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PubMed2026

Psychotherapy training in psychiatry: a systematic review and narrative synthesis on the supervision experiences of early-career psychiatrists.

BACKGROUND: Supervision is a fundamental component of psychotherapy training, transforming theoretical knowledge into clinical skills through real-world practice. Psychotherapy training practices vary widely between countries, training programs, and over time, including supervision. Our systematic review aimed to investigate and describe the experiences of psychotherapy supervision through early-career psychiatrists' (ECPs) views. METHODS: We systematically searched PubMed/MEDLINE, Scopus, and PubPsych for survey-based studies on ECPs' experiences of psychotherapy supervision during or after their psychiatry training and reported our findings according to the PRISMA guidelines. Of 32,877 articles screened, 29 articles were included. Each article underwent quality assessment, and results were synthesized narratively. RESULTS: Included articles published between 2000 and 2025, were from Europe (N = 16, 55.1%), the Americas (N = 5, 17.2%), Western Pacific (N = 4, 13.7%), South-East Asia (N = 2, 7%), Eastern Mediterranean (N = 1, 3.5%), and Africa (N = 1, 3.5%), with a total of 4691 participants. Supervision access rates ranged from 26.2% in Nigeria to 85.5% in Russia, with significant variation across countries and psychotherapy modalities. Most ECPs received 50-100 total hours of supervision, frequently delivered in weekly sessions. While formats, individual, group, or mixed, varied by country and training scheme, supervision was generally provided by a psychiatrist-psychotherapist. Common learning techniques included oral consultations and case discussions, followed by audio recordings or transcripts. The need to self-fund psychotherapy supervision costs was identified as a prominent barrier. CONCLUSIONS: Psychotherapy supervision is inconsistent globally, with barriers including supervisor availability and cost. There is a large implementation gap between recommendations and evaluated practice. Digital tools and competency-based frameworks may improve access and quality.

Humans↗
PubMed2007

The effect of supervised exercise and cilostazol on coagulation and fibrinolysis in intermittent claudication: a randomized controlled trial.

BACKGROUND: The prothrombotic, hypofibrinolytic state that develops in patients with intermittent claudication (IC) upon walking due to ischemia-reperfusion injury (IRI) of the leg muscles may contribute to the high incidence of life- and limb-threatening thrombotic events observed in this patient group. Treatments, such as angioplasty, that obtund the IRI also ameliorate the procoagulant diathesis. The effect on this diathesis of supervised exercise and cilostazol, both of which provide symptomatic benefit in IC, but without significantly obtunding IRI, is unknown. METHODS: Thirty-four patients (27 men and 7 women; median age, 67 years; range, 63-72 years) were randomized to receive best medical therapy (BMT) plus supervised exercise (n = 9), BMT plus cilostazol (n = 9), BMT plus supervised exercise plus cilostazol (n = 7), or BMT alone (n = 9) in a 2 x 2 factorial design. Thrombin-antithrombin complex and prothrombin fragments 1 and 2, both markers of thrombin generation; plasminogen activator inhibitor antigen and tissue plasminogen activator antigen, both markers of fibrinolysis; ankle-brachial pressure index (ABPI); and initial and absolute claudication distance (ACD) were measured at baseline and then 3 and 6 months after randomization. RESULTS: At 6 months, when compared with receiving BMT only, supervised exercise and cilostazol resulted in improvements in ABPI of 18% and 13% and in ACD of 40% and 64%, respectively. The effects on ABPI and ACD of combining supervised exercise and cilostazol were additive. Supervised exercise, cilostazol, and supervised exercise combined with cilostazol had no significant effect on any of the four hemostatic markers. CONCLUSIONS: Treatment of IC by supervised exercise or cilostazol results in significant improvements in ABPI and ACD but has no demonstrable effect on the prothrombotic diathesis. This suggests that supervised exercise and cilostazol, unlike angioplasty, are unlikely to have a long-term beneficial effect on the thrombotic risks faced by these patients.

Aged↗
PubMed2000

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.

Adult↗
PubMed2001

Psychiatric nurses' conceptions of how a group supervision programme in nursing care influences their professional competence: a 4-year follow-up study.

