Understanding Sociology in Nursing

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Helen Allan, Michael Traynor, Daniel Kelly & Pam Smith

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    About the Authors

    Helen Allan qualified as a nurse in 1978 at University College Hospital (UCH) and worked in various staff nurse posts (in acute care) until she decided she wanted to specialize in intensive care nursing. She completed her JBCNS 100 (ICU) at Guys Hospital, London and worked as a ward sister in intensive care at UCH from 1982–86. She then went into education working as a clinical teacher, leaving to complete a BSc (Sociology) at the London School of Economics and Political Sciences, London, graduating in 1990. She completed her PGDE and registered as a nurse tutor in 1992, and starting work on her PhD while working as a nurse tutor in 1993. She graduated as a PhD in 1999. Helen began her research career at the University of Surrey in 2001, had a brief interlude at York in 2013, before starting at Middlesex University in 2014. Her first Chair in Nursing was a joint appointment with the Royal Surrey County Hospital and subsequently she has held chairs at York and Middlesex. Helen has taught social sciences to nursing students pre and post registration for over 20 years and used her sociological insights into examining taken-for-grated assumptions about nursing practice over the same period.

    Michael Traynor was born in London. Michael read English Literature at Cambridge, then completed general nursing and health visiting training. After working as a health visitor in London, he moved to Australia where he was a researcher for the South Australian Health Commission. Michael worked at the Royal College of Nursing in London from 1991 to 1996 and undertook a three-year study of nursing morale in the wake of the 1991 National Health Service reforms. Drawing on his background in literature, his PhD examined the language employed by nurses and their managers. It was published as a book by Routledge. He worked at the Centre for Policy in Nursing Research at the London School of Hygiene & Tropical Medicine. He is now Professor of Nursing Policy at Middlesex University in London. He researches professional identity and the application of discourse analysis and approaches from literary theory and psychoanalysis to nursing policy and healthcare issues. He is editor of the journal Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine and European editor of Nursing Inquiry. He recently wrote Nursing in Context: Policy, Politics, Profession published by Palgrave Macmillan.

    Daniel Kelly undertook the integrated Social Sciences and Nursing degree at Edinburgh University. On qualifying in 1984 he worked in intensive care and trauma nursing before specializing in oncology. He undertook oncology training at The Royal Marsden hospital in London before returning to Edinburgh to take up two Charge Nurse posts in HIV and oncology. During this time he completed a masters degree in advanced cancer care. He returned to the Royal Marsden to teach cancer care for several years before moving to University College Hospitals as Senior Nurse for Research & Development. During this time he undertook a PhD in Sociology at Goldsmiths, University of London on the embodied impact of prostate cancer. He has worked at a number of universities since then including City, Middlesex and Cardiff. His research interests have included cancer, end of life care, nursing innovation and more recently workplace culture and related factors such as leadership. He is Visiting Professorial Fellow in Nursing Studies at Edinburgh University and has been awarded a Churchill Fellowship. Underpinning this work has been an ongoing interest in sociology and the role of everyday behaviour in shaping healthcare practices.

    Pam Smith is Professorial Fellow, Nursing Studies in the School of Health in Social Science, University of Edinburgh and a Visiting Professor in Nursing, King’s College London. She is a graduate of the University of Manchester’s Bachelor of Nursing programme where she qualified as a registered nurse, district nurse and health visitor (1970). Pam undertook postgraduate studies at London University where she obtained a certificate in adult education (Garnet College), an MSc in Medical Sociology (Bedford College) and her PhD on how student nurses learn to care (King’s College). Pam worked as a nurse and teacher in Tanzania, Mozambique and Britain and as a nurse researcher in Britain and the USA. She spent 1989–90 with Professor Arlie Russell Hochschild at the University of California at Berkeley, developing the application of emotional labour to nursing. Former posts include Head of Nursing Studies, University of Edinburgh (2010–13), General Nursing Council Trust Chair in Nurse Education and Director of the Centre for Research in Nursing and Midwifery Education at the University of Surrey (2002–2008), Professor of Nursing, London South Bank University (1997–2001) and Director of Nursing Research and Development, Camden and Islington Health Authority (1988-92). Pam’s qualitative research includes collaborative studies of international aid and maternal and child health services in Nepal and Malawi; online education of maternal and child health professionals in Malawi; transitions from active to palliative care for children with cancer, parents and professionals; an exploration of the experiences of patients living with neuromuscular degenerative conditions and their families; patient safety and healthcare professional education; the UK experiences of overseas trained nurses; primary care and healthcare reform. Pam is the author of The Emotional Labour of Nursing: How Nurses Care (1992: Palgrave Macmillan) and The Emotional Labour of Nursing Revisited: Can Nurses Still Care? (2012: Palgrave Macmillan).

    Foreword

    This book is an excellent introduction to how clinical work can be understood as affected by particular social and cultural forces. It helps foreground not just how nurses train and work in complex environments – the normal chaos of healthcare services under strain – but how important it is to understand that these environments are also deeply structured.

    Nurses are never ever free to do whatever they choose. So many clinical textbooks represent nurses as autonomous decision-makers with the discretion to conduct care in line with standards and protocols decided far from the plane of action, providing they have the right education, knowledge, skills and experience. What these ways of representing nursing leave out is how nursing is conducted in environments that are complex, prefigured by social and cultural, not just clinical or bioethical, values. For example, nursing is entangled in cultural preoccupations that privilege some kinds of knowledge and work, such as highly techno-medical work, and that deface other kinds of knowledge and work, for example ‘body’ or ‘care’ work. In addition nurses are continuously being positioned by multiple and often competing agendas. For example those carried by an audit culture which intensifies the need to be seen to meet particular targets rather than the needs and cares of an individual patient. As the Francis Report amongst others has put it, it is as if nurses are being asked to care more for the system, including extremely limited ideas about efficiency, than for their patients.

    Sociology is concerned with helping illuminate this complexity and its unintended consequences. It also helps us to see all the invisible and often neglected patching and knitting work that nurses do to make these complex environments run at all. And that’s what this book helps do. It helps us to see how to draw in different theoretical positions not just to make sense of the complexity but to illuminate the aspects of being a nurse and doing nursing, and of becoming ill and being a patient, that remain invisible if we only examine them from a biomedical or even a psychological perspective.

    It is in this respect that I appreciate the way that the book grounds discussion and explication of key sociological ideas in the everyday worlds of nursing students’ experience, helping to illuminate how this is rooted in the social, cultural and political conditions of contemporary healthcare. Here the book draws on examples from each authors’ extensive repertoires of empirical research as well as a vast array of literature across key domains: being a patient, becoming a nurse and doing nursing, the social construction of health and illness, the gendering of nursing and the division of healthcare labour, the meanings of care, patient safety and organisational complexity, the body and emotional labour, and the problems with discourses of leadership and technologies of management.

    The book will not only help nurses to think critically about how and why they work in the ways that they do but will empower them to do things differently. For a long time sociology has been a core subject in medical education. I have long argued it should be a core subject for nurse education. This erudite but eminently accessible book should be compulsory reading on every undergraduate nursing programme.

    Joanna Latimer, Professor of Sociology, Science & Technology, University of York.

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