SOC 301 EXAM 1
Davis (1972:46) found that the majority of students sought nurs- ing training
"as a kind of life insurance," should marriage and having a family not occur or should the marriage be less than ideal and result in "childlessness, divorce, premature widowhood, excessive financial burdens, or boredom with the home."
Genetic or genomic information may also furnish the basis for
"designer" drugs tailored to match the DNA (deoxyribonucleic acid) of a particular individual and provide more precise healing with fewer side effects. This approach is leading to the establishment of personalized health care or personalized medicine programs that are intended to provide care customized to meet the specific needs of individuals.
there are signs that gender inequality is losing some of its power in nurse-doctor relationships. The changes appear to be the result of three developments:
(1) greater assertiveness by nurses (2) increased numbers of male nurses (3) the growing numbers of female doctors.
there are currently three types of programs available for RNs
- 2 yrs ADN - hospital based diploma programs (2 1/2 - 3 yrs) - 4 year BSN
nurse practitioner/clinician
- a registered nurse trained in the diagnosis and management of common ailments needing medical attention. - provide some of the same care as physicians, but are limited in the types of treatment they can provide to patients - work is supervised by a physician who can be called to assist if necessary - allows doctor to concentrate more on complex probs
first accredited schools of nursing in united states
- bellevue hospital in nyc - connecticut training school in new haven - boston training school
ADN programs
- inexpensive - place graduates on the same career track as graduates of diploma and baccaluareate degree schools - have become the largest single source of nurses in the United States. - work role has expanded into supervisory and management functions. - these programs are more vocational than professional
six distinct stages of socialization (nursing students)
- initial innocence - labeled recognition of incongruity - psyching out - role simulation - provisional internalization - stable internalization
male physicians + women pt
- males lack sensitivity -> lead to formation of womens health movement (organizations evolved to advocate natural childbirth, midwifery, home childbirth, abortion rights, etc) - some male physicians exhibit sexist attitudes and behavior towards their women pt and health workers - fail to be sensitive to the needs and complaints of women seeking care ex: fisher research = women were not satisified with their treatments. treatment decision were not in womens best interest.
social history of doctor - pt relationship
- medical profession went from low status occupation to highly respected scientific field - image of caring physician and trusting pt ended by 1960s - doctors became more distant and pt grew more active and informed - high cost of care, doctors high salaries, superior attitudes, organized opposition to health reform caused pt to become disillusioned - doctors became resentful about pt and others who questioned their commitment
strongest influences on compliance
- motivation to be health - a perceived vulnerability to an illness - potential for negative consequences - effectiveness of the treatment - sense of personal control - effective communication
today's doctor patient interaction
- pt are more active, seek multiple forms of care and often have needs that are long term, have risk based strategies - physicians find more actors who intervene in their relationship with pt = insurance comps, government regulations, managed care systems - less paternalistic towards pt, more willing to share decision making with them
information can be an important therapeutic tool in medical situations if it meets three tests
1) reduces uncertainty 2) provides a basis for action 3) strengthens the physician-patient relationship
the most prestigious nursing program
4 yr BSN intended not only to provide training in nursing skills and theory but also to provide the background for becoming a nursing educator or leader.
florence nightingale
An English Protestant from a respectable middle-class family - believed god called her to the service of christianity as a result of a vision - established a hospital for "Sick Gentlewomen in Distressed Circumstances" and staffed it with trained nurses from good families. - insisted that nursing was intended to become an honorable and respected occupation, achieve this purpose through a formal training program with recruits from upper- and middle-class social backgrounds.
nurses + today
BSN rns have expanded their range of services to include hospital administration, primary care healing, nurse anesthetists, cardiovascular nurse specialists, and other areas of specialization in nursing
how is technology affecting the doctor pt relatioship
Electronic monitoring devices will allow the patient to keep track of his or her physical and mental state and report these to physicians or databases by computer Physicians may be consulted by means of home computers, electronic mail, Skype, or teleconferencing, rather than in person. A computer can be used to diagnose the patient's ills and determine treatment. Prescription drugs may be ordered electronically and delivered to the patient. Questions by patients can also be answered
Shu-Fen Tseng and Liang-Ming Chang (1999) compared doctor-patient relationships in Taiwan on the Internet and in face-to-face visits in a community hospital.
