Using critical realism in nursing and health research: promise and challenges

Genomic research continues to 'change the landscape' of healthcare worldwide (Camak, 2016, p.86). Genomics is beginning to reshape healthcare delivery by changing the way we prevent, diagnose, treat and monitor illness, providing the opportunity to offer more precise and tailored treatments. As genomic developments change healthcare, so too are they changing the nursing profession. This revolution has led to a new responsibility for all nurses to be knowledgeable of genomics and incorporate genomics into nursing practice. Research addressing the integration of genomics into nursing practice in Australia is limited. The aim of this study was to determine how nurses engage with genomics in nursing practice in this country. Case study research was used to achieve the research aim. A case study is 'an empirical inquiry that investigates a contemporary phenomenon (the 'case') in depth and within the real-world context' (Yin, 2014, p. 16). A single holistic case study design drawing on the works of Robert Yin (2014) was conducted. This case study was underpinned by a critical realist philosophy. Critical realism is concerned with the nature and knowability of the social world and social phenomena (Schiller, 2016), making it a suitable framework to guide an exploration of Australian nurses' engagement with genomics. Data were collected via a cross-sectional survey of Australian registered nurses and midwives in 2016, and via semi-structured interviews with registered nurses working in oncology departments within a regional Australian hospital in 2018. Key case findings were generated using thematic analysis, and grouped into three categories: Point of learning (education), Point of reference (professional expectations) and Point of care (clinical practice). These three categories were used as a framework to describe the case, and presented in relation to the key tenets of critical realism - (i) the primacy of ontology, (ii) the stratified character of the realworld (reality) and the search for generative mechanisms, and (iii) the interplay between social structures and human agency (Bhaskar, 1975/2008, 1979/1998, 2011). The case indicated that Australian nurses have limited engagement with genomics at the point of learning, point of reference and point of care. Nurses' inadequacy at each of these points is sequential, meaning that if nurses are not knowledgeable about genomics and are unclear about professional expectations, they cannot be expected to adequately integrate genomics into their practice. The critical realist philosophy underpinning the case led to consideration of the way point of learning, point of reference and point of care form the context for nursing practice. How nurses respond to this context determines the extent to which they are able to transform education, policy and practice. Australian nurses' limited engagement with genomics has consequences for the nurse, the patient and the wider nursing profession. This limited engagement must be addressed. It is recommended that (i) genomics be embedded throughout the nursing curricula with healthcare applications made clear to the learner (point of education), (ii) nursing policy articulates the alignment between the NMBA's Standards for Practice and genomic competencies (point of reference), and (iii) nurses incorporate genomics knowledge and skills into practice (point of care). The 'genomic revolution' (Jenkins et al., 2005, p.98) will require further development of Australia's capacity, capability and infrastructure if these are to support the integration of genomic information and technology into the national health system (Australian Health Ministers' Advisory Council, 2017b). As the largest component of the Australian health workforce, nursing cannot ignore the opportunity before us.

