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The construct of social support is also not without some controversy and ambiguity. Sarason, Sarason and Pierce (1990) contended that “characteristic personality patterns, relatively enduring social ties, developmental histories and situational demands combine to produce the effects that, in the simplified world of a few years ago, we might have attributed to that amorphous entity, social support” (p.1). As this quote suggests, social support is a multidisciplinary area that has been researched from several perspectives, an outlook supported when studying the development of the Social Support Questionnaire

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While the papers of the epidemiologist Cassel (1976), and the medical doctor Cobb (1976) are considered seminal in any discussion of social support, the work of Weiss (1974), who described six provisions derived from social relationships is worthy of consideration when investigating adaptation to stress. The provisions he discerned were attachment (sense of security and place), social integration

(companionship and exchange of services), opportunity for nurturance (assisting others), reassurance of worth (recognition of competence), reliable alliance (commitment from others in times of stress) and

guidance (advice and emotional support).

Cassel (1976) emphasised the buffering effect of social support on stress within the context of the social environment generally, and the individual specifically. He recognised that for disease prevention, it was more effective to strengthen the individual’s social supports rather than trying to limit their exposure to stress. Cobb (1976) also saw social support as a buffer used in times of crisis, and not as an agent of improved adaptation. He proposed that the buffering effect was achieved because social support meant

that individuals felt cared for, believed they were loved, esteemed, and valued, and that they belonged to a reciprocal network which provided the basis for providing protection from disease, accelerated recovery from illness, and generated greater compliance with ‘doctors orders’.

Some within the field of community psychology followed up the earlier work of sociologists where some studies had suggested that stressors were more common in economically disadvantaged groups. The community psychologists had witnessed individuals without supportive networks, not coping effectively, but being supported by professionals and para-professionals (Sarason, et al., 1990). Auerbach and Kilman (1977) and Whitcher and Fisher (1979) were able to demonstrate that this emotional support was beneficial to health. Sarason et al (1990) also elucidated the role of child development. Child development provided the basis of the concept that social support is a personality variable with its source in early close relationships. They made the point that this notion arises particularly from attachment theory as proposed by Bowlby(1979) in the early 1970’s.

This history of the foundations of social support suggests it is necessary to consider which concept of social support is to be utilised, and then match an appropriate measurement technique, something that Holahan and Moos (1983) considered initially resulted in a somewhat ad hoc development of measures suited to the needs of particular studies. The three major methodological approaches used in social support research, as defined by Sarason et al (1990) include: (a) the mapping of social networks, (b) the assessment of support available to individuals in their daily lives, and (c) estimating the perception of the amount of support available to the individual. In terms of operationalising and measuring social support, Thoits (1982) concluded that it could be done in relation to its function or its structure. Cohen and Wills (1985) concurred with this, judging that support measures typically assess the function of the social support or the network structure within which it occurs. House and Kahn (1985) also identified

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function and structure plus quantity of social relationships as important properties of social support, concluding that quantity of social relationships measures were reliable and stable. In this vein, various patterns of relationships were found between the type and scope of social support when studying the buffering effect of social support in the stress – burnout relationship (Koniarek & Dudek, 1996). In reviewing multidimensional models of social support to develop a model with the potential to match the characteristics of any given stressful event to specific beneficial forms of social support, Cutrona and Russell (1990) concluded that Weiss’s (1974) theoretical conceptualisation had inspired the greatest number of measurement scales. In this realm, they further contended that the factor structure of their

Social Provisions Scale was found to correspond to the six dimensions described by Weiss and support the notion that social support is a multidimensional construct. In relation to the Social Provisions Scale, Wills and Shinar (2000) point out that there are both functional and structural areas of support

represented, but instrumental support is not well represented. Further to this, because there is high subscale correlations that may lend it to measuring a higher-order construct of perceived support, this same feature may prevent it from detecting effects for any individual function.

The complexity of assessing social support is further highlighted by research that has focussed on the interaction effect of various factors. An example of one aspect to be considered was explored by Cutrona, Cohen and Igram (1990). In a study of university students the interaction of context with situation was explored where it was found that whether the support was offered spontaneously or requested, whether it was consistent with what was required, and the nature of the relationship with the person providing the support significantly affected the perceived supportiveness of the behaviour. A more recent study considered the potential of social support to combat the stress associated with variable workloads, which in turn resulted in diminished productivity (Hauck, Snyder, & Cox- Fuenzalida, 2008).

There exists a series of findings supporting the significance of individual dimensions as described by Weiss with regard to the experience of stress. The reassurance of worth dimension has been negatively associated with perceived stress (Cutrona & Russell, 1987a; Varvel, et al., 2007), especially when provided by workplace supervisors (Constable & Russell, 1986). In conjunction with reassurance of worth, Varvel et al. also found that reliable alliance and social integration were also negatively associated with perceived stress. Similarly with regard to burnout in military nurses, personal achievement was significantly predicted by social provisions (Cutrona & Russell).

Within the realm of nursing, an early study looked at the relationship of social support and the work environment on burnout in U.S. army nurses (Constable & Russell, 1986) and found that lack of supervisor support was a significant predictor of emotional exhaustion on the MBI, indicating the

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buffering effect of this form of social support. Mallett et al (1991) compared the incidence of burnout in American hospice and critical care nurses in terms of their perception of the quantity and quality of social support available to them. They found significant but low negative correlations between burnout and the number of support persons, and the nurse’s satisfaction with that support. McIntosh (1991) adopted a similar approach when identifying and investigating the properties of social support in a group of American general nurses. The divergent conclusion that increased numbers of providers can neutralise the positive impact of social support was made. It was found that there was a significant negative correlation between emotional exhaustion and the amount and adequacy of support. An incidental finding suggested the amount of supervisory support to be significant in moderating stress effects. A recent study of Jordanian nurses supports the notion of the moderating effect of social support, finding an interaction between job stress and the support of co-workers and supervisors (Abualrub, Omari, & Abu Al Rub, 2009).

Eastburg, Williamson, Gorsuch and Ridley (1994) sought to include personality factors in their study of social support and burnout in Californian nurses. Their results suggested that extraverted nurses were more sensitive to variations in peer support than were introverted nurses, and required more peer support if they were to avoid the burnout dimension of emotional exhaustion. Further to these approaches, Tyler and Cushway (1995) studied stress in a group of English nurses in terms of coping and social support. They concluded that the more social support the nurses had within the organisation, the better they felt. However those without social support were not more reactive to stress, concluding that social support does not ameliorate the occupational stress of nurses.

In exploring the interactions of social support and coping style on the relationship between occupational stress and health, Button (2008) found social support had a reverse buffering effect on the psychological health of nurses. For low levels of social support with high levels of work-related stress, psychological health was good but if the stress was low poorer psychological health was experienced. High levels of social support with high work stress saw the psychological well being of the nurses being compromised while low job stress was associated with better psychological health.