In the discipline of nursing, the term critical theory refers to a foundational perspective that grounds emancipatory knowing. This term can be confusing in that it does not reflect the usual connotation of theory in nursing. The concept of critical has a range of negative common meanings that are not relevant in the context of critical theory. In this context, critical implies analysis that moves beyond the surface and beyond what is usually assumed. Generally, critical theory is a broad term that is used to describe both the process and the product of work that takes a historically situated and sociopolitical perspective and that challenges social inequities and injustices. Such theory is critical in the sense that it analyzes the roots and consequences of social inequities and injustices that privilege one group over another (Carnegie & Kiger, 2009).

As a method, critical theory has roots in the classic sociologic traditions of Karl Marx, Max Weber, and Emile Durkheim (Morrow, 1994). These early philosophic traditions were quite unfavorable to capitalist governments such as that of the United States and were viewed in the United States as being allied with communist ideology. The extreme anti-communist sentiments that prevailed in the United States during the 20th century made it difficult for U.S. scholars to engage in discourse surrounding the emergence of critical theory and philosophy. Scholars in countries that have strong social welfare policies and values have generally been more open and accepting of critical theory. As the political structures of the world began to change and the 40-year Cold War that began in the late 1940s abated, scholars in the United States gradually became more open to critical theory. This circumstance illustrates the tremendous influence of context on people’s thinking in that fears of communism created barriers to understanding critical theory and suppressed openness to the possibilities offered by critical theoretic approaches.

Critical theory began to emerge as a specific approach to the study of society through the work of scholars who were exiled from Germany by Adolf Hitler in 1932. These scholars became known as the “Frankfurt School.” Within the Frankfurt School, the term critical theory designated a form of sociologic theory that recognized society as evolving historically and that promoted a deliberate engagement with the problems of society and the processes of social transformation. Typically (but not always), when the term critical theory is capitalized, it refers specifically to the work of the Frankfurt School (Morrow, 1994). We use the lowercase format throughout our discussion to indicate a perspective that encompasses a broad range of philosophies, methods, and approaches that share a common fundamental engagement with the problems of society.

During the 1960s, Jürgen Habermas assumed a prominent position in shaping new conceptions of critical theory with broad interdisciplinary connections between the human sciences and philosophy (Morrow, 1994). Habermas’s critical social theory posited three fundamental human interests, each of which demanded its own method: (1) Technical interest is the human capacity to create things and processes to understand the physical world; this requires empiric methods. (2) Practical interest is the human capacity to communicate and to get along within a social community; this requires interpretive and philosophic methods. (3) Emancipatory interest is the human capacity to see that something needs to change and to take action to change it; this requires critical and reflective methods. Each of these interests is necessary for human survival (Habermas, 1973, 1979). Although critical nurse scholars have grounded their thinking in the work of a number of critical scholars and philosophers, the influence of Habermas is significant.

Paulo Freire was an important liberation theorist whose ideas have also had a significant influence among nursing scholars. Freire was a Brazilian educator who championed critical approaches to education. His work was philosophically grounded in the ideas of Karl Marx, Friedrich Engels, Georg Hegel, Gyorgy Lukacs, Herbert Marcuse, and Erich Fromm (Freire, 1970). Freire’s work grew out of a project to teach peasants in rural Brazil how to read. His ideas were not only specific approaches to teaching; they could also be used for any grassroots project of human liberation. Traditional education is based on the assumption that its primary purpose is to pass along the existing knowledge and values of the culture. Freire questioned this assumption, and, in doing so, formalized liberation theory, which considered education as a means of challenging the existing knowledge and values of the culture (Freire, 1970; hooks, 1993; Weiler, 1991). Because of the broad significance of his philosophy and the practical action-oriented perspective that he articulated, Freire’s ideas have had a widespread influence that has gone well beyond the scope of education.

Michel Foucault’s poststructuralist philosophy has also had a major influence on nurse scholars because of his insights with regard to the power imbalances that are embedded in and sustained by verbal and symbolic social discourses. Social discourses are whole systems of representation—writing, images, advertisements, artwork, and everyday verbal and nonverbal language—that create perceptions of social reality. For critical poststructuralists, there is no reality in an objective sense. Rather, what seems real is created for us by dominant social discourses. Verbal and symbolic discourses are powerful because they interconnect to both enable and limit what it is socially acceptable to know (Aston, 2008; Bradbury-Jones, Sambrook, & Irvine, 2008).

