4. RESULTADOS 21
4.2. Funcionamiento del nuevo interruptor genético en Escherichia coli 28
No matter how they are conceptualised or organised, the family is an intrinsic feature of the cultural and social fabric of society. As Fitzgerald (2004, p. 489) suggests, the family is a “cultural universal and a cultural icon”. The family provides a key context for socialisation by helping to forge a person’s identity and by moulding that person’s
36 behaviour in relation to others (Ember and Ember, 1992; Gropper, 1996; Ravertz, 1998; Winkelman, 1999; 2005; Fitzgerald, 2004; Giger and Davidhizar, 2004; Galanti, 2008). It is the context in which the beliefs, values, attitudes, and customs that guide much of everyday life are learnt and reinforced (Bonder, Martin and Miracle, 2001; 2002; 2004). Even if a person’s family is not physically or emotionally accessible, it may still exert an important influence on their life (Fitzgerald, 2004). Despite its universality, “much ink has been used up, in anthropology and comparative sociology, trying to define ‘the family’” (Keesing and Strathern, 1998, p. 233). Thus, there is no great surprise that practitioners find the concept of family seemingly simple, yet difficult to understand and deal with during their ‘multicultural clinical interactions’ (Fitzgerald, 1992; 2004). One standard anthropological definition of the family is that it can be understood as “a social and economic unit consisting minimally of one or more parents and their children” (Ember and Ember, 1988, p. 329). According to Fitzgerald (2004), such a simple definition, however, belies the complexities of family configurations and reconfigurations that emerge over time and in relation to things like marriage, births, deaths, divorces, migration, illnesses, and other relevant factors. Although some ideal family configuration may be identified at a given place and point in time, in any given society there is a great deal of diversity in family structure, role, and responsibilities (Sparling, 1991; Hartley, 1995; Ingoldsby and Smith, 1995; Gropper, 1996; Winkelman, 1999; 2005; Galanti, 2008). Patterns of parenting, marriage, kin relationships, and responsibilities vary across and within cultures, as does the nature of family life, childrearing, and care of the aged (Fitzgerald, Mullavey-O’Byrne, Twible and Kinebanian, 1995; Fitzgerald, Mullavey- O’Byrne, Clemson and Williamson, 1997). Responsibilities and roles within families also are structured by age and gender (Fitzgerald, 2004).
This diversity in family form, role, and responsibility is readily apparent in multicultural societies where there is immigration and internal migration (Fitzgerald, 2004). Family relationships are most often based on ‘blood’ and genealogical ties, but other criteria can be used to determine family membership, both in the long term and for special situations (e.g., god parents) (Winkelman, 1999; 2005). A member of a family based on ‘fictive’ kin ties may acquire similar rights and responsibilities to a member of a family that is organised around blood and genealogical ties (Fitzgerald,
37 2004). All these factors illustrate that the concept of family is a cultural construction or ‘cultural unit’ (Sparling, 1991) that is constantly redefined and reconfigured. In addition, even within a distinct cultural group, each family unit must be considered as unique (Storer, 1985; Sparling, 1991; Fitzgerald, Mullavey-O’Byrne, Twible and Kinebanian, 1995; Fitzgerald, Mullavey-O’Byrne, Clemson and Williamson, 1997). Fitzgerald and colleagues’ (1997a) note that the literature on the cultural construction of the family has tended to suggest that it plays a more involved and critical role in the lives of its members in non-western societies. Often this literature dichotomises the family form by using terms such as ‘idiocentric’ (self-centred) versus ‘sociocentric’ (social group centred), or ‘individualist’ versus ‘collectivist’ (Hofstede, 1980; Mullavey-O’Byrne, 1994a; Brislin and Yoshida, 1994; Berry, Poortinga, Breugelmans and Chasiotis, 2011). However, some academics have pointed out that such broad conceptual distinctions need to be treated with caution (Fitzgerald, et al., 1997a; Seeley, 2006).
