The presence of love in ethical caring

Caring as a virtue and an act of ethics is from both a natural and a professional point of view inseparably related to love as a universal/ontological value. Love is shown, like suffering and death, to be a concept of universal or metacharacter. From current nursing/caring science as well as from ethical and philosophical perspectives, this paper explores how love can be visible in caring through virtue and that the art of caring creates its evidence. The ethical and existential practicing of love, particularly unselfish love, allows a caregiver to come distinctly closer to the essence of his or her own personality and to live in a more authentic manner. Obstacles and alienation in caregivers that induce a holding back of one's own natural impulses to give the suffering patient tender, dignified care are examined. Economy, paradigm, and caring culture are cited, but ultimately it is a question concerning every caregiver's decision and responsibility to come forward to serve those the caregiver is actually there to represent, the suffering patient. This does not always require new knowledge, rather, liberation of the inner life and authenticity in caregivers. Love, if viewed only as a phenomenon without connection to a universal or ontological philosophy, risks being a problematic concept for caring science. If, on the other hand, it is viewed as the ontological basis for caring and ethical acts, then we can look for and practice phenomenological expressions for love that can enhance the patient's understanding of life as well as giving relief from suffering.     

A systematic review of clinical supervision evaluation studies in nursing

According to the international, extant literature published during the last 20 years or so, clinical supervision (CS) in nursing is now a reasonably common phenomenon. Nevertheless, what appears to be noticeably ‘thin on the ground’ in this body of literature are empirical evaluations of CS, especially those pertaining to client outcomes. Accordingly, the authors undertook a systematic review of empirical evaluations of CS in nursing to determine the state of the science. Adopting the approach documented by Stroup et al. (JAMA, 283, 2000, 2008), the authors searched for reports of evaluation studies of CS in nursing – published during the years 1995 to 2015. Keywords for the search were ‘clinical supervision’, ‘evaluation’, ‘efficacy’, ‘nursing’, and combinations of these keywords. Electronic databases used were CINAHL, MEDLINE, PsychLIT, and the British Nursing Index. The research evidence from twenty‐eight (28) studies reviewed is presented, outlining the main findings with an overview of each study presented. The following broad themes were identified and are each discussed in the study: narrative/anecdotal accounts of positive outcomes for clinical supervision, narrative/anecdotal accounts of negative outcomes for clinical supervision, empirical positive outcomes reported by supervisee, and empirical findings showing no effect by supervisee.     

Cost and resource implications of clinical supervision in nursing: an Australian perspective

AIM: The aim of this article was to explore the resource and management issues in introducing and maintaining a clinical supervision programme for nurses. BACKGROUND: A number of federal, state and non-governmental agency reports have recently indicted the quality of present-day mental health service provision in Australia. Clinical supervision in nursing has been widely embraced in many parts of the developed world, as a positive contribution to the clinical governance agenda, but remains largely underdeveloped in Australia. METHOD: Using data derived from several empirical clinical supervision research studies conducted in mental health nursing settings, preliminary financial modelling has provided new information for Nurse Managers, about the material implications of implementing clinical supervision. FINDINGS AND CONCLUSIONS: It is suggested that, on average, the cost of giving peer group one-to-one supervision to any nurse represented about 1% of an annual salary. When interpreted as a vanishingly small cap on clinical nursing practice necessary to reap demonstrable benefits, it behoves Nurse Managers to comprehend clinical supervision as bona fide nursing work, not an activity which is separate from nursing work.     

Nursing students' perception of group supervision during clinical training

Aim. The aim of this study was to investigate nursing students’ perception of and satisfaction with clinical group supervision based on a special model, used in nursing training. Background. Long‐standing efforts have been made to create supervision models in nursing training that promote personal and professional development and prepare nursing students to cope with the complex and demanding situations they will face as registered nurses. Methods. Data were collected from nursing students (n = 43) during their clinical training by means of two questionnaires. Most questions were concerned with the importance of factors involved in the contract and the students’ experiences of how these factors were covered during the clinical group supervision. Findings. The findings showed that, before starting the supervision programme, most all the students expressed positive attitudes towards group supervision, but 25% had negative expectations as well. At the end of the programme all students thought that group supervision had been an important support to them during their training and almost everyone wanted to participate in group supervision in the future as registered nurses. The findings showed that both the structure and the climate were important for the success of the group supervision. Relevance to clinical practice. The findings will strengthen the model and confirm its usefulness in clinical training for nursing students. Using this supervision model, which includes reflection about feelings, thoughts and actions, the students will be well prepared for demanded situations in their future role as a registered nurse. A replication of this study addressed to trained nurses would be valuable.     

