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Evidence-Based Practice in Nursing & Healthcare t
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A Guide to Best Practice ◆ Third Edition e
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Bernadette Mazurek Melnyk l
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Ellen Fineout-Overholt Based Practice
Make evidence-based practice an integral part of your everyday
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Written in a friendly, conversational style, the Third Edition of Evidence-Based Practice id e
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to improve patient outcomes. Real-world examples and meaningful strategies in every o e
chapter demonstrate how to take a clinical issue from initial inquiry to a sustainable B -
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solution that drives a preferred standard of care. Authors Bernadette Mazurek Melnyk e
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and Ellen Fineout-Overholt continue to help all clinicians, no matter their healthcare role, t s
to accelerate the translation of research findings into practice and the use of practice data P e
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Key Features of This Edition ic ra
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◆ Making EBP Real features at the end of each unit present successful case stories ◆ t A Guide to
in real-world settings that emphasize salient content. ic
◆ EBP Fast Facts highlight important points from each chapter. Th e
Best Practice
◆ Critical appraisal checklists, evaluation tables, and synthesis tables help students ir i
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master key concepts. E
◆ New chapters provide insights on leadership and sparking innovation in EBP. d N
◆ Web alerts direct students to helpful online resources to further develop evidence- it u Third Edition
i
based practice knowledge and skills. on rs
◆ Inspirational quotes encourage students to actively engage in evidence-based in
practice and accomplish personal goals. g Bernadette Mazurek Melnyk
&
A free package of instructor and student ancillaries including the American Journal Ellen Fineout-Overholt
of Nursing EBP Step-by-Step series and a revised Test Generator is available at H
http://thepoint.lww.com/Melnyk3e. e
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Thank you
for purchasing this eBook.
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Evidence-
Based Practice
in Nursing
& Healthcare
A Guide to Best Practice
Third Edition
Evidence-
Based Practice
in Nursing
& Healthcare
A Guide to Best Practice
Third Edition
Bernadette Mazurek Melnyk,
PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN
Associate Vice President for Health Promotion
University Chief Wellness Officer
Dean and Professor, College of Nursing
Professor of Pediatrics & Psychiatry, College of Medicine
The Ohio State University
Editor, Worldviews on Evidence-Based Nursing
Partner, ARCC llc; President, COPE for HOPE, Inc.; Founder, COPE2Thrive, llc
Ellen Fineout-Overholt,
PhD, RN, FNAP, FAAN
Mary Coulter Dowdy Distinguished Professor of Nursing
College of Nursing & Health Sciences
University of Texas at Tyler
Editorial Board, Worldviews on Evidence-Based Nursing
Partner, ARCC llc
Acquisitions Editor: Chris Richardson
Product Development Editor: Meredith L. Brittain
Development Editor: Robin Bushing
Editorial Assistant: Zachary Shapiro
Production Project Manager: Marian Bellus
Design Coordinator: Holly McLaughlin
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Marketing Manager: Dean Karampelas
Prepress Vendor: Integra Software Services Pvt. Ltd.
3rd edition
Copyright © 2015 Wolters Kluwer Health
Copyright © 2011 Wolters Kluwer Health / Lippincott Williams & Wilkins. Copyright © 2005 Lippincott Williams &
Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmit-
ted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by
any information storage and retrieval system without written permission from the copyright owner, except for brief
quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part
of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request
permission, please contact Wolters Kluwer Health at Two Commerce Square, 2001 Market Street, Philadelphia, PA
19103, via email at [email protected], or via our website at lww.com (products and services).
9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Melnyk, Bernadette Mazurek, author.
[Evidence-based practice in nursing & healthcare]
Evidence-based practice in nursing and healthcare : a guide to best practice / Bernadette Mazurek Melnyk,
Ellen Fineout-Overholt. — Third edition.
p. ; cm.
Preceded by: Evidence-based practice in nursing & healthcare / Bernadette Mazurek Melnyk,
Ellen Fineout-Overholt. 2nd ed. c2011.
Includes bibliographical references and index.
ISBN 978-1-4511-9094-6
I. Fineout-Overholt, Ellen, author. II. Title.
[DNLM: 1. Evidence-Based Nursing—methods—Practice Guideline. 2. Nurse Clinicians—Practice
Guideline. WY 100.7]
RT42
610.73—dc23
2014021179
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warran-
ties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each
patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication
history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance
and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use
of this work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of
medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made
and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare profession-
als are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to
verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or
contradictions, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic
range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any
injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any
reference to or use by any person of this work.
