Received: 5 April 2019 | Revised: 13 May 2019 | Accepted: 17 May 2019

DOI: 10.1111/nup.12260

ORIGINAL ARTICLE

Research paradigms and the politics of nursing knowledge:

Stuart Nairn PhD, MA, RGN

Correspondence
Stuart Nairn, Derbyshire, UK. Abstract
Email: [email protected] A standard view would suggest that research is a neutral apolitical activity. It neutral‐
izes external pressures by its fidelity to robust scientific methods. However, politics is
an inevitable part of human knowledge. Our knowledge of the world is always medi‐
ated by human priorities. What matters is therefore a contested and political debate
rather a neutral accumulation of factual data. How researchers manage this varies.
Research paradigms are one way in which research engages with knowledge. They
frame knowledge within epistemological and ontological philosophies. In this paper,
I will explore this view in relation to neo‐positivism, qualitative research, Foucault
and critical realism. I will argue that if nursing knowledge is to be effective it needs
to acknowledge the political, particularly in the context of neoliberalism. Healthcare
systems are having to cope with a social world increasingly dominated by market
fundamentalism, extreme levels of inequality and a rise in xenophobia. These forces
are undermining the provision of ethically sound health care, misdirecting research
practice and contributing to a discourse of dehumanization. These forces need to
be challenged politically and I will argue that epistemologically diverse approaches,
alongside a realist ontology can provide a way forward for nursing research.

KEYWORDS
critical realism, foucault, hermeneutics, neo‐positivism, phenomenology, politics, positivism,
research paradigms

1 | I NTRO D U C TI O N interchangeably, but despite the disputes about these terms, there are
important distinctions. While ideology is a critique rooted in a con‐
When the philosopher of science Feyerabend (2011) was questioned cern to unpack a truth, a truth that is obfuscated through ideas; dis‐
about the nature of truth, he argued that there was no clear answer course problematizes the very notion of truth. Discourses are situated
to this as truth was dependent on the question, the topic and the cir‐ knowledge's and while they may be utilized to undermine predominant
cumstances in which truth was being asserted. In the current climate discourses, they are not replaceable by a more truthful one. Ideology
where the buzzword of post‐truth is circulating through the media, seems to suggest that a prevailing view is a perspective that reflects
these claims do not seem that remarkable. But the term post‐truth the material interests of a particular social group, while critiquing that
suggests that previously truth was taken more seriously, whereas ideology potentially generates a more accurate description of the
now this is not the case. The very expectation that the truth matters world (Fairclough, 2010; Foucault, 1994). In either case, an alternative
has become problematic (Butler‐Adam, 2017). perspective challenges what is apparently normative.
Some of these tensions are present in the way that the terms However, for clinical practice clear guidelines and knowledge
ideology and discourse are used. Sometimes these terms are used for practice is more than an academic discussion about truth claims,

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but a practical task. Moreover, for researchers, meeting these needs interest in Polanyi's (2001) 1944 book The Great Transformation is
implies that firm knowledge, in some circumstances, is preferable indicative of this concern (Block, 2015; Holmes, 2018; Rogan, 2017).
to relativism. However, the nature of knowledge, accessing it and Polanyi argued that the emphasis on market economics in the 19th
applying it to practice is rarely straightforward. In this paper, I will century was responsible for the many problems faced in the first half
examine the way that knowledge is situated within a complex sci‐ of the 20th century. Economics should not be a totalizing force in
entific, philosophical and political context. The standard view of sci‐ shaping society. What is required is a moral economy that takes ac‐
ence suggests that robust knowledge is attained through rigorous count of the social and cultural dynamics of people's lives, otherwise
methods. Providing these rules and procedures are adopted, the the social emerges into a wasteland where essential components of
question of philosophy and politics can be neutralized, and any in‐ being human are reduced to a utopian vision of an auto‐regulated
sertion of these ideas is mere interlopers in the practice of scientific free market. This market economy, currently framed by a neoliberal
research (Chalmers, 2013). In other words, scientific questions are ideology, is not simply the outcome of human nature; rather free
answered through a neutral, nonpolitical epistemology. market economics frames the way that human beings behave by fo‐
Philosophers of science, however, problematize key features cusing on a limited and reductionist understanding of what it means
of science. Primarily they address the issue of the relationship be‐ to be human.
tween theory and data and argue that data are always theory satu‐ The impact of a neoliberal approach on health care is conten‐
rated which raises the question of where these theories come from. tious, but the evidence that it is effective and improves care is not
Various solutions are proposed to this, ranging from the perspective proven. Indeed, there is strong evidence that it is more inefficient
that theories can only really emerge from the empirical data to those and results in a more expensive and management heavy healthcare
who suggest that empirical data are simply a product of theory. This system (Benbow, 2018; Paton, 2014). At the level of a moral econ‐
can lead to political questions. The political is about power, vested omy of care, there is concern that this focus generates an increasing
interests and the social. While the standard view of science rejects commodification of care (Nairn, 2016). On a broader societal level,
these factors as external to science, I will suggest in this paper that the impact has implications for growing inequality in health, dis‐
politics is central to the whole scientific enterprise, but how this is courses of efficiency that undermine holistic care and where staff‐
managed is not a settled question. ing levels and skill mix are often under resourced (Karanikolos et al.,
To address this, I will explore the use of research paradigms. 2013; Kerasidou & Kingori, 2019; Labonté & Stuckler, 2016; Leys,
Research paradigms are the tools whereby researchers’ ask “why” 2001; Rajmil & Fernandez de Sanmamed, 2019).
questions. They are the frameworks within which questions are One of the consequences of an increasing neoliberal approach
framed, pertinent empirical data identified, and potential explan‐ has been a concerted assault on welfare provision and a belief that
atory conclusions generated to answer the research questions. the state is top heavy and unaffordable. A prolonged period of an
Different paradigms produce different data and focus on different ideologically driven discourse of austerity has been the result gener‐
aspects of a topic. I will address this though neo‐positivism, the leg‐ ating increased inequality, a growing sense of disempowerment, dis‐
acy of Foucault, humanism with a focus on hermeneutic‐phenome‐ enchantment with politicians that, it is argued, has produced a more
nology and critical realism. Each of these has the potential to explore volatile and populist response (Blyth, 2013; Davies, 2016; Pühringer
the political dimension of knowledge and in my view can benefit re‐ & Ötsch, 2018). Some of this has come from the political left, but it
searchers and help them both to frame their questions and come to has also come from the nationalist right. Concerns about the rac‐
potentially useful conclusions. However, before engaging with these ist character of some of these movements challenge healthcare
paradigms there is value in situating knowledge in the current social systems that should be committed to nondiscriminatory provision,
and political context. My contention is that all knowledge is part of but which are not immune from broader concerns and moral panics
the historical context in which it emerges and cannot be fully under‐ about resources and immigration (Halikiopoulou, 2018).
