Randomised controlled trials in clinical practice: The continuing debate

Abstract

The need for nurses to debate issues concerned with randomised controlled trials (RCTs) has its origins in several areas of professional concern. These include the need to design and implement research, the need for evidence- based health care and the need for nurses to contribute knowledgeably to local research ethics committees. The randomised controlled clinical trial, when conducted well, is the'gold standard' and is becoming increasingly important. Yet nurses in the UK face dilemmas in the use of the RCT. Their apparent antipathy to the RCT is explored and it is suggested that the main problems stem from lack of experience, education and understanding of this method of research. The question of the academic identity of nursing and how RCTs might fit in are also briefly discussed. Some of the practical and ethical problems are covered with a view to encapsulating nurses' discomfort with the process. The discussion is widened to cover general points concerned with the use of the RCT, particularly when a practice is perceived to do good, when patients have preference about their treatment or there is a new unproven treatment needing evaluation. Finally, suggestions are given indicating how nurses can improve the picture by becoming more informed and taking up opportunities for becoming involved in RCTs.