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PubMed1996

The organization of clinical supervision within the nursing profession: a review of the literature.

There is a considerable amount of literature available on the subject of supervision within the nursing profession. However, there appears to be little structure regarding how this subject is organized within the professional literature. Thus, although the subject of supervision appears within the nursing literature as a fairly consistent theme, there has been little or no attempt by the profession to give structure to either its underpinning theory or its practice. It is apparent that the term 'supervision' within the nursing profession has different meanings for different individuals and groups. In an attempt to explore the literature relating to the United Kingdom, the author has developed a structure for the review, based upon his reading of the literature and his own experience within the profession. The review covers five areas. The first area is that of examining the need for clinical supervision within the practice of nursing. The second area of the review identifies the various ways in which the concept of supervision is used in practice, particularly identifying the variety of terminology. The third area of the review is that of the profession's perception of good practice regarding supervision. The fourth area of the review seeks to identify various models of supervision as they are used within the nursing profession. Lastly, the preparation and training for the role of supervisor is reviewed.

Clinical Nursing Research↗
PubMed2006

Efficacy of clinical supervision: influence on job satisfaction, burnout and quality of care.

AIM: This paper reports a study to determine how supervisees' backgrounds and surrounding infrastructure predict the efficacy of clinical supervision among Finnish nursing staff, their job satisfaction, levels of burnout and perceptions of the quality of care. BACKGROUND: Several studies have described the effects of clinical supervision, but few have focused on evaluating it. Until recently, no studies have examined how clinical supervision evaluations are related to supervisees' backgrounds, surrounding infrastructure or respondents' levels of burnout, job satisfaction and perceptions of the quality of care. METHODS: The survey involved supervisees completing a range of standardized and validated evaluation measures. The respondents were identified from 12 regional, central and university hospitals across Finland (n = 799). The data collection took place from October 2000 to February 2001. FINDINGS: The evaluations varied statistically significantly and were associated with statistically significant variations in the respondents' backgrounds. Clinical supervision infrastructure was also strongly related to evaluation scores. Supervisees' age, education, gender, employment status, area of specialty, working hours, work experience and experience as a supervisor were statistically significant predictors for evaluations of the efficacy of clinical supervision. These evaluations of clinical supervision were also found to predict the respondents' job satisfaction, levels of burnout and assessments of good nursing. CONCLUSION: Nursing staff, especially those who have over 10 years' work experience, work in general care, have a nursing diploma, are non-tenured, work part-time and work 24-hour rotating shifts can benefit from clinical supervision. However, resources need to be invested in supervisor education and nursing staff need to be encouraged to start working in both supervisor and supervisee roles because of the positive effects on job satisfaction and quality of care.

Adult↗
PubMed2005

Factors influencing the effectiveness of clinical supervision.

Clinical supervision is widely accepted as an essential prerequisite for high quality nursing care. This paper reports findings from a study that aims to identify the factors that may influence the effectiveness of clinical supervision for community mental health nurses (CMHNs) in Wales, UK. Two hundred and sixty (32%) CMHNs from an estimated total population of 817 completed the Manchester Clinical Supervision Scale (MCCS) and a demographic questionnaire. The MCCS is a 36-item questionnaire measuring the quality and effectiveness of the supervision received. Three-quarters of CMHNs reported having participated in six or more sessions of supervision in their current posts. Clinical supervision was more positively evaluated where sessions lasted for over one hour, and took place on at least a once-monthly basis. Perceived quality of supervision was also higher for those nurses who had chosen their supervisors, and where sessions took place away from the workplace. These findings have important implications for the organization and delivery of mental health nursing services.

Adult↗
PubMed2006

The value of caring in nursing supervision.

