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PubMed1999

An evaluative study of clinical supervision based on Proctor's three function interactive model.

This paper reports on a study of the benefits reported from participation in clinical supervision by registered nurses (n=201) working in a large English community and mental health NHS Trust. It summarizes the emergent practical and theoretical 'key ingredients' of clinical supervision in the United Kingdom and argues that these provide a basis for generalizable research practice. The study is based on Proctor's three function interactive model previously commended as a guide for supervisory practice and evaluation. Within this study, the three functions underpin instrument design but are also a primary focus of evaluation. The development of this instrument through semi- structured interviews with supervisors and supervisees is described. The study aims to assess and compare reported benefits in each of the three functions of accountability, skill development and support in order to examine the effects of contract use, length of experience of clinical supervision and length of service as a registered nurse on reported benefits by using non-parametric statistical analysis. The results indicate that reported benefits are experienced in almost equal proportion across each of these three functions. Statistical analysis indicates a significant positive correlation between experience of clinical supervision and its reported benefits. An inverse correlation is reported between length of service and overall benefits; however, no similar reduction over time against normative benefits was found. There was no relationship between contract use and reported benefits. Limitations of the study are discussed with reference to bias, interview transcription and overlap between the three functions. The paper concludes that nurses report clear benefits from clinical supervision in each of the three functions. This validates the three function interactive model and demonstrates that clinical supervision is used to critically examine and change nursing practice. The content and usage of contracts is identified as an aspect that merits further study.

Clinical Competence↗
PubMed2000

Clinical supervision: a concept analysis.

Clinical supervision: a concept analysis Clinical supervision is a commonly discussed concept within nursing. There appears to be a common belief that it is a good thing for nursing. Many practitioners, however, are still unsure what clinical supervision is and what is expected of them. A number of definitions and models of supervision have been developed but it remains ill defined. This paper develops a conceptual analysis of clinical supervision using the method developed by Rodgers (1989). A review of the literature precedes description of the attributes, antecedents, consequences and references. A model case is outlined prior to a proposed definition of supervision being given. It is hoped that this paper will stimulate further exploration and study of this concept.

Attitude of Health Personnel↗
PubMed2001

John Heron's six-category intervention analysis: towards understanding interpersonal relations and progressing the delivery of clinical supervision for mental health nursing in the United Kingdom.

AIMS: This paper provides a critique of how Heron's six-category intervention analysis framework has been adopted by nursing in the United Kingdom (UK) as a theoretical framework in nursing research and model for clinical supervision. From this, its merits as an analytic framework and model for clinical supervision in nursing are discussed. BACKGROUND: Heron's six-category intervention analysis has been acknowledged as a means by which nursing could develop its therapeutic integrity. It has also been used as a theoretical framework in nursing research focusing on nurses' perceptions of their interpersonal style. More recently descriptions of this framework have been proposed as a structure for clinical supervision. However, its use as a theoretical framework to underpin research investigating the interpersonal skills of nurses and as a model of clinical supervision must firstly be scrutinized. FINDINGS: Returning to Heron's original description and comparing this with its current adoption in the UK, misconceptions of this framework can be identified. Its value as an analytic tool investigating interpersonal relations in nursing has still to be evaluated. Furthermore, nursing's emphasis on certain intervention categories has undermined the potential potency of this framework and its contribution as a model for clinical supervision in nursing. CONCLUSION: We argue that Heron's six-category intervention analysis as a framework to investigate the interpersonal competence of nurses, particularly mental health nurses, requires investigation. This, in turn, would provide an opportunity to challenge the framework's theoretical standpoint. In addition to its value as an analytic tool, all six categories of Heron's framework have equal relevance to its contribution in nursing as a supervision model.

Authoritarianism↗
PubMed2002

Clinical supervision using video-conferencing technology: a reflective account.