LONERGAN'S "CRITICAL REALISM" AND RELIGIOUS PLURALISM TIMOTHY R. STINNETT University of Detroit Mercy Detroit, Michigan THE PHENOMENON of religious pluralism is raising ome basic questions for philosophical thought that must e faced not only by philosophies not linked to any particular religious tradition but also by the theologies or philosophies of specific religious traditions. Christian theologians seem first to have discovered the range of questions raised by religious pluralism in the face of apparently conflicting truth claims. No less important, however, are certain moral questions: how the advocates of the various religious traditions should bear witness to their respective traditions, and how they should go about identifying and correcting the ideological biases that seem inevitably to occur as the result of the historical and cultural conditions in which their respective witnesses emerge and develop. Thus, a philosophical treatment of religious pluralism will need to make explicit the relevant conditions of truth by which religious claims must be assessed. It will also need to clarify how apparently conflicting truth claims may be examined to see whether they are genuinely conflicting and then how genuinely conflicting truth claims may be adjudicated. Bernard Lonergan's philosophy of critical realism may be considered a valuable resource for addressing such questions insofar as he undertakes to answer such fundamental questions as " What am I doing when I am knowing? Why is doing that knowing? What do I know when I do it? " 1 Attention to these questions 1 Bernard Lonergan, Method vn Theology (New York: The Seabury Press, 1979), p. 25. See also Bernard Lonergan, A Third Collection: Papers by Bernard I. F. Lonergan, S.J., edited by Frederick E. Crowe, S.J. (New York: Paulist Press, 1985), p. 210. 97 98 TIMOTHY R. STINNETT promises clarification about how religious truth claims may be shown to be true (and thus to count as " knowledge ") and how genuinely conflicting truth claims may be adjudicated. It also promises to clarify how one may recognize ideological bias and correct for it in a fully reflective understanding of a particular religious witness. For Lonergan, answers to the three questions cited above provide respectively a cognitional theory, an epistemology , and a metaphysics, all three of which together constitute his philosophy of critical realism.2 In this essay I will explore the relevance of his critical realism for philosophical treatment of questions raised by religious pluralism. After an analysis of the salient features of Lonergan's philosophy, I will consider the disadvantages and advantages it affords a philosophy of religious pluralism. By attending to the disadvantages I will register an immanent criticism of Lonergan's critical realism, and I will atexplain how it must be revised in order to become a useful resource for treating philosophical questions raised by religious pluralism. Lonergan's "Critical Realism" The human capacity to know is for Lonergan what constitutes human being as spirit. " Let us say," he writes, that intelligibility that is not intelligent is material, and that intelligibility that is intelligent is spiritual. . . . But inasmuch as we are spiritual, we are orientated towards the universe of being, know ourselves as parts within that universe, and guide our living by that knowledge.8 Knowing, then, is a process with distinguishable moments, and it is completed in action consistent with what is known. Moreover , what can be known by a human subject determines the parameters of "proportionate being." The coordination of all of the departments of human knowledge is the object of metaphysics, 2 Method in Theology, pp. 25, 83, 261, 316. See also Bernard Lonergan, Insight: A Study of Human Understanding, revised ed. (New York: Harper & Row, 1978), pp. 322ff., p. 350. a Insight, p. 516. LONERGAN ON RELIGIOUS PLURALISM 99 which Lonergan defines as " the integral heuristic structure of proportionate being." 4 Proportionate being is not, however, a comprehensive term for everything that exists ; there is also "transcendent being." Transcendent being is revealed as mystery, and knowledge of it is obtained through the operation of grace in religious conversion.5 But I will postpone discussion of this knowledge of transcendent being for the moment. The orientation of the human spirit toward " the universe of being" manifests itself in "the primordial drive" to know. "It...

This article examines critical realists’ key contention that ‘causing’, or the operation of causal powers, is real or mind-independent. Against their opponents (causal idealists), they point out the (seeming) empirical obviousness of the mind-independence of causal powers, causal idealism’s lack of ‘ontological grounding’, its ‘epistemic fallacy’ and so on. The validity or force of such arguments is ultimately dubious, however. Still, the understanding that causal powers are real is a necessary presupposition of scientific knowledge production and application and of our everyday thinking and practice; realists and idealists can converge on this point. Moreover, there is nothing in causal idealism as such that is incompatible with critical realists’ key insight that causal laws should be understood as stating the ways things work, producing observable regularities only in closed systems and that regularities are not an intrinsic feature of causal relations. I conclude by exploring the implications of this line of thinking for the study of world politics, endorsing a move from a search for parsimonious theories that explain regular patterns observable in the international system towards a historical study of global social relations, which pays attention to causal complexes, diversity of historical contexts and the contested nature of causal interpretations.

In recent years, much social scientific scholarship in sport, exercise and health (SEH) has repudiated (post) positivist research and has instead persuasively argued in favour of qualitative research from constructivist–interpretivist paradigmatic approaches. While this scholarship has enriched the field in numerous ways, this paper contends that constructivist–interpretivist assumptions elicit a modus operandi which is inimical to the accomplishment of two associated contemporary research agendas: interdisciplinarity and impact. In seeking an alternative philosophy of science, the purpose of this paper is to explore how critical realism – meta-theoretical position that has been somewhat absent to date in SEH research – might offer qualitative researchers a new conceptual framework with which greater interdisciplinarity and impact can be achieved. Two main critical realist claims are introduced: (1) the epistemic fallacy can be avoided by adopting a stratified ontology and judgemental rationality, and (2) social science would benefit from seeking causal explanations underpinned by a transformational model of social activity. By de-coupling interpretive epistemologies from constructivist ontologies, it is argued that critical realism permits greater methodological plurality and hence can help transcend persistent paradigmatic boundaries. Indeed, by adopting a realist social ontology and complex, emergent conception of causality, this paper suggests that critical realism permits and encourages impact by asking researchers to focus on explaining the enduring social relations that produce real-world problems. The paper concludes by pointing out the limitations of critical realism and highlighting other ways that interdisciplinarity and impact can similarly be achieved.

