Theoretical foundation to the study: symbolic interactionism

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CHAPTER 3 Theoretical foundation to the study: symbolic interactionism

INTRODUCTION

Symbolic interactionism (SI) seeks to explain relationships among human beings and human beings and their environment in this study. SI has been selected as the theoretical foundation to complement the grounded theory design used. A brief discussion on the symbolic interactionism in terms of its historical background, definitions, main focus and major concepts is presented as well as its application to this study is presented.
The philosophy was chosen by the researcher because of its social constructionist approach to understanding social life that focuses on how reality is constructed by active and creative role actors who in this study are the nurse and the patient. The researcher had interest to investigate how nurses create meaning during their social interaction with patients in the context of provision of spiritual nursing. The theory seemed appropriate to assist the researcher to identify how nurses in a health care context construct their identity (‘I’, ‘me, and ‘self’) as professionals and how they define situations that impacts on the demand to provide holistic patient care. One of the central ideas of the perspective is that people act as they do because of how they define situations. It is also concerned with the way of how individuals and people from different cultures and religious backgrounds interpret symbols of communication and how behaviour is influenced towards the other (Blumer1969:7). The tenets of the philosophy are amenable to qualitative methods of research which was the research approach of choice for this study.

DEFINITIONS OF SYMBOLIC INTERACTIONISM

Definitions of symbolic interactions indicate that this concept is used to refer to a theory, a process and an investigative approach.
Symbolic interactonism as a theory is defined as:
“… a theory which focuses on the manner in which people make sense of social interactions and the interpretations they attach to social symbols such as language” (Blumer 1969:16).
“… an approach that focuses on symbols and meaning in interaction” (Glaser 1978:47; Glaser & Strauss 1967:45; Strauss 1987:78-85).
“… an interactionist theory, which helps to illuminate how human beings define their experiences and give meaning to their identities, behaviours, realities and social interactions (Hewitt 2000:49)
“… a sociological perspective that stresses the way societies are created through the interactions of individuals” (Dictionary of the Social Sciences 1987).
Symbolic interactonism as a process is defined as:
“… a process of interaction that leads to the formation of meanings for individuals” (Blumer 1969:12).
“… the peculiar and distinctive character of how humans interact with one another “(Blumer 1969:18).
“… a very complex process by which ideas are converted into social facts” (Dictionary of Critical Sociology 1989).
Symbolic interactonism as an investigative approach is defined as:
“… a study of the intersections of interaction, biography and social structure in a particular historic moment” (Denzin 1989b:15).
“… a social constructionist approach to the understanding of social life that focuses on how reality is constructed by active and creative actors through their interaction with others” (Rice & Ezzy 2002:17-18).
SI can therefore be defined as a conceptualisation of communication between and amongst individuals or individual and the environment using language, actions, behaviour, expressions and objects to create meaning. In this study, SI relates to the analysis of the provision of spiritual nursing care as a social process of interaction or relationship between the nurses and the patient in a health care environment.

HISTORICAL ORIENTATION ON SYMBOLIC INTERACTIONISM

Symbolic interactionism is one of the important theoretical perspectives in sociology and social psychology (Griffin 1997:19) which has its roots in American sociology (Rice & Ezzy 2002:17-18). It has a long intellectual history, beginning with Weber (1864-1920), who was a German social psychologist from Chicago sociological tradition, who believed that human beings are best understood in a practical and interactive relation to others and their environment (Goffman 1958:12-13). This notion is relevant to the current study that seeks to explore how nurses provide spiritual nursing care in the context of health care.
Mead (1863-1947), as cited in Jeon (2004:250), is considered to be the founder and philosophical progenitor of symbolic interactionism. Amongst the classic American pragmatists, Mead was the principal precursor of SI. Mead’s (1934:7) interest in symbolic interactionism was prompted by essentially philosophical questions concerning the essence of language, its perceptual process and epistemological implications, and the prerequisites for scientific enquiry. While Mead’s contribution was primarily philosophical, Blumer (1969), who further advanced SI, was more concerned with aspects of sociological theory and research approach (Blumer 1969:7; Goffman 1958:12-13; Griffin 1997:18; Jeon 2004:250; Lynch & McConatha 2006:89). Blumer (1969:1) explains that SI represents a “relatively distinct approach to the study of human group life and human conduct”, and has practical consequences in its bearing to human interest and behaviour. In this instance, SI seeks to explore the conduct of nurses in nursing units as they relate with patients who experience spiritual distress.
Goffman (1958:12) used the SI approach to examine human interaction in social settings. He developed a method of analysis of the interaction order or environments between and amongst people In his research, Goffman (1974:7) has outlined the various elements that make up the joint actions of interacting individuals. These are:
Interaction involves two or more individuals taking one another’s point of view.
Interaction occurs in social settings which can be physically located and described.
Social objects fill social settings and will be acted on by the individuals under study.
When taking one another’s perspective, individuals use a set of rules that guides and shapes their on-going interactions. These rules may be civil, legal or spiritual in nature. The rules are usually relational and specific to the individuals in question. People in relationships typically act in terms of rules and understandings unique to their relationship. Goffman (1974:13) also clarifies that saving face in a social setting is part of the code or rules that actors use in social interaction.
All interactions involve relationships. These may be with strangers, friends, colleagues or civil acquaintances. The total amount of time two or more individuals spend in one another’s presence is termed the occasion of interaction.
Every focused exchange between these individuals is termed an Social situations furnish the occasions of interaction, which in turn produce the conditions for encounters.
The interaction process is filtered through social identities.
Goffman’s (1958:235) method is considered the best in the analysis of the interaction between the nurse and the patient who are in one another’s space day and night during a time when patients experience pain, sickness, suffering or even death.

