The Relevance of Social Assessment

The Relevance of Social Assessment

Social assessment is a key part of individual and community assessment. Understanding the link between lifestyle behaviors and choices, socioeconomic status, and health can assist nurses and health care professionals in identifying wellness concerns and devising realistic plans for intervention.
Review the multimedia presentation Social Assessment/Analysis Framework. Based on your knowledge, information from the presentation, research in the Capella library and the Internet, and your own experience, describe the relevance of social assessment in health care planning, particularly for high-risk populations.

Reference
Clark, C. C., & Paraska, K. K. (2014). Health promotion for nurses a practical guide. Burlington, MA. Jones & Bartlett.

Use your Health Promotion for Nurses text to complete the following:
Review Chapter 1, "Health and Health Promotion," pages 1–24.
Read Chapter 2, "Health Promotion and Theory," pages 31–67.
Read Chapter 4, "Promoting Physical Health," pages 145–194.

SOCIAL ASSESSMENT AND ANALYSIS FRAMEWORK
The entry points of enquiry for social assessment are: The stakeholders, social diversity, participation, institutional rules/behaviors, and social risk.

These entry points offer a starting point for the construction of a social assessment.
LEVEL OF ASSESSMENT
There are a series of questions that a nursing professional must ask to assess the level of the patient during a social assessment:
Individual-Level:
• Age, gender, address, type of work, ethnicity, culture, religion, marital status, next of kin.
• Lifestyle?
• Smoking/Drinking habits.
• Is client stigmatized because of health problems?
• Does the clients’ health problem affect his/her social and economic role in society?
• Do the clients health problems lead to greater need for social, economic and other support?
• Is there discrimination in terms of access to resources such as health care, housing, job opportunities, etc?
• Does the client engage in any illegal activity and does he/she suffer as a consequence?
• Are there consequences for their interpersonal relations with family and friends?
Community-Level:
• How do community norms affect the social consequences of health behavior?
• What is the influence of community settings?
• How are communities affected by the health problem or behavior?
• What are the social consequences for families?
• What are the social consequences for other people and the wider community?
Structural-Level:
• What is the social impact of local and national policies on the client?
• Is the client subject to special legal or other interventions because of his/her health problem, behavior or status?
• Is the client offered special additional support and welfare benefits?
• What is the impact of the social, economic and legal environment on the client?
• What is the significance of public attitudes on the health problem or the population group?
THE STAKEHOLDERS
Stakeholders are essentially the individual or groups of individuals within society who are subject to the process of health assessment. Stakeholders include:
• Patients.
• Healthcare consumers.
SOCIAL DIVERSITY
All societies comprise a range of socially diverse groupings. The health status of individuals and groups can be directly linked to a number of these factors:
• Gender.
• Social class.
• Ethnicity, culture and religion.
• Age.
PARTICIPATION
When using participation as a dimension of social assessment, you need to examine the extent to which individuals or social groups can and do participate in the development of potential health plans constructed in collaboration with healthcare professionals.
Social assessment is more than considering the available health-related resources, but also recognizing and enhancing the capability of people to access the available resources. The role of the nurse in comprehensive social assessment is to determine which assets and capabilities are present and which are lacking.
INSTITUTIONAL RULES/BEHAVIORS
A comprehensive assessment of health would need to encompass an analysis of the relationship between organizations and institutions within the community; that is, the formal and informal rules of the important relationships played out in societies that influence the health of the community.
An appreciation of all the agencies and institutions involved in the provision of health and social care is essential for the nursing considering the assessment of patients.
SOCIAL RISK
All health assessments and consequent actions have inherent risks attached for all the stakeholders. Five risk categories are:
• Vulnerability—healthcare professionals may already be dealing with individuals or groups who are classed as vulnerable or at risk.
• Community risk—These types of risks could include patients with severe and mental illness (risk of social exclusion); Specific environmental factors (high density or poor housing).
• Institutional risk—All assessors need to have a clear understanding about the services that may be required for a patient.
• Iatrogenic risk—This is a risk related to problems generated by the professional intervention itself.
• Political-economic risk—Risks to consider with this category are: major disasters (Chernobyl, 9/11, etc.), scapegoating ethnic groups (terrorist threats, etc.) and advances of science (greenhouse gas emissions, water fluoridization, use of pesticides, etc.).
REFERENCES
• Crouch, A. & Meurier, C. (2005). Health Assessment. Malden, MA: Blackwell.
CREDITS
Subject Matter Expert:
Terry Karjalainen
Interactive Design:
LaVonne Carlson
Instructional Designer:
Vicki Olund
Project Manager:
Paul Schwoboda
Image Credits:
© iStockphoto.com/David Lewis
© iStockphoto.com/Andrew Gentry
© iStockphoto.com/Annett Vauteck
© iStockphoto.com/Claudio Rossol
© iStockphoto.com
Licensed under a Creative Commons Attribution 3.0 L