For example, discourses of beauty for young women suggest that a flawless face is more beautiful than a normally flawed and plainer face. Discourses also reinforce the idea that beauty of a certain type—that which is achieved by cosmetics and airbrushing—is attainable and a normal way to be. Because these messages appear everywhere, young women may only understand “beauty” as what is constructed and prescribed by these systems of discourse. Such discourses are powerful because they create barriers to societal resources for some as well as opportunities for others. Young women who cannot or choose not to achieve the popular standard of beauty may develop low self-esteem, and they run the risk of being denied social resources, such as popularity among peers and the social interactions for which most young people yearn.

This same example could be applied to young men, for whom popular discourses prescribe what is considered a typical movie-star appearance (being handsome, having well-defined muscles, and wearing well-fashioned clothing) as opposed to that which is considered “geeky” or “nerdy” (being thin, wearing glasses, and having casual, disheveled, or mismatched clothing). It is in this way that discourses construct “realities” that create power imbalances (in our example, between young women and men who are “beautiful” or “handsome” and those who are not). As alternative discourses that counter notions of beauty begin to undermine dominant discourses, they begin to lose their power to control how young people spend their money and time (Phillips, 2006).

As a poststructuralist, Foucault viewed language and discourse, including theory, as systems of representation that are necessary in the social order in that they produce meaning or ways to comprehend the world. However, as the examples of discourses related to beauty illustrate, these systems of language and discourse also limit what is understood, known, or perceived in a way that has lasting negative consequences. According to Foucault, we can only know things as they have meaning, and it is systems of discourse that produce or construct meaning (Hall, 2001). Critical poststructuralism analyzes how discourse functions to create imbalances that creates disadvantage for whole classes of persons in an effort to illuminate possibilities for change (Doering, 1992; Foucault, 1980, 1984).

During the latter half of the 20th century, a growing number of nurse scholars and activists began to develop disciplinary perspectives that are clearly connected to an emancipatory pattern of knowing. During the 1960s, Lydia Hall—who declared that there is no “shortage of nurses” but rather a “shortage of nursing”—established the Loeb Center for Nursing and Rehabilitation at Montefiore Hospital in the Bronx, New York. Her ideas and what proceeded from them are notable examples of emancipatory knowing in nursing. Believing that nursing was the chief therapy for those recovering from chronic illness, Hall established the Loeb Center as a place where nursing (rather than medicine) could be practiced and where physicians were under the direction of nurses (Hall, 1966). Hall envisioned the Loeb Center when she noticed that nurses were taking on medical tasks and becoming what she called “physician extenders” rather than providing bodily care and nurturing the cores of individuals after medicine’s curative role. Hall’s model of nursing at Loeb was revolutionary because it differentiated nursing from medicine and allowed nurses to practice in an environment that did not require the performance of curative tasks associated with the growth of medical technology during the 1960s.

Early literature in nursing that reflected emancipatory knowing also grew out of feminist perspectives. As reluctant as nurses in general were to accept feminist ideas and to align themselves with the women’s movement of the 1960s and 1970s in the United States, there were those who spoke out and published ideas that challenged the status quo. One of the earliest publications that reflected an emancipatory perspective was an article by Wilma Scott Heide published in the American Journal of Nursing in which Heide made a case for the importance of feminist ideas for nursing (Heide, 1973). In 1976, JoAnn Ashley’s book entitled Hospitals, Paternalism, and the Role of the Nurse was published. Basing her argument on historical evidence, Ashley contended that the apprenticeship system of education that prevailed in nursing situated nurses and nursing in a context that not only exploited the labor of women in hospitals but that also undermined the fundamental values of nursing related to health and health care. Her feminist analysis drew the essential connection between a misogynist (woman-hating) society and the resulting health policies and practices that constricted the role of nurses in the delivery of health care (Kagan, 2006).

Another significant publication that reflected nursing’s development of emancipatory perspectives was the 1983 publication of Susan Jo Roberts’ article entitled “Oppressed group behavior: Implications for nursing.” Drawing on Freire’s work and from literature about colonized Africans, Latin Americans, African Americans, Jews, and women, Roberts made the case that nurses also can be viewed as an oppressed group. Emphasizing that this insight can lead to substantive action to change nursing and health care, she concluded the following:

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