PICOT Analysis

PICOT Analysis

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Fourth edition

Copyright © 2019 Wolters Kluwer.

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

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