SOCIAL DECISION MAKING
Introduction to Social Psychology
Everybody has heard of peer pressure, but most people argue that they are not affected by it, or at least not affected as ‘most people. The truth is, we are all affected by the people we interact with, many of whom we don’t even know personally. Our social environments play a significant role in how we view ourselves, and conversely, how we see ourselves impacts our view of the world.
This chapter will discuss the various aspects of social psychology and the role these play in our everyday lives. We will emphasize the interaction between our view of self and others, the role of power in social interactions, and how groups, or the people with whom we interact, affect our decision making process.
Our View of Self and Others
The way we look at ourselves plays an important role in how we see the world. The way we see the world plays an important role in how we see ourselves. In this sense, our view of self and others is an ever-changing circle of influence. We know that those who are happy see more positive aspects of the world than those who are depressed. We also know that living in an abusive household or an overly restrictive environment can both lead to depression. This section will explore the social areas of attribution (how we interpret those around us) and attraction (what we seek in a friend or partner).
Attribution Theory
We tend to explain our own behavior and the behavior of others by assigning attributes to these behavior. An attribute is an inference about the cause of a behavior. According to the Attribution Theory, we tend to explain our own behavior and the behavior of others by assigning attributes to these behavior.
There are basically two sources for our behavior; those influenced by Situational (external) factors and those influenced by Dispositional (internal) factors. Imagine walking into your boss’s office and he immediately tells you, in an angry tone, not to bother him. An external explanation of this behavior might be, “He’s really a nice guy but the stress is overwhelming. He needs a vacation.” On the other hand, you might see the same behavior and say, “What a jerk, I don’t know why is is so angry all the time.” The same behavior is given two very opposite explanations.
Many factors play a role in how we assign attributes to behaviors. Obviously our view of the world, our previous experience with a particular person or situation, and our knowledge of the behavior play an important role. Other factors can influence our interpretation as well, and there are two important errors or mistakes we tend make when assigning these attributes.
1. Fundamental Attribution Error.
This refers to the tendency to over estimate the internal and underestimate the external factors when explaining the behaviors of others. This may be a result of our tendency to pay more attention to the situation rather than to the individual (Heider, 1958) and is especially true when we know little about the other person. For example, the last time you were driving and got cut off did you say to yourself “What an idiot” (or something similar), or did you say “She must be having a rough day.” Chances are that this behavior was assigned mostly internal attributes and you didn’t give a second thought to what external factors are playing a role in her driving behavior.
2. Self-Serving Bias.
We tend to equate successes to internal and failures to external attributes (Miller & Ross, 1975). Imagine getting a promotion. Most of us will feel that this success is due to hard work, intelligence, dedication, and similar internal factors. But if you are fired, well obviously your boss wouldn’t know a good thing if it were staring her in the face.
This bias is true for most people, but for those who are depressed, have low self-esteem, or view themselves negatively, the bias is typically opposite. For these people, a success may mean that a multitude of negatives have been overlooked or that luck was the primary reason. For failures, the depressed individual will likely see their owegative qualities, such as stupidity, as being the primary factor.
Attraction
Why are we attracted to certain people and not others? Why do our friends tend to be very similar to each other? And what causes us to decide on a mate? Many of these questions relate to social psychology in that society’s influence and our own beliefs and traits play an important role. Research has found five reasons why we choose our friends.:
1. Proximity – The vast majority of our friends live close to where we live, or at least where we lived during the time period the friendship developed (Nahemow & Lawton, 1975). Obviously friendships develop after getting to know someone, and this closeness provides the easiest way to accomplish this goal. Having assigned seats in a class or group setting would result in more friends who’s last name started with the same letter as yours (Segal, 1974).
2. Association – We tend to associate our opinions about other people with our current state. In other words, if you meet someone during a class you really enjoy, they may get more ‘likeability points’ then if you met them during that class you can’t stand.
3. Similarity – On the other hand, imagine that person above agrees with you this particular class is the worse they have taken. The agreement or similarity between the two of you would likely result in more attractiveness (Neimeyer & Mitchell, 1988)
4. Reciprocal Liking – Simply put, we tend to like those better who also like us back. This may be a result of the feeling we get about ourselves knowing that we are likable. When we feel good when we are around somebody, we tend to report a higher level of attraction toward that person (Forgas, 1992; Zajonc & McIntosh, 1992)
5. Physical Attractiveness – Physical attraction plays a role in who we choose as friends, although not as much so as in who we choose as a mate. Nonetheless, we tend to choose people who we believe to be attractive and who are close to how we see our own physical attractiveness.