For both groups of patients, mutual participation was the most common form of interaction with physicians. those patients who visited doctors in person expressed more confidence in physicians and relied on doctors more to treat their ailments than online users. The online users showed less confidence in doctors, less compliance with a physician's instructions, and a greater willingness to use alternative medicine also indicated a strong preference for continued use of the Internet for physician consultations and medical information. online users did not rely exclusively on the Internet but visited physicians when necessary. The Internet often served as a "second opinion" on their health problems.
court case with genes
NYC, judge invalidated patents belonging to myriad genetics fo two genes (BRCA1 AND BRAC2_ linked to ovarian and breast cancer they patented a 3k test for these genes that showered whether a woman was at high risk for either cancers caused other labs to not be able to do research on the genes and develop similiar tests court ruled that genes are products of nature and fall outside of boundaries of objects that can be patented
the Crimean War afforded Nightingale a much better opportunity to establish nursing as a formal occupation....
She organized a group of nurses and, assisted by money raised by public subscription - she and her group sailed for the Crimea - Once there, Nightingale offered to the British military authorities the nursing services of her women for sick and wounded troops. - at first the military refused to employ her nurses -> then she refused to allow any of the nurses to provide care -> worked only when assistance was requested by physicians
What are the models of doctor-patient interaction?
Szasz and Hollender. Hayes-Bautista
why is the nurse seen as a mother figue
The registered nurse, in turn, supervises lesser-trained females (practical nurses and nurses' aides) and lesser-trained males (orderlies and attendants).
The rapid progress in genetics following completion of the Human Genome Project has attracted considerable attention from medical sociologists b/c
This advance forecasts a potential change in doctor-patient interaction, as patients learn through genetic screening what diseases they are likely to get and what measures are needed to treat them.
the results of the Human Genome Project provide researchers with
a map of the human genetic code.
controversy surrounding genetics
abortions available for fetuses identified with gene defects cloning privacy use of genetic information control and ownership of genes
consumerism
an identifiable pattern among many americans the consumer wants to make informed choices about the services available and not be treated as inferior patients have more status
contrary to the conclusions of previous studies, many nurses now regard their employment
as a career
auxiliary nursing personnel
assist registered and practical nurses by performing less skilled medical care tasks and by providing many services designed for the overall personal comfort and welfare of patients.
why was nightingales hospital not entirely successful
because of the role conflict between the duties of the nurse and the prevailing standards of proper behavior for "ladies." Some of her nurses, for example, were reluctant to view nudity or to be present at physical examinations
primary task of licensed practical nurses
bedside care of patients. They may also assist in the supervision of auxiliary nursing workers, such as certified nurse's aides (CNAs), orderlies, and attendants.
Nightingale's approach to nursing training emphasized a code of behavior that idealized nurses as
being responsible, clean, self-sacrificing, courageous, cool headed, hard- working, and obedient to the physician and possessing the tender qualities of the mother. "disciplined angels"
How does the Szasz and Hollender model show how the physician-patient relationship is affected?
by the severity of the pt symptoms
with the social turbulence associated with the civil rights movement and the vietnam war, the relationship of individuals to authority began to
change in the united states
secular nurses
characterized as "women off the streets" or "of bad character," who were considered little or no better than the low class of patients for whom they provided their services.
role simulation
characterized by students performing so as to elicit favorable responses from the instructors. The approved mode of behavior was the exhibition of an objective and "professional" (detached) attitude toward patient care, which included an understanding of the principles behind nursing techniques as well as mastery of those techniques. Many of the students felt they were "playing at acting like a nurse," and they questioned their lack of conviction about the role. the more successful they became at convincing others that their performance was authentic, the more they began to gain confidence in themselves as nurses. This stage usually came at the end of the first year.
