Infusing Evidence Into Observations:
Evidence-Based Observations in
Speech-Language Pathology
Mary Pannbacker
Louisiana State University Health Sciences Center, Shreveport
E
vidence-based practice refers to an approach in
which current, high-quality research evidence
is integrated with clinical experience and client
preference when making clinical decisions about diagnosis
and treatment (American Speech-Language-Hearing Association [ASHA], 2004). Observation is a valuable and
crucial component of clinical practice and can be made in a
variety of settings. Typically, the observer is a passive participant, that is, he or she observes without becoming part
ABSTRACT: Purpose: The purpose of this article is to
apply the principles of evidence-based practice to clinical observation; that is, the highest level of evidence for
making decisions about these observations. In addition, a
format for reporting and evaluating evidence-based observations (EBOs) is described.
Method: Literature relevant to EBOs was reviewed.
Results: A framework for reporting and evaluating EBOs
was developed, and specific evaluation criteria were
identified. The steps identified were the application of
EBOs to clinical training and practice, and reporting
and evaluating EBOs. Forms for reporting and evaluating
observations are provided.
Conclusion: Speech-language pathologists should apply
the highest level of evidence to make clinical decisions,
although there is a gap between the use of research and
clinical practice. EBOs should in part reduce this gap.
This information may also be useful to other health care
professionals.
KEY WORDS: evidence based, observations, speechlanguage pathology
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of the process (McMillan, 2004). Training can often improve
the accuracy of observations and ensure that observations
are reliable, or that events are interpreted in the same way
(Lum, 2002).
Observation is an important aspect of clinical training
in speech-language pathology. According to Cornett and
Chabon (1988), observation is an extremely valuable clinical strategy. Nation and Aram (1984) believed that every
activity that occurs in assessment and treatment is a source
of data to be observed, and that “no source of information
should go unobserved or be wasted” (p. 158). The purpose
of this article is to provide a rationale for evidence-based
observations (EBOs) and a format for reporting and evaluating these observations.
What Is the Importance of
Infusing Evidence Into Observations?
Speech-language pathologists are increasingly being held
responsible for (a) obtaining evidence that supports clinical decisions (Finn, Bothe, & Bramlett, 2005); (b) applying
the best available research evidence to clinical observations;
(c) teaching the skills necessary to integrate evidence and
clinical observation; and (d) meeting ASHA’s standards for
the Certificate of Clinical Competence in Speech-Language
Pathology (2005). These standards include items such as
“the applicant must demonstrate knowledge of processes
used in research and the integration of research principles
into evidence based clinical practice” (Standard III, F) and
“twenty-five hours must be completed in clinical observation” (Standard V, C).
Infusing
Evidence Into Observations
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adjectives would have a score ranging from 10 (lowest) to
50 (highest). This score can be converted to a percentage
for grading.
How Can EBOs be Reported?
Figure 1 is a sample EBO report form that can be used
to synthesize information about observations and credible
research. The form incorporates observations with evidence
from published research or clinical practice guidelines.
The form may need to be modified depending on the
observation (client vs. facility). It should also be noted that
confidentiality of client information must be maintained.
The ASHA (2003) Code of Ethics Principle 1, Rule L,
states that “individuals shall not reveal, without authorization any professional or personal information about identified persons served professionally” (p. 2).
Summary and Conclusion
The application of evidence-based practice to clinical
observation serves to reduce the gap between research and
clinical practice and facilitates clinical decision making.
Speech-language pathologists should know about the reasons for and use of EBOs. Furthermore, EBOs should be an
integral part of clinical training.
How Can Reports of EBOs be Evaluated?
REFERENCES
EBOs can be evaluated using a Likert-type scale based on
factors shown in Figure 2 and Table 1. Another approach to
evaluating these reports is the application of semantic differentials. This involves adjective pairs representing factors
associated with EBOs. Figure 3 provides an example of 10
semantic differentials that can be used to evaluate EBOs.
