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[The reference nurse--position on the practice of training and supervision].

This qualitative research discusses the nurse known as the reference nurse who is more specifically in charge of the training and supervision, and evaluation of the student nurse who has in-service training in care unit. The research notably describes the practice and position of the Reference Nurse (hereafter RN) in this role. As the aim is to know better the practice of the RN for the training and supervision of student nurses, this is an approach of mutual understanding that every RN is individually interviewed, then that researchers meet them again, this time in groups (by region), which enables among other things, to discuss certain positions which came out of a first analysis of discussions. In this aim, within a university hospital, twenty-four nurses working in internal Medicine, Psychiatry and Surgery, were interviewed by a research team. The context of this research is particular and interesting in several respects. The research was carried out in partnership between two institutions, one institution of university care and one institution of training in nursing care; the research team therefore includes people from both institutions. It is the encounter of two worlds that have a joint function, that is to train nurses, but that also have trend and themes that are specific to them, or even antinomic; all this in a context of educational and organizational changes of the nursing training. The research themes are the activities of training and supervision carried out, the arbitration of their caring and educational practice, the key moments of training and supervision, their objective look at this role, the ideal thing as they would see it. RN described a system which is not much formal, essentially marked out by key moments such as the entry in the care unit of the student, the welcome, exchanges with the student, punctuated with educational assessment and end-of-training assessment. When giving to the patients, RN develop some forms of activities with the student which ensure the work prescribed on behalf of their responsibilities, while trying to adapt themselves and interact with the student as well as with the contextual situation. The student's questions are uses as much to check her knowledge, her understanding of the caring situations, her ability to get organised, to argue as to understand her better in her real-life experience, her self-esteem, to put her well at ease, in confidence to facilitate her apprenticeship. The quality of dialogistic communication is strongly emphasized as necessary to training and supervision. Evaluation is an important part of the supervisory work and reference nurses actually showed a tension between a control position and a confidence position in the practice of the student's follow-up. RN expressed their wish to have specific time to train and supervise the student, would like to increase partnership with schools, and requested some educational support. Their talks brought to light the various skills, as much technical as social, that this role of training and supervision requires, but also the emancipatory impact of these various roles held.

Adult↗

Therapy supervision: the phenomena and the need.

Nursing has lagged behind in development, utilization, and valuing of therapy supervision. Nevertheless the mental health nursing clinical specialist is expected to be supervised and to be a supervisor of other professional staff. The integral nature of supervision in mental health nursing practice is demonstrated when one defines "therapy supervision," identifies its characteristics, and studies its clinical phases. As the role of the mental health clinical nurse specialist continues to expand, the importance of supervision in developing high level therapeutic skill has become more evident. In this paper various meanings of the concept of supervision and its similarities and differences with associated concepts, such as teaching and therapy, are explored. Essential characteristics are identified, and the application of the concept in practice and research is discussed. The inclusion of supervision training in graduate nursing curriculum, continuing education and in-service programs is advocated.

Education, Nursing↗

Nurses' perceptions of the elements of good supervision.

This paper explores the concept of good clinical supervision from the perspective of the nurse being supervised. A focused discussion with a group being supervised was used to develop a questionnaire, which was then given to 50 post-registration students who were receiving formal clinical supervision (seven students were on the ENB higher award and 43 were on ENB clinical award courses). A number of characteristics of good supervision were identified. These were grouped into one of three themes: relevant knowledge, supervisory/teaching skills and personal relationship skills. This paper is part of a larger study that aimed to explore the concept of good clinical supervision from the perspectives of the supervisor, the person being supervised, the professional bodies and nursing lecturers.

Attitude↗

Differences in labor and delivery experience in family physician- and obstetrician-supervised teaching services.

BACKGROUND: Other studies have shown that family physicians' pregnancy management styles are different from obstetricians' styles. This study examines whether these differences also exist in teaching services supervised by family physicians and obstetricians. METHODS: A retrospective study was done of deliveries performed by residents at five teaching hospitals in five states. A total of 4,558 women were admitted to teaching services supervised by either family physicians (n = 1,754) or obstetricians (n = 2,804). Medical records for women whose labor and delivery were supervised by family physicians and obstetricians were reviewed and compared for demographics, pregnancy history, delivery management, and outcome variables. RESULTS: Women admitted to teaching services supervised by family physicians were more likely to be younger and have no insurance, compared with those on services supervised by obstetricians. Even after adjustment for pregnancy risk, obstetrician-supervised teaching services had an increased incidence of preterm labor, more frequent use of epidural anesthesia, and higher episiotomy and cesarean section rates than family practice teaching services. CONCLUSIONS: The demographic and clinical characteristics of family practice and obstetric teaching services differ. Patients on the services supervised by family physicians were more representative of the maternity practice of practicing family physicians.

