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PubMed2005

Bourdieu's theory of practice and its potential in nursing research.

AIMS: This paper seeks to consider the utility of Bourdieu's "Theory of Practice" in nursing, and considers specifically its use as a framework for research exploring nurses' conceptualizations of illness and the patients in their care. Bourdieu's work uses the concepts of field, capital and habitus to explain interactions within the social world. This paper describes these concepts and their relationship with nursing is discussed using dementia care as an example. BACKGROUND: The work of French scholar Pierre Bourdieu has contributed to debates throughout the social sciences, but has had relatively little attention in the nursing literature. Pierre Bourdieu's work developed against a backdrop of change in the academic world. The emergence of the social sciences and the debate around objective and subjective styles of research were influential in the development of his "Theory of Practice". DISCUSSION: The importance of the conceptualization process is discussed, and the considerable potential influence of conceptualization on patient care is highlighted. Reflexivity is a cornerstone of Bourdieu's work, and is an important feature of nursing research. Examples of health care research using his work as a framework are discussed, and some of the challenges of the approach are outlined. CONCLUSIONS: The use of Bourdieu's "Theory of Practice" as a research framework could allow nurse researchers to explore the interactions of nurses with the structures, agents and symbols of illness within the field of care. This work could enhance understanding of how nurses view and react to patients in their care, and promote the development of practice innovations and policy change. The theory may, therefore, have much to offer future nursing research.

Attitude of Health Personnel↗
PubMed1983

Needs assessment and community development: an ideological perspective.

Many practitioners of the social sciences have fostered the value-free, apolitical and ahistorical character of their disciplines. This position distorts the real perception that should permeate the theory, methodology, techniques and practices of the social sciences. This paper, by examining the method of needs assessment, focuses on the undesirability of preserving this point of view. Needs assessment is discussed as a political process for the organization, mobilization and consciousness-raising of groups and communities.

Community Mental Health Services↗
PubMed1998

Establishing the doctor-patient relationship: science, art, or competence?

Establishing and sustaining strong doctor-patient relationships is an important aim in clinical practice, since it is through these relationships that the effectiveness of our work as healers is mediated. In recent years, a research literature emerging from the application of social science to medicine is beginning to highlight certain specific physician behaviors, especially those involved in doctor-patient communication, as actions of considerable importance to both physicians and patients. Successful physicians will further understand that our patients and their families also have high expectations for additional behaviors of physicians, particularly those recognized in the popular culture as professional, respectful of patients' circumstances, and supportive of patients' efforts. To the extent that physicians make an explicit effort to understand and appreciate the "life-world" of patients, and even to modify medical recommendations in order to maximize the meaningfulness and goodness-of-fit of these recommendations, the "art" of medicine also becomes an essential part of routine clinical practice. In the final analysis, new science, art, and behavioral competence are all required for strengthening doctor-patient relationships.

Art↗
PubMed2006

A literature review of palliative care, end of life, and dementia.

OBJECTIVE: Little attention has been paid in research to the palliative care of those dying with dementia. This literature review summarizes current research in the social sciences, including medical sociology on palliative care in the example of dementia. METHODS: A designated set of search words was applied to a comprehensive set of university-based search engines to ensure that relevant social science research since 200 was included. RESULTS: Primary themes discussed in the article include person-centered care, grief, agitation, aggression, pain management, care provision, training and education, decision-making, primary settings of care, and spirituality and dignity. Other key gaps in the literature are discussed. SIGNIFICANCE OF THE RESULTS: Given the projected increase within the next 20 years of people dying with dementia (Hanrahan et al., 2001), palliative care for those dying with dementia will become more relevant than ever.

Caregivers↗
PubMed1996

The nurse researcher: an added dimension to qualitative research methodology.

