The nursing discipline is undergoing transition. As patient acuity and complexity increase, nurses are required to undertake a role that is more comprehensive in patient outcomes and health care leadership (Josephsen, 2014). As the discipline evolves so is the nursing educational program curricular framework changing from being based on a certain nursing theory, to an overall metaparadigm to the contemporary emphasis on meeting the standards of curricular content developed by accrediting agencies. The 1970s witnessed a call from nursing education and accrediting agencies for each nursing programs to select a specific nursing theory as their conceptual framework for developing their curriculum, for instance the Orem’s self-care deficit theory. This theory demonstrated inadequacies with regard to meeting the needs of curriculum, as such nursing theories have their primary focus on health issues but are not comprehensive curricular theory (Berbiglia, 2011). Nursing education then advanced to employing metaparadigm conceptual framework for curricular development. In this model, nursing metaparadigm encompassed concepts of health person, nursing and environment, which were used to display the human experience in a holistic view with regard to the nursing discipline. However, this model was also considered incomplete because of not being applicable to various disciplines in healthcare (Josephsen, 2014).
Presently, nursing education programs employ national standards of curricular accreditation, including the American Association of Colleges of Nursing (AACN) standards for curriculum organization and development. These standards focus on curricular contents, including baccalaureate generalist nursing practice competencies and professional values and professionalism (Josephsen, 2014). Even though these national standards focus on values such use of evidence-based practice, continuing education, and professionalism, they seem to be more focused on general actions and roles of the professional registered nurse. In addition to these roles, the registered nurse is required to have patient advocacy roles, offer sound clinical judgment, and think critically. The AACN standards indicate that development of these skills should culminate in clinical experience that gives the student a chance to develop these clinical evaluation and reasoning skills (Josephsen, 2014). The focus the standards of AACN accreditation is that of development of competency with regard to the nursing discipline, with skills, including clinical judgment developing spontaneously with practical clinical experiences. Nonetheless, students need skills to engage in patient in patient advocacy and critical thinking that call for further curricular focus: that of metacognitive development founded on Critical theory and constructivism (Josephsen, 2014).
The emergence of the Critical theory was spearheaded by professors from the Institute for Social Research, and has been supported on the Marxist philosophical base. Since its inception, the critical theory has made significant contributions to the nursing discipline. Application of this theory establishes a dialectic vision of health. For nursing, putting into consideration its dialectic nature, it means that, after imparting the theory, it should be applied in practice to achieve better learning from feedback (Mosqueda-Diaz, Vilchez-Barboza, Valenzuela-Suazo, & Sanhueza-Alvarado, 2014). Accomplishing the actual dialectic nature of the nursing discipline necessitates that nurses break with the identity of docility in their discipline, leaving behind the invisible, submissive, fragmentary, technical, and pathocentric intramural professional exercise. Dialectics focus their attention on novel ways of addressing ill health from various contexts. From this perspective, the critical theory allows nursing to put into consideration various factors that contribute to health and ill health, and to transform circumstances by applying knowledge innovatively to address current challenges facing health care. Application of Critical theory in nursing serves as an effective solution for modifying disparities, promoting the dialogue of science in daily activities and increasing individual participation in their healthcare (Mosqueda-Diaz et al. 2014). Overall, Critical theory offers a proper conceptual framework for interpreting findings and guiding nursing practice. It also makes it possible for student nurses to acquire appropriate skills necessary for contemporary practice (Josephsen, 2014).