The sociogram, a complementary tool to the genogram and a means of
enriching the interview
By Margot Phaneuf, RN, Ph.D.
The nurse’s interview with a patient enables the attainment of different objectives,
amongst others to gather information which will help understand their life experience and
behaviour for a more adequate intervention.
This meeting, as all personal contacts, should be carried out in a Rogerian approach of
confidence, non-judgment and positive consideration, for the interview is a highly
important professional act. It requires knowledge of interpersonal behaviour, and a good
dose of sensitivity and diplomacy with respect to the process of questioning. And above
all, it requires “presence” which enables one to have a compassionate and open mind.
The sociogram as a tool which reveals the relationships between people
The genogram gives us precious information about the composition of the family and the
interactions and influences between generations but it does not show the nature of the
relationships within a family nor those with the exterior environment, which may be very
useful in certain situations. A practical and concrete way is to use another tool of
sociology, the sociogram with its two variants: the sociogram of the familial attachment
group and the targeted sociogram.Definition and diverse applications
In the context of this article, the sociogram has many facets. It is above all a graphic
representation, a social diagram of the relationships which a person has with his family,
this is known as the sociogram of the family attachment group. But the sociogram is also
intended for the collateral members of the family and the exterior social group.
The sociogram
Is a graphic representation which serves to reveal and analyse the
relationships of a person with their family or social circle, or to visualise
the relationships within the family or of certain members of the family
with their external environment such as health and education services,
leisure time activities, work, friends or place in the extended family.
Both personal and professional relationships are taken into account. They may involve
principally the members of the family (grandparents, uncles, aunts, cousins, nieces,
nephews, grand children), friends and neighbours, supervisors and work colleagues,
school personnel or classmates. But it is also possible to establish more general ties with
various institutions such as the workplace, health services, leisure time services, etc. This
is what we can see in the first example of the sociogram of the Hubert family. We can
also see that according to our needs, this strategy can become more analytical, in which
case it takes the form of a “targeted sociogram”.
The basis of this strategy
The sociogram was developed a long time ago by Jacob Levi Moreno, a Roumanian
psychiatrist, whose writings on sociometry and psychodramas are well known. He
presented this tool in 1933 and since then it has served as a means of showing what takes
place in a group. On a theoretical level, the use to which this visual concept has been put
classes it amongst the strategies used in the study of restricted groups of which the most
well known theorist is Kurt Lewin. Since then it is he who has had the greatest influence
on its use and interpretation.
Objectives
This sociological approach is used in several ways and in pursuing various objectives.
The first is to demonstrate the group dynamic surrounding the individual observed,
whether it be their immediate family, or others in their surroundings such as their
belonging group, their reference group, their functional group or their affinity group.
2A human being is born within a family, with parents who protect him, a family circle and
a specific environment. This is known as the belonging group, with which, in one way
or another, the person maintains a lifelong tie. A human
group, whatever its nature, always presents a particular
character, with specific values, distinct cultural tastes, a
dynamic and an ideology which make it unique. The
persons, groups or organisations which serve as role models
for the person’s moral, religious or political conduct is the
reference group. The sociogram can target either one or the
other of these groups. The functional group has as its
primary objective a professional function, such as worker,
nurse, teacher, student or other; whereas an affinity group, is
concerned with the persons who associate by choice.
Belonging group:
This is the human
environment in
which a person
evolves, that is,
family, friends and
immediate social
surroundings.
Another objective of the sociogram is to reveal in a concrete and specific manner the type
