Sam Dessaix-Porter

This paper examines Florence Nightingale's realist philosophy of science by comparing it to the contemporaneously dominant philosophy of positivism. It starts by adumbrating the tenets of positivism and continues by assessing the degree to which Nightingale accepted or rejected those tenets. It is argued that while she accepted much of positivism, on realist grounds she opposed its belief in phenomenalism, its rejection of speculative philosophy, its separation of fact and value, and its rejection of religion. Following an examination of how Nightingale's philosophy impinged on her approach to nursing and health care, the paper concludes with a comparison of her ideas with those of modern realism and a discussion of the contemporary salience of her ideas. It is argued that while some aspects of her approach may no longer provide an appropriate basis for modern nursing, her environmental approach, her transcendental realism, and her adherence to caring values may still be of use to contemporary nurses.

New nursing researchers are faced with a smorgasbord of competing methodologies. Sometimes, they are encouraged to adopt the research paradigms beloved of their senior colleagues. This is a problem if those paradigms are no longer of contemporary methodological relevance. The aim of this paper was to provide clarity about current research paradigms. It seeks to interrogate the continuing viability of positivism as a guiding paradigm for nursing research. It does this by critically analysing the methodological literature. Five major paradigms are addressed: the positivist; the interpretivist/constructivist; the transformative; the realist; and the postpositivist. Acceptance of interpretivist, transformative or realist approaches necessarily entails wholesale rejection of positivism, while acceptance of postpositivism involves its partial rejection. Postpositivism has superseded positivism as the guiding paradigm of the scientific method. The incorporation in randomized controlled trials of postpositivist assumptions indicates that even on the methodological territory that it once claimed as its own, positivism has been rendered redundant as an appropriate paradigm for contemporary nursing research.

Background: Randomized controlled trials have been criticized for their inability to identify and differentiate the causal mechanisms that generate the outcomes they measure. One solution is the development of realist trials that combine the empirical precision of trials' outcome data with realism's theoretical capacity to identify the powers that generate outcomes. Main Body: We review arguments for and against this position and conclude that critical realist trials are viable. Using the example of an evaluation of the educational effectiveness of virtual reality simulation, we explore whether Partial Least Squares Structural Equation Modelling can move statistical analysis beyond correlational analysis to support realist identification of the mechanisms that generate correlations. Conclusion: We tentatively conclude that PLS-SEM, with its ability to identify ‘points of action’, has the potential to provide direction for researchers and practitioners in terms of how, for whom, when, where and in what circumstances an intervention has worked.