Evidence Based Practice into Clinical Practice

Assignment: Integrating Evidence-Based Practice

Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with (2) sources (1 outside source and the textbook) using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment. Evidence Based Practice into Clinical Practice

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Part 1:

Describe the eight steps to integrating evidence-based practice into the clinical environment. What barriers might you face in implementing a new practice to address your research topic (as identified in Module 1)? this topic is delirium in the adult ICU setting Describe strategies that could be used to increase success including overcoming barriers.

Part 2:

Describe six sources of internal evidence that could be used in providing data to demonstrate improvement in outcomes.

Assignment Expectations:

Length: 1000 – 1500 words
Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.
References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of one (1) scholarly source and the textbook are required for this assignment.
Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.
Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf)
File name: Name your saved file according to your first initial, last name, and the assignment number (for example RHall Assignment 1.docx)

Also use the following articles in writing the paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554074/

Please use the attached PDF files the APA citation for these would be:

Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.) Philadelphia, PA: Wolters Kluwer Health.

attachment

Melnyk_PPT_Chapter_11.ppt

Chapter 11

Leadership Strategies and Evidence-Based Practice Competencies to Sustain a Culture and Environment That Supports Best Practice

Factors Influencing EBP Implementation

Studies have found that resistance to accepting EBP is declining; however, factors that still influence EBP implementation include:

Beliefs and attitudes about EBP
Knowledge about EBP
Organizational commitment to EBP
Organizational support for EBP
An organizational culture responsive to change
Support of EBP ideas/initiatives

Interventions Vital to Consistent Implementation of EBP

EBP education combined with active repetitive skills building
EBP mentorship and support
A culture and an environment that supports EBP
Leaders and managers who support and role model EBP
Strategies that overcome system barriers to EBP

Question

Research studies over the last two decades have found that some barriers to EBP have changed in their importance while others remain. Select all of the barriers that still have impact on building and sustaining an environment favorable to EBP:

a. Organizational support and commitment

b. Resistance to EBP implementation

c. Attitude about the importance of EBP

d. Knowledge about EBP processes

Answer

a, b, and d

Rationale: Over the last decade, studies have shown that attitude toward the importance of EBP to clinical practice has improved; however, barriers such as organizational support and commitment, resistance to EBP implementation on site, and sound knowledge about the EBP process continue to be barriers to its implementation.

Nursing Organizations That Incorporate EBP Into Their Standards and/or Expectations of Leadership

American Nurses Association (ANA) ANA Scope and Standards of Practice for the Nurse Administrator (2010)
The American Organization of Nurse Executives (AONE) AONE Nurse Executive Competencies
The American Nurses Credentialing Center (ANCC) Magnet Recognition Program

Leadership Theories for Contemporary Nursing and Healthcare Leadership

Focus on the relationship between the leader and the follower
Leader creates an environment where individuals are supported and recognized for their work
Workers feel inspired and empowered to innovate and change
Leadership theories include:
Innovation leadership
Transformational leadership
Servant leadership
Authentic leadership

Leadership Theories: Innovative Leader

Leadership that creates the context in which innovation occurs and sustains. Evidence Based Practice into Clinical Practice

Competencies of the innovative leader:

Focuses on the essence of the innovation
Possesses knowledge and experience in concepts and processes of innovation
Possesses an understanding of their own personal strengths and limitations
Demonstrates effective collaboration based on listening, encouraging feedback, openness, and conflict resolution

Leadership Theories: Innovative Leader—(cont.)

Competencies of the innovative leader—(cont.):

Manages considerable amounts of data and information and quickly evaluates the evidence, its value, and potential outcomes
Collects related information/evidence when gaps are identified in the information or evidence
Evaluates new technology from the perspective of enhancing the organization rather than purely as a new technology
Coaches others in the principles of innovation, adult learning, and change

Leadership Theories: Transformational Leader

- Leader is the one who provides a vision and motive and is an inspiration to others

- Four dimensions of transformational leadership:

- Idealized influence: Role models with a focus on doing things right rather than ensuring that others do the right things

Leadership Theories: Transformational Leader—(cont.)