of relationship which a person has with each family member
and with the different groups to which they belong. This
enables us to understand the strengths and weaknesses of
their support network, which is very important for their care,
or if we want to know what the relationship is between a
worker and his supervisor or work colleagues.
This strategy also enables us to show the nature of the child’s
social ties at school and at play, which facilitates the
comprehension of their psychological reactions and is a
measure of their capacity to establish relationships. In psychiatry, these objectives are
extremely important. By this means one can discern if the subject is isolated, or even
rejected or if he has a significant relationship with someone, if he has accepted the rules
of the group, or if he is dysfunctional. This sociometric tool consequently enables one to
have a clearer image of the person’s position and influence in his group and to know
where one needs to intervene in order to better their socialization.
Reference group:
all of the persons,
groups or
organisations
which influence a
person’s values
and behaviour.
Interpretation
In this graphic representation, as in the genogram, the intensity of the ties is indicated by
a code of lines: a dotted line indicates a weak relationship, and as the dots get weaker, the
relationship is weaker.
3If the dotted line is white, the relationship is almost non-existent. A single line shows a
good bond, two
lines a closer
bond and three
lines a
relationship
which is even
more important,
but also
conflicting. A
line with a slash
represents a
difficulty. A
broken line or
with two slashes
signifies a
rupture, while a
zigzag line
reveals a
conflict. An
arrow indicates
unilateral
relationship, that
is, the subject feels an attachment to the indicated person or group but this is not
reciprocal, in other words, the indicated person or group reject them. The arrow can also
indicate a particular responsibility or inversely, for example, the case of a daughter who
takes care of her mother. The subject observed is indicated by a double circle, a c
a
ircle
ithin a square or their name is written in letters of a different colour.
diagram of the attachment group, both of which favour the study of the family
roup.
he first example
ure time activities and their friends. Guy is the problem child who is
eing observed.
Margot Phaneuf Inf. PhD. 36
Sociogram
Hubert family
Lucy’s
health
Lucy’s
work
Lucy’s
mother
Denis’
school
Paul’s
work
Denis’
leisure
activties
Parents
leisure
activties
Paul’s
Family
Denis’
friends
Computor
course
Trade
union
activities
Guy’s
leisure
activties
Guy’s
school
Guy’s
Friends
Guy
w
The dimensions depend on what one wants to show, for example, we might want to show
the openness of a family system to exterior human relationships i.e. friendships, the
enlarged family, leisure time activities or even the relationship of a single person to their
work environment, eg. a nurse with her work team or a student with a few of his
classmates. This visual tool complements the other two sociological tools: the genogram
and the
g T
The attached example shows the ensemble of the relationships of the Hubert family:
Paul, the father, Lucy, the mother, Guy and Denis, their two sons, with their in-laws, the
health and educational system, the mother and father’s professional activities and their
involvement in social organisations. It also shows the children’s relationship with their
school, their leis
b
4One can thus see that Paul is intensely involved with his work which signifies that he is
somewhat absent at home especially since he is involved with trade union work.
Moreover, his relationship with his family of origin is not very strong. As far as Lucy is
concerned, one notices that she works outside the home, is taking a computer course and
that she has some health problems all of which suggest that this may be causing some
difficulties. Moreover, she has a very strong, even confluent relationship with her
mother and with Guy. There is not much evidence of leisure time activities shared by the
ntire family.
too distracted by friends or his leisure time
the family since there is a conflicting
lationship with his father. He is a problem child.
he second example
me ties with Lucy’s family. We can also see that his relationship with Guy
broken.
e
These observations indicate several factors of imbalance. As far as the children are
activities; whereas his brother Guy has trouble in school but
has a network of friends who occupy his leisure time which may be a cause of his school
problems and a compensation for what is missing in
