This paper addresses Foucauldian theory and its usefulness to nursing research. It is written in the form of a discussion between the authors on the merits and liabilities of Foucauldian theory as applied to analyses of nursing. As such, it focuses upon some of the more pertinent critiques of both Foucauldian and postmodern theory. By addressing Foucault from two different positions, the discussion seeks to demonstrate the complexity of Foucauldian theory and warns against oversimplification in its application to nursing research. (...) The authors also argue for an awareness of the strengths and weaknesses of any given theoretical stance. (shrink)

This paper critically analyses realist evaluation, focussing on its primary analytical concepts: mechanisms, contexts, and outcomes. Noting that nursing investigators have had difficulty in operationalizing the concepts of mechanism and context, it is argued that their confusion is at least partially the result of ambiguities, inconsistencies, and contradictions in the realist evaluation model. Problematic issues include the adoption of empiricist and idealist positions, oscillation between determinism and voluntarism, subsumption of agency under structure, and categorical confusion between context and mechanism. In (...) relation to outcomes, it is argued that realist evaluation's adoption of the fact/value distinction prevents it from taking into account the concerns of those affected by interventions. The aim of the paper is to use these immanent critiques of realist evaluation to construct an internally consistent realist approach to evaluation that is more amenable to being operationalized by nursing researchers. (shrink)

New nursing researchers are faced with a smorgasbord of competing methodologies. Sometimes, they are encouraged to adopt the research paradigms beloved of their senior colleagues. This is a problem if those paradigms are no longer of contemporary methodological relevance. The aim of this paper was to provide clarity about current research paradigms. It seeks to interrogate the continuing viability of positivism as a guiding paradigm for nursing research. It does this by critically analysing the methodological literature. Five major paradigms are (...) addressed: the positivist; the interpretivist/constructivist; the transformative; the realist; and the postpositivist. Acceptance of interpretivist, transformative or realist approaches necessarily entails wholesale rejection of positivism, while acceptance of postpositivism involves its partial rejection. Postpositivism has superseded positivism as the guiding paradigm of the scientific method. The incorporation in randomized controlled trials of postpositivist assumptions indicates that even on the methodological territory that it once claimed as its own, positivism has been rendered redundant as an appropriate paradigm for contemporary nursing research. (shrink)

This paper examines Florence Nightingale's realist philosophy of science by comparing it to the contemporaneously dominant philosophy of positivism. It starts by adumbrating the tenets of positivism and continues by assessing the degree to which Nightingale accepted or rejected those tenets. It is argued that while she accepted much of positivism, on realist grounds she opposed its belief in phenomenalism, its rejection of speculative philosophy, its separation of fact and value, and its rejection of religion. Following an examination of how (...) Nightingale's philosophy impinged on her approach to nursing and health care, the paper concludes with a comparison of her ideas with those of modern realism and a discussion of the contemporary salience of her ideas. It is argued that while some aspects of her approach may no longer provide an appropriate basis for modern nursing, her environmental approach, her transcendental realism, and her adherence to caring values may still be of use to contemporary nurses. (shrink)

PORTER S and O’HALLORAN P. Nursing Inquiry 2012; 19: 18–28The use and limitation of realistic evaluation as a tool for evidence-based practice: a critical realist perspectiveIn this paper, we assess realistic evaluation’s articulation with evidence-based practice (EBP) from the perspective of critical realism. We argue that the adoption by realistic evaluation of a realist causal ontology means that it is better placed to explain complex healthcare interventions than the traditional method used by EBP, the randomized controlled trial (RCT). However, we (...) do not conclude from this that the use of RCTs is without merit, arguing that it is possible to use both methods in combination under the rubric of realist theory. More negatively, we contend that the rejection of critical theory and utopianism by realistic evaluation in favour of the pragmatism of piecemeal social engineering means that it is vulnerable to accusations that it promotes technocratic interpretations of human problems. We conclude that, insofar as realistic evaluation adheres to the ontology of critical realism, it provides a sound contribution to EBP, but insofar as it rejects the critical turn of Bhaskar’s realism, it replicates the technocratic tendencies inherent in EBP. (shrink)

The argument that nurses should be Marxists is made by looking at the primary areas of nursing activity in turn, giving an example of how capitalist economic relations negatively impact upon that activity, and providing a Marxist explanation of the reasons why it has that impact. In relation to the nursing activity of health promotion, it is argued that capitalism's generation of social inequality undermines the health of the population. In relation to curative activities, the focus is on how capitalism's (...) reckless pursuit of profit has subverted the sustainability of bactericidal interventions. The argument in relation to comforting and assistive care is that the ownership and control of health services by capitalist corporations undermines therapeutic relationships. Finally, in relation to supportive care, it is contended that capitalism's requirement for a disciplined workforce can compromise healthcare professionals’ support of employees. It is concluded that if nurses aspire to have some control over their activities, then it is a good idea for them to avail of Marxism's capacity to identify the socio‐economic mechanisms by which capitalism affects nursing care. (shrink)

The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever‐increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the (...) UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population is also addressed. Marx's writings on the state and its relation to the capitalist class were fragmentary and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class‐balance theory, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations includes Poulantzas's abdication theory and Miliband's instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie's ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie. (shrink)

Background: Randomized controlled trials have been criticized for their inability to identify and differentiate the causal mechanisms that generate the outcomes they measure. One solution is the development of realist trials that combine the empirical precision of trials' outcome data with realism's theoretical capacity to identify the powers that generate outcomes. Main Body: We review arguments for and against this position and conclude that critical realist trials are viable. Using the example of an evaluation of the educational effectiveness of virtual (...) reality simulation, we explore whether Partial Least Squares Structural Equation Modelling can move statistical analysis beyond correlational analysis to support realist identification of the mechanisms that generate correlations. Conclusion: We tentatively conclude that PLS-SEM, with its ability to identify ‘points of action’, has the potential to provide direction for researchers and practitioners in terms of how, for whom, when, where and in what circumstances an intervention has worked. (shrink)