Effective clinical supervision of allied health professionals: a mixed methods study

Access to and effectiveness of clinical supervision for allied health workers: A cross-sectional survey

INTRODUCTION

Clinical supervision supports patient care and health worker wellbeing. However, access to effective clinical supervision is not equitable. We aimed to explore the access and effectiveness of clinical supervision in allied health workers.

METHODS

A cross-sectional survey design using the Manchester Clinical Supervision Scale (MCSS-26), including open-ended survey responses, to collect data on effectiveness. Multivariable regression was conducted to determine how MCSS-26 scores differed across discipline, work location and setting. Open-ended responses were analysed using content analysis.

RESULTS

1113 workers completed the survey, with 319 (28%) reporting they did not receive supervision; this group were more likely to hold management positions, work in a medical imaging discipline and practice in a regional or rural location. For those who received supervision, MCSS-26 scores significantly differed between disciplines and work settings; psychologists and those practising in private practice settings (i.e. fee-for-service) reported the highest levels of effectiveness. Suggested strategies to enhance effectiveness included the use of alternate supervision models, dedicated time for supervision, and training.

CONCLUSION

Targeted subgroups for improving access include senior staff, medical imaging professionals, and those working across regional and rural settings. Where supervision was least effective, strategies to address behaviours with organisational support may be required.

Interprofessional supervision among allied health professionals: a systematic scoping review

Clinical supervision typically occurs between clinicians who are trained in the same discipline, and this assumption is present across much of the relevant literature. However, the use of interprofessional supervision (IPS), wherein clinicians do not share the same discipline, has increased in recent years. As IPS increases in usage, it is key that the implications of this approach are explored. In order to map the existing evidence, a scoping review was conducted to explore what is known about the use of IPS across five allied health professions (psychology, speech and language therapy, occupational therapy, physiotherapy and social work). A systematic literature search of four electronic databases was conducted, with 27 articles meeting the inclusion criteria. The data were analyzed using thematic synthesis. Six key themes were identified relating to factors impacting the appropriateness of IPS, necessary steps in the IPS process, and impacts of IPS for clinicians. Limited application of standardized tools and theoretical frameworks within the existing research was highlighted. The findings identified within this review present a broad overview of the existing research relating to IPS, which can be used to inform future research in this area.

Key Performance Indicators: A Framework for Allied Healthcare Educational Institutions

Background

Performance evaluation in the allied healthcare education sector is complex, making it essential for policymakers and managers to approach it comprehensively and thoughtfully to understand their performance. Hence, the development and monitoring of Key Performance Indicators (KPIs) in this domain must be considered one of the key priorities for the policymakers in AHIs.

Aim

This study aims to develop a framework for the AHIs to extract and profile the indicators, measure, and report the results appropriately.

Methods

The authors adopted a general review of the literature approach to study the primary goals of the institutional KPI framework, emphasizing the need for benchmarking while implementing KPIs and how to track performance using a KPI dashboard.

Results

The study provides the scope, relevant KPI categories, and a list of KPIs for evaluating the effectiveness of allied healthcare programs. The study findings also emphasized the need for benchmarking the KPIs and establishing a KPI dashboard while measuring and monitoring performance.

Conclusion

KPIs are considered an invaluable tool that contributes immensely to the performance monitoring process of AHIs, irrespective of the specialties. This helps to identify and guide AHIs for developing KPIs and the associated minimum data set to measure organizational performance and monitor the quality of teaching and learning. In addition, the KPI framework reported in this study is a tool to assist performance monitoring that can subsequently contribute to the overall quality of AHIs.

Contribution of peer group supervision to nursing practice: An interpretive phenomenological study

AIM

To provide insight into peer group supervision practices through understanding the lived experience of community health nurses.

BACKGROUND

The recent Covid-19 health crisis highlights the importance of supportive mechanisms to sustain and retain nurses in the workforce. While the support of quality clinical supervision for registered nurses is recognised, the benefits and challenges of peer group supervision are less clearly articulated.

DESIGN

Nurses' experiences of peer group supervision in an Australian tertiary health service were explored using a Gadamerian philosophical hermeneutic approach.

