Chapter 7Critical Theory and

Emancipatory Knowing

Introduction

• Emancipatory knowing involves reflecting on social, cultural, and political injustice and how and why it came to exist.

• This pattern of knowing is critical for nurses, because they are constantly seeking to identify forces that stand in the way of maximum health and well-being for all people, families, and communities.

Nursing’s Patterns of Knowing (1 of 2)

• Per Carper (1978), there are four fundamental patterns of knowing in nursing:– Empirics, or the science of nursing– Ethics, or the component of moral knowledge– The component of personal knowing– Aesthetics, or the art of nursing

• Later theorists also identify a fifth pattern: emancipatory knowing, which emphasizes the universal human desire for liberation.

Nursing’s Patterns of Knowing (2 of 2)

• All five patterns have two dimensions:– Knowing (epistemological) dimension addresses

how we come to know or understand things, and what is required to admit something as knowledge

– Being/doing (ontologic) dimension addresses how what nurses know is manifested in who they are and what they do

Foundations of Emancipatory Knowing in Nursing

• Emancipatory knowing is grounded in several fundamental assumptions:– There is no historical, value-neutral knowledge– Research is a political activity– Power relations inform knowledge development– Language is constructed to carry power meanings– Social oppressions are not natural or fixed

Habermas’s Critical Social Philosophy (1 of 2)

• Philosopher Jürgen Habermas helped shape nursing’s emancipatory perspective.

• Habermas’s critical social philosophy is concerned with the practices that sustain people on a day-to-day basis.

• This philosophy was among the first to recognize that understanding the world requires a number of different approaches.

Habermas’s Critical Social Philosophy (2 of 2)

• Habermas described three human interests that are fundamental to everyday life:– Technical interest involves the capacity to use and

create tools and systems necessary for daily living– Practical interest involves the communicative

functions of life– Emancipatory interest involves the capacity to

recognize that something is wrong or unjust and to try to make it right

Freire’s Theory of Human Liberation (1 of 4)

• Theorist Paulo Freire also greatly shaped the emancipatory perspective.

• Freire’s theory of human liberation focuses on the conditions that sustain privilege for some people and disadvantage for others.

• According to Freire, certain traits are characteristic of both those who are privileged (“the oppressors”) and those who are disadvantaged (“the oppressed”).

Freire’s Theory of Human Liberation (2 of 4)

• Common traits of the privileged are as follows:– Powerful and unified– Fail to recognize non-privileged individuals as human– Have an ethic of self-interest and use their power to

sustain their own interests– Prescribe reality so that everyone views the status

quo as simply “the way things are”– Exploit others without apology

Freire’s Theory of Human Liberation (3 of 4)

• Common traits of the disadvantaged include:– Powerless and divided– Barred from realizing their full potential– Think and behave according to the prescribed norms

of the dominant group– Internalize the consciousness of the privileged– Exploited and manipulated but typically don’t realize

it

Freire’s Theory of Human Liberation (4 of 4)

• Per Freire, disadvantaged groups cannot be liberated until they engage in two processes:– Consciousness raising, or becoming aware of the

situation– Consciousness of actions, or developing a course of

action that is feasible but not yet tried or tested

• Liberation also requires unity with others who are disadvantaged, as well as love for self and for those who are privileged.

Implications of Emancipatory Philosophy

• Once a person incorporates an emancipatory perspective in his or her own practice, several shifts become possible.

• For instance, the nurse may now view people’s problems as linked to social processes, recognize the need to change social circumstances, or recognize all people’s potential to become agents of change.

Emancipatory Nursing Practice (1 of 3)

• Several traits characterize emancipatory nursing practice, including the following:– Critique: Nurses must take stock of a situation to

determine what is wrong, then identify what political and social structures sustain this injustice.

– Context: The people who are directly affected by conditions of injustice must play central roles as active participants.

Emancipatory Nursing Practice (2 of 3)

– Politics: Nurses must clearly express their intent to expose and correct injustice and discrimination.

– Emancipatory intent: The people who are most directly affected by injustice should dominate the discourse, with their voices serving as the basis for solutions or actions.

– Democratic structure: All people who participate in a project should be treated as equals, with each person both learning from and teaching others.

Emancipatory Nursing Practice (3 of 3)

– Dialectic analysis: There should be a focus on understanding the contradictory elements of any social structure.

– Reflexivity: Nurses must examine not just what they are doing, but also how they are doing what they are doing.

Emancipatory Knowing and Essentials of Advanced Practice (1 of 3)

• An emancipatory approach strengthens each of the AACN’s seven Essentials of Doctoral Education for Nursing Practice (2006):1. Scientific underpinnings for practice: An emancipatory

lens allows nurses to question the value of what is taken to be an underpinning.

2. Leadership for quality improvement: Emancipatory knowing is a type of systems thinking, so each participant in the care process is vested in trying to improve that process.

3. Clinical scholarship and evidence-based practice: With an emancipatory approach, any research method can be employed as part of a project.

4. Technology for the improvement of health care: An emancipatory lens focuses on the worth and desirability of technologic tools, asking whether they are appropriate and who they truly benefit.

5. Health care advocacy: Emancipatory approaches support grassroots initiatives that, by definition, serve the bests interests of the people.

Emancipatory Knowing and Essentials of Advanced Practice (2 of 3)

6. Interprofessional collaboration for improving outcomes: Emancipatory approaches demand the involvement of all parties to a situation, including all members of the health care team.

7. Clinical prevention and population health: Because emancipatory thinking focuses on addressing sources of disadvantage, it is an upstream approach that leads to better prevention and population health.

Emancipatory Knowing and Essentials of Advanced Practice (3 of 3)

Emancipatory Approach Can Strengthen Essential Competencies (1 of 2)

• Essential I: goes deeper than simply determining the methodological strengths and weaknesses of research reports.

• Essential II: facilitative and supportive leadership seek quality and transformative improvements.

• Essential III: diversity of research methods and deeper exploration of evidence for practice.

• Essential IV: critical questions determine the worth and desirability of technological tools.

Emancipatory Approach Can Strengthen Essential Competencies (2 of 2)

• Essential V: approaches take the discussion to the people and allies and advocates follow the will of the people allow refinement of ideals sought through policy.

• Essential VI: cooperation and collaboration in providing high quality care are significantly increased.

• Essential VII: brings the patterns into focus as a social construction that can be changed.

Conclusion

• Emancipatory approaches to nursing deeply probe into the causes of disadvantage and injustice in health care.

• Such approaches lead to social and political change that contributes to better care for those who need it most.