Clinical supervision UK style: good for nurses and nursing?

British nursing has presented a particular view of clinical supervision and has made its availability an essential requirement for all nurses in the United Kingdom (UK). Through a plethora of literature, this view of clinical supervision has become widespread, as has the notion that it is good for nurses and nursing. In this paper, utilising a Foucauldian approach to discourse, power-knowledge and clinical gaze, I radically interrogate this seemingly unproblematic conceptualisation of clinical supervision and its rising popularity and influence.     

Clinical group supervision in an intensive care unit: a space for relief,and for sharing emotions and experiences of care

Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.     

The role of the nurse providing therapeutic care for the suicidal patient

In this study, nurses perceived that the implementation of special supervision is the most effective preventive method in the nursing care of suicidal patients, but they also expressed the view that special supervision is non-therapeutic The results of these findings show that it is possible to provide nursing care in the prevention of further harm to the patient but that nurses may not necessarily be proficient in demonstrating the interpersonal caring skills essential for the development of a therapeutic relationship and hence patient recovery This paper demonstrates there is now (a) a need for special supervision as a preventive method when caring for the suicidal patient, (b) a need for a planned therapeutic programme of care during special supervision, (c) a need for the development of essential interpersonal and counselling skills and dimensions for effective therapeutic intervention and empathic nursing care, (d) a need to bridge the gulf between theory and practice by giving nurses the opportunity to practise those skills in the clinical setting under the supervision of an expert clinician, (e) a need for the patient to experience that nurses do care, i e experience empathy, during the complete therapeutic programme including the period of special supervision, and (f) a need for further research regarding the patient's perception of nursing care experienced following a failed suicidal attempt     

A staff development programme to support the incorporation of the McGill model of nursing into an out-patient clinic department

In order to adopt a nursing model as a framework for professional practice in an out-patient department of a paediatric tertiary care hospital, a staff development programme was instituted The nursing model chosen was the McGill model of nursing, which emphasizes the complementary role of nursing and focuses on people's health, strengths and potentials Staff development initially consisted of a journal club and clinic nurses were exposed to such concepts as family, coping, and health As the nurses acquired theoretical knowledge, the staff development programme was concerned with applying this knowledge to clinical situations As well as the nursing in-service training, clinical supervision with small groups of nurses was instituted A study showed that staff development helped nurses to build a larger repetoire of family nursing skills The nursing role in the department evolved Nurses developed a more professional practice and provided health services which were complementary to those offered by other health professionals     

Nurse-patient interaction: a review of the literature

Aims. The aims of this paper are to review a theoretical model useful for developing nursing knowledge related to nurse–patient interaction, review the literature on nurse–patient interaction, and discuss areas for further research. Theoretical model. Goffman's theory of face work. Results. Nurse–patient interaction is a central element of clinical nursing practice. This paper shows how Goffman's model can be used as a theoretical framework for understanding nurse–patient communication. Relevance to clinical practice. Issues such as power, the social and cultural context, and interpersonal competence are shown to be important in the quality of nurse–patient interactions and nurses need to take cognizance of these factors in their interactions with patients.     

Clinical supervision: what do we know and what do we need to know? A review and commentary

AIMS: This study is addressed to nurses but the issues are of equal concern to both midwives and health visitors. Clinical supervision ideally both challenges nurses as well as help their practice. There is need to identify critical elements that help professional practice and understand more clearly the changing nature of supervisory relationships. BACKGROUND: Clinical supervision in nursing is over a decade old in the UK and yet emerging nursing literature suggests that many ideas remain unfamiliar to nursing practice. The resistance shown by nurse towards clinical supervising remains perplexing. Moreover, ideas concerning clinical supervision have been applied without a substantive evidence base. METHODS: The discussion draws on varied ideas concerning supervision, including those outside of nursing, to ask what do we know and still need to know about clinical supervision. This study suggests that, a single approach to clinical supervision could be unhelpful to nursing. FINDINGS AND CONCLUSION: Nursing knowledge concerning many aspects of clinical supervision is increasing because of research. Much of the literature suggests that clinical supervision is scholarly activity requiring much the same attention to relationships as the therapeutic activities it supports. This discussion concludes with the idea that clinical supervision might work at its best as a quiet activity allowing nurses to think about nursing work in ways that suit individual learning styles.     