AIM: The aim of the study was to describe, after 4 years, psychiatric nurses' conceptions of how a 2-year group supervision programme within nursing care had influenced their professional competence. BACKGROUND: The intention of group supervision in nursing care is to understand nurses' experiences within real care settings and to structure these in a professional and personal context. METHODS: Ten psychiatric nurses participated in a 2-year group supervision programme. They were interviewed 4 years after the group supervision was ended. Data were analysed according to the phenomenographic method. FINDINGS: Six description categories emerged: a feeling of job satisfaction; gaining knowledge and competence; gaining a sense of security in nursing situations; a feeling of personal development; realizing the value of supervision; and a sense of professional solidarity. CONCLUSIONS: The findings of the 4-year follow-up showed that a group supervision programme in nursing care had lasting influences on the psychiatric nurses' professional competence in the form of a pronounced professional identity and an integrated nursing care perspective. Group supervision contributes to maintaining the strength and energy needed to carry on working, which makes continuing supervision necessary. IMPLICATIONS: An important research implication could be to investigate the type of knowledge that ought to be developed within group supervision in nursing care.

Attitude of Health Personnel↗
PubMed2005

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.

Adult↗
PubMed2005

Evaluation of the concept of supervision related to public health nurses in Norway.

AIM: The aim of the study is to clarify the concept of supervision by means of concept analysis, in order to evaluate the concept's application to the practise of public health nurses. BACKGROUND: According to the World Health Organization, a change in strategies for improving public health is necessary. This change demands new strategies. There exists little research concerning intervention strategies in public health. The concept of supervision is well used, but neither well-defined nor well described, either within the nursing discipline or across disciplinary boundaries. METHODS: The method is a review of literature. Twenty scientific papers covering the years 1996-2001 are analysed, using a concept-analysis methodology. FINDINGS: Supervision can be defined as a formal, pedagogical, relational enabling process, related to professional competence. Relationship and dialogue are central aspects. Supervision is based on theory and humanistic values, has a normative, formative and restorative function. The supervisor's competence is of great importance. Supervision has unclear boundaries with concepts such as psychotherapy, consultation and counselling. CONCLUSION: The concept of supervision as described in the selected papers is applicable to public health nurses' supervision of clients, with adaptation caused by the contextual variation of the relationship. Related to clients, supervision can be defined as a formal, pedagogical, relational enabling process with the purpose to strengthen resources, enhance assertiveness and improve independence and coping. It is necessary that registered public health nurses have the competence to supervise.

Humans↗
PubMed2003

Inadequate supervision as a cause of injury deaths among young children in Alaska and Louisiana.

OBJECTIVE: Inadequate supervision of children has contributed to injuries. However, the association of inadequate supervision with injury events in children has not been quantified. The purpose of this study was to describe and quantify the role of inadequate supervision of children in injury deaths. METHODS: Injury deaths among children aged 0 to 6 years in Alaska during 1993 to 1995 and Louisiana during 1994 were classified using 10 child safety standards to assess the role of parent/caregiver supervision in the circumstances of injury death. RESULTS: The leading categories of injury death for both states combined were motor vehicle injury and fire-related injury. Of the classifiable injury deaths in both states (157 [77%] of 203 deaths), the most commonly violated safety standard was "children should be supervised by a responsible care provider" (64 deaths [41%]). Of these deaths, the caregiver was absent in 38%, and the caregiver increased the danger to the child in 17%. Male injury deaths more typically involved a supervision standard violation. Drowning and pedestrian deaths typically involved a supervision standard violation, whereas asphyxiation, homicide, and occupant motor vehicle injury deaths did not. CONCLUSION: Alaska and Louisiana child injury deaths were mostly attributed to preventable violations of 10 child safety standards, most commonly the supervision standard. The methods in this report were useful in identifying target populations and causes of death, which can be used to plan and implement interventions to improve supervision of children.

Alaska↗
PubMed2002

Clinical Supervision of Athletic Training Students at Colleges and Universities Needs Improvement.