Student nurses' perception of independence of supervision during clinical nursing practice

The purposes of this longitudinal study were to examine Swedish student nurses' perceptions of independence and to explore to what extent the students had had opportunities to practise different tasks during clinical practice. Data were collected on weekly self-assessment forms during the first and final clinical courses of a 3-year nursing programme for 60 and the remaining 48 students, respectively. The majority of the students rated themselves as being independent of supervision to a great extent both at the beginning and throughout the clinical courses. Some students reported no or few opportunities to practise certain tasks during both courses. Factors that may have influenced the students' perception of independence are discussed, such as preparation before the clinical courses and the importance students gave to certain tasks. Clinical practice should be carefully planned and individualized to facilitat students' opportunities to practise different tasks.     

Nursing leadership from the perspective of clinical group supervision: a paradoxical practice

bondas t. (2010) Journal of Nursing Management 18, 477–486
Nursing leadership from the perspective of clinical group supervision: a paradoxical practice Aim Increase understanding of nursing leadership in group clinical supervision (CS). Background Leadership in CS has received little interest besides the theories in use and administrative CS. Method Hermeneutic interpretation of written narratives of 24 clinical nurse supervisors. Results Continuity in structuring, story and mission and reflection in group and leadership processes and theories of nursing and caring characterize leadership in CS. Leadership by inhibiting and creating fear, inapproachability and indistinctiveness were patterns in content brought to CS. Supervision when leadership was involved illuminated a reflexive change in focus from leadership to nursing care, from particular experiences to nursing and caring science, and from the unfamiliar to the well known and the well known to the unknown. Conclusions Continuity and reflective changes using nursing and caring theories seem to be core ideas of nursing leadership from the perspective of CS. The poles of separation and communion show opposites of nursing leadership as it is illuminated in CS. The findings add knowledge to Bondas’ theory of caritative leadership. Implications for nursing management CS is a reflexive practice of support and guidance that seems to have an impact on the trajectory of nursing care and staff development using nursing and caring theories.     

A study on how mental health practitioners address ethical issues in clinical audit

Although much debate has taken place within the literature on the differences between research and clinical audit, the ethical dimensions of audit have frequently been neglected. Furthermore, no research has of yet explored what ethical issues auditors consider in relation to their projects or how they manage them in practice. Using data collected from audit documentation, semi-structured interviews and a researcher-administered questionnaire, this study sought to advance this position by exploring how 14 clinicians undertook audits in one mental health Trust addressed the ethical dimensions of their project. Analysis of the data revealed that the Trust had no formal mechanisms for reviewing and monitoring audit projects whilst other informal mechanisms were not utilized by all auditors. A number of projects had contact with both clinicians and service users through interviews, focus groups and questionnaires; however, issues such as informed consent, confidentiality and anonymity were not adequately addressed by auditors. The implications of these findings are discussed and recommendations for practice outlined.     

Clinical supervision

• ? The introduction of clinical supervision to a wider sphere of nursing is being considered from a professional and organizational point of view.
• ? Positive views are being expressed about adopting this concept, although there are indications to suggest that there are also strong reservations.
• ? This paper examines the potential for its success amidst the scepticism that exists.
• ? One important question raised is whether clinical supervision will replace or run alongside other support systems.

     

A discussion of the ethics of clinical guidelines

Clinical guidelines are an increasingly common part of medical practice. The desire to standardize practices may seem a noble one, but overzealous application can make guidelines seem restrictive, leading to resentment or, worse, disregard. This conception of guidelines as unbreakable rules can lead to comparisons with deontological duties. Or where guidelines restrict access to services, utilitarianism might seem a better fit. Here, clinical practice guidelines are examined in terms of these theories of normative ethics, and it is argued that in fact, the process of writing and implementing guidelines is more accurately modelled through the lens of virtue ethics.     