stood outside of these processes. While I do not have space in this Nursing requires a body of knowledge and a research practice
paper to justify this claim, Malik's (2014) history of ethics is a good that can effectively respond to these pressures, that upholds key
example of how ideas are dependent on context and fundamentally values about truth, morality and a political commitment to concepts
situated within cultural processes. of social justice. But the nature of knowledge is not straightforward
and an understanding of the philosophical principles that underpin
that knowledge need to be promoted so that we can avoid research
2 | TH E S O C I A L A N D P O LITI C A L that simply reproduces existing ideas and that can critically engage
CO NTE X T with the practice of research. This paper upholds a position of a re‐
alist ontology alongside epistemological diversity. My interpretation
There are three major processes at work in the current period that of this means that a flexible approach to finding out about the world
I regard as problematic. These illustrate why a political approach to is combined with a realist understanding about the external world,
knowledge is necessary to make sense of nursing knowledge. They both as a natural and a social phenomenon (Bhaskar, 2016). I will
are market fundamentalism, increasing inequality and the growth of argue in this paper that of the theories that I outline, critical realism
increasingly authoritarian nationalist ideologies. The resurgence of is the most convincing approach. However, this is not a rejection of
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the other theories since they have useful epistemological positions increasingly nationalist and fascist ideologies, is challenged through
that generate important research findings. However, my central ar‐ a commitment to a logical, ahistorical approach to knowledge. The
gument is more specific. I will suggest that all these approaches have Vienna circle was therefore not simply an abstract philosophy of sci‐
important political consequences, both in the research findings and ence but situated at the centre of the political violence of the time.
in the methods they use in collecting data. The political is a ubiq‐ Uebal and others (Reisch, 2005) have attempted to rescue positivists
uitous feature of research. Sometimes this political aspect is fun‐ from many of the caricatures of their position, but at the centre of
damental and controversial and in others is banal and trivial. What their thinking was an instrumental logic, the purpose of which was to
matters is that researchers are conscious about this aspect of their promote, what Sigmund (2017) succinctly refers to as “exact thinking
work and are prepared to highlight it rather than marginalize it and in demented times.”
let the data simply “speak for itself.” The following discussions are Perhaps the most useful way of thinking about these approaches
not intended to provide a robust understanding of these theories is through the idea that positivism promotes a solution to politics and
and are not a comprehensive overview. I do not, for example, cover ideology, by excluding it from our knowledge base. Science needs to
many useful theories such as pragmatism, standpoint epistemologies separate itself from the social but is nonetheless a crucial tool in
and so on. It is more a reflective discussion about the nature of the enhancing our political lives. Archie Cochrane, the influential author
political and how this is an integral part of how we need to under‐ of Effectiveness and efficiency (Cochrane, 1972) is the key figure in
stand the research process. this legacy and represents this tension. Originally, his views were a
response to the rise of Nazism, and he served in the International
Brigade during the Spanish civil war. However, he became deeply
3 | N EO ‐ P OS ITI V I S M A N D TH E concerned about communist science whereby publication of scien‐
E X TE R N A LIT Y O F TH E P O LITI C A L tific papers depended on their Marxist orthodoxy rather than their
scientific value resulting in the notorious Lysenko affair (McKee,
Neo‐positivism is an attempt to remove anything that interferes with 2007). Cochrane's response was to emphasize the efficacy of inter‐
a scientific approach to knowledge. Health research is largely based ventions, which preferably should be supported by randomized con‐
on this standard view, which is a combination of positivist and post‐ trolled trials. As an example of this approach, Cochrane argued that
positivist philosophies (Chalmers, 2013; Corry, Porter, & McKenna, psychiatry was unproven and possibly dangerous, and that psycho‐
2019). My use of the term neo‐positivism draws upon the defini‐ therapy and psychotropic drugs should not be used without measur‐
tion put forward by Blaikie and Priest (2017) as a convenient term ing their benefits to patients (Cochrane, 1972:59). Hill (2000:1192)
that reflects this combination of the positivist and the postpositiv‐ suggests that this use of scientific knowledge can protect medicine
ist. It is committed to an objective and neutral research practice. It from external threats posed by other health disciplines and what he
wishes to remove the subjective and base any statements about the refers to as people “who deny the value of positivist science.” For
world on factual data. Methods are considered the key way that this Hill, the “increased rationality implicit in the Cochrane legacy will, I
can be achieved. It is though methods that subjective effects are believe, strengthen the profession against these challenges.” What
neutralized. So, a randomized controlled trial becomes a robust way is being argued for is that a nonpolitical science will have political
of accessing knowledge. The results simply emerge as an objective consequences. However, this approach can be used in explicitly po‐
statement of whether one intervention works over another. litical ways and Hart (2006) for example, pursues this with an explicit
The purpose of neo‐positivism is to find a universal language. commitment to a socialist healthcare system rooted in the Cochrane
Transparency is central. Each statement about the world has a clear legacy and applied to a political economy of health.
evidential base and the purpose is complete clarity in communicat‐ Although much of this discussion has assumed a positivist fram‐
ing these statements. They are universal and not the preserve of ing of scientific research, the practice of health research has a more
any social group. However, there is a paradox at the centre of this postpositivist approach. Popper's theory of falsification and the
approach. The early positivists of the Vienna circle often held very hypothetic‐deductive model frames a substantial amount of health
strong political views and were writing in the politically fractious pe‐ research (Corry et al., 2019). Empiricism is a strong driver for this
riod of the 1920s and 1930s. This apparent paradox it is deceptive approach. The evidence‐based practice movement is an attempt
as it is not clear that the thinkers in the Vienna circle would agree. to embed a scientific evidence base into clinical practice (Sackett,
They were calling for a rational way of thinking that contradicted the Rosenberg, Gray, Haynes, & Richardson, 1996). However, the con‐
predominant thinking of their time. Uebel (2016) argues that many sequences have not been a reduction in political interference in
of the Vienna circle saw the assertion of a robust language that op‐ research. Indeed, Goldacre (2012) has written extensively about
erationalized statements in a way that excluded the metaphysical the way that external interests have distorted science. Ioannidis
as a route into critiquing large sections of philosophical thinking (2005) in a seminal and much cited paper argues that the majority
and indeed suggested that such thinking was not so much wrong as of published research is false. This falseness is built on the practice
meaningless. Therefore, the growing problem of a supra‐individual of research and not on the value of the science method. In other
holism, whereby the state exists above the individual and the so‐ words, it is bad science not anti‐science. As he argues in a later paper
cial is understood as an organic whole, which led, in this context, to (Ioannidis, 2016), he is an acolyte of Sacket and the evidence‐based
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movement but is perplexed by the way that neoliberal and vested in‐ critical knowledge through narratives that challenge disciplinary
terests have systematically undermined the scientific basis of health forces of academic socialization (Bochner, 2018).
