Evidence-Based Practice Inquiry

Evidence-Based Practice Inquiry

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Fourth edition

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Third edition © 2015 Wolters Kluwer Health. Second edition © 2011 Lippincott Williams & Wilkins, a Wolters Kluwer business. First edition © 2005 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted 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 at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services).

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Library of Congress Cataloging-in-Publication Data

Names: Melnyk, Bernadette Mazurek, author. Title: Evidence-based practice in nursing & healthcare : a guide to best

practice / Bernadette Mazurek Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN, 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, 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, Editorial Board, Research in Nursing & Health.

Other titles: Evidence-based practice in nursing and healthcare Description: Fourth edition. | Philadelphia : Wolters Kluwer Health, [2019] |

Includes bibliographical references. Identifiers: LCCN 2018032178 | eISBN 9781496386892 Subjects: LCSH: Evidence-based nursing—Practice. | Nurse

practitioners—Practice. Classification: LCC RT42 .M44 2019 | DDC 610.73—dc23 LC record available at https://lccn.loc.gov/2018032178

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties 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 professionals 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 contraindications, 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.





I dedicate this book to my loving family, who has provided 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 accomplished with a spirit of enthusiasm and determination, and my sister Chris, who taught me to “just get out there and do it!” 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

For Rachael and Ruth, my precious daughters who are my daily inspiration. May you have the kind of healthcare you deserve—evidence- based with demonstrated reliable outcomes that is delivered by conscientious care providers who intentionally incorporate your preferences into your care. For my dear husband, Wayne, and my sweet Mom, Virginia Fineout, from whom I learn so much about how healthcare could/should be. Finally, this edition is dedicated to all care providers in primary care, community/public health, and at point of care in acute and long-term care who diligently seek to consistently deliver evidence-based care.

Ellen Fineout-Overholt






Professor of Nursing and Neurology Acute, Critical Care and Department of Neurology Chief Nurse Practitioner UTHSC Memphis Mobile Stroke Unit University of Tennessee Health Science Center at Memphis Memphis, Tennessee

Karen Balakas, PhD, RN, CNE

Retired Director of Research & EBP St. Louis Children’s Hospital & Missouri Baptist Medical Center St. Louis, Missouri

Cecily L. Betz, PhD, RN, FAAN

Professor Department of Pediatrics University of Southern California Keck School of Medicine General Pediatrics Children’s Hospital Los Angeles Los Angeles, California

Cheryl L. Boyd, PhD, MSN, RN

Adjunct Assistant Professor College of Nursing The Ohio State University Director Professional Development Nationwide Children’s Hospital Columbus, Ohio

Barbara B. Brewer, PhD, RN, MALS, MBA, FAAN

Associate Professor College of Nursing The University of Arizona Tucson, Arizona

Tracy L. Brewer, DNP, RNC-OB, CLC

Clinical Professor College of Nursing




University of Tennessee-Knoxville Knoxville, Tennessee

Terri L. Brown, MSN, RN, CPN

Clinical Specialist Quality and Safety Texas Children’s Hospital Houston, Texas

Jacalyn S. Buck, PhD, RN, NEA-BC

Administrator Health System Nursing ACNO Medical Surgical and Women and Infants Nursing Health System Nursing Medical Surgical and Women and Infants Nursing The Ohio State University Wexner Medical Center Columbus, Ohio

Emily Caldwell, MS

Media Relations Manager University Communications/Office of the President The Ohio State University Columbus, Ohio

Katie Choy, DNP, RN, CNS, NEA-BC, RN-BC

Consultant Nursing Practice and Education San Jose, California

Denise Cote-Arsenault, PhD, RN, CPLC, FNAP, FAAN

Eloise R. Lewis Excellence Professor School of Nursing University of North Carolina Greensboro Greensboro, North Carolina

John F. Cox III, MD

Associate Professor of Clinical Medicine Department of Medicine Primary Care Physicians School of Medicine & Dentistry University of Rochester Internist, Clinton Medical Associates Rochester, New York

Laura Cullen, DNP, RN, FAAN

Adjunct Faculty




University of Iowa College of Nursing University of Iowa EBP Scientist Office of Nursing Research, EBP and Quality Department of Nursing and Patient Care Services University of Iowa Hospitals and Clinics Iowa City, Iowa

Maria Cvach, DNP, RN, FAAN

Assistant Director Nursing, Clinical Standards The Johns Hopkins Hospital Baltimore, Maryland