AIM: The aim of this study was to explore and describe nurse supervisors' views of the value of caring in nursing supervision and how they strive to make this value visible. BACKGROUND: The academic part of nursing education presupposes scientifically based nursing knowledge. Several strategies have been suggested for ensuring high-quality clinical nursing education, including nursing supervision, as it facilitates the fusion and integration of theory and practice. To achieve high-quality nursing supervision it is important to describe the supervisors' interventions. METHOD: Data were collected by means of focus group interviews and analysed by qualitative content analysis. FINDINGS: Four themes emerged: genuine encounter, consciousness of one's own value base, confirmation and a relationship characterized by learning and consolation. The supervisors' description of how they strived to make the value of caring in nursing supervision visible can be expressed as follows: the value of caring is inherent in all aspects of nursing supervision; in the narratives of the patients' situations; in relation to the professional role; and in the benefits of participating in group supervision. CONCLUSIONS: The value of caring in nursing supervision was described as a genuine encounter, consciousness of one's own value base, confirmation and a relationship characterized by learning in addition to providing consolation. The role of the supervisor is characterized by three dimensions: willingness, knowledge and courage.

Attitude of Health Personnel↗
PubMed2006

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.

Adaptation, Psychological↗
PubMed2006

Multidisciplinary attitudinal positions regarding clinical supervision: a cross-sectional study.

AIM: The aim of this study was to describe multidisciplinary attitudes towards/about Clinical Supervision. BACKGROUND: Clinical Supervision continues to be a matter of high interest for nurses and other health care disciplines. Despite the existence of a body of a substantive literature, gaps in our knowledge base remain. DESIGN: Data was collected using a form composed of 17 statements. A total sample of 74 participants completed the form and rank-ordered the statements. The sample was comprised of a mix of eight different disciplines: Registered Nurses (hospital based), Chiropodists, Occupational Therapists, Learning Disability Nurses, Registered Nurses (community based), Registered Mental Health Nurses, Health Visitors and Physiotherapists. Data were analyzed by descriptive and non-parametric statistics. RESULTS: The respondents' agreement was high concerning the rankings of the item (11) ''Confidentiality is assured and agreed''. Almost all respondents ranked this item as the most important characteristic for group supervision. The respondents shared almost a total agreement concerning the item (17) ''The supervisor should be a manager''. This was ranked as the least important characteristic for group supervision. CONCLUSION: The importance of having a clinical supervisory relationship that remains separate from administrative/managerial supervision and one where confidentiality is assured was highlighted by this study. Furthermore, the attitudes were not restricted to one professional or disciplinary group. The effective support system of clinical supervision should therefore not be diluted by awkward and unnecessary amalgamations with administrative/managerial supervision.

Attitude of Health Personnel↗
PubMed2005

Public health nurses' supervision of clients in Norway.

AIM: The aim of this study was to explore and describe what public health nurses (PHNs) understand by client supervision and how they perform it. BACKGROUND: The main principles of the health promotion discourse initiated by the World Health Organization (WHO) over the last 20-30 years are client participation and the view of the client as expert. Supervision is one relevant intervention strategy in the empowerment process, in which these principles play a central role. There is a lack of research pertaining to the intervention models employed by PHNs. METHODS: Twenty-three transcribed audiotaped dialogues between PHNs and their clients were analysed by means of qualitative content analysis. FINDINGS: What the PHNs understand by supervision and how they perform it can be described by three themes: continuity in relationships and reflexivity in the supervision approach, communicating with the client about his/her needs, problems and worries; and the organization of client supervision. CONCLUSIONS: The PHNs in this study understand client supervision as communication and relationships with clients on the subject of a healthy lifestyle, child development and coping with everyday life. The PHNs' approach to client supervision seemed to include aspects of empowerment by means of client participation and the view of the client as expert. However, the PHNs themselves had an expert role.

Child↗
PubMed2005

The effect of two models of supervision on selected outcomes.