This paper discusses three nursing practitioners' experiences of clinical supervision using video-conferencing (VC) technology. The study, based on supportive action research, involved 40 practising community and hospital nurses from a variety of specialties and took place over an 18-month period. The research was collaborative, educational and applied and focused on the effects of remote clinical supervision on the development of professional practice. Data were obtained through pre- and post-study questionnaires, repertory grids, focus group interviews and written narratives. The three research participants found that clinical supervision, as a mediator of learning, was vital in enabling them to develop their reflective and problem-solving skills. Through critical conversations with either a supervisor or within peer group supervision, the participants increased both their confidence and self-awareness and gained more insight into the practices and needs of other practitioners. They also examined critically patient care issues resulting in attention to existing or the development of new care protocols. They did, however, experience some impediments to the process of clinical supervision, mainly lack of peer and management support and ongoing education. The participants had mixed perceptions with regards to using VC technology for clinical supervision. They experienced technical and accessibility problems and communication problems, suggesting the need for clear protocols for both technical support and applied training.

Clinical Nursing Research↗
PubMed2003

User views on supervised methadone consumption.

To assess the views of opiate-dependent individuals about supervised methadone consumption. Three groups of opinions were sought: (i). new patients referred for assessment and treatment, using rating scales; (ii). the consensus view of the Methadone Alliance (a national users' forum); and (iii). the consensus view of a local service users' forum. All three groups expressed the view that supervised consumption has an important place in methadone treatments. Users understand the need for daily supervision of methadone and are generally willing to accept it. Users' views provide support for the introduction of flexible methadone prescribing regimes incorporating supervised consumption. Privacy in pharmacies and the possibility of moving away from supervision are important elements in an acceptable programme. Supervised consumption is an important component of safe, effective and responsible methadone prescribing.

Adult↗
PubMed2005

Understanding unintentional injury risk in young children II. The contribution of caregiver supervision, child attributes, and parent attributes.

OBJECTIVE: To identify child and parent attributes that relate to caregiver supervision and examine how these factors influence child-injury risk. METHODS: Mothers completed diary records about supervision of their young child (2-5 years) when at home. Standardized questionnaires provided information about child attributes, maternal attributes, and children's history of injuries. RESULTS: Correlations revealed that child attributes and parent attributes related both to actual maternal supervision and child-injury scores. Regression analyses to predict injury scores revealed child-temperament factors alone predicted all levels of severity (minor, moderately severe, and medically attended), but parent supervision also contributed to predict medically attended injuries. CONCLUSIONS: Both child and parent factors influenced caregiver's supervision of young children at home and related to child-injury risk. For medically attended injuries, child attributes and parent supervision both predicted risk, whereas for less serious injuries, child factors alone determined risk.

Attitude↗
PubMed2001

Caregivers' descriptions of patients with advanced breast cancer in connection with supervision sessions in a surgical ward.

The purpose of this study was to describe the content of caregivers' (health care professionals') presentation of care situations as told at supervision sessions. For 1 year, 21 caregivers in a surgical ward of a county hospital in the middle of Sweden participated in a clinical supervision session 2 hours every third week. The participants in the supervision sessions were divided so as to form three mixed groups composed of registered nurses, practical nurses, physiotherapists, and physicians. The purpose of the supervision sessions was to give caregivers the opportunity to reflect on different care situations in a way that contributed to the development of patient care. The 38 supervision sessions were tape-recorded and transcribed verbatim. The transcripts were analyzed using a qualitative content analysis. The caregivers described difficult care situations focusing on the feelings of patients, relatives, and caregivers, with an emphasis on the caregivers' being dominant. Difficult care situations were described as giving caregivers feelings of discomfort, powerlessness, and reduced self-esteem. These feelings were described as arising in connection with caring for women with advanced breast cancer and other seriously ill patients in an organization lacking clear goals and rules. This study found that supervision sessions offering an opportunity to reflect on the difficult care situations are important for caregivers. These sessions seem therefore to be of vital importance for the future development of cancer care on the surgical ward.

Adult↗
PubMedDate not supplied

Effects of home versus supervised exercise for patients with intermittent claudication.