Delivery, Obstetric↗

NanoSSL: attention mechanism-based self-supervised learning method for protein identification using nanopores.

MOTIVATION: Nanopores are cutting-edge interdisciplinary tools that can analyze biomolecules at the single-molecule level for many applications, e.g. DNA sequencing. Efforts are underway to extend nanopores to proteomics, including the development of machine learning algorithms for protein sequencing and identification. However, single-molecule data are intrinsically noisy and hard to process. Moreover, the development and performance of machine learning for nanopore is jeopardized by data scarcity. Self-supervised learning is an emerging method that may yield advantages in nanopore scenarios. RESULTS: We propose and experimentally validate Nanopore analysis using Self-Supervised Learning (NanoSSL), a generative self-supervised learning framework based on attention mechanisms for the identification of protein signals from nanopores. Leveraging a two-step approach consisting of self-supervised pre-training and supervised fine-tuning, NanoSSL learns useful feature representations from empirical data to facilitate downstream classification tasks. Inspired by the concept of fragmentation in conventional protein sequencing technologies, during pretraining each translocation event is split into multiple non-overlapping fragments of equal size, some of which are randomly masked and reconstructed using a masked autoencoder. Learning the feature representations of the reconstructed nanopore events facilitates molecular identification in fine-tuning. In this study, we retested a publicly available nanopore multiplexed protein sensing dataset for model iteration, and subsequently measured Alzheimer's disease biomarker Aβ1-42 using homemade solid-state nanopores. Empirical results indicated NanoSSL achieved an unprecedented performance across four metrics: accuracy, precision, recall, and F1 score, when classifying two mutated Aβ1-42, E22G and G37R. The self-supervised learning and attention mechanism were verified as the source of performance gains. AVAILABILITY AND IMPLEMENTATION: The main program is available at https://doi.org/10.5281/zenodo.17172822.

Nanopores↗

Remotely Supervised, Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder: Systematic Review and Meta-Analysis.

BACKGROUND: Major depressive disorder affects over 280 million people worldwide, and access to effective treatment remains limited. Transcranial direct current stimulation (tDCS) is a noninvasive option, and portable devices now allow for home-based delivery under varying degrees of remote supervision. OBJECTIVE: This study aimed to systematically review and meta-analyze the efficacy, safety, feasibility, and acceptability of home-based and remotely supervised tDCS for depressive disorders. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidelines, we searched MEDLINE, Embase, Web of Science, the Cochrane databases, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to July 2025, with backward and forward citation searching. Two reviewers independently screened records, extracted data, and assessed risk of bias (version 2 of the Cochrane risk-of-bias tool for randomized trials, Newcastle-Ottawa Scale for observational studies, and Critical Appraisal Skills Programme for qualitative studies) and certainty of evidence (Grading of Recommendations Assessment, Development, and Evaluation; GRADE). RESULTS: This review included 12 distinct studies (16 reports), of which 6 (50%) were randomized sham-controlled trials forming the meta-analytic pool. Active home-based tDCS produced a small, statistically significant improvement over sham (pooled Hedges g=0.36, 95% CI 0.06-0.66; P=.03; I2=34.3%). The effect was not robust to removal of the single largest positive trial (omitting the one study from 2025: g=0.39, 95% CI -0.12 to 0.91), and trial-level results were mixed: the 2 largest trials (one unsupervised [n=210] and one self-administered [n=141]) were negative on their primary depression outcomes, whereas the largest real-time supervised trial (n=174) was positive (between-group 95% CI 0.51-4.01; P=.01). This estimate was concordant in direction with an independent peer-reviewed meta-analysis of overlapping trials, which reported a pooled Montgomery-Åsberg Depression Rating Scale reduction (weighted mean difference -2.74, 95% CI -4.19 to -1.29) and Hamilton Depression Rating Scale reduction (weighted mean difference -2.24, 95% CI -4.16 to -1.49), attenuating to nonsignificance (P>.05) in major depressive disorder without comorbid cognitive impairment. The pooled effect fell at or near the minimal clinically important difference. GRADE certainty was moderate. Adverse events were predominantly mild: one pilot study was terminated early for skin lesions, and one nonfatal suicide attempt occurred in an unsupervised trial. CONCLUSIONS: Home-based and remotely supervised tDCS produces a small, statistically significant but clinically modest antidepressant effect that is sensitive to the inclusion of the largest positive trial, with the 2 largest trials being negative. The available controlled evidence does not establish supervision intensity as a determinant of efficacy. Current data are insufficient to recommend routine clinical adoption; adequately powered trials with standardized supervision and longer follow-up are needed.