- Four dimensions of transformational leadership—(cont.):

Inspirational motivation: Articulates a clear vision that inspires and motivates others to accomplish great achievements
Intellectual stimulation: Encourages innovation and creativity by empowering others to explore new ways of doing things and approaching problems using the EBP process
Individualized consideration: Supports and encourages others by offering reward and recognition for unique contributions

Leadership Theories: Servant Leader

- Leadership based on the essential elements of trust, empathy, caring, and a focus on others

- Foundational characteristics that are central to servant leadership:

Intent and careful listening to others
Seeking to understand and empathize with those they lead
Healing relationships by helping others to solve problems and conflicts, thus supporting and promoting personal growth in others

Leadership Theories: Servant Leader— (cont.)

- Foundational characteristics that are central to servant leadership—(cont.):

Self-awareness that allows a better understanding of issues surrounding ethics, power, and values
Ability to build consensus among others and a reliance on persuasion rather than power to influence
Seeing beyond the “day-to-day” and focusing on long-term goals
Learning from the past to understand the present consequences of decisions

Leadership Theories: Servant Leader— (cont.)

- Foundational characteristics that are central to servant leadership—(cont.):

Belief that serving the needs of others is an obligation
Commitment to the personal, professional, and spiritual growth and development of each individual
Desire to develop a true community among businesses served

Leadership Theories: Authentic Leader

- A composite of other leadership types; these leaders are confident, hopeful, optimistic, resilient, transparent, self-aware, and possess high moral character. They assure that their communication is transparent and comprehended as intended.

- Leadership based on four central behaviors:

Balanced processing: Ability to objectively analyze data to formulate decisions while soliciting views that may challenge ideas without being self-protective

Leadership Theories: Authentic Leader—(cont.)

- Leadership based on four central behaviors—(cont.):

Internalized moral perspective: Role models high standards of moral and ethical conduct
Relational transparency: Presents genuine self to followers and shares their values, emotions, and goals in a transparent manner that encourages others to be forthcoming with their ideas and opinions
Self-awareness: Assesses their strengths and weaknesses to come to a better understanding of their own unique talents, beliefs, and desires in order to enhance their leadership effectiveness

Question

There are four leadership theories that have been identified as congruent with initiating and sustaining evidence-based practice. Match the hallmark characteristics with the theory to which they belong.

a. Innovative leader	__ Doing things right rather than ensuring that others do the right things
b. Transfor-mational leader	__ Based on the essential elements of trust, empathy, caring, and a focus on others
c. Servant leader	__ Presents genuine self to followers and shares their values, emotions, and goals in a transparent manner
d. Authentic leader	__ Evaluates new technology from the perspective of enhancing the organization rather than purely “to be first”

Answer

In order: b, c, d, a

Rationale: Although there are some commonalities among characteristics described in leadership theories, each of the theories has at least one distinctive trait, as identified in previous PowerPoint slides and in the textbook. Evidence Based Practice into Clinical Practice

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment

Strategy	Activities
EBP education and skills building	Develop EBP content and skill-building programs targeted at clinicians in various levels of practice including staff, managers, and directors Include EBP content and EBP competencies in orientation and residency programs designed for new hires

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
Operational budgets for EBP resources	Purchase computers dedicated for EBP work Allot/budget time for EBP project work
Library services support	Access to library with adequate clinical databases and journals available Support from librarians knowledgeable in EBP steps and processes

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
Job descriptions and performance evaluation tools	Write or revise job descriptions with EBP competencies/expectations articulated Write or revise performance appraisal tools with EBP outcomes/deliverables articulated
Clinical ladder requirements	Write or rewrite clinical ladder application with progressive EBP requirements at each level

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
Organizational mission, vision, and values statements	Write or revise organizational and departmental mission, vision, and values statements with EBP language integrated throughout
EBP mentors aligned within the organization	Structure EBP mentors/champions centrally within the organization to promote, support, and sustain a unified message and vision of EBP Designate a dedicated, knowledgeable EBP leader to oversee EBP activities and create and inspire the EBP culture