PURPOSE: This study was performed to test the efficacy of a supervised, hospital-based exercise program compared with a home-based exercise program involving minimal supervision, for both walking ability and quality of life measures in patients with exercise-limiting intermittent leg claudication. METHODS: Twenty-one patients were assigned randomly to 12 weeks of supervised exercise or to a home-based exercise group. After 12 weeks the participants in the supervised group transitioned to a home-based program. Both groups were then reevaluated at the end of 24 weeks. The initial claudication distance (ICD) and absolute claudication distance (ACD) on progressive treadmill exercise was measured at baseline, 12 weeks, and 24 weeks. Additionally, self-reported quality of life status was evaluated using the MOS SF-36 questionnaire. RESULTS: Each group improved (P < 0.01) ACD from baseline to 12 weeks, which was sustained at the 24-week follow-up. Both groups experienced similar long-term improvements (P < 0.05) in ACD (521.5 +/- 253.4 meters to 741.9 +/- 365.6 meters for the supervised group, 532.2 +/- 263.5 meters to 715.0 +/- 394.4 meters in the home group, P not significant, between groups). The supervised group experienced a greater improvement (P < 0.01) in the ICD after 12 weeks than the home group but not at 24 weeks. The on-site group also experienced significant improvements in ICD after 24 weeks (P < 0.05). Neither group manifested an improvement in self-reported physical function or mental health as assessed by the MOS SF-36. CONCLUSION: A structured exercise program was more effective in improving the ICD over a 24-week period than a less formal, home-based program. However, if patients are screened properly and receive adequate instruction, a home-based program can be a safe, low-cost alternative providing similar long-term (24 weeks) exercise benefits in ACD.

Aged↗
PubMed2004

Partially supervised learning using an EM-boosting algorithm.

Training data in a supervised learning problem consist of the class label and its potential predictors for a set of observations. Constructing effective classifiers from training data is the goal of supervised learning. In biomedical sciences and other scientific applications, class labels may be subject to errors. We consider a setting where there are two classes but observations with labels corresponding to one of the classes may in fact be mislabeled. The application concerns the use of protein mass-spectrometry data to discriminate between serum samples from cancer and noncancer patients. The patients in the training set are classified on the basis of tissue biopsy. Although biopsy is 100% specific in the sense that a tissue that shows itself to have malignant cells is certainly cancer, it is less than 100% sensitive. Reference gold standards that are subject to this special type of misclassification due to imperfect diagnosis certainty arise in many fields. We consider the development of a supervised learning algorithm under these conditions and refer to it as partially supervised learning. Boosting is a supervised learning algorithm geared toward high-dimensional predictor data, such as those generated in protein mass-spectrometry. We propose a modification of the boosting algorithm for partially supervised learning. The proposal is to view the true class membership of the samples that are labeled with the error-prone class label as missing data, and apply an algorithm related to the EM algorithm for minimization of a loss function. To assess the usefulness of the proposed method, we artificially mislabeled a subset of samples and applied the original and EM-modified boosting (EM-Boost) algorithms for comparison. Notable improvements in misclassification rates are observed with EM-Boost.

Algorithms↗
PubMed1996

Clinical supervision: a plea for 'pit head time' in cancer nursing.

The concept of clinical supervision has received considerable attention in the nursing literature of late, enjoying favour not only with many practitioners and managers, but academics and policy makers alike. The following paper considers the utility of clinical supervision within the cancer nursing setting, concentrating particularly on the development of self-awareness and the facilitation of responsive, reflective, therapeutic relationships. The paper is predicated on the belief that clinical supervision not only provides a valuable means of peer review and support, for nurses both in the pre- and post-registration spheres, but that structured process of systematic supervision sustains the necessary environment for the protection and enhancement of quality nursing interventions (Butterworth, 1992). The potential of clinical supervision, as regards the wider development of nursing as a practice discipline, is illustrated by the incorporation of an extensive literature review which explores the theoretical and practical imperatives pertaining to the notion of clinical supervision, not only in relation to the individual, but to cancer nursing and nursing per se.