Humans↗

Group supervision in psychotherapy: the relationship between focus, group climate, and perceived attained skill.

This study examined supervisees and supervisors' view on focus and group climate in group supervision and their relationship with supervisees' attained skill. After supervision, supervisees completed a revised version of Buckley's measure of psychotherapeutic skill. Supervisees and supervisors' experience of focus and climate in the supervision was measured with a questionnaire, Topics and Climate (TAC). The results showed that supervisors' ratings of the extent to which different foci were used in the supervision were significantly higher compared to supervisees' ratings. Hierarchical regression analysis showed that differences in supervisor style were related to supervisees' experience of attained skill. Supervisees' experience of the degree to which focus in supervision was on psychodynamic processes was positively related to perceived attained skill, whereas focus on Theoretical aspects was negatively related. These findings underline the importance of research work with topics and group processes in group supervision.

Adult↗

Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals.

BACKGROUND: There has been concern that a reduced level of surgical resident supervision in the operating room (OR) is correlated with worse patient outcomes. Until September 2004, Veterans' Affairs (VA) hospitals entered in the surgical record level 3 supervision on every surgical case when the attending physician was available but not physically present in the OR or the OR suite. In this study, we assessed the impact of level 3 on risk-adjusted morbidity and mortality in the VA system. METHODS: Surgical cases entered into the National Surgical Quality Improvement Program database between 1998 and 2004, from 99 VA teaching facilities, were included in a logistic regression analysis for each year. Level 3 versus all other levels of supervision were forced into the model, and patient characteristics then were selected stepwise to arrive at a final model. Confidence limits for the odds ratios were calculated by profile likelihood. RESULTS: A total of 610,660 cases were available for analysis. Thirty-day mortality and morbidity rates were reported in 14,441 (2.36%) and 63,079 (10.33%) cases, respectively. Level 3 supervision decreased from 8.72% in 1998 to 2.69% in 2004. In the logistic regression analysis, the odds ratios for mortality for level 3 ranged from .72 to 1.03. Only in the year 2000 were the odds ratio for mortality statistically significant at the .05 level (odds ratio, .72; 95% confidence interval, .594-.858). For morbidity, the odds ratios for level 3 supervision ranged from .66 to 1.01, and all odds ratios except for the year 2004 were statistically significant. CONCLUSIONS: Between 1998 and 2004, the level of resident supervision in the OR did not affect clinical outcomes adversely for surgical patients in the VA teaching hospitals.

Female↗

Supervision in social health insurance: a four country study.

This article presents the results of an international comparative study of a widely neglected element in social health insurance: supervision upon the sickness funds as implementing agents of social health insurance. The following countries were included: Belgium, Germany, Switzerland and the Netherlands. A comparative analysis of the institutional structure of supervision revealed many differences. The goals of supervision are more or less the same in each country: preserving the lawfulness of implementation; ensuring trust and stability; preserving efficiency and supporting policymaking. The analysis of the supervision process focused upon three sub-processes: the collection of information; the assessment of the performance of the sickness funds and interventions to correct deviant behaviour. Finally, the analysis deals with changes in supervision, in particularly the impact of market competition in social health insurance upon supervision. It is argued that market competition will substantially alter the role of supervisory agents in social health insurance.

Belgium↗

Concordance between supervised and postal administration of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) was very high.