MAIN FOCUS OF SYMBOLIC INTERACTIONISM

SI conceptualises social reality as symbolic, communicated and subjective in both form and content (Dictionary of Social Sciences 1987). Theoretically, SI serves as a framework for viewing the social world. The context of health care where patients suffer from HIV/AIDS, asthma, injuries, acute, chronic and terminal illness was identified as the social world of the participants and their patients. It clarifies the existence of a social reality but does not suggest any preconceived ideas of such a reality. It is used to evaluate human interaction, particularly the behaviour and actions and responses to the communication process involved in human interaction (Griffin 1997:27; Meltzer 1978:11). Nurses are the first point of contact for patients within the health care system. In the units nurses play a key role in meeting the patient’s needs including referral to the appropriate members of the health care team such as the hospital chaplain. The fundamental theoretical concern of SI involves obtaining an understanding of human beings in interaction. Spiritual nursing care interventions include taking direction from the patient’s perspective because patients come in with their own belief systems which must be respected and incorporated into their care (Denzin 1989a:5). Symbolic interactionism is therefore a perspective through which social behaviour can be studied and understood (Benzes & Allen 2000:543).
SI stresses the many ways that human and psycho-social interaction takes. These are linguistic and gestural communication and particularly the role of language (Dictionary of Critical Sociology 1989).
Denzin (1995:37) argues that to understand the pragmatics of human behaviour, it is important to understand the basic premises of SI. Often nurses have the ability to make sense of patient’s physical ailments and to a certain extent their psychological and social experiences as a result of their illnesses but find it difficult to make sense of their spiritual distress. Blumer (1969:6) contends that the basic premises of symbolic interactionism are rooted in Mead’s (1934:39) basic tenets of ‘I’, ‘Me’ and ‘self’ and the inner conversation that is continually occurring between people and their environments in the context of social interaction. Mead (1934:40) suggests that the premises of symbolic interactionism are as follows:
Firstly, human beings act and react towards people and things on the basis of the meanings that they assign to those people or things.
Secondly, the meanings which humans attach to people and things are derived from or arise out of the social interaction that they have with others and the society.
Thirdly, these meanings are handled in, and modified through an interpretative process used by humans in dealing with the people and things that they encounter.
Although the first premise may not seem to represent a position distinct from other philosophical perspectives, Blumer (1969:2) asserts that it makes a point on its own right, especially in the context of the time when the understanding of human beings as active agents in the construction of the social world was seriously questioned. The other two premises were acknowledged as significant for SI as they specify that the use of meanings by the actor occurs through a process of interpretation (Blumer 1969:5; Jeon 2004:251).
Crooks (2001:14) have outlined other aspects that underpin symbolic interactionism where he states that:
Human beings are endowed with a capacity for thought and that capacity is shaped by social interaction.
Through social interaction people learn the meanings and symbols essential to the expression of thought.
This understanding in turn allows people to carry out actions and interactions.
As people interpret their situations, they modify their meanings and symbols used in interaction.
Interaction within the self and with others allows people to understand a situation and make choices.
Symbolic interactionism according to Blumer (1969: 21), “provides the essentials for a provocative philosophical scheme that is peculiarly attuneded to people’s social experience”. It is seen as a perspective in empirical social science designed to yield verifiable knowledge of the human group life, conduct or act (Blumer 1969: 21)
To explain this further, the premises and the core principles of SI as presented by Blumer (1969:2) and Denzin (1989a) are applied in analysing and interpreting data collected for this study.

Philosophical underpinnings of symbolic interactionism

The philosophical underpinnings of symbolic interactionism are pragmatism and social behaviourism.
Pragmatism
Pragmatists maintain that human beings go through a continuing process of adaptation in the constantly changing social world, and that the existence of a mind through which contemplation of a situation occurs makes this process possible (Griffin 1997:18; Jeon 2004:252). Denzin (1989a:5) claims that the pragmatism of symbolic interactionism rests on three basic assumptions, namely that:
Social reality is sensed, known and understood as a social production. Interacting individuals produce and define their own situations.
Humans are assumed to be capable of engaging in self-reflexive behaviour. They are capable of shaping and guiding their own behaviour and that of others.
In the course of taking a standpoint and fitting that standpoint to the behaviour of others, humans interact with one another. Interaction is therefore seen as symbolic because it conveys messages in terms of symbols, words, gestures, meanings and languages.
In the context of this study pragmatism defines the wards where patients are cared for as the social world where they have to continuously adapt to a sick role. They interact with nurses, other members of the health team and visitors. Nurses as professionals render care which is expected to be holistic in nature.

