Positioning positivism, critical realism and social constructionism in the health sciences: a philosophical orientation

Cruickshank, Justin

doi:10.1111/j.1440-1800.2011.00558.x

Cited by 76 publications

(69 citation statements)

References 44 publications

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“…EBP is situated within a postpositivistic paradigm that is underpinned by a commitment to empirical epistemology. Empirical epistemology maintains that knowledge is derived from sensory data obtained from objective observation, with the assumption that we cannot know reality directly; we can only support or not support theoretical claims with evidence (Crotty, ; Cruikshank, ). Although proponents of EBP acknowledge that research evidence alone is not sufficient for informing care decisions, many who have taken up this approach have oversimplified the process by privileging the empirical and giving lip service to clinical expertise and patient values and preferences, despite the call for integration of the three domains (DiCenso, ; Doane & Varcoe, ).…”

Section: Nursing and The Evidence‐based Practice Imperativementioning

confidence: 99%

Can nursing epistemology embrace p‐values?

Hall

Thorne

2017

Nursing Philosophy

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The use of correlational probability values (p-values) as a means of evaluating evidence in nursing and health care has largely been accepted uncritically. There are reasons to be concerned about an uncritical adherence to the use of significance testing, which has been located in the natural science paradigm. p-values have served in hypothesis and statistical testing, such as in randomized controlled trials and meta-analyses to support what has been portrayed as the highest levels of evidence in the framework of evidence-based practice. Nursing has been minimally involved in the rich debate about the controversies of treating significance testing as evidentiary in the health and social sciences. In this paper, we join the dialogue by examining how and why this statistical mechanism has become entrenched as the gold standard for determining what constitutes legitimate scientific knowledge in the postpositivistic paradigm. We argue that nursing needs to critically reflect on the limitations associated with this tool of the evidence-based movement, given the complexities and contextual factors that are inherent to nursing epistemology. Such reflection will inform our thinking about what constitutes substantive knowledge for the nursing discipline.

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Section: Nursing and The Evidence‐based Practice Imperativementioning

confidence: 99%

Can nursing epistemology embrace p‐values?

Hall

Thorne

2017

Nursing Philosophy

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“…Finally, the fourth feature presented is a critique of the prevailing social order (McEvoy & Richards, , p. 412). Cruickshank () identified the use of critical realism as a means to criticize illegitimate practices and as a means of improving existing theories through criticism. McEvoy & Richards () also note that although taking up critical realism does not necessarily ‘entail a commitment to a specific theory or sociopolitical agenda’ (p. 413), critical realism can be used to examine how structures maintain social inequities.…”

Section: Critiques Of the Conceptual Framing Of Moral Distressmentioning

confidence: 99%

Moving from conceptual ambiguity to knowledgeable action: using a critical realist approach to studying moral distress

Musto

Rodney

2015

Nursing Philosophy

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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.

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“…Bhaskar draws a distinction between reality and the accepted knowledge of that reality [33]. Although reality is believed to be independent of knowledge and perception (intransitive domain), the generation of knowledge about that reality is socially derived and a human activity that is dependent on theories, methods, models, and techniques used by researchers at a certain time and place (transitive domain) [3234].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Implementation and Delivery of a Social Prescribing Intervention: A Research Protocol

Pescheny¹,

Pappas²,

Randhawa

2018

International Journal of Integrated Care

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Background:In response to the increasing numbers of people with (multiple) chronic conditions, the need for integrated care is increasing too. Social prescribing is a new approach that aims to integrate the social and healthcare sector to improve the quality of care and user experience. Understanding main stakeholders’ perceptions and experiences is key to the implementation of social prescription and for informing future initiatives.Objectives:This paper presents the protocol of a qualitative research study to explore factors that (i) facilitate and hinder the implementation of a social prescribing pilot in the East of England, and (ii) affect the uptake, adherence, and completion rates by service users.Methods:A qualitative study including semi-structured interviews with managers, health professionals, service providers, navigators, and service users. Iterative thematic analysis will be used to analyse the data.Conclusion:This study will produce evidence on factors that hinder and facilitate the implementation of a social prescribing programme, as well as factors affecting the engagement, and non-engagement, of service users. Findings can contribute to the development of an evidence base for social prescription programmes in the UK, and inform practice, policy, and future research in the field.

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Positioning positivism, critical realism and social constructionism in the health sciences: a philosophical orientation

Cited by 76 publications

References 44 publications

Can nursing epistemology embrace p‐values?

Can nursing epistemology embrace p‐values?

Moving from conceptual ambiguity to knowledgeable action: using a critical realist approach to studying moral distress

Evaluating the Implementation and Delivery of a Social Prescribing Intervention: A Research Protocol

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