'The Relentless Nature of Whiteness': Black Psychologists' Experiences of Racial Microaggressions in Cross-Cultural Supervision

OBJECTIVES

Research suggests that cross-cultural supervision can be prone to microaggressions with deleterious effects for ethno-racial minorities. There are currently no known studies examining the impact of racial microaggressions in supervision on qualified psychologists. This study aimed to explore Black psychologists' experiences of microaggressions in supervision with a White supervisor and their impact.

METHODS

Semi-structured interviews were conducted with 10 individuals who had completed clinical or counselling psychology doctoral training. Interviews were transcribed and analysed using interpretative phenomenological analysis.

RESULTS

Three superordinate themes and 12 subthemes were derived from the analysis. The superordinate themes were: 'It's the subtle things', 'It's an ordeal' and 'Surviving Whiteness in psychology'. The findings illustrate the complex nature of racial microaggressions and their profound and lasting impact on individuals. The cumulative impact of these experiences resulted in significant negative psychological outcomes.

CONCLUSIONS

The results suggest that there are common microaggressions that recur in supervision. Encountering microaggressions impeded the supervisory relationship, supervision and professional development. Clinical implications include recommendations for including multicultural competency in psychology trainings and ongoing professional development plans.

Exploring pharmacists' perceptions of using a clinical supervision skills competency tool to reflect and develop their supervisory practices

INTRODUCTION

To date, there are no formal self-reflection tools routinely used by pharmacists within the Australian pharmacy profession. The study involved utilizing the Clinical Supervision Skills Competency Tool (CSSCT) at a metropolitan teaching hospital in Victoria, Australia. It explored pharmacists' perceptions of the CSSCT and its impact on their ability to self-reflect and develop their supervisory practices.

METHODS

The qualitative study involved adapting the Clinical Supervision Skills Review Tool (CSRT), a clinician-validated tool. Prior to tool completion, participants attended an orientation session on the CSSCT. Thematic analysis and an inductive approach was then applied to data collected from two semi-structured focus group sessions and an online survey, for those not able to attend the focus groups.

RESULTS

A total of 19 pharmacists were recruited and completed the CSSCT. The three major themes regarding the CSSCT identified were: feasibility of the tool, aspects of the CSSCT, and future planning. Use of rating scales and breakdown of the supervisory competencies were perceived to be helpful. Conversely, the tool's length, pharmacists' high workloads and time pressures, were identified as potential barriers to using the tool.

CONCLUSIONS

Given pharmacists internationally currently lack a formal tool to enhance their supervisory methods, the CSSCT or similar tools emerge as valuable resources for steering pharmacists towards self-reflection and goal setting. Notably, the CSSCT sheds light on previously overlooked yet critical aspects of clinical supervision in the pharmacy context, including the wellbeing and cultural sensitivity of learners.

The effect of the clinical supervision model on nursing internship students' nursing process-based performance: an experimental study

BACKGROUND

The nursing process is a systematic method for identifying the patient's problems and planning to resolve them. It is also a crucial pillar of high-quality nursing care. Nursing internship students may lack the necessary skills to implement the nursing process due to the increased independence, the absence of constant professorial supervision, and limited experience. The clinical supervision model is a method of clinical education that bridges the gap between theory and practice.

OBJECTIVE

This study was conducted to investigate the impact of the clinical supervision model on the performance of nursing internship students in each of the five stages of the nursing process, as well as overall.

METHOD

This experimental study was conducted in 2022. The 70 eligible internship students were conveniently selected and randomly assigned to either an intervention or a control group. In the present study, the clinical supervision model was implemented for the intervention group, while the control group received routine supervision. This was carried out over six sessions in three months. The data collection was conducted using a researcher-developed checklist of nursing process-based performance in both groups. Moreover, the Manchester questionnaire was used to evaluate the model in the intervention group. The variables considered as confounding factors included age, gender, marital status, number of monthly shifts, and grades of the nursing process credit completed in the third semester. SPSS version 16 software, descriptive statistics (frequency distribution, percentage, mean, and standard deviation), and analytical statistics (independent t-test, chi square, repeated measures Anova and LSD) were used to analyze the data.