women doctors can be hindered in
combining a demanding career with motherhood, especially if they have young children a mother either has to find a position with flexible hours and pays less or fewer hours on the job
key for avoiding noncompliance
communication
compliance requires
comprehension by the pt
development of computerized information highways
connects pt computer to those of doctors, hospitals, drug companies, medical suppliers, health insurers, medical databases allows them to obtain health information directly from their own computer rather than visiting a physician
Nursing activities in hospitals were viewed as acts of charity because they were usually carried out under
difficult and unpleasant circumstances, as nurses served the personal needs of patients who were usually dirty and illiterate as well as diseased. (this was seen as an act that could help u attain spiritual salvation by the church)
a successful doctor- nurse game creates a
doctor-nurse alliance and allows the doctor to have a good "score" by gaining the respect and admiration of the nursing staff. The nurse, in turn, scores by being identified by the physician as "a damn good nurse." If the doctor fails to play the game well, pleasant working relationships with the nurses may become difficult, and the doctor may have problems of a trivial yet annoying nature when it comes to getting his work done.
Not only is the Internet providing individuals with an abundance of health information, but also
electronic support groups (ESGs) are forming among people with similar health needs who wish to share their experiences online and develop greater expertise.
how have third party payers affect the doctor-patient relationship
ex: medicare, medicaid, private health insurance companies and managed care programs they monitors the number of pt seen by physicians, amount of time spent with them, micromanage the physicians clinical decision they decide whether they will reimburse a physician for his or her services and how much they will pay - the shift in the states role from protecting the medical profession to protecting corporate health care interests to reduce costs - the proliferation of commercial products for the body that the pt can use independent of the physician - rise of chronic disease
labeled recognition of incongruity
feelings of frustration, which usually came during the first semester of training, generated the second stage nursing students began to collectively articulate their disappointment and openly question their choice of becoming a nurse At this point, a number of students resigned from the school because they did not or could not adjust to the incongruity between pre-nursing expectations and actual training.
how do female and male physicians differ
female = more empathic and egalitarian in their relationships with pt, more respectful of their concerns and more responsive to pt psychosocial difficulties women doctors also stress their value to pt and use words like help and care male = tended to speak only of their technical skills and choices of appropiate treatment when they assess their accomplisments
The registered nurse, who has the most advanced training and professional qualifications of any of the nursing workers, is generally a
female who is matched occupationally with a physician, whose role is dominant and who, in the past, was likely to be a male although this distinction is rapidly changing.
biographical medicine
focuses on pt oral account of his or her medical history
Nursing students have traditionally been characterized as
having lower-middle-class and working-class social origins, often from small towns or rural areas, who are attracted to nursing as a means of upward social mobility.
Nursing tasks occur in a system of social relationships that were
historically stratified by sex.
Although they were intended to be separately administered, the new nursing schools were affiliated with
hospitals that provided financial support and required, in turn, that the students furnish much of the nursing services on the hospital wards.
who are known for trying to retain decision making authority for themselves and to present information to their pt and their families that justifies action
icu physicians and surgeons
The interest of medical sociologists in genetics is in
infancy ex: can genetic testing become a form of social control, and if so, what are the consequences for the individual and society? such testing could lead to new forms of stigma and discrimination, as people are classified according to their genetic traits and potential for a healthy life.
techno medicine
involving the extensive use of advanced technology for testing, diagnosis, and the scientific determination of treatment in a more differentiated world of health care delivery
the original focus of nursing
its primary focus as religious activity was in spiritual considerations. Nuns were not under the authority of doctors, and they could refuse any orders they did not believe appropriate for themselves or their patients. Nuns were also reported to have refused to treat certain categories of patients, such as unwed mothers or persons with venereal disease
female physicians + nurses
less likely to play the doctor nurse game with either male or female nurses they are more likely than male physicians to have their actions questioned by nurses
some pt may perceive women physicians as
less of an authority figure than male physicians
those pt with dissimilar class backgrounds to their physicians are
likely to find communication more difficult because their communication style is different
how does class affect the doctor-pt relationship
lower class = more passive, show decreased sense of personal control middle and upper class = more consumer oriented as discerning seekers and active participiants, more likely to try and negotiate with doctors and involve themselves as partners in decision making about their medical problem
the two groups in society who have been identified as generally having the most communication problems with physicians
lower class and women
From the perspective of hospital administrators, registered nurses can be used more economically in managerial and supervisory positions, because
lower-paid personnel are available for bedside tasks.
