Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice, by Bernadette Mazurek Melnyk and Ellen Fineout-Overholt, Philadelphia, Pa: Lippincott Williams & Wilkins, Inc. 2004. 608 pages; CD ROM; softcover, $49.95.

The nurse of today is expected to be many things to all people. Nurses must demonstrate skill, critical thinking, and compassion; they need to identify actual and potential health problems, develop plans to prevent or ameliorate these problems, and finally, evaluate the outcomes of their care. All of this occurs in a fast-paced, rapidly changing environment that often permits little time for reflection. Out of this complex world comes the challenge to accomplish this with care that is based on valid, reliable scientific evidence-to move nursing toward evidence-based practice (EBP).

But how? Melnyk and Fineout-Overholt's recent book, Evidence-Based Practice in Nursing and Healthcare, provides practitioners at all levels with a foundation for understanding the steps of EBP, practical guidelines for implementing EBP, and exemplars that illustrate "real-life" applications of EBP. The book moves the reader through the arguments that support nurses' needs to provide care that is research based, citing studies that demonstrate the positive patient outcomes that result from well-designed studies of clinical care, through the first steps of implementing EBP, and then translating research into practice.

The units that discuss the critical appraisal, application, and dissemination of evidence are perhaps the most useful for nurses just beginning to think about and trying to implement EBP. They contain straightforward, easy-to-use guides for asking questions that guide the search for evidence as well as tools to evaluate the evidence one discovers. For a novice practitioner, a very clear discussion of databases, the type of data found in each, and directions on how to access them is offered. Equally important and useful are the chapters that outline the process of appraising available research evidence. The authors review the process for both quantitative and qualitative research and include brief discussions of reliability, validity, bias, applicability, and data analysis. Although these are all presented clearly and with examples, a novice practitioner will likely need more formal mentoring to actually put these concepts into practice. Experienced practitioners could skim through this section.

The authors also offer a clear discussion about the differences between models of research utilization and models of EBP. Both the conceptual differences and the differences in practitioner skill sets needed are discussed. The following models of EBP are discussed in varying degrees of detail: The Iowa Model, Rosswurm and Larrabee's model, Kitson's model, and The Advancing Research and Clinical practice through close Collaboration (ARCC) model. The discussion includes references to help the reader examine each in greater depth.

Also included in the book is a unit focused on creating the culture needed to implement EBP. The authors of these chapters provide very specific insight into teaching EBP, including curriculum guidance, and creating a vision that supports organizational change to EBP. Finally, the book provides readers with many case examples, including a PowerPoint presentation, of evidence-based approaches to specific clinical problems in a variety of populations and settings. These are found in the appendices and on the enclosed CD-ROM.

This book would be a valuable, much-used addition to both institutional and personal professional libraries. It is clearly written, easy to read, extremely well-referenced, and "sells" the reader on the premise that EBP can help nurses and other health care professionals make sizeable gains in the positive outcomes they achieve with their patients.