Critical Caring

Contributor: Adeline Falk-Rafael
August 20, 2018

Author – Adeline Falk-Rafael, PhD, RN, FAAN

Year First Published – 2005
Falk-Rafael's Critical Caring model (used by permissoin)
Falk-Rafael’s Critical Caring model (used by permissoin)
Major Concepts of the Theory

Caring, Critical Caring Health Promoting Processes, political activism, social justice, public health nursing practice


Hybrid midrange nursing theory

Brief Description

Critical caring is grounded in nursing through Watson’s caring science and Nightingale’s legacy of social activism, as well as in feminist, critical theory. Critical caring emerged from the practice experience of expert public health nurses. Critical caring is conceptualized as a way of being (ontology), knowing (epistemology), choosing (ethics), and doing (praxis) expressed through 7 carative health promoting processes derived from Watson’s 10 clinical caritas processes. Falk-Rafael, A. & Betker, C. (2012).  Also see Critical Caring Model Update!

Primary Sources for the Theory

Falk-Rafael, A. (2005). Speaking truth to power: Nursing’s legacy and moral imperative. Advances in Nursing Science, (28)3, 212-223.

Falk-Rafael, A. (2005). Advancing nursing theory through theory-guided practice: The emergence of a critical caring perspective. Advances in Nursing Science, 28(1), 38-49.

Falk-Rafael, A. & Betker, C. (2012a). The primacy of relationship: A study of public health nursing practice from a critical caring perspective. Advances in Nursing Science, 35(4), 315-332

Falk-Rafael, A. & Betker, C. (2012b). Witnessing social injustice downstream and advocating for health equity upstream: The “trombone slide of nursing.” Advances in Nursing Science, 35(2), 98-112.

Falk-Rafael, A.R. (In press). Critical Caring. In Smith, M. (Ed). Nursing Theory and Nursing Practice (6th ed.) F.A. Davis: Philadelphia

  • Reutter and Kushner advocated that nurses use a Critical Caring approach in meeting the challenges of the WHO Commission on Social Determinants of Health.
    • Reutter, L., & Kushner, K. E. (2010). “Health equity through action on the social determinants of health”: Taking up the challenge in nursing. Nursing Inquiry, 17(3), 269–280.
  • Critical caring has been included in the discussion of theoretical foundations for community health nursing in the 2015 edition of Canadian Community Health Nursing : a Canadian Perspective (a community health nursing text book. The authors examined the theory within the context of the Canadian Community Health Nursing Standards of Practice and found a connection with all seven standards.
    • Betker, C., MacDonald, M., Hill, M., & Kirk, M. (2015). Theoretical Foundations of Community Health Nursing (4th ed.). In Leeseberg Stamler, L., Yiu, L. & Dosani, A. (Ed.), Community Health Nursing: A Canadian Perspective. Toronto, ON: Pearson.
  • Butcher, Howard Karl. (2022). Community-Based Participatory Research Guided by Critical Caring Theory. Nursing Science Quarterly, 35(4), 400–408.
  • Dickson and Lobo (2018) explored the usefulness of the theory in advocating for comprehensive sexual health education (CSHE) and concluded that the theory helps explain, guide, and provide clarity for public health nurses in this work.
    • Dickson, E., & Lobo, M. L. (2018). Critical caring theory and public health nursing advocacy for comprehensive sexual health education. Public Health Nursing, 35(1), 78–84.
  • Shearer (2017) used Critical Caring in theory synthesis to develop a critical caring theory of protection for migrant and seasonal farm workers (MSFW).
    • Shearer, J. E. (2017). A Critical Caring Theory of Protection for Migrants and Seasonal Farmworkers. Public Health Nursing, 34(4), 370–379.)
  • Used as part of the educational program to prepare nurses for practice in the Nurse-Family Partnership program. (Dr. S. Jacks, McMaster University, Hamilton, Ontario (personal communication)
  • Integrated with Chinn’s theory of Peace & Power and Nodding’s philosophy of caring in a proposed nursing pedagogical model.
    • Chinn, P. & Falk-Rafael, A. (in press). Embracing the focus of the discipline: Critical caring pedagogy. Journal of Nursing Scholarship.


Adeline Falk-Rafael (1943 – )
Adeline Falk-Rafael

Dr. Falk-Rafael is a senior scholar at York University, School of Nursing in Toronto, Canada. During her career, she held a number of leadership positions, including Director of that School and President of the Registered Nurses Association of Ontario. Since 2004, her scholarship has focused on Critical Caring, a mid-range theory she originally developed for public health nursing.