Nurse researchers are increasingly adopting qualitative methodologies for research practice and theory development. These approaches to research are, in many cases, more appropriate for the field of nursing inquiry than the previously dominant techno-rational methods. However, there remains the issue of adapting methodologies developed in other academic disciplines to the nursing research context. This paper draws upon my own experience with interpretive research to raise questions about the issue of nursing research within a social science research framework. The paper argues that by integrating the characteristics of nursing practice with the characteristics of research practice, the researcher can develop a 'nursing lens', an approach to qualitative research that brings an added dimension to social science methodologies in the nursing research context. Attention is drawn to the unique nature of the nurse-patient relationship, and the ways in which this aspect of nursing practice can enhance nursing research. Examples are given from interview transcripts to support this position.

Humans↗
PubMed2001

Sapir's vision of culture and personality.

For Edward Sapir the concept of culture was a reification of processes that were rooted in individuals' personality and psychology. Sapir suggested that psychiatry's focus on individual biography and pathology gives it unique relevance for social science efforts to understand the mechanisms of cultural transmission and transformation. As a discipline that must integrate culture and biology in theory and practice, psychiatry can provide a corrective to the extremes of biological or cultural reductionism. Although mainstream psychiatry has largely abdicated the role it once had in the social sciences, the interdisciplinary field of cultural psychiatry may meet some of Sapir's hopes. Recent work in cultural psychiatry is centrally concerned with illness narratives that arise from the interaction of personal and collective meaning. Illness narratives may serve individual defensive functions, position individuals in a social world, and help to maintain overarching cultural formations. They also may challenge or subvert existing cultural meanings and create new forms of discourse. The close analysis of how cultural and individual meanings interact that is provided by cultural psychiatry has much to offer the wider field of cultural anthropology.

Anthropology, Cultural↗
PubMed1996

The right to a family environment for children with disabilities.

To access services for children with disabilities, the children often have been required to leave their families of origin. However, social science evidence indicates that there are substantial psychological benefits for children to remain with their families whenever possible. The U.N. Convention on the Rights of the Child (U.N. General Assembly, 1989) supports policies and programs that enable children with disabilities to receive services without leaving their family environment. This article briefly reviews the social science literature and the U.N. Convention, and it documents trends in U.S. law consistent with the implications of the scientific evidence and international consensus. The authors conclude that it is important for the federal government to maintain these progressive programs and policies even as responsibilities for social programs shift to the states.

Child↗
PubMed2006

Diagramming patients' views of root causes of adverse drug events in ambulatory care: an online tool for planning education and research.

OBJECTIVE: Diagram patients' views of the causes of adverse drug events (ADEs) in ambulatory care, examine characteristics of causes reported by patients, and identify those that have been studied in the medical and social science literatures. METHODS: Twenty-two primary care patients were interviewed using a root cause analysis approach. Diagrams derived from interviews were consolidated and displayed online as a composite interactive causal diagram. Patient-reported causes were compared to evidence in the social science and medical literatures. RESULTS: Patients ascribed 164 causes to ADEs occurring through eight major pathways, including medication nonadherence, prescriber-patient miscommunication, patient medication error, failure to read medication label/insert, polypharmacy, patient characteristics, pharmacist-patient miscommunication, and self medication. Most frequently reported causes were intrapsychic and interpersonal in nature. Most patient-reported causes have been studied, however, several practical and motivational antecedents lack research. CONCLUSION: Conducting root cause analysis with patients reveals multiple logically linked aspects of medication safety in community settings that merit further research and consideration in patient and prescriber education. PRACTICE IMPLICATIONS: This causal diagram provides a broadly accessible planning tool for reducing ambulatory ADEs by showing a comprehensive picture of potential causes, identifying causal factors supported by evidence, and disclosing likely consequences of change efforts. Also, patient-centered medication safety strategies should address psychological and practical barriers patients face in their everyday lives.

Adolescent↗
PubMed2006

Who needs 'pukka anthropologists'? A study of the perceptions of the use of anthropology in tropical public health research.

