Sociology: Nurses and their patients in a modern society

3-12

Book

ideals for future services for the elderly or facts about actual services available? No problems either way. it appears. GiLen statistics were scanty. and one had to make too many inferences. Eight) “geriatric consulting rooms” and polyclinics exist nationwide. commonly part of hospital out-patient clinics (some staffed by physician pensioners). In the case of the Uzbek SSR. “the activity of all geriatric institutions is guided by the chief geriatrist of the Republic”. who must therefore be quite some guy. Does he make home visits like the U.K. geriatric physicum’! Yet. one IS left unclear about specialized in-patient resources in general hospitals. being informed only that they do exist for’ research and care. 1968 figures are quoted from Loginova. which imply a need for. rather than availability of. such specialized geriatric units. but on a greater scale than even the U.K. services. Likewise an excessive provision is made for long-term care beds (which the specialized geriatric units are supposed to obviate by rehabilitation and return to the community). In short. these Russian statistics. present or future. looked like American tigures (especially for long-term care beds) arranged on a British board! The specialty of “long-term care medicine” was officially recognized in Sweden in 1969. But one infers that organized in-patient hospital assessment units are exceptional (Vasa Hospital). and that what was described in the Netherlands prevails in Sweden to-specialty-dominated hospital services favoring “acute illness” and rejecting the elderly disabled. Nor does the “long-term care” specialist follow the methods of his British counterpart by screening and assessing the disabled elderly in their homes. So it is little wonder that estimates for long-term care beds approximate American rather than British figures. There is only one professorial post in geriatrics and that “fulfills mainly a theoretical function with medical research”. Surprisingly. the favorable factors of small population size. ethnic homogeneity. and long histories of publiclysupported care for the chronically ill. have brought neither Sweden nor the Netherlands into any more remarkable atate of professional development and organisation (with respect to its older citizenry) than that huge. recently crcatcd. polycthnic society. the United States. Or has your rc\ lcwcr mlsscd something in these non-comparable accounts’! Australia. from Dr. Gibson’s account. has something from cveryhody. Like the USA. there are llourishing pri\atc nursing homes in New South Wales and wide differcncc% from \talc to \Iatc. Like the U.K.. “some large gencral ho\pl(als have applied rhcmselves to the development of dcparrmcnl\ of gcriatrtc medicine and they have conduclctl hospilal and community programs. their activiIIC\ arc likely lo provide the basic models in any future tlcvclopmcm”. Hut “in gcncral Icrms” (it /pmcnt of day hospital and home cart. and academic and \cicnrilic \tandinS. “WC have no money. thcrcforc we tnu\c think”. zaid a rcccnt British Mcdicul Journal leader wit11 rc\pccl IO \tr;~tcgy wlrhin the National Health &vice. I\ that parl of lhc \ccrcl. ” “(;c,r!~trril~ (‘[I).<’ ifI .~llllXlt‘~~~l Sl~c~r(‘lIc~\” rai$c\ \ornc of ~hc facts hut dots not answer the point. cvcn wilh a ~lurdy. pioneering Brit collating the matcrlal.