care. Ioannidis does not use the term neoliberalism, but reading this However, many nurses have taken a less explicitly political ap‐
rather depressing paper, it is hard not situate his argument within it. proach and adopted a hermeneutic‐phenomenology approach. I do
So, his commitment to evidence‐based medicine is struggling with not mean by this that it is not political, but that it prioritizes indi‐
what he refers to as finance‐based medicine, where science is not vidual experience. This is largely a response to the reductionism of
used to prioritize care but as a mere advertising tool. The tools of the medical model and an assertion of the lived experience (Van der
science are distorted by data dredging, spurious correlations are uti‐ Zalm & Bergum, 2000). As Streubert Speziale and Carpenter (2003)
lized as causal claims and researchers are reliant on positive results argue, phenomenology fits in well with a nursing emphasis on the
because their jobs rely on them rather than the scientific and clini‐ holistic and which focuses on the detail of people as complex and
cal usefulness of the research. If Archie Cochrane's enemy was the individual humans. The enemy is reductionism and the instrumental
soviet distortion of science, for Ioannides it is neoliberalism. What logic of neo‐positivism. This type of research can act as an additional
both were concerned with, was the protection of a standard view body of knowledge to existing quantitative research, but generally
of scientific knowledge, whereby the methods of the research pro‐ suggests that qualitative does some types of research better than
cess provided a protective paradigm against the external threats of quantitative.
vested interests. The work of van Manen (1990) is one resource for nursing re‐
search that prioritizes the holistic and the lived experience. His em‐
phasis on thematic analysis provides a means of generating ideas
4 | TH E C H A LLE N G E O F H U M A N I S M A N D about the how the lived experience can be utilized for clinicians.
Q UA LITATI V E R E S E A RC H Themes are the outcome of narrative knowledge and thus the cli‐
nician can adapt their practice to patient needs in a holistic manner.
Neo‐positivism is consistent with the medical model. So, despite its In this way, hermeneutic‐phenomenology is practical; its purpose is
potential for political critique, it does work within limited parame‐ to transform our understanding of another person's experience and
ters. It is concerned with measurement and statistical regularities. It through such understanding to re‐orientate practice to human needs
adopts a largely reductionist language that sees health care as based (Van der Zalm & Bergum, 2000). The tension between the subject's
on biological principles and when it does move into psychosocial as‐ transcripts’ and the generation of themes is a central problem with
pects it relies upon measurement tools to define patients. It is essen‐ this approach and indeed for all qualitative research. Predominantly
tially a top‐down approach to patients. Experts have the knowledge qualitative research is an interpretation of an interpretation, the
and patients are passive. subject has already interpreted the world through their experience
Some anthropological and sociological explorations are explicitly and embodiment in the world and then the social scientist attempts
critical of this approach and developed an interest in exploring the to interpret the interpretation. Each step results in the finished re‐
world of the patient and illness narratives (Frank, 2013; Kleinman, port that is further away from the original source. Attempts to limit
1989). Some of this became very political in the sense that medicine this continue to pre‐occupy researchers with some questioning the
was characterized as reproducing capitalist norms, individualizing methodological move to themes. Peck and Mummery (2018), for
the patient experience and extracting them from the socio‐political example, argue that thematic approaches may be an accomplish‐
context (Waitzkin, 1991), while others explored the way that power/ ment in generalizing, but a loss that erases the nuances of individual
knowledge discourses disciplined human bodies and reconstituted experiences.
human subjectivity into passive recipients of medical power (Turner, It may be argued that the further one goes into the individual,
1995). The use of qualitative research to promote a political agenda the further away one goes from the political. Indeed, individual‐
of social justice is now well established (Denzin & Giardina, 2009). ization has been critiqued as a neoliberal strategy to undermine
The relationship between qualitative and quantitative meth‐ a critical political response (Browne, 2001). So, can hermeneu‐
ods has generated some tension within nursing (Risjord, 2011). tic‐phenomenology be a resource for critique? If we only listen to
Sometimes paradigms compete with each and sometimes they are individuals and focus on their personal idiosyncratic selves, then
complementary. But qualitative research continues to struggle with is there any scope to use this knowledge politically. Heidegger
its legitimacy as a form of evidence as the recent exchange in the explicitly denied his philosophy was political and yet his work,
BMJ illustrates (Greenhalgh et al., 2016; Loder, Groves, Schroter, given his associations with fascism, is subject to extensive dis‐
Merino, & Weber, 2016). Some qualitative researchers express frus‐ cussions on its political content (Dallmayr, 1984; Love & Meng,
tration at the criticism of qualitative research and claim that many re‐ 2018). More broadly, both Heidegger and Gadamer have been
searchers have inappropriately adopted the language of positivism in associated with a conservative response to modernism (Shalin,
a desperate attempt to enhance the “scientific” credibility of qualita‐ 2010). However, phenomenology has also been associated with
tive research, which in the process undermines the central strengths Marxism (Coole, 2001). Any attempt to draw phenomenology into
of the qualitative method (Pierre, 2016). This “science envy” in effect a clear and logical relation to a political ideology is unlikely to be
suppresses the human voice and the political process of generating successful. Nonetheless, this does not mean that emphasizing the
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phenomenological is politically neutral. Implicitly there is a cri‐ Foucault conflates power with knowledge. Knowledge is not
tique of reductionist models of health care. However, it can also capturing an external world independent of us, but implicated in its
be utilized in a more explicitly political manner. construction, in the very methods and means we adopt to access
Paterson and Hughes (1999) make explicit use of phenomenol‐ knowledge. If all knowledge is contained and defined within a social
ogy to critique the idea that the disabled body is little more than and historical epistemology, then all knowledge is inherently polit‐
a passive recipient of oppressive and exclusionary social practices. ical. It is about what matters, what is culturally salient and what is
They use phenomenology as a way of restoring agency to the dis‐ marginal. The world is categorized and then re‐categorized accord‐
abled body. For them, the medical model treats the body as a “pas‐ ing to power relations. Foucault's approach entails genealogically
sive precultural object.” By excluding the sentience of human bodies, unpacking those power relations in the construction of a discourse.