Over the past 50 years, there have been considerable changes both in how medical anthropologists view their relationship to tropical public health and in how tropical public health professionals view the role of anthropologists. In particular, in recent decades critical currents have emerged from an anthropology of medicine, calling for an examination of biomedicine and its conceptualisation of public health. There are parallel debates in public health about a narrow disease-focused or broader socio-cultural approach to improving population health. Based on a review of the literature and a qualitative study of the views of public health professionals and anthropologists working in tropical public health, the data presented in this paper suggest that public health professionals remain unaware of many of the contributions anthropology could make to tropical public health theory and practice. However, the objectives of a critical social science are not dissimilar to those of the broader concept of public health. We suggest that there are grounds for optimism. For those of us concerned not just with disease but also with inequities in health, the challenge is to work towards a critical tropical public health which draws as much from social science as from biomedicine, in theory and practice.

Anthropology, Cultural↗
PubMed2004

Racial science in social context: John R. Baker on eugenics, race, and the public role of the scientist.

In 1974 a British biologist, John Randal Baker (1900-1984), published a large and controversial book simply entitled Race that reiterated persistent eugenicist themes concerning the relation between race, intelligence, and progress. The history of Baker's book is a case study in the politics of scientific publishing, and his ideas influenced scholars associated with later works such as The Bell Curve. Baker, a student of Julian Huxley, was a longtime participant in the British eugenics movement and opponent of what he took to be a facile belief in human equality. In 1942, together with Michael Polanyi, he founded the Society for Freedom in Science to oppose those who advocated the central planning of scientific research. Baker's eugenics, political activities, and views on race express an elitist individualism, associated with the conservative wing of the eugenics movement, that this paper explores in the context of his career as a whole.

Behavioral Sciences↗
PubMed1979

Neurobiology, culture, and behavior disturbances. An integrative review.

The study of the influence of culture on behavior disturbances has a long history in psychiatry. Attention has principally focused on etiological questions and on how psychiatric illness is handled socially, although there is a tradition which deals with the manifestations of so-called functional psychiatric illnesses. In all of these instances, the methods and rationale of the social sciences have been employed and underlying neurobiological factors neglected. However, since a people's culture is learned, it is obviously internalized in some way in the individual. A basic question is how cultural influences may possibly affect the organization and functioning of the nervous system and, by extension, behavior and its disturbances. The relevance of this topic for psychiatry and the social sciences is illustrated by analysis of four prototypical organic psychiatric illnesses.

Alcohol Amnestic Disorder↗
PubMedDate not supplied

Practice development: purpose, methodology, facilitation and evaluation.

Different approaches to practice development are associated with different assumptions, and these need to be made explicit if practice development is to be transparent, rigorous and systematic in its intentions and approaches. A practice development methodology underpinned by critical social science is advocated because it focuses on achieving sustainable change through practitioner enlightenment, empowerment and emancipation and an associated culture, rather than focusing only on technical practice development. Implications of different worldviews about practice development for facilitation and outcome evaluation are highlighted. Emancipatory practice development underpinned by critical social science is argued as synonymous to emancipatory action research.

Critical Care↗
PubMed2000

[A review of socio-behavioural studies on adherence to antiretroviral treatments: beyond biomedical models?].