re\ iews

ing to make comparisons from rhe non-comp3lablc: “The USSR. Great Britain and S\\cden all no\v ha\e estahllhhcL! specialists in sieniticant numbers” But I concludrd that the British Geriatric Ph! s~c~an. the S\\edish l_. Of course. that diverse. hetsro~sncous group of mar\cllous people do present a need for ‘requisite \ariet!‘ 111the responsive roles. systems. and agencies of our socleueb. It is no wonder that nations hake come up \\ith Jltl’erent answers. But if services to the cIderi> are Icft unorpanlrcd and unsystematized. left to develop ;IZ ma! be \itth onl! money guaranteed. are the rcalirtcs 11f the dilTeren[ ‘u,\\\cr> all that different? Take that ambi\alcnt professmnal cornplex called the “general hosp!tal”: al\\a! 5. e\rr!whcrc. except within the British s)slcm. it is reported to be chahing to serve a character of morbidit! out of phabe \\~th the times. while rejecting the morbidit? thar IS. Wh!‘! For future cross-national studies of geriatric medical care. your reviewer cautions againsr the approach ol Brocklehurst et trl.: or perhaps. more faIrI>. it should be done once, and this is it. I would suggest a few princlplcs for a future study: I. First pick a segment of services. an cIderI> charactcristic. or a professional role 10 stud). The elderI> ar.e too heterogeneou< and the ser\,ices too I aricd to be comprehensively studied like this. 2. The contributing team should be truly cross-national and interdisciplinary. not a collection of single author\ each dealing with his own countrk’s superlence. Nor can health care administrators and physicians do it alone. Qualitative analysis and terminologic standardization. a> ucll as study of the social and pohtical origins of similarltlrb and differences. will require the social and behavlorul sciences. Do such teams exist’! Can they he funded’! 3. Format. statistics. and content should enable cornpar,son by reporting institutional and agency heri ices per 1000. 65 years and over, and. even hettcr. for 75 years and oier: by reporting varieties of institutmnal long-term care. not by national name but hy ratio of patients lo nursing-statl’ or by comparisons to the pc’r (lirrn costs of a general hospltal bed in the same area: and by cornparIng professional roles according to operational functions not status titles. And what about the consumer Loice. the disabled elderl) and their families under \h-es? 15 thert‘ actual crushnational evidence of their occr-u\c of XXICL’S which politecians commonly surmise ;ind against which tiscal administrators devise’!

Sociology: Nurses rncl Their Patients In a 3lodcrn Societ!. hq LII,A F. TIIO~II~~)\. MI< II,\II tl. MIII.II< .~nd HII.I\ F. HI(;I I I<.C’ V Mash!. St. LOUI<. 1’)75. Ninth Editton. 2x0 pp. X7.95. While this cIcmcn1;Ir\ tcxthook rcprcbcnt5 an attempt to inlroducc sociology to nursc5. il question remains unanswered ah to who could hen&t from this book. When this lext was lirst introduced in the 1920’s. nursing students were cducared in diploma schools with littlc theoretical background in social Gcnccs. At lhc prcbcnt time. nursing students arc reyulrcd 111 Litud) basic \cicnccs. Onlc lhosc sludents m 7-yr or ~ocatlonal nursing programs are less likely lo have a \ulid ha&ground 111\ocial sclcnces: c\rn these students may lind lhn hook both clcmentary and

Book reviews uninteresting. The material is presented in a style that is simplistic, non-analytical, uncritical, and patronizing Regardless of the audience, students will find little new content and few explanations for the observations and data presented. Probably the most serious weakness of the book is its failure critically to address major defects of the United States health care system. No mention is made of the tremendous rate of growth of the health care industry and the serious financial probiems created for the public and the government. Issues of cost controls, redistribution of resources, over-specialization, poor access to services, and poor quality of services are not noted. No attempt is made to present the political, social, and economic problems of the health system while the authors are actually misleading in their statement that there are no economic barriers to health in this country (p. 6). Even though a spirited debate was occurring about the need for national health insurance and for greater emphasis on public health measures when this book was originally conceptualized, the authors did not allude to these controversies nor discuss why such problems have not been solved in the United States in the last 50yr. The authors utilize a standard functionalist approach without recognition of other theoretical views or an explanation of why they selected theirs. Their traditional analysis does not recognize conflicts within the society or the health system but rather assumes an orderly arrangement of components within society. Even beginning students will wonder about the authors’ contention that the health system is held together by a common “health philosophy”. There is no discussion of the structural basis for the health care system, i.e. industrial technology, market economy, and so&o-political systems. The authors preferred instead to focus on less controversial and less important sociological aspects of population and culture, the structure of communities, major institutions, the hospital, and the individual. Throughout the book, traditional sex roles for both men and women are presented and condoned. In an apparently exhaustive list (p. 9) the authors present the roles of women as nurses, wives, students, and “club members”. Traditional pronouns are used for nurses (feminine) while patients and physicians are considered masculine. The book notes, but does not challenge, the current inequitable practices among professionals such as the dominance of male physicians over female nurses or the fact that male nurses move ‘*rapidly into better paying administrative positions”. The authors actually glamorize and elaborate the traditional roles of nurses as supportive, compassionate. and dedicated professionals who serve as physicians’ helpers. This approach serves to perpetuate the subordinate role of nurses and sexual stereotyping without encouraging critical analysis of either problems or solutions for women in the health professions. The book contains several areas which are both misleading and inaccurate. For example, under a discussion of race (p. 60) the authors make the totally inaccurate statement that blacks have lower rates of hypertension when. in fact, blacks have higher rates than whites. They also insist that blacks have higher rates of tuberculosis, venereal disease. and nutritional problems, erroneously implying that these are genetic or cultural. rather than based upon economic. social. and political factors. including discrimination. Genetically-linked diseases, such as sickle cell anemia and its historical neglect by medical science. are not discussed. One cannot wonder if the inaccuracies and misleading discussion of racial factors throughout this book are not reflections of some historic racial prejudices commonly held by society. rather than simple errors and oversights by the authors. Other erroneous ideas are laced throughout the text. The authors suggest that elderly persons are more healthy noa

