S4: Fundementals of Nursing

Key unit competence:
Explain the concepts of sociology in health promotion and wellbeing

10.1. Definition and characteristics of sociology

Learning activity 10.1.

Sociology is a study of social facts, which are ways of acting, feeling and thinking
common to a society which coerce individuals in that society to conform. Sociological
knowledge enables us to look at society and human relationships in a certain way
and to understand, explain and make predictions about members of that society.
The broad statement that sociology is the study of society can be refined by more
specific definitions such as ‘the scientific study of human society through the
investigation of the social behavior of man.

Sociology is the youngest among the Social Sciences. The term “Sociology” is
derived from Latin word “Socius” means ‘Companion’ or ‘Associate’ and Greek word
“LOGOS” means ‘Science’ or ‘Study of Society’. Thus the etymological meaning of
the term Sociology is “Study of Society”. The nature and characteristics of sociology
can be summarized in the following way:

1. Sociology is an independent science
Sociology is not treated and studied as a branch of any other science like philosophy
or political philosophy. As an independent science, it has its own field of study,
boundary and method of approach.

2. Sociology is a Social Science and not a physical Science
Sociology belongs to the Social Science and not to Physical Science. As a social
science, it concentrates its attention on man, his Social behavior, Social Activities,
and Social life. It is intimately related to other social Sciences like Anthropology,
Political Science, Economics, Psychology, etc.

3. Sociology is a categorical and not a Normative Discipline
Sociology Studies things “as it is” and not “as they ought to be”. As a Science,
Sociology is necessarily silent about the questions of value. It does not make any
kind of value-judgements. Its approaches neither moral nor immoral but amoral. It
is ethically neutral. It cannot decide the directions in which Sociology ought to go.

4. Sociology is a pure science and not an Applied science
Sociology is a pure Science because the immediate aim of Sociology is the
acquisition of knowledge. On the contrary an applied science is interested in the
application or utilization of that knowledge. Sociologists never determine questions
of public policy and do not recommend legislators what laws should be passed
or repealed. But the knowledge acquired by a Sociologist is of great help to the
administrator, legislators, diplomats, teachers, social workers, and citizens.

5. Sociology is relatively an abstract science and not a concrete science
Sociology does not confine itself to the study of particular or concrete instances of
human events. But it studies the abstract forms of human events and their patterns.
For example, it does not limit itself to the study of any particular war or revolution.
On the contrary, it deals with them in a general or abstract manner, as social
phenomena, i.e., as types of Social conflict. In a similar manner, it makes such
generalized Studies of marriage, religion, family, group, etc.

6. Sociology is a Generalizing and not a particularizing science
Sociology tries to make generalizations on the basis of the study of some selected
events. For example, a sociologist makes generalizations on the following:
 Joint families are more stable than the nuclear families.
 Social changes tale place with greater rapidity in urban communities than in
    tribal or rural communities.

7. Sociology is a General Social science and not a Special Social Science
The area of inquiry of Sociology is general and not specialized. It is concerned with
human activities whether they are political, economic, religious, social, etc., in a
general way.

8. Sociology is both an Empirical and a Rational Science
Sociology is an empirical science because, it emphasizes the facts that result from
observation and experimentation, it rests on trial, or experiment or experience. It is
a rational Science because it stresses that role of reasoning and logical inferences.
An empiricist collects facts where as a rationalist co-ordinates and arranges them.
All modern science including Sociology avail themselves of both empirical and
rational resources.

Self-assessment 10.1.

1) Define sociology.
2) Describe the characteristics of sociology

10.2. Definition of health and illness in social context

Learning activity 10.2.

