CLICK HERE

Foreword

Like many of you, I have appreciated healthcare through a range of experiences and
perspectives. As someone
who has delivered healthcare as a combat medic, paramedic, nurse, and trauma surgeon, the
value of evidence-

based practice is clear to me. Knowing what questions to ask, how to carefully evaluate the
responses,

maximize the knowledge and use of empirical evidence, and provide the most effective clinical
assessments

and interventions are important assets for every healthcare professional. The quality of U.S. and
global
healthcare depends on clinicians being able to deliver on these and other best practices.

The Institute of Medicine (now the National Academy of Medicine) calls for all healthcare
professionals

to be educated to deliver patient-centered care as members of an interdisciplinary team,

emphasizing

evidence-based practice, quality improvement approaches, and informatics. Although many

practitioners

support the use of evidence-based practice, and there are indications that our patients are better
served when

we apply evidence-based practice, there are challenges to successful implementation. One barrier
is

knowledge. Do we share a standard understanding of evidence-based practice and how such

evidence can best

be used? We need more textbooks and other references that clearly define and provide a standard
approach to

evidence-based practice.

Another significant challenge is the time between the publication of research findings and the
translation

of such information into practice. This challenge exists throughout public health. Determining
the means of

more rapidly moving from the brilliance that is our national medical research to applications that
blend new
science and compassionate care in our clinical systems is of interest to us all.

As healthcare professionals who currently use evidence-based practice, you recognize these
challenges and

others. Our patients benefit because we adopt, investigate, teach, and evaluate evidence-based
practice. I

encourage you to continue the excellent work to bring about greater understanding and a more
generalizable

approach to evidence-based practice.

Richard H. Carmona, MD, MPH, FACS

17th Surgeon General of the United States

16

Preface

OVERVIEW OF THIS BOOK

The evidence is irrefutable: evidence-based practice (EBP) is key to meeting the quadruple aim
in healthcare.

It improves the patient experience through providing quality care, enhances patient outcomes,
reduces costs,

and empowers clinicians, leading to higher job satisfaction. Although there are many published

interventions/treatments that have resulted in positive outcomes for patients and healthcare
systems, they are

not being implemented in clinical practice. In addition, qualitative evidence is not readily
incorporated into

care. We wrote this book to address these issues and many others as well. We recommend that
learners read

this book, then read it again, engage in the online resources, the appendices, the glossary . . . then
read it
again. It is chock-full of information that can help learners of all disciplines, roles and
educational levels

discover how to be the best clinicians. We hope you find that EBP pearl that is just the right
information you

need to take the next step in your EBP journey to deliver the best care!

Purpose

The purpose of Evidence-Based Practice in Nursing and Healthcare has never changed. The
purpose of this

edition, as with the last three, is to incorporate what we have learned across the years to provide
resources and
information that can facilitate clinicians’ ready translation of research findings into practice, as
well as their

use of practice data to improve care and document important outcomes, no matter the clinician’s
healthcare

role. Each edition has provided additional features and resources for readers to use in their
journey to become

evidence-based clinicians. Since the first book was published, there has been some progress in
the adoption of

EBP as the standard of care; however, there is still much work to be done for EBP to the
paradigm used in

daily clinical decision making by point-of-care providers. Clinicians’ commitment to excellence

in healthcare

through the intentional integration of research findings into practice while including patients in
decisions

remains a daunting endeavor that will take anywhere from years to decades. Therefore, increased
efforts across

the healthcare industry are required to provide a culture that fosters empowered point-of-care
clinicians with

the knowledge, skills, attitudes, and resources they need to deliver care that demonstrates
improved healthcare

system, clinician, and patient outcomes.

We will always believe that anything is possible when you have a big dream and believe in your
ability to

accomplish that dream. It was the vision of transforming healthcare with EBP, in any setting,
with one client–

clinician encounter at a time and the belief that this can be the daily experience of both patients
and care

providers, along with our sheer persistence through many “character-building” experiences
during the writing

and editing of the book, that culminated in this user-friendly guide that aims to assist all
healthcare
professionals in the delivery of the highest quality, evidence-based care.

