This essay will address how psychological and sociological insights help nurses to understand health lifestyles by exploring life sciences, focusing on people who engage in smoking and how they seem to override the fact that they are putting their health at risk. In addition to this I will also be highlighting statistics and briefly discussing the health complications that develop from smoking. Consequently, it is important for nurses to understand how people function, more so when they are healthy so we know how to help when a health problem arises. Functioning as a person involves social and psychological aspects, as well as having functioning body systems. Over the decades there have been many different explanations on how people function, this essay will discuss psychological and sociological ideas that will give nurses an understanding of people’s behaviour, thoughts, feelings and lifestyles. For this purpose, this essay will be reflecting on the psychological perspectives of social learning theory, unrealistic optimism and the health model locus of health.
Secondly, it shall be discussing the sociological perspectives of socio-class and low-incomes and socialisation to discover why people may start to smoke and why people continue to smoke knowing the risks involved. Ironically, as recent as the 1940’s smoking was considered harmless and the overall attitude of people was that smoking relieved tension but research has since confirmed that smoking causes many diseases detrimental to one’s health such as cancer, cardiovascular and lung diseases. Smoking is a greater cause of death and disability than any single disease, says the World Health Organisation (WHO). According to WHO, smoking is responsible for approximately five million deaths worldwide every year (WHO, 2012). Presently, in the United Kingdom smoking is the leading cause of death with 120,000 people dying annually due to smoking related diseases and costs the National Health Service (NHS) the sum of £2.7 billion to provide health care for people with smoking related illnesses (Department of Health, 1998).
Even so, people still continue to engage in this life threatening behaviour despite knowing the dangers and risks that it involves. Therefore, as nurses we need to consider how addictive smoking is to some individuals (Rana, Upton. 2009) this can influence the health choices people make. Health psychologists attempt to predict how people make choices about their lifestyles. According to Albert Bandura’s theory (1965,1991) on social learning suggested that learning can occur not only by association, reward and habitation but also by observing others behaviour and by imitating it and does not require the individual to be actively involved in the learning process (Barker, 2007) this is referred to as vicarious learning through modelling. The social learning perspective implies that smoking behaviour is learned by modelling and social influences (Rana, Upton, 2009).
Statistically, most smokers start smoking as teenagers (Payne, Walker 1996) and children are more likely to smoke if their parents smoke and their parent’s attitude to smoking is an important factor (Action on Smoking and health, 2011).Valente et al (2005) suggests that one of the main reasons for adolescents to start to smoke is the influence of peers and siblings and parents generally become less influential ( Rana, Upton, 2009). Therefore leads us on to social influence, this refers to the way in which people’s behaviour is influenced by the presence and actions of others (Cialdini, 2004). Despite knowing the health risks of smoking, young people still conform to engage in smoking as the number of young people who smoke remains the same (ASH, 2012). Some will manage to quit but a good percentage will endure to smoke for decades, this increases the risk substantially in developing illness and early death (Department of Health, 1998) even though 7 out of 10 adults say that they would like to give up but continue to smoke, the reasons for continuing they say it is a way of coping with stress, a way of relaxing and women seem to be anxious with putting on excess weight.
Understanding when and why the individual started to smoke and the reasons for continuing can help the nurse understand more about the individual’s lifestyle. The nurse can then offer support and advice on how the individual can use different strategies enabling them to overcome these hurdles and promote the health benefits of quitting smoking. In an attempt to explain why individuals continue to damage their health by continuing to smoke, Weinstein (1983, 1984) suggests that the reasons people often engage in unhealthy behaviour is due to the individuals perceptions of risk and susceptibility are inaccurate (Rana, Upton. 2009). A study carried out by Weinstein, he asked subjects to examine a list of health problems and to rate their chances of developing the problem, compared to others of the same age and sex.
The outcome of this study showed that most of the subjects believed that they were less likely to develop the health problem. Weinstein called this phenomenon ‘unrealistic optimism’, as he argued that not everyone can be less likely to develop an illness (Ogden, 2007). He claims that individuals ignore their own health risks and smokers convince themselves that they are not at risk of developing illnesses, as much as other smokers. Many smokers have the belief that if there is not a problem now there will not be one in the future and their lifestyle continues knowing the risks. This model can be used in nursing to help the nurse to understand the attitudes of most smokers. Understanding the attitudes the nurse can help promote healthy lifestyle choices by providing the individual appropriate information about the impact that smoking has on their health. Reasons for continuing this lifestyle can be explained using the Health Locus of Control (HLC), people’s attributions about health and illness.
For instance, Wallaston & Wallaston 1982, states that internal control is when individuals tend to regard the control of their health there responsibility by believing that their health and recovery of illness are dependent on their own actions (Payne, Walker. 1996) or they believe it is down to fate or luck this could relate to people that continues to smoke. Whereas external control is when the individuals believes their health is not controllable by them and is controlled by powerful others, for example; doctors and nurses and are less likely to take their own action and believe that it is the responsibility of external factors. The health locus of control has been shown to relate to whether the individual changes their behaviour towards smoking. External individuals who wish to give up smoking will generally be more complying to change their lifestyle and seek advice and help from health care professionals more so than internal individuals (Odgen, 2007).