How not to do clinical supervision in nursing

The widespread nursing interpretation of clinical supervision following the accepted definitions of Butterworth and Faugier, elides refinement of boundaries between personal and professional development and growth. In so doing, nursing interpretation confuses the differences between two similar processes and ultimately distorts the purpose of clinical supervision. In nursing supervision, the patient can become lost, thus perpetuating the avoidance of anxiety in intimate therapeutic work, originally described by Menzies in 1959. While a tension naturally exists between the two processes, this paper demonstrates the utter importance of working within the tension of boundaries that define the triadic situation of supervisor, supervisee and patient. When supervision is accepted as personal development, the triadic situation may deteriorate into a dyadic one between supervisor and supervisee only, significantly altering the relationship to the point where the supervisee becomes a patient. Parallel process, ordinarily reflecting the therapeutic nurse-patient relationship in the supervisory one, may then become merely a process running parallel to the supervisee, while utilizing the patient as a source of material for personal growth. This paper demonstrates through Faugier's casework material the necessity of defining boundaries and the difficulties associated in maintaining them, rather than prosaically declaring that 'supervision is not therapy'.     

Group supervision for nursing students during their clinical placements: its content and meaning

holmlund k., lindgren b. &athlin e. (2010) Journal of Nursing Management  18, 678–688
Group supervision for nursing students during their clinical placements: its content and meaning Aim To explore what situations students focus on during group supervision sessions, and what this supervision meant to nursing students during their clinical placements. Background Knowledge about clinical supervision of nursing students in groups is scarce concerning what situations the students bring to the sessions. Method Open-ended questionnaires were filled out by students after each session. Qualitative content analysis was performed. Results The content evolved as: being a nursing student, encountering demanding situations and becoming a nurse. The meaning of group supervision was captured in the categories: ‘satisfaction of being together in the supervision group’, ‘new understanding and insights’ and ‘hesitation and discomfort’. A change of pattern was found over time showing a development among the students from a self-centred focus to a profession-centred focus. Conclusion The value of group supervision as a tool to support nursing students’ personal and professional development was emphasized. The students’ great need for and lack of support in ‘bed-side nursing’ was obvious. Implications for nursing management Our findings would be valuable for nurse managers when striving for a good learning environment in clinical placements, as well as for nursing teachers, in their supportive role to both students and preceptors.     

Nurse supervisors' actions in relation to their decision-making style and ethical approach to clinical supervision

AIM: The aim of the study was to explore the decision-making style and ethical approach of nurse supervisors by focusing on their priorities and interventions in the supervision process. BACKGROUND: Clinical supervision promotes ethical awareness and behaviour in the nursing profession. METHODS: A focus group comprised of four clinical nurse supervisors with considerable experience was studied using qualitative hermeneutic content analysis. FINDINGS: The essence of the nurse supervisors' decision-making style is deliberations and priorities. The nurse supervisors' willingness, preparedness, knowledge and awareness constitute and form their way of creating a relationship. The nurse supervisors' ethical approach focused on patient situations and ethical principles. The core components of nursing supervision interventions, as demonstrated in supervision sessions, are: guilt, reconciliation, integrity, responsibility, conscience and challenge. The nurse supervisors' interventions involved sharing knowledge and values with the supervisees and recognizing them as nurses and human beings. CONCLUSION: Nurse supervisors frequently reflected upon the ethical principle of autonomy and the concept and substance of integrity. The nurse supervisors used an ethical approach that focused on caring situations in order to enhance the provision of patient care. They acted as role models, shared nursing knowledge and ethical codes, and focused on patient related situations. This type of decision-making can strengthen the supervisees' professional identity. The clinical nurse supervisors in the study were experienced and used evaluation decisions as their form of clinical decision-making activity. The findings underline the need for further research and greater knowledge in order to improve the understanding of the ethical approach to supervision.     

