Understanding Causation in Healthcare: An Introduction to Critical Realism

Koopmans, Erica; Schiller, Catharine J.

doi:10.1177/10497323221105737

Cited by 15 publications

(5 citation statements)

References 37 publications

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“…A critical realism ontological paradigm with contextualism epistemology was used to approach the research question [ 24 ]. Critical realism as a paradigm is increasingly used in health services research to frame, identify and understand complex phenomena experienced by individuals in interaction with their contexts [ 25 ]. It can identify mechanisms and processes of the underlying structures and power dynamics that influence individual experiences [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

Health System Factors Affecting the Experience of Non-Invasive Ventilation Provision of People with Neuromuscular Disorders in New Zealand

Perry¹,

Jones

Jenkins³

et al. 2023

IJERPH

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Non-invasive ventilation (NIV) is a critical therapy for many patients with neuromuscular disorders (NMD), supporting those with respiratory failure to achieve adequate respiration and improve their quality of life. The aim of this study was to explore the experiences of access to, consent, uptake, maintenance and safe use of non-invasive ventilation by people with NMD. Semi-structured individual interviews were conducted with 11 people with NMD, each using NIV for more than 12 months. A critical realism ontological paradigm with contextualism epistemology guided the Reflexive Thematic Analysis. An Equity of Health Care Framework underpinned the analysis. Three themes were interpreted: Uptake and informed consent for NIV therapy; Practicalities of NIV; and Patient-clinician relationships. We identified issues at the system, organization and health professional levels. Conclusions: We recommend the development of national service specifications with clear standards and dedicated funding for patients with NMD and call on the New Zealand Ministry of Health to proactively investigate and monitor the variations in service delivery identified. The specific areas of concern for patients with NMD suggest the need for NMD-related NIV research and service provision responsive to the distinct needs of this population.

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Section: Methodsmentioning

confidence: 99%

Health System Factors Affecting the Experience of Non-Invasive Ventilation Provision of People with Neuromuscular Disorders in New Zealand

Perry¹,

Jones

Jenkins³

et al. 2023

IJERPH

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“…We assume that there is an actual patient journey from symptom onset to treatment initiation, but that our description and understanding of this will vary depending on the method of inquiry used and to whom this is delivered. Explicit acknowledgement of the real level allows us to delve into questions about causal mechanisms and how or when they are triggered within complex systems 39…”

Section: Methods and Analysismentioning

confidence: 99%

“…Explicit acknowledgement of the real level allows us to delve into questions about causal mechanisms and how or when they are triggered within complex systems. 39…”

Section: Methods and Analysis Ontology And Epistemologymentioning

confidence: 99%

From symptom onset to treatment initiation: protocol for a narrative study exploring the journey of older adults with tuberculosis in the English Midlands, UK

Kidy,

McCarthy,

Seers

2023

BMJ Open

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IntroductionTime from symptom onset to treatment initiation in tuberculosis (TB) remains stubbornly prolonged despite reductions in disease incidence. Delays may contribute to increased morbidity, mortality, onward spread of disease and poor patient experiences. Most delays occur prior to hospital referral. The average primary care healthcare provider in England is unlikely to see TB on a regular basis. Little is known about primary care diagnostic and referral challenges.Adults aged 65 years or older are more likely to experience delays. However, little is known about their journey from symptom onset to treatment initiation.Methods and analysisWe will carry out a narrative study including adults aged 65 years or older, living in the English Midlands and receiving treatment for active TB. Twelve English and 12 Urdu or Punjabi speakers will be recruited from TB clinics and interviewed. Their primary care records will be accessed, and the primary care story and secondary care letters will be extracted. Each of the data sources will be analysed using dialogical narrative analysis. Data will be triangulated within participants and across the data set.Ethics and disseminationThis study received approval from the Health Research Authority and the Research Ethics Committee in April 2022. Risk management and equity considerations have been made a priority. Findings will be disseminated through publication in open access peer-reviewed journals, presentations to policy makers, primary healthcare and secondary healthcare professionals, and through public facing materials developed in conjunction with patients, members of the pubic, TB services and charities.

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“…Kriittisen realismin mukaan empiirisesti havaittavien ilmiöiden lisäksi myös havaintojemme ulkopuolella olevaa maailmaa voidaan tutkia ja tehdä näkyväksi (Pekkarinen & Tapola-Haapala 2017). Kriittinen realismi on tarjonnut viitekehyksen useille sosiaalitieteellisille ja hoitotieteellisille tutkimuksille, joiden rajapinnoilla tämä tutkimus liikkuu (Mäntysaari 2006;Koopmans & Schiller 2022).…”

Section: Johdantounclassified

Omavalvonnan toimeenpanon haasteet iäkkäiden asumispalveluyksiköissä

Kiljunen,

Välimäki,

Kankkunen

2024

Janus

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Asiakas- ja potilasturvallisuus sekä palvelujen laatu turvataan sosiaali- ja terveyspalveluissa ensisijaisesti omavalvonnalla. Tässä artikkelissa kuvataan omavalvonnan toimeenpanon haasteita iäkkäiden asumispalveluissa. Kuvailevan implementaatiotutkimuksen tutkimusmenetelmänä oli laadullinen dokumenttianalyysi. Tutkimusaineisto koostui aluehallintovirastojen valvontapäätöksistä (n=93). Tulosten mukaan henkilöstön vaihtuvuus ja saatavuusongelmat, uudistetun vanhuspalvelulain henkilöstömitoituksen laskentaan liittyvät tekijät, sekä johtamiseen ja ohjaukseen liittyvät puutteet vaikeuttivat omavalvonnan toimeenpanoa iäkkäiden asumispalveluyksiköissä. Tuloksiin heijastuivat COVID-19 pandemian vaikutukset. Palveluntuottajien on tärkeä tukea omavalvontatyötä esimerkiksi mahdollistamalla riittävä esihenkilötyöresurssi, tarvittavat tietojärjestelmät ja riittävä moniammatillinen ohjaus. Tämän lisäksi tarvitaan palvelunjärjestäjän tarjoamaa ohjausta sekä ylemmän tason toimia, kuten lainsäädäntöä, tukemaan omavalvonnan toimeenpanoa.

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Understanding Causation in Healthcare: An Introduction to Critical Realism

Cited by 15 publications

References 37 publications

Health System Factors Affecting the Experience of Non-Invasive Ventilation Provision of People with Neuromuscular Disorders in New Zealand

Health System Factors Affecting the Experience of Non-Invasive Ventilation Provision of People with Neuromuscular Disorders in New Zealand

From symptom onset to treatment initiation: protocol for a narrative study exploring the journey of older adults with tuberculosis in the English Midlands, UK

Omavalvonnan toimeenpanon haasteet iäkkäiden asumispalveluyksiköissä

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