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Jackson D, Brady J, Dawkins D. Positioning, power and agency in postgraduate primary care supervision: a study of trainee narratives. BMC Med Educ 2023; 23:880. [PMID: 37978527 PMCID: PMC10656937 DOI: 10.1186/s12909-023-04826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Postgraduate supervision takes place within complex training environments, where experiences are shaped by the socio-cultural context and wider profession, and where tensions permeate. Bordin's working alliance-based model of supervision suggests that quality relationships encompass agreement on the goals and tasks of supervision, in the context of an emotional bond. However, as trainees and their supervisors navigate the demands of providing safe clinical care, alongside educational support, disagreement on expectations for supervision may emerge. By applying a critical lens, this research draws on positioning theory to explore General Practice trainees' experiences of supervision. METHODS In 2017-2019 a series of narrative interviews were undertaken with 13 General Practice trainees in the United Kingdom (UK). Participants were purposively sampled based on end-of-year performance, gender, training location and training status. Interviews were analysed using Brown and Gilligan's Listening Guide, which was adapted to incorporate an exploration of positioning, power and agency. RESULTS Trainees appeared to hold variable positions, such as 'insiders', 'outsiders', 'peers' and 'problem trainees'. Supervisors, through talk and the degree of access afforded, contributed to this positioning. Some trainees viewed their supervisors as brokers and guides as they navigated their training, whilst others were suspicious of the supervisor role. For trainees who raised concerns about their supervisor through formal channels, results were not often satisfactory. Others chose to navigate difficulty in supervision through informal means. This typically involved mastery of artefacts of training, such as the electronic appointment book or training portfolio. CONCLUSIONS This paper builds on Bordin's model of supervision to encourage greater clarity in supervisory discussions, exploring assumptions, and recognising the influences of environment, power, positioning, and agency. We have developed a Model of the Supervisory Alliance in Postgraduate GP Training (MSA-GP) to serve as a springboard for discussion for trainees and their supervisors.
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Affiliation(s)
- Dawn Jackson
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Josephine Brady
- Mary Immaculate College, South Circular Road, Limerick, V94 VN26, Ireland
| | - Donna Dawkins
- School of Education, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Lee MCY, Thackeray L. Relational processes and power dynamics in psychoanalytic group supervision: A discourse analysis. The Clinical Supervisor 2023. [DOI: 10.1080/07325223.2022.2164537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Michelle CY Lee
- The Anna Freud National Centre for Children and Families, London, UK
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Lisa Thackeray
- The Anna Freud National Centre for Children and Families, London, UK
- Child Attachment and Psychological Therapies Research Unit (Chaptre), London, UK
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von Hippel C, Brener L, Rose G. Lived Experience as a Protective Factor for Mental Health Workers. Psychiatr Serv 2022; 73:999-1004. [PMID: 35291818 DOI: 10.1176/appi.ps.202100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE When clients do not seem to be improving, mental health workers have more negative job attitudes, experience higher levels of client-related burnout, and are more interested in leaving the field. Nonetheless, it is unclear whether all mental health workers are equally susceptible to burnout caused by feelings that their clients are not improving. Specifically, people with lived experience of mental illness are intimately familiar with their own recovery challenges and thus may be less susceptible to this source of burnout. METHODS To test this possibility, mental health providers (N=179) from a nongovernmental community mental health organization in Australia completed a survey assessing their perceptions of client improvement from treatment, their feelings of client-related burnout, and a range of organizational outcomes (job satisfaction, job engagement, workplace well-being, and intentions to resign). RESULTS Moderated mediation analyses revealed that although mental health providers who felt that their clients were not improving experienced client-related burnout, lived experience served as a buffer. Staff with lived experience were less susceptible to burnout associated with perceptions that their clients were not improving from treatment. Mental health providers with lived experience also reported more positive job attitudes compared with providers without lived experience. CONCLUSIONS Given the high rates of burnout in the mental health profession, future research should examine why lived experience appears to buffer staff from burnout when they believe that their clients are not improving. This knowledge could aid in the development of interventions to boost resilience, engagement, and longevity in the field.
