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anything beyond the observed, described and measured is impossible to the positivist. Taking this a step further, a positivist would argue those things not directly observed (for example, thoughts, feelings and emotions) are not legitimate subjects for study. A fundamental positivist would argue what cannot be measured is irrelevant. Positivists believe empiricism (the pursuit of knowledge by observation and experiment) to be central to scientific endeavour. Hence positivistic research is usually of an experimental design and uses quantitative approaches to data collection such as those described in the first phase of the EQUANs study (Dyson et al., 2006). Post-positivism In recent times (since the mid-20th century) thinking about science has undergone a marked shift, with a rejection of the positivistic view that science works through observation and experiment and that this is distinctly different from how everych_01.indd 6 13/09/2013 16:24 Understanding the language of research 7 day life is experienced. In an era now defined as post-positivism scientists do not view scientific reasoning and common sense reasoning as mutually exclusive, but as part of the same process, namely an attempt to make sense of the world. Scientific research relies on results, which are verifiable, accurate and consistent. Although common sense reasoning does not always proceed in a systematic way, it is often underpinned by observation and measurement. When thinking about everyday healthcare practice you will be able to recall occasions when you knew your patient’s condition had deteriorated long before any clinical observations confirmed your suspicions. This is intuitive practice, and while not underpinned by evidence in the scientific sense, it is based on observations of similar patients with similar conditions over considerable periods. Indeed, Patricia Benner’s classic work recognised that nurses arrive at an understanding of patient care over time, not only through a sound educational base, but from a multitude of experiences (Benner, 1984). The most common form of post-positivist thinking is a philosophy known as critical realism, which attempts to reconcile the position taken by the positivist and that taken by the interpretivist. By way of an example, the second phase of the EQUANS study sought to understand from the pregnant women and their midwives what it is like to be asked and to ask an ethnicity question, during the first meeting of mother and her midwife, namely at the ‘booking in’ antenatal visit. The research team observed the interaction between mother and midwife and followed this up with an interview. The midwife was asked to describe the experience of asking pregnant women to describe their ethnicity in order to assess their risk of carrying genes associated with sickle cell disorder, and the pregnant women were asked to describe their experience of being asked an ethnicity question. The assumption underpinning this phase of the EQUANS study was a belief in the possibility of knowing another person’s experience by asking that person to describe their experiences, and furthermore that this is a legitimate form of knowledge. Interpretivism As we have shown, the positivist researcher places emphasis on explanation, prediction and control. Enquiry using a positivistic approach answers questions that readily lend themselves to numerical measurement: for example, how many nursing and midwifery students use the library facilities at the weekend, and during which hours. These types of questions are important, as we need to be able to predict library usage in the future and to ensure supply can meet demand. ch_01.indd 7 13/09/2013 16:24 Research skills for nurses and midwives 8 Important questions around the provision of healthcare services lend themselves to positivistic enquiry: for example, the length of time that patients and clients may be waiting for healthcare services. Answers to these questions are important in order to ensure that users of services receive the care they need in a timely fashion in the most cost-effective manner (you can think of many more important questions that lend themselves to this type if enquiry). What positivist approaches to enquiry cannot tell us is how the individual, whether student or service user (or indeed individuals in any social situation) perceives, interprets and makes sense of the situation. To continue with the earlier examples, we might also want to know what students think about the library’s weekend opening times, how this relates to their view of the university as a whole, and how it helps or hinders their overall study experience. Similarly, we need to know how service users feel about waiting for healthcare services, how this influences their experience of health (for example pregnant women experiencing antenatal care) and illness (for example patients experiencing coronary heart disease), and how they make sense of these experiences now and the likely impact of this on future health behaviour. Collecting numerical data to help predict and control will not shed light on these important questions. For this we need a different approach, namely an interpretive approach to enquiry. The interpretive approach to enquiry links with philosophy and the human sciences. Researchers adopting an interpretivist approach think of individuals as
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