RESULTS

Intergroup analysis revealed that there was no significant difference between the scores of nursing process steps and the total score before the intervention in the control and intervention groups, as well as in baseline characteristics (P > 0.05). According to the intragroup analysis, the intervention group showed a significant increase in both the total scores and scores of nursing process steps over time (P < 0.001), whereas the control group exhibited contradictory results (P > 0.05). Finally, the "P-Value Intervention" demonstrated the effectiveness of this training model in improving the performance of the intervention group based on the nursing process compared to the control group. The mean score of the Manchester questionnaire in the intervention group was 136.74, indicating the high impact of implementing the clinical supervision model in the intervention group.

CONCLUSION

The results indicated that the implementation of the clinical supervision model led to improved utilization of the nursing process by nursing internship students at all stages. Therefore, it is recommended that nurse educators utilize the clinical supervision model by providing feedback on errors in action during supervision sessions to enhance the quality of nursing care provided by nursing internship students and improve patient safety in clinical environment.

Exploring internship nursing students' experiences regarding the effect of supervision model implementation on medication safety: A descriptive qualitative study

BACKGROUND

Medication safety is one of the main aspects of safe care in the nursing profession, which leads to increasing patient safety and preventing medication errors. Clinical supervision is an integral part of nursing education that leads to the professional and social development of nursing students. This study was designed with the aim of revealing the experiences of nursing internship students from the implementation of the clinical supervision model on medication safety.

MATERIALS AND METHODS

This descriptive qualitative study was done in 2022. The participants were selected from nursing internship students (Last year undergraduate) of Isfahan University of Medical Sciences, Isfahan, Iran. Participants in this study were 15 nursing internship students selected using a purposeful sampling method. Data were collected using in-depth semi-structured interviews. The qualitative content analysis approach was used for data analysis.

RESULTS

After analyzing the data, four categories, "promotion medication safety competence and knowledge," "development trust and respect climate," "outcome of feedback," and "role of clinical supervisor," and 10 subcategories were extracted from the participants' experiences.

CONCLUSION

The implementation of the clinical supervision model led to an increase in the competence of nursing internship students in medication safety. The students believed that this educational method made them follow the principles of medication safety administration. The feedback provided in the clinical supervision sessions made students think about their clinical activities, understand the reason for their mistakes, and use the reliable nursing resources introduced by the supervisor to improve their performance.

Linguistic Minority International Counseling Psychology Trainees’ Experiences in Clinical Supervision

The present study discusses clinical supervision from the perspectives of 20 international counseling psychology trainees with a focus on English-specific experiences in training. Using concept mapping, we identified four clusters of sociolinguistic experiences in clinical settings: Growth and Strength Through Embracing Vulnerability, Barriers to Showing Clinical Potential, Fear of Being Seen as Incompetent, and Self-Doubt About Therapeutic Performance and Relationships. Helpful supervisory events included seven clusters: Genuine Curiosity and Understanding, Exploration and Validation Regarding Linguistic Identity, Affirmation and Illumination of Strengths, Facilitation of Clinical Communication, Multicultural Awareness and Cultural Humility, Humanity and Compassion, and Externalization and De-emphasis of the Act of Language use Itself. Lastly, unhelpful supervisory events fell into seven clusters: Seeking Understanding From a Deficits-Lens, Lack of Self-Awareness and Cultural Humility, Acts of Disrespect, Disregard and Lack of Interest, Judgment and Over-Correction, Disempowerment, and Superficial Fixes. Implications for practice and advocacy and suggestions for future research are discussed.

Contribution of supervision to the development of advanced practitioners: a qualitative study of pharmacy learners' and supervisors' views

OBJECTIVE

To apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians).

DESIGN

Qualitative semistructured telephone interviews applying Billet's theory of workplace pedagogy for interpretation.

SETTING

England.