This last statement brings up an important factor in how we determine our friends and partner. Ever wonder why very attractive people tend to ‘hang around’ other very attractive people? Or why wealthy men seem to end up with physically attractive, perhaps even much younger, women? There is some truth to these stereotypical scenarios because we tend to assign “social assets” or “attraction points” to everyone we meet.
These points are divided into categories such as physical attractiveness, sense of humor, education, and wealth. If we view education as very important, we may assign more points to this category making it more likely that our friends or our mate will have more education. If we view wealth as more important then we will be more likely to find a mate who has more money.
We rate ourselves on these same categories and, at least at some level, know our score. We tend to then pick friends and partners who have a similar score that we do. Hence an attractive person hangs with other attractive people; or a wealthy older man gets the beautiful younger woman. Think about your friends and how you would rate them in these categories to find out what is important to you.
Obedience and Power
Why do we obey some people and not others? Why are you able to influence your friends? What attributes cause a person to be more influential? These questions are paramount in understanding social order. The answers to these questions also play an important role in many professions, such as sales and marketing and of course politics.
Lets start with a closer look at what ‘power’ is. Power is typically thought of has having a certain attribute which gives one person more influence over another. This attribute could be intelligence or experience, it could be job title, or perhaps money. According to most social psychologists, there are five types of power: coercive, reward, legitimate, expert, and referent.
Coercive power means the power punish.
Parents are said to have coercive power because they can place their child in time-out, for example; bosses have coercive power because they can fire an employee or assign an employee a less pleasing job. Reward power is almost the opposite; it is the power to reward. In that sense parents and bosses have this type of power as well, as do many others in our lives. Legitimate power refers to the power granted by some authority, such as the power a police officer has due to the local or state government or the power a professor has due to the rules of a college or university.
Expert power results from experience or education. Those individuals with more knowledge tend to have more power in situations where that knowledge is important.
For instance, the physician will have more power in a medical emergency than the plumber. But, when the pipes explode and the house is being flooded, the physician is not the person to call. Finally, referent power refers to admiration or respect. When we look up to people because of their accomplishments, their attitude, or any other personal attribute, we tend to give them more power over us. Imagine being asked to do something by your “hero” or your favorite movie star; we are very likely to comply out of admiration or respect.
Using Power to Influence Others
Now that we know what power is and how people get it, lets talk about how this power is used to influence others. Most of us know that liking and agreeing tend to go together. We agree with our friends about many issues, especially the bigger ones, and often disagree with our opponents. Also, beliefs and behaviors tend to go together. For instance, most people who believe stealing is very immoral would not steal, most who believe littering is wrong, do not litter.
What’s interesting about this latter concept is what happens when our belief and our behavior do not correspond. You might think that we would change the way we act, but in the real world, we tend to change our belief about a topic before we would change our behavior. The person who believes littering is wrong, after throwing a soda can from their car window, might say to himself, “It was only one time,” or “look at all the other trash on the freeway.” in this sense, his belief has changed; littering is now okay if it is only done once or if others have littered first.
To equate this with influencing others, we see that if we can change the way a person behaves, we can change the way they think or feel. Imagine the car salesman who is able to convince the potential buyer that this new car is the one he wants to buy. The sales man might try to use many different techniques, but one is the ‘test drive.’ The theory behind this is that if the person’s actions include driving the car, they are more likely to change their belief about the car.
There are other variables associated with influencing others or attitude change. Lets take a look first at what attributes the source or the talker help her influence others. First of all is power, as discussed above. The more types of power and the stronger each of these is, the more influential she will be. Second, a person must be believable in order to influence us. The source must therefore be trustworthy, after all, if we don’t believe someone, they’re going to have a much more difficult time changing our minds. Finally, attractiveness plays a role in how influence us. We tend to be influenced more by attractive people, including physical and social attractiveness, likeability, demeanor, and dress.
The target or listener plays a role in how he will be influenced as well. Those with low self-esteem and/or high self-doubt tend to be more influenced that others. The more we doubt our own ability, the more we look to others for guidance or input. Other factors such as age, IQ, gender, or social status do not appear to play a significant role in how we are influenced by others.
Finally, lets look at the relationship between the source and the target. First of all, there needs to be some similarity between the two people. If the target or listener does not feel any similarity with the talker, he is much less likely to accept what she is saying. After all, we have nothing in common so what could she possible know about my life. The more similar the two, the greater the influential ability. Second, there needs to be a moderate discrepancy in attitude. If the difference between the two is too large, changing the listener’s attitude or belief will be too difficult. If the difference is too small, theo significant change will take place at all. The difference must be great enough that a change is possible but small enough that the listener is open to the change.
