[Cardiotocography--centrally supervised. Experience with a central supervision unit].
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Electrocardiography↗
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SNM house of delegates approves physician supervision guidelines; HCFA delays physician supervision rule.
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Centers for Medicare and Medicaid Services, U.S.↗
Improving the supervision of therapy assistants in Western Australia: the Therapy Assistant Project (TAP).
INTRODUCTION: Multidisciplinary therapy assistants (TAs) are increasingly seen as a model suited to the provision of allied health services in rural and remote areas. Supervision is a key aspect of therapy assistant practice. The rural context presents many challenges in supervising TAs including: a multidisciplinary TA role, outreach service delivery models, inexperienced allied health professionals (AHPs) and a high turnover of AHPs. At present there are no accepted standards for supervising TAs in this context. This study aimed to improve the supervision of TAs by AHPs in a rural setting. Improving supervision formed one aspect of the Therapy Assistant Project (TAP). METHODS: Minimum standards for supervision were developed, a process for recording TA supervision introduced, and training in supervision skills was delivered to AHPs. A mixed method study design was used to determine the impact of introducing minimum standards and supervisor training on supervision practices. RESULTS: Minimum supervision standards included: program and administrative discussion, observation, and demonstration of therapy sessions. Methods recommended for supervising allowed regular supervision of TAs in small, distant rural towns. Developing minimum standards for supervision, a process for recording supervision, and training in supervisory skills resulted in increased supervision between AHPs and TAs. AHP and TA participants expressed satisfaction with minimum supervision standards. The frequency and amount of supervision increased although videoconferencing for supervising TAs in distant towns was not widely used for supervision. CONCLUSION: This study provides a new resource for supervision practices for rural TAs. The minimum standards for supervision would be a suitable resource to assist health services seeking to improve supervision of TAs or commencing a TA program. Further exploration of the use of videoconferencing for supervising TAs in distant rural towns is suggested. Training in supervision skills for AHPs should include introductory and complex supervision methods. This study represents one step in defining standards for rural and remote TA practice.
Allied Health Personnel↗
Effective supervision in clinical practice settings: a literature review.
CONTEXT: Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective. PURPOSE: To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision. CONTENT: The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness. CONCLUSIONS: The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.
Clinical Clerkship↗
What is effective supervision and how does it happen? A critical incident study.
OBJECTIVES: To identify the key features of supervision from the perspectives of educational supervisors and specialist registrars. DESIGN: Critical incident study. Telephone interviews were conducted with selected informants representing a range of specialties. The sample comprised educational supervisors with an identified interest in supervision, specialist registrars and GP trainees in the Yorkshire region. RESULTS: Educational supervisors and specialist registrars were generally agreed on what constitutes effective supervision: direct supervision was seen as very important. Educational supervisors and specialist registrars had very different concerns in relation to ineffective supervision: specialist registrars were concerned with inadequate supervision whilst educational supervisors were concerned with failures in direct supervision and poorly performing trainees. Supervision practices varied between specialties; in this study there seemed to be particular problems in anaesthesia, medicine and paediatrics. CONCLUSIONS: Direct supervision and the quality of the supervisory relationship are key to effective supervision. There is a need for clear guidance on supervision and the establishment of appropriate procedures and mechanisms to resolve difficulties relating to inadequate supervision for trainees and performing trainees. Insufficient numbers of supervisors have received training in supervision.
Attitude of Health Personnel↗
Promoting nursing quality through supervision.
This article discusses the concept and content of supervision and related forms of staff training. Of special concern is the implementation of supervision in nursing organizations and its role in promoting nursing quality. Finally, the article looks at the future prospects of supervision and the need for further development. In Finland, supervision was first introduced as a method of staff training in the 1960s, but it is only during the past decade or so that it has been adopted on a wider scale in different fields of health care. Recently, there has been increasing debate on the definition of the concept, on its content, and on how supervision should be distinguished from other forms of staff training. Critics are saying that existing conceptual analyses are superficial and remain surrounded by considerable ambiguity. In the practice of nursing supervision, the emphasis is often too heavily on the problems of nursing practice. As a result, any creative new ideas on the part of the supervised employee are easily ignored. Every effort should now be made to develop a more accurate and comprehensive definition of supervision by closely comparing supervision with related forms of staff training, many of which differ from supervision only marginally in terms of, say, goals and contents. Supervision is here compared with consultation, hierarchic supervision, guidance, and therapy.