OBJECTIVES: To assess the type and amount of clinical supervision athletic training students received during clinical education. DESIGN AND SETTING: An online survey was conducted with a questionnaire developed specifically for this study. SUBJECTS: Head athletic trainers from National Collegiate Athletic Association Division I (28), Division II (34), and Division III institutions (30). Thirty-four represented Commission on the Accreditation of Allied Health Education Programs-accredited athletic training education programs, 20 represented athletic training programs in Joint Review Commission on Athletic Training candidacy, and 35 offered the internship route. MEASUREMENTS: Descriptive statistics were computed. Three sets of chi-square analyses were completed to assess associations among athletic training students with first-responder qualifications, program and institution characteristics, certified athletic trainer medical coverage of moderate- and increased-risk sports, and clinical supervision. A trend analysis of students' class standing and time spent in different types of clinical supervision was also completed. The alpha level was set at <.05. RESULTS: Most of the athletic training students (83.7%), particularly in accredited programs, had first-responder qualifications. More than half of the head athletic trainers (59.8%) indicated that athletic training students were authorized to provide medical care coverage without supervision. A minimal amount of medical care coverage of moderate- and increased-risk sports was unsupervised. No significant difference between the size of the education or athletic program and type and amount of clinical supervision was noted. Freshman athletic training students spent more time in direct clinical supervision and less time in unsupervised experience, but the opposite was true for senior students. CONCLUSIONS: Athletic training students are being utilized beyond appropriate clinical supervision and the scope of clinical education. Future research should employ methods using nonparticipant observation of clinical instructors' supervision of students as well as students' own perceptions of their clinical supervision.

Journal Article↗
PubMedDate not supplied

Clinical supervision in a challenging behaviour unit.

AIM: As part of an ongoing service development programme at St Andrew's Hospital, Northampton, it was identified that it would be beneficial to explore whether qualified nursing staff in the hospital's five clinical divisions were satisfied with the clinical supervision they received. Also, the survey examined whether supervision was of good quality, was suitable for different specialist environments and if it affected motivation, skills, confidence and stress levels. The survey also explored if there was a difference between D or E-grade nurses and nurses who are F grade and above regarding their perception of clinical supervision. METHOD: This included a Likert scaled questionnaire (Ladany et al, 1996); and a retrospective (ex-post-facto) cross-sectional survey design. A questionnaire and information sheet was dispatched to 50 qualified nursing staff. Ten nurses from each of the five divisions were invited to participate. After one month, 35 (70 per cent) had returned the questionnaires. RESULTS: Senior staff benefit more and are more satisfied with regular supervision than junior staff. The survey shows that clinical supervision is in quite good shape, with most nurses receiving regular supervision within a limited time span. CONCLUSION: Large numbers of qualified nurses receive supervision in the hospital and this is extremely positive. However, there are a number of discrepancies regarding who receives supervision, and within what time frame, and why so many qualified nurses feel the supervision is not helping them work more effectively.

Data Collection↗
PubMed2006

Group clinical supervision in pre-registration nurse training: the views of mental health nursing students.

In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. In response to this recommendation, the now defunct English National Board (ENB) stated that: "It will be a requirement that all students of pre-registration nursing programmes receive preparation in what to expect from clinical supervision" (ENB, 1995, p. 4). Despite the fact that no further guidance was issued there is an emerging body of literature exploring this area. This paper reports findings from the initial phase of a three-year prospective longitudinal study examining students' experiences of group clinical supervision undertaken as part of their pre-registration training. In this part of the study 32 mental health nursing students participated in focus groups in which they discussed their expectations of clinical supervision. Content analysis of the data produced five major categories: 'the nature of clinical supervision'; 'roles and responsibilities'; 'staying safe and doing no harm'; 'being in a group'; and 'being a student'. The findings suggest that the idea of supervision is attractive to students, although there are significant anxieties both about supervision in general and of group supervision in particular.

Attitude of Health Personnel↗
PubMed1999

Continuous visual field test supervision may not always be necessary.

OBJECTIVE: To assess the effect of supervision on computerized visual field (VF) performance and to determine what patient characteristics predict poor unsupervised performance. DESIGN: Randomized, crossover, cross-sectional, clinical trial. PARTICIPANTS: Two hundred unselected patients with definite or suspect glaucoma or neuro-ophthalmic VF indication participated. INTERVENTION: All patients completed two 30-2 tests of one eye on a Humphrey perimeter, one with continuous active technician supervision and one without supervision after the initial 2 minutes of the test. MAIN OUTCOME MEASURES: Visual field reliability and global VF indices were measured. RESULTS: Supervision had a positive effect on overall reliability (P = 0.04) but not on individual reliability parameters or any of the global VF indices. There was no difference between Humphrey Field Analyzers I and II in the need for supervision. Predictors of need for supervision were low educational level and a prior test result with false-positive responses. Predictors of an unreliable test were advanced age and a prior test with a high proportion of fixation losses. CONCLUSION: Supervision is necessary for those with risk factors for unsatisfactory perimetry such as advanced age, low level of formal education, and prior test results with false-positive responses or high fixation losses; in the remainder, omission of supervision can be considered.