The Role of Groups
Do you think you act differently when alone than when other people are around? The answer to this question is typically a resounding ‘yes.’ We are concerned with our social image or how other people see us; some more than others, but very few people see no difference in their behavior. This section will discuss various theories relating to our behavior in group settings or when others are present.
Lets start with one of the most simple theory related to social psychology. When alone, we tend to be more relaxed, less concerned with the outward expression of our behavior, and are basically ‘ourselves.’ Add just one other person, even if we don’t know that person, our behavior tends to change, and not always for the better. Research has found that when others are present, our level of arousal is increased (Zajonc, 1965). In other words, we are suddenly more aware of what’s going on around us. Because of this, we tend to perform better at tasks that are well learned or simple (Guerin, 1993). When completing a difficult or new task, however, our performance level decreases and we tend to do more poorly.
This phenomenon is called Social Facilitation (Guerin, 1993), and as we try harder due to the presence of others, our performance actually decreases for difficult or unlearned tasks. Think about learning to play basketball for the first time. If you are alone, you will likely be more relaxed, and better able to concentrate. When others are watching you, however, you are more likely to be self-conscious, and therefore make more mistakes. Professional basketball players, however, because the task is so well learned, perform better when others are watching and they are able demonstrate their confidence and ability.
Group Think and Group Polarization
If you’ve ever been involved in a group decision making process, you’ve probably seen one of two things happen: either the group agrees on all of the major issues, or there is significant dissent that splits the group. If the group is cohesive; if they agree on most issues, they tend to stifle dissent because group harmony is the anticipated outcome (Janis, 1972). When we all agree, and are happy with that agreement, we typically do not want to hearopposing arguments. This phenomenon is referred to as Group Think. It can lead to impulsive decisions and a failure to identify and/or consider all sides of an argument. Some classic examples of group decisions going bad include lynch mobs, actions of the Ku Klux Klan, discrimination among hate groups, and mass riots.
Similar to this, Group Polarization refers to a groups tendency to talk itself into extreme positions. In this case, a group gets so focused and energized about a decision that it creates an internal fuel, so to speak, which pushes itself forward faster than originally intended. Imagine a group of protesters, all agreeing and deciding to picket. You can see how this could get out of hand because opposing views (Group Think) are not considered and the push to move forward for the cause is fueled internally (Group Polarization).
Another phenomenon that occurs in groups is referred to as Social Loafing. This theory states that as a group gets larger, the individual contribution decreases disproportionate to the group size (Everett, Smith, & Williams, 1992; Hardy & Latane, 1986; Ingham et al., 1974). This is due to the diffusion of responsibility created as the size of the group increases. Imagine being assigned a project to complete by yourself. Most likely you would complete 100% of it. Now if two people are involved, the percentage will typically not be 50/50. As more people are added to the group, you will end up with a small percentage doing a large portion of the work and a large percentage doing a much smaller proportion.
Bystander Effect
This last phenomenon is an unfortunate reality which has been observed far to many times in groups and in larger cities. We’ve all heard stories of people getting mugged, or beaten, or raped in broad daylight while people around offered no assistance. We have found that the internal push to help a person ieed decreases as the group gets larger, very similar to Social Loafing. In this instance, however, people tend to be followers and will only get involved if they witness another person getting involved. What results is a group of people witnessing a crime and wondering why nobody is helping. This does not occur if you are the only person witnessing the crime. If nobody else is around, a person will tend to help the victim. The more people, however, the less likely someone will offer assistance.
The effect of illness and hospitalization
Physically isolated
Surrounded by strangers
Visiting hours
Procedures that are intimate
At first very dependent – then learn to move back to balance of independence/dependence
What can studying communication skills offer us as medical practitioners?
Increased nurse Job Satisfaction
Decreased Conflict Within The Consultation
More Accurate And Efficient Interviews
Better Clinical Hypothesis Generation
Increased Patient Satisfaction
Increased Patient Understanding And Recall
Improved Compliance And Disease Outcome
Decreased Medico Legal Complaints
Actual Savings In Time
More Structure And Control Of The Difficult Consultation
Patient’s Satisfaction.
Many researches have also shown a significant relationship between the clinician’s interpersonal skills and patient’s motivation and satisfaction. When the nurse dominates the interview, verbally and emotionally, the result is always leads to dissatisfaction of the patients and their relatives. This may also be related to the patient’s expectation about the role of the nurse.
