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Being and doing politics: an outdated model or 21st century reality?
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JAN JOURNAL OF ADVANCED NURSINGDISCUSSION PAPER
Being and doing politics: an outdated model or 21st century reality?
Elaine Carnegie & Alice Kiger
Accepted for publication 15 May 2009
Correspondence to E. Carnegie: C A R N E G I E E . & K I G E R A . ( 2 0 0 9 ) Being and doing politics: an outdated model or
e-mail: elaine.carnegie@googlemail.com 21st century reality? Journal of Advanced Nursing 65(9), 1976–1984.
doi: 10.1111/j.1365-2648.2009.05084.x
Elaine Carnegie MMedSci PhD RN
Centre for Advanced Studies in Nursing,
Abstract
Centre of Academic Primary Care, School of
Medicine and Dentistry, University of Title. Being and doing politics: an outdated model or 21st century reality?
Aberdeen, UK Aim. This paper presents a discussion of how critical social theory can be used as a
tool for research, reflection and exploration of the political role of the nurse.
Alice Kiger BA MSc PhD Background. Sociological theory can be used to examine ideologies within nursing
Director systems in order to contribute to the future development of the profession. The
Centre for Advanced Studies in Nursing, importance of critical social theory has been identified in the literature as being
Centre of Academic Primary Care, School of
directly relevant to holism which is central to the nature of nursing.
Medicine and Dentistry, University of
Data sources. Texts published in English were identified from 1990 to 2008 using
Aberdeen, UK
the keywords critical social theory, community nursing, political advocacy, social
justice, sociological theory, health inequalities, health democracy, equity and
inequality.
Discussion. Critical social theory can be used as a tool to highlight ethical ways to
practise nursing. One reason for examination of the community nurse’s political role
is a shift in focus from the individual as patient to communities experiencing health
inequalities. Nursing needs to decide whether the profession will work at the
political level, and where advocacy and citizenship are located within a community
role.
Conclusion. Nurse educators must prepare nurses for political participation, and
nurse managers need to focus on national and local contexts in order to encourage
policy analysis and community engagement within nursing practice. An under-
standing of critical social theory can aid decision-making in relation to global and
local policy, enable the nursing profession to respond to social injustice, and permit
nurses to work with communities in the pursuit of community health.
Keywords: community nursing, critical social theory, health inequalities, political
advocacy, politics, social justice, sociological theory
The International Council of Nurses (2007) describes
Introduction
nurses’ policymaking roles and states that nurses should
The aim of this paper is to present a discussion of how critical contribute to public policy pertaining to the determinants of
social theory can be used as a tool for research, reflection and health. Previous research suggests that the political role of the
exploration of the political role of the nurse. nurse is under-developed and that the context for a political
1976 2009 The Authors. Journal compilation 2009 Blackwell Publishing Ltd
, JAN: DISCUSSION PAPER Being and doing politics
role requires clarification (Rains & Barton-Kriese 2001, sociological theory, health inequalities, health democracy,
Wilson 2002). Conducting an analysis of power in order to equity and inequality. The following databases were
‘fashion a more equitable society’ will require nurses to work searched: Cambridge scientific, Medline, Embase, CINAHL
more closely with communities (Drevdahl 2002, p. 18). and Ovid library, Web of Science from 1990 to 2008 for
Scandrett et al. (2000) emphasize the need for an analysis of papers in the English language only. The aim of the literature
power to accompany the pursuit of social justice. They suggest search was to determine how critical social theory is being
that working with powerless groups in the community is understood and utilized by nursing theorists and practitioners
strategically more significant than working with power- across the globe.
holders, even though this does not directly address policy.
Discussion
Background
Critical social theory
Over a decade ago, Robottom and Colquhoun (1992) wrote
that health educators require a greater understanding of Fossey et al. (2002) argue that the interpretive research
social processes, community structures and participatory paradigm seeks to understand meaning for individuals within
decision-making procedures. In order to face the challenge of their own experience and actions, whereas the critical
politicization and empowerment of communities, health research paradigm emphasizes ‘social and historical origins
educators ought to become aware of key concepts such as and contexts of meaning’, acquired through critical discourse
‘empowerment, community development, consciousness rais- and debate rather than objective enquiry (p. 720). Critical
ing, problematization, reflection, politicization, social and social theory proposes that the political and ideological
community action’ (Robottom & Colquhoun 1992, p. 459). contexts of social behaviour are missing from the positivistic
More than a decade later, for many health professionals and and interpretive research paradigms which seek to explain
health educators these concepts remain distant and problem- social behaviour, and its intention is to transform society so
atic (Adams et al. 2002, Bambra et al. 2005). This indicates a that it is ‘based on equality and democracy for all its
need for a holistic approach instead of a socially and members’ (Cohen et al. 2000, p. 28). Critical social theory
politically neutral approach by nurses. Long and Baxter seeks to understand a situation and to alter conditions, thus
(2001) suggest that health can only be understood through an leading to emancipation, equality and freedom for individ-
analysis of social, economic, environmental and historical uals. This is achieved by identifying the ‘false’ consciousness
relations. Nursing theorists link critical theory directly to that has led to a group or individual losing or gaining power.
holism which, in their view, is central to the nature of nursing It explores their underlying interests and the legitimacy of
(Wilson-Thomas 1995, Fulton 1997, Hartrick 1997, Boutain these interests and whether they serve equality and democ-
1999, Dickinson 1999, Manias & Street 2000, Browne racy. Critical theorists perceive that oppressed individuals
2001). A focus on power relations by nursing, using critical can be unaware of these processes, unable or unwilling to
social theory as a tool, might improve the health outcomes alter their conditions because of conflicts. Kuokkanen and
for members of society who are disadvantaged, as well as Leino-Kilpi (2000) have described the process of legitimiza-
challenge the future development of the profession. An tion. Power is characterized by domination and coercion. For
examination of sociological theory might aid interpretation one group to increase its power, another group is required to
and understanding of national and international social relinquish its power. ‘Legitimate’ power includes status,
systems and structures that contribute to inequality within action, conditioning, knowledge and expertise. This power
societies, as well as to social injustice in the context of the enables institutions and groups to control individuals, their
nursing profession itself. Using a critical social theoretical activities and economic resources (Kuokkanen & Leino-Kilpi
perspective might also encourage and enable community 2000).
nursing to operate beyond its current parameters. Critical social theory emerged after the First World War in
Germany. Relationships between material conditions, culture
and the psyche were explored by members of the Frankfurt
Data sources
Institute for Social Research (Rogers & Pilgrim 2005). Many
In order to explore critical social theory in relation to critical theories emerged from scientists connected to the
nursing, literature searches were conducted using the Frankfurt Institute. Theorists such as Theodor Adorno,
following keywords singly or in combination: critical social Jurgen Habermas and Axiol Honneth have contributed to
theory, community nursing, political advocacy, social justice, the debate on a non-positivist social science epistemology,
2009 The Authors. Journal compilation 2009 Blackwell Publishing Ltd 1977
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