Ecological Validity of Evidence-Based Practice in the Philippines

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RUNNING HEAD: Ecological Validity of EBP in the Philippines

Ecological Validity of Evidence-Based Practice in the Philippines Maria Carmela L. Domocmat

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Introduction Evidence-based practice (EBP) has been observed in developed countries since the 90’s. Two decades had past and it is barely being established in the Philippine health care system. The purpose of this paper is to define EBP or evidence-based nursing (EBN) and explore its ecological validity in a developing country such as the Philippines.

Evidence-based Practice Defined The most popular definition of evidence-based practice is provided by Sackett, Rosenberg, Muir Gray, Haynes, and Richardson (1996). They describe EBP as the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. On the other hand, Muir Gray (1997) simply defines it “doing the right things right”. He emphasizes efficiency, quality care, and beneficence. The American Psychological Association (2006, p. 4) describe EBP as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences." Additionally, Melnyk and Overholt (2010, p. 90) describes evidence-based practice in the context of nursing as “a paradigm and life-long problem solving approach to clinical decisionmaking that involves the conscientious use of the best available evidence …with one’s own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities, and system.” Finally, Borromeo (2012) states that evidence-based practice is a “science-to-service model of engagement of critical thinking to apply research-based evidence and practice-based evidence within the context of patient values to deliver quality, costsensitive care.

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Among the definitions mentioned above, I prefer the last one provided by Borromeo. Since it offers the most extensive description of the concepts enclosed in evidence-based practice. Sackett, et al and Muir Gray emphasize on the critical evaluation of best evidences but fails to incorporate the importance of patient autonomy (i.e., the focus of care is on the health care provider). Both the APA and Melnyk and Overholt’s definition consider the patient’s uniqueness. However, the latter’s description had broaden the range of care from individual patient care to groups, communities, and even the system which a person belong to. This encloses an important aspect of patient care for the reason that nurses do not just care for individual patient but also the significant others in the patient’s life. Especially in the Philippines wherein the “family is considered the highest value in the Filipino culture” (Tan Alora, 2004 p.72). However, all these four definitions lack one important aspect as EBP applies in the Philippine context of health care system. This deficiency is incorporated in the last definition given by Borromeo (2012) which is the consideration of the available resources. Since in the Philippines, for the most part, the available resources in the hospital or the client’s own resources (i.e., financial constraint) dictate the “quality” of patient care in lieu of patient preference, best evidence available, and nursing expertise.

The Feasibility of EBN in the Philippines Can evidence-based nursing be a realistic concept in the Philippine health care system? Before answering this query, the possible hurdles and facilitators in the application of EBN will be scrutinized first.

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Barriers in the implementation of EBN Some fundamental questions regarding EBN and Filipino nurses include: What are the knowledge, attitude and skills of nurses towards EBN? Do Filipino nurses have the necessary skills and competency both in conducting research and...
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