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Evidence based practice is a strategy to utilize research findings in clinical practice and stimulate discussion of what counts as evidence, and whether findings from RCT-trials constitute valid and objective knowledge. Findings from studies conducted under conditions far from reality may not produce results relevant for practice, and opponents claim that findings from RCT-trials are not applicable to complex interventions common in health care, including nursing. The pragmatic RCT-trial complements the traditional RCT-trial and is part of the suite of designed controlled studies that contribute to methodologically sound research findings. The pragmatic RCT design is more flexible than the traditional RCT-trial, allowing complex and context-dependent interventions to be performed under natural conditions. This paper presents the pragmatic RCT- design, depicting the flexibility of the pragmatic approach by explaining the dimensions in the tool «PRECIS-wheel». We exemplify our discussions using findings from an empirical study and discuss inherent weakness and strength of the design in terms of internal and external validity. We believe the pragmatic RCT-design will be instrumental and contribute to highly relevant findings for best practice development in nursing.

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