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
EBP mentor positions	Create specific job descriptions for designated EBP mentors (include robust knowledge and skills in EBP, motivation, and change theory) Align EBP mentors centrally in the organization
Manager and leader accountability	Write/revise leadership job descriptions to reflect clear EBP expectations Write/revise performance appraisal tools with required EBP outcomes/deliverables

Evidence-Based Practice Competencies for Practicing Registered Nurses

Questions clinical practices for the purpose of improving the quality of care
Describes clinical problems using internal (organization-generated) evidence
Participates in the formulation of clinical questions using PICOT format
Searches for external (research) evidence to answer focused clinical questions
Participates in critical appraisal of pre-appraised evidence. Evidence Based Practice into Clinical Practice

Evidence-Based Practice Competencies for Practicing Registered Nurses—(cont.)

- Participates in the critical appraisal of published research studies to determine their strength and applicability to clinical practice
- Participates in the evaluation and synthesis of a body of evidence gathered to determine its strength and applicability to clinical practice
- Collects practice data systematically as internal evidence for clinical decision making
- Integrates evidence gathered from external and internal sources in order to plan evidence-based practice changes

Evidence-Based Practice Competencies for Practicing Registered Nurses—(cont.)

- Implements practice changes based on evidence and clinical expertise and patient preferences to improve care processes and patient outcomes
- Evaluates outcomes of evidence-based decisions and practice changes for individuals, groups, and populations to determine best practices
- Disseminates best practices supported by evidence to improve quality of care and patient outcomes
- Participates in strategies to sustain an evidence-based practice culture

Question

Is the following statement true or false?

Evidence-based practice competencies as identified by Melnyk, Gallagher-Ford, Long, and Fineout-Overholt (2014) are basically the same for both the practicing registered nurse (RN) and the advanced practice nurse (APN).

Answer

False

Rationale: Although several of the competencies as described by Melnyk et al. (2014) are built on the practicing registered nurse competencies, several of them, such as leading interdisciplinary teams in applying synthesized evidence, are exclusive to the APN role.

attachment

Melnyk_PPT_Chapter_10.ppt

Chapter 10

The Role of Outcomes and Quality Improvement in Enhancing and Evaluating Practice Changes

Evidence-Based Quality Improvement (EBQI) and Outcomes Management (OM)

EBQI: Systematic and continuous actions that lead to improvement in health services and the health status or health outcomes of targeted patient groups (U.S. Department of Health and Human Services, 2011)
OM: “Technology of patient experience designed to help patients, payers, and providers make rational medical care-related choices based on better insight into the effect of these choices on patient life” (Ellwood, 1988, p. 1549)

Basic Principles Supporting Outcomes Management

Emphasizing practice standards that providers can use to select interventions
Measuring patient functional status, well-being, and disease-specific clinical outcomes
Pooling outcome data on a massive scale
Analyzing and disseminating outcomes, in relation to the interventions used, to appropriate decision makers and stakeholders (Ellwood, 1988)

Health Outcomes Institute’s Outcomes Management Model

First model to provide steps to guide measurement of the impact of new interventions on improving healthcare outcomes

First two phases of the model:

Define clinical problem, including structure/process contributors and descriptive and confounding variables; identify desired outcomes and related measures; build database; measure baseline
Compare appraised evidence with traditional practice; engage stakeholders; negotiate adoption of new practice; develop methods to support new practice; adopt new standard

Health Outcomes Institute’s Outcomes Management Model—(cont.)

Last two phases of the model:

3. Educate all stakeholders; assure that role models and resources are available for troubleshooting processes; monitor reliability and stability of measures and refine as needed; finalize the refined process and measurement methods; begin data collection

4. Close first data collection cycle; analyze results and disseminate to stakeholders; identify opportunities for further improvement (return to phase 2 to begin refinement of improvement)

Question

Is the following statement true or false?

The Health Outcomes Institute’s Outcomes Management Model provides a four-step process for the critical appraisal of evidence.