The fourth edition of this book has been revised to assist healthcare providers with implementing
and

sustaining EBP in their daily practices and to foster a deeper understanding of the principles of
the EBP

paradigm and process. In working with healthcare systems and clinicians throughout the nation
and globe and

17

conducting research on EBP, we have learned more about successful strategies to advance and
sustain

evidence-based care. The new material throughout the book, including new chapter material, a
unit-by-unit

EBP example, new chapters, EBP competencies, and tools to advance EBP, are included so that
clinicians can

use them to help with daily evidence-based decision making.

Worldview

A solid understanding of the EBP paradigm, or worldview, is the first mastery milestone for
readers of this
EBP book. The next milestone is using the paradigm as the foundation for making clinical
decisions with

patients. This worldview frames why rigorously following the steps of the EBP process is
essential, clarifies

misperceptions about implementing evidence-based care, and underpins practical action

strategies that lead to

sustainable evidence implementation at the point of care. It is our dream that the knowledge and

understanding gained from thoughtfully and intentionally engaging the contents of this book will
help

clinicians across the country and globe accelerate adoption of the EBP paradigm until evidence-
based care is

the lived experience for clinicians, patients, and health professions students across various
healthcare settings

and educational institutions.

NEW FEATURES AND RESOURCES FOR THIS EDITION

The book contains vital, usable, and relatable content for all levels of practitioners and learners,
with key

exemplars that bring to life the concepts within the chapters. Each unit now begins with “Making

Connections: An EBP Exemplar.” This unfolding case study serves as a model or example of
EBP in real-life

practice. We recommend that learners read each unit exemplar before they engage in that unit’s
content; the

characters in the healthcare team in the exemplar use the information within the unit’s chapters
to carry out

the steps of EBP, leading to a real evidence-based change to improve the quality and safety of
care. These

characters may be fictional, but the exemplar is based on an important quality indicator (i.e.,
hospital falls) and

an actual synthesis of published research that offers the opportunity for readers to better
understand how they

can use EBP in their clinical practice or educational setting to improve outcomes. Readers may
wish to refer
back to the exemplar as they are reading through the chapters to see how the healthcare team
used the

information they are learning. Furthermore, it is recommended that readers follow the team as
they make

evidence-based decisions across the units within the book. There are online resources as well as
resources

within the appendices of the book that will be used in the exemplar, offering readers the
opportunity to see

how the team uses these resources in evidence-based decision making.

Our unit-ending feature, “Making EBP Real: A Success Story,” has been updated and continues
to

provide real-life examples that help readers to see the principles of EBP applied. Readers can
explore a variety

of ways that the steps of the EBP process were used in real EBP implementations. Clinicians
who desire to

stimulate or lead change to a culture of EBP in their practice sites can discover in both of these
unit-level

features how functional models and practical strategies to introduce a change to EBP can occur,
including

overcoming barriers in implementing change, evaluating outcomes of change, and moving

change to

sustainability through making it standard of care.

To help recognize that knowledge and understanding of EBP terms and language is essential to
adopting

the EBP paradigm, in this edition, we added EBP Terms to Learn that features key terms at the
beginning of

18

•
•

each unit and chapter. Readers can review terms in the glossary before reading the chapters so
that they can

readily assimilate content. Furthermore, we have provided learning objectives at the unit and
chapter level to

continue to reinforce important concepts and offer the opportunity for readers to quickly identify
key chapter

content. When readers come across bolded terms within the chapter, they are encouraged to go to
the glossary

at back of the book to further explore that concept. EBP Fast Facts is an important feature at the
end of each

chapter that we retained for this edition, offering readers some of the most important pearls of
wisdom from

the chapter. These elements in our fourth edition will help learners master the terminology of
EBP and

identify important content for developing EBP competence.

Finally, for faculty, there is new content in the chapter on teaching EBP in academic settings that
can help

educators to parse teaching EBP across academic learning degrees. Educators are encouraged to
review the

online resources that can facilitate teaching EBP in both academic and clinical settings.
Further resources for all readers of the book include appendices that help learners master the
process of

evidence-based change, such as rapid critical appraisal checklists (be sure to check online on for
Word

versions of RCA checklists for readers to use), sample instruments to evaluate EBP in both
educational and

clinical settings, a template for asking PICOT questions, and more. Some appendices appear
online only on

, including an appraisal guide for qualitative evidence, an ARCC model EBP mentor role
description,
and examples of a health policy brief, a press release, and an approved consent form for a study.
More details

about the great resources available online can be found below.