Case: A father went in a vacation with his family; in their way, they meet with a
disabled person who was begging for money. In their discussion, the disabled
person tells them that he lost his arm in a car accident which happened when he
was still young. He said that he was very hungry and that his survival depends
on humanitarians who have him something. The father gave him money and
left. In their car the child asks his parent this question “why does that man
survival depend on begging? Losing one arms means that he is ineligible to do
anything? In your groups debate on these two question

Health is a physiological and a psychological state but it is also, fundamentally, a
social state. The human being make sense of health and illness by drawing on a
stock of current social belief, ideas and practices. In the process of social learning;
humans start to interpret and discuss the social world since infancy. The educational
institution helps people to understand ‘what health is’ and is not, and what are
appropriate responses to disease and illness. In encounters with the structures of
power in society, people learn what it means to be ‘sick’, ‘dependent’ or ‘disabled’.
As they come into contact with organisations which provide health services they
develop their understanding of how to be a ‘patient’ or a ‘career’.

Medical sociologists use social constructionist theory to explain health and illness.
In medical profession, disease is a biological condition. Referring to the social
constructionist theory, illness is the social meaning of that condition.

 In social constructionist theory, impairment refers to a physical illness or
     injury; disability is the social experience of impairment.
 Illness can reshape an individual’s identity. For example, deafness can be a
     cultural identity that replaces individual identity.
 Medicalization—the act of reducing illness to strictly a medical definition
    ignores the social context of disease.

Self-assessment 10.2.

1) Match the terms in column A with their specific definition or examples
      in column B

10.3. Biomedical model and holistic approach toward
           health

Learning activity 10.3.

Search online books about model of health and with example explain the
following terms
1) Bio-chemical model of health
2) Holistic approach of health

10.3.1. Introduction
A positive view of health is maintaining and achieving a balanced diet and a healthy
lifestyle. the individual may regard running and walking in a positive view or taking
supplements for mental and physical well-being. Generally feeling good within is a
good indicator of good health. However, obsession toward having positive view of
health can have its consequences physically and mentally. For example, physical
activity can become unhealthy when it’s taken to extreme measures. People
normally start off at a moderate pace to stay healthy but slowly become obsessed
with fitness and health. This compulsive behaviour could lead to heart and arteries
been damage due to excessive training and consequently to heart attack.

A negative view on health is believing you don’t have to go to the local General
practitioner because you feel ok within yourself. Due to not seeing any physical
evidence or symptoms of illness such as blood and vomiting, they automatically
assume they are healthy. Individuals like this regard good health as normal and
they do the minimum to maintain their health. The problem with the negative attitude
towards health is it puts the individual at a huge disadvantage regarding their own
health as certain diseases may only show physical symptoms when the disease
may become untreatable, such as pancreatic cancer and heart disease. These
individuals tend to live a shorter life than the general population, as they don’t act
upon changes in their health or physical well –being.

10.3.2. The Biomedical Model of health
The Biomedical model is a scientific method used by clinicians and other health
professionals. It treats the human body as a very complex device and advocates the
treatment of symptoms through the use of medical intervention. The main objective
of the biomedical model is to focus on the human body solely and treat the illness
and diseases separate from the mind.

 a. Advantage of biomedical model of health
 It has a high success rate regarding research and diagnosis of humans.
 Depending on the illness, the model can be used to learn about the disease
      and avoid it recurring.
 The model states health can be restored through treatment and a variety of
     techniques including nuclear medication and drugs.

Example, if you fracture your leg you can have surgery which will allow you to walk
again. Many illnesses can be treated through medical intervention and advance
research. At the beginning of the 20th century, the leading causes of death were
tuberculosis, pneumonia, influenza and diarrhea. The biomedical model was used
to rule out the cause and influence treatment.

b. Disadvantage of Biomedical model of health
 The biomedical model fails to include other factors like psychosocial that
     are sometimes found to be the main influences of illness.
 The model fails to address any illness or disease which doesn’t display any
    physical signs and symptoms.

Criticizing the model, Foucault (1973) states that Doctors who use this model see
their patients like robots in need of repair. He then suggested that due to medicine
and science, doctors are solely focused on the function and structure of the human
body and they don’t consider any other factors which may contribute to illnesses
such as poverty, stress and poor housing.

