Complexity and uniqueness in nursing practice: commentary on Richards and Hamers (2009).

Richards and Hamers (2009) aim in their paper to ‘consider the place of randomised controlled trials in nursing’. In doing so, they make a number of largely unsubstantiated observations about ‘those that reject the positivist approach to science’, assuming that ‘readers will be familiar with the case made by objectors’. In fact, the only source cited by Richards and Hamers for the arguments against RCTs is a paper I wrote seven years ago for a somewhat different purpose (Rolfe, 2002). As the sole named ‘objector’ to the RCT, I will attempt here to correct some of the unreferenced and unsubstantiated misconceptions that Richards and Hamers put forward in their paper, and then expand on the somewhat simplistic and one-dimensional position attributed to myself and other unnamed and unreferenced authors who have questioned the place of the RCT in nursing. First, I do not ‘reject the positivist approach to science’, and nowhere in my paper which they cite as evidence of this view do I even mention positivism. What I have claimed elsewhere, however, is that whilst the positivist approach to science produces useful evidence for certain types of nursing interventions, the value of the ‘hard science’ paradigm for nursing is somewhat over-