scientific medicine affirms a Cartesian dualism that leads to a hier‐ This results in an historical account of how a discourse emerges,
archy of identities that is a product of social processes. Therefore, which challenges foundational claims to knowledge. Furthermore,
phenomenology turns the body into a political project that engages part of Foucault's legacy is a critique of the overpowering emphasis
with and provides a potentially active response to the disempow‐ of social structures as monolithic entities and reorients analysis to‐
ering process of the social world. Phenomenology's focus is on the wards the microphysics of power, the way it is dispersed rather than
personal, the experiential, often under theorizes the structural, and centralized. What emerges is a multitude of surveillance mechanisms
therefore fails to engage with explicitly political issues (Nairn, 2009). that discipline and shape human subjects (Foucault, 1970, 1972,
However, the lived experience often results in explicitly political re‐ 1973, 1977, 1978, 1994) These mechanisms work by reconstituting
sponses as the external world imposes itself on that experience. subjectivity, exerting its influence through soft power, rather than
So, Paterson and Hughes (1999) utilize the experiential to cri‐ force (Hoy, 2005).
tique social practices of exclusion. Similarly, Ahmed (2007) writes Foucault was concerned with how knowledge was scientifically
about her structural position of being in a white academic depart‐ imposed on people, it did not simply come from the external world,
ment where her status is one of a “guest,” a “stranger” who should it actively constructs it. So, for scientific medicine it was necessary
be grateful for the University's hospitality and as a mere signifier of to abstract the patient from the clinical gaze (Foucault, 1973). The
a diversity agenda. Her phenomenological approach to this experi‐ salience of anatomy and physiology reconstituted the clinical assess‐
ence does not exclude the structural and the institutional processes ment from asking the patient what the matter is to focused questions
at work. Indeed, they are a salient feature of the experience, but I about symptoms. It entails the removal of irrelevant narrative infor‐
would argue that phenomenology and indeed qualitative research mation. Foucault's (1970, 1972) analysis is a persistent questioning
in general, manages a more political approach once it incorporates of what has been naturalized. Why is this discourse more prominent
the implicit realism of structural arguments. This is particularly clear than another? Who is responsible for promoting this interpretation?
in a paper by Van Bogaert et al. (2016). Their examination of staff How is this influencing subjectivity? How is the subject objectified
nurses’ reactions and experiences of institutional changes illustrates through classification schemes? For Foucault, it is through an excess
the way that a phenomenological understanding of empowerment of rationalization that political power is realized and how the subject
within a set of structural relationships manifests itself in their expe‐ has laws of truths imposed upon them by different rationalities, each
rience and contains useful understandings of the efficacy of those one connected to a discursive formation, such as medicine, psychi‐
policy dynamics. atry and criminology. For Foucault, therefore, the political response
I will return to these themes at the end of this paper, but a realist was not to liberate people from the state but rather to promote new
understanding of context is, in my view, a useful way of contextu‐ forms of subjectivity that resists these laws of truth (Foucault, 1994).
alizing the hermeneutics of everyday experiences (Vandenberghe, Foucault is an important figure whose influence is interdisciplin‐
2013). In short, the qualitative matters, and abandoning science envy ary. Criminologists, for example, have found his ideas about the dis‐
and a pedantic concern with methods in favour of narrative and flex‐ persal of power particularly useful as disciplinary practices broaden
ibility in the ways that we access that knowledge, promotes a more and incorporate more and more people into the net of surveillance
politically sensitive and theoretically robust approach to research. mechanisms (Cohen, 1985). Health studies have also found his work
productive (Petersen & Bunton, 1997) and this has influenced nurs‐
ing research (Clinton & Springer, 2016; Henderson, 1994; Roberts,
5 | D I S CO U R S E A N D TH E LEG AC Y O F 2005).
FO U C AU LT Henderson (1994) in her analysis of intensive care uses Foucault
to show how the patient in intensive care units become reduced to
Neo‐positivism attempts to erase the political through a focus on their physiological parameters that diverts attention away from the
methods. Humanist approaches insert a philosophical grounding for psychosocial and undermines meaningful nurse–patient relationship.
their research. Those influenced by Foucault, emphasize the politi‐ For Roberts (2005), psychiatric patients internalize discourses and
cal. In this section, I will focus on Foucault as an influential thinker in subject themselves to the political knowledge of psychiatry. Psychiatry
a tradition of thinking that has evolved into a more cultural analysis is therefore not a culture free science, but a discourse that incorpo‐
of knowledge. rates the patient into a normative value system. Perron (2013) makes
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6 of 10 | NAIRN

the relation between nursing and politics most explicit. For Perron, that kindness is a central part of human relationships, and has a long
discourses are full of contradictions that reflect power relations. So, philosophical concern, it is now a source of embarrassment. While
while there is a salient discourse of professional autonomy, this is kindness is morally sound, it becomes little more than a discourse
contradicted by increasing levels of regulation. Furthermore, even in of suspicion and denigrated as feminine and trivial. More fundamen‐
the micro interactions of individualized care, politics penetrates the tally however, for Phillips and Taylor (2009), this means that kindness
way in which the self, the nurse as a subject interacts with prevailing cannot simply be appropriated into some professional power/knowl‐
discourses about altruism and selflessness. These act as disciplinary edge discourse but is an important component of what it means to
forces on nurses that erases nurses actively taking care of themselves be human. This challenges’ the conflation of power with knowledge,
as well as their patients. Perron is engaging with Foucault's later work since explanations and understandings of ideas are not simply dis‐
that emphasizes the active self rather than his earlier work where peo‐ cursive abstractions utilized for political purposes but can also be
ple disappeared into discourse. Politics is less about the broader mana‐ a means to make sense of our socio‐material lives. They can reflect
gerial and bureaucratic policy dynamic, but a constant and provocative collective notions of community and solidarity; not just struggles for
stance of critiquing, an assertion of freedom and being disobedient power.
from established norms. It is an ethical response to power and asserts However, Traynor's critique does have some value. His book on
a subjectivity that is engaged in a political project that problematizes organizations and nursing (Traynor, 1999) is an interesting account
the existing state of affairs. of how managerialism works, and which resists any attempt at es‐
The idea of agency in Foucault's work is problematic. Perron's sentialist and over confident approaches. Moreover, professional
take on this illustrates the tension within Foucault's work. Foucault's groups do tend to promote professional status over and above pa‐
emphasis on discourses and governmentality arguably undermines tient needs. But by adopting a discourse approach, the benefits of a
agency despite his late work on care of self (Foucault, 1978). In my more realist approach is lost, and it is unclear where the problems
view, Foucault's ideas are more effective when he is critiquing pre‐ that he identifies can be addressed and it is to the potential uses of
vailing discourses and where researchers deconstruct the legitimacy realism that I now turn.
