Thompson Carl
Centre for Evidence-Based Nursing, University of York, UK.
Worldviews Evid Based Nurs. 2004;1(1):9-17; discussion 18-9. doi: 10.1111/j.1741-6787.2004.04004.x.
Many of the interventions that nurses develop and implement are in themselves complex and have to operate in situations of irreducible complexity and uncertainty.
This article argues that the primary means of generating knowledge for the evidence-based deployment of complex interventions should be the pragmatic randomised controlled trial. Randomised controlled trials represent the only research design to adequately deal with that which we know and (far more importantly) that which we do not.
Using the example of practice development as an exemplar for complexity, and drawing on the objections often voiced as a response to calls to make use of randomised controlled trials in nursing and nursing research, the article presents a developmental framework and some methodological solutions to problems often encountered.
Randomised controlled trials, whilst undoubtedly methodologically and strategically challenging, offer the most robust basis for developing primary research knowledge on the effects of complex interventions in nursing and their active components.
护士制定和实施的许多干预措施本身就很复杂，且必须在不可简化的复杂性和不确定性情况下发挥作用。
本文认为，为基于证据地部署复杂干预措施而生成知识的主要手段应该是务实的随机对照试验。随机对照试验是唯一能够充分应对我们已知的（以及更重要的是我们未知的）情况的研究设计。
以实践发展为例来阐释复杂性，并借鉴针对在护理及护理研究中使用随机对照试验的呼吁所常提出的反对意见，本文提出了一个发展框架以及一些针对常见问题的方法学解决方案。
随机对照试验虽然无疑在方法和策略上具有挑战性，但为开展关于护理中复杂干预措施及其有效成分效果的基础研究知识提供了最坚实的基础。