In scoring the semantic differentials, each item (adjective pair) counts from 1 to 5 for the total score. The most
positive response is 5, and the most negative is 1. Therefore, the total semantic differential consisting of 10 pairs of
American Speech-Language-Hearing Association. (2003). Code
of ethics. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2004). Evidence-based practice in communication disorders: An introduction. Retrieved from www.asha.org/members/deskref-journals/
deskref/default.
American Speech-Language-Hearing Association. (2005).
Standards and implementation procedures for the Certificate of
Clinical Competence in speech-language pathology. Rockville,
MD: Author.
Figure 1. Example of an evidence-based observation form.
Evidence-Bas
__
Observer: __
________
__________
School
Facility:
Hospital
ion
ed Observat
____
Date: ______
__________
hab
Outpatient Re
__________
y): ________
Other (specif
__________
_
e
Nursing Hom
__________
____
ory:
Relevant Hist
n:
e observatio
Purpose of th
Observation:
observation:
references to
Application of
References:
Questions:
1.
2.
3.
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Figure 2. Example of an evidenced-based observation scoring form.
se
Evidenced-Ba
n
d Observatio
Rating Scale
y
e acceptabilit
represents th
ber that best
m
nu
e
th
ct
Sele
report.
Good
Fair
Poor
3
2
Unacceptable
1
0
ation
of this observ
Excellent
4
that apply)
Justification
g (check all
ons for ratin
as
_____
re
te
ca
di
In
__________
__________
__________
__
__
__
__
________
Vague ____
formation
Incomplete in
nfidentiality
Breach of co
zation
Weak organi
rences
fe
re
t
Irrelevan
ce (opinion)
rvation
Weak eviden
nces to obse
tion of refere
ica
pl
ap
or
Po
estions
/unrelated qu
observation
Inappropriate
ferences to
re
n
tio
ica
pl
Poor ap
rencing
Incorrect refe
low)
g is 3 or be
mment if ratin
co
t
us
(m
ts
Commen
Table 1. Factors for evaluating evidence-based observations.
Client characteristics
Age
Severity
Nature of speech-language disorder
Etiology
Prognosis
Relevant history
Confidentiality
Observation
Purpose
Integration of references
Focused
Professional
Writing style
Organization
Content
References
Questions
High-level evidence
Relevant to observation & references
Peer reviewed
Application of appropriate reference(s)
References follow APA format
Pannbacker: Infusing Evidence Into Observations
151
Figure 3. Semantic differentials for evaluating evidence-based observation reports.
Observation
Report
e
represents th
pair that best
ch adjective
ea
of
e
ac
tween the sp
Check (^) be
report.
n
io
at
rv
Complete
se
ob
5
4
3
High evidence
2
–
1
–
–
Professional
–
Incomplete
–
–
–
–
Maintained
–
Low evidence
–
–
–
l
na
–
sio
confidentiality
es
of
pr
–
Un
–
n
ai
nt
ai
m
to
Organized
Failed
–
–
–
confidentiality
Concise
–
–
–
–
–
Accurate
–
Unorganized
–
–
–
–
Focused
–
Verbose
–
–
–
–
Integrated
–
Inaccurate
–
–
–
–
APA correct
–
Unfocused
–
–
–
ation
gr
–
te
in
of
ck
–
La
–
APA errors
%
r ____/50 =
Total numbe
Cornett, B. S., & Chabon, S. S. (1988). The clinical practice of
speech language pathology. Columbus, OH: Merrill.
McMillan, S. H. (2004). Educational research. Boston, MA:
Pearson.
Finn, P., Bothe, A. K., & Bramlett, R. E. (2005). Science and
pseudoscience in communication disorders: Criteria and application. American Journal of Speech-Language Pathology, 14,
172–186.
Nation, J. N., & Aram, D. M. (1984). Diagnosis in speech language disorders. San Diego, CA: College Hill.
Lum, C. (2002). Scientific thinking in speech and language
therapy. Mahwah, NJ: Erlbaum.
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Contact author: Mary Pannbacker, Speech-Language Pathology
Program, Louisiana State University Health Sciences Center, 3735
Blair Street, Shreveport, LA 71103. E-mail: [email protected].
DISORDERS • Volume 37 • 149–152 • Fall 2010