Social support is an example of a middle range nursing theory that addresses the issues in the structure and interaction that are involved in the course of relationships. The theory has a significant impact on the health status, health behavior, and the utility of health services. Nurses often have access to clients’ social networks. This fact creates the need to utilize this platform to promote and strengthen the social support that the patient desires. The analysis in this research highlights the positive consequences of social support, which include health-promoting behaviors, self-worth, and personal competence (Cohen S., 2001). Further research on the social support theory can provide nurses with knowledge of the best strategies for strengthening social support for clients that contributes to improved health status.
John Cassel in 1974 was among the first theorists who introduced the term social support in the medical fraternity. His research was based on animal studies where he was able to establish that strengthening social supports could assist in improving the health of human beings. Studies during that period had also established that social support could mediate the negative effects brought about by stress. Until that time, the buffer and the attachment theories were the only theories that had been used as the basis for research on the relationship between health and social support. The buffer theory holds that social support protects people from life stressors while the attachment theory states that the ability to form socially supportive relationships lies in the secure attachments that are formed during childhood. In the period ranging from 1970 to 1980, literature described social support in concrete terms alluding to factors such as interactions and relationships. Presently the term is used in a more abstract form to include other factors like perceptions, the quality and quantity of support, social systems and behaviors. Furthermore, the analysis and testing of social support has gained more multidisciplinary interest and is prominent in social-psychological literature and nursing. For nurses, especially family nurse practitioners, social support can connect patient needs, family assessment, and health outcomes.
Norbeck in 1981 contributed to the development of the social support theory by utilizing social support as a nursing intervention meant to improve health outcomes. In his research, the social support environment of the client was assessed by a determination of the need for social support as compared to its availability (Fleury, 2009). In his assessment, he established that if there was inadequate social support, there was a necessity for developing an intervention plan that could increase social support. The possible interventions were to focus on the strengthening of the existing support structure of the client and provide direct support needed when there is a crisis. It was established that adequate social support could result in positive health outcomes whereas inadequate social support that is not characterized by any intervention would lead to a negative result.
More research has been undertaken to investigate the relationship between the social support theory and health. In 1986, Heller et al. stated that two facets of social support; stress-related and esteem-enhancing appraisal, interpersonal transactions have an effect on clinical outcomes. Their research hypothesized that the perception of social interaction has a positive impact on the health of individuals as compared to the support activity itself. They were able to form a network consisting of a system of interpersonal transactions, which contributed to support functions that positively enhanced health and mental health outcomes.
Cohen et al. did further research in 2001, and they described the two models that explained how social support influences health. In analyzing the stress-buffering model, they stated that it holds that social support contributes to health-promoting behaviors in those people experiencing stress (Cohen S., 2001). The support resources in a facility should strengthen an individual’s ability to cope with stressful situations rather than focusing on behaviors that might be harmful to health. Such beliefs lead to a more robust response to stressful situations and have the effect of decreasing negative behavioral responses. In such a case, an individual is more likely to have an adaptive response to the stressful situation thus avoiding a negative response that would have otherwise led to negative health effects. The second model suggested by Cohen et al. stated that social support had a direct effect on psychological and physical health. There is a need for integration into a social network as opposed to isolation since this can provide social control and peer pressure to engage in healthy promoting behaviors. This leads to positive psychological states key to them being a sense of stability, predictability, belonging, purpose, and security. Furthermore, social networks can provide multiple sources of information concerning health care services and informal health care thereby leading to a prevention of progression of the illness.
Other studies in nursing have also concurred that there is a positive relationship between social support and improved health behavior. Manning-Walsh in 2005 did research in which social support is utilized as a mediator that contributes to improved clinical outcomes. The study focused on women with breast cancer and established that personal support provided by close friends and family-mediated by the adverse effects of common symptoms that contribute to distress during the treatment (Manning-Walsh, 2005). In a study of Taiwanese women in early pregnancy, it was established that women with higher levels of social support would record less stress and predictor variables of nausea and vomiting. In all this research reference is still given to the buffer and attachment theory that enhance the functionality of the social support theory.
Theory Description
The phenomenon of concern in this theory is the relationship between social support and healthcare needs. The protagonists of this theory attempt to establish how social support can be utilized to enhance healthcare needs of patients. In establishing that, they also explain how a lack of social support can have adverse consequences on the health of patients. The theory is quite relevant to family nurse practitioners who engage with clients for an extended period. If they utilize the social support theory effectively, then they can ensure that their patients can recover fully by having a social support system that enhances that recovery.
The social support theory utilizes retroductive reasoning where the fact that social support has been provided and the patient has recovered well, and then social support can be attributed to being a contributing factor towards the patient getting well. It is abduction reasoning since the authors are not sure that this the only factor that led to the patient recovering in a short span of time. Other explanations could come into play, for instance, a different set of drugs were administered than the usual ones, or even the technological facets of the equipment utilized in treatment were quite effective in meeting the set objective. However, in retroductive reasoning a hypothesis is created and then tested to establish its applicability. This is the case with social support theory since all researchers of the theory perform relevant experiments to confirm their hypothesis, but it is not necessarily the sole explanation of the patients getting well.