ORGANIZATION OF THE BOOK

As in prior editions, the Table of Contents is structured to follow the steps of EBP:

Chapters 1 to 3 in Unit 1 encompass steps 0, 1, and 2 of the EBP process. This unit gets learners
started by building a strong foundation

and has significant content updates in this new edition.

Chapters 4 to 8 in Unit 2 delve deeply into step 3 of the EBP process, the four-phased critical
appraisal of evidence. In this edition,

Chapters 7 and 8 were moved into Unit 2 to better align the steps of the EBP process with the
chapters, including the important

consideration of patient concerns, choices, clinical judgment, and clinical practice guidelines in
the recommendation phase of critical

appraisal.

In Unit 3, Chapters 9 to 12 move the reader from recommendation to implementation of

sustainable practice change. To facilitate

understanding how to implement evidence-based change, Chapter 11 was added to describe the
context, content, and outcome of

implementing EBP competencies in clinical and academic settings.

Unit 4 promotes creating and sustaining a culture of EBP. In this unit, we included new content
and resources in the chapters on teaching

EBP in educational and healthcare settings (Chapters 16 and 17, respectively). Educators can be
most successful as they make the EBP

paradigm and process understandable for their learners.

Unit 5 features a new Chapter 19 on health policy. In today’s political climate, nurses and
healthcare professionals need to understand how

to ensure sustainable change through influencing the formulation of policies governing

healthcare, fully supported by the latest and best

evidence. This new chapter joins Chapter 20 on disseminating evidence.

In Unit 6, Chapter 21 now combines two previous chapters’ content on generating evidence
through qualitative and quantitative research,

greatly streamlining the material for enhanced understanding of important concepts and making
the information more accessible to learners.

Chapter 23 provides updated information on ethics in EBP and research generation.

The glossary is one of the best resources within this book. Readers are encouraged to use it
liberally to understand and master EBP

language, and thereby enhance their fluency.

Often, educators teach by following chapters in a textbook through their exact sequence;
however, we

recommend using chapters of this fourth edition that are appropriate for the level of the learner
(e.g., associate

degree, baccalaureate, master’s, doctoral). For example, we would recommend that associate
degree students

19

•
•

benefit from Units 1, 3, and 4. Curriculum for baccalaureate learners can integrate all units;
however, we

recommend primarily using Units 1 to 4, with Unit 5 as a resource for understanding more about
research

terminology and methods as readers learn to critical appraise evidence. Master’s and doctoral
programs can

incorporate all units into their curricula. Advanced practice clinicians and doctorally-prepared
clinical experts

will be able to lead in implementing evidence in practice, thoughtfully evaluate outcomes of

practice, and

move to sustainable change, whereas those learning to become researchers will understand how
to best build

on existing evidence to fill gaps in knowledge with valid, reliable research that is clinically
meaningful.

An important resource for educators to use as a supplement to this EBP book is the American
Journal of

Nursing EBP Step-by-Step series, which provides a real-world example of the EBP process from
step 0

through 6. We recommend this series as a supplement because the series was written to expose
readers to the

EBP process in story form, but used alone it does not provide the level of learning to establish
competence in

evidence-based care. In the series, a team of healthcare providers encounters a challenging issue
and uses the
EBP process to find a sustainable solution that improves healthcare outcomes. If educators
choose to use this

series, we caution on using it as the sole source for learning about EBP. Rather, assigning the
articles to be

read before a course begins or in tandem with readings from this book that match the article
being read

provides a complete learning opportunity, including context and adequate content for
competence—the goal

of learning about EBP, regardless of the learner’s level of education or clinical practice. For
example, the first
three chapters of the book could be assigned along with the first four articles, in an academic or
clinical

setting. The learners could use discussion boards or face-to-face group conference-type settings
to discuss how

the team used the content the learners studied within the chapter, allowing educators opportunity
for

evaluation of content mastery (see suggested curriculum strategy at this book’s companion
website on ,

http://thepoint.lww.com/Melnyk4e). Multiple approaches are offered for educators and learners

to engage

EBP content, and, in doing so, we believe that this book continues to facilitate changes in how
research

concepts and critical appraisal are being taught in clinical and academic professional programs
throughout the

country.

