some putative condition.” (1941a. 1973.” where the objective element is “a verifiable condition. or in other words how a social problem becomes (is constructed as) a social problem. however. now classical. The were. The value-conflict approach appears to have laid the groundwork for a fuller articulation of the subjectivist views of. again mainstream thinking. This is clearly a “mainstream approach. 1973) in the early 70s Put simply. situation. and the solution of a social problem is evidently the discovery of a method for this removal or correction. Hence. and still are. The history of the definitional perspective is rather complicated. p. what they consider . there exists a conflict concerning the value of such a foundation. or event. This is in contrast to Merton and Nisbett’s (1971. among others. 259).” Waller (1936) evinced similar views a decade later and even explicitly acknowledged a debt to Frank’s work. and work with. they go so far as to suggest that the inclusion of objective state of affairs in social problem analysis results is little more than a (return to) functionalism (Spector & Kitsuse. By this I do not mean the definition of a social problem. sociological. Moreover. as cited by Kitsuse & Spector. that “A social problem. for Spector and Kitsuse the objective (that is realist or materialist) conditions of a social problem. the definitional perspective essentially problematizes the traditional/mainstream/commonsense view of what a social problem is. Blumer (1971) and Spector and Kitsuse (1973.” (Spector & Kitsuse. 1973) functionalist view. heralded the. 146. social problems are constructed by the subjective attitudes. which places significant emphasis on the objectivity of social problems. we clearly see the emergence of a subjectivist constituent to social problems theory. Hence they arrive at their. definitional approach to the sociology of social problems. is there anything. in Waller. Spector and Kitsuse then. now famous. Put simply then. that connects all social problems? It turns out that indeed there might be and that is – how social problems are defined. however I shall attempt to briefly review it here. 146). in that while the foundation is a material one. meanings and approaches that individuals (or groups) evince in the definition of. p. as we shall see in a moment. Such a constitution of social problems. but rather asking the question. 25). such problems were founded on realist assumptions. for them. Kitsuse & Spector. Fuller and Myers (1941a. as Himes (1955) put it “Waller… saw social problems as emerging from conflicts between the ‘organizational’ and the ‘humanitarian’ mores. in a thoroughly objectivist fashion. are irrelevance to proper sociological analysis. appears to be any difficulty or misbehavior of a fairly large number of persons which we wish to remove or correct. activities. the definitional view is not a unified approach at all. social constructionists in that. Early in the 20th century Frank (1925) claimed. p.
But calling a statement a claim does not discredit it. 2003b) calls “contextual constructionism. (Best. As Ibarra and Kitsuse (2003) put it “The very concept social problem is itself problematic. not without its controversy. Contextual constructionists argue that any claim can be evaluated.” Contextual constructionism. in order to be a social problem. 1) the traditional (or mainstream) view. or social constructionist. 2) definitional perspectives (or strict constructionism) which hold that social problems can only be understood by examining those (individuals and/or groups) who define. be an important element in sociological analysis: Obviously. 19). and 3) contextual constructivism. argues that there are some objective conditions to social problems and moreover these can be used in sociological analysis. handle. discourse and work of social problems. albeit cautiously. give it existence. it is founded on constructionist assumptions. 1995. any discussion about social conditions is a social construction. which takes issue with Spector and Kitsuse and those who followed them. a social problem is not an objective (obvious if you will) condition of the world that everyone agrees on and is working to fix. that all social problems have a common sociology in that. that is claims-makers and counter claims-makers. Best (1995. which are in turn social constructions… contextual constructionists assume that they can know – with reasonable confidence – something about social [objective] conditions. wherein social problems are simply problems in a given society that require a solution.” (p. A claim may be based on various sorts of evidence. is. As previously mentioned. the definitional. instantiated largely by Spector and Kitsuse (1973). 2003b) has labelled Spector and Kitsuse’s version of constructionism “strict constructionism.” in that their research method precludes any reference to objective conditions. It is however. which suggest that definitional perspectives are of great importance.to be social problems. position is. of course. against for example naïve realism or materialism. To summarize. This is in contrast with what Best (1995. however there are some objective (or . in some cases denying that it is a problem altogether). Rather it views social problems as constructed by would-be claims-makers and counter claims-makers in an effort to not only deal with the problem. but in fact. There is indeed another perspective. though still constructionist. such as official criminal statistics or public opinion polls. or deal with the social problem in question quite differently (in fact. important to note that this is not a regression to the previously mentioned value-conflict theory. delineate. and moreover these claims (about social problems) are often met with counterclaims. while recognizing the importance of the definitional aspects of social problems. Rather. 347-348) I have outlined three (sociological) ways of viewing social problems. however contextual constructionists posit that certain objective conditions are important to social problems investigation and can therefore. from a constructionist perspective. they must be defined as such by subjective interests (again individuals or groups) – called claimsmakers. A claim that crime (or fear of crime) is increasing is just that – a claim. their focus is to analyize the claims-makers and counter claims-makers that produce the definitions. which is to say other individuals or groups which may well define. From this standpoint. p. Controversy in Constructionist Views of Social Problems: The definitional perspective of social problems. and work with social problems (there is no problem without someone to label it as such).