10.3.3. The Holistic approach of health
The Holistic Model of health focuses on the whole person instead of specific parts
of the body like the biomedical model. Many Holistic Doctors believe all parts of the
human body work in sync with one another. Meaning that if one part of the body,
isn’t working properly then the rest of the body doesn’t work. The main objective
of the holistic Doctor is not to solely examine the body but to understand why it is
happening.

c. Advantage of holistic approach of health
 The Holistic approach takes into consideration the whole person including
      their psychological and emotional health.
 The holistic approach allows alternative. Alternative medication is a
     treatment which is alternative to mainstream medication. Example herbal
     medicine which uses herbs and plants as an alternative.
 Yoga and massage are aspects of holistic model and these have proven to
     reduce stress

d. Disadvantage of holistic approach of health
For people who has serious medical illness like cancer, time spent looking for other
treatments can cause the disease to spread which could lead to the disease to
become untreatable. Holistic drugs don’t always reveal the true ingredients on the
packaging, so you could take a holistic medication which may have a contraindication
when taking conventional medication.

Self-assessment 10.3.

1) Differentiate biomedical model of health from holistic approach of health

10.4. Sociology and nursing practices

Learning activity 10.4.

1) Discuss the concepts of sociology and effect on nursing practice

The relevance of sociology to nursing
In 1991, the World Health Organization (WHO) proposed that nurses should
be required to develop and perform functions related to the promotion and
maintenance of health as well as disease prevention and rehabilitation. Nurses
need to be aware of the physical, psychological, social and spiritual aspects of
health, illness, disability and dying. Nursing models developed in nursing have

been influenced by the social and biological sciences and are intended to help
raise standards of nursing care. Sociology may help nurses to achieve their primary
objective of caring for patients in four ways: (i) implications of changing patterns of
disease, dependency and death; (ii) social and cultural variations in perceptions of,
and responses to, pain and diseases; (iii) organizational analyses, with particular
reference to the importance of nurse-patient communication and; (iv) sociological
studies on interpersonal relationships

Self-assessment 10.4.

1) Explain the ways by which sociology may help nurses to achieve their
objective

10.5. Determinants of health

Learning activity 10.5.

Observe the pictures above and answer the following questions:
1) What do you see on pictures A, B, C, and D?
2) According to your point of view, what might be the relation between: (a).
people’s access to health services and their own health; (b). education
access and health status; (c). Social circumstance and health status;
(d). Income status and health status?

10.5.1. Introduction to determinants of health
Many factors combine together to affect the health of individuals and communities.
Whether people are healthy or not, is determined by their circumstances and
environment. To a large extent, factors such as where we live, the state of our
environment, genetics, our income and education level, and our relationships with
friends and family all have considerable impacts on health, whereas the more
commonly considered factors such as access and use of health care services often
have less of an impact.

The determinants of health include:
 The social and economic environment,
 The physical environment, and
 The person’s individual characteristics and behaviours.

The context of people’s lives determines their health, and so blaming individuals
for having poor health or crediting them for good health is inappropriate. Individuals
are unlikely to be able to directly control many of the determinants of health. These
determinants—or things that make people healthy or not—include the above
factors, and many others:
 Income and social status - higher income and social status are linked to
better health. The greater the gap between the richest and poorest people,
the greater the differences in health.
 Education – low education levels are linked with poor health, more stress
and lower self-confidence.
 Physical environment – safe water and clean air, healthy workplaces, safe
houses, communities and roads all contribute to good health.
 Employment and working conditions – people in employment are healthier,
particularly those who have more control over their working conditions
 Social support networks – greater support from families, friends and
communities is linked to better health. Culture - customs and traditions, and
the beliefs of the family and community all affect health.
 Genetics - inheritance plays a part in determining lifespan, healthiness and
the likelihood of developing certain illnesses.
 Personal behaviour and coping skills – balanced eating, keeping active,
smoking, drinking, and how we deal with life’s stresses and challenges all
affect health.
 Health services - access and use of services that prevent and treat disease
influences health

 Gender - Men and women suffer from different types of diseases at different
ages.