METHOD

Semi-structured in-depth interviews were conducted in 2021 and provided nurses with the opportunity to share their experiences of using the New Zealand Coaching and Mentoring Model of peer group supervision. The study included a total of 31 nurse participants across multiple community health contexts. Interview data were analysed using a hermeneutic approach from which themes arose.

FINDINGS

The findings demonstrated that strong peer group supervision foundations that include personal and professional preparation and active participation are essential. Dual pillars of "the unique individual" and "the unique group" with responsibilities identified in each pillar that enable interactions and worthiness in peer group supervision practice. The foundations and pillars support peer group supervision in nursing practice to provide a mechanism for reflection, support and professional guidance.

CONCLUSIONS

Peer group supervision is a worthy, contributory process in community health nursing when implementation processes are supported and teams are educated and prepared. Perceptions of peer group supervision are unique and varied across individuals. The individual experience has an impact on the group experience and vice versa. Knowledge of the process and group by participants is required to enable professional reflection through nursing peer group supervision.

Barriers to effective clinical supervision from the perspective of nurses: A descriptive qualitative study

AIM

The present study aimed to explain the barriers to effective clinical supervision from the perspective of nurses.

DESIGN

Qualitative descriptive study.

METHODS

The present study enrolled 21 nurses selected by purposive sampling. Data were collected through semi-structured interviews, which were digitally recorded and immediately transcribed verbatim, and analysed using content analysis method.

RESULTS

From the nurses' perspective, the influential barriers included poor academic, ethical, communicational, professional competencies at the passive management level, defects in supervision prerequisites, conventional beliefs, ineffective organization, shortage of workforce at the level of inappropriate context, lack of motivation and poor accountability at inadequate professional maturity level.

PUBLIC CONTRIBUTION

The following items affect how clinical supervision is implemented: Motivation, accountability at the personal level, sufficient workforce, conducive conditions, effective organization of resources, and preparing the individual for supervision at the organizational level to implement effective clinical supervision.

Is learning being supported when information is provided to informal carers during inpatient stroke rehabilitation? A qualitative study

Purpose: To explore how health professionals provide information to informal carers during inpatient stroke rehabilitation and whether these practices align with adult learning principles.Methods: Informal carers and survivors of stroke who had completed inpatient rehabilitation, and health professionals working in inpatient stroke rehabilitation were interviewed. Directed qualitative content analysis was conducted using an adult learning model, to determine how closely reported practices aligned to adult learning principles.Results: 14 carers, 6 survivors of stroke and 17 health professionals participated. Carers (79% female, 57% spouse/partner) reported having incomplete knowledge during rehabilitation, lacking information about mechanisms of stroke recovery, rehabilitation processes, long-term effects of stroke, and navigating post-discharge services. Health professionals supported carers to address their learning needs related to safety of caring for stroke survivors. Carers indicated they were responsible for their own non-safety related learning. Health professionals tended not to check carers' understanding of information provided nor offer learning opportunities beyond written or verbal information.Conclusions: Health professionals consistently provide certain information to carers during inpatient rehabilitation, but adult learning principles are not routinely applied when information is provided. Fostering adult learning among informal carers may improve preparedness of carers to support stroke survivors after discharge from inpatient rehabilitation.

Pharmacy professionals' perceptions of educational supervision in primary care through the lens of Proctor's model

BACKGROUND

Educational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England. Proctor's three-function model of clinical supervision (consisting of formative, restorative, and normative functions) is assumed to apply to educational supervision, but this has not been tested empirically. The aim of this study was to establish perceptions of the purpose of educational supervision from the perspective of primary care pharmacy professionals enrolled on a national training pathway in England.

METHODS

Using a mixed methods design, data were collected using a validated 25-item online survey and respondents were invited to add comments explaining their responses. The survey was sent to all 902 learners enrolled on a postgraduate training pathway for pharmacy professionals working in primary care. Principal components analysis (PCA) was used to interpret patterns in the survey data, and framework analysis of qualitative free text comments was used to identify themes and aid interpretation of quantitative findings.

RESULTS

One hundred eighty-seven pharmacy professionals responded (response rate 20.7%). PCA extracted three factors explaining 71.5% of the total variance. Factor 1 corresponded with survey items linked to the formative function of Proctor's model, while factor 2 corresponded with survey items linked to the restorative function. No items corresponded with the normative function. Framework analysis of qualitative free-text comments identified two themes: learning support, which corresponded with factor 1; and personal support, which corresponded with factor 2.

