Neoliberalist to make healthy choices and assume

Neoliberalist Assumption underlying
Individualistic Approach to Health Promotion

The assumption underlying the
neoliberal policy with regard to the existence of individualism in health
promotion practice is that “ethics, morality and social ideals are the
responsibility of each individual person” (McGregor, 2001, p. 3). The
literature has shown that nursing practice is influenced by neoliberal
ideological assumptions in light of the individualistic approach to health
promotion (Browne, 2001, Stevens, & Hall, 1993; Williams, 1989). Within the
principles of the capitalist economy, the free-market advocated by neoliberalism
promotes self-regulation and differences in individual choices (Baum, &
Fisher, 2014). Thus, nursing health promotion theory and practice are also
underpinned by the neoliberal assumptions that regard “individuals as rational
and freely choosing”  (Browne, 2001, p.
124). A number of theoretical models that inform nursing health promotion
practice have been developed from the biomedical disease perspective. According
to Baum, and Fisher (2014), biomedical research are promoted and funded in
institutions driven by  neoliberalist
ideology with the underlying assumption that harmful health behaviours are the
result of individual choices. Some examples of theories and models that are
developed from studies about individual reactions to health and disease include
the health belief model, the theory of planned action, and the transtheoretical
model of change (Cox, 1982; Foley et al., 2015; Jennings-Dozier; Tanner-Smith,
& Brown, 2010). The focus of these models is to provide individuals with
the necessary education that will enable them to make healthy choices and
assume responsibility for their health (Browne, 2001; Williams, 1989). It could
be argued that knowledge developed along this line is “… goal-directed or
problem solving action…” that does not promote individuals’ interest (Habermas,
1984, p. 12).

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Furthermore, regarding the idea of
free-choosing as a feature of neoliberalism, some nursing scholars have
suggested the concept of free-choosing as one that is applicable nursing
practice. The support given to qualitative nursing inquiry that is oriented to
understanding individuals’ lived experiences privileges subjective
epistemology. According to this modle of inquiry, behaviour is viewed as a
matter of individual choice and is seen as being exclusively personal. As such,
the individual is viewed as being fully responsible for their decisions
(Browne, 2001; Williams, 1989). This position rests on the assumptions of
neoliberal individualism that views “individuals as rational and freely
choosing” beings (Browne, 2001, p. 124). Thus, some nurse scholars have
suggested that nursing must fully embrace health promotion to generate
knowledge about the broader context, one that recognizes the problems of
oppression and the influence of socioeconomic and political hardship and that
this might be possible through the adoption of emancipatory practice (Browne,
2001; Hartrick, & Lindsey, 1994; Stevens, 1992).

Potential Contributions of Theory
of Communicative Action to Health Promotion Theory and Practice

Drawing on the theory of
communicative action to contribute to the nursing health promotion framework
does not indicate that the contemporary framework is ineffective. Rather, the
purpose is to provide nursing with the capacity to embrace a practice framework
that will allow nurses to view clients as “experiencing and communicative
individuals” rather than as “clinical events” (Kim, & Holter, 1995, p,
216). Browne (2001) articulates the need for knowledge about the broader
context, one that recognizes the problems of oppression and the influence of
socioeconomic and political hardship. Similarly, Steven (1989) suggests that it
is essential for nursing to broaden its view to include social determinants of
health. As increasing emphasis is placed on preventative health promotion in health
care (Hartrick, & Lindsay, and 1994). Having said this, I take the stance
that nursing can embrace a framework informed by Habermas’s TCA for health
promotion, specifically, I propose the incorporation of the framework of
communicative action into nursing practice.

Several nurse scholars (Browne,
2000; Judy et al., 2001; Kim & Holter, 1995) have argued that Habermas’s
theory offers an adequate philosophical foundation as a nursing practice
framework. Browne (2001) argues that if nursing maintains the status quo and
fails to adopt an approach that promotes the empowerment of clients with regard
to health promotion in a manner that enhances the client’s interest, nursing
run the risk of inadvertently reinforcing forms of oppression grounded in the
liberal individualistic ideology. Adopting the framework of communicative
action offers nursing the ability to view nursing health promotion theory and
practice as a process that promotes collaboration and mutual understanding
between nurses and their clients. To achieve this, nursing must therefore,
study and reflect on existing theories and models that informs nursing practice
(Ray, 1992).