LWW.com
I dedicate this book to my loving and understanding family, who has pro-
vided tremendous support to me in pursuing my dreams and passions: my
husband, John; and my three daughters, Kaylin, Angela, and Megan; as
well as to my father, who always taught me that anything can be accom-
plished with a spirit of enthusiasm and determination. It is also dedicated
to all of the committed healthcare providers and clinicians who strive
every day to deliver the highest quality of evidence-based care.
Bernadette Mazurek Melnyk
The third edition of this book is thoughtfully dedicated to all healthcare
consumers. Particularly, I dedicate this edition to my precious family,
Wayne, Rachael, and Ruth, and my Mom, Virginia Fineout, who are the
primary consumers who inspire me to persist in partnering to transform
health care and healthcare education to achieve best outcomes. Also,
I dedicate this edition to the loving memory of my Dad, Art Fineout, my
brothers Mark and Paul Fineout, and our baby, Wayne P. Overholt. The
experiences with these losses continue to shape my commitment to
best care.
Ellen Fineout-Overholt
Contributors to the Third Edition
Anne Wojner Alexandrov, PhD, RN, Cecily L. Betz, PhD, RN, FAAN
NVRN-BC, ANVP-BC, CCRN, FAAN Clinical Associate Professor
Professor and U.S. National Principal University of Southern California
Investigator Los Angeles, California
International Stroke Nursing Research Chapter 18, Disseminating Evidence Through
Collaboration Publications, Presentations, Health Policy Briefs,
Australian Catholic University and the Media
Sydney, Australia
Professor Barbara B. Brewer, PhD, RN, MALS, MBA,
Nursing FAAN
University of Tennessee Health Science Center
Associate Professor
Memphis, Tennessee
The University of Arizona College
Program Director
of Nursing
NET SMART
Tucson, Arizona
Health Outcomes Institute
Chapter 10, The Role of Outcomes and Qual-
Fountain Hills, Arizona
ity Improvement in Enhancing and Evaluating
Chapter 10, The Role of Outcomes and Quality
Practice Changes
Improvement in Enhancing and Evaluating
Practice Changes
Terri L. Brown, MSN, RN, CPN
Karen Balakas, PhD, RN, CNE Assistant Director
Director Texas Children’s Hospital
Research Houston, Texas
St. Louis Children’s Hospital Chapter 9, Implementing Evidence in Clinical
St Louis, Missouri Settings
Chapter 16, Teaching Evidence-Based Practice in
Clinical Settings Jacalyn (Jackie) Buck, PhD, RN, NE-BC
Administrator, Health System Nursing Quality,
Marcia Belcher, MSN, BBA, RN, CCRN-CSC,
Research, Education and EBP
CCNS
The Ohio State University Wexner Medical
Clinical Nurse Specialist
Center
The Ohio State University Wexner Medical Center
Clinical Assistant Professor
Evidence-based Practice Mentor
College of Nursing
Clinical Instructor of Practice
The Ohio State University
The Ohio State University
Columbus, Ohio
College of Nursing
Research Communications
Columbus, OH
Chapter 11, Leadership Strategies and Evidence-
Making EBP Real, Unit 2
Based Practice Competencies to Sustain a
Michael J. Belyea, PhD Culture and Environment That Supports Best
Practice
Research Professor
College of Nursing & Health Innovation
Arizona State University
Phoenix, Arizona
Making EBP Real, Unit 6
vi
Contributors to the Third Edition vii
Donna Ciliska, PhD, RN, Alba DiCenso, PhD, RN
Professor CHSRF/CIHR Chair in Advanced Practice
Scientific Director of the National Collaborating Nursing
Centre for Methods and Tools Professor, School of Nursing
Co–Principal Investigator, McMaster Evidence Professor, Department of Clinical Epidemiology
Review and Synthesis Centre & Biostatistics
School of Nursing McMaster University
McMaster University Director of the Ontario Training Centre for
Hamilton, Ontario, Canada Health Services and Policy Research (OTC)
Chapter 13, Models to Guide Implementation Hamilton, Ontario, Canada
and Sustainability of Evidence-Based Practice Chapter 13, Models to Guide Implementation
and Sustainability of Evidence-Based Practice
Robert E. Cole, PhD
Associate Professor of Clinical Nursing Lynn Gallagher-Ford, PhD, RN, DPFNAP,
University of Rochester NE-BC
Rochester, New York Director
Chapter 19, Generating Evidence Through Center for Transdisciplinary Evidence-Based
Quantitative Research Practice
The Ohio State University
John F. Cox III, MD Columbus, Ohio
Assistant Professor Chapter 7, Integration of Patient Preferences and