What is clearly evolving is not just e-health (electronic health), but
m-health (mobile health) as people use their mobile devices to acquire information that was formerly obtained from health care providers in face-to-face or telephone conversations.
mutual participation (Szasz and Hollender)
management of chronic illness in which the pt works with the doctor as a full participant in controlling the affliction. pt modifies their lifestyle (changing diet, stop smoking, etc), responsible for taking medication on time. ex: diabetes or heart disease
top specialities such as surgery and internal medicine were characterized as
masculine with traits like toughness, macho and demanding
one example of male physician misperceptions about female patients
misdiagnose heart attacks as stomach or anxiety problems, even when a women has signs of a heart attack (chest pain, numbness on left side)
doctors from upper-middle class backgrounds communicated...
more info to their pt than doctors with lower-middle or working class origins
pt who are similar to the physician in social class are
more likely to share their communication style and communicate effectively with them
The general rule of law that has recently emerged is that genes are
naturally occurring organic matter, not something invented by humans, and therefore cannot be patented.
What does the szasz and hollender and hayes-bautista model suggest
non emergency situations = patents are not as passive when interacting with their doctors in health matters
the doctor-nurse game today
nurses are no longer willing to be treated as mere subordinated by physicians - declining public esteem for doctors b/c of widespread questioning of the profit motive in medical practice + greater recognition that physician makes mistakes - increased number of women doctors - nursing shortage has emphasized to doctors the value of highly trained, competent nurses - most nurses today are educated in academic settings - womens movement may be encouraging nurses to define their own roles with greater autonomy
who represents the largest single group of health workers in the US
nursing
initial innocence
nursing students wanting to do things for patients within a secularized Christian-humanitarian ethic of care and kindness, consistent with the lay (mother- surrogate) image of nursing. feelings of inadequacy, worry, and frustration, as the nursing instructors failed to support the lay image of the nurse. Nursing faculties have tended to insist on students viewing their patients objectively, and this tendency has operated to de-emphasize an intimate nurse-patient relationship. Instead, the students were directed toward seemingly inconsequential tasks of patient care, such as making beds and giving baths.
Nursing was an attractive occupation for many of these women who immigrated or migrated, because it afforded an
opportunity for a woman to make a living and also to have a respectable position in the community.
with the increasing perception of nursing as a career in itself, the notion that nurses regard their first priority as finding a spouse is
out of date
most important factor engendering trust in the doctor-pt relationship
physicans behavior
Szasz and Hollender
physician-patient interaction falls into 3 possible models Activity-passivity Guidance-Cooperation Mutual Participation (the norm)
the essence of the doctor-nurse game
physicians and nurses agree that the physician is superior and this hierarchical structure must be maintained. nurses may make recommendations to doctors as long as they appear to be initiated by the physician and disagreement is avoided
Prior to the late nineteenth century, hospitals were generally defined as
places for the poor and lower social classes, often little more than "flophouses." richer ppl were treated at home
Guidance-cooperation (Szasz and Hollender)
pt has an acute, often infectious illness such as the flu or measles. pt knows whats going on and can cooperate. physician still makes the decisions. pt just follows his or her physicians guidance
Activity-Passivity (Szasz and Hollender)
pt is seriously ill or being treated on an emergency basis in a state of helplessness. (severe injury or lack of consciousness). physician is working in a state of high activity to stabilize pt condition. DECISION MAKING AND POWER IS ON THE DOCTORS SIDE. PT IS PASSIVE, CONTRIBUTES LITTLE OR NOTHING
Hayes-Bautista
pt try to modify the treatment prescribed by a physician physicians respond by pointing out their expertise (ur health will be threatened if treatment is not followed properly / treatment is correct, progress is just slow ) physicians take on roles such as educator, detective, negotiator, salesperson, cheerleader, and police officer to induce pt adherence)
registered nurses
responsible for the nature and quality of all nursing care patients receive, as well as for following the instructions of physicians regarding patients. also supervise practical nurses and other health personnel involved in providing patient care
There is already new computer technology and software available for use in doctor's offices and local laboratories that can
sequence (put in order) an individual's genome that can be used to determine that person's genetic probabilities for cancer, rare diseases, and responses to drugs. Not only will such screening anticipate an individual's susceptibility to various diseases, but gene therapy also has the potential to eliminate many afflictions before they happen.
