Exploring the use of feminist philosophy within nursing research to enhance post-positivist methodologies in the study of cardiovascular health

Redefining global cardiac surgery through an intersectionality lens

Although cardiovascular diseases are the leading cause of morbidity and mortality worldwide, six billion people lack access to safe, timely and affordable cardiac surgical care when needed. The burden of cardiovascular disease and disparities in access to care vary widely based on sociodemographic characteristics, including but not limited to geography, sex, gender, race, ethnicity, indigeneity, socioeconomic status and age. To date, the majority of cardiovascular, global health and global surgical research has lacked intersectionality lenses and methodologies to better understand access to care at the intersection of multiple identities and traditions. As such, global (cardiac) surgical definitions and health system interventions have been rooted in reductionism, focusing, at most, on singular sociodemographic characteristics. In this article, we evaluate barriers in global access to cardiac surgery based on existing intersectionality themes and literature. We further examine intersectionality methodologies to study access to cardiovascular care and cardiac surgery and seek to redefine the definition of 'global cardiac surgery' through an intersectionality lens.

The search for understanding: the role of paradigms

BACKGROUND

Kuhn's ( 1962 ) acknowledgement of a paradigm as a way that scientists make sense of their world and its reality gave recognition to the idea of 'paradigm shift'. This shift exposes the transience of paradigm development shaped by societal and scientific evolution. This ongoing evolutionary development provides the researcher with many paradigms to consider regarding how research is undertaken and the search for understanding achieved.

AIM

An understanding of paradigm development is necessary when planning a study and can shape the search for understanding. It is hoped that the discussion presented here will assist novice and experienced researchers in articulating the rationales for their paradigm choices.

DISCUSSION

An overview of the dominant paradigms is presented, reflecting ongoing paradigm development shaped by ontological, epistemological and methodological perspectives. Potential paradigm choices that shape research aims, objectives and focus in the search for understanding are considered.

CONCLUSION

The inherent debates about paradigm shift, division, war and synthesis leave the researcher many perspectives to consider. Articulating the world views underpinning constructivism, interpretivism and pragmatism is particularly challenging because of the blurring of boundaries between them.

IMPLICATIONS FOR PRACTICE

The evolutionary nature of paradigmatic development has provided nurse researchers with the opportunity for methodological openness to the myriad research approaches, methods and designs that they may choose to answer their research question. However, it is imperative that researchers consider their ontological stances and the nature of their research questions. This is challenging in constructivism, interpretivism and pragmatism, where there is often an overlap of paradigm world views.

Methodological support for the further abstraction of and philosophical examination of empirical findings in the context of caring science

Phenomena in caring science are often complex and laden with meanings. Empirical research with the aim of capturing lived experiences is one way of revealing the complexity. Sometimes, however, results from empirical research need to be further discussed. One way is to further abstract the result and/or philosophically examine it. This has previously been performed and presented in scientific journals and doctoral theses, contributing to a greater understanding of phenomena in caring science. Although the intentions in many of these publications are laudable, the lack of methodological descriptions as well as a theoretical and systematic foundation can contribute to an ambiguity concerning how the results have emerged during the analysis. The aim of this paper is to describe the methodological support for the further abstraction of and/or philosophical examination of empirical findings. When trying to systematize the support procedures, we have used a reflective lifeworld research (RLR) approach. Based on the assumptions in RLR, this article will present methodological support for a theoretical examination that can include two stages. In the first stage, data from several (two or more) empirical results on an essential level are synthesized into a general structure. Sometimes the analysis ends with the general structure, but sometimes there is a need to proceed further. The second stage can then be a philosophical examination, in which the general structure is discussed in relation to a philosophical text, theory, or concept. It is important that the theories are brought in as the final stage after the completion of the analysis. Core dimensions of the described methodological support are, in accordance with RLR, openness, bridling, and reflection. The methodological support cannot be understood as fixed stages, but rather as a guiding light in the search for further meanings.

Exploring paradigms in postpartum depression research: the need for feminist pragmatism

Postpartum depression (PPD) is an important area of women's health research internationally and across disciplines. There is no guiding paradigm, however, to ensure that PPD research results translate to women on a global level. This commentary builds on the work of Doucet, Letourneau, and Stoppard ( 2010 ) to determine a "best fit" paradigm with which to guide PPD research. Postpositivism, critical theory, constructivism, and pragmatism are combined with a feminist ideology and critiqued as potential guiding paradigms for PPD research. After thorough examination, I conclude the need for further use of a feminist pragmatist paradigm in PPD research.

Ethnic differences in exercise and leisure time physical activity among midlife women

AIM

This paper is a report of a study of factors associated with ethnic differences in exercise and leisure time physical activity levels among midlife women.

BACKGROUND

Most studies on physical activity have focused mostly on identifying correlates of physical activity. However, 'ethnicity/race' as a factor affecting exercise and leisure time physical activity has rarely been considered.

METHOD

This study was a secondary analysis of data from a larger Internet study on menopausal symptoms of midlife women from four ethnic groups in the United States of America. A total of 441 women aged 40-60 years were recruited through the Internet from 31 January 2005 to 31 December 2007. The data were analysed using descriptive statistics, chi-square analysis, analysis of variance and multiple regressions.

FINDINGS

Non-Hispanic White people had a statistically significantly higher level of leisure time physical activity than Asian Americans and Hispanics. African Americans reported the lowest level of exercise. Body mass index was inversely associated with exercise among African Americans. Menopausal symptoms were positively associated with exercise among non-Hispanic White people and African Americans. Employment and number of children had a statistically significantly inverse association with exercise among Asian Americans.

CONCLUSION

Correlates of exercise are ethnic-specific. The dual role situation of working outside and inside their homes is an important factor in explaining the lower participation of exercise among Asian Americans. Health factors influence exercise participation in non-Hispanic White people, African Americans and Hispanics. Nurses should take into account ethnic diversities when designing physical activity interventions for women.

Grounded theory and feminist inquiry: revitalizing links to the past

Grounded theory has served feminist research endeavors since the mid-1990s. Researchers from a variety of disciplines claim methodological compatibility and incorporate feminist principles into their grounded theory studies. This article seeks to demonstrate the epistemological affinity between feminist inquiry and grounded theory. Although this relationship is not necessarily unique, the authors contend that when combined, it loosens the androcentric moorings of the empirical processes underpinning grounded theory, enabling the researchers to design inquiry with greater potential to reveal issues particular to the lives and experiences of marginalized women. The article begins by retracing the roots of grounded theory and feminist inquiry to identify six key areas where the underpinnings of GT are enriched by a feminist perspective when working with women. In addition, the authors draw on the literature and their experience from a 2005 study of peer support and lone mothers' health to demonstrate the advantages of combining these theoretical perspectives. Finally, the authors recommend that nurse researchers draw on feminist principles to guide their use of grounded theory to better serve the interests of women by surfacing issues of gender and power that influence the health experience.