concerned, Denis is a good student who is not
re
T
The second example is centred on Lucy who is undergoing psychiatric care. It is more
detailed and indicates that Lucy is suffering from depression and is unemployed, that her
widowed mother also suffers from depression and that their too close relationship is not
harmonious. As for Paul, we can see that he has broken ties with his own family but
maintains so
is
If the sociogram reveals a particular difficulty for one of the persons, we can dig deeper
by proceeding with a diagram of the familial attachment group. It enables us to better
understand the basic internal dynamic and gives us information on the quality of the
Margot Phaneuf Inf. PhD. 114
The familial attachment group
Denis Guy
Paul
Lucy
The Hubert family is
dysfunctional. The
relationship between
Lucy and Paul is no
very good wherea
the relationship
between Lucy and
her son Denis is very
good and is confluen
with her son Guy.
The relationship
between Paul and
Guy is conflicting but
is good with his other
son, Denis. The
relationship between
the two brothers,
Guy and De
t
s
t
nis, is not
very good.
5intrafamily ties. This is what we can see in the example for Guy, the problem child of the
aul
anner the nature of the
een
h a tool is also useful in pediatrics when one wants to
etter understand what is going on in the environment of a sick child. Isn’t it true that a
rds?
fficulties reveal
e limits of his capacity to form relationships and may explain his difficult behaviour.
From this illustration we can better understand how we should intervene.
couple Lucy-P
Usefulness
the family members
and to see where
dysfunctions, bonds,
rejections, and conflicts occur. Suc
In psychiatry, this diagram enables us to visualize in a concrete m
interactions betw
b
picture is worth a thousand wo
The targeted sociogram
But intrafamily relationships are not the only ones that can be revealed. In a family, or
any other kind of group, if one person is dysfunctional, one may want to examine their
social environment at school, at work or even in the enlarged family. A targeted
sociogram can help us to further understand the relationship between the subject and the
persons closest to them in their school, work or leisure time environment. In this diagram
we can see that Guy has three good friends, even a very strong relationship with Tom.
One could say that these friends form an affinity group. One can also notice that he is in
conflict with Marc and is rejected by Pierre. His intra and extra-family di
th
Margot Phaneuf Inf. PhD. 113
Targeted sociogram of Guy’s
interactions in school
Simon
Luc
Guy
Marc
Peter
Tom
Here is the group of
Guy’s classmates. He
is a leader, the one
who establishes mos
of the positive
relationships. With
Tom, Luc and Simon,
he forms a sub-group
which gets along well.
His ties with Marc and
Peter are tense; he is
t
in conflict w
and
ith Marc
rejected by Peter.
6We can thus notice, that these sociological tools are an interesting means of favouring an
awareness of the
functional and
relational
problems of a
person. They are
not only
invaluable in
nursing and
psychiatric care,
but also in
educational and
work
organisations,
etc. when one
wants to better
understand the
dynamics which
are occurring in
a school or
professional
group.
Margot Phaneuf Inf. PhD.
The relationship with a reference group
The last example shows the relationship between Guy and his scout group. A comparison
of the social tools used shows that this child has difficult relationships in all the spheres
to which he belongs. The diagram of his reference group also shows that he seeks an
authority figure, probably to replace his absent father with whom he is in conflict;
unfortunately, Guy feels rejected by him.
Creation of the sociogram
As with all the other strategies of a relational nature, the sociogram is created in
partnership with the interested person, in an environment of empathetic confidence. The
use of questions is the major method, but one must avoid that this quest for information
becomes an inquest. Everything should take place in a climate of comprehensive
empathy where the person is first of all informed of the objectives and the process of this
approach and is convinced that the nurse is there to help.
115
Targeted sociogram of Guy’s interactions
with his scout reference group
Wolf
Guy
Squirrel
Eagle
Head
scout
Here is Guy’s
reference scout
group. We notice
that he feels
rejected by the
head scout, that
he has a very
strong, probably
dependent
relationship with
Small Wolf, a
conflicting
relationship with
Squirrel and that
his ties with
Eagle are just
about nonexistent.
78
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