,
,EVIDENCE-
BASEDPRACTICE m
in Nursing & Healthcare
m m m
A GUIDE T O BE S T PR A C TI CE
m m m m
● BernadettemMazurekmMelnyk,mPhD,mRN,mCPNP/PMHNP,m
FNAP,mFAAN
DeanmandmDistinguishedmFoundationmProfessorminmNursing mAr
izonamState mUniversity m College m of m Nursing m& mH ealth mInnovation
mPhoenix, m Arizona
Associate m Editor,Worldviews m on m Evidence-
BasedmNursing mPartner,mARCCmllc;mPresident,mCOPEmformHOP
E,mInc.
Foundermand mC hair,m National mA ssociation mof mPediatric m Nurse mPractitioners’ m(NA PNA
P)mKySSm(Keepm yourm children/yourselfm SafemandmSecure)mCampaign
Promoting m the m Mental mHealthm of mC hildren,T eensm & mFamilies mM e
mber,Them United mStates mPreventive m Services mTask mForce
● Ellenm Fineout-Overholt,mPhD,mRN,mFNAP,mFAAN
ClinicalmProfessormandmDirector
Centermfor mA dvancementmofmEvidence-BasedmPractice
Arizona mState m University mC olleg e mof mNursing m& mHealth mInnovati
onmPhoenix,mArizona
Partner,mARCCmllc
seco n d ed it io n m
, Acquisitions mEditor:mHilariemSurrena
mProductmManager:mHelenmKogutmV
endor mManager:mCynthiamRudymDe
signmCoordinator:mJoanmWendt
IllustrationmCoordinator:mBrettmMacNaughtonmMan
ufacturingmCoordinator:mKarinmDuffieldmPrepress m
Vendor:mSPimTechnologies
2ndmedition
Copyrightm©m2011mWolters mKluwermHealthm|mLippincottmWilliams m&mWilkins.
Copyrightm©m2005mbymLippincottmWilliams m& mWilkins.mAllmrights mreserved. mThis mbookm ismprotectedmb
ymcopyright.mNompartmofmthis mbookmmaymbemreproduced mormtransmittedmin manymform mormbymanym means,m
includingmasmphotocopies mormscanned-
inmormothermelectronicmcopies,mormutilizedmbymanyminformationmstoragemandmretrieval
systemmwithoutmwrittenmpermissionmfrommthemcopyrightmowner,mexceptmformbriefmquotations membodiedminmc
riticalmarticles mandmreviews.mMaterials mappearingmin mthismbookmprepared mbymindividuals m asmpartmof mtheirm
officialmdutiesmasmU.S.mgovernmentmemployees maremnotmcoveredmbym themabove-
mentionedmcopyright.mTomrequestmpermission,mplease mcontactm Lippincott mWilliams m&m Wilkins matm TwomC
ommercemSquare,m2001mMarketmStreet,mPhiladelphia,mPA m19103,mviam emailm ,mor
mviamourmwebsitematmlww.comm(products mandmservices).
9m 8m 7m 6m 5m 4m 3m 2m 1
PrintedminmChina
LibrarymofmCongress mCataloging-in-Publication mData
Melnyk,mBernadettemMazurek.
Evidence-
basedmpracticeminmnursingm&mhealthcarem :mamguidemtombestmpracticem /mBernadettemMazurekmMelnyk,mEllenm
Fineout-Overholt.—2ndmed.
p.m;mcm.
Othermtitle:mEvidence-
basedmpracticeminmnursingmandmhealthcaremIncludes mbibliographicalm
references mandmindex.
ISBN m978-1-60547-778-7
1.m Evidence-basedmnursing.m2.m Evidence-basedmmedicine.m I.mFineout-
Overholt,mEllen.m II.mTitle.m III.mTitle:mEvidence-basedmpracticem inmnursingm andmhealthcare.
[DNLM:m1.m Evidence-BasedmNursing—methods—PracticemGuideline.m2. m NursemClinicians—
PracticemGuideline.m WYm100.7mM527em2011]
RT42.M44m2011m610.
