University of Tasmania, Australia
Christine Stirling has a career long interest in improving community based healthcare through research. Christine is Deputy Dean Graduate Research at the University of Tasmania and Vice-President of the AAG National Board. Her research includes improving services for people with dementia and she was lead investigator on the IM/NPACT project. She had published widely in international peer reviewed journals and has received over 1.5 million dollars in research grants.
This paper describes how a Critical Realist (CR) philosophy, which acknowledges the interaction of agency, society and context, was used to assist in the reconceptualization of an undergraduate nursing curriculum. CR allows us to understand all individuals as thinking/reflective individuals with agency and identifies how this agency interacts with pre-existing social structures such as organizations (for example hospitals) and collective identities (such as nurses). Students have a diverse range of motivations for enrolling in nursing courses and bring different life experiences, but their undergraduate experiences must help them adopt the necessary features of the collective identity of a professional nurse. These features include critical thinking, the use of evidence based practice, person-centred care, and the range of skills and knowledge that nurses need at graduation. Not only does CR recognize the agency of nurses but also can help students understand the agency of the people for whom they care and the impact of life circumstances and social structures. This lends itself well to the development of a modern nursing curriculum that highlights tenets of 21st Century health care including autonomous decision-making, the self-management of chronic illnesses, and the social determinants of health. CR provides a strong contemporary solution to the need for nursing curricula to have a structural and theoretical framework that supports the student’s development as a professional through critical engagement with modern health care systems.