Clinical supervision - factors defined by nurses as influential upon the development of competence and skills in supervision

The aim of this study was to describe factors defined by nurses as influential upon the development of competence and skills in supervision. Although clinical supervision has been widely studied and described during the last decade, influential factors regarding the development of supervisory competence, as defined by clinical supervisors themselves, is little documented. Focus group interviews were analysed using methods of qualitative content analysis as described by Kvale. Factors related to three areas of importance for the development of competence and skills in student supervision are defined by nurses in this study. They are didactics, role functions and organizational framework. Didactic factors described included: integration of theory and practice; reflection on clinical situations; clarification of supervision aims and student evaluation. Role function factors were described as: feelings of security and awareness in supervision, differentiation between student and supervisor roles and the meaning attached to being a role model. Framework factors included nursing faculty and clinical field expectations. An understanding of how nurses describe what they need to support their development as clinical supervisors gives a basis for the development of postgraduate education in clinical supervision. Competent clinical supervisors can be better able to support students as they build bridges between theory and practice.     

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.     

Lost in the crucible of supportive clinical supervision: supervision is not therapy

Clinical supervision as a mechanism that supports both professional and personal development is a concept that has captured the imagination of nurses. Though nurses generally agree that 'supervision is not therapy', a clear distinction cannot be enunciated between these two processes when both aim at personal growth. In combining personal and professional growth, the rationale for clinical supervision is unnecessarily confused, with the unfortunate result that supervision may, unwittingly, become a form of therapy for nurses. This paper examines a model of supportive clinical supervision qua Chambers and Long's example of a facilitative therapeutic supervisory style, that reflects nurses' conceptualization of clinical supervision as enhancing personal and professional growth. However, it could be argued that this stance is in crucial respects incorrect, and needs to be rethought if clinical supervision is to be established as credible in nursing. Subsequently, it is important to remember that the utilization of certain techniques rather than their stated goals, will dictate the form that supervision, or therapy, will take. The purpose of this paper is to demonstrate the logical unacceptability in combining two processes as one, while developing a conceptual framework that differentiates supervision from therapy.     

Clinical supervision: from rhetoric to accident and emergency practice

Clinical supervision is firmly on the nursing agenda and, when implemented, will affect every practising nurse. However, current literature offers little in the way of advice on the practical application in a setting like the Accident and Emergency department (A & E).The aim of this article is to encourage A & E nurses to consider how clinical supervision can best be implemented into their current practice.A framework is presented to show how one A & E department has embraced the concept of clinical supervision and incorporated it into their A & E nursing practice.The evaluation, to date, has been positive and A & E nurses have reported that they enjoy the sessions and consider clinical supervision to be a useful learning experience.     

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.     

The rhetoric of caring and the recruitment of overseas nurses: the social production of a care gap

Aims and objectives. I will argue that overseas nurse recruitment is the consequence of a care gap, which arose from several policy shifts in the 1990s and in part from the rhetoric of a normative moral discourse in the UK which claims that caring is the moral essence of nursing. I will suggest that this discourse has masked the uncoupling of caring from nursing practice and that this uncoupling places the overseas nurses in a contradictory position. Background. In an increasingly competitive global labour market, the UK is faced with a nursing shortage and has been recruiting trained nurses from abroad (NMC 1993–2002). Design and methods. This paper is based on two related, qualitative studies using semi‐structured focus groups and individual interviews. The first explored the experiences of overseas nurses in the UK and the second investigated the equal opportunities and career progression of overseas nurses in the UK. Results. The data from these studies challenge the normative UK value that caring is at the heart of nursing. These data are the lens through which we see this contradiction explicitly played out. Overseas nurses observe that caring (as undertaken by health care assistants in care homes) is not nursing yet caring is being passed down the line as a process that marginalizes the overseas nurses and at the same time devalues their skills. I do not argue that overseas nurses care at a higher standard (although this may be the case) just that they care differently, that they expected UK nurses to deliver basic care and, instead, experience UK nursing practice as less autonomous and of a lower standard than they expected. Conclusions. I argue that the overseas nurses’ views help us understand the processes by which the uncoupling of caring from nursing has come about. Relevance to clinical practice. This paper discusses a workforce issue which is directly relevant to clinical practice because it focuses on the meaning of care; what is caring, what are caring activities and how are these represented in the discourse on caring in the literature? This paper also reveals significant worries among nursing managers about how to staff the nursing workforce and what nurses should be doing in the clinical areas.     

Learning from practice? Mental health nurses' perceptions and experiences of clinical supervision

In recent years nursing as a whole has moved from a position of apparently little manifest concern in the issue of 'clinical supervision' to a veritable explosion of interest which is beginning to find expression in the literature. Beginning with a discussion of clinical supervision from within a psychodynamically informed interpersonal nursing framework this paper reports on a small scale qualitative inquiry which aimed to explore mental health nurses' perceptions and experiences of clinical supervision. Analysis of data derived from a series of semi-structured interviews provides very encouraging early indications that mental health nurses are becoming better able to reflect upon the nature of their own formative learning needs and so to take seriously their need for professional support as they strive towards a more therapeutic relationship with their patients. However, whilst all of the participants in the study had a positive perception of the potential value of clinical supervision, there is clear evidence to suggest that their actual experience was that 'good enough supervision' was more the exception than the rule. The participants' perceptions and experiences are described and the implications for research, practice, education and the management of service delivery systems are outlined.     