Deborah Dang, PhD, RN, NEA-BC

Graduate School of Nursing Johns Hopkins University Director of Nursing, Practice, Education, & Research Central Nursing Administration The Johns Hopkins Hospital Baltimore, Maryland

Lynn Gallagher-Ford, PhD, RN, DPFNAP, NE-BC, FAAN

Senior Director Director, Clinical Core The Helene Fuld Institute for Evidence-based Practice in Nursing and Healthcare College of Nursing The Ohio State University Columbus, Ohio

Martha J. Giggleman, RN, DNP

Consultant Evidence-based Practice Livermore, California

Doris Grinspun, RN, MSN, PhD, LLD (hon), Dr (hc), O.ONT

Adjunct Professor Lawrence S. Bloomberg Faculty of Nursing University of Toronto Chief Executive Officer Registered Nurses’ Association of Ontario (RNAO) Toronto, Ontario

Tami A. Hartzell, MLS




Senior Librarian Werner Medical Library Rochester General Hospital Rochester, New York

Marilyn J. Hockenberry, PhD, RN, PPCNP-BC, FAAN

Associate Dean for Research Affairs Bessie Baker Professor of Nursing Center for Nursing Research Duke University School of Nursing Durham, North Carolina

Robin Kretschman, HC-MBA, MSN, RN, NEA-BC

Vice President Clinical Business Strategic Operations Nursing Administration OSF HealthCare Peoria, Illinois

June H. Larabee, PhD, RN

Professor Emeritus West Virginia University and West Virginia University Hospitals Charleston, West Virginia

Lisa English Long, PhD, RN

Consultant Evidence-based Practice Cincinnati, Ohio

Jacqueline M. Loversidge, PhD, RNC-AWHC

Associate Professor of Clinical Nursing College of Nursing The Ohio State University Columbus, Ohio


Associate Professor of Clinical Practice College of Nursing The Ohio State University Columbus, Ohio Psychiatric/Mental Health Nurse Practitioner Pediatrics Yavapai Regional Medical Center Prescott, Arizona

Tina L. Magers, PhD, MSN, RN-BC

Nursing Excellence and Research Coordinator




Mississippi Baptist Medical Center Jackson, Mississippi

Kathy Malloch, PhD, MBA, RN, FAAN

Clinical Professor College of Nursing Ohio State University Columbus, Ohio

Mikki Meadows-Oliver, PhD, RN, FAAN

Associate Professor Department of Nursing Quinnipiac University School of Nursing North Haven, Connecticut

Dianne Morrison-Beedy, PhD, RN, WHNP, FNAP, FAANP, FAAN

Chief Talent & Global Strategy Officer Centennial Professor of Nursing College of Nursing The Ohio State University Columbus, Ohio

Dónal P. O’Mathúna, PhD

Associate Professor Fuld Institute for Evidence-based Practice College of Nursing The Ohio State University Columbus, Ohio Associate Professor School of Nursing & Human Sciences Dublin City University Glasnevin, Dublin 9, Ireland

Tim Porter-O’Grady, DM, EdD, APRN, FAAN, FACCWS

Clinical Professor School of Nursing Emory University Clinical Wound Specialist Street Medicine Program/Clinic Mercy Care of Atlanta Atlanta, Georgia

Cheryl C. Rodgers, PhD, MSN, BSN

Associate Professor Duke University School of Nursing




Durham, North Carolina

Jo Rycroft-Malone, PhD, MSc, BSc(Hons), RN

Professor and Pro Vice-Chancellor Research & Impact School of Health Sciences Bangor University Bangor, United Kingdom

Alyce A. Schultz, RN, PhD, FAAN

Consultant Clinical Research and Evidence-based Practice Bozeman, Montana

Kathryn A. Smith, RN, MN, DrPH

Associate Professor of Clinical Pediatrics Department of Pediatrics Keck School of Medicine General Pediatrics Children’s Hospital Los Angeles Los Angeles, California

Cheryl B. Stetler, RN, PhD, FAAN

Retired Consultant

Kathleen R. Stevens, RN, MS, EdD, ANEF, FAAN

Castella Endowed Distinguished Professor School of Nursing University of Texas Health Science Center San Antonio San Antonio, Texas

Susan B. Stillwell, DNP, RN ANEF, FAAN

EBP Expert Mentor and Independent Consultant Vancouver, Washington

Timothy Tassa, MPS

Network for Excellence in Health Innovation Washington, District of Columbia

Amanda Thier, RN, MSN

Staff Nurse Specialty Care Unit Baylor University Medical Center Dallas, Texas

Kathleen M. Williamson, RN, PhD

Professor, Chair Wilson School of Nursing

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