UPDATED FEATURES

This edition of Evidence-Based Practice in Nursing & Healthcare includes many features that
readers have come

to expect. These features are designed to benefit both learners and educators:

Quotes: As proponents of cognitive-behavioral theory, which contends that how people think
directly influences how they feel and behave,
we firmly believe that how an individual thinks is the first step toward or away from success.
Therefore, inspirational quotes are intertwined

throughout our book to encourage readers to build their beliefs and abilities as they actively
engage in increasing their knowledge and skills

in EBP to accomplish their desired learning goals.

Clinical Scenarios describe a clinical case or a supervisory decision clinicians could encounter in
clinical practice, prompting readers to seek

out best evidence and determine a reasonable course of action.

Web Tips: With the rapid delivery of information available to us, web tips direct readers to
helpful Internet resources and sites that can
be used to further develop EBP knowledge and skills.

EBP Fast Facts act as a chapter-closing feature, highlighting important points from each chapter.
Reviewing these pearls can help readers

know if they retained the important concepts presented within the chapter.

Making EBP Real: A successful real-world case story emphasizing applied content from each
unit.

NEW: Learning Objectives: Each unit and chapter now begins with learning objectives, to help
learners focus on key concepts.

NEW: EBP Terms to Learn: Each unit and chapter also now includes a list of the key terms
discussed or defined in the chapter that are to

help students build familiarity with the language and terminology of EBP.

20

•
•

•
•

NEW: Making Connections: An EBP Exemplar: Opening each unit, this new feature walks the
learner through the EBP process in an

unfolding case study that is applicable to a real-time important practice issue.

ADDITIONAL RESOURCES ON

Evidence-Based Practice in Nursing and Healthcare, fourth edition, includes additional resources
for both

learners and educators that are available on the book’s companion website at

http://thepoint.lww.com/Melnyk4e.

Learner Resources Available on

Learners who have purchased Evidence-Based Practice in Nursing and Healthcare, fourth
edition, have access to

the following additional online resources:

Appendices D, E, F, G, H from the book

Learning Objectives for each chapter

Checklists and templates in MS Word format include checklists for rapid critical appraisal,
conducting an evidence review, or holding a

journal club; sample templates for PICOT questions and for evaluation and synthesis tables; an
ARCC model EBP mentor role description;

and more.

A searching exercise to help develop mastery of systematic searching.

Journal articles corresponding to book chapters to offer access to current research available in
Wolters Kluwer journals.

The American Journal of Nursing EBP Step-by-Step Series, which provides a real-world
example of the EBP process as a supplement to
learning within the EBP book.

An example of a poster (to accompany Chapter 20).

A Spanish–English audio glossary and Nursing Professional Roles and Responsibilities

See the inside front cover of this book for more details, including the passcode you will need to
gain access to

the website.

Educator Resources Available on

Approved adopting instructors will be given access to the following additional resources:

An eBook allows access to the book’s full text and images online.

Test generator with updated NCLEX-style questions. Test questions link to chapter learning
objectives.

Additional application case studies and examples for select chapters.

PowerPoint presentations, including multiple choice questions for use with interactive clicker
technology.

An image bank, containing figures and tables from the text in formats suitable for printing,
projecting, and incorporating into websites.

Strategies for Effective Teaching offer creative approaches.

Learning management system cartridges.

Access to all learner resources.

COMPREHENSIVE, INTEGRATED DIGITAL LEARNING SOLUTIONS

We are delighted to introduce digital solutions to support educators and learners using Evidence-
Based Practice

in Nursing & Healthcare, Fourth Edition. Now for the first time, our textbook is embedded into
an integrated

digital learning solution that builds on the features of the text with proven instructional design
strategies. To

learn more about this solution, visit http://nursingeducation.lww.com/, or contact your local
Wolters Kluwer

representative.