CONCLUSIONS

This study identified that pharmacy professionals perceived educational supervision to perform two functions, formative (educational) and restorative (pastoral), but did not perceive it to perform a normative (surveillance) function. Educational supervision has the potential to support allied health professionals advancing their roles and we suggest the need for more research to develop models of effective educational supervision which can inform practice.

Exploring sonographer emotional well-being: NHS sonographers' experience of the restorative function of professional supervision

Introduction

Following recommendations of the Francis report (2013), healthcare professional groups have formalised restorative supervision within practice in order to maintain emotional well-being among staff and provide quality of care for patients. There is a scarcity of research available on how professional supervision is utilised as a restorative device within current practice for sonographers.

Methodology

An online cross-sectional, descriptive survey was used to gain qualitative details and nominal data on sonographer experiences of professional supervision. Themes were developed through thematic analysis.

Results

A total of 56% of participants did not identify professional supervision as part of their current practice; 50% of participants felt emotionally unsupported within their work. The majority felt 'unsure' of how professional supervision would affect their working day; however, they highlighted that a restorative function would be valued equally as professional development functions of practice. The barriers to professional supervision as a restorative function demonstrate that an understanding of what sonographer needs are should be considered in approaches to professional supervision.

Conclusion

This study found that participants identify professional supervision in its formative and normative functions more commonly than its restorative functions. It also found that sonographers are found wanting of emotional support, with 50% of sonographers feeling unsupported and identifying a restorative supervision need to their working practice.

Implications for practice

The need to establish a system that supports the emotional well-being of sonographers is highlighted. This should help with retention of sonographers in a career where burnout is evidenced.

Implementation of behaviour change training in practice amongst pharmacy professionals in primary care settings: Analysis using the COM-B model

BACKGROUND

The Pharmacy Integration Fund (PhIF) was established in England in 2016, with funded learning programmes or 'pathways' designed to support the development of clinical pharmacy practice in a range of settings. Despite pharmacy staff being well positioned to provide more clinical work, limited research has investigated behaviour change training targeted at widespread practice transformation.

OBJECTIVE(S)

To investigate implementation of PhIF learning in practice, using the COM-B model of behaviour change.

METHODS

An online survey distributed in February and October 2020 included questions on motivations for learning, confidence in target behaviours and impact of PhIF training on behaviour. The October 2020 survey also included questions exploring the effect of the COVID-19 pandemic. Quantitative data were analysed in SPSS. v.27 (IBM). Inferential statistics were used to compare between the pathways (Primary care pathways [PCP], Post-registration pathway [PRP] and Accuracy Checking Pharmacy Technician [ACPT] pathway). Free text comments were categorised and themed.

RESULTS

Three-hundred and eighty-three responses were received (49% PRP learners, 39% PCP learners and 12% ACPT learners). Learners generally had the capacity and opportunities to apply learning, and were strongly motivated to implement behaviours in practice, although learners based in community pharmacy (those on the PRP) were less likely to report receiving employer support. Enhanced knowledge/skills (capacity) were more commonly reported than change to patient-facing activities, leading clinical services and conducting medication reviews with patients with complex needs (clinical practice behaviours targeted by the pathways). The COVID-19 pandemic heightened barriers to implementing practice change.

CONCLUSIONS

Implementation of a range of clinical practice behaviours following at scale training appears to have been largely successful. Despite this, the community pharmacy context, where funded service opportunities may be lacking, continues to present challenges to workforce transformation plans. More work is needed to understand how training can be implemented to promote practice change for pharmacy professionals in all settings.

The Supervisees' Perspectives Concerning the Clinical Supervision of Radiologic Sciences Students at Clinical Sites: Implications and Future Directions

INTRODUCTION

Clinical supervision (CS) is essential to practice-based learning in radiology. The assessment of the effectiveness of CS is essential to ensure the success of the process and to provide high-quality patient care.

PURPOSE

This study aimed to evaluate the CS of both Diagnostic Radiography (DR) and Nuclear Medicine (NM) technology students studying at Kuwait University.

METHODS

The Manchester Clinical Supervision Scale-26 (MCSS-26©) was distributed electronically to 90 third and fourth year students from Radiologic Sciences department. Ethical approval was obtained from the Health Sciences Centre (HSC) Ethical Committee and all the participants provided electronic informed consent. Data are presented as mean ± SD.