PARTICIPANTS

Fifty-one learners and ten supervisors.

PRIMARY OUTCOME

Contribution of clinical and educational supervision to the development of advanced practitioners in primary care.

RESULTS

Findings were mapped against the components of Billet's theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings and ad hoc contact when needed (clinical supervision), along with ongoing support as learners progressed through a learning pathway (educational supervision). Clinical supervisors supported learners in developing proficiency and confidence in translating and applying the knowledge and skills they were gaining into practice. Learners benefited from having clinical supervisors in the workplace with good understanding and experience of working in the setting, as well as receiving clinical supervision from different types of healthcare professionals. Educational supervisors supported learners to identify their learning needs and the requirements of the learning pathway, and then as an ongoing available source of support as they progressed through a pathway. Educational supervisors also filled in some of the gaps where there was a lack of local clinical supervision and in settings like community pharmacy where pharmacist learners did not have access to any clinical supervision.

CONCLUSIONS

This study drew out important elements which contributed to effective supervision of pharmacy advanced practitioners. Findings can inform the education and training of advanced practitioners from different professions to support healthcare workforce development in different healthcare settings.

Clinical supervision: A mechanism to support person-centred practice? An integrative review of the literature

AIMS

To explore whether clinical supervision has an influence on person-centred practice.

BACKGROUND

The ability to deliver person-centred care and the ability to engage in reflective practice are two key skills expected of nurses. Person-centred care shifts nurses thinking from the patient's disease state to their personhood. Clinical supervision has been proposed as a place to explore person-centred care. Person-centred practice extends person-centredness to enhance healthful relationships between care providers, services users and their significant others.

METHODS

An integrative literature was conducted with the key words 'clinical supervision' and 'person-centredness' within CINAHL, Medline, PsychInfo and Google Scholar. The PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and PRISMA diagram reports the selection process. The Mixed Methods Appraisal Tool was used to appraise the articles, followed by a thematic analysis. The Template for Intervention Description and Replication was used to explore the concept of clinical supervision.

RESULTS

Twelve articles met the inclusion criteria. Person-centredness and clinical supervision are not universally defined concepts. Clinical supervision in this context was mainly an adjunct to educative programmes. Clinical supervision has a positive influence on participants' person-centred attributes, but the influence on others is less clear. The clinical supervisor's qualities are pivotal to supervisions' success.

CONCLUSIONS

Clinical supervision is a common reflective strategy used to explore nursing practice, yet as a strategy to enhance person-centred practices, is under-researched. Participants can experience person-centredness when their supervisor has person-centred attributes, an important aspect in delivering person-centred care.

RELEVANCE TO CLINICAL PRACTICE

This review identified a gap in the literature between two common nursing concepts 'clinical supervision' and 'person-centred care/practices'. There is a need to conduct further research into the combination of these concepts to seek ways to embed person-centredness into health care and everyday nursing practice.

Future Directions of Training and Fieldwork in Diversity Issues in Applied Behavior Analysis

This paper examines the perceptions of behavior-analytic professionals holding credentials through the Behavior Analyst Certification Board® (BACB®)-including Board Certified Behavior Analysts-Doctoral™, Board Certified Behavior Analysts®, and Board Certified Assistant Behavior Analysts®-regarding multiculturalism and diversity issues in their graduate training, fieldwork, and supervision. This paper predominantly focuses on future directions for improving graduate training, fieldwork, and supervision requirements in the field of applied behavior analysis (ABA) to produce more culturally competent professionals. Results from a preliminary survey of BACB® certificants (N = 575) are included to provide a context for recommendations on how to move the field of ABA forward to enhance the training and preparation of future credentialed professionals.

Health workforce cultural competency interventions: a systematic scoping review

Background

Addressing health workforce cultural competence is a common approach to improving health service quality for culturally and ethnically diverse groups. Research evidence in this area is primarily focused on cultural competency training and its effects on practitioners’ knowledge, attitudes, skills and behaviour. While improvements in measures of healthcare practitioner cultural competency and other healthcare outcomes have been reported, there are concerns around evidence strength and quality. This scoping review reports on the intervention strategies, outcomes, and measures of included studies with the purpose of informing the implementation and evaluation of future interventions to improve health workforce cultural competence.