Answer

False

Rationale: The Health Outcomes Institute’s Outcomes Management Model delineates a process that can be used to guide measurement of the impact of new interventions on improving healthcare outcomes. It does not provide a specific process for critical appraisal of the literature.

Sources of Internal Data for EBQI

Internal Data Resources	Type/Source of Data
Quality management department	Incident reports, patient satisfaction scores, data collected for regulatory or accreditation bodies
Finance department	Charges for tests, medications, equipment, or supplies; patient days; readmission rates; patient demographics; patient diagnosis coding (MS-DRG, ICD-9/10)
Human resources	Staff turnover and education levels; hours by pay/labor category; contract labor use; provider skill mix; staffing ratios

Sources of Internal Data for EBQI—(cont.)

Internal Data Resources	Type/Source of Data
Clinical systems	Will vary with system—at minimum typically diagnostic test results and pharmacy data
Administration	Patient complaints
Electronic health record	Patient-level information captured through documentation of clinical care

Question

Which of the following two sources would be the most likely to house the data needed to measure patient outcomes related to a proposed change in the nursing skills mix at a hospital?

Finance and administration
Human resources and the quality management department
Clinical systems and the electronic health record
Administration and the quality management department

Answer

b. Human resources and the quality management department

Rationale: The human resource department is a key source of data related to nursing skills mix and the quality management department collects data on patient outcomes through incident reports, patient satisfaction scores, and data collected for regulatory or accreditation bodies. Administration data are usually limited to patient complaints, and financial data are related to charges, such as for tests, medications, equipment, or supplies. Finally, clinical systems address lab results and pharmacy orders, while the electronic health record is based on clinical documentation, from which aggregate outcomes are hard to derive.

When Existing Data Sources Are Unavailable

Measurement instruments that are developed must be evaluated as to whether they are valid and reliable

Validity: Is the instrument actually measuring what it is supposed to measure?
Content validity: The minimum demonstration of validity needed; often reflected through a panel of experts reviewing the instrument

When Existing Data Sources Are Unavailable—(cont.)

Reliability: Does the instrument measure the construct consistently every time it is used?

Cronbach’s alpha: A Cronbach’s alpha of .80 or greater usually indicates that an instrument should perform reliably each time that it is used

Levels of Data Measurement

Level of Measurement	Characteristics	Example
Nominal	Data sorted into categories; any numbers assigned to categories used only for labeling	Gender, presence or absence of a quality (e.g., disease)
Ordinal	Data can be ranked in order, but the absolute difference between each level is not equal	Likert scales

Levels of Data Measurement—(cont.)

Level of Measurement	Characteristics	Example
Interval	Numeric data with equal and consistent mathematical values separating each discrete measurement point, however, lacks an absolute zero	Fahrenheit temperature scale
Ratio	Same data characteristics as interval-level data, but also has an absolute zero value	Kelvin temperature scale

Reporting to Key Stakeholders

All parties involved with the process of practice change should have an opportunity to understand the results achieved
Two methods of presenting data in an understandable way are:
Scorecards
Dashboards

Reporting to Key Stakeholders: Scorecards

Reporting to Key Stakeholders: Dashboards

Why Would Quality Projects Need IRB Approval?

HIPAA regulations require IRB approval of all studies involving personal health information (PHI)

If it is possible that knowledge might be shared outside of the specific quality improvement initiative and institution (e.g., publication or presentation of strategies used and resultant outcomes), then IRB approval is required prior to initiation of the project

Question

A rating scale asks patients to rate their nausea by describing it as “no nausea,” “slight nausea,” “significant nausea,” or “severe nausea.” What is the highest level of data measurement that this scale provides?

Nominal
Ordinal
Interval
Ratio

Answer

b. Ordinal

Rationale: In Likert-type scales, data can be ranked in order, but the absolute difference between each level is not equal. It is not possible to calculate a mean or a standard deviation.

attachment

Melnyk_PPT_Chapter_09.ppt

Chapter 9

Implementing Evidence in Clinical Settings

Essential Elements Needed to Create an EBP Environment

(With permission from Hockenberry, M., Walden, M., Brown, T., & Barrera, P. (2007). Creating an evidence-based environment: One hospital’s journey. Journal of Nursing Care Quality, 22(3), 223.)

