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.

     

Evaluating the efficacy of reflective practice within the context of clinical supervision

This paper explores the efficacy of reflective practice within the context of clinical supervision. It examines some potential limitations that reflective practice has within the context of clinical supervision drawing upon the literature and the early stages of the author's empirical work. It concludes that whilst there is considerable congruence in the use of reflective practice within clinical supervision sessions, there are potential disadvantages in making the assumption that reflective practice should be an integral part of all forms of clinical supervision.     

Clinical supervision: outsider reports of a research-driven implementation programme in Queensland,Australia

white e. & winstanley j. (2010) Journal of Nursing Management  18 , 689–696
Clinical supervision: outsider reports of a research-driven implementation programme in Queensland, Australia Aim The aim of the present study was to explore substantive issues related to the implementation of Clinical Supervision (CS). Background Historically, the treatment of mental illness in Australia has been inadequate. CS has shown promise as a positive contribution to the clinical governance agenda, as a structured staff support mechanism. Evaluation Within the wider context of a randomized controlled trial (RCT) of CS, semi-structured interviews (n = 17) were conducted with staff who worked alongside colleagues that attempted to implement CS. Key issues Senior managers embraced CS and were disappointed when junior managerial colleagues did not hold a similar conviction, when tested by the realities of CS implementation. If CS was regarded as an additional activity, it stretched human resources and created inter-staff tensions. Conclusions The personal testimony of these ‘outsiders’ spoke about the practicalities of implementing CS and the prevailing culture into which they were introduced. When perceived as a tour de force for culture change, CS was polarized as an opportunity by many, but also as a threat by some. Implications for nursing management A single, cohesive and explicit management position on CS in each Health Service entity may obviate some of the impediments to CS implementation.     

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.     

Clinical supervision and managerial supervision: some historical and conceptual considerations

The current lack of consensus among authors in the United Kingdom on the concept of clinical supervision continues unabated, although enthusiasm for its implementation is being questioned by those who would be supervised. The literature now reports confusion among practitioners on the differences between clinical and managerial supervision, and supervision and therapy. This paper addresses the differences between clinical and managerial supervision by revealing nursing's history of clinical supervision. It is argued that until the current underlying conceptual ambiguities are identified and corrected, clinical supervision remains at risk of deteriorating into managerial supervision.     

Clinical supervision in the emergency department: a critical incident study

Objectives

To identify the key features of effective clinical supervision in the emergency department (ED) from the perspectives of enthusiastic consultants and specialist registrars. To highlight the importance of clinical supervision within emergency medicine, and identify obstructions to its occurrence in everyday practice.

Methods

A critical incident study was undertaken consisting of structured interviews, conducted by telephone or in person, with 18 consultants and higher level trainees selected for their interest in supervision.

Results

Direct clinical supervision of key practical skills and patient management steps was considered to be of paramount importance in providing quality patient care and significantly enhancing professional confidence. The adequacy of supervision varied depending upon patient presentation. Trainees were concerned with the competence and skills of their supervisor; consultants were concerned with wider systemic constraints upon the provision of adequate supervision to juniors.

Conclusions

The value of supervision extends to all patient presentations in the ED. The study raised questions concerning the appropriate attitudes and qualifications for supervisors. Protected supervisory time for those with trainees is mandatory, and must be incorporated within ED consultant job planning.     

An evaluation of a local clinical supervision scheme for practice nurses

This paper presents the findings of an evaluation of a local clinical supervision scheme for practice nurses in Leicestershire, UK. A baseline and a follow-up postal questionnaire were sent to all practice nurses (including supervisors) and general practice senior partners to find out how far the objectives of the local scheme had been met during the first year of implementation. Two focus groups gathered qualitative data about the process of implementation. Twelve months after implementation 12% of practice nurses and over two thirds of GPs reported that they were unaware of the scheme. Forty-three percent of practice nurses did not know who their local supervisor was; most reported that they would like to have known. Eighteen percent of practice nurses reported uptake of supervision through the local scheme. The benefits of involvement were professional development tailored to individual learning needs and regular opportunities to share work-related problems with peers; about a third reported benefits for the practice as well. The existing availability of peer support and time needed to undertake clinical supervision were common reasons given for non-involvement in the scheme. Misconceptions about the purpose of clinical supervision presented further obstacles. At follow-up over half of the practice nurses remained undecided about their future involvement in the scheme. If the benefits associated with clinical supervision are to be realized, the obstacles that currrently hinder practice nurses' involvement need addressing.     