Humans↗
PubMed2006

In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation.

BACKGROUND: Supervision and feedback are essential factors that contribute to the learning environment in the context of workplace learning and their frequency and quality can be improved. Assessment is a powerful tool with which to influence students' learning and supervisors' teaching and thus the learning environment. OBJECTIVE: To investigate an in-training assessment (ITA) programme in action and to explore its effects on supervision and feedback. DESIGN: A qualitative study using individual, semistructured interviews. SUBJECTS AND SETTING: Eight students and 17 assessors (9 members of staff and 8 residents) in the internal medicine undergraduate clerkship at Vrije Universiteit Medical Centre, Amsterdam, the Netherlands. RESULTS: The ITA programme in action differed from the intended programme. Assessors provided hardly any follow-up on supervision and feedback given during assessments. Although students wanted more supervision and feedback, they rarely asked for it. Students and assessors failed to integrate the whole range of competencies included in the ITA programme into their respective learning and supervision and feedback. When giving feedback, assessors rarely gave borderline or fail judgements. DISCUSSION AND CONCLUSION: If an ITA programme in action is to be congruent with the intended programme, the implementation of the programme must be monitored. It is also necessary to provide full information about the programme and to ensure this information is given repeatedly. Introducing an ITA programme that includes the assessment of several competencies does not automatically lead to more attention being paid to these competencies in terms of supervision and feedback. Measures that facilitate change in the learning environment seem to be a prerequisite for enabling the assessment programme to steer the learning environment.

Clinical Competence↗
PubMed2006

Cost and resource implications of clinical supervision in nursing: an Australian perspective.

AIM: The aim of this article was to explore the resource and management issues in introducing and maintaining a clinical supervision programme for nurses. BACKGROUND: A number of federal, state and non-governmental agency reports have recently indicted the quality of present-day mental health service provision in Australia. Clinical supervision in nursing has been widely embraced in many parts of the developed world, as a positive contribution to the clinical governance agenda, but remains largely underdeveloped in Australia. METHOD: Using data derived from several empirical clinical supervision research studies conducted in mental health nursing settings, preliminary financial modelling has provided new information for Nurse Managers, about the material implications of implementing clinical supervision. FINDINGS AND CONCLUSIONS: It is suggested that, on average, the cost of giving peer group one-to-one supervision to any nurse represented about 1% of an annual salary. When interpreted as a vanishingly small cap on clinical nursing practice necessary to reap demonstrable benefits, it behoves Nurse Managers to comprehend clinical supervision as bona fide nursing work, not an activity which is separate from nursing work.

Adult↗
PubMed2005

Conducting client supervision in community health care.

The aim of the present study was to examine registered public health nurses' views and reported actions related to client supervision in community health care. Transcript-based, qualitative and interpretative content analysis was used to analyse the findings from six focus group interviews. The main findings represented the following themes: the components of the assessment basis related to choosing supervision as an intervention strategy, the strategies related to conducting supervision and the meaning of supervision as an intentional act. In conclusion, the registered public health nurses' reported model for conducting supervision seems to correspond with principles in the new strategies for health promotion initiated by the World Health Organization. Further research is needed to explore what the nurses really do when conducting supervision in order to provide extended knowledge about their model.

Adaptation, Psychological↗
PubMed1982

Effect of calving supervision upon the calving performance of Hereford heifers.

The calving performance of 268 two-year-old Hereford heifers was studied in 2 commercial herds and at a research station to compare supervision and non-supervision during calving. Supervision in the 3 herds involved twice-daily paddock inspections of calving heifers using a vehicle and the provision of obstetrical aid to those in difficulty. The unsupervised controls were inspected once weekly and were not assisted. The supervised heifers experienced a higher incidence of live-natural births and fewer dead calves compared with the unsupervised heifers. Dam survival rates were significantly (p less than 0.05) increased in all supervised treatments. Calving supervision was justified by higher survival of both heifers and calves as well as humans considerations. It was endorsed as a worthwhile management practice in commercial herds with significant levels of dystocia in calving heifers.