Aged↗
PubMed2005

An investigation of the acceptability of undergraduate supervision by Senior House Officers and General Professional Trainees.

AIM: This study assessed whether Senior House Officers (SHO)/General Professional Trainees (GPT) are, or would be, comfortable supervising clinical undergraduates, whether they find this to be a valuable experience within their training programme, and whether undergraduates are or would be comfortable with SHO/GPTs supervising them. METHOD: Questionnaires were distributed to fourth and final year students at Glasgow and Dundee Dental Schools and fourth year students at Newcastle Dental School. Questionnaires were also distributed to SHO/GPTs at Glasgow Dental Hospital and School and Edinburgh Dental Institute. RESULTS: Seventy-nine per cent of respondent SHO/GPTs were currently not involved in the supervision of undergraduates within their present rotation, 65% of whom stated that they would value the experience of this within their training. Of those involved in supervision, 83% found the experience valuable. Forty-four per cent of students were unsure or not comfortable with SHO/GPTs supervising within an oral surgery department and approximately the same in other departments. Twenty-eight per cent of respondents felt that university lecturers should be the main trainer. CONCLUSION: SHO/GPTs value supervising undergraduates as part of their training experience. More than half of students are comfortable with SHO/GPTs supervising them. Both groups suggest that SHO/GPTs should receive some form of training in teaching prior to supervising undergraduates.

Attitude of Health Personnel↗
PubMed2001

Cost--benefit analysis of team supervision: the development of an innovative model and its application as a case study in one Finnish university hospital.

AIM: To develop a model of costs and benefits of team supervision and a formula, which are examined more closely by means of an example. BACKGROUND: The popularity of clinical supervision (CS) as one of the methods of supporting health care practitioners' professional development (formative function), coping (restorative function) and quality improvement (normative function) has increased in the 1990s. CS may take the form of one-to-one or group supervision. Team supervision is a special form of group supervision. It means a group that has an interrelated work life outside the group. A host of literature and articles is available on CS. However, the costs and benefits of CS are less examined even though these have given rise to discussion particularly among decision-makers, because the monetary benefit of CS remains unsolved. METHOD: A nominal group technique was used to develop a model of costs and benefits of team supervision and a formula was derived on the basis of the model. The existing statistical data, for example a hospital ward's annual reports, data on sick days and reports on indemnities were utilized in the application of the formula. FINDINGS AND CONCLUSION: Team supervision was efficient in economic terms on the example ward. The model and the formula constitute a first attempt to ascertain the net present benefit of team supervision. Both the model and the formula need to be further tested, specified and refined.

Cost-Benefit Analysis↗
PubMed2003

Nurse managers' conceptions of quality management as promoted by peer supervision.

AIM: The aim of the study was to describe nurse managers' conceptions of quality management in their work as promoted by peer supervision. BACKGROUND: Quality management is one of the topical issues in a nurse manager's demanding and changing work. As first-line managers, they have a key role in quality management which is seen to create the system and environment for high quality services and quality improvement. Despite the official recommendations and definitions of quality management, several published reports have shown that there is no single solution for quality management. Peer supervision or the support provided by it to nursing managers have rarely been a subject of study. This study was carried out at Tampere University Hospital between 1996 and 1998. The peer supervision intervention was organized once a month, 2 hours at a time and in closed supervisor-led groups of nine nurse managers. METHODS: Data were collected by themed interviews. Fifteen nurse managers participated in the study. The data were analysed using the phenomenographic method. FINDINGS: Two main categories were formed of nurse managers' conceptions. The first described supportive and reflective characteristics of peer supervision. This main category was described by horizontal, hierarchical categories of support from peer group and reflection. The second main category described nurse managers' conceptions of individual development of leadership during peer supervision. This main category was also described by three horizontal categories: personal growth, finding psychological resources and internalization of leadership. CONCLUSION: The finding of this study show that peer supervision benefited nurse managers in quality management through reflection and support. The reflective and supportive characteristics of peer supervision promoted the nurse managers' individual development, but also that of leadership. It can be concluded that peer supervision promotes quality management in nurse managers' work.