of these claims such as Slemon's (2018) paper on the way that pro‐
cesses of standardization restrict nurses understanding of clinical
practice and Dillard‐Wright (2019) work on electronic health records. 6 | H U M A N FLO U R I S H I N G A N D A R E A LI S T
Perron (2013) is supporting a key feature of Foucault's think‐ O NTO LO G Y
ing; that discourses are not monolithic and in their very production
generate a subjective response. A key weakness of a more orthodox Perhaps the most critical component of a critical realist approach
use of discourse analysis is prominent in Traynor's (2009) paper on to research and knowledge is that its view of what it means to be
humanism. Humanistic approaches and the focus on the human ex‐ human is at the centre of its analysis. Although much is made of
perience is not seen as a way of understanding and grappling with fine distinctions between the empirical, the actual and the real
the nuances of experience so that nurses can interact with patients and the subsequent identification of mechanisms in critical real‐
in a more humanistic fashion, but simply to enhance the professional ism (Bhaskar, 2008), it is as a theory of ethics and political prac‐
status of nursing. Nurses’ adoption of these methods is then seen tice that is the endpoint a critical realist analysis. Understanding
as part of Nietzschean slave morality whereby nurses are simply as‐ mechanisms is a means to initiate a practical engagement with
serting their weak position against medicine. It is in other words little the world. These theories build upon the foundations of a realist
more than a powerless group trying invert existing power relations. understanding of what it means to be human. Neo‐positivism has
No wonder that writers like Bewes (1997) referred to this type of a predominantly instrumentalist perspective on the human as a
thinking as profoundly cynical. While Traynor's paper explicitly in‐ measurable set of operational constructs. Phenomenology, partly
corporates the political into humanism, he does it in a way that fun‐ as a reaction to this sees human beings as saturated with meanings
damentally undermines anything but the most cynical interpretation. that emerge out of the lived experience as an embodied nondualis‐
This type of relativism undermines critique since any critique; in‐ tic ontological being. Foucault tended to follow a more structural‐
cluding the author's, is problematic as when they produce academic ist and anti‐humanist approach relying on discourses to analyse
papers and books, they are themselves guilty of the same problem. human activity, framing it within socially constructed norms.
Indeed, since academics primary professional tool is language, there Critical realism is fundamentally a humanistic philosophy (Porpora,
is a professional interest in focusing on discourse because it priori‐ 2015). It is not anthropocentric in that it does not attempt to ex‐
tizes language. This degeneration into relativism leads us nowhere plain or understand the world purely through human activity. This
other than a theoretical vacuum where everything is political but is sometimes the weakness of phenomenology, but critical real‐
our ability to do anything about it is lost, resulting in a paralysing, ism does place human concerns at the centre of research activity.
intellectual stagnation. Furthermore, it situates the critique within a Indeed, Archers (2000) exploration of human agency builds upon
longstanding denigration of humanist principles. the phenomenology of Merleau‐Ponty.
As Phillips and Taylor (2009) argue, the dismissal of critical con‐ While there is much debate within critical realism on the nature
cepts such as kindness is a constant refrain and while they suggest of the human (Archer, 2000; Elder‐Vass, 2012; Porpora, 2015),
 1466769x, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/nup.12260 by Mcmaster University Library Co, Wiley Online Library on [12/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
NAIRN | 7 of 10

there are some broad principles. Essentially humans are both structures and practices that obstruct (the path to‐
real and socially constructed. There is a strong emphasis on the wards achieving) generalized human flourishing, and
way that humans develop emergent properties based upon their thereafter forming strategies for transforming them.
human capacities. Humans are biological before they are social. Such processes are obviously fallible. But then so are
Humans as purely discursive constructs are denied by asserting any other form of science  (Lawson, 2014: 364)
that experience predates language and that there is no reason to
assume that this aspect of our selves disappears as we grow into So, research is not primarily about methods, or even science, but
adulthood. Our memories are embodied within us and generate is derivative of a conception of what it means to be human and there‐
an ongoing and enduring sense of self. Insights from neurobiology fore seeks to identify in what circumstances do humans flourish or
and epigenetics provide support for this (Nairn, 2014). However, not flourish. This is a political project. It examines and proposes an
this sense of self is not independent of the social world. While the ontological understanding of the way the world is and how humans
social is emergent from human agency, it nonetheless develops a are situated in that world. It then attempts to identify what contexts
relative autonomy from the self and loops back onto human ac‐ are ethically good for people and which are not. In short it proposes a
tivity (Archer, 1995). Therefore, this relationship is mediated by philosophy of ethical naturalism for research practice.
reflexivity. Humans have the capacity to reflect on their circum‐
stances and to act upon it, in ways that are responsive to the so‐
cial. Our individual causal powers operate together with biological 7 | TH E P O LITI C S O F K N OW LE D G E
and social mechanism that can either work positively or negatively
on our human experience and praxis. The political is a critical component of research, whether one sees it
Given this realist approach to the world, a critical realists re‐ as an unfortunate contextual reality that undermines science or an
search programme promotes a strong emphasis on ethical natural‐ integral component of epistemology. As I argued earlier, the socio‐
ism. If humans live in real worlds, and this is a practical relationship, political forces at work in the current period contain several threats
then the purpose of research is to identify those mechanisms in to healthcare provision. These being the marketization of care, ine‐
which people can flourish and those mechanism that obstruct quality and a growing authoritarian nationalism. The early positivists
human flourishing. Ethics is not a separate set of abstract con‐ adopted a position that tackled similar problems through the lens
cepts but an integral part of human activity. Factual statements of an apolitical science that became political and quite radical. The
are linked to interests and therefore political in nature (Lawson, Vienna circle did not have a uniform political stance. However, many
2014). So, inequalities in health are not just statements of fact, but of its members had politically progressive views. This became in‐
reflect socio‐political arrangements in which some people flourish creasingly neutralized and by the end of the Second World War had
at the expense of others. taken on a more conservative perspective (Reisch, 2005). However,
However, for Lawson (2014), human flourishing is a relational writers like Ioannidis (2016) have utilized a neo‐positivist view of
concept and is not reliant on personal interests. It is dependent on science to insert a radical critique of the context of science, while
the flourishing of others. While everyone has their own individual asserting the value of an orthodox epistemology. While the health
interests, needs and desires, in other words we flourish in our own sciences have been incorporated into a largely conservative frame‐
ways, this should not be at the expense of others. Health inequal‐ work, characterized by powerful funding sources that systematically
ities may entail increased life expectancy for some but the more distort knowledge (Crouch, 2016), there are still spaces where aca‐
equal a society is, the more socially cohesive the society, which en‐ demics and researchers can find spaces that limit these influences.
hances quality of life for all social groups including life expectancy Ioannidis (2016) does not reject the principles of evidence‐based
(Wilkinson & Pickett, 2010). So, a research agenda is an ethical and practice and sees them as an important scientific limitation on the
a political one. It prioritizes research with an ethical purpose which pernicious effects of neoliberalism and Goldacre has combined the
identifies real mechanisms in the world, and this has a basis in under‐ standard view with politically effective interventions (see his blog at
lying processes. https​://www.badsc​ience.net/ and webpage https​://www.phc.ox.ac.