21

Lippincott CoursePoint is a rich learning environment that drives academic course and
curriculum success to

prepare learners for practice. Lippincott CoursePoint is designed for the way students learn. The
solution
connects learning to real-life application by integrating content from Evidence-Based Practice in
Nursing &

Healthcare with video cases, interactive modules, and evidence-based journal articles. Ideal for
active, case-

based learning, this powerful solution helps students develop higher-level cognitive skills and
asks them to

make decisions related to simple-to-complex scenarios.

Lippincott CoursePoint for Evidence-Based Practice features:

Leading content in context: Digital content from Evidence-Based Practice in Nursing &
Healthcare is embedded in our Powerful Tools,

engaging students and encouraging interaction and learning on a deeper level.

The complete interactive eBook features annual content updates with the latest evidence-based
practices and provides students with

anytime, anywhere access on multiple devices.

Full online access to Stedman’s Medical Dictionary for the Health Professions and Nursing
ensures students work with the best medical

dictionary available.

Powerful tools to maximize class performance: Additional course-specific tools provide case-
based learning for every student:

Video Cases help students anticipate what to expect as a nurse, with detailed scenarios that
capture their attention and integrate clinical

knowledge with EBP concepts that are critical to real-world nursing practice. By watching the
videos and completing related activities,

students will flex their problem-solving, prioritizing, analyzing, and application skills to aid both
in NCLEX preparation and in

preparation for practice.

Interactive Modules help students quickly identify what they do and do not understand so they
can study smartly. With exceptional
instructional design that prompts students to discover, reflect, synthesize, and apply, students
actively learn. Remediation links to the

eBook are integrated throughout.

Curated collections of journal articles are provided via Lippincott NursingCenter, Wolters
Kluwer’s premier destination for peer-reviewed

nursing journals. Through integration of CoursePoint and NursingCenter, students will engage in
how nursing research influences

practice.

Data to measure students’ progress: Student performance data provided in an intuitive display
lets instructors quickly assess whether

students have viewed interactive modules and video cases outside of class, as well as see
students’ performance on related NCLEX-style

22

quizzes, ensuring students are coming to the classroom ready and prepared to learn.

To learn more about Lippincott CoursePoint, please visit: http://nursingeducation.lww.com/our-

solutions/course-solutions/lippincott-coursepoint.html

A FINAL WORD FROM THE AUTHORS

As we have the privilege of meeting and working with clinicians, educators, and researchers
across the globe

to advance and sustain EBP, we realize how important our unified effort is to world health. We
want to thank

each reader for your investment of time and energy to learn and use the information contained
within this

book to foster your best practice. Furthermore, we so appreciate the information that you have
shared with us
regarding the benefits and challenges you have had in learning about and applying knowledge of
EBP. That

feedback has been instrumental to improving the fourth edition of our book. We value
constructive feedback

and welcome any ideas that you have about content, tools, and resources that would help us to
improve a

future edition. The spirit of inquiry and life-long learning are foundational principles of the EBP
paradigm

and underpin the EBP process so that this problem-solving approach to practice can cultivate an
excitement
for implementing the highest quality of care. As you engage in your EBP journey, remember that
it takes time

and that it becomes easier when the principles of this book are placed into action with
enthusiasm on a

consistent daily basis.

As you make a positive impact at the point of care, whether you are first learning about the EBP

paradigm, the steps of the EBP process, leading a successful, sustainable evidence-based change
effort, or

generating evidence to fill a knowledge gap or implement translational methods, we want to

encourage you to

keep the dream alive and, in the words of Les Brown, “Shoot for the moon. Even if you miss,
you land among

the stars.” We hope you are inspired by and enjoy the following EBP rap.

Evidence-based practice is a wonderful thing,

Done with consistency, it makes you sing.

PICOT questions and learning search skills;

Appraising evidence can give you thrills.

Medline, CINAHL, PsycInfo are fine,

But for Level I evidence, Cochrane’s divine!

Though you may want to practice the same old way

“Oh no, that’s not how I will do it,” you say.

When you launch EBP in your practice site,

Remember to eat the chocolate elephant, bite by bite.

So dream big and persist in order to achieve and

Know that EBP can be done when you believe!