Regarding the contribution of
communicative action to nursing health promotion theory and practice, operating
from the stance of communicative rationality provides nursing with the
possibility of engaging in a conversation with the system with the ultimate
goal of arriving at a validity claim that can be either contested or agreed to.
As Habermas writes, “Reaching an understanding function as a mechanism for
coordinating actions only through the participants in interaction coming to an
agreement concerning the claimed validity of their utterances, that is, through
intersubjectively recognizing the validity claims they reciprocally raised”
(Habermas, 1984, p. 99).

Another contribution for nursing
theory and practice relates to the influence of neoliberal ideology on nursing
health promotion practice and the way in which it reduces the importance of
individual interests and structural oppressions that are generated from
societal practices (Browne, 2000). To address this challenge, nurse scholars
have suggested that, rather than recommending the adjustment of the neoliberal
individualistic perspective or questioning the existence of structural
oppressions, one approach would be to be critical about the status quo with
regard to health promotion programs from the perspective of the TCA in order to
challenge the dominant ideology of neoliberalism (Browne, 2001; Judy et al.,
2001; Stevens & Hall, 1992).

In regard to the challenging the
status quo, a couple of questions are relevant to the process of critical
reflection to complete with regard to enhancing health promotion practice..
Several issues come up when the biases held by neoliberal ideology are examined
with respect to individualistic health promotion (Williams, 1989). For example,
does the behaviour-centred approach to health promotion render the process of
being and staying healthy more likely to be successful; are educational and
economic resources needed to stop or change harmful behaviours equally
distributed within society; whose interests have been  are promoted by the individualistic approach;
how does social stratification with regard to age,  gender, and physical ability influence the
chances for healthy behaviour? (Browne, 2000; Steven, & Hall, 1992;
Williams 1989). These questions might influence nursing health promotion
practice in a direction that will move it towards reaching a balance for
coordinating actions by way of consensus. The adoption of the process of the
TCA suggested would provide nursing with insights regarding the link between
health and social structures, thus enhancing the efficacy of nursing
interventions that are shaped by knowledge of the determinants of health (Judy
et al., 2001).

Implications for Nursing Discipline

Several nursing scholars have
identified that Habermas’s TCA is capable of offering nursing the opportunity
to engage in practical discourse about health promotion. (Cody, 1998; Kim, &
Holter, 1995; Ray, 1992; Stevens, & Hall, 1992). According to Habermas,
power relations are present in society and are not observed because they are
taken for granted. Therefore, advancing health promotion towards the
perspective of TCA will allow nursing to contribute to the facilitation of
…”oppressive social system…” (Ray, 1992, p. 99) and more effectively challenge
the status quo to enhance the development of emancipatory knowledge.

As such, Browne (2000), recommends
that before nursing can develop emancipatory critiques and processes it “must
critique its own complacency with the ruling relations as they are enacted in
theory development ” (p. 50). Browne (200) suggests that this will provide the
field of nursing with the opportunity to consider its role with respect to the
essence of generating and applying disciplinary knowledge in an unjust
situation. Similarly, Ray() recommends that it might be beneficial for nursing
to  study …”existing models and theories to
more adequately communicate what is really going on in nursing…”(p. 99)
Consequently, a health promotion practice that is based upon a coherent,
receptive and reflective communication-type of discourse between nurses and
clients could be achieved.


examining the potential contribution of the perspective of Habermas’s  TCA towards enhancing health promotion theory
and practice in nursing, I have highlighted the benefits that could be gained
by approaching nursing health promotion practice from the perspective of
communicative rationality. I have argued that nursing health promotion theory
and practice should be informed by an epistemology that is developed within the
domain of emancipatory practice. If nursing is to fully embrace health
promotion practice, the range of epistemological requirements in nursing should
be identified, and positioned accordingly within the framework offered by the
TCA. Furthermore, as I have previously explained, the most significant portion
of Habermas’ s idea beliefs with regard to TCA could be achieved through a
critical reflection that examines the challenges of the individualist approach
to health promotion. Continuing to develop nursing knowledge for theory and
practice in the context of neoliberalism, runs the risk of maintaining the
status quo, and inadvertently reinforcing 
forms of oppression enacted both on the individuals, on nursing
profession, and on health care. Therefore, failure to challenge the assumptions
of the dominant neoliberal ideology that operates in nursing and health care runs
contrary to lifeworld’s communicative reality, which is oriented to mutual
understanding, and possibly result in undistorted communication.