or in this specific case assuming problems uncritically. And it surely does not make for a critical and emancipatory (read higher) education. and that is as true of intellectual as it is of practical problems. and to be sure dogmatic. Assuming Problems: Social Problems Theory and Nursing Education: So what then can this aforementioned epistemological confusion. the individuals on both sides of them (that is those afflicted and those who serve them). I hope that outlining the multiple perspectives of social problems theory has provided a cogent example of how sociology might be of use in nursing education. confusing. human agency (Giddens versus Archer). I have used . 201) Indeed. if not dangerously dogmatic. viewpoints. add to nursing education? Although it is true that such confusion does not easily translate into a secure knowledge base for practice – this is just the point I wish to make. This fact of reality is. sociology as I have attempted to argue does have the emancipatory potential that Cooke called for in that. Walter Lippman. it tends to be inclusive (accessing a diversity of voices. Forgive the cumbersome way of putting it. but that does not mean that such definitional behaviour cannot be wrong). it provides for a complex and multi-perspective view of a complex and multi-perspective world. Second. as I have mentioned several times. this overview of social problems theory. positions and possibilities) rather than a monolithic.” he said. social problems are not necessarily uncomplicated. self-referring conditions that simply need fixing. however to ignore the confusion is. Conclusion: In this paper I have attempted to address the longstanding debate regarding the usefulness and/or relevance of sociology to nursing. (p. As Toulmin (1990) put it. with reference to Lippman: … we may recall the comment on social and political affairs made by that humane. perspectives. ignoring the complexity of the world we practice. Such diversity of perspective is not only the case with social problems. (for example Marx against Foucault). or are going to practice. which distils much of what has come to light in our inquiry. More specifically. but to problematize problems is good for problems and as well. again I hope. First. in for some pseudo-certain knowledge from which to act (practice) is problematic. as well as to. it prevents students from assuming practice uncritically. denigrate nursing students ability to be critically educated and still practice with compassionate competence. it is democratic in that. neat. I have suggested that Hannah Cooke (1993a) was correct when she began the debate by claiming that sociology can provide a critical and emancipatory agenda for nursing (education).actual) characteristics to the problem being defined which can also be a matter of study (yes people have to define a problem for it to exist. I think. power. assists me to make three important points. grumpy. In effect. epistemologically. social progress (critical theory versus postmodernism) and so on. but as well with gender (the multi-faceted nature of feminism). understanding that is exclusive. or can be. class (Marx versus Weber). to risk dogmatic practice. and certainly one that nursing students should have access to no less than researchers. “To every human problem. but normally clearheaded commentator. “there is a solution that is simple. methodologically and pragmatically. And finally. Indeed. What it does do for nursing students is to demonstrate that there is simply not a single way of seeing/understanding the world we live (and practice) in. and wrong”.
& Martin. and should. Following this. J. Challenges and Choices Constructionist Perspectives on Social Problems (pp. Developing the sociology of health in nurse education: Towards a more critical curriculum. Part 1. be applicable to nursing education. little known in many respects. 433-438. After providing an overview of the sociological debate. history of social responsibility in nursing. K. S. D. New York: Aldine De Gruyter. I presented a summary of the diverse perspectives of social problems and then discussed how this (as an example of sociological theory) can. Nurse Education Today. I discussed the concept of assuming practice and the. an education in “sociological theory and methodology. 15. Images of Issues: Typifying Contemporary Social Problems. 561-567. Tales of sociology and the nursing curriculum: Revisiting the debates. (1995b). J. 982). (2003a). I. K. 386-396. Balsamo. (1995a). and insightful. Miller (Eds. 133-152). 23(3). Linking methodology and epistemology. (1995). Aranda. Andragogy and sociology in Project 2000. Holstein & G. 427-432. Developing the sociology of health in nurse education: Towards a more critical curriculum.). Best. In J.social problems theory to make my point. In J. . 337-354). Best. Part 2. D. 15. Nurse Education Today.” (p. Best (Ed. & Martin. Nurse Education Today. Constructionism in context.). at least. & Law. S.” References Allen. Finally. I. Review article: Nursing and sociology: An uneasy marriage? Sociology of Health and Illness. A. New York: Aldine De Gruyter. (pp. “… if university level education is required for other professionals then it is also required for nurses [and] if a proper university level education is not offered to nurses… then nurses should be educated elsewhere. (2001). D. Staying alive: Prospects for a constructionist theory. I submit that a “proper university level education” means. Balsamo. 27. comment on nursing education from Watson and Thompson (2008). I would like to conclude with a recent. (2007).
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