Why Create an EBP Clinical Environment?

- Regulatory initiatives and insurance-mandated outcomes
- National Strategy for Quality Improvement in Healthcare’s “triple aim”
- Magnet Recognition Program’s expectations that the nursing culture promotes superior performance through EBP

Essential Objectives for an EBP Vision

Objectives

Develop a mental framework

Establish a motivating image for change

Create specific goals

Gain administrative support

Establish a leadership team

Involve experts and EBP mentors in clinical practice

Strategies for an EBP Vision

Objectives	Strategies
Develop a mental framework	Develop a written summary of what you want to accomplish Brainstorm with colleagues regarding the environment you want to create
Establish a motivating image for change	Use creativity to capture attention of the clinical staff Take advantage of real clinical scenarios to stress the need for changes in practice
Create specific goals	Focus on short-term, attainable goals Establish only two or three goals at a time

Strategies for an EBP Vision—(cont.)

Objectives	Strategies
Gain administrative support	Create a presentation that reflects the need for transforming the culture into an EBP environment Seek administration support for the project to be identified as an organizational priority
Establish a leadership team	Identify key personnel with a passion for EBP Conduct small focus group meetings
Involve experts and mentors in clinical practice	Identify clinical experts and EBP mentors Engage clinical expert support

Question

Is the following statement true or false?

Implementation of EBP is the responsibility of graduate-prepared nurses and members of the nursing leadership.

Answer

False

Rationale: Implementation of EBP in the clinical setting is dependent on broad engagement and participation from all care providers at all levels, as well as leaders, administrators, and members of other disciplines.

Common Barriers to Implementing Evidence-Based Practice

Barriers	Rationale
Inadequate knowledge and skills	The best evidence-based policies are of no value when staff lack knowledge of how to implement them in practice
Weak beliefs about the value of EBP	Poor dissemination of the relationship between evidence-based practice and patient outcomes can result in weaker belief in the effectiveness and efficacy of EBP
Poor attitudes toward EBP	Negative attitudes about clinical research can make it difficult for staff to become engaged in EBP

Common Barriers to Implementing Evidence-Based Practice—(cont.)

Barriers	Rationale
Lack of EBP mentors	Findings from research have indicated that a lack of EBP mentors in the environment also can be a barrier to implementing EBP by point-of-care staff
Lack of support by leaders and clinicians	Knowledge, attitudes, and beliefs of mid-level and upper-level administrators and their perceived roles in communicating support for this change affect lower-level support

Common Barriers to Implementing Evidence-Based Practice—(cont.)

Barriers	Rationale
Economic restrictions	Lack of consideration that one type of cost may be readily offset with savings in time (i.e., workload), satisfaction, or the additional expense of patient complications

Objectives and Related Strategies to Develop Staff Engagement in EBP

Objective	Strategies
Engage staff and stakeholders in assessing and eliminating barriers	Engage stakeholders to identify educational content and strategies to learn about the practice change Seek information from staff about their attitudes toward the affected practice Involve influential staff and leaders in conducting discussions with colleagues

Objectives and Related Strategies to Develop Staff Engagement in EBP—(cont.)

Objective	Strategies
Prioritize clinical issues	Select clinical issues of direct interest and responsibility of clinician stakeholders Choose issues with solid empiric evidence to begin an organizational area’s EBP endeavors

Objectives and Related Strategies to Develop Staff Engagement in EBP—(cont.)

Objective	Strategies
Evaluate the infrastructure	Determine the individuals and committees who have decision-making authority Gain administrative support for adequate time and personnel for the initiative Enlist experts to lead EBP initiatives Ensure access to databases, search engines, and full-text articles

Objectives and Related Strategies to Develop Staff Engagement in EBP—(cont.)

Objective	Strategies
Develop experts in the evidence-based process	Utilize leaders within the organization or form an academic partnership to provide expertise in research, EBP design, and evaluation Provide formal classes and/or small-group sessions on finding and evaluating evidence Mentor staff in critically appraising research studies and formulating practice recommendations

Question

Which of these strategies below is the most effective strategy for engaging care providers in a proposed EBP change?