Social behaviourism

Proponents of the SI philosophy indicate that symbolic Interactionism has evolved principally from social behaviourism (Dictionary of Social Sciences 1987). The distinction between human beings and lower animals is in the response to various stimuli in the environment. With lower animals the response is instinctive. According to psychology, the response takes place immediately without the influence of interpretation or assigning of meaning (Blumer 1969:18). Animals are unable to conceive alternative responses to the stimuli (Herman & Reynolds 1994:10). In humans, human cognition interrupts the stimulus-response process. In human life, cooperation is influenced by conscious thinking rather than instinct and biological programming. This understanding should not be taken to indicate that humans never behave in a strict stimulus-response fashion, but rather that humans have the capability of not responding in that fashion (Herman & Reynolds 1994:10). When people are sick or injured they think and attach meaning to their situation, objects and symbols such as prayer, an empathetic touch or Bible text. Therefore, the stimulus-cognition-response concept according to this theory may be influenced by interaction with the health team.

Table of contents Page
CHAPTER 1 Research problem and overview
1.1 INTRODUCTION
1.2 BACKGROUND INFORMATION TO THE STUDY
1.3 SIGNIFICANCE OF THE STUDY
1.4 AIM OF THE STUDY
1.5 CONCEPTUAL AND OPERATIONAL EXPLANATIONS OF KEY CONCEPTS
1.6 FOUNDATIONS OF THE STUDY
1.7 RESEARCH DESIGN AND METHODOLOGY
1.8 PLANNING PHASES FOR THE STUDY
1.9 STRUCTURE OF THE THESIS
1.11CONCLUSION
CHAPTER 2 Spiritual nursing care: a concept analysis
2.1 INTRODUCTION
2.2 CONCEPT ANALYSIS METHODS
2.3 ANALYSIS OF THE CONCEPT ‘SPIRITUAL NURSING CARE’
2.4 CONCLUSION
CHAPTER 3 Theoretical foundation to the study: symbolic interactionism
3.1 INTRODUCTION
3.2 DEFINITIONS OF SYMBOLIC INTERACTIONISM
3.3 HISTORICAL ORIENTATION ON SYMBOLIC INTERACTIONISM
3.4 MAIN FOCUS OF SYMBOLIC INTERACTIONISM
3.5 SYMBOLIC INTERACTIONISM AND GROUNDED THEORY RESEARCH
3.6 CONCLUSION
CHAPTER 4 Research design and method
4.1 INTRODUCTION
4.2 RESEARCH SETTING
4.3 RESEARCH DESIGN
4.4 QUALITATIVE RESEARCH
4.5 RESEARCH METHOD
4.6 ETHICAL CONSIDERATIONS
4.7 MEASURES TO ENSURE TRUSTWORTHINESS
4.8 CONCLUSION
CHAPTER 5 Data analysis and interpretation
5.1 INTRODUCTION
5.2 STATISTICS OF THE DEMOGRAPHICS
5.3 QUALITATIVE DATA ANALYSIS
THEME 1: MEANING OF SPIRITUAL NURSING CARE
Category 1.1 Human being
Category 1.2 Interrelationships of body, mind and spirit
Category 1.3 Challenges of understanding spiritual nursing care
THEME 2: NURSE RELATIONSHIPS IN THE HEALTH CARE CONTEXT
Category 2.1 Relationships
THEME 3: PROVISION OF SPIRITUAL NURSING CARE
Category 3.1 Promoting transcendence
Category 3.2 Communication
Category 3.3 Consequences of provision of spiritual nursing care
THEME 4: CHALLENGES INTHE PROVISION OF SPIRITUAL NURSING CARE
Category 4.1 Feeling spiritually inadequate
5.7 CONCLUSION
CHAPTER 6 Development of a model on integration of spiritual nursing care to clinical practice
6.1 INTRODUCTION
6.2 MODEL DEVELOPMENT
6.3 A SUMMARY OF THE HUMANE CARE MODEL
6.4 CONCLUSION
Chapter 7 Conclusions and recommendations
7.1 INTRODUCTION
7.2 PURPOSE OF THE STUDY
7.3 CONCLUSIONS OF THE STUDY
THEME 1: MEANING OF SPIRITUAL NURSING CARE
THEME 2: NURSES RELATIONSHIPS IN THE HEALTH CARE ARENA
THEME 3: PROVISION OF SPIRITUAL NURSING CARE
THEME 4: CHALLENGES INTHE PROVISION OF SPIRITUAL NURSING CARE
7.4 SCOPE AND LIMITATION OF THE STUDY
7.5 RECOMMENDATIONS .
7.6 CONTRIBUTIONS OF THE STUDY
7.7 IMPLICATIONS OF THE STUDY research
7.8 CONCLUSION.
GET THE COMPLETE PROJECT
A MODEL FOR INTEGRATING SPIRITUAL NURSING CARE IN NURSING PRACTICE: A CHRISTIAN PERSPECTIVE