Animals↗
PubMed2005

Supervised learning through neuronal response modulation.

Neural networks that are trained to perform specific tasks must be developed through a supervised learning procedure. This normally takes the form of direct supervision of synaptic plasticity. We explore the idea that supervision takes place instead through the modulation of neuronal excitability. Such supervision can be done using conventional synaptic feedback pathways rather than requiring the hypothetical actions of unknown modulatory agents. During task learning, supervised response modulation guides Hebbian synaptic plasticity indirectly by establishing appropriate patterns of correlated network activity. This results in robust learning of function approximation tasks evenwhenmultiple output units representing different functions share large amounts of common input. Reward-based supervision is also studied, and a number of potential advantages of neuronal response modulation are identified.

Feedback↗
PubMed1979

Clinical supervision of the initial interview: effects on patient care.

The authors raise the question of whether the directly supervised initial evaluation of outpatients by psychiatric residents influences the quality of patient care. The charts of 78 patients with direct supervision and 78 patients with traditional supervision were randomly selected for review four months after the initial interview. More than twice as many patients with direct supervision remained in active treatment or terminated after successful short-term treatment compared with traditionally supervised patients in the early intake period. Patients with direct supervision also received a less pathological diagnosis.

Ambulatory Care↗
PubMedDate not supplied

Supervision of students may protect academic physicians from cognitive bias: a study of decision making and multiple treatment alternatives in medicine.

OBJECTIVE: To determine how professional characteristics and practices of physicians alter the selection of medical treatments involving multiple alternatives. Situations involving multiple alternatives can increase the difficulty of making a decision, resulting in more choice deferral than when fewer alternatives are available. DESIGN, SETTING, PARTICIPANTS: A survey and scenario were mailed to a random sample of 314 primary and emergency care physicians affiliated with the Indiana University Medical Center. Using a scenario involving treatment decisions for a patient with osteoarthritis, the effects of multiple treatment alternatives on decision making were explored. Other physician factors included experience, workload, fatigue, continuing education, and supervision. MAIN OUTCOME MEASURES: Physicians' treatment decisions. RESULTS: Physician response was 61% (n = 192). In contrast to previous studies, physicians in the present study were equally likely to prescribe a new medication, regardless of whether they were deciding about 1 medication or between 2 similar medications (54.5% v. 56.0%, P = 0.841). However, physicians who supervise medical students were far less influenced by the cognitive bias associated with multiple choices than those who did not supervise medical students. Supervising physicians were more likely to defer making a decision when there was only 1 treatment option than when there were 2 (49.3% v. 37%, P = 0.143), whereas the opposite was true for nonsupervising physicians (33.3% v. 63%, P = 0.040). The number of hours spent supervising medical students and the number of years as a physician were also important factors in the decision-making process. CONCLUSIONS: Multiple treatment alternatives may result in a deferral of choice. However, this cognitive bias is attenuated by experience and supervision, thus enhancing decision making. Implicit and explicit learning gained through experience and the supervisory process appears to be a central mechanism by which the physicians are protected from this cognitive bias.

Academic Medical Centers↗
PubMedDate not supplied

Through the looking glass: women and ministry supervision.

Issues pertaining to women and clinical pastoral supervision are identified and examined in this essay. An in-depth literature review regarding the relationship between gender and supervised pastoral training provides the basis for the identification of the following themes: the relative lack of female supervisors; how and why we ought to talk about gender and ministry supervision; the contextual relevance of systemic marginalization to ministry supervision; the relationship between pastoral care and the "feminine"; the relevance of a panentheistic God to gender and ministry supervision; and, lastly, the relevance of gender to the supervisory relationship. Although the focus is on the ways in which gender dynamics can affect the female supervisee's experience, the author also takes a brief look at how female supervisors might experience the relevance of their gender to the art of supervision.

Journal Article↗