PURPOSE: To evaluate the effect of training in two different supervisory models on the supervision itself, the quality of care, and job satisfaction of nurses in different service settings in a district health service (DHS) in South Africa. DESIGN: As part of a larger health systems study, the results of supervision training were evaluated. The quantitative study was done in three health districts in South Africa. METHODS: The modified matrix (MM) model of supervision was taught and implemented in District A, the Centre for Health and Social Studies (CHESS) model in District B, and the control was District C. Checklists based on direct observation and record reviews were used to measure quality of care (quality of hand-over between shifts, nursing records, management of chronic diseases, and implementation of universal precautions). Questionnaires were used to measure perception of supervision and patient satisfaction. Chi-square analysis was done. FINDINGS AND CONCLUSIONS: Supervision ratings before and after the interventions differed significantly in the total sample, but not by district. In the district with the MM model, care for people with chronic diseases improved significantly, but other measures did not. The supervision training had some influence, but more measures of effectiveness of supervision training are needed.

Attitude of Health Personnel↗
PubMed2006

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.

Attitude of Health Personnel↗
PubMed1999

Training and supervision needs and experience: a longitudinal, cross-sectional survey of accident and emergency department senior house officers.

The aim of this study was to investigate senior house officers' (SHOs) perceptions about their training needs, satisfaction with teaching and supervision, and the relationship this has with psychological distress levels. All 171 SHOs employed within 27 accident and emergency (A&E) departments in the South Thames region were sent questionnaires at the start of their attachments in A&E, at the end of months four and six. The questionnaires asked SHOs to rate on visual analogue scales their perceived need for further training for 23 clinical and practical activities relevant to A&E practice. At the end of the fourth month SHOs were asked to indicate who had provided them with the most valuable teaching and supervision, indicate their satisfaction levels with training received, and suggest ways to improve teaching and supervision. SHOs' psychological distress levels were measured in all three questionnaires. Overall, satisfaction with supervision and training was mixed. SHOs perceived greatest need for further training in areas encountered less frequently in A&E. Registrars were the most valued providers of supervision and teaching. Increased numbers of middle grade staff and protected study time were suggested as ways to improve supervision and teaching. SHOs with higher scores for training need at the end of their attachment in A&E expressed significantly less satisfaction with training and higher psychological distress levels. The variation between SHOs' perceptions of training needs indicates the importance of tailoring training and supervision to individual requirements.

Cross-Sectional Studies↗
PubMed2001

The Columbia Supervision Project: data from the dyad.

Anonymous questionnaires were sent to all candidates and supervisors at the Columbia University Center for Psychoanalytic Training and Research (hereafter "Columbia"). Questions focused on the four domains most emphasized in the literature on supervision: logistical issues; the "teach or treat" question; the evaluatory function of the supervisor; and the affective experience of supervision. By coding the questionnaires, anonymity of respondents was maintained while allowing for a matched pair of analyses of supervisors and supervisees. Return rate was over 85 percent. In general, rates of satisfaction with supervision were high, and candidates and supervisors agreed on such issues as the "teach or treat" question, as well as the technical and theoretical frame of reference of the supervisor. However, there were striking disagreements between candidates and supervisors as to the role of the supervisor, what candidates find useful in supervision, the evaluatory function, and the relation between supervision and progression to graduation. Although 50 percent of candidates reported anxiety about receiving credit for cases, this was not routinely discussed in supervision, and the supervisory relationship itself was not discussed in over 50 percent of dyads. Despite high overall satisfaction ratings, 25 percent of candidates said they wished they had a different supervisor for the case, and 75 percent believed that a candidate who asked to switch supervisors would be labeled problematic. In contrast, over 75 percent of supervisors reported that switching supervisors carries no stigma. In a follow-up study conducted one year later, many candidates reported that they feared reprisals for switching, and some reported that their training analysts advised against "rocking the boat." Candidates felt that participating in the study emboldened them to think more openly about supervision and in some cases to make changes.

Accreditation↗
PubMed1976

Utilizing reflected countertransference Applying the reflection process as a teaching tool in supervision.