Realism accepts the argument that the world exists at some level uk/team/ben-goldacre).
independently of us as human beings. This is not only in the natural In my view, it would be problematic to simply dismiss this work
world but also in the realm of knowledge, beliefs and values. At the on the basis that it is positivist. Firstly, as I suggested earlier, much
very least they pre‐exist our own individual existences, and there‐ of this work operates within a more postpositivist paradigm and
fore our understanding of the world is never entirely about us, but secondly, while there are considerable problems if this approach is
also about how the world is. As Lawson succinctly puts it (Lawson, adopted in reductionist terms, if it is incorporated as one epistemo‐
2014: 364): logical strategy amongst others it can contribute to a broader under‐
standing of healthcare interventions. In short, most drug therapies
How do we seek to identify morally good objectives at some point require a randomized controlled trial and it is unclear
and actions? We do so through empirically informed to me that other methods could be utilized when the research ques‐
processes of reasoning, oriented to identifying tion is this specific.
 1466769x, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/nup.12260 by Mcmaster University Library Co, Wiley Online Library on [12/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
8 of 10 | NAIRN

Neo‐positivism is the predominant force in the health sciences, exercises in data extraction. Being aware of the political context
but particularly for nurses, the limitations of this research paradigm are and the ethical purpose of the research should, in my view frame
clear, which is why phenomenology is such an attractive alternative. our whole justification for generating nursing knowledge so that
Nurses, and others, through their clinical practice realize the value of we have a sound rationale for promoting a humanistic approach to
the patient voice. This can be complementary to the neo‐positivist ap‐ nursing care.
proach. Qualitative approaches do not need to follow a phenomeno‐
logical approach and I would certainly promote a more realist method
ORCID
(Maxwell, 2012), but the broad argument that a more humanist focus
is necessary for a truly holistic approach to care is, in my view, essen‐ Stuart Nairn https://orcid.org/0000-0002-6487-7456
tial for good care to take place. Phenomenology has certainly been
an important component of this strategy within nursing. While I have
identified ways in which phenomenology has been used politically, REFERENCES
in general it has a subdued response to the political and rarely takes
Ahmed, S. (2007). A phenomenology of whiteness. Feminist Theory, 8(2),
on broader issues of neoliberalism except in experiential terms. The 149–168. https​://doi.org/10.1177/14647​0 0107​078139
Foucauldian legacy is not so wary about the political. Nor does it at‐ Archer, M. S. (1995). Realist social theory: The morphogenetic approach.
tempt to marginalize the political as external to methods as neo‐pos‐ Cambridge, UK: Cambridge University Press.
Archer, M. S. (2000). Being human: The problem of agency. Cambridge, UK:
itivists suggest. The result is forceful research that openly challenges
Cambridge University Press.
prevailing political discourses and has considerable resonance for Benbow, D. I. (2018). Juridification, new constitutionalism and mar‐
nurses suffering the consequences of market fundamentalism and an ket reforms to the English NHS. Capital & Class. https​://doi.
instrumentalist approach to patient care as well as confronting dis‐ org/10.1177/03098​16818​780647
Bewes, T. (1997). Cynicism and postmodernity. London, UK: Verso.
criminatory practices such as racism and sexism.
Bhaskar, R. (2008). A realist theory of science. London, UK: Verso.
However, my own view is that while all these paradigms offer Bhaskar, R. (2016). Enlightened common sense: The philosophy of critical
useful epistemological strategies, they could all benefit for a more realism. London, UK: Routledge.
explicit realist ontology that draws on the principles of ethical natu‐ Blaikie, N., & Priest, J. (2017). Social research: Paradigms in action.
ralism. In a world framed by powerful socio‐political forces that pro‐ Cambridge, UK: Polity Press.
Block, F. (2015). A Neo‐Polanyian theory of economic crises. American
mote market fundamentalism, which are increasingly combining with
Journal of Economics and Sociology, 74(2), 361–378. https​://doi.
nationalist and xenophobic ideologies, it is important that research org/10.1111/ajes.12095​
prioritizes a humanist approach that maximizes human flourishing, Blyth, M. (2013). Austerity: The history of a dangerous idea. Oxford, UK:
that frames research practice on the principles of real human bodies Oxford University Press.
Bochner, A. P. (2018). Unfurling rigor: On continuity and change in
and that can identify and understand the multiple mechanisms (bi‐
qualitative inquiry. Qualitative Inquiry, 24(6), 359–368. https​://doi.
ological, psychological and sociological) that can either obstruct or org/10.1177/10778​0 0417​727766
promote wellbeing. Bourdieu, P. (2004). Science of science and reflexivity. Cambridge, UK:
This means that science is not simply a detached product of Polity.
Browne, A. J. (2001). The influence of liberal political ideology on nurs‐
methods, but it also does not mean that science is simply cultural.
ing science. Nursing Inquiry, 8(2), 118–129. https​://doi.org/10.1046/
In Bourdieu's (2004) analysis of science, through the sociological j.1440-1800.2001.00095.x
concepts of habitus and field, he did not abandon the values of Butler‐Adam, J. (2017). What could scientists do about 'post‐truth'? South
objectivity and a robust approach to methods, despite his acute African Journal of Science, 113(1–2), 1–1. https​://doi.org/10.17159/​
sajs.2017/a0195​
awareness of the politics of the scientific enterprise. If science is
Chalmers, A. F. (2013). What is this thing called science? Maidenhead, UK:
little more than endless power struggles, then there is little left Open University Press.
for us than relentless deconstruction. In this sense, the neo‐posi‐ Clinton, M. E., & Springer, R. A. (2016). Foucault's legacy for nursing:
tivists have an important point. Nonetheless, this not an either/or Are we beneficiaries or intestate heirs? Nursing Philosophy, 17(2),
119–131.