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than in the past (p. 58) in spite of the growing problems of chronic disease, environmental pollutants, and other health hazards. Urban and rural differences in health status are noted without taking account of social class differences, and rural populations are considered more unhealthy, in part, because there are fewer hospitals in rural areas (p. 85). Here again, there is no evidence that geographic proximity of hospitals improves the health status of people. In another discussion, the text implies that differences in IQ were generally considered to be genetic rather than environmental until very recently when an author pointed to evidence that environment is an important factor (the footnote to this study was from Time magazine!). This again is ludicrous considering the lengthy historical debates over heredity and environment. One wonders how this text, which appears more appropriate for the 1920’s than for 1976, could have had such demand as to require nine editions. If the nursing profession creates a demand for such mundane and misleading social science books, ignoring theoretical works in sociology, it is little wonder that sociology has been viewed as having little to offer nurses. Ca/@riia Stutr Department

CHARLENE HARRINGTON

qf Health. Sacramento,

Cal$orrtia, U.S.A. Proviaiat for the DissbIad, by EDA TOFUSS.Basil Blackwell, Oxford, 1975. 163 pp. fA.50. ‘The concept of disability is a slippery ow-gliding imperceptibly into disadvantage or deviance unless somewhat arbitrarily defined . . .’ Ms. Topliss shows a healthy respect for

the taxonomy of her subject matter, and has produced a useful guide to the incidence, nature, needs of and support available to the disabled population of this country. It is refreshing to read a comprehensive but dispassionate report in this emotive area. The breadth of coverage will prove most useful for students and newcomers to the field but inevitably leaves something to be desired in the depth -of discussion achieved. The first point that might have been given greater emphasis is that the disabled have nothing in common but their disability: they can be young, old, rich, poor, suffer a static or progressive condition, possess every available appliance and support or be isolated and unaware of the help available. This heterogeneity has prevented the establishment of a panacea such as the National Disability Income (NDI) advocated by the Disablement Income Group (DIG). This is the reason why income maintenance provision has always been related to cause of disability rather than level of disability. The second issue worthy of further discussion is that of stigma and de-fit&ion--not unique to the disabled, but pertinent. Given that a clear definition of disability would make the development of more sharply directed services for the disabled possible, more discriminatory and less universal in their coverage and perhaps achieving better value for money; any such clear definition involves the possibility of stigmatising the disabled recipient and perhaps discouraging him from ‘using the particular service; for example ND1 might run into problems with cases like Ms. Topliss’ example of the woman who refused to admit that she was suffering from multiple sclerosis. The issue is touched on in the chapter on accommodation. which asks--is it better to build a well designed community for the disabled (such as the Fokus Scheme in Sweden) or to make do with less effective equip ment in the community? It seems an unnecessary dilemma in that good design should be available anywhere, but in practice a charismatic project usually produces a higher level of equipment and supporting personnel. With such