There are times when teaching cannot proceed through the abstract presentation of content and must progress by the demonstration of what is to be taught. This is true whenever a student is unable, for whatever reason, to appropriately apply such abstract material to the concrete task before him. This may be due to a number of factors, one of the most common of which is the lack of qualitatively similar experiences to which to refer. The teaching of complicated processes such as psychotherapy is an example, especially when the trainee is relatively unsophisticated and/or seems unable to abstract from discussion of blocking phenomena, where it may become necessary to "act in" the feeling tones which are to be the cues for the behaviour to be learned, instead of persisting with abstract interpretations. When, in supervision, a supervisee recreates the conditions existing in the therapeutic situation, this procedural behaviour is called the "Reflection Process". This process often appears to be unconsciously motivated by the need of the supervisee to solicit from the supervisor a practical demonstration which he does not know how to solicit otherwise. Even if the Reflection Process is due mainly to unresolved, unconscious conflicts of the supervisee, it can be a useful clue as to what transference-countertransference problems he is having difficulties with. The fact that such behaviour on the part of the supervisee may arise out of unresolved unconscious conflictual material should not become a reason for dismissing it. Instead, supervisors should become proficient at recognizing the countertransferential feelings in themselves, which can be an accurate reflection of the feelings troubling the supervisee in his dealings with this patient; and they should recognize the distress signal on the part of the supervisee, which can often be responded to constructively. In the supervision, the supervisor at times can, almost unwittingly, come to play the role which the supervised therapists plays in the supervised therapy and, if not aware of the Reflector Process, he may not realize that the countertransferential feelings which underly his assuming that role may not be primarily a response to the character of the therapist he is supervising but rather to that of the patient. They may also be a reflection of the process problem in the supervised therapy. It is not essential that this process be labeled in the supervision; what is essential is that its ramifications be recognized by the supervisor.

Allied Health Personnel↗
PubMed2004

An audit of clinical supervision in primary care.

This article reports on an audit of clinical supervision in one primary care trust (PCT). Data were collected by telephone interviews with 44 respondents from a range of professions occupying different clinical and managerial grades in the organization. Clinical supervision was varied both in terms of its availability and management between different professional groups and teams reflecting, in part, differing levels of motivation towards supporting clinical supervision by individual practitioners and managers as well as a perceived lack of trust leadership. Respondents also reported several potential and actual benefits of clinical supervision, including the improvement and standardization of practice and the facilitation of learning and professional development, although there was no consensus regarding the most appropriate format (e.g. individual, group or team) or structure (e.g. uni-professional or multi-professional) for clinical supervision. It was widely agreed that the introduction of mechanisms for monitoring both the process and outcomes of supervision, greater protection of time allocated for supervision and more training opportunities to increase the skill and number of available supervisors were needed.

Clinical Competence↗
PubMedDate not supplied

Legal aspects of clinical supervision 1: Employer vs employee.

In order to implement clinical supervision some major issues need to be clarified. This article looks at clinical supervision in terms of the relationship between the employer and the employee. It discusses clinical supervision as a contractual requirement and a voluntary system and examines some of the related problems. The implementation of clinical supervision may be limited by the significant cost of training. Possible frameworks for setting up a system for supervision are suggested. Employers need to be adequately informed about the clinical supervision process so that it can become both effective and flexible. The second article in this series will consider legal issues relating to professional accountability, patients' rights, and records and record keeping. These two articles refer to information generated from a workshop held at Prince Philip Hospital, Llanelli, in which practitioners looked at some of the legal issues relating to clinical supervision.

Contract Services↗
PubMedDate not supplied

To record or not to record: documentation in clinical supervision.

Despite the continued interest of nurses in clinical supervision there remain many unanswered questions and unresolved issues. One such key issue is that of record keeping within clinical supervision. Consequently, this article reviews the limited literature that addresses this issue. It is evident that there are three principle discrete positions regarding recording in supervision and these are summarized as (1) the superviser records minimum data to meet the needs of audit (2) the supervisee makes extensive notes for his/her learning journal, reflective diary and (3) the superviser records headings or key words to be used as an aide-mèmoire. The article then uses three case studies to illustrate particular concerns that the trainee supervisees have raised with regard to record keeping that centre around these three positions, and discusses the issues that arise from these concerns. As a result of this discussion, the author reasons that, when entering supervision, either as a new superviser or as a supervisee, it may well be necessary and beneficial to give mind to issues of recording. While it is unlikely that there is one 'perfect way' that will suit every practitioner, the article concludes with some general guidelines whih may help in this deliberation.