The supervision of Project 2000 students in the clinical setting: issues and implications for practitioners

• ? The aim of this 2-year study funded by the English National Board for Nursing, Midwifery and Health Visiting was to examine the relationship between teaching, support, supervision and role modelling in student clinical learning within the context of Project 2000 courses.
• ? The research, using a two-stage case-study design, employing predominantly qualitative methods of data collection, investigated the perceptions of students, tutors and practitioners of their experiences of these processes in the clinical setting.
• ? This paper focuses on the findings obtained from the practitioner data, highlighting not only the significant role played by practitioners in facilitating student learning, but also the implications for practitioners in undertaking this role.
• ? The preparation required for supervising clinical learning, the integration of theory and practice and the organization of patient care have been identified as particularly important to the development of effective clinical learning environments.

     

Expert supervisors' views of clinical supervision: a study of factors promoting and inhibiting the achievements of multiprofessional team supervision

BACKGROUND: Only a few studies are available of team supervision and its challenges to supervisors. A multiprofessional team supervision project was accomplished in 1995-1998 in one university hospital in Finland. Eighty-two practitioners from five wards participated in the project and 10 experienced supervisors implemented their team supervision. AIM: The aim of this qualitative study is to describe the experiences of five supervisor pairs (n=10) of multiprofessional team supervision. METHODS: Data were collected by semi-structured interviews from the supervisor pairs. The interviewing style was open and followed that of a guided conversation between supervisors and researcher. Interview data were analysed using thematic content analysis. FINDINGS: The factors that influenced team supervision were as follows: advanced knowledge of supervision and confidence in supervisors, commitment and motivation, interaction and collaborative relationships and the arrangements of team supervision. The positive effects of team supervision as identified by the supervisors were as follows: influence on interaction and human relationships in the work community, supervisees' strengthened professional identity and the development of multiprofessional practice. CONCLUSIONS: Several factors can promote or inhibit the achievements of team supervision. Regardless of all the difficulties related to team supervision, its effects on a work community are positive. For the supervisors, team supervision is a demanding and challenging but also a rewarding process.     

Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery

Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery Cognitive therapy has an undisputed evidence base upon which its clinical application flourishes. This approach is now a well-recognized and widely adopted method used in the treatment of a diversity of psychological problems. More recently, prominent innovators of this psychotherapy have devised a framework to guide the clinical supervision of cognitive therapists. In keeping with its therapeutic application, the cognitive therapy framework for supervision is focused, structured, educational and collaborative. It serves to enhance the therapeutic proficiency of the cognitive therapist. In contrast, the supervision models reported in the recent nursing literature are less precise in their mission and when evaluated their contribution to nursing is shown to be dubious. Following an overview of the supervision models commonly cited in the nursing literature, a more focused comment on the evaluative research concerning Proctor's three-function interactive model will be offered. It is suggested that the unconvincing research findings may be related to the conceptual muddle surrounding clinical supervision, and the expectation for clinical supervision to deliver more than an opportunity for the progression of our therapeutic integrity. From this, a cognitive therapy supervision framework is described and suggested by the authors as a structure from which supervisors can guide discovery.     

Reflections on the role of the nursing development facilitator in clinical supervision and reflective practice

The notions of clinical supervision and reflective practice are attracting considerable interest across the spectrum of nursing. This paper focuses upon how the two were linked together and, with the support of an independent survey, were used to evaluate the nursing development facilitator role. It is argued that reflective practice, as a model of clinical supervision, may provide a forum for nurses to explore the value of their actions. Linked to this, the personal knowledge that is revealed may mirror reality and as a result it is argued that there is benefit in evaluating practice through reflection.     

Model for investigating the benefits of clinical supervision in psychiatric nursing: a survey study

The objective of this study was to test a model for analysing the possible benefits of clinical supervision. The model suggested a pathway from participation to effectiveness to benefits of clinical supervision, and included possible influences of individual and workplace factors. The study sample was 136 nursing staff members in permanent employment on nine general psychiatric wards and at four community mental health centres at a Danish psychiatric university hospital. Data were collected by means of a set of questionnaires. Participation in clinical supervision was associated with the effectiveness of clinical supervision, as measured by the Manchester Clinical Supervision Scale (MCSS). Furthermore, MCSS scores were associated with benefits, such as increased job satisfaction, vitality, rational coping and less stress, emotional exhaustion, and depersonalization. Multivariate analyses indicated that certain individual and workplace factors were related to subscales of the MCSS, as well as some of the benefits. The study supported the suggested model, but methodological limitations apply.