RESULTS

Seventy responses were collected from DR and NM (response rate 78%, DR: n= 51, NM: n=19). Overall, the mean CS score from the MCSS was 67.7±11.3, n=70. CS in NM scored more effective than that in DR with a p=0.037 (72.3±10.1, 66.0±11.3, respectively).

CONCLUSION

The effectiveness of CS has been evaluated in third and fourth year students across the two divisions of RS the department at Kuwait University. This study showed that students value the impact of CS in their professional role and 70% reported being satisfied with the overall CS experience. Limited studies are available that focuses on students' perceptions about clinical supervision; therefore, more studies are needed to evaluate the effectiveness of CS among RS students. Implications for interprofessional education are presented.

Experiences of the COVID-19 Lockdown and Telehealth in Aotearoa New Zealand: Lessons and Insights from Mental Health Clinicians

OBJECTIVE

The COVID-19 pandemic rapidly changed health service delivery and daily life. There is limited research exploring health professional experiences with these changes. This research explores mental health clinicians' experiences over the first COVID-19 lockdown in New Zealand to inform future pandemic responses and improve usual business practices.

METHOD

Thirty-three outpatient mental health clinicians in three Aotearoa New Zealand regions took part in semi-structured interviews. Interviews were analysed thematically applying an interpretive description methodology.

RESULTS

Three key themes emerged: (1) life in lockdown, (2) collegial support, and (3) maintaining well-being. Clinicians, fearful of contracting COVID-19, struggled to adapt to working from home while maintaining their well-being, due to a lack of resources, inadequate pandemic planning, and poor communication between management and clinicians. They were uncomfortable bringing clients notionally into their own homes, and found it difficult to separate home and work spheres. Māori clinicians reported feeling displaced from their clients and community.

CONCLUSION

Rapid changes in service delivery negatively impacted clinician well-being. This impact is not lessened by a return to normal work conditions. Additional support is required to improve clinician work conditions and ensure adequate resourcing and supervision to enable clinicians to work effectively within a pandemic context.

Clinical supervision in podiatry in Australia and New Zealand: supervisor challenges in this role

BACKGROUND

Clinical supervisors play an integral role in preparing podiatry graduates for clinical practice. Not enough is, however, known about how prepared podiatry clinical supervisors are for this role, in terms of training received and the challenges they face in the role. Informed by previous qualitative research, this study extends our understanding of what it means to be a clinical supervisor in podiatry.

METHODS

An online survey comprising closed and open-ended questions gathered data from 67 registered podiatrists who were also clinical supervisors. Descriptive analysis was undertaken. Chi-square analysis was used to test independence between preparedness for supervision and variables of interest (e.g. training received). Item analysis was assessed using Cronbach's alpha coefficients and Kendall's Tau to determine whether statistically significant associations existed across the broad challenges previously identified (i.e. supervisor-specific, curriculum and students). Open-ended comments were analysed using content analysis.

RESULTS

Generally, most supervisors (64%, 43/67) initially felt " prepared" to supervise, despite the majority (58%, 39/67) not having received any training or educational support. Overwhelming, supervisors (97%, 65/67) considered universities responsible for ensuring quality clinical supervision. They perceived many of the previously identified supervisor-specific challenges (e.g. time-consuming), curriculum issues (e.g. limited hands-on patient contact in private practice placements) and student deficiencies (e.g. poor time management). Positive correlations were found across the three sets of challenges, with the strongest measure of association found between overall student deficiencies and overall curriculum issues (p < .001).

CONCLUSION

These findings contribute to a deeper understanding of clinical supervision in podiatry. The study identified inconsistent support for clinical supervisors from partner universities. This study found a clear desire and need for supervisor training. A partnership approach is recommended in which universities work with clinical supervisors to address their overall challenges in terms of supervisor professional development, paying attention to curriculum issues, and improving student preparedness during placements.

The impact of the COVID-19 pandemic on clinical guidance and risk assessments, and the importance of effective leadership to support UK obstetric sonographers

INTRODUCTION

The COVID-19 pandemic had a profound impact on the provision of obstetric ultrasound services, leading to the publication of new guidance and requirement for individual departmental risk assessments in the UK. The impact of these changes on clinical practice for UK obstetric sonographers is not currently well reported in published literature.