© 2004 Bernadette Melnyk

Bernadette Mazurek Melnyk and Ellen Fineout-Overholt

Note: You may contact the authors at [email protected]

[email protected]

23

Acknowledgments

This book could not have been accomplished without the support, understanding, and assistance
of many

wonderful colleagues, staff, family, and friends. I would first like to acknowledge the
outstanding work of my

coeditor and cherished friend, Ellen—thank you for all of your efforts, our wonderful friendship,
attention to

detail, and ongoing support throughout this process; I could not have accomplished this revised
edition

without you. Since the first edition of this book, I have grown personally and professionally
through the many

opportunities that I have had to teach and mentor others in evidence-based practice across the
globe—the

lessons I have learned from all of you have been incorporated into this book. I thank all of my
mentees for

their valuable feedback and all of the authors who contributed their time and valuable expertise
to this book.
Along with my wonderful husband John and my three daughters, Kaylin, Angela, and Megan, I
am

appreciative for the ongoing love and support that I receive from my mother, Anna May
Mazurek, my brother

and sister-in-law, Fred and Sue Mazurek, and my sister, Christine Warmuth, whose inspirational
words to

me “Just get out there and do it!” have been a key to many of my successful endeavors. I would
also like to

thank my wonderful colleagues and staff at The Ohio State University for their support,
understanding, and
ongoing commitment to our projects and their roles throughout this process, especially Dr.
Margaret Graham

and Kathy York. Finally, I would like to acknowledge the team at Wolters Kluwer for their
assistance with

and dedication to keeping this project on track.

Bernadette Mazurek Melnyk

Now is the time to join together to ensure that EBP is the paradigm for clinical decision making.
Healthcare

providers and educators have made tremendous strides across the years to establish that EBP is
an expectation

of providers, educators, and systems. I am grateful to the American Nurses Credentialing Center
(ANCC) for

the impact of the Magnet movement as well as educational accrediting agencies (e.g.,
Commission on

Collegiate Nursing Education [CCNE], National League for Nurses Accreditation Commission
[NLNAC],

Liaison Committee on Medical Education [LCME], Accreditation Council of Pharmacy

Education

[ACPE]) for putting forward standards that have had an impact on adoption of the EBP paradigm
and
process in education, practice, and policy. As a result, all of us across the wonderful diversity of
providers who

make up the healthcare team are supported as we choose the EBP paradigm as the foundation for
daily

clinical decisions. Thank you to the students, clinicians, healthcare leadership, clinical educators,
faculty, and

researchers for demonstrating the ownership of practice that is the key to placing EBP at the
center of

healthcare transformation. We are at a tipping point . . . let’s see it through to fruition!

To those of you who have shared with me personally the difference this book has made in your
practice,

educational endeavors, and teaching, I heartily extend my deepest thanks. The value of our work
is measured

by the impact it has on advancing best practice in healthcare and how it helps point-of-care
providers and

educators make a difference in patients’ and students’ lives and health experiences. You help us
know that we

are making progress on achieving our dream of transforming healthcare—one

client–clinician/learner–

24

educator relationship at a time. Bern, almost 30 years ago, we started our work together—not
knowing where

our path would take us. Thank you for seeing the potential and taking the chance—I have
enjoyed the

wonderful privilege to work alongside you to bring our dream to life. To my colleagues at
University of Texas

at Tyler, thank you for the privilege of joining the family—you are the best!!

With the writing of this fourth edition, my life experiences, and those of contributors to the book,
have
helped me recognize more completely how blessed I am to have the support of my precious
family and friends

and to have wonderful people in my life who are committed to this often-arduous journey toward
best care for

all patients. My sweet family has trekked with me across these four editions. With the first
edition, our eldest

daughter wasn’t yet one year old; now, she is a senior in high school. Our youngest daughter was
a dream who

is now is in eighth grade. Every day, these sweet young ladies inspire me to continue to strive to
achieve the
goal of evidence-based care as the standard for healthcare. Their gift of love and laughter
delivered in

packages of hugs is invaluable—Thank You, Rachael and Ruth! Thank you to my steadfast
husband, Wayne,

who faithfully offers perspective and balance that are so important to me—your support for this
work is

invaluable! Thank you to my mother, Virginia (Grandginny), who continues to help me see the
best and not

best in healthcare as she experiences it as an older old adult (now 87). Her encounters remain a
reminder that

advocating for evidence-based consumers is an imperative. Thank you to my brother John, and
his family,

Angela, Ashton, and Aubrey—your music lifts my spirits; your healthcare experiences serve as
fodder for this

work. To those of you who have prayed for me during this writing adventure—thank you so very
much!