BACKGROUND AND OBJECTIVE: There is increasing international interest in using patient-based outcome measures to evaluate interventions. We compared responses to postal administration of Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) with the gold standard of supervised self-completion. STUDY DESIGN AND SETTING: Validation study involving 96 adults, recruited from U.K. general practice, sent the postal questionnaires with an instruction sheet 1 week before supervised self-completion. Responses for those whose quality of life (n=56) or asthma control (n=61) had 'not changed' between postal and supervised completions were compared using paired-sample t-tests, Pearson's correlation coefficient (r), and intraclass correlation coefficient (ICC). RESULTS: For the MiniAQLQ, overall mean scores were similar in both groups: Postal=5.14 (SD=1.42) vs. Supervised=5.17 (SD=1.39), with mean difference of -0.03 (95% CI=-0.14, 0.08; P=.59), with a high degree of correlation (r=.96, P<.001) and concordance (ICC=0.96; 95% CI=0.93, 0.98; P<.001). For the ACQ, overall mean scores (with SD) were also similar in both groups: Postal=1.24 (SD=1.09) vs. Supervised=1.26 (SD=1.10), with mean difference of -0.02 (95% CI=-0.12, 0.08; P=.74), with good correlation (r=.94, P<.01) and concordance (ICC=0.94; 95% CI=0.90, 0.96; P<.01). CONCLUSIONS: Correlation and concordance between supervised and postal administration of the MiniAQLQ and ACQ are very high. Users may confidently choose the mode of administration most appropriate to their needs.

Adult↗

Supervision in childhood injury cases: a reliable taxonomy.

This paper describes the development of the "Chicago Children's Supervision Taxonomy" which operationally defines supervision based on the age of an injured child and the ages, familiarity, and proximity of that child's companions. The reliability, coverage, and utility of this taxonomy are illustrated by its application to 142 cases of urban childhood pedestrian injury. All cases were unambiguously classified with good interrater reliability. Most injured children were in unsupervised groups (42%) but 36% had supervisors nearby, thus, supervisor presence does not guarantee protection. Supervising more than one child (especially likely when the supervisor was a teenager) may increase injury risk compared with one-to-one supervision. The taxonomy provides a needed framework adaptable for describing direct supervision in most child injury situations and can facilitate studies of more complex aspects of supervision.

Accident Prevention↗

Peer supervision: an experimental scheme for nurse lecturers.

This paper reports on the implementation of a scheme of peer supervision in a team of mental health nursing lecturers working within a university setting. The rationale for the introduction of this scheme was the implementation of clinical supervision in nursing nationally and the role nurse education can play in this. Supervision is advocated as a way of providing education, support and quality checks for lecturers involved in supervising students. The peer supervision scheme is described and the experience of the lecturers involved discussed. The authors stress the value of this innovation to their professional lives and promote it as a good way of contributing to the implementation of clinical supervision in mental health nursing.

Attitude of Health Personnel↗

Parallel process in clinical supervision: enhancing learning and providing support.

The introduction of clinical supervision in nursing is gaining momentum and is proposed as having numerous benefits for nurses, organizations, and ultimately patient care. The necessity for such supervision has arisen partly from a fundamental shift in the nature and definition of nursing work. The emphasis on individualized, holistic care has led to a change in role from one characterized by professional distance to one in which interpersonal involvement is seen as central. Such a shift, though seen as positive, may lead to increased vulnerability as nurses negotiate the blurred boundaries between the personal and the professional in their relationships with patients. Such boundary negotiation is a legitimate focus for learning and support in clinical supervision. However, as with many aspects of nursing, the subtle processes involved in relationship development are often hidden from consciousness, thus missing potential learning opportunities. One way that such hidden aspects of practice may be explored in clinical supervision is through attendance to the way that such processes are parallelled in the supervisory relationship. Drawing on theory and practice from the fields of counselling and mental health nursing, this paper explores the nature of 'parallelling' in clinical supervision. The implications for clinical supervision in nursing more generally are examined in relation to enhancing learning and providing support for supervisees and supervisors.

Clinical Competence↗

Clinical supervision for 'potent' practice.

The author has received regular supervision since completing his training in biodynamic massage therapy. This is a requirement of the Code of Conduct for the Association of Holistic Biodynamic Massage Therapists. Initially, this proved difficult to arrange as supervisors familiar with this form of bodywork were based either in London or Cambridge, UK and the author has been living and working in the North West of England. One-to-one supervision was tried over the telephone, supported by 3-monthly meetings with a supervisor in London. Four years ago, the author was able to obtain monthly one-to-one supervision locally. He is now a member of a small supervision group who meet for 3 hours per month. More recently, he has taken on the role of supervisor with a focus on working with nurses involved in either complementary therapies and/or in developing clinical supervision. The following article explores the concept of supervision with the intention of sharing these experiences and promoting discussion on an understanding of the process and potential application within therapeutic nursing work.

Clinical Competence↗

Supervision: its contributions to treatment efficacy.