Clinical Competence↗
PubMedDate not supplied

Reported level of supervision of young children while in the bathtub.

BACKGROUND: Unintentional drownings cause over 600 deaths annually among children < or =5 years of age. Bathtubs are one of the leading sites for such drownings for children < or =2 years of age and especially for children 1 year or younger. OBJECTIVE: To determine reported levels of supervision of children while they are in the bathtub. METHODS: A face-to-face questionnaire was administered to a convenience sample of parents or guardians of children < or =5 years of age who presented to the emergency centers of 2 children's hospitals. The investigators developed a 17-point survey that included items related to general demographics and bathtub supervision. Parents and guardians were asked details concerning who supervised while the child was bathing, any unsupervised periods, length of unsupervised periods, and activities during any unsupervised periods. RESULTS: A total of 259 families participated in the survey (16% Caucasian, 79% African American, 1% Hispanic, 3% Asian, and 1% biracial). The mean caregiver age was 29.1 years (SD 7.9). The mean age of the child was 30.5 months (SD 22). Overall, 31% of the respondents reported leaving their child unsupervised for some period of time in the bathtub. The mean age of children left alone was 37.5 months, with the youngest being 5 months old. Seventeen percent of children < or =24 months of age (N = 123, mean age 12.7 months) and 15% of children < or =12 months of age (N = 60, mean age 6.7 months) were reportedly at times left unsupervised in the bathtub. Common caregiver activities when leaving the child unsupervised included getting a towel or diapers, answering a phone, and cooking. A 5-month-old child was left unsupervised for >2 minutes, and an 8-month-old child was reportedly left unsupervised for >5 minutes to cook a meal. In addition, 20 of 259 respondents (7.7%) reported that their children bathed alone before the age of 5 years, and 4 respondents (1.5%) reported that their children bathed alone before the age of 2 years. Although most primary supervisors were adults, 5 children were at times supervised by children <10 years of age. No significant differences were seen based on the hospital, race, or educational level of the families. CONCLUSIONS: Many parents reported leaving their young children at times inadequately supervised in the bathtub. This occurred in children as young as 5 months of age. Given the potential risk of drowning when their children are inadequately supervised, parents should be advised concerning proper supervision in early anticipatory guidance.

Adult↗
PubMed1996

Supervision and consultation services for pediatric occupational therapists.

OBJECTIVE: Occupational therapists with advanced experience or expertise provide supervision and consultation services in a variety of settings. This pilot study examined the use of such supervision and consultation services by pediatric occupational therapists. METHOD: Special education administrators and pediatric occupational therapists from Massachusetts, a state often regarded as a leader in special education, responded to surveys designed especially for this study. These surveys asked about current supervision and consultation use, satisfaction with present services, and the need for additional resources in this area. Opinions regarding practice areas that would best be addressed by supervision and consultation were also obtained. RESULTS: Both administrator and therapist respondents agreed that expert occupational therapy supervision and consultation are needed. Identified areas of interest were classroom supervision and consultation strategies, service delivery decisions, and evaluation methods. CONCLUSION: Pediatric occupational therapists need expert supervision and consultation from occupational therapists with advanced experience or expertise in addition to traditional management, education, and training methods.

Administrative Personnel↗
PubMedDate not supplied

Research supervision.

BACKGROUND: Nurses are expected to base their practice on research, and to carry out research themselves. Whereas research supervision is useful to the experienced researcher, it is vital to the novice. It is surprising, therefore, that there is little published work on research supervision. Practical advice based on first-hand experience is the focus for most work and, ironically, very little of that available is research based. This literature review is categorised into three main sections: the supervision relationship, good practice in supervision, and the context of supervision. A review is necessary to address what information is known, to provide guidance both to supervisors and supervisees, and to highlight the need for further work. CONCLUSION: The little research evidence that is available suggests a way forward based on practical experience of both supervising and being supervised. The implications of this are briefly outlined.

Benchmarking↗