Finland↗
A survey of community mental health nurses' perceptions of clinical supervision in Northern Ireland.
Since the early 1990s, clinical supervision has been the subject of debate by nurse academics and practitioners. This debate has encouraged the adoption of clinical supervision by the profession throughout the United Kingdom. Search of the literature demonstrates that there has been little published research regarding clinical supervision in Northern Ireland. This study is designed to redress this information deficit. The current position of clinical supervision in relation to community psychiatric nursing in Northern Ireland is explored and evaluated. A survey approach was adopted, collecting data from community psychiatric nurses (CPNs) in Health and Social Services Trusts in Northern Ireland. Data was obtained relating to the practice of clinical supervision and to attitudes of CPNs, their managers and supervisors. Results indicate that there is support for clinical supervision and that it is being implemented within community psychiatric nursing in Northern Ireland, although not in all cases. However, the findings indicate that serious education and training deficits exist, and the importance of the interface between managerial and clinical supervision is emphasized. The issues of providing effective education and training in supervision skills, and the uncertainty that was highlighted regarding fundamental concepts underpinning clinical supervision, have implications for nursing practice, education and management. In addition, based on findings of this study, the difference between management-led supervision and clinical supervision as envisaged by the UKCC, which promotes the personal and professional development of nurses, requires further exploration.
Adult↗
The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury.
OBJECTIVE: To ascertain the association between early computed tomography (CT) scan findings and the need for assistance with ambulation, activities of daily living (ADLs), and supervision at rehabilitation discharge and at 1 year after traumatic brain injury (TBI). DESIGN: Prospective longitudinal design. SETTING: Seventeen Traumatic Brain Injury Model Systems (TBIMS) centers. PARTICIPANTS: A total of 1,839 adults with TBI admitted to TBIMS trauma centers with subsequent acute rehabilitation; 849 were followed to 1 year after injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Accumulated CT scan pathology from the first week after injury; FIM instrument and Disability Rating Scale at rehabilitation discharge and 1 year after injury; and Supervision Rating Scale at 1 year. RESULTS: Chi-square analyses showed that individuals with a midline shift greater than 5mm (lateral compression) were more likely to require the assistance of another person at discharge from acute rehabilitation with ambulation (29% vs 17%-19%, P=.02), toileting (47% vs 33%-38%, P=.05), lower-body dressing (57% vs 39%-46%, P=.015), bladder continence (32% vs 19%-23%, P=.03), and overall supervision (53% vs 44%, P=.0006) than patients with a midline shift of lesser degree. At 1 year, 57% of patients with a midline shift greater than 5mm on acute CT scans were being supervised in the home versus 30% to 39% of those with a shift of lesser degree (P=.003); there were no significant differences in the percentages of those needing assistance for ambulation or ADLs. The association of subdural hematoma with ambulation, self-care, and supervision needs was related to the degree of midline shift but not to the presence of subdural hematoma. Individuals with subcortical contusions were more likely to require assistance at rehabilitation discharge for ambulation (32% vs 18%, P<.0001), lower-body dressing (61% vs 44%), toileting (52% vs 35%), bladder continence (34% vs 22%), and overall supervision (61% vs 44%) than those without subcortical contusions (P<.0001). At 1 year, individuals with acute subcortical contusions were more likely to need assistance with ambulation (15% vs 8%, P=.004) and stair climbing (15% vs 9%, P=.03). Those with bilateral frontal (54% vs 46%, P=.009) or bilateral temporal (58% vs 46%, P=.03) contusions were more likely to need assistance with overall supervision at rehabilitation discharge, compared with those with unilateral or no cortical contusions. CONCLUSIONS: The presence of either a midline shift greater than 5mm or a subcortical contusion on acute CT scans is associated with a greater need of assistance with ambulation, ADLs, and global supervision at rehabilitation discharge. Patients with bilateral cortical contusions require more global supervision at rehabilitation discharge but no more supervision for ambulation and ADLs. These findings may aid health care professionals and potential caregivers in planning for rehabilitation and supervision needs after rehabilitation discharge and, to a lesser extent, at 1 year after TBI.
Activities of Daily Living↗
Reflections on psychodynamic psychotherapy supervision for psychiatrists in clinical practice.