Clinical supervision as an emancipatory process: avoiding inappropriate intent

As clinical supervision becomes more widely implemented in the United Kingdom with concerns and resistances being eroded as practitioners discover its benefits, it is important that potential limitations and perhaps failures are avoided. This paper utilizes Johns' (1996) intent-emphasis axis to explore how a technical interest, misunderstanding of expert practice, and confusion of self awareness with counselling, can detract from the supervisory process. Several of the criticisms of reflective practice will be examined to demonstrate where concerns are valid and where they may be based on misunderstandings and the need to control clinical supervision. Greater awareness of inappropriate emphasis and intent should enable even relatively inexperienced supervisors to help their supervisees move towards independence, emancipation and evolving expertise.     

Clinical supervision for nurses in administrative and leadership positions: a systematic literature review of the studies focusing on administrative clinical supervision

AIM: The aim of this systematic literature review was to describe administrative clinical supervision from the nursing leaders', directors' and administrators' perspective. BACKGROUND: Administrative clinical supervision is a timely and important topic as organizational structures in health care and nursing leadership are changing in addition to the increasing number of complex challenges present in health care. METHODS: The material in this review was drawn from national and international databases including doctoral dissertations, distinguished thesis and peer-reviewed articles. The material was analysed by means of content analysis. The theoretical framework for the analysis was based on the three main functions of clinical supervision: administrative, educational and supportive. FINDINGS: The findings demonstrated that the experiences of the administrative clinical supervision and its supportiveness were varying. The intervention was seen to provide versatility of learning experiences and support in challenging work experiences. Administrative clinical supervision effects and assures the quality of care. The effects as a means of development were explained through its resemblance to a leading specialist community. CONCLUSIONS: The findings support earlier perceptions concerning the importance and significance of administrative clinical supervision for nursing managers and administrators. However, more research is needed to develop administrative clinical supervision and to increase understanding of theoretical assumptions and relationships of the concepts on the background.     

Clinical supervision revisited

AIM: The paper is a means to signpost the hazards of clinical supervision (or supervision) as it is currently understood and enacted. BACKGROUND: The interpretation or understanding given to clinical supervision by professional groups is based on several factors namely origin/history, dynamic changes, relevance in the concept, language used and the meaning attached to this language. EVALUATION: In this paper we take a position that clinical supervision is not a thing or a homogenous entity. We describe it as a 'multi-meaninged' phenomenon defined through the context of its use. KEY ISSUES: Who uses it and in what circumstances leads to different versions of clinical supervision with different enactments and functions. Practitioners and managers do not necessarily recognize this state of affairs. CONCLUSIONS: We make some suggestions for more complex versions that may be suitable as the profession develops.     

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities This paper provides a discussion of some of the professional and policy outcomes associated with implementing clinical supervision within a community service for adults with learning disabilities. It is based upon a small qualitative study whose aim was to examine how clinical supervision was operating, its strengths, its weaknesses and where improvements might be made. The study followed the introduction of clinical supervision 9 months earlier for nurses and carers employed in three community homes and one community multiprofessional team. The method consisted of direct observation of individual and group supervision and staff completing critical incident questionnaires, followed by semi-structured, audio-taped interviews with seven registered nurses and four community team members, including a social worker, psychologist and physiotherapist. Outcomes were expressed in two ways: in terms of the benefits of clinical supervision or of its ambivalence. The range of matters brought for discussion, or resolution, in supervision reflected some of the difficulties or dilemmas staff faced working in this area, for example promoting empowerment and assisting clients to make choices, and dealing with clients' challenging and inappropriate behaviours. As for the role of supervisor there was some evidence of nurses expressing apprehension or unpreparedness, also a perceived general concern over the relatively low status of clinical supervision, thought to be due to absence of visible management approval or failure to articulate properly the objective of supervision. A limitation of the study was its small subject sample although considerable data were gathered in each of the units through relatively long-term contact.     