73—dc22
2010007467
Caremhas mbeenmtakenmtomconfirmmthemaccuracymofmtheminformationmpresentedm andmtomdescribemgenerallym a
cceptedmpractices.mHowever,mthe mauthor(s),meditors,mandmpublisher mare mnot mresponsiblemfor merrors mormomiss
ions mormformanymconsequences mfrommapplication mofmthem informationm inmthismbookm andmmakemnomwarranty,
mexpressedmormimplied,mwithmrespectmtomthemcurrency,mcompleteness,mormaccuracymofmthemcontents mofmthemp
ublication.mApplicationmofmthisminformationm inma mparticularmsituationmremains mthemprofessionalmresponsibil
itymofmthempractitioner;mthe mclinicalmtreatments mdescribed mandmrecommendedm maymnot mbemconsideredm abs
olutemandmuniversalmrecommendations.
Themauthor(s),meditors,mandmpublishermhavemexertedmeverymeffortmtom ensuremthatmdrugmselectionmand
m dosagemsetmforthminmthis mtextmareminmaccordancemwithmthemcurrentmrecommendations mandmpracticematmth
emtimemofmpublication.mHowever,minmview mofmongoingmresearch,m changes m inmgovernmentmregulations,man
dmthemconstantmflow mofminformationmrelatingm tomdrugmtherapym andmdrugmreactions,mthemreader mismurgedm t
omcheckmthempackageminsertmformeachmdrugmform anymchangeminmindications mandmdosagem andmformaddedmw
arnings mandmprecautions.mThis mismparticularlym importantmwhenm themrecommendedm agentm ismamnew morminf
requentlymemployedmdrug.
Somemdrugs mandmmedicalmdevicesmpresentedm inmthis mpublicationmhave mFoodmandmDrugmAdministrat
ionm(FDA)mclearancemformlimitedmuseminmrestrictedmresearchmsettings.mItmis mthemresponsibilitymof mthemhea
,EVIDENCE-
BASEDPRACTICE m
in Nursing & Healthcare
m m m
A GUIDE T O BE S T PR A C TI CE
m m m m
● BernadettemMazurekmMelnyk,mPhD,mRN,mCPNP/PMHNP,m
FNAP,mFAAN
DeanmandmDistinguishedmFoundationmProfessorminmNursing mAr
izonamState mUniversity m College m of m Nursing m& mH ealth mInnovation
mPhoenix, m Arizona
Associate m Editor,Worldviews m on m Evidence-
BasedmNursing mPartner,mARCCmllc;mPresident,mCOPEmformHOP
E,mInc.
Foundermand mC hair,m National mA ssociation mof mPediatric m Nurse mPractitioners’ m(NA PNA
P)mKySSm(Keepm yourm children/yourselfm SafemandmSecure)mCampaign
Promoting m the m Mental mHealthm of mC hildren,T eensm & mFamilies mM e
mber,Them United mStates mPreventive m Services mTask mForce
● Ellenm Fineout-Overholt,mPhD,mRN,mFNAP,mFAAN
ClinicalmProfessormandmDirector
Centermfor mA dvancementmofmEvidence-BasedmPractice
Arizona mState m University mC olleg e mof mNursing m& mHealth mInnovati
onmPhoenix,mArizona
Partner,mARCCmllc
seco n d ed it io n m
, Acquisitions mEditor:mHilariemSurrena
mProductmManager:mHelenmKogutmV
endor mManager:mCynthiamRudymDe
signmCoordinator:mJoanmWendt
IllustrationmCoordinator:mBrettmMacNaughtonmMan
ufacturingmCoordinator:mKarinmDuffieldmPrepress m
Vendor:mSPimTechnologies
2ndmedition
Copyrightm©m2011mWolters mKluwermHealthm|mLippincottmWilliams m&mWilkins.