This paper, based on a review of the literature of socio-behavioural research in this field, shows how the AIDS epidemic has renewed traditional approaches to patients behaviour toward medical treatment by substituting the notion of adherence for the traditional one of compliance. It shows how this issue of patients adherence has come to the forefront of HIV care with the recent diffusion of highly active antiretroviral therapeutics (HAART), because inadequate adherence has profound implications for the individual and public heath effectiveness of these therapeutic advances. The paper argues that two alternatives, and indeed conflicting, approaches to adherence to treatment in HIV infection however persist. The aim of the first approach remains to predict and correct non-adherent behaviour in certain patients and sometimes suggests that such predictions may provide justification for denying individuals treatment. This 'predictive' approach focuses on identification of individual barriers to 'good' adherence and calls on social science research to help improve the 'acceptability' of prescribed regimens for patients. An alternative 'empathic' approach focuses more on encouraging and supporting all HIV-infected patients medically eligible for HAART to devise appropriate individualised plans that can facilitate management of their treatment in their daily life. This latter approach more willingly learns from social science research which recognises the patient's subjective experience of illness as a central concern. In the future, the respective contributions of these two alternative approaches will have to be judged on the basis of their capacity to analyse both the factors which influence HIV-infected patients' initial adherence to antiretroviral treatment and those, potentially quite different, which interfere with adherence on the long term. They will also be judged for their capacity to inspire effective psychological and socio-behavioural interventions aimed at facilitating patients adherence.

Anti-HIV Agents↗
PubMed2000

Borderline personality disorder. Overview of biologic factors.

Exploring the biology of neurotransmitters and polymorphic genes that influence behavior most certainly will increase understanding of the complexity of personality disorders and the people who suffer with them. Continuing biologic exploration of the personality disorders will also provide new and valuable information that will inform and direct ever more sophisticated and specific psychiatric treatments. Further, it will supply knowledge that might begin to erode the strong biases and negative labels that have for too long been applied to these patients. These labels may have been applied not because these patients are bad people, but because of ignorance in understanding their complexity and limited ability to improve their condition. Nonetheless, clinicians must refrain from concluding that the answers to all problems in psychiatric treatment can be answered by the molecular geneticist or biologic researcher. As Reiss et al have written when speaking about nonshared environmental effects and its role in the development of psychopathology: "Psychiatry has been forced into the chronically uncomfortable position of straddling biomedicine and the social sciences and seems always to hunger for relief.... [Yet] the data simply do not permit a conception of the future centered on a straightforward biomedical answer to the fundamental question of the pathogenesis of major disorders. Indeed, a balanced image of the future contains a growing and equal partnership of the social sciences and molecular biology."

Borderline Personality Disorder↗
PubMed1984

The patient's view.

Deference to the importance of the patient's view has recently become a major feature of much medical practice and social science research. This paper, however, argues that attempts to establish the authentic version of what the patient says is misplaced as investigation can only reveal what is heard, not what is said. The changes in perception which enable some things to be heard, and not others, are traced through medicine and the social sciences during the last 50 years and it is suggested that recent interest in the validity of the patient's view are no more than artefacts of these changes in perception.

Attitude of Health Personnel↗
PubMed2005

Validity of measures is no simple matter.

PURPOSE AND METHOD: This article aims to promote a better understanding of the nature of measurement, the special problems posed by measurement in the social sciences, and the inevitable limitations on inferences in science (so that results are not overinterpreted), by using the measurement of blood pressure as an example. As it is necessary to raise questions about the meaning and extent of the validity of something as common as measured blood pressure, even more serious questions are unavoidable in relation to other commonly used measures in social science. The central issue is the validity of the inferences about the construct rather than the validity of the measure per se. CONCLUSION: It is important to consider the definition and validity of the construct at issue as well as the adequacy of its representation in the measurement instrument. By considering a particular construct within the context of a conceptual model, researchers and clinicians will improve their understanding of the construct's validity as measured.

Blood Pressure Determination↗
PubMed2003

From neurons to neighborhoods: old and new challenges for developmental and behavioral pediatrics.

Rapidly advancing research in neurobiology and the behavioral and social sciences, coupled with dramatic changes in the social and economic circumstances under which families are raising young children, has created a highly dynamic context for early childhood policy, service delivery, and child rearing in the United States. A recent report from the National Research Council and the Institute of Medicine, presents a critical analysis of that complex knowledge base and a set of recommendations designed to close the gap between what we know and what we do to promote the healthy development of young children. This article examines the report through the lens of developmental and behavioral pediatrics and highlights both exciting opportunities and sobering challenges.

Behavioral Medicine↗