Nurses can apply this model to people with external HLC who are considering giving up smoking by providing the appropriate information enabling the individual to seek help from the available sources and work alongside them to devise a programme in which will benefit them (Rana, Upton. 2009). The sociology perspectives look at the social world and differences in lifestyles that can influence the individual’s health. Studies have shown that inequalities in health is not just down to ones behaviour but displays a connection to the social and economics and environment all of which influence peoples lifestyles (Taylor, Field. 2007). The Black Report 1980 inevitably found that poor health and earlier deaths are the magnitude to socio-economic inequalities (Denney, Earle. 2010).
The socio economic classes are still divided as the prevalence of smoking regular among people who work manual jobs are more than likely to smoke more so than people that work in non manual jobs ( Action on Smoking and Health, ASH. 2012), (appendices 1.1). Smoking prevalence is an important element of the differences in the state of health and death rates between social classes and remains high among men and women in the lower socio economic group (Richardson, 2001). As nurses we need to be aware of the social world in which we practice, understanding the differences in how people live will determine the lifestyle choices they make (Marsh, Keating. 2006). Nurses must consider the factors underlying the socio economic differences in smoking such as occupational status, income, education, housing and environment. It may be considered that the decision to smoke is influenced by social factors and social circumstances of the individual.
The behaviour of smoking is often linked to poverty and illness, as the poorest family group- single parents have the highest rates of smoking an 80% chance of being smoker if you fall into this social class (Crosier, unknown). Marsh and McKay (1994) reported that people who are living on low income are most likely to smoke; least able to quit smoking; least able to afford smoking; most likely to suffer increased hardship due to the expenditure on tobacco (Richardson, 2001). The debate about women and smoking illustrates this well. Despite over the past decade, the number of people smoking has declined but only has shown a small decrease in women smoking, yet the differentiation between the working and middle class women has increased (Nettleton, 2006). Research into women in low income families with young children, smoke as it is a means of a coping strategy to help deal with the multiple demands that are placed upon them.
Graham (1987) found that mothers on low incomes used smoking as a coping strategy that could provide ‘time out’. The mothers where all aware of the health risks associated with smoking so providing more education was unlikely to have an impact (Scambler, 2008). The nurse would, however, have to address that the added pressure for the mothers on low incomes, to give up smoking may cause more stress and could lead to additional health implications, as a result this could have a negative impact on their lives (Bury, Gabe. 2004).It is the nurses role to address this issue by providing appropriate support and information on alternative ways of coping with stress, whilst retaining their autonomy (Naidoo, Wills. 2004).
Socialization is more often than not the main reason for people to start smoking, as 82% of adult smokers started smoking in their teenage years (ASH, 2012), as adolescences are more than likely to indulge in risk taking behaviour such as smoking, to create a sense of belonging to a peer group (Clarke, 2010), this soon becomes a regular daily smoking pattern, sustained by nicotine addiction but is reinforced by social norms (Ewles, 2005). It is a nurse’s role to help change of attitudes of the younger society by continuing to provide education on the addiction of nicotine and health risks of smoking and prevention of disease.
The Department of Health brought about The White paper: Smoking Kills (1998) as they recognised the health issues of smoking and that one of their main concern was the rises in children /adolescences smoking, Appendices 1.2. They have put in measures to reduce smoking among the younger generation by minimilising tobacco adverts in shops, proof of age cards were introduced and the age to purchase tobacco has risen from 16 to 18 years old. Although in general we are living healthier and longer lives due to the overall improvements that has been made throughout the past decades there is still room for improvement in health inequalities within the top and bottom ends of the social scale (Clarke, 2010). To conclude, nurses need to understand the principles of psychological and sociological insights to health lifestyles.
As a result, this helps the nurse understand the reasons why people choose to take up smoking and continue to smoke, leading a lifestyle that is detrimental to their health. From exploring these life sciences the nurse will have a better understanding of the different attitudes, health beliefs, thoughts and feelings that differ within the socio-economic classes, this gives the nurse the ability to deliver the holistic approach relevant to the individuals needs.
As nurses by providing care to people, more often than not we do not share the same values and beliefs and may not agree with the life choices people have made but gaining an insight to their lifestyle will in turn enable us to provide the appropriate support, information and treatment. Nurses are obliged to promote good health behaviour but this does not always work towards smoking, many people will take the advice and may try to quit smoking (Appendices 1.3) but due to demands of life some have a tendency to start again but we must realise as nurses, smoking is an addiction and is not easy to give up it, so we have to respect the individuals lifestyle choices without being judgemental.
Courtney from Study Moose
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