METHODS

Obstetric sonographers working in the UK (n = 138) used the Qualtrics XM^TM platform to complete an anonymous, online questionnaire about their experiences during the pandemic. Participants responded to closed-type questions about national guidance, risk assessment and their perception of support, and provided additional detail about their experiences in these areas through free-text response options.

RESULTS

Over 90% of respondents were aware of or had read guidance issued by professional organisations, although challenges for its implementation in departments were identified. These were commonly related to the clinical working environment and included limitations on physical space (76.3%), time constraints (67.5%) and ventilation (61.3%). Sonographers felt most supported by their ultrasound colleagues (83.5%) and line managers (41.2%). They felt least supported by senior management and leadership personnel (60.8%), other antenatal colleagues (51.5%) and professional organisations (41.2%).

CONCLUSION

Obstetric sonographers will need support from the wider service team and professional organisations to facilitate post-pandemic recovery of the workforce. Formal clinical supervision programmes may be beneficial in facilitating a more holistic approach to peer-support, although there is currently limited evidence of their use in sonographic practice.

Enhancing the quality of allied health clinical supervision in a regional setting: An action research study

OBJECTIVE

To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting.

SETTING

A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services.

PARTICIPANTS

Allied health managers employed at the health service were members of an action research group.

DESIGN

This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis.

RESULTS

The action research group met 11 times over a 5-year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision.

CONCLUSION

The findings from this comprehensive longitudinal study provide evidence-based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health.

Does Online Professional Development for Physical Therapists Enhance Clinical Practice and Patient Outcomes? Protocol for a Mixed Methods, Randomized Controlled Trial

OBJECTIVE

Online clinical mentoring has shown potential as a flexible professional development activity that enhances physical therapist practice. Online delivery can overcome time and distance barriers to participation in professional development. The impact of this learning activity on physical therapist practice and patient outcomes has not been rigorously tested. Thus, the aim of this study is to determine whether online clinical mentoring is more effective than asynchronous online lectures at improving physical therapist practice and patient outcomes. An additional aim is to explore the lived experience of physical therapist learners who participate in online clinical mentoring.

METHODS

In this mixed methods evaluation, 24 physical therapist learners will be randomized to 1 of 2 online professional development activities. Experimental group physical therapists will complete 6 online clinical mentoring sessions. Control group physical therapists will complete 6 online lectures. The primary outcome evaluated will be the effect on the physical therapist's patients, using the Patient-Specific Functional Scale. Physical therapist learner secondary outcomes are confidence, self-reflection, and satisfaction. Accounting for possible dropouts, a sample size of 216 patients was determined using a pragmatic sample of 24 physical therapists, power of 0.80, alpha of 0.05, and between-group differences of 1.0 (SD = 2.0) on the Patient-Specific Functional Scale. Consecutive, eligible patients under the care of the physical therapist learners will complete outcome measures at initial appointment and at 4 weeks follow-up. Linear mixed model regression analysis will be used to estimate treatment effects from the posttreatment group means at 4 weeks. Participants undertaking online clinical mentoring will complete semi-structured interviews that will be thematically analyzed using a phenomenological approach.

IMPACT

This research study will establish the effectiveness of online clinical mentoring to inform future professional development. The qualitative component will identify the potential mechanisms by which online clinical mentoring might be effective, thus informing future implementation of this professional development activity.

Using normalisation process theory to understand implementation of integrated multi-sector pre-registration trainee pharmacy technician training

BACKGROUND

The pre-registration trainee pharmacy technician (PTPT) integrated training programme is a workforce intervention designed to train PTPTs in multiple sectors. The programme recruited 35 PTPTs to 2-year training posts which involved employment in one sector, and a minimum of 12 weeks' work-based training in ≥2 further settings each year.

AIM

To identify facilitating and inhibiting factors to implementation of the PTPT integrated training programme and make recommendations on ways to embed and maintain PTPT integrated training in routine practice.

METHODS

Normalisation Process Theory (NPT) constructs were used as a framework for analysis. Semi-structured interviews (14 PTPTs, 15 supervisors) explored PTPTs' learning and practice experiences over their 2-year training. A survey explored training outcomes (confidence and preparedness to practise) of integrated (n = 31) and single sector PTPTs (n = 39).