problem. Having an empirically grounded knowledge base is never
Cochrane, A. L. (1972). Effectiveness and efficiency: Random reflections on
going to be politics free, even if such knowledge is essential for health services. London: Nuffield Trust.
clinical practice. Nonetheless, research that ignores the political, Cohen, S. (1985). Visions of social control: Crime, punishment and classifica‐
both as an external context for science, but also the way it is inte‐ tion. Cambridge, UK: Polity Press.
grated into the very process of constructing research, is also a key Coole, D. (2001). Thinking politically with Merleau‐Ponty. Radical
Philosophy, 108, 17–28.
feature of nursing knowledge. What matters is that those values
Corry, M., Porter, S., & McKenna, H. (2019). The redundancy of posi‐
are fully acknowledged and reflect humanist principles in which tivism as a paradigm for nursing research. Nursing Philosophy, 20(1),
ideas around care, compassion and kindness are promoted. These e12230. https​://doi.org/10.1111/nup.12230​
principles matter, whether one is doing a randomized controlled Crouch, C. (2016). The knowledge corrupters: Hidden consequences of the
financial takeover of public life. Cambridge, UK: Polity Press.
trial or a phenomenological study of patient experiences. What
Dallmayr, F. R. (1984). Ontology of freedom: Heidegger and polit‐
matters is the implications for human flourishing. Research para‐ ical philosophy. Political Theory, 12(2), 204–234. https​://doi.
digms are critical components of research and not simply technical org/10.1177/00905​91784​01200​2004
 1466769x, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/nup.12260 by Mcmaster University Library Co, Wiley Online Library on [12/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
NAIRN | 9 of 10

Davies, W. (2016). The new neoliberalism. New Left Review, 101, 121–134. Loder, E., Groves, T., Schroter, S., Merino, J. G., & Weber, W. (2016).
Denzin, N. K., & Giardina, M. D. (2009). Qualitative inquiry and social jus‐ Qualitative research and the BMJ. BMJ, 352, i641.
tice: Toward a politics of hope. Oxon, UK: Routledge. Love, J., & Meng, M. (2018). Heidegger's Metapolitics. Cultural Critique,
Dillard‐Wright, J. (2019). Electronic health record as a panopticon: A 99, 97–122. https​://doi.org/10.5749/cultu​ralcr​itique.99.2018.0097
disciplinary apparatus in nursing practice. Nursing Philosophy, 20, Malik, K. (2014). The quest for a moral compass: A global history of ethics.
e12239. https​://doi.org/10.1111/nup.12239​ London, UK: Atlantic Books Ltd.
Elder‐Vass, D. (2012). The reality of social construction. Cambridge, UK: Maxwell, J. A. (2012). A realist approach for qualitative research. London,
Cambridge University Press. UK: Sage.
Fairclough, N. (2010). Critical discourse analysis: The critical study of lan‐ McKee, M. (2007). Cochrane on communism: The influence of ideology
guage. Oxon, UK: Routledge. on the search for evidence. International Journal of Epidemiology,
Feyerabend, P. (2011). Tyranny of science. Cambridge, UK: Polity Press. 36(2), 269–273. https​://doi.org/10.1093/ije/dym002
Foucault, M. (1970). The order of things. London, UK: Routledge. Nairn, S. (2009). Social structure and nursing research. Nursing Philosophy,
Foucault, M. (1972). Archaeology of knowledge. London, UK: Routledge. 10(3), 191–202. https​://doi.org/10.1111/j.1466-769X.2009.00403.x
Foucault, M. (1973). The birth of the clinic. London, UK: Routledge. Nairn, S. (2014). Nursing and the new biology: Towards a realist, anti‐re‐
Foucault, M. (1977). Discipline and punish: The birth of the prison. ductionist approach to nursing knowledge. Nursing Philosophy, 15(4),
Harmondsworth, UK: Penguin Books. 261–273. https​://doi.org/10.1111/nup.12067​
Foucault, M. (1978). The will to knowledge: The history of sexuality, Vol. I. Nairn, S. (2016). The purpose and scope of sociological theory:
Harmondsworth, UK: Penguin Books. Implications for nursing. In M. Lipscomb (Ed.), Social theory and nurs‐
Foucault, M. (edited by J.D. Faubion). (1994). Michel Foucault, power, es‐ ing. Taylor & Francis (pp. 116–130). Oxon, UK: Routledge.
sential works of Foucault 1954–1984. London, UK: Penguin UK. Paterson, K., & Hughes, B. (1999). Disability studies and phenomenol‐
Frank, A. W. (2013). The wounded storyteller: Body, illness, and ethics. ogy: The carnal politics of everyday life. Disability & Society, 14(5),
Chicago, IL: University of Chicago Press. 597–610. https​://doi.org/10.1080/09687​59992​5966
Goldacre, B. (2012). Bad pharma: How drug companies mislead doctors and Paton, C. (2014). Garbage‐can policy‐making meets neo‐liberal ideol‐
harm patients. London, UK: Fourth Estate. ogy: Twenty five years of redundant Reform of the English National
Greenhalgh, T., Annandale, E., Ashcroft, R., Barlow, J., Black, N., Bleakley, Health Service. Social Policy & Administration, 48(3), 319–342.
A., … Checkland, K. (2016). An open letter to The BMJ editors on https​://doi.org/10.1111/spol.12044​
qualitative research. BMJ, 352, i563. Peck, B., & Mummery, J. (2018). Engaging Gadamer and qualia for the
Halikiopoulou, D. (2018). The far right challenge: Comment on" The mot juste of individualised care. Nursing Inquiry, 26, e12279.
Rise of Post‐truth Populism in Pluralist Liberal Democracies: Perron, A. (2013). Nursing as ‘disobedient’ practice: Care of the nurse's
Challenges for Health Policy". International Journal of Health Policy self, parrhesia, and the dismantling of a baseless paradox. Nursing
and Management, 7(2), 195. https​://doi.org/10.15171/​ijhpm.2017.82 Philosophy, 14(3), 154–167. https​://doi.org/10.1111/nup.12015​
Hart, J. T. (2006). The political economy of health care: A clinical perspec‐ Petersen, A. R., & R. Bunton (Eds.) (1997). Foucault, health and medicine.
tive. Bristol, UK: The Policy Press. London, UK: Routledge.
Henderson, A. (1994). Power and knowledge in nursing practice: Phillips, A., & Taylor, B. (2009). On kindness. London, UK: Penguin UK.