Much has been written about psychotherapy supervision for trainees in psychiatry. Psychiatrists are also encouraged to receive supervision when dealing with difficult patients or when involved in personal events that have the potential to have an impact on their psychotherapeutic work. Nevertheless, a literature search, conducted through Medline, revealed few publications dealing with supervision of psychiatrists who conduct psychotherapy in clinical settings after completion of training. This article discusses the issues involved in psychotherapy supervision for the supervisor, supervised psychiatrists, and their practice settings and patients. The author first discusses the benefits of psychotherapy supervision for psychiatrists in clinical practice, including helping psychiatrists maintain and improve psychotherapeutic skills, assistance in dealing with patients who have complex or especially challenging problems (e.g., personality disorders, intractable depression, difficulties with compliance, complex psychosocial problems), addressing ethical concerns, boundary issues, and transference and countertransference, and helping psychiatrists deal with personal issues that may cause difficulties in providing psychotherapy or issues that arise in working with a multidisciplinary team. The author then reviews key issues related to the supervisory process, including group versus individual supervision, the role of the supervisor, different supervisory styles, and factors that can contribute to feelings of shame or vulnerability in the supervisee. The author also discusses different supervisory styles, clarifies the distinction between therapy and supervision, and discusses issues that arise in the supervision of experienced psychodynamic therapists. Barriers that may keep psychiatrists from seeking psychotherapy supervision are reviewed. Finally the author discusses the supervision of those acting as supervisors for other clinicians.
Education, Medical, Continuing↗
How medical residents perceive the quality of supervision provided by attending doctors in the clinical setting.
INTRODUCTION: The supervision of medical residents is a key responsibility of attending doctors in the clinical setting. Most attending doctors, however, are unfamiliar with the principles of effective supervision. Although inconsistent, supervision has been shown to be both important and effective for the professional development of medical residents. OBJECTIVE: To examine how medical residents perceive the supervisory roles of attending doctors, in terms of what they perceive as poor supervision and what they characterise as good supervisory practice. METHOD: We carried out a questionnaire survey of 38 medical residents at the Department of Paediatrics at the teaching hospital of the University of Amsterdam, the Netherlands. Attending doctors directly involved with the supervision of medical residents participated in the study. The clinical settings where supervision occurred included the neonatal and paediatric intensive care units and the general paediatric wards. RESULTS: Medical residents rated the quality of supervision they received in all departments positively. A majority of the attending doctors were rated highly in 'overall supervision'. Creating pleasant learning environments and being stimulated to learn and function independently were aspects of supervision characterised positively. Coaching in clinical skills and procedures, effective communication skills and clinical decision making using principles of cost-appropriate care were aspects of supervision found to be deficient. DISCUSSION: This study shows that medical residents enjoy supervision from collaborative, understanding and patient attending doctors. Medical residents prefer to be treated as adult learners and enjoy feedback that is constructive, measured and adapted to their professional needs.
Attitude of Health Personnel↗
A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors.
BACKGROUND AND PURPOSE: Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors. This study compared the effectiveness of a 10-week supervised strengthening and conditioning program (supervised) with a 1-week supervised instruction program followed by a 9-week unsupervised home program (unsupervised) and evaluated retention of changes at 6 months and 1 year after program completion. METHODS: Seventy-two subjects retained at baseline (27 women, 45 men; mean+/-SD age, 64.6+/-11.8 years) were randomly allocated to receive the supervised or unsupervised program. The primary outcome was walking speed over 6 minutes, and secondary outcome measures were Human Activity Profile, Medical Outcome Study 36-Item Short-Form survey (SF-36), Physiological Cost Index, and lower extremity muscle strength. RESULTS: The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year. The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year. The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year; the unsupervised group showed significant improvement at 1 year. Women made greater gains in supervised programs, but men made greater gains in unsupervised programs. CONCLUSIONS: Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year, although supervised programs showed trends to greater improvements in self-reported gains. Gender differences require further research.
Activities of Daily Living↗
Empirical study of supervised gene screening.