RESULTS

Whilst some understood the intervention well, others had differing understandings of its purpose and potential benefits (coherence). Educational and practice supervisors acknowledged the importance of regular communication but reported difficulties implementing this due to time constraints (cognitive participation). PTPTs benefitted from having an educational supervisor oversee learning and progress over 2-years, and a practice supervisor for their day-to-day learning. PTPTs' experiences of supervision were inconsistent due to variation in supervisors' availability, knowledge, experience, and level of support (collective action). Participants perceived the PTPT integrated training as supporting development of a flexible pharmacy technician workforce able to work across sectors. The survey found that integrated PTPTs felt significantly more prepared than single-sector PTPTs to work in different settings (reflective monitoring).

CONCLUSIONS

PTPTs on the programme had better ability to work in different sectors. Improving implementation requires clear understanding of the intervention's purpose by all stakeholders; clarity on supervisors' roles/contributions; and effective communication between supervisors to create effective learning opportunities. Findings can inform implementation of future multi-sector education and training globally.

Is there a role for professional supervision in supporting the professional and personal wellbeing of the sonographic workforce? A literature review

OBJECTIVES

The sonographer workforce in the UK is under pressure due to chronic staff shortages and increased service demands. The Health and Care Professions Council and the Society of Radiographers both advocate for the use of professional supervision to support wellbeing and development, however the use of professional supervision is not widespread within the sonographer workforce. The aim of this literature review was to explore the evidence around the use of professional supervision and how this could support sonographer wellbeing.

KEY FINDINGS

Professional supervision was found to be of importance for providing emotional support which can lead to increased job satisfaction, lower levels of burnout and subsequently impact on retention of the workforce. Professional supervision supported personal development and therefore increased quality of patient care, allowing professionals to discuss evidence-based care, policies and practice development through reflection. Whilst important for emotional and professional support, this review found that there are conflicting pressures which can impact the effectiveness of supervision including the supervisory relationship itself and time and organisational pressures. Demands on the workforce made a significant impact on the availability of quality clinical supervision.

CONCLUSION

Professional supervision has an important role in supporting the sonography workforce and enable increased wellbeing and emotional support. There are clear benefits to undertaking professional supervision to support the workforce however there are competing demands which may affect the effectiveness of professional supervision.

IMPLICATIONS FOR PRACTICE

There is limited international research on the use of professional supervision in the radiographer and sonographer workforce. There are clear benefits for supporting professional wellbeing and development under a structured professional supervision framework however within the United Kingdom there is a significant gap in the literature where further research is required.

Effective Clinical Supervision in Nursing: Systematic Review

BACKGROUND: Clinical supervision is part of the leadership function to observe and evaluate the nursing care process, affecting service delivery and improving employee skills. AIM: This systematic review was designed to evaluate effective clinical supervision in nursing. METHODS: Databases were searched for relevant studies: Google Scholar, PUBMED, ScienceDirect, and ProQuest to study screening tools used to identify effective clinical supervision in nursing that were published within 2011-2022. Information about purpose, method, and result. The quality of the study was assessed using equipment from the Manchester Clinical Supervision Scale (MCSS). Validation and reliability were performed on all instruments. Data reliability using Cronbach's coefficient. RESULTS: Data from retrieved studies were reviewed and tabulated according to purpose, study design, characteristics of the population, and result. Eight hundred twenty-nine identified references and 12 full-text articles were reviewed, and 8 for eligibility which has been tested and included in a systematic review, and articles have instruments with included criteria. CONCLUSION: Limitations of effective clinical supervision of the head of the department. The organization is very important because a private hospital can work effectively if there is a healthy and supportive working environment between management and employees. Therefore, future research should focus on using clinical supervision in the health care system to identify effective supervision.

Allied health clinical supervision: An opportunity lost

This study investigated clinical supervision with Allied Health professionals in a public health setting. Staff perceptions and experiences were explored through focus group discussions. Key themes identified that supervisees "tip-toe into complexity" by engaging in reflective practice for incremental personal and professional development. In contrast, supervisors identified that reflexivity was required for the opportunity to "develop at a deeper level". Offering a choice of supervisor and providing supervisor training enhanced supervision experiences. Challenges to effective supervision were identified. Competing priorities, inconsistent modes of delivery, major organisational change and the role of clinical supervision in line with professional development confounded the experiences. Health managers could improve the processes and outcomes by implementing consistency with approach, timing, documentation, language, and structure of Clinical Supervision.