This article is the first in a series of four articles that engage critically with the arguments of two recent and significant additions to the literature on critical realism, namely Bhaskar’s ‘Enlightened Common Sense: The Philosophy of Critical Realism’, and Bhaskar et al.’s ‘Interdisciplinarity and Wellbeing: A Critical Realist General Theory of Interdisciplinarity’. Using the method of immanent critique and focusing mainly, but not exclusively, on the arguments of Enlightened Common Sense, I identify, and propose solutions to, a range of problems pertaining to the concepts of depth, emergence and transfactuality. In identifying and resolving these problems, my aim is to clarify and develop the categories of original critical realism and thereby ensure that critical realism as a whole is as effective an underlabourer for science as it can be.

ABSTRACTWhile a critical realist (CR) philosophy of science has gained increasing popularity in the social sciences, its application to the study of sport has so far been limited. Building on the small body of work on CR and sport, this paper considers the ways that a CR informed approach can aid a critical investigation of sport policy. It shows how CR principles were used by the author to design and conduct a large-scale investigation into the implementation of the English Football Association’s equality policy. In particular, the use of Margaret Archer’s morphogenetic approach shaped both the ontological assumptions of the research and its methodological design. The CR approach helped in identifying some of the underlying causes of resistance to policy implementation which emerged from the data collected. This then began to show how the policy in question appeared to have the opposite effect in enforcing change in the grassroots game; existing structural conditions were strengthened through the actions of key personnel rather than elaborated or altered. The paper argues that adopting a CR approach can lead to deeper insights into the outcomes of policy implementation. CR offers critical sport scholars useful ontological and methodological guidance from which to design studies investigating issues in sport policy.

In the context of modern nursing practice that is embedded within complex social situations, critical discussions about the contribution of major philosophers are relevant and important. Whilst nurse theorists have advanced and shaped nursing as a discipline, other major philosophers can offer much to advance nursing enquiry. In this paper, we focus on philosopher Roy Bhaskar who, amongst others, developed critical realism, a philosophy for social science which connects with how many of us think about the world. Bhaskar's work focuses our attention on the interplay between structure and agency and on the search for the causative or generative mechanisms that explain the social world. Bhaskar was interested in human emancipation, and we suggest his work is of great importance to advance understanding of complex social situations. Critical realism has already been endorsed by a range of disciplines, especially in research which focuses on real problems and acknowledges the complexities of the social world. In recent evidence from healthcare literature, there has been a surge in research using realist methodology (realist evaluation and realist synthesis), which is underpinned by the philosophy of critical realism and which offers a different perspective to understanding nursing and healthcare problems through the realist lens. However, we suggest that sufficient attention is not always paid to the philosophical roots of this methodology. In this paper, we provide insight into Bhaskar's work and demonstrate how research positioned within critical realism and realist methodology can advance nursing and healthcare-related knowledge. Through shining a light on Bhaskar, we illustrate how critical realism philosophy is a natural fit with human and health science enquiry, including nursing.

This paper draws on Margaret Archer's morphogenetic realist social theory, the philosophy of critical realism upon which it is based, and activity theory to analyse the relationship between the individual and society, and the implications this relationship has for the way we understand learning. It is important that we theorise this relationship, because our ontological assumptions shape our understandings of the nature of learning, and have implications for the way we construct learning environments and develop policy, qualifications, and curriculum.In particular, I argue that conceptions that downplay individual agency tend to privilege workplace learning at the expense of the broader development of the individual, and do not take sufficient account of the unequal power relationships that structure the socio- cultural context in which learning takes place. Approaches that ignore the social result in abstract and disembodied learning divorced from the social context in which it is to be realised. Understanding the relational interplay between the individual and society, and the relative autonomy of both, results in policy and pedagogy that does not reduce the needs of the learner to the needs of workplace and identifies the different needs of both.

<i>Reconstructing Sociology: The Critical Realist Approach</i>. By Douglas V. Porpora. New York: Cambridge University Press, 2015. Pp. 249. $35.99 (paper).<i>The Relational Subject</i>. By Pierpaolo Donati and Margaret S. Archer. New York: Cambridge University Press, 2015. Pp. 356. $37.95 (paper).