BACKGROUND: Microarray studies provide a way of linking variations of phenotypes with their genetic causations. Constructing predictive models using high dimensional microarray measurements usually consists of three steps: (1) unsupervised gene screening; (2) supervised gene screening; and (3) statistical model building. Supervised gene screening based on marginal gene ranking is commonly used to reduce the number of genes in the model building. Various simple statistics, such as t-statistic or signal to noise ratio, have been used to rank genes in the supervised screening. Despite of its extensive usage, statistical study of supervised gene screening remains scarce. Our study is partly motivated by the differences in gene discovery results caused by using different supervised gene screening methods. RESULTS: We investigate concordance and reproducibility of supervised gene screening based on eight commonly used marginal statistics. Concordance is assessed by the relative fractions of overlaps between top ranked genes screened using different marginal statistics. We propose a Bootstrap Reproducibility Index, which measures reproducibility of individual genes under the supervised screening. Empirical studies are based on four public microarray data. We consider the cases where the top 20%, 40% and 60% genes are screened. CONCLUSION: From a gene discovery point of view, the effect of supervised gene screening based on different marginal statistics cannot be ignored. Empirical studies show that (1) genes passed different supervised screenings may be considerably different; (2) concordance may vary, depending on the underlying data structure and percentage of selected genes; (3) evaluated with the Bootstrap Reproducibility Index, genes passed supervised screenings are only moderately reproducible; and (4) concordance cannot be improved by supervised screening based on reproducibility.
Artificial Intelligence↗
The relationship between neuropsychologic function and level of caregiver supervision at 1 year after traumatic brain injury.
OBJECTIVES: To evaluate distribution of levels of caregiver supervision at 1 year after traumatic brain injury, and to determine neuropsychologic predictors of supervision level. DESIGN: Prospective longitudinal design, concurrent measurement of neuropsychologic function and supervision level. SETTING: Seventeen Traumatic Brain Injury Model Systems centers. PARTICIPANTS: A total of 563 adults tested at 1 year postinjury; and a subgroup of 452 studied for neuropsychologic function in the absence of impairment in mobility or basic self-care, as assessed by high FIM instrument motor scores. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Supervision level measured by scores on Supervision Rating Scale (SRS). RESULTS: Two thirds (69%) of the sample was rated as independent of supervision. Participants without significant dysfunction on motor FIM were grouped into supervision groups differing in intensity of time commitment from caregiver (independent, moderate supervision, heavy supervision). In univariate analyses, groups differed on demographic variables (education, race, productivity prior to injury), duration of altered consciousness, and all but 1 neuropsychologic measure. A binomial regression model (complementary log-log model) revealed that supervision at 1 year was predicted by education and scores on the Trail Making Test Part B and digits backward. CONCLUSIONS: Findings confirm the importance of preinjury status and measures of working memory and cognitive flexibility in predicting functional independence after TBI. The SRS appears prone to ceiling effects in persons followed prospectively after moderate to severe TBI.
Adolescent↗
Supervision and responsibility: The Royal College of Anaesthetists National Audit.
BACKGROUND: The Royal College of Anaesthetists audited consultant supervision and responsibility in anaesthesia in the UK during 2003. METHODS: Consultants (supervising) and non-consultants (supervised) were surveyed on their attitudes to supervision, experience of their own hospital system for supervision and of induction for new starters. Local coordination was achieved through anaesthesia audit coordinators who provided information on local policies, induction programmes and anaesthesia charts. Supervision was audited over a 5-day period. RESULTS: 135 departments of anaesthesia took part (43% of 315 departments), questionnaires being returned by 2297 anaesthetists. Anaesthesia record charts in use do not meet criteria considered desirable locally. Most trainees, but less than half staff grade/associate specialists, received an induction programme, often not supported by written documentation. Consultants find conflicting demands of service and supervision difficult. Many work in systems which do not permit providing direct, immediate support to those supervised. Most anaesthetists think supervision is very important. Around half disagree with national guidance that every NHS patient should have a named consultant. Two per cent of non-consultants during the audit period reported assistance from consultants not being obtainable soon enough. CONCLUSIONS: This audit found departure from standards and the potential for risk and failure. New standards may be needed regarding anaesthesia record sheets, induction, accountability, when to seek help and care of sick patients. Supervision systems in over 40% of hospitals need review to ensure they provide a named consultant and immediate direct support for elective lists.
Anesthesia Department, Hospital↗
The impact of supervision on stock management and adherence to treatment guidelines: a randomized controlled trial.