specialities like family practice, pediatrics and psychiatry were considered
soft
genetic testing makes it possible to learn about
someone's likely health future that even that person may not know. Genetic information therefore has unique implications for families and groups, and this information is potentially valuable to employers, insurance companies, researchers, and pharmaceutical firms who would use it for their own purposes.
A major barrier to effective communication lies in the differences between physicians and their patients with respect to
status education professional training authority
top specialities were open to women but women moving into these fields tended to
take on masculine traits such as being assertive, highly professional, and not expressing warmth to be successful
gender bias and uncertainty in primary care doctors diagnostic decisions about coronary heart diseas
the diagnostic model of coronary heart disease held by physicians fit male symptoms better than females female docs were more attentive to pt comments and medical histories, especially women -> but women did not receive better quality care male doctors were less influenced by gender in making diagnosis both male and female physicians paid particular attention to a male pt age and considered more age-related diseases for men than women
The last two years of nursing school were characterized as
the fifth stage of provisional internalization and the sixth stage of stable internalization. During these final two stages, the nursing students took on a temporary self-identity as a "professional" nurse, as defined by the faculty, and settled into this identification by the time of their graduation.
major source of nurses in the United States had traditionally been
the hospital- based diploma school
psyching out
the nursing students attempted to anticipate what their instructors wanted them to know and to concentrate upon satisfying these requirements Although some students may have attempted to "psych out" the instructors from the very beginning, it now became a group phenomenon, with the entire class collectively participating in the process.
doctor-nurse game
the object of the game is for the nurse to be bold, show initiative, and make significant recommendations to the doctor in a manner that appears passive and totally supportive of the "super-physician." central rule = avoid open disagreement between the players. requires nurse to communicate a recommendation without appearing to do so, while the physician, in seeking a recommendation, must appear not to be asking for it
a major characteristic of the clinical consultation
the physicians dominant role in the encounter they control and guide what should be don their focus is limited to medical issues
Following the rise of Christianity in the Western world, the practice of nursing as a formal occupation was significantly influenced by
the presence of large numbers of nuns who performed nursing services under the auspices of the Roman Catholic Church.
The study of gene-environment interaction, along with research on the social use, privacy and control of genetic information, risks, and ethics of genetic research has promoted the birth of a new field in medical sociology:
the sociology of genetics
types of cloning
therapeutic (organs) or reproductive (people themselves)
male nurses tend to disrupt the traditional gender role of submission for nurses b/c
they are not as likely to play the doctor-nurse game they are also more likely to express their feeling and have it accepted by male doctors
The idea behind gene therapy is simple
to treat or cure disease by giving patients healthy genes to replace defective ones.
While the licensed registered and practical nurses and nurses' aides are generally women, orderlies and attendants are
usually men employed to care for male patients and perform whatever heavy duties are required in nursing care.
relevance of hayes-bautista model
view of interaction as a process of negotiation, rather than the physician simply giving orders and the pt is following them in an automatic, unquestioning manner
can cultural differences affect the physician patient relationship
yes some pt may describe their symptoms dif (irish vs italian) difference in languages causes a barrier (hispanics who speak little or no english) difference in beliefs this can cause pts to not receive all necessary information and fail to request doctors to provide more