What's Critical About Critical Realism?: Essays in Reconstructive Social Theory&nbsp;draws together&nbsp;4 major articles that are situated at the intersection of philosophy and sociology. Preceded by a general presentation of Bhaskar´s work,&nbsp;critical realism is used&nbsp;to reconstruct the generative structuralism of Pierre Bourdieu, warn about the dangers of biocapitalism, theorize about social movements and explore the hermeneutics of internal conversations. Together, the essays form a logical sequence that starts with a search for a solid conception of social structure through a realist critique of Bourdieu´s rationalist epistemology, proceeds to an ideology critique of posthumanism through an investigation of Actor-Network Theory, extends critical realism to social movements through an investigation of the constitution of collective subjectivities and engages in a sustained dialogue with Margaret Archer through an attempt to reconnect hermeneutics and pragmatism to critical realism. The result is an ongoing dialogue between British critical realism, French historical epistemology, German critical theory and American pragmatism. As suits a collection of essays in social theory, this book will address a broad audience of sociologists, philosophers, social psychologists and anthropologists who are interested in contemporary social theory at the cutting edge. Academics and advanced students who relate to critical realism and critical theory, epistemology and philosophy of the social sciences, hermeneutics and pragmatism, or anyone else who follows the work of Roy Bhaskar, Pierre Bourdieu, Bruno Latour or Margaret Archer will find a keen interest in some of the theoretical questions the book raises.

ABSTRACTIn this article, the second of a series of four articles that engage critically with the arguments of two recent and significant additions to the literature on critical realism (Bhaskar’s Enlightened Common Sense: The Philosophy of Critical Realism and Bhaskar et al.’s Interdisciplinarity and Wellbeing: A Critical Realist General Theory of Interdisciplinarity), I present the results of a critical engagement with other categories of original or basic critical realism. Using the method of immanent critique and focusing mainly, but not exclusively, on the arguments of Enlightened Common Sense, I identify, and propose solutions to, a range of problems pertaining to the concepts of intransitivity, the domains of the real and the subjective, and the domain of the actual. In identifying and resolving these problems, my aim is to clarify and develop the categories of original critical realism and thereby ensure that critical realism as a whole is as effective an underlabourer for science as it can be.

Critical realism is a philosophy of social science that analyses and aims to remedy current problems and gaps. Basic tenets of positivist and quantitative research tend to contradict those of qualitative and interpretive research, and critical realism proposes ways to resolve the contradictions. Vital themes in childhood research that are reviewed in this article include a comparison with feminist research, critical realism, being and thought, transitive and intransitive, theory/practice consistency, agency and structure, closed and open systems, micro and macro in the global/local nexus, four planar social being, facts and values, and transformative change through the four-stage MELD dialectic. Critical realism aims to understand the world in order to be able move from coercion towards creative liberating power.

ABSTRACTColin Hay’s extensive work on politics helps illustrate that ideas can have significant traction of their own which inhibits change. Therefore, accounts of conceptual development in the political and social sciences should examine the possibility of slow dialogue, as a form of communication hospitable to innovation. For critical realism, justified explanations must avoid the ‘epistemic fallacy’ of conflating ontological questions about what reality is with epistemological questions about how we know reality; it prefers basing explanations on an ontology of structure and agency. I argue, using Popper and Lakatos’s problem-solving epistemology, that the critical-realist construction of the epistemic fallacy is untenable, and that attempts at justification entail what I call ‘speedy’ dialogue, with putatively ‘unjustified’ positions being simply rejected; unlike the slow dialogue that problem-solving demands. I also use Hay to show how problem-solving needs to include ontological references, once they are separated from the attempt to justify ideas.

The aim of this article is to analyse the conceptof subjectivity and the category of concern in Margaret Archer’s critical realism from theperspective of embodied cognition and the category of affordances. It explores the possibilityof using the notions of affordances and field of affordances to describe the synchronic anddiachronic relationship between the subject and the environment within critical realism.This perspective aligns with efforts to naturalize critical realism (Kaidesoja, 2013) andto highlight the role of non­‐​­ reflective determinants of behaviour within it (Tofilski, 2024).The article begins by outlining the fundamental assumptions: critical realism and themodel of subjectivity proposed by Margaret Archer, with particular emphasis on concernand reflexivity as key elements shaping the subject in its relationship with the environment.It then presents more naturalistically oriented approaches within critical realism and theirconnections to embodied cognition. The final section focuses on the concept of a field ofaffordances and the mechanisms of its formation, illustrated by the example of addictionunderstood as a monopolization of the hierarchy of concerns. The conclusions indicate thatintegrating affordances into critical realism requires both modification of Archer’s originalmodel of agency and the adoption of the concept of affordances in line with a moderateembodiment perspective — rather than James Gibson’s original proposal.

In this article we identify three key reasons for considering Kalecki's work within the context of debates about post-Keynesian economics and critical realism. We then use six criteria to assess whether his work is consistent with a critical realist approach to empirical research and theory development. We conclude that Kalecki's work fits within the tenets of critical realism and provides insights for those wishing to include formal modelling and econometric techniques within a critical realist framework. Copyright The Author 2010. Published by Oxford University Press on behalf of the Cambridge Political Economy Society. All rights reserved., Oxford University Press.