Clinical Medicine Values and Clinician Expertise Into Evidence-
University of Rochester School of Medicine Based Decision Making
Rochester, New York Chapter 11, Leadership Strategies and Evidence-
Chapter 15, Teaching Evidence-Based Practice in Based Practice Competencies to Sustain a
Academic Settings Culture and Environment That Supports Best
Practice
Laura Cullen, DNP, RN, FAAN
Doris Grinspun, RN, MSN, PhD, LLD (Hon),
Evidence-Based Practice Scientist
OONT
University of Iowa Hospitals and Clinics
Chief Executive Officer
Iowa City, Iowa
Registered Nurses’ Association of Ontario
Chapter 13, Models to Guide Implementa-
Toronto, Ontario, Canada
tion and Sustainability of Evidence-Based
Chapter 8, Advancing Optimal Care With Rigor-
Practice
ously Developed Clinical Practice Guidelines
Maria Cvach, DNP, RN, CCRN and Evidence-Based Recommendations
Assistant Director
Tami A. Hartzell, MLS
Nursing, Clinical Standards
Clinical and Translational Science Librarian &
The Johns Hopkins Hospital
Expert EBP Mentor
Baltimore, Maryland
Rochester General Hospital
Chapter 13, Models to Guide Implementa-
Rochester, NY
tion and Sustainability of Evidence-Based
Chapter 3, Finding Relevant Evidence to Answer
Practice
Clinical Questions
Deborah Dang, PhD, RN, NEA, BC Marilyn J. Hockenberry PhD, RN, PNP-BC,
Director FAAN
Nursing Bessie Baker Professor of Nursing
Johns Hopkins University School of Nursing School of Nursing
Baltimore, Maryland Duke University
Chapter 13, Models to Guide Implementa- Durham, North Carolina
tion and Sustainability of Evidence-Based Chapter 9, Implementing Evidence in Clinical
Practice Settings
viii Contributors to the Third Edition
Sheila Hofstetter, MLS, AHIP Tina L. Magers, MSN, RN-BC
Health Sciences Librarian Nursing Professional Development and Research
Arizona State University Coordinator
Tempe, Arizona Mississippi Baptist Health Systems
Chapter 3, Finding Relevant Evidence to Answer Jackson, Mississippi
Clinical Questions Making EBP Real, Unit 1
Diana Jacobson, PhD, RN, PNP-BC, PMHS Kathy Malloch, PhD, MBA, RN, FAAN
Assistant Professor President, KMLS, llc
College of Nursing & Health Innovation Clinical Professor
Arizona State University The Ohio State University College of Nursing
Phoenix, Arizona Columbus, Ohio
Making EBP Real, Unit 6 Professor of Practice
Arizona State University College of Nursing and
Stephanie Kelly PhD, RN, FNP-BC Health Innovation
Assistant Research Professor Phoenix, AZ
College of Nursing & Health Innovation Chapter 12, Innovation and Evidence: A
Arizona State University Partnership in Advancing Best Practice and
Phoenix, Arizona High Quality Care
Making EBP Real, Unit 6
Flavio F. Marsiglia, Ph.D.
Robin Kretschman, MSA, RN, NEA-BC Southwest Interdisciplinary Research
Vice president of Patient Care Services Center
Ministry Saint Joseph’s Hospital (SIRC) Director
Marshfield, WI Distinguished Foundation Professor of Cultural
Diversity and Health
June H. Larrabee, PhD, RN
Arizona State University
Professor and Clinical Investigator Phoenix, Arizona
West Virginia University and West Virginia Making EBP Real, Unit 6
University Hospitals
Charleston, West Virginia Dianne Morrison-Beedy, PhD, RN,
Chapter 13, Models to Guide Implementation WHNP-BC, FNAP, FAANP, FAAN
and Sustainability of Evidence-Based Practice Professor
Senior Associate Vice President, USF
Lisa English Long, PhD(c), RN, CNS Health
Expert Evidence-based Practice Mentor Dean, College of Nursing
Clinical Instructor University of South Florida
Center for Transdisciplinary Evidence-based Tampa, Florida
Practice Chapter 19, Generating Evidence Through
College of Nursing Quantitative Research
The Ohio State University
Chapter 7, Integration of Patient Preferences and Dónal P. O’Mathúna, DPO
Values and Clinician Expertise Into Senior Lecturer in Ethics, Decision-Making and
Evidence-Based Decision Making Evidence
School of Nursing
Pamela Lusk, DNP, RN, PMHNP-BC Dublin City University
Clinical Associate Professor Glasnevin, Dublin, Ireland
Psychiatric/Mental Health Nurse Practitioner- Chapter 5, Critically Appraising Quantitative
Community Health Center Evidence for Clinical Decision Making
The Ohio State University College of Nursing Chapter 22, Ethical Considerations for Evidence
Yavapai County, Arizona Implementation and Evidence Generation
Making EBP Real, Unit 3