The efficacy of supervision in training of psychotherapists is discussed in relation to (a) trainees' attitudes, beliefs, and skills, (b) trainee's performance in the therapist role, (c) interactional process events in supervision and psychotherapy, and, (d) client change. Although investigations to date suggest the potential of supervision for teaching advanced skills of psychotherapy, few studies exist that examine directly the relation of therapist performance and client change to supervision. There are virtually no studies that compare the efficacy of supervision to other training methods. If supervision is to remain an integral part of training, then standardized training manuals, analogous to those in psychotherapy, need to be developed.

Curriculum↗

Some reflections on clinical supervision: an existential-phenomenological paradigm.

This paper reviews psychotherapy, counselling, and nursing literature related to ideas of clinical supervision and attempts to illuminate areas important to effective health related practice and specifically palliative care. Included are explorations of existentialism, phenomenology, existential phenomenology and psychoanalytical concepts. The phenomenological idea of lived experience is outlined and the Heideggerian notion of authenticity is explored in context. The paper also examines dynamic forces such as hope, trust and personal values that might influence clinical supervision design and so inform a framework for practice. An existential-phenomenological method of supervision is offered as one basis for professional practice. The central recommendation of this paper is, however, to identify relevant value and belief systems to direct clinical supervision. Nursing models might appropriately instruct approaches to supervision. The writer considers the phenomenological idea of the lived experiences as a means by which to at once capture the essence of palliative care nursing and guide the supervision towards the existential idea of authenticity.

Clinical Competence↗

Some experiences of professional practice and beneficial changes derived from clinical supervision by community Macmillan nurses.

This is a report of an interpretative study that explored some 'lived experiences' of community Macmillan nurses as they recounted them during clinical supervision meetings. This discussion is concerned with serious illness, dying and bereavement and the potential of supervision to reach the 'life-world' of professional practice but also potential benefits for Macmillan nurses. Accounts of professional practice are considered in the context of clinical supervision meetings. Five nurses--four women and one man--undertook individual clinical supervision with the researcher for 6 months over three phases for 18 months in total. Meetings took place in the clinics and health centres in which the Macmillan nurses worked. The method of clinical supervision drew on and developed established ideas from the health science literatures to guide supervisory practice. A synthesis of psychoanalytic ways of thinking and existential phenomenology provided a framework for understanding the data. Five salient themes were identified as emerging from accounts of professional practice: Biographical Determinants, Compulsion, Existential Concerns, Empathic Insufficiency in the Organisation of Palliative Care and Empathic Attainment in the Organisation of Palliative Care. The study shows a need to consider structuring environments that both help and protect community Macmillan nurses and fellow workers. Methods of clinical supervision should be informed by and complement lived experiences of working with serious illness, dying and bereavement.

Empathy↗

The nature and structure of supervision in health visiting with victims of child sexual abuse.

RATIONALE: Part of a higher research degree to explore professional practice. AIM: To explore how health visitors work with victims of child sexual abuse and the supervision systems to support them. OBJECTIVE: To seek the views and experiences of practising health visitors relating to complex care in order to consider the nature and structure of supervision. METHODOLOGY: The research reported in this paper used a qualitative method of research and semi-structured interviews with practising health visitors of varying levels of experience in venues around England. Qualitative research enabled the exploration of experiences. OUTCOMES: Identification of the need for regular, structured, accountable opportunities in a 'private setting' to discuss whole caseload work and current practice issues. RESULTS: Supervision requires a structured, formalized process, in both regularity and content, as a means to explore and acknowledge work with increasingly complex care, to enable full discussion of whole caseloads. Supervision is demonstrated as a vehicle to enable the sharing of good practices and for weak practices to be identified and managed appropriately. Supervision seeks to fulfil the above whilst promoting a stimulating, learning experience, accommodating the notion that individuals learn at their own pace and bring a wealth of human experience to the service. STUDY LIMITATIONS: The size of the study was dictated by the amount of time available within which to complete a research master's degree course primarily in the author's own time, over a 2-year period. The majority of participants volunteered their accounts in their own time. For others I obtained permission from their employers for them to participate once they approached me with an interest in being interviewed. CONCLUSIONS: This research provides a model of supervision based on practitioner views and experiences. The article highlights the value of research and evidence-based information to enhance practice accountability and the quality of care. Proactive risk management can safeguard the health and safety of the public, the practitioner and the organization.

Child↗