Attitude of Health Personnel↗
PubMed2001

Multiprofessional clinical supervision: challenges for mental health nurses.

Recent reform and developments in mental health care provision have increasingly espoused the value of multiprofessional teamwork in order to ensure that clients are offered co-ordinated packages of care that draw on the full range of appropriate services available (DoH 1999a; DoH 2000). Supervision in some form is seen as a key part of all professional practice to provide support to practitioners, enhance ongoing learning, and, to a greater or lesser degree, offer some protection to the public (Brown & Bourne 1996, UKCC 1996). Clinical supervision has gained increasing momentum within the nursing profession, but to a large extent this has been within a uni-professional framework -- nurses supervising other nurses. This paper seeks to explore the ways in which multiprofessional working and clinical supervision interlink, and whether supervision across professional boundaries might be desirable, possible, and/or justifiable. Whilst our own view is that multiprofessional supervision is both possible and desirable, we seek to open up a debate, from our perspective as mental health nurses, about some of the issues related to the concept. Our motivation to explore this topic area emanates from our experiences as supervisors to colleagues within multiprofessional teams, as well as the experiences of those attending supervisor training courses. Following a brief overview of the development of clinical supervision in mental health care and recent policy guidelines, some models of clinical supervision are reviewed in terms of their suitability and applicability for multiprofessional working.

Clinical Competence↗
PubMed2006

Group supervision in facilitating learning and teaching in mental health clinical placements: a case example of one student group.

Clinical supervision has become an essential component in nursing practice. This paper explores the experiences of two small groups of Finnish Registered General Nurse students receiving supervision during a clinical placement in mental health care (N = 23). Both groups worked in similar clinical placements, with one group receiving group supervision, the other individual supervision. Students reported that group supervision was a positive experience and a good alternative to the traditional supervision they had received earlier. Group supervision allowed students to begin to address their fears and anxieties over their ability to deal with the unfamiliar emotional and psychological demands of practice. Eighteen students reported that the staff nurse mentor was most important in helping them better understand the core concepts and practice of nursing. All the students who thought that nurse teacher was important in this regard came from the group supervision group.

Adult↗
PubMed2006

Group-format clinical supervision for hospice nurses.

This paper discusses the aspects of a small research study, which used mixed research methods. The study concerned group-format supervision as a means of helping five hospice nurses, four women and one man, discuss their work experiences. An aim of the study was to understand something of the professional work of hospice nurses and how they might best be supported. Ethical considerations and some benefits derived by group members from clinical supervision are summarized in the context. The research method entailed 12 sessions of group-format clinical supervision. The discussion explores the forming, management and dynamics of a small clinical supervision group. Hospice work is emotionally demanding of nurses. Nurses throughout this small study thought over issues concerning serious illness, death and bereavement, as well as working together as a supervision group. Group-format supervision is potentially helpful to nurses examining professional practice. However, group work can be as challenging to participants as it is helpful. The discussion concludes with an appraisal of the potential gains for nurses from clinical supervision in group-format. This paper proposes that supervision groups could help hospice nurses to identify and explore issues related to professional practice. Adequate preparation of nurses, organizational support and the competency of group facilitators should be considered critical to safe and effective management of professional groups.

Adaptation, Psychological↗
PubMed2004

Client supervision: meaning and experiences from the perspective of Norwegian public health nurses.

The aim of the present study was to examine the meaning and experiences of client supervision from the perspective of Norwegian public health nurses. The World Health Organization (WHO) states that new intervention strategies to improve public health are necessary. Supervision represents such a strategy. Three focus groups were interviewed twice. The data were analyzed by qualitative content analysis. The findings revealed three themes: (i) the meaning of the umbrella term client supervision; informing, teaching, giving advice and ensuring the quality of supervision; (ii) factors influencing supervision; the public health nurses' available time and competence and the clients' ability to be supervised; and (iii) events and content representing the complexity of conducting supervision. In conclusion, the width of the concept, the influencing factors and the complexity claim that public health nurses have competence to supervise.

Counseling↗