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Affiliation(s)
- Courtney von Hippel
- Faculty of Health and Behavioural Sciences, School of Psychology, University of Queensland, Brisbane, Queensland, Australia (von Hippel); Centre for Social Research in Health, University of New South Wales, Kensington, New South Wales, Australia (Brener); Flourish Australia, Sydney, New South Wales, Australia (Rose)
| | - Loren Brener
- Faculty of Health and Behavioural Sciences, School of Psychology, University of Queensland, Brisbane, Queensland, Australia (von Hippel); Centre for Social Research in Health, University of New South Wales, Kensington, New South Wales, Australia (Brener); Flourish Australia, Sydney, New South Wales, Australia (Rose)
| | - Grenville Rose
- Faculty of Health and Behavioural Sciences, School of Psychology, University of Queensland, Brisbane, Queensland, Australia (von Hippel); Centre for Social Research in Health, University of New South Wales, Kensington, New South Wales, Australia (Brener); Flourish Australia, Sydney, New South Wales, Australia (Rose)
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Glebova T, Lal A, Girard A, Van Ligten J. Burnout in MFT trainees: Impact of demands and resources. J Marital Fam Ther 2022; 48:908-926. [PMID: 34687556 DOI: 10.1111/jmft.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
Burnout, defined as a state of physical, mental, and emotional exhaustion caused by involvement in emotionally demanding work, is an occupational risk of helping professions that has significant negative consequences. This study examined burnout among Couple/Marriage and Family Therapy (C/MFT) trainees and its association with various demands and resources at the individual and practice-related levels as well as variables specific to their trainee status. Data came from an online study on 78 C/MFT trainees from 13 states enrolled in Couple and Family Therapy graduate programs nationwide. More than half of the participants reported various levels of burnout indicating that the issue of burnout merits the special attention of C/MFT educators and supervisors. All significant factors associated with burnout were related to the training context and included: supervision satisfaction, hours spent in a setting and caseload dissatisfaction. Findings and implications for supervision are discussed in the context of C/MFT training.
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Affiliation(s)
- Tatiana Glebova
- Couple and Family Therapy Program, Alliant International University, Sacramento, California, USA
| | - Arpita Lal
- Marriage and Family Therapy Program, Chapman University, Orange, California, USA
| | - Alix Girard
- Marriage and Family Therapy Program, Chapman University, Orange, California, USA
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Guindon J, Myhr G, Renaud J. A qualitative examination of trainee perspectives on cognitive behavioural supervision. tCBT 2022; 15:e53. [DOI: 10.1017/s1754470x22000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Clinical supervision is the main method by which mental health professionals acquire the competence to deliver safe and effective therapy. The cognitive behavioural supervision (CBS) approach to supervision parallels CBT in structure and form, which may facilitate learning. Although supervision is integral to trainee development, little is known about what CBS interventions trainees consider helpful. Using a qualitative content analysis methodology, we aimed to identify the specific CBS interventions that trainees find most helpful. Eight trainees completing a CBT rotation in an out-patient hospital setting received weekly individual supervision by staff psychiatrists and psychologists. Following each supervision meeting, trainees completed open-ended responses describing what they found most and least helpful. Responses from 127 meetings were coded using a CBS framework. Overall, trainees found many aspects of supervision helpful. The interventions most frequently noted as valuable were teaching, planning, formulating, training/experimenting, and evaluation of their work. When trainees mentioned unhelpful events, insufficient collaboration and a desire for more or less supervision structure were most frequently noted. These results suggest that the perceived helpfulness of supervision may be tied to the use of CBS interventions that provide trainees with concrete skills that facilitate learning. Further suggestions and implications for supervisors are discussed.
Key learning aims
(1)
To identify the aspects of cognitive behavioural supervision that trainees perceive as most and least helpful for their learning.
(2)
To integrate trainees’ perspectives with the existing research on supervision satisfaction.
(3)
To consider limitations, challenges and future directions of cognitive behavioural supervision research.
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Martin P, Lizarondo L, Kumar S, Snowdon D. Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review. PLoS One 2021; 16:e0260156. [PMID: 34797897 PMCID: PMC8604366 DOI: 10.1371/journal.pone.0260156] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To review the impact of clinical supervision of post-registration/qualification healthcare professionals on healthcare organisational outcomes. BACKGROUND Clinical supervision is a professional support mechanism that benefits patients, healthcare professionals and healthcare organisations. Whilst evidence is growing on the impact of clinical supervision on patient and healthcare professional outcomes, the evidence base for the impact of clinical supervision on organisational outcomes remains weak. METHODS This review used a convergent segregated approach to synthesise and integrate quantitative and qualitative research findings, as per the Joanna Briggs Institute's recommendations for mixed methods systematic reviews. Databases searched included CINAHL, Embase, PubMed, PschINFO, and Scopus. Whilst a narrative synthesis was performed to present the findings of the quantitative and qualitative studies, the evidence from both quantitative and qualitative studies was subsequently integrated for a combined presentation. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS Thirty-two studies including 27 quantitative, two qualitative and three mixed methods studies, were included in the review. The results of the quantitative analysis showed that effective clinical supervision was associated with lower burnout and greater staff retention, and effective supervisor was associated with lower burnout and greater job satisfaction. Qualitative findings showed that healthcare professionals believed that adequate clinical supervision could mitigate the risk of burnout, facilitate staff retention, and improve the work environment, while inadequate clinical supervision can lead to stress and burnout. The evidence from quantitative and qualitative studies were complementary of each other. CONCLUSION Clinical supervision can have a variable effect on healthcare organisational outcomes. The direction of this effect appears to be influenced by the effectiveness of both the clinical supervision provided and that of the clinical supervisor. This highlights the need for organisations to invest in high quality supervision practices if maximal gains from clinical supervision are to be attained.
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Affiliation(s)
- Priya Martin
- Senior Research Fellow, Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD, Australia
- Advanced Clinical Educator Interprofessional, Advance Queensland Industry Research Fellow, Cunningham Centre, Darling Downs Health, Toowoomba, QLD, Australia
| | - Lucylynn Lizarondo
- Research Fellow: Implementation Science, Joanna Briggs Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Saravana Kumar
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - David Snowdon
- Research Fellow, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Allied Health Research Lead, Academic Unit, Peninsula Health, Melbourne, VIC, Australia
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Zhu P, Luke MM. A Supervisory Framework for Systematically Attending to Outcomes in Clinical Supervision. Int J Adv Counselling 2021. [DOI: 10.1007/s10447-021-09455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bradley WJ, Becker KD. Clinical Supervision of Mental Health Services: A Systematic Review of Supervision Characteristics and Practices Associated with Formative and Restorative Outcomes. Clin Superv 2021; 40:88-111. [PMID: 34045790 DOI: 10.1080/07325223.2021.1904312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this review, the authors examined supervision characteristics and practices associated with formative (e.g., skill development) and restorative (e.g., well-being) provider outcomes. We used qualitative review to summarize supervision characteristics associated with desired outcomes. Then, we applied a distillation approach (Chorpita et al., 2005) to identify practices associated with formative and restorative outcomes. The most common practices for promoting formative outcomes were corrective feedback, discussing intervention, and role play. Findings indicate several supervision strategies have demonstrated empirical support for improving formative outcomes. However, more rigorous research is needed in community settings, particularly for understanding which strategies improve restorative outcomes.
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Abstract
Background: Clinical supervision provides support and facilitates professional and personal development. Aim: To identify and synthesise all available qualitative research on palliative care nurses' experiences of clinical supervision. Methods: Guided by the ‘enhancing transparency in reporting the synthesis of qualitative research’ (ENTREQ) statement, eight databases were searched using a systematic search strategy (Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, Medline, Web of Science, ProQuest, Embase, Psychological and Behavioural Sciences). The findings of all included studies were analysed guided by Thomas and Harden's approach. Confidence in the review findings was determined guided by Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Findings: Nine qualitative studies were included in this synthesis and four analytic themes were identified: negative experiences and misunderstandings of clinical supervision; clinical supervision needs structure and clarity; supervisor needs to be a conductor and a producer; finding your ‘inner supervisor’. Conclusion: The review illuminates the benefits of clinical supervision as a renewal process for palliative care (PC) nurses, but also highlights the challenges in its provision. Organisations should provide designated time and opportunities for PC nurses to attend clinical supervision sessions during working hours.
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Affiliation(s)
- Sinéad Keane
- Staff Nurse, Galway Hospice Foundation, Renmore Galway, Ireland
| | - Aoife Ryan
- Assistant Psychologist, London Borough of Sutton, Sutton Civic Offices
| | - Niamh Adams
- Librarian, Irish Nurses and Midwives Organisation
| | - Maura Dowling
- Senior Lecturer, School of Nursing and Midwifery, National University of Ireland, Galway, University Road, Galway, Ireland
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Gonsalvez CJ, Hamid G, Savage NM, Livni D. The Supervision Evaluation and Supervisory Competence Scale: Psychometric Validation. Australian Psychologist 2020. [DOI: 10.1111/ap.12269] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Geaty Hamid
- Department of Psychology, South Western Sydney and Sydney Local Health Districts Population Health,
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Morris EM, Bilich‐eric L. A Framework to Support Experiential Learning and Psychological Flexibility in Supervision: SHAPE. Australian Psychologist 2020. [DOI: 10.1111/ap.12267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Hanetz Gamliel K, Geller S, Illuz B, Levy S. The Contribution of Group Supervision Processes to the Formation of Professional Identity among Novice Psychotherapists. Int J Group Psychother 2020; 70:375-398. [PMID: 38449216 DOI: 10.1080/00207284.2020.1727747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Group supervision is a commonly employed method in graduate psychology training. The present study examines the role of group processes in the formation of professional identity among 129 Israeli graduate students following the conclusion of their supervision process. The following three identity statuses were identified: achievement, diffusion, and moratorium. Working alliance and group engagement were significantly higher for achievement students and differentiated between achievement and moratorium students. Cohesion was significantly lower for moratorium students than for students at each of the other two identity statuses. All differences were maintained when controlling for anxiety. Finally, working alliance was found to be the dominant process in predicting committed professional identity status. The findings stress the links between group processes in group supervision and a committed professional identity.
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von Hippel C, Brener L, Rose G, von Hippel W. Perceived inability to help is associated with client-related burnout and negative work outcomes among community mental health workers. Health Soc Care Community 2019; 27:1507-1514. [PMID: 31368620 DOI: 10.1111/hsc.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/27/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
Community mental health is a vital service, but it faces ongoing challenges from its high staff-turnover rates. The current study provides a preliminary test of a novel explanation for employee disengagement in community mental health. It is proposed that providing assistance to clients, while simultaneously feeling that only limited progress is being made, is associated with client-related burnout among community mental health providers, leading to negative work outcomes. Employees (N = 349) from three non-governmental community mental health organisations in Australia completed a survey assessing their perceptions of client improvement from treatment, client-related burnout and a range of organisational outcomes. Analyses revealed that perceptions that clients are not improving was associated with burnout, which in turn is related to lower job satisfaction, decreased job engagement, poorer workplace well-being, and increased turnover intentions. These findings suggest that interventions that highlight positive changes among clients could reinforce the important service provided by community mental health employees and may minimise burnout and negative work outcomes.
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Affiliation(s)
| | - Loren Brener
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Grenville Rose
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - William von Hippel
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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Park EH, Ha G, Lee S, Lee YY, Lee SM. Relationship Between the Supervisory Working Alliance and Outcomes: A Meta‐Analysis. Journal of Counseling & Development 2019. [DOI: 10.1002/jcad.12292] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Sujung Lee
- Department of Education, Korea University
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Abstract
The Supervisory Working Alliance Inventory–Trainee Form (SWAI-T) is among the most frequently used instruments for measuring the quality of supervisor–supervisee relationships within counselor supervision. Although the full-scale SWAI-T instrument has proven utility, there are instances when a shorter form may be useful for research and field applications. The current study used secondary data from a pair of cross-sectional studies to test the utility of a brief form of the SWAI-T in a two-step process: (a) reduction of the SWAI-T based on item analyses from an electronic survey of 87 rehabilitation counselors working in a Western state vocational rehabilitation agency and (b) an initial validation study of the instrument using electronic survey responses from a national sample of 228 rehabilitation counselors working in private rehabilitation. The resultant 5-item scale showed evidence of high internal consistency, convergent validity, and minimal differences in psychometric properties relative to the full-scale instrument. An abbreviated supervisory working alliance scale offers practical advantages for select research purposes and for continuous evaluation of supervisory relationships in field environments.
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Affiliation(s)
- Karen Sewell
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Simpson-Southward C, Waller G, Hardy GE. How do we know what makes for “best practice” in clinical supervision for psychological therapists? A content analysis of supervisory models and approaches. Clin Psychol Psychother 2017; 24:1228-1245. [DOI: 10.1002/cpp.2084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - Glenn Waller
- Department of Psychology; University of Sheffield; Sheffield UK
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Pollock A, Campbell P, Deery R, Fleming M, Rankin J, Sloan G, Cheyne H. A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals. J Adv Nurs 2017; 73:1825-1837. [DOI: 10.1111/jan.13253] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alex Pollock
- Nursing Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; UK
| | - Pauline Campbell
- Nursing Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; UK
| | - Ruth Deery
- Institute of Healthcare Policy and Practice; University of the West of Scotland; UK
| | - Mick Fleming
- School of Nursing, Midwifery and Social Care; Napier University; Edinburgh UK
| | - Jean Rankin
- Health, Nursing and Midwifery; University of the West of Scotland; UK
| | | | - Helen Cheyne
- Nursing Midwifery and Allied Health Professions Research Unit; University of Stirling; UK
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Watkins CE. THE ALLIANCE IN REFLECTIVE SUPERVISION: A COMMENTARY ON TOMLIN, WEATHERSTON, AND PAVKOV'S CRITICAL COMPONENTS OF REFLECTIVE SUPERVISION. Infant Ment Health J 2015; 36:141-5. [DOI: 10.1002/imhj.21497] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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