Clinical supervision: empowerment in practice

Registered Nurse Participation in Performance Appraisal Interviews

Performance appraisal interviews have, over the past two decades, become a common phenomenon in nursing. Yet evidence--both anecdotal and those reported in the literature--suggest that these interviews provide minimal satisfaction and are thus not always effective. This article presents the findings of an interpretive study that explored and documented the meaning and impact of participating in performance appraisal interviews. Data gleaned from nine New Zealand registered nurses employed by a single district health board provide evidence that nurses are often disappointed by the process of performance appraisal. Although they believe in the potential value of performance appraisal interviews, they seldom experience the feedback, direction, and encouragement necessary for an effective appraisal process. Changes to the current professional development program and its accompanying performance appraisal will require skilled commitment on the part of nurses, managers, and the employing organization to improve and develop the assessment and promotion of nursing practice.

An evaluation of a clinical supervision programme

In response to needs identified by community nurses in remote and isolated areas in North Argyll, Scotland, a programme of clinical supervision was implemented. The term 'practice support' was chosen by the community nurses for this project. The purpose was to provide peer support to counteract geographical isolation and to facilitate professional development through the use of reflective practice. Practice support was carried out over a period of 9 months. Pre-implementation and post-implementation questionnaires were used to evaluate the project.

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.

Psychiatric nurses' conceptions of how a group supervision programme in nursing care influences their professional competence: a 4-year follow-up study

AIM

The aim of the study was to describe, after 4 years, psychiatric nurses' conceptions of how a 2-year group supervision programme within nursing care had influenced their professional competence.

BACKGROUND

The intention of group supervision in nursing care is to understand nurses' experiences within real care settings and to structure these in a professional and personal context.

METHODS

Ten psychiatric nurses participated in a 2-year group supervision programme. They were interviewed 4 years after the group supervision was ended. Data were analysed according to the phenomenographic method.

FINDINGS

Six description categories emerged: a feeling of job satisfaction; gaining knowledge and competence; gaining a sense of security in nursing situations; a feeling of personal development; realizing the value of supervision; and a sense of professional solidarity.

CONCLUSIONS

The findings of the 4-year follow-up showed that a group supervision programme in nursing care had lasting influences on the psychiatric nurses' professional competence in the form of a pronounced professional identity and an integrated nursing care perspective. Group supervision contributes to maintaining the strength and energy needed to carry on working, which makes continuing supervision necessary.

IMPLICATIONS

An important research implication could be to investigate the type of knowledge that ought to be developed within group supervision in nursing care.

Effective supervision in clinical practice settings: a literature review

CONTEXT

Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective.

PURPOSE

To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision.

CONTENT

The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness.

CONCLUSIONS

The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.

Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery

Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery Cognitive therapy has an undisputed evidence base upon which its clinical application flourishes. This approach is now a well-recognized and widely adopted method used in the treatment of a diversity of psychological problems. More recently, prominent innovators of this psychotherapy have devised a framework to guide the clinical supervision of cognitive therapists. In keeping with its therapeutic application, the cognitive therapy framework for supervision is focused, structured, educational and collaborative. It serves to enhance the therapeutic proficiency of the cognitive therapist. In contrast, the supervision models reported in the recent nursing literature are less precise in their mission and when evaluated their contribution to nursing is shown to be dubious. Following an overview of the supervision models commonly cited in the nursing literature, a more focused comment on the evaluative research concerning Proctor's three-function interactive model will be offered. It is suggested that the unconvincing research findings may be related to the conceptual muddle surrounding clinical supervision, and the expectation for clinical supervision to deliver more than an opportunity for the progression of our therapeutic integrity. From this, a cognitive therapy supervision framework is described and suggested by the authors as a structure from which supervisors can guide discovery.

Clinical supervision and managerial supervision: some historical and conceptual considerations

The current lack of consensus among authors in the United Kingdom on the concept of clinical supervision continues unabated, although enthusiasm for its implementation is being questioned by those who would be supervised. The literature now reports confusion among practitioners on the differences between clinical and managerial supervision, and supervision and therapy. This paper addresses the differences between clinical and managerial supervision by revealing nursing's history of clinical supervision. It is argued that until the current underlying conceptual ambiguities are identified and corrected, clinical supervision remains at risk of deteriorating into managerial supervision.

The effectiveness of a group approach to clinical supervision in reducing stress: a review of the literature

There is little research evidence to suggest that clinical supervision reduces stress. However, this probably does not mean that clinical supervision is not valuable, just that the evidence is not yet there, because consensus exists that group clinical supervision may be beneficial in reducing stress in nurses. The work by Butterworth et al. is the only directly relevant study investigating the stress-reducing potential that a group approach to clinical supervision has, and this work establishes ground rules for future evaluation.

Understanding clinical supervision from a nursing perspective

During the last 10 years there has been an increase in the amount of nursing literature dealing with clinical supervision. As a result, there has been a gradual growth in the use of clinical supervision to provide support, increase clinical competence and improve client care. Unfortunately, there has not been a comparable increase in research and as a result the amount of empirical knowledge is minimal. This article will discuss the key empirical studies that have focused on identifying the outcomes of supervision and isolating the characteristics that make a good clinical supervisor. Recommendations for practice and research will be suggested.