Methods

This systematic scoping review was completed as part of a larger systematic literature search conducted on cultural competence intervention evaluations in health care in Canada, the United States, Australia and New Zealand published from 2006 to 2015. Overall, 64 studies on cultural competency interventions were found, with 16 aimed directly at the health workforce.

Results

There was significant heterogeneity in workforce intervention strategies, measures and outcomes reported across studies making comparisons of intervention effects difficult. The two main workforce intervention strategies identified were cultural competency training and other professional development interventions including other training and mentoring. Positive outcomes were commonly reported for improved practitioner knowledge (9/16), skills (7/16), and attitudes/beliefs (5/16). Although health care (6/16) and health (2/16) outcomes were reported in some studies there was very limited evidence of positive intervention impacts. Only four studies utilised existing validated measurement tools to assess intervention outcomes.

Conclusion

Training and development of the health workforce remain a principle strategy towards the goal of improved cultural competence in health services and systems. Diverse approaches are available to increase health workforce cultural competence. However, the effects of interventions beyond practitioner knowledge and attitudes remains unclear. Assessment of practitioner behavioural outcomes as well as measures of intervention impact on healthcare and health outcomes are needed to build a stronger evidence base.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3001-5) contains supplementary material, which is available to authorized users.

Putting the Benchmarks Into Practice

This article explores how the TCP Major Contribution, “Multicultural Clinical Supervision and Benchmarks: Empirical Support Informing Practice and Supervisor Training,” can be applied to the refining of competencies for the profession of psychology. It examines the major contributions’ thoughtful conclusions regarding effective supervisor behaviors, including the focus on the supervisory working alliance, provision of feedback to supervisees, supervisor use of self, empowering supervisees, supervisor as a competent clinician, and multicultural competencies. Implications for research and practice to enhance the profession and protect the public are discussed.

Supervision

The authors provide reaction to the Major Contribution (MC) “Multicultural Clinical Supervision and Benchmarks: Empirical Support Informing Supervision Practice and Supervisor Training.” The article begins with an overview reaction to the MC. Following this, each of the four articles that compose the MC are discussed. The reactions provide both a contextual response to the articles as well a response to the central theme of the MC—that is, the intersection of supervision, multiculturalism, and the competency benchmarks.

The Supervision Competency

The competency of supervision is one that is receiving increased attention in the professional psychology literature. References to supervision in historical and current competency models including the benchmarks are described to illustrate this. Ways in which our understanding of the supervision competency and competency-based education and training broadly is advanced through this major contribution are noted, including focus on empirical support for the essential components of the competency, considerations of how competency models work and do not in other countries, and attention to the interrelationships between competencies. While this major contribution helps expand the scholarly literature on the competency of supervision, challenges remain in the broader adoption of competency-based education and training, including program and systems-level support and the need to identify effective education and training practices to promote competency development.

Multicultural Clinical Supervision and Benchmarks

The purpose of this Major Contribution is to provide background knowledge and context for competency-based clinical supervision and to showcase a diversity of methodologically sound empirical approaches to study effective supervision, including multiculturally competent supervision, and comparative perspectives on supervision cross-culturally. The intent is to begin to provide the empirical data necessary to assist the supervisor in supporting supervisees’ development of the benchmark competencies and to provide direction for future training of supervisors. Specifically, the articles in this major contribution address competencies in clinical supervision and the Competency Benchmarks on three pivotal topics: empirical support defining effective supervision, innovative empirically based approaches to cross-cultural and international supervision, and an empirical analysis of feminist supervision in a multiculturally diverse group context. Each of the articles addresses particular Competency Benchmarks and provides prototypical models of rigorous research procedures to inform the practice of multicultural supervision and training of supervisors, and implications.