Patient’s satisfaction plays a major role in assessing quality medical care in the newly adopted health system (manages care) in the
Cognitive Satisfaction: How satisfied is the patient with their understanding of the diagnoses, treatment, and prognoses. This is related to the nurse’s Verbal Behavior.
Emotional Satisfaction: This is related to the nurse’s non-verbal behavior. The ability to show care and concern by tone of voice, eye gaze, facial expression, body movement and posture.
Treatment Outcome:
Effective diagnoses and treatment depends not only on identifying physical symptoms of illness, but also on the nurse’s ability to detect and respond to verbal and non-verbal cues, to elicit all relevant information (physical and psychosocial), relevant to diagnoses and treatment.
Patient’s Adherence:
A poor communication skill is related to poor compliance. Communication skill training has a positive influence on patient compliance with prescribed medication. Effective communication enables nurses/Nurse and other health professions to pass on relevant health information, and to motivate patient to pursue healthier lifestyle. This is a very important part on health promotion.
Nurse’s Competence & Self-Assertion:
Research has also shown that better nurse’s patient’s communication can also contribute to the clinical professional and personality (self-confidence) aspects.
CORE COMMUNICATION SKILLS
Core communication skills covers three dimensions:
• nurse -patient interpersonal skills
• Information gathering skills
• Information giving skills and patient education
Advanced Communication Skills
• Skills for motivating patient adherence to treatment plans
• Other applications of core communication skills in specific situations.
Nurse-patient interpersonal skills
Appropriate physical environment
The need to establish an appropriate physical environment to enhance privacy and attentiveness. Small things like arranging seating in a manner which neither threatening nor distant, or having a curtain to create a sense of privacy will in outcome of the interview.
Greeting patients in a manner acceptable within the cultural norms in relation to age, sex. etc. will help maintain their dignity and encourage their participation.
Active listening involves using both verbal and non-verbal communication techniques. The nurse should clearly signal that the patient has his/her full attention by look, by offering acceptance and continuation signals such as nods, phrases such as “right”/”I see” etc. A willingness to listen actively is however best signaled by use of open questions to promote fuller answer.
Empathy, respect, interest, warmth and support
These issues are at the heart of interpersonal skills. They cannot easily be faked, and if nurse do not have them, they cannot easily be taught things to do by way of them. Success in this area is not a matter of skills but of attitude. However, health practitioners should clearly signal their interest in how the patient’s problem is perceived, whether it concerns them, what their hopes and expectations are.
Nurse should ask questions to discover patient perception “Does the thought of the operation worry you?”. The nurse should also learn to show respect, interest, warmth and support. This will also involve being non-judgmental in attitude. THESE ARE THE CORE FACTORS IN RAPPORT BUILDING.
Language
Avoid medical jargon. You should consider the educational cultural and developmental level of the patient e.g., “ You have got appendicitis” is appropriate for most adults but not young children etc),. It is also important for nurses to monitor their use of potentially frightening words “Cancer”/”lump” etc.
Non-verbal communication
Skills ion-verbal communication like eye contact, physical proximity, and facial expressioeed to be improved to enhance patient’s satisfaction and adherence to treatment. This should convey to the patient that the Health practitioner is attentive and interested.
Avoid Overreacting
Some patients may appear demanding, dependent or even at times, adversarial. It is the physician’s responsibility to not overreact to these situations. This can be achieved by establishing limitations (boundaries) on what can be provided and suggesting appropriate ways for the patients to contact them.
Establishing Boundaries
Frequent phone calls, unscheduled visits, and unrealistic expectations, are ways in which some patients lose perspective of the shared responsibility of their care. Nurses need to establish boundaries for patients in a way that doesn’t belittle them.
Closing the interview
In addition to the skills of setting up, beginning and continuing an interview, the way of closing the interview is also important. The nurse should clearly signal that the interview is drawing to a close, usually by summarizing what has been said and what has beeegotiated.
Basic to interpersonal skills is to consider the importance of such factors as gender, cultural and socioeconomic factors, which could greatly affect perceptions of norms and standards of appropriate communication.
It is also essential for all practitioners to realize that what is needed is not only to know how to recognize a disease, but also how to recognize and to respond to a patient’s emotional response to their disease. In their interactions with patients, it is important for the clinicians to be aware of patients’ emotional responses to their situation and at the same -aware of their own emotional reactions toward the patients.
Information gathering skills
A critical part of all nurse-patient interactions involves eliciting information from patient. The core skills which are needed to facilitate the process of information gathering are skills which help to facilitate the patients’ involvement in the medical interview in away that enables the nurse to arrive at an accurate diagnosis of a patient’s problem or symptoms.
Using an appropriate balance of open to closed questions
Open questions invite an extended answer, not a “Yes/No” response. Generally questions such as “Please tell me about your pain” are better at eliciting information than closed questions such as “Is it a stabbing pain?”. Open questions are particularly useful patients are being asked to describe their problem; which they should be allowed to do minimal interruption early on in the consultation.
Silence
You need to learn to use silence appropriately as a way to encourage express themselves more fully, raise difficult topics and remember important
Clarifying patient expectations about the consultation
You need to clarify with the patient what their expectations are consultation, and should avoid making premature conclusions about the reason person’s visit to the nurse. This may helps to reveal cases where the symptom the patient is not in fact the patient’s main concern, and will also help to avoid inaccurate diagnosis of the patient’s complaints.
Clarifying the information given by the patient
You need to clarify the meaning of what the patient is saying and the nurse perceives from the patient’s non-verbal communication in order to he/she understands the patient fully.
Sequencing of events
After eliciting a broad description of the patient’s situation, students need to help the patient to sequence events and experiences in order to develop a logical of the patient’s situation.
Directing the flow of information
While it is important that patients be allowed the opportunity to communicate at the same time the student needs to learn to maintain control of the interview, by guiding the interview content towards a diagnosis of the problem.
Summarizing
Since a lot of information can be exchanged in consultations, you should be able to summarize the main issues raised during the consultation and should ensure that a shared understanding of these.
Information giving skills and patient education
The medical interview usually involves the nurse in providing information to the patient about their illness or problem, and when appropriate the nurse will give inform and advise about the proposed treatment plan or treatment options.
Providing clear and simple information by monitoring jargon, and by checking the patient’s understanding before (“What do you know about asthma?”) and during (“Have I made myself clear?”) the explanation process.
Using specific advice with concrete examples. Abstract or general advice/inform should be exemplified in terms that make sense to the patient “Don’t use acidic foods for example steer clear of fried things”.
Putting important things first. Research suggests that what is said first is remembered. A nurse should say first what it is most important for the patient to recall
Using repetition. Repetition should be used carefully to a level appropriate to patient. Often it is best to recycle information using slightly different words, in case the formulation has been only partly understood.
Summarizing. This is an important interview-closing skill (see above). Sum should be brief, and repeat the main points agreed in language, which is unambiguous clear. Patients may also be invited to repeat the nurse’s instruction to ensure that they shared understanding.
Categorizing information to reduce complexity and aid recall. Where the information to be conveyed is complex, or where there is a lot to be said, it should be clearly b down into manageable units which are clearly signaled to the patient, using markers s “there are three things we need to think about … firstly/secondly/thirdly etc”.
Using tools: Complex information could well be accompanied by a series of heading and diagrams. Some nurses offer tape recorders of their consultations to patients where the information has been intellectually demanding and psychologically distressing.
Checking patient understanding of what has been said. Repeating instructions, using diagrams, written instructions, and sometimes-technical aids to explain difficult concepts are useful. The student must be competent in summarizing the information given and in checking patient understanding by asking the patient to repeat what heard and understood.
Skills for motivating patient adherence to treatment plans
The list below includes skills for the promotion of behaviour. Realistic compliance with treatment plans may require patients to make significant changes in their diet, lifestyle or daily routine on a short term or long term basis.
Providing a rationale for behavior change
Providing examples of role models
Allowing opportunities for verbal rehearsal of the details of the treatment
Feedback (positive reinforcement of constructive behaviour changes already achieved since earlier consultations)
Finally, nurses should be aware about the clincial, communication and interpersonal skills that are required when dealing with difficult patients,(e.g., overdependent, dramatizing and exaggerating, aggressive, and antisocoial personalit.
Collaboration with patients and families
To win the collaboration of patients and their families, those providing care need to elicit, negotiate and agree on a definition of the problem they are working on with each patient.
They must then agree on the targets and goals for management and develop an individualised collaborative self management plan. This plan should be based on established cognitive behavioural principles and on the evidence relating to the management of the chronic condition.
Principles of collaboration
Understanding of patients’ beliefs, wishes, and circumstances
Understanding of family beliefs and needs
Identification of a single person to be main link with each patient
Collaborative definition of problems and goals
Negotiated agreed plans regularly reviewed
Active follow up with patients
Regular team review