The contribution of Foucault. Journal of Advanced Nursing, 20(5), Pierre, E. A. S. (2016). The long reach of logical positivism/logical empir‐
935–939. https​://doi.org/10.1046/j.1365-2648.1994.20050​935.x icism. In N. Denzin, & M. Giardina (Eds.), Qualitative inquiry through a
Hill, G. B. (2000). Archie Cochrane and his legacy: An internal challenge critical lens (pp. 27–38). Oxon, UK: Routledge.
to physicians' autonomy? Journal of Clinical Epidemiology, 53(12), Polanyi, K. (2001). The great transformation: The political and economic or‐
1189–1192. https​://doi.org/10.1016/S0895-4356(00)00253-5 igins of our times. Boston, MA: Beacon Press.
Holmes, C. (2018). Polanyi in times of populism: Vision and contradiction in Porpora, D. V. (2015). Reconstructing sociology: The critical realist ap‐
the history of economic ideas. Oxon, UK: Routledge. proach. Cambridge, UK: Cambridge University Press.
Hoy, D. C. (2005). Critical resistance: From poststructuralism to post‐cri‐ Pühringer, S., & Ötsch, W. O. (2018). Neoliberalism and right‐wing popu‐
tique. Cambridge, MA: MIT Press. lism: conceptual analogies. In Forum for social economics (Vol. 47, No.
Ioannidis, J. P. (2005). Why most published research findings are false. 2, pp. 193–203). Oxon, UK: Routledge.
PLoS Med, 2(8), e124. https​://doi.org/10.1371/journ​al.pmed.0020124 Rajmil, L., & Fernandez de Sanmamed, M. J. (2019). Austerity policies
Ioannidis, J. P. (2016). Evidence‐based medicine has been hijacked: A and mortality rates in European Countries, 2011–2015. American
report to David Sackett. Journal of Clinical Epidemiology, 73, 82–86. Journal of Public Health, 109, e1–e3. https​://doi.org/10.2105/
https​://doi.org/10.1016/j.jclin​epi.2016.02.012 AJPH.2019.304997
Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, Reisch, G. A. (2005). How the Cold War transformed philosophy of science:
D., … McKee, M. (2013). Financial crisis, austerity, and health in To the icy slopes of logic. Cambridge, UK: Cambridge University Press.
Europe. The Lancet, 381(9874), 1323–1331. Risjord, M. (2011). Nursing knowledge: Science, practice, and philosophy.
Kerasidou, A., & Kingori, P. (2019). Austerity measures and the trans‐ Chichester, UK: John Wiley & Sons.
forming role of A&E professionals in a weakening welfare system. Roberts, M. (2005). The production of the psychiatric subject: Power,
PLoS ONE, 14(2), e0212314. knowledge and Michel Foucault. Nursing Philosophy, 6(1), 33–42.
Kleinman, A. (1989). Illness narratives: Suffering, healing and the human https​://doi.org/10.1111/j.1466-769X.2004.00196.x
condition. New York, NY: Basic Books. Rogan, T. (2017). The moral economists: RH Tawney, Karl Polanyi, EP
Labonté, R., & Stuckler, D. (2016). The rise of neoliberalism: How Thompson, and the critique of capitalism. Princeton, NJ: Princeton
bad economics imperils health and what to do about it. Journal of University Press.
Epidemiology and Community Health, 70(3), 312–318. https​://doi. Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., & Richardson,
org/10.1136/jech-2015-206295 W. S. (1996). Evidence based medicine: What it is and what it
Lawson, T. (2014). Critical ethical naturalism: an orientation to ethics. In isn't. British Medical Journal, 312, 71–72. https​://doi.org/10.1136/
S. Pratten (Ed.), Social ontology and modern economics (pp. 359–387). bmj.312.7023.71
Oxon, UK: Routledge. Shalin, D. N. (2010). Hermeneutics and prejudice: Heidegger and
Leys, C. (2001). Market‐driven politics: Neoliberal democracy and the public Gadamer in their historical setting. Russian Journal of Communication,
interest. London, UK: Verso. 3(1–2), 7–24. https​://doi.org/10.1080/19409​419.2010.10756760
 1466769x, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/nup.12260 by Mcmaster University Library Co, Wiley Online Library on [12/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
10 of 10 | NAIRN

Sigmund, K. (2017). Exact thinking in demented times: The Vienna circle phenomenological study. PLoS ONE, 11(4), e0152654. https​ ://doi.
and the epic quest for the foundations of science. New York, NY: Basic org/10.1371/journ​al.pone.0152654
Books. Van der Zalm, J. E., & Bergum, V. (2000). Hermeneutic‐phenomenology:
Slemon, A. (2018). Embracing the wild profusion: A Foucauldian anal‐ Providinglivingknowledgefornursingpractice.JournalofAdvancedNursing,
ysis of the impact of healthcare standardization on nursing knowl‐ 31(1), 211–218. https​://doi.org/10.1046/j.1365-2648.2000.01244.x
edge and practice. Nursing Philosophy, 19(4), e12215. https​ ://doi. Van Manen, M. (1990). Researching lived experience: Human science for an
org/10.1111/nup.12215​ action sensitive pedagogy. New York, NY: New York Press.
Streubert Speziale, H. J., & Carpenter, D. R. (2003). Qualitative research in Vandenberghe, F. (2013). What's critical about critical realism?: Essays in
nursing, 3rd. ed. Lippinicott Williams and Wilkins: Philadelphia, USA. reconstructive social theory. London, UK: Routledge.
Traynor, M. (1999). Managerialism and nursing: Beyond oppression and pro‐ Waitzkin, H. (1991). The politics of medical encounters: How patients and
fession. London, UK: Routledge. doctors deal with social problems. New Haven, CT: Yale University
Traynor, M. (2009). Humanism and its critiques in nursing research lit‐ Press.
erature. Journal of Advanced Nursing, 65(7), 1560–1567. https​://doi. Wilkinson, R., & Pickett, K. (2010). The spirit level: Why equality is better
org/10.1111/j.1365-2648.2008.04956.x for everyone. London, UK: Penguin UK.
Turner, B. S. (1995). Medical power and social knowledge. London, UK:
Sage.
Uebel, T. (2016) In E. N. Zalta (Ed.), "Vienna Circle", The Stanford
How to cite this article: Nairn S. Research paradigms and the
Encyclopedia of Philosophy (Spring 2016 Edition). https​://plato.stanf​
politics of nursing knowledge: A reflective discussion. Nurs
ord.edu/archi​ves/spr20​16/entri​es/vienna-circl​e/
Van Bogaert, P., Peremans, L., Diltour, N., Van heusden, D., Dilles, T., Philos. 2019;20:e12260. https​://doi.org/10.1111/nup.12260​
Van Rompaey, B., & Havens, D. S. (2016). Staff nurses’ perceptions
and experiences about structural empowerment: A qualitative