Developers of the social support theory have varied definitions of social support that encompass a variety of component labels that include: aspects, defining attributes, categories, interpersonal transactions, types, taxonomies, constructs, dimensions, and sub-concepts. The fact that there exists a variety of definitions of social support that is provided by theorists illustrates the lack of consensus about the nature of social support. Due to the lack of consensus, there seems to be much complexity in the evaluation of support outcomes and interventions, comparing research findings, and developing the theory. The predominant definition is that social support is an aid or assistance that is exchanged through interpersonal transactions and social relationships. This is an operational definition that is almost consistent with all aspects of the research. An explicit definition is given of the concepts of social support for instance in the elaboration of the structure and functionality of social support. Social support is said to be structural when it focuses on who provides the support, and it can also be functional when it emphasizes the action of providing social support activities (Finfgeld-Connett, 2005).
Many characteristics influence the quality and adequacy of social support such as stability, the source of support, and direction. Social networks come into play and can be described by the number of categories of persons within the vicinity that provide social support key examples being family members, neighbors, coworkers, professionals, and close friends. A relationship is established between the major concepts of the social support theory since it is imperative for connections to be established for the support to be offered. Social support can further be described as a well-intended action that is given willingly to an individual with whom there is a special relationship that is meant produce a delayed or immediate positive response from the recipient.
Theory Evaluation
The theory recognizes certain variables that influence its perception in nursing. These forms the value systems under which the theory is anchored on and can be viewed as explicit assumptions to the theory. The variables that affect the social support theory include the need and availability of support, duration, the motivation for providing support, source of support, timing, direction, life stage, and social network. A social support system consists of a series of activities that comprises of these variables for the theory to be sufficiently applicable.
The provider of the social support should first recognize the need for them to provide the required support and determine the kind of response that would satisfy the need. If there is a mismatch between the perception of the need of support between the provider and the recipient, then the support might not be considered helpful. If the assumption holds, then such help would only lead to a feeling of inadequacy, dependency, and lowered self-esteem. Timing is quite important because social support is a dynamic process and needs to be relevant on a needs basis. Motivation is a factor that plays a significant role in social support and can have an effect on the quality of support that is to be offered. Previous interactions and cost of the support can be considered before offering the prerequisite assistance that is needed. Duration of the support is also a consideration for persons who experience long-term loss and those who are chronically ill. The direction of the support can either be unidirectional or bidirectional where professional support is often one way while that of family members is both ways. The provision for receiving social support depends on life span where at a certain stage in life one can be capable of providing social support while at another they would need more of receiving than giving (Chou, 2008).
There are four theoretical constructs of the theory, which are emotional, informational, instrumental, and appraisal supports. Emotional support is the experience of feeling respected, admired, loved, and liked. Instrumental support is a provision for tangible aid, services, or goods. Informational support is the provision of information during the time of stress whereas appraisal support is the affirmation of one’s statements or actions. However, there can be negative social support that could hurt the healthcare needs of an individual. The support that is being offered can sometimes be perceived negatively by the recipient and may be unhelpful and undermine self-esteem. Characteristics of this include conflicted social network, absent or misguided support, avoidance, disagreement, or even inappropriate support (Fleury, 2009). It is imperative for health practitioners to check on the characteristics of social support being offered to establish if it is relevant. These are factors that are relevant to the theory since they affect the perception of the social support and their overall effectiveness. This theory offers consistency in clarity and explanations by giving a chronological relationship between its application and better healthcare.
Theory Application
The social support theory is quite applicable in the area of family nurse practice. By studying the theory, nurses can have the knowledge and expertise to assess the social and interpersonal environments of clients. When they do so, they can implement health promotion strategies and facilitate the provision of self-care practices. Through network therapy nurses can assess social support adequacy and use existing support measures to provide clients with increased independence and positive support initiatives.
An example of preventive support is comprehensive home visitations that can be carried out for vulnerable young mothers. In such a scenario nurses provide regular home visits to young mothers from the beginning of their pregnancy and continue with such visitations until their children are two years of age. The purpose of such visits can be to improve pregnancy outcomes and promote the child’s healthy development. Nurses within such a setup can provide social support and strengthen the informal support to ensure set objectives are met.
An example of a situation that could present itself in future would be that of modifying how an individual seeks or perceives support that is provided by others. The situation could be that of a pregnant woman placed on bed rest for high-risk pregnancy, and her husband works long hours though she depends on him as the pillar of social support. As a family nurse practitioner the best social support intervention would include an assessment of the available components and sources of social support (Olds, 2007). It would then be prudent to educate her on the importance of the bed rest (informational support), counsel her on the need to seek alternative sources of support (appraisal support), listen to the client’s concern (emotional support), and arrange for help with child care from available social support systems (Instrumental support). The knowledge of social support theory would ensure that health practitioner nurses can provide better services that is patient centered and meets the required healthcare needs.
References
Chou, F. A. (2008). Relationships between nausea and vomiting, perceived stress, socail support, pregnancy planning and psycho-social adaptation in a sample of mothers: A questionnaire survey. International Journal of nursing Studies, 1185-1191.
Cohen S., G. B. (2001). Social relationships and health: Challenges for measurement and intervention. Advances in Mind-Body Medicine, 129-141.
Finfgeld-Connett, D. (2005). Telephone social support of nursing presence? Analysis of a nursing intervention. Qualitative Health Research, 19-29.
Fleury, J. K. (2009). Social support theoretical perspectives. Geriatric Nursing, 11-14.
Manning-Walsh, J. (2005). Social support as a mediator between symptom distress and quailty of life in women with breast cancer. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 482-493.
Olds, D. K. (2007). Effects of nurse home visiting on maternal and child visiting. Pediatrics, 832-845.