Factors influencing the supervision of nursing students administering medication: the registered nurse perspective

Administering medication is an important function of registered nurses. It is therefore necessary that nursing students develop knowledge and skill in this field. Given the propensity for, and negative consequences of, medication errors, it is essential that nursing students are properly supervised in this role. There is currently a paucity of research examining the practices of supervising medication administration by nursing students, particularly from the perspectives of registered nurses. The aim of this study was to explore the opinions and insights of registered nurses regarding the supervision of nursing students administering medication. Focus groups were conducted with registered nurses with experience of working with students in the clinical environment. Focus groups were transcribed verbatim and data analysis was conducted using the five stage framework approach. Four main themes were identified that reflected the participants’ views of the factors most strongly influencing the provision of supervision: communication, busyness, attitudes, and pressure to conform. The participants identified the importance of providing student supervision and suggested strategies for improvement, such as a closer working relationship between the clinical facilitator and the registered nurses providing supervision.     

Development of a group model of clinical supervision to meet the needs of a community mental health nursing team

Clinical supervision is an important tool in the development of quality nursing care. It involves a process of reflection upon practice, the aim of which is to improve clinical practices and hence improve patient outcomes. The term 'clinical supervision' is itself problematic in that it implies an hierarchical, rather than a nurse-centred and reflective, process. In addition there are a variety of models of supervision which range from the purely managerial to the clinical. This gives rise to confusion and in some cases suspicion, in clinicians. This paper reports on the development, implementation and evaluation of a group model of clinical supervision developed by a small team of mental health nurses in a community mental health setting. This team recognised the need for a formal clinical supervision model but was unsure as to the model which best suited their practice situation and needs. Through collaboration with a university department of nursing, this group developed its own model of group clinical supervision. This paper reports on the development of the model and its evaluation. The model was developed with a small team of community nurses and hence may not be applicable to other teams and other settings. However, the methods described may be useful as a guide to other nurses who wish to plan, implement and evaluate a model of clinical supervision in their workplace.     

Reflection on how clinical nursing supervision enhances nurses' experiences of well-being related to their psychosocial work environment

Aim The aim of this study was to make a synthesis of three studies that deal with the following research question: ‘How does clinical nursing supervision enhance nurses’ experiences of well‐being in relation to their psychosocial work environment?’ Background Clinical nursing supervision is one way to support nurses in coping with their stressful work situation. Method A hermeneutic approach was used to reflect and interpret nurses’ experiences of well‐being in relation to clinical nursing supervision and psychosocial work environment. Results The findings suggest that clinical nursing supervision has an influence on nurses’ experiences of well‐being and in relation to their psychosocial work environment. Nurses attending clinical nursing supervision reported increased satisfaction with their psychosocial work environment. Conclusions The significance of caring and nursing becomes evident when nurses realize and understand that clinical nursing supervision positively influences their existence and well‐being. The value of work becomes clear when nurses reflect on themselves as professionals and as authentic human beings in clinical nursing supervision. This will lead to the emergence of self‐recognition.     

At the intersection of science and theory: How the Nurse Role Integration Model reconciles the conflict

As more nurses embrace precision science, there is a tendency to utilize theoretical frameworks from other disciplines thus, placing nursing at risk of losing its autonomy and independence. The discipline has fallen prey to internal binary opposition, eliminating opportunities to engage in civil discourse. To explore how the roles nurses select might fit together in a theoretical framework and help nurses understand how the roles they choose to support their identity as nurses, this paper introduced a model of nursing that includes the bench scientists, the policy activists, and bedside nurses, using the Neuman Systems Model (NSM). The Nurse Role Integration Model (NRIM) espouses the basic tenets of NSM: prevention counteracts stressors from penetrating the client’s lines of defense thus, reducing stress response. Primary prevention reflects the work of the nurse bench scientists, investigating the underlying mechanisms behind pathophysiology; secondary prevention is applied nurse scientists who build upon nurse researchers’ work, identifying and testing potential interventions; tertiary prevention is nurse policy activists, the fulcrum, who leverage primary and secondary findings to argue policy change at all levels. Once policy change is adopted, bedside nurses are educated and implement the change. This lens provides an opportunity to create greater solidarity, strengthening the unity and autonomy of the discipline.     

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.