As the family forms a central feature of most people’s lives, pre-registered mental health student nurses often interact with service users’ families during clinical placement (Bonham, 2004). The clinical anthropological (Fitzgerald, Mullavey- O’Byrne and Clemson, 1997; 2001; Fitzgerald, et al., 1997a; Fitzgerald, 2004; Bonder, Martin and Miracle, 2001; 2002; Galanti, 2008), transcultural nursing (Murphy and Clark, 1993; Kim, 1998; Spence, 1999; Boi, 2000; Gerrish, 2000; 2001; Ozolins and Hjelm, 2003; Cortis, 2004; Cioffi, 2005; 2006; Hultsjo and Hjelm, 2005; Lundberg, Backstrom and Widen, 2005; Vydelingum, 2006; Berlin, Johansson and Tornkvist, 2006; Severinsson, 2008; Berlin, 2010), and related health sciences literature (Phipps, 1995; Fadiman, 1997; Yang, Shek, Tsunaka and Lim, 2006), has suggested that families are part of the everyday discourse of health care practitioners. This discourse about families is cultural discourse, as it “is grounded in cultural ideas and ideals about families” (Fitzgerald, 2004, p. 489). Much of the transcultural and anthropological nursing literature (Gardenswartz and Rowe, 1998; Luckmann, 1999; Giger and Davidhizar, 2004; Boyle, 2008; Galanti, 2005; 2008; Holland and Hogg, 2010) also has encouraged nurses to understand the role that the family can play in a service user’s life and to involve families in the care of service users. For a variety of reasons, it also is clear that when mental illness is involved,
38 the family may play a somewhat different role than if the family member is suffering
from a physical illness (Fitzgerald, et al., 1997a).
Summary
This chapter has outlined the philosophical, theoretical and conceptual context of this study. A meaning-centred (Good and Good, 1981; Gaines, 1982a; Good, 1994) medical anthropological paradigm was chosen, because of its compatibility with the cultural constructionist philosophical approach of this study (Gaines, 1991; 1992). The structure and types of clinical placement were described and pre-registered mental health student nurses’ clinical encounters with service users and/or other participants such as the service user’s family members were conceptualised as ‘multicultural clinical interactions’ (Fitzgerald, 1992). ‘Multicultural clinical interactions’ are embedded in the health care system and draw on aspects of its three sectors (Kleinman, 1978; 1980; 1984). The service user’s family is central to the everyday discourse of health care professionals (Whybrow, Fitzgerald and Mullavey-O’Byrne, 1996; Fitzgerald, Mullavey-O’Byrne and Clemson, 1997; 2001; Fitzgerald, et al., 1997a; Kilshaw, Ndegwa and Curran, 2002; Russell, et al., 2002; Fitzgerald, 2004; Seeley, 2006; Galanti, 2008); and therefore the cultural meaning of family (Sparling, 1991) was addressed in this background chapter.
The concept of culture used in this study is firmly located in the ‘mentalist’ perspective (Fitzgerald and Mullavey-O’Byrne, 1996; Fitzgerald, Williamson and Mullavey-O’Byrne, 1998) and was then linked to the concept of culture general competency (Fitzgerald, 2000). The central concept of culture is key to understanding institutional, professional and a student nurses’ personal values (Bonder, Martin and Miracle, 2002), ‘clinical realities’ (Kleinman, Eisenberg and Good, 1978), notions of the ‘self’ (White and Marsella, 1982; Seeley, 2006), family (Fitzgerald, 2004), definitions of ‘abnormality’ (Good and Good, 1986), and ‘explanatory models’ (Kleinman, 1980). The next chapter conceptualises pre- registered mental health student nurses’ ‘multicultural clinical interactions’ as the transaction of explanatory models (Kleinman, Eisenberg and Good, 1978; Kleinman, 1980). These explanatory models are situated in the ‘clinical realities’ of ‘disease’
39 and ‘illness’ (Eisenberg, 1977), cultural notions of the ‘self’ (White and Marsella, 1982; Seeley, 2006), and the problematic clinical concept of ‘insight’ (Jacob, 2010).
40