Ensuring the availability of essential drugs and using them appropriately are crucial if limited resources for health care are to be used optimally. While training of health workers throughout Zimbabwe in drug management (including stock management and rational drug use) resulted in significant improvements in a variety of drug use indicators, these achievements could not be sustained, and a new strategy was introduced based on the supervision of primary health care providers. This was launched in 1995 with a training course in supervisory skills for district pharmacy staff. In order to evaluate the impact of the supervision and the effectiveness of the training programme, adherence to standard treatment guidelines (STG) and stock management protocols was evaluated in a randomized controlled trial. The study compared three different groups of health facilities: those that received supervision for either use of STG (n = 23) or stock management (n = 21) - each facility acting as control for the other area of supervision - and a comparison group of facilities which received no supervision (n = 18). On-the-spot supervision by a specially trained pharmacy staff, based around identified deficiencies, took place at the start of the study and 3 months later. The evaluation compared performance on a variety of drug management indicators at baseline and 6-8 months after the second supervisory visit. The results of the study showed that, following supervision, overall stock management improved significantly when compared with the control and comparison groups. Similar improvements were demonstrated for adherence to STG, although the effect was confounded by other interventions. The study also showed that supervision has a positive effect on improving performance in areas other than those supervised, and demonstrated that pharmacy technicians with limited clinical skills can be trained to influence primary health care workers to positively improve prescribing practices. Allocating resources to supervision is likely to result in improved performance of health workers with regard to the rational use of essential drugs, resulting in improved efficiency and effectiveness.
Drug Utilization Review↗
The impacts of supervision, patient mix, and numbers of students on the effectiveness of clinical rotations.
PURPOSE: This study investigated whether supervision, patient mix, and numbers of students influence the effectiveness of clinical rotations. METHOD: The authors administered a questionnaire to 1,208 medical students in 1999 to evaluate the rotations' quality. They computed four variables--overall effectiveness, supervision, patient mix, and number of students contemporaneously involved--and analyzed the data using analysis of variance. RESULTS: Supervision and patient mix positively influenced a rotation's effectiveness. A higher level of supervision and a higher level of patient mix led to higher overall effectiveness scores. The number of students did not significantly influence the effectiveness score, although a low number led to a higher score as compared with a high number. Furthermore, the two-way interaction between supervision and patient mix was significant. Supervision more strongly influenced the rotation's effectiveness when patient mix was limited than when it was high. Also, when the patient mix was limited and supervision was high, the average effectiveness score was still 7.7 (scale 1-10). CONCLUSIONS: The effectiveness of clinical rotations depends on the supervision provided and patient mix, but not the number of students. Furthermore, supervision more strongly influences effectiveness when patient mix is limited than when it is high. Finally, high-quality supervision guarantees at least a sufficient score for the rotation's effectiveness, irrespective of the level of patient mix.
Curriculum↗
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 Competence↗
Measuring parent attributes and supervision behaviors relevant to child injury risk: examining the usefulness of questionnaire measures.
OBJECTIVE: This study aimed to identify self report questionnaire measures of parent attributes and behaviors that have relevance for understanding injury risk among children 2-5 years of age, and test a new Parent Supervision Attributes Profile Questionnaire (PSAPQ) that was developed to measure aspects of protectiveness and parent supervision. METHODS: Naturalistic observations were conducted of parents' supervision of children on playgrounds, with questionnaires subsequently completed by the parent to measure parent education, family income, parent personality attributes, attributes relevant to parent supervision, and beliefs about parents' control over the child's health status. These measures were then related to children's risk taking and injury history. RESULTS: Visual supervision, auditory supervision, and physical proximity were highly intercorrelated, indicating that parents employed all types of behaviors in service of supervision, rather than relying predominantly on one type of supervisory behavior. Physical proximity was the only aspect of supervision behavior that served a protective function and related to children's risk taking behaviors: parents who remained close to their children had children who engaged in less risk taking. On questionnaires, parents who reported more conscientiousness, protectiveness, worry about safety, vigilance in supervision, confidence in their ability to keep their child safe, and belief in control over their child's health had children who showed less risk taking and/or experienced fewer injuries. The new PSAPQ measure was associated with specific aspects of supervision as well as children's risk taking and injury history. CONCLUSIONS: This study reveals several parent attributes and behaviors with relevance for child injury risk that can be measured via self report questionnaires, including the new PSAPQ.
Accident Prevention↗