10.5.2. Social determinants of health
Social determinants of health (SDOH) are conditions in the places where people
live, learn, work, and play that affect a wide range of health risks and outcomes.
The World Health Organization also provides a definition of social determinants of
health. Social determinants of health as the conditions in which people are born,
grow, live, work and age. These circumstances are shaped by the distribution
of money, power, and resources at global, national, and local levels. The social
determinants of health are mostly responsible for health inequities – the unfair and
avoidable differences in health status seen within and between countries. Healthy
People 2030 use a place-based framework that outlines five key areas of SDOH:

a. Health care access and quality
There is connection between people’s access to and understanding of health
services and their own health. This domain includes key issues such as access to
healthcare, access to primary care, health insurance coverage, and health literacy.

b. Education access and quality
There is connection of education to health and wellbeing. This domain includes
key issues such as graduating from high school, enrolment in higher education,
educational attainment in general, language and literacy, and early childhood
education and development.

c. Social and community context:
There is connection between characteristics of the contexts within which people
live, learn, work, and play, and their health and wellbeing. This includes topics like
cohesion within a community, civic participation, discrimination, conditions in the
workplace, and incarceration.

d. Economic stability
There is connection between the financial resources people have – income, cost of
living, and socioeconomic status – and their health. This area includes key issues
such as poverty, employment, food security, and housing stability.

e. Neighborhood and built environment
There is connection between where a person lives – housing, neighborhood, and
environment – and their health and wellbeing. This includes topics like quality of
housing, access to transportation, availability of healthy foods, air and water quality,
and neighbourhood crime and violence.

10.5.3. Addressing social determinants of health
Resources that enhance quality of life can have a significant influence on population
health outcomes. Examples of these resources include safe and affordable housing,
access to education, public safety, availability of healthy foods, local emergency/
health services, and environments free of life-threatening toxins. We also know
that poverty limits access to healthy foods and safe neighbourhoods and that
more education is a predictor of better health. Differences in health are striking
in communities with poor SDOH such as unstable housing, low income, unsafe
neighbourhoods, or substandard education. By applying what we know about
SDOH, we can not only improve individual and population health but also advance
health equity.

Self-assessment 10.5.

1) Outline any 4 determinants of health
2) 2.Explain how the following factors can have an influence on population
health
a) Income and social status
b) Physical environment
c) Employment and working conditions
d) Social support networks
e) Genetics
f) Personal behavior
g) Gender

10.6. Religion, culture, social norms, beliefs, values,
            customs, practice and implications to health

Learning activity

1) Discuss about the following topics
a) Religion and its importance in mental health
b) Culture and cultural perception
c) Types of norms
d) Importance of values

10.6.1. Religion and implications to health

Religious practice substantially contributes to physical and mental health. Regular
religious practice lessens depression, promotes self-esteem, and builds familial
and marital happiness. Religious worship also increases longevity, improves an
individual’s chances of recovering from illness, and lessens the incidence of many
diseases.

Theory and literature suggests that the reasons religiously involved people tend to
have good health outcomes are because they have healthy lifestyles and behaviors
in accord with religious beliefs. Other literature suggests that religious involvement
may play a negative role in health outcomes due to beliefs about illness originating
as punishment for sins.

Good mental health is highly correlated to religious participation. An increase in
religious practice was associated with having greater hope and a greater sense of
purpose in life. Religious affiliation and regular church attendance were among the
most common reasons people gave to explain their own happiness. Happiness was
greater and psychological health was better among those who attended religious
services regularly.

More frequent attendance at religious services predicted less distress among
adults. Membership in a religious community can enhance coping skills. One study
found that people were much more inclined to use positive coping responses when
they received spiritual support from fellow church members.