Clinical supervision using video-conferencing technology: a reflective account

This paper discusses three nursing practitioners' experiences of clinical supervision using video-conferencing (VC) technology. The study, based on supportive action research, involved 40 practising community and hospital nurses from a variety of specialties and took place over an 18-month period. The research was collaborative, educational and applied and focused on the effects of remote clinical supervision on the development of professional practice. Data were obtained through pre- and post-study questionnaires, repertory grids, focus group interviews and written narratives. The three research participants found that clinical supervision, as a mediator of learning, was vital in enabling them to develop their reflective and problem-solving skills. Through critical conversations with either a supervisor or within peer group supervision, the participants increased both their confidence and self-awareness and gained more insight into the practices and needs of other practitioners. They also examined critically patient care issues resulting in attention to existing or the development of new care protocols. They did, however, experience some impediments to the process of clinical supervision, mainly lack of peer and management support and ongoing education. The participants had mixed perceptions with regards to using VC technology for clinical supervision. They experienced technical and accessibility problems and communication problems, suggesting the need for clear protocols for both technical support and applied training.     

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.     

The problem of workforce for the social world of Australian rural nurses: a collective action frame analysis

AIM AND BACKGROUND: Globally, nursing workforce shortages are a hot topic for discussion among politicians, academics and clinicians. This paper uses collective action framing to analyse the literature about the problem of workforce for Australian rural nurses. EVALUATION: As part of a larger constructivist grounded theory study, we utilize collective action framing to bridge social world mapping and the literature. Data sources included journal databases, newspapers, newsletters and websites. We limited the years searched from 2000 to 2005. This analytical heuristic categorizes text into three main categories: diagnoses of a problem, postulations of solutions and actions to motivate change. KEY ISSUES: Having mapped the social world of Australian rural nurses as comprising four groups of collective actors - community, advocates, academics and government - we trace the texts that they have produced with a focus on mentoring as a potential solution to the problem of workforce. CONCLUSIONS: Mentoring entered the literature about the problem of workforce for Australian rural nurses because of a combination of political and academic will. These collective groups are now changing how they are framing the problem of workforce to focus instead on the globalization of nursing workforce shortages, which is resulting in diminished support for mentoring activities in clinical practice.     

Clinical supervision as a model for clinical leadership

Clinical leadership and clinical supervision are topical areas of nursing development. A project was established to facilitate the growth of leadership ability with a group of ward sisters through individual clinical supervision. The work revealed that ward managers struggled to fulfil their leadership roles largely because of embodied ways of relating within a prevailing organizational culture that constrained them. The paper also reflects on the impact of supervision to develop leadership practice.     

The effectiveness of a group approach to clinical supervision in reducing stress: a review of the literature

There is little research evidence to suggest that clinical supervision reduces stress. However, this probably does not mean that clinical supervision is not valuable, just that the evidence is not yet there, because consensus exists that group clinical supervision may be beneficial in reducing stress in nurses. The work by Butterworth et al. is the only directly relevant study investigating the stress-reducing potential that a group approach to clinical supervision has, and this work establishes ground rules for future evaluation.     

Experiential learning: issues for supervision

This paper reports on an evaluation of work-based learning within a postregistration community health nursing degree programme. Work-based learning is primarily concerned with the process of learning and with encouraging the individual to be explicit about how and what they learn so that their experiential learning may be assessed and accredited. The methodology of Illuminative Evaluation was adopted, with case studies (n=6) used as the means of exploring in depth the different perspectives of the major stakeholders (that is, the students, their workplace supervisors and their academic supervisors). The data comprised documentation, participant and nonparticipant observation, interviews and focus groups. The initial aim was to examine the potential benefits of work-based learning to students and to describe its impact on their practice. However, what emerged through the course of inquiry was a gap between the educational philosophy of work-based learning and the way in which work-based learning was delivered within the department concerned. Work-based learning provides educators with an opportunity to debate openly fundamental issues about the nature of educational practice; in particular, about the role of the supervisor in facilitating students' learning. As the evaluation highlights, if this debate does not occur, existing educational practice remains unchanged and the potential benefits to students of this new educational philosophy are not realized. Furthermore, it is by engaging in a reflective process in relation to their own experience that educators can begin to understand how to facilitate that process in others.     

The process, logistics and challenges of implementing clinical supervision in a generalist tertiary referral hospital

Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses.