This paper considers proposals for developing ‘co-productive’ medical partnerships, within the UK National Health Service (NHS), concentrating in particular on the potential problem involved in combining professional and lay conceptions of health. Much of the literature that advocates the introduction of co-productive healthcare partnerships assumes that medical professionals and patients share, or can easily come to share, a common set of beliefs about what is valuable with regard to health interventions and outcomes. However, a substantial literature documents the contestability of (...) the concept of health, particular across professional and lay divides. We suggest that this potential disagreement ought to be taken seriously, and suggest that the prospect of a co-productive NHS in which patients and professionals act in partnership is threatened by the existence of unresolved epistemic differences. We suggest that part of the solution may lie in re-framing this potential disagreement in the terms provided by Engel’s bio-psycho-social account of health, and demonstrate how support for this account can be grounded upon a critical realist foundation. What we call a ‘stratified conception of health’ reveals the potential complementarity between health beliefs which may have at first seemed to be essentially contradictory. We consider some of the practical implications this idea has for conceiving and creating co-productive medical partnerships. (shrink)

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the impact of moral (...) constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques – critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of ‘constraint’ and ‘agency’. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach. (shrink)

This study highlights deficits in current leadership concepts; and offers new perspectives through the application of a critical realist analysis. Whilst today’s business world is changing and needs effective leadership to survive, nevertheless, leadership is poorly understood, and current leadership research lacks a unified theory or framework. Such a unified framework is suggested here, based on a layered ontology of leadership. It argues that the causal configuration of leadership – the multiple interacting causes that result in its emergence – is (...) best understood as the interplay between the key mechanism of power, along with human agency and collaborative agency, within specific structural and contextual conditions. This explanation requires a critical realist design of a layered ontology; it would not be possible from the perspectives of either positivism or constructivism. (shrink)

In this review essay I offer a critical assessment of the work of David Byrne, an applied social scientist who is one of the leading advocates of the use of complexity theory in the social sciences and who has drawn on the principles of critical realism in developing an ontological position of ‘complex realism’. The key arguments of his latest book, Applying Social Science: The Role of Social Research in Politics, Policy and Practice constitute the frame of the review; however, (...) since these overlap with those of his previous books, Interpreting Quantitative Data and Complexity Theory and the Social Sciences, I consider all three books together. I identify aspects of Byrne’s ontological position that are in tune with the principles of original and dialectical critical realism and aspects that are not. I argue that these inconsistencies, which Byrne must resolve if he is to take his understanding of complexity further, stem from the residual influence of various forms of irrealism in his thinking. (shrink)

ABSTRACTThis article uses the philosophy of critical realism to overcome the problem that most contemporary guidelines for interdisciplinary research fail to provide would-be researchers with adequ...

In this wide-ranging interview Berth Danermark discusses several things. First, his route into realism via community activism, an interest in the theory and practice of Marx and Engels and the philosophy of Mario Bunge, and inspiration drawn from Herman Hesse. Second, the formation of the Nordic Network for Critical Realism and realism's enduring foothold in Scandinavia. Third, the career trajectory that took him from research on urban planning to the formation of the Swedish Institute for Disability Research (SIDR). He discusses (...) how the well-known introduction to critical realism and applied social science, Explaining Society, came to be written, some misconceptions regarding critical realism and methods, the challenges involved in undertaking disability research and the development of and influences for his work of concepts such as interdisciplinarity and critical methodological pluralism, as well as issues related to transdisciplinary research and professional collaboration. The interview concludes with some advice for researchers. (shrink)

Abstract This paper explores gender and mental health with particular reference to the emerging philosophical field of critical realism. This philosophy suggests a shared ontology and epistemology for the natural and social sciences. Until recently, most of the debate surrounding gender and mental health has been guided either implicitly or explicitly within a positivist or constructivist philosophy. With this in mind, key areas of critical realism are explored in relation to gender and mental health, and contrasted with the positions of (...) positivism and constructivism. It is argued that critical realism offers an alternative philosophical framework for the exploration of gender issues within mental health care. (shrink)