During my extenuating health issues that have flavored this fourth edition, my Savior and
Friend’s continual

care for me has been profound. I am eternally grateful. Healthcare should serve all of us well. Let
us all strive

to ensure that every encounter is an experience in excellent care.

Finally, I am grateful to each of you who choose to read this book, take the knowledge contained
in its

pages, and make the EBP paradigm and process come alive in your work. You make our dream
of healthcare

transformation through EBP live! The Wolters Kluwer team with whom we have had the
privilege to work

has been so helpful to make this fourth edition the best yet!! Thank you so much! This book is
not written by

one person—or even two. It is written by many people who give of their expertise and wisdom
so that readers
can have such a wonderful resource. I am very grateful for each of the faithful contributors to
this work and

their decision to join us in advancing EBP as the solution for improving healthcare.

Ellen Fineout-Overholt

25

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9
Chapter 10

Chapter 11

Chapter 12

UNIT 1

UNIT 2

UNIT 3

Contents

Steps Zero, One, Two: Getting Started

Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry

Bernadette Mazurek Melnyk and Ellen Fineout-Overholt

Asking Compelling Clinical Questions

Ellen Fineout-Overholt and Susan B. Stillwell

Finding Relevant Evidence to Answer Clinical Questions

Tami A. Hartzell and Ellen Fineout-Overholt

Unit 1 Making EBP Real: A Success Story. Using an Evidence-based, Autonomous Nurse
Protocol to Reduce Catheter-

Associated Urinary Tract Infections in a Long-term Acute Care Facility

Step Three: Critically Appraising Evidence

Critically Appraising Knowledge for Clinical Decision Making

Ellen Fineout-Overholt and Kathleen R. Stevens

Critically Appraising Quantitative Evidence for Clinical Decision Making

Dónal P. O’Mathúna and Ellen Fineout-Overholt

Critically Appraising Qualitative Evidence for Clinical Decision Making

Mikki Meadows-Oliver

Integration of Patient Preferences and Values and Clinician Expertise into Evidence-Based
Decision Making

Ellen Fineout-Overholt, Lisa English Long, and Lynn Gallagher-Ford

Advancing Optimal Care With Robust Clinical Practice Guidelines

Doris Grinspun, Bernadette Mazurek Melnyk, and Ellen Fineout-Overholt

Unit 2 Making EBP Real: A Success Story. Intradermal Lidocaine Intervention on the
Ambulatory Unit: An Evidence-

Based Implementation Project

Steps Four and Five: Moving From Evidence to Sustainable Practice Change

Implementing Evidence in Clinical Settings

Cheryl C. Rodgers, Terri L. Brown, and Marilyn J. Hockenberry

The Role of Outcomes and Evidence-Based Quality Improvement in Enhancing and Evaluating
Practice

Changes

Anne W. Alexandrov, Tracy L. Brewer, and Barbara B. Brewer

Implementing the Evidence-Based Practice Competencies in Clinical and Academic Settings to

Ensure

Healthcare Quality and Improved Patient Outcomes

Bernadette Mazurek Melnyk, Lynn Gallagher-Ford, and Cindy Zellefrow

Leadership Strategies for Creating and Sustaining Evidence-Based Practice Organizations

Lynn Gallagher-Ford, Jacalyn S. Buck, and Bernadette Mazurek Melnyk

Unit 3 Making EBP Real: A Success Story. Improving Outcomes for Depressed Adolescents
With the Brief Cognitive

Behavioral COPE Intervention Delivered in 30-Minute Outpatient Visits

Creating and Sustaining a Culture and Environment for Evidence-Based Practice

26

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

UNIT 5

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Appendix A

Appendix B

Appendix C
Appendix I

Appendix J

Appendix K

UNIT 4 Chapter 13

UNIT 6

Innovation and Evidence: A Partnership in Advancing Best Practice and High Quality Care

Kathy Malloch and Tim Porter-O’Grady

Models to Guide Implementation and Sustainability of Evidence-Based Practice

Deborah Dang, Bernadette Mazurek Melnyk, Ellen Fineout-Overholt, Jennifer Yost, Laura
Cullen, Maria Cvach,

June H. Larabee, Jo Rycroft-Malone, Alyce A. Schultz, Cheryl B. Stetler, and Kathleen R.