10.6.2. Culture and implications to health
a. Definition
Culture refers to a set of the ideas, customs, and social behavior of a particular
people or society. Culture involves how a person lives, speaks, interacts with others
and what individuals create, but perception considers how that individual sees the
world, or what happens when these two concepts are combined into a single phrase.
Cultural perception is how people gather information, learned within their specific
culture, to inform themselves about their world. This takes into account all aspects
of the individual’s life. How a person sees art, language, religion, etc. is all informed
by how those elements of the world are seen within the context of their culture

b. Elements of culture
i. Values
Values are a culture’s standard for discerning what is good and just in society.
Values are deeply embedded and critical for transmitting and teaching a culture’s
beliefs. Values help shape a society by suggesting what is good and bad, beautiful
and ugly, sought or avoided.

ii. Beliefs
Beliefs are the tenets or convictions that people hold to be true. Individuals in a
society have specific beliefs, but they also share collective values.

iii. Norms
Norms define how to behave in accordance with what a society has defined as
good, right, and important, and most members of the society adhere to them.
Formal norms are established, written rules. They are behaviors worked out and

agreed upon in order to suit and serve the most people. Informal norms are casual
behaviors to which an individual generally conforms.

iv. Symbols
Symbols are gestures, signs, objects, signals, and words that help people
understand their surrounding world.

v. Language
Language is the principal method of human communication, consisting of words
used in a structured and conventional way and conveyed by speech, writing, or
gesture. Language is considered as a system of communication used by a particular
country or community.

c. Culture influence to health
Culture influences healthcare at all levels, including communications and
interactions with doctors and nurses, health disparities, health care outcomes, and
even the illness experience itself. People in some cultures believe illness is the will
of a higher power, and may be more reluctant to receive health care.

A culture of Health is broadly defined as one in which good health and well-being
flourish across geographic, demographic, and social sectors; fostering healthy
equitable communities guides public and private decision making; and everyone
has the opportunity to make choices that lead to healthy lifestyles

Self-assessment 10.6

1) Discuss about the following 4 topics
a) Religion and positive implication to health
b) Culture and negative implication to health
c) Social norms and positive implication to health
d) Values and negative implication to health

10.7. Health beliefs and practices and their influence on
          health, health promotion and illness prevention

Learning activity 10.7.

In groups, discuss about the followings:
1) Health beliefs
2) Health practices
3) Health promotion

10.7.1. Health in social context
Health is determined by the conditions in which we live our everyday lives. Those
conditions include the social, cultural, economic, educational, and occupational as
well as the physical and mental environment, which influence health behavior and
lifestyle and so the health status. Health beliefs are the tenets or convictions that
people hold to be true regarding health promotion.

10.7.2. Illness
Illness is defined as the ill health the person identifies themselves with, often based
on self -reported mental or physical symptoms. In some cases, this may mean only
minor or temporary problems, but in other cases self - reported illness might include
severe health problems or acute suffering.

10.7.3. Health promotion
Health promotion is the process of enabling people to exert control over the
determinants of health and thereby improve their health. It moves beyond a focus on
individual behavior towards a wide range of social and environmental interventions.

Health beliefs and practices and influence on health promotion and illness prevention

Health beliefs are what people believe about their health, what they think constitutes
their health, they are also what they consider the cause of their illness, and ways
to overcome an illness. Healthy practices mean the actions intending for “first do
not harm”. Healthy practices mean to teach or advise patients to use their own non-
specific mechanisms of defense to promote health and prevent illness in order to
live a healthy life.

People will not change their health behaviors unless they believe that they are
at risk. Example: Individuals who do not think they will get the sexual transmitted
disease are less likely to use condom during sex intercourse. People who think they
are unlikely to get malaria are less likely to sleep under mosquito net

Self-assessment 10.7.