Disseminating the evidence that underlies the proposed change
Reminding staff of their obligation to provide optimal care
Bringing in EBP experts to speak to staff members
Creating dissatisfaction with current practice and outcomes. Evidence Based Practice into Clinical Practice

Answer

d. Creating dissatisfaction with current practice and outcomes

Rationale: If care providers are not satisfied with the status quo, then they will be open to evidence-based change. Other strategies, such as bringing in outsiders to teach, disseminating research findings, and telling caregivers that they are obliged to change, are less likely to engage them and foster genuine change.

Integration of EBP into the Clinical Environment

Objective	Strategies
Establish formal implementation teams	Enlist APNs and other expert staff as clinical team leaders
Build excitement	Create discomfort with the status quo Enlist local opinion leaders who can attest to the need for practice change Bring in outside speakers who have the potential to connect and inspire key stakeholders

Integration of EBP into the Clinical Environment—(cont.)

Objective	Strategies
Disseminate evidence	Utilize multifaceted strategies to overcome knowledge deficits, skill deficits, and skepticism Promote experience sharing to emphasize the need for change and positive outcomes of change Provide time to assimilate new practices

Integration of EBP into the Clinical Environment—(cont.)

Objective	Strategies
Develop clinical tools	Anticipate tools and processes that the staff will need to transform practice Revise patient care documentation records Ensure easy access to clinical resources Integrate alerts and reminders into workflow processes at the point of care Repeatedly expose the staff to evidence-based information

Integration of EBP into the Clinical Environment—(cont.)

Objective	Strategies
Pilot test	Choose pilot sites with consideration to unit leadership strength, patient population diversity, acuity, and geographic location Address the root causes of problems Decide to adopt, adapt, or abandon at the end of the pilot test
Preserve energy sources	Engage support personnel Implement smaller, more manageable projects Anticipate setbacks and have patience and persistence

Integration of EBP into the Clinical Environment—(cont.)

Objective	Strategies
Allow enough time	Develop incremental project steps Establish a timeline
Celebrate success	Acknowledge the staff instrumental in process Ensure recognition by supervisors and administration

Evaluating Outcomes of EBP Change

Area of Evaluation	Examples
Outcomes	Measures of death, disability, iatrogenic effects of treatment, health behaviors, economic impact of therapy, and illness management
Quality care improvement	Success of symptom management such as pain, fatigue, nausea and vomiting, sleep disturbance, and depression
Patient-centered quality care	Patient perception of healthcare providers’ effective communication, consideration of cultural and religious beliefs, respect, empathy, and caring attitude

Evaluating Outcomes of EBP Change— (cont.)

Area of Evaluation	Examples
Efficiency of processes	Timeliness of procedures, medication administration, diagnostic tests, transfer, and discharge
Environmental changes	Unit/department resource (equipment, supplies, and personnel) availability
Professional expertise	Knowledge and competency of staff

Question

When considering the six areas of EBP evaluation of the clinical environment, which of the following is considered an outcome measure?

Number of times that heart failure patients are discharged within the case management time parameter
Incidence of pressure ulcers
Number of discharged patients who are satisfied with their pain management
Average turnaround time needed for repair of inoperative intravenous pumps

Answer

c. Incidence of pressure ulcers

Rationale: Incidence of pressure ulcers is an iatrogenic effect of hospitalization. The number of times that heart failure patients are discharged within the case management time parameter is an example of the efficiency of processes. The number of discharged patients who are satisfied with their pain management is an example of patient-centered quality. The average turnaround time needed for repair of inoperative intravenous pumps is a measure of the availability of resources. Evidence Based Practice into Clinical Practice

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Evidence Based Practice into Clinical Practice

Evidence Based Practice into Clinical Practice

ORDER NOW FOR COMPREHENSIVE, PLAGIARISM-FREE PAPERS

Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.) Philadelphia, PA: Wolters Kluwer Health.

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