Stevens

Creating a Vision and Motivating a Change to Evidence-Based Practice in Individuals, Teams,

and

Organizations

Bernadette Mazurek Melnyk and Ellen Fineout-Overholt

Teaching Evidence-Based Practice in Academic Settings

Ellen Fineout-Overholt, Susan B. Stillwell, Kathleen M. Williamson, and John F. Cox III

Teaching Evidence-Based Practice in Clinical Settings

Ellen Fineout-Overholt, Martha J. Giggleman, Katie Choy, and Karen Balakas

ARCC Evidence-Based Practice Mentors: The Key to Sustaining Evidence-Based Practice

Ellen Fineout-Overholt and Bernadette Mazurek Melnyk

Unit 4 Making EBP Real: A Success Story. Mercy Heart Failure Pathway

Step Six: Disseminating Evidence and Evidence-Based Practice Implementation

Outcomes

Using Evidence to Influence Health and Organizational Policy

Jacqueline M. Loversidge and Cheryl L. Boyd

Disseminating Evidence Through Presentations, Publications, Health Policy Briefs, and the
Media

Cecily L. Betz, Kathryn A. Smith, Bernadette Mazurek Melnyk, and Timothy Tassa

Unit 5 Making EBP Real: A Success Story. Research Projects Receive Worldwide Coverage

Generating External Evidence and Writing Successful Grant Proposals

Generating Evidence Through Quantitative and Qualitative Research

Bernadette Mazurek Melnyk, Dianne Morrison- Beedy, and Denise Cote-Arsenault

Writing a Successful Grant Proposal to Fund Research and Evidence-Based Practice

Implementation Projects

Bernadette Mazurek Melnyk and Ellen Fineout-Overholt

Ethical Considerations for Evidence Implementation and Evidence Generation

Dónal P. O’Mathúna

Unit 6 Making EBP Real: Selected Excerpts From A Funded Grant Application. COPE/Healthy
Lifestyles for Teens: A

School-Based RCT

Question Templates for Asking PICOT Questions

Rapid Critical Appraisal Checklists

Evaluation Table Template and Synthesis Table Examples for Critical Appraisal

ARCC Model Timeline for an EBP Implementation Project

Sample Instruments to Evaluate EBP in Educational Settings

Sample Instruments to Evaluate EBP in Clinical Settings

Glossary

Index

APPENDICES AVAILABLE ON

27
Appendix D

Appendix E

Appendix F

Appendix G

Appendix H

Walking the Walk and Talking the Talk: An Appraisal Guide for Qualitative Evidence

Example of a Health Policy Brief

Example of a Press Release

Example of an Approved Consent Form for a Study

System-Wide ARCC Model Evidence-Based Practice Mentor Role Description

28

UNIT

Steps Zero, One, Two: Getting Started

To accomplish great things, we must not only act, but also dream; not only plan,

but also believe.

—Anatole France

EBP Terms to Learn

Background questions

Bibliographic database
Body of evidence

Boolean connectors

Clinical inquiry

Critical appraisal

EBP competencies

Evidence-based practice (EBP)

Evidence-based quality improvement (EBPI)

External evidence

Foreground questions
Grey literature

Internal evidence

Keywords

Meta-analysis

Outcomes management

PICOT format

Point-of-care resources

Preappraised literature

Proximity searching

Randomized controlled trials (RCTs)

Reference managers

Search strategy

Subject headings

Yield

UNIT OBJECTIVES

Upon completion of this unit, learners will be able to:

Identify the seven steps of evidence-based practice (EBP).

Describe the differences among EBP, research, and quality improvement.

Explain the components of a PICOT question: population, issue or intervention of interest,
comparison of interest, outcome, and

time for intervention to achieve the outcome.