1) “Health is determined by the conditions in which we live our everyday
lives” basing on this statement list four conditions in which we live that
determine our health?
2) Explain how health beliefs influence health promotion?

10.8. Health enhancing versus risk-taking behaviors;
           smoking, alcohol abuse, drugs and other
           substance abuse

Learning activity 10.8.

In groups, Discuss about the following topics
1) Smoking and health
2) Alcohol abuse and health
3) Drugs/substances abuse and health

While adults almost always view risk-taking in negative terms, not all risk-taking is
dangerous or detrimental to a young person’s health. In fact, a degree of risk-taking
is essential for personal growth and development: it allows a young person to test
their limits, learn new skills, develop competence and self-worth, and assume
greater responsibility for their life

For some young people, risk-taking is a way of resolving developmental challenges
(for example, a young male who drinks heavily to prove that he is as grown-up
as his peers). For others, risk-taking may be a way of dealing with problems or
escaping unhappy situations or feelings (such as a young woman who engages in
sexual activity in response to her low self-esteem and feelings of worthlessness, or
her experience of sexual assault). While risk-taking behavior can constitute a major
health problem in itself, it may also be an indicator of an underlying problem in the
young person’s life. Angry, acting-out behaviour can mask depression, or it may
reflect the young person’s experience of violence. Risk-taking behaviours which
can have serious negative implications for young people’s health include:

 Early and/or high risk sexual activity
 Drink driving
 Substance or alcohol abuse
 Running away from home
 Dropping out of school
 Criminal activity
 Severe dieting
 Dissociation
 Suicidal thoughts and talk
 Self-harm
 Assaulting others

10.8.1. Smoking
Nicotine is a highly addictive chemical found in the tobacco plant. The addiction
is physical, meaning habitual users come to crave the chemical, and also mental,
meaning users consciously desire nicotine’s effects. Nicotine addiction is also
behavioural. People become dependent on actions involved with using tobacco.

10.8.2. Alcohol abuse
Alcohol abuse or alcohol use disorder is a condition in which a person continues to
consume alcohol despite the adverse consequences.

10.8.3. Drug abuse
Drug abuse is the use of illegal drugs or the use of prescription or over-the-
counter medications in ways other than recommended or intended. It also includes
intentional inhalation of household or industrial chemicals for their mind altering
effects.

10.8.4. Health enhancement versus risk taking behaviours
Drug addiction and other risk taking behaviour have been termed as a disease
because their effects cause permanent changes in the dopamine reward pathway
of the brain leading to compulsive use even after the initial pleasurable effect of the
drug has warm off. Therefore, the repetitive use of the drug leads to craving and
withdrawal symptoms which lead to continuation and maintenance of drug abuse

Self-assessment 10.8.

1) What is nicotine and its effects in human body
2) Explain drug abuse in few words?
3) Why is drug addiction considered as disease?

End unit assessment 10.

From question 1 to 5; select the best answer
1) The term socious derived from which language?
a) German
b) Greek
c) Latin
d) Roman

2) Which are the words composing the term sociology
a) Society and community
b) Socious and Logos
c) Society and Science
d) Socious and science

3) Which among the following is a youngest science?
a) History
b) Sociology
c) Geography
d) Philosophy

4) In biomedical model of health a ‘sick’ organ is best described as being:
a) Depressed
b) Unwell
c) Ill
d) Diseased

5) Which of these is an assumption of the biomedical model?
i. All illness has one underlying cause.
ii. Disease is always that single cause.
iii. Stopping, removing, or minimizing the disease will return a person
to good health.
a) II only
b) I only
c) I, II
d) I, II, III

1) Match terms in column A with their specific definition or example in column
     B

Differentiate the biomedical model of health and the holistic approach of health?
2) How can sociology impact nurses to achieve their primary objective of
      caring?
3) Describe the implication of Religion to health
4) With example describe how negative health believes can negatively
     influence health promotion and illness prevention

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