Copyrightm©m2005mbymLippincottmWilliams m& mWilkins.mAllmrights mreserved. mThis mbookm ismprotectedmb
ymcopyright.mNompartmofmthis mbookmmaymbemreproduced mormtransmittedmin manymform mormbymanym means,m
includingmasmphotocopies mormscanned-
inmormothermelectronicmcopies,mormutilizedmbymanyminformationmstoragemandmretrieval
systemmwithoutmwrittenmpermissionmfrommthemcopyrightmowner,mexceptmformbriefmquotations membodiedminmc
riticalmarticles mandmreviews.mMaterials mappearingmin mthismbookmprepared mbymindividuals m asmpartmof mtheirm
officialmdutiesmasmU.S.mgovernmentmemployees maremnotmcoveredmbym themabove-
mentionedmcopyright.mTomrequestmpermission,mplease mcontactm Lippincott mWilliams m&m Wilkins matm TwomC
ommercemSquare,m2001mMarketmStreet,mPhiladelphia,mPA m19103,mviam emailm ,mor
mviamourmwebsitematmlww.comm(products mandmservices).
9m 8m 7m 6m 5m 4m 3m 2m 1
PrintedminmChina
LibrarymofmCongress mCataloging-in-Publication mData
Melnyk,mBernadettemMazurek.
Evidence-
basedmpracticeminmnursingm&mhealthcarem :mamguidemtombestmpracticem /mBernadettemMazurekmMelnyk,mEllenm
Fineout-Overholt.—2ndmed.
p.m;mcm.
Othermtitle:mEvidence-
basedmpracticeminmnursingmandmhealthcaremIncludes mbibliographicalm
references mandmindex.
ISBN m978-1-60547-778-7
1.m Evidence-basedmnursing.m2.m Evidence-basedmmedicine.m I.mFineout-
Overholt,mEllen.m II.mTitle.m III.mTitle:mEvidence-basedmpracticem inmnursingm andmhealthcare.
[DNLM:m1.m Evidence-BasedmNursing—methods—PracticemGuideline.m2. m NursemClinicians—
PracticemGuideline.m WYm100.7mM527em2011]
RT42.M44m2011m610.
73—dc22
2010007467
Caremhas mbeenmtakenmtomconfirmmthemaccuracymofmtheminformationmpresentedm andmtomdescribemgenerallym a
cceptedmpractices.mHowever,mthe mauthor(s),meditors,mandmpublisher mare mnot mresponsiblemfor merrors mormomiss
ions mormformanymconsequences mfrommapplication mofmthem informationm inmthismbookm andmmakemnomwarranty,
mexpressedmormimplied,mwithmrespectmtomthemcurrency,mcompleteness,mormaccuracymofmthemcontents mofmthemp
ublication.mApplicationmofmthisminformationm inma mparticularmsituationmremains mthemprofessionalmresponsibil
itymofmthempractitioner;mthe mclinicalmtreatments mdescribed mandmrecommendedm maymnot mbemconsideredm abs
olutemandmuniversalmrecommendations.
Themauthor(s),meditors,mandmpublishermhavemexertedmeverymeffortmtom ensuremthatmdrugmselectionmand
m dosagemsetmforthminmthis mtextmareminmaccordancemwithmthemcurrentmrecommendations mandmpracticematmth
emtimemofmpublication.mHowever,minmview mofmongoingmresearch,m changes m inmgovernmentmregulations,man
dmthemconstantmflow mofminformationmrelatingm tomdrugmtherapym andmdrugmreactions,mthemreader mismurgedm t
omcheckmthempackageminsertmformeachmdrugmform anymchangeminmindications mandmdosagem andmformaddedmw
arnings mandmprecautions.mThis mismparticularlym importantmwhenm themrecommendedm agentm ismamnew morminf
requentlymemployedmdrug.
Somemdrugs mandmmedicalmdevicesmpresentedm inmthis mpublicationmhave mFoodmandmDrugmAdministrat
ionm(FDA)mclearancemformlimitedmuseminmrestrictedmresearchmsettings.mItmis mthemresponsibilitymof mthemhea
