Medical Observation and Assessment
A general response to the question on the relationship between theory and objective observation would involve two aspects, viz. the impact of sensory experience and professional commitment to training and empirical evidence (Estany, 2001). In the healthcare practice, observation is often made in reference to a particular theory. Observational evidence must support empirical evidence for a particular course of action to be taken. In particular, evidence-based practice in healthcare often relies on theories, thus making it an observation and diagnosis theory-laden. It is apparent that the application of evidence-based practice in health care tends to encourage the application of theory in the assessment of patients and care delivery. This aspect seems to weaken perceptual experience and objectivity in practice as practitioners rely on established theories and principles to interpret clinical observations and assessments.
Moreover, medical professionals are required to practice within a set of professional norms and standards. The professional codes of ethics as well as evidence-based practice principles, which guide healthcare professionals, derive from empirical evidence and literature. Therefore, medical professionals are trained to make inferences of an observed case based on theoretical evidence and to practice within the realms of professional ethics. Therefore, arguably, perceptions in the medical practice are theory-laden for the rational acceptability of observations made by the professional is justified by theoretical principles (Estany, 2001). Even if the theoretical evidence does not corroborate the assessment or observations, often confirmation of observational evidence is sought from data or research. In contrast, observational evidence in healthcare settings is often not used to confirm a theory or a principle of professional practice. In this regard, a pure and objective practice may not be possible; hence, medical observations are theory-laden.
As a nurse in hospice settings, sometimes I find evidence-based theories contradictory to one another. This aspect happens when the explanations given by either theory seem to be incompatible as accepting one explanation excludes the other theory. Under these circumstances, observational evidence may be applicable in selecting the most applicable theory. However, given that medical practice is theory-laden, it is often difficult to obtain purely neutral observational evidence as most clinical assessments and observations have scientific underpinnings. Therefore, medical observations and assessments, by their very nature, cannot be neutral. As such, relying on observational evidence to select one theory over another cannot be considered a rational or an objective choice.
Evidence-Based Practice: Palliative Care
The nursing role in palliative care involves addressing patient needs including physical, social, spiritual, and psychological needs. Evidence-based practice is essential to guide palliative care, especially for terminally ill patients. Qaseem et al. (2008) provide a guideline, based on theoretical evidence, to support end-of-life care in hospice settings. They recommend that clinicians should conduct regular assessments of patients in their end of life stages. Vital signs to assess include pain, distress, and dyspnea (Qaseem et al., 2008). In addition, nurses should use drug therapies to manage patient pain, but the dosage should be based on the patient’s level of pain. Another evidence-based practice in palliative care involves the use of drug therapies such as opioids to manage dyspneic condition and oxygen to prevent hypoxemia in terminally ill patients (Qaseem et al., 2008). Clinicians should also use evidence-based therapies to manage distress in patients such as psychosocial therapy and the use of antidepressants. Advance planning and completion of care directives is recommended for patients with terminal illnesses.
Reference List
Estany, A. (2001). The thesis of theory-laden observation in the light of cognitive psychology. Philosophy of Science, 68, 203-217.
Qaseem, A., Snow, V., Shekelle, P., Casey, E., Cross, T., Owens, K. (2008). evidence- based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 148(2), 141-146.