Ideas Matter: a Realist Critique of ‘Culture’ in Qualitative Research

Decisions made on the basis of false information (e.g. erroneous research findings) may be bad decisions. From a realist perspective, many qualitative nurse researchers misunderstand and therefore misuse the descriptor ‘culture’ and, in consequence, qualitative research reports employing this concept often contain flimsy arguments and disputable assumptions. Inevitably, findings grounded on ill thought through theories and concepts are vulnerable to error. Such findings are likely to misdirect decision makers.
Building on the work of Joseph Maxwell, Ray Pawson and Margaret Archer, this presentation outlines a realist conception of culture. It challenges non-realist qualitative nurse researchers to reconsider their foundational beliefs. It raises questions about the self-limiting or insular nature of nursing research and scholarship, and it connects abstract conceptual ideas about culture with real world clinical practice.
In line with the conference theme and realist precepts, it is precisely because “minds don’t think alike” that heterogeneity is at least as important as homogeneity when considering the cultural influences and understandings that define and explain key aspects of healthcare organisation and provision. It is argued that nurse researchers need to engage more fully or deeply with the concepts that they use in order that their thinking and activities can be as productive as they might be and, if this is accepted, nurse researchers cannot continue to ignore developed and influential non-nursing anthropological, ethnographic and (broadly) philosophic literatures. Specifically, if the outputs of nurse researchers and scholars are to effectively inform leaders seeking to improve NHS cultures and practices, then those outputs need to accurately describe and realise what culture is. In the absence of adequate comprehension, leaders cannot grasp what it is they are seeking to modify and their endeavours will probably be unproductive. The leitmotif of this presentation is that ‘ideas matter’.