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.

Barriers and facilitators to accessing effective clinical supervision and the implementation of a clinical supervision exchange model in the Australian alcohol and other drugs sector

INTRODUCTION

Internationally, clinical/practice supervision is considered essential in the development and maintenance of professional proficiency across health disciplines. Among alcohol and other drug (AOD) workers, however, access to effective clinical supervision is limited. This study examined perceived barriers and facilitators to: (i) AOD workers accessing effective clinical supervision; and (ii) effective implementation of a clinical supervision exchange model in the AOD sector.

METHODS

Qualitative interviews with frontline workers (n = 10) and managers (n = 11) employed by eight government and non-government AOD treatment services in Brisbane, Australia were undertaken. Interviews were audio recorded, transcribed and data were thematically analysed.

RESULTS

Frontline workers and managers shared similar views. Reported barriers and facilitators to accessing effective clinical supervision included limited time, the high cost of providers, availability of skilled clinical supervisors, supervisor-supervisee matching and supervision modality. Participants considered the implementation of a clinical supervision exchange model to be a resource-effective strategy to increase access to external, individual clinical supervision while also exposing workers to a greater diversity of perspectives, increasing sector collaboration and improving the perceived value of clinical supervision among the workforce.

DISCUSSION AND CONCLUSIONS

The findings of this study suggest that limited time, cost and availability of skilled supervisors are primary barriers to AOD workers accessing high-quality clinical supervision. Implementation of a clinical supervision exchange model is perceived by frontline workers and service delivery managers to be a resource-effective strategy for increasing access to high-quality clinical supervision among workers.

Job satisfaction and associated factors in Greek public hospitals

BACKGROUND AND AIM

To investigate the level of job satisfaction of health care professionals in the public hospitals of the 1st Regional Health Authority of Attica and further to assess its determining factors.

METHODS

The Job Satisfaction Survey questionnaire was administered to health professionals in thirteen hospitals. The 36 items of the questionnaire are expressed on a Likert scale and are divided into nine dimensions. Additional questions were added covering the demographic and socio-economic characteristics.

RESULTS

The reliability of the tool was: α Cronbach = 0.89. The response rate was 81.95%, 3,278 questionnaires were collected overall, of which 52,96% (n=1,736) originated from the nursing staff, 24.50% (n=803) from the medical staff and 22.54% (n=739) from other health employees. The average overall job satisfaction is moderate (3.33 out of 6). The category with the lowest score in job satisfaction was that concerning salaries (2.12). Questions related to promotion (2.45), additional benefits (2.67), operating procedures (2.82) received low job satisfaction rates. Instead, the categories that garnered positive job satisfaction concerned questions related to the supervision (4.66), the nature of work (4.34), and co-workers (4.25). Questions related to communication received 3.79.

CONCLUSIONS

The findings showed lowest satisfaction levels in pay, fringe benefits, contingent rewards, promotion and operating procedures dimensions of job satisfaction. Participants were more satisfied with the nature of work, supervision and co-workers. The findings can be used as a set of reference levels and indicators for the human resources development component of the quality management system in the public hospitals.

The implementation of Journeying through Dementia: Strategies to run a successful pragmatic multicenter trial of a complex intervention

OBJECTIVE

A key challenge in delivering pragmatic trials of complex interventions is effective implementation within the study period and beyond. We describe a trial of an intervention to improve quality of life in mild dementia (Journeying through Dementia), describe some of the challenges raised in terms of implementation, and illustrate the methods used to ensure effective implementation.

METHOD

The intervention was delivered by staff within local services and supervised by more experienced clinicians within those services in order to test the intervention in real-world settings and establish the potential for future embedding into practice. Researchers delivered training sessions for all facilitators and supervisors, met at regular intervals with intervention supervisors, and provided feedback on summaries of intervention sessions created by facilitators. We conducted a thematic analysis of the content of meetings and written correspondence between the researchers and intervention supervisors regarding implementation issues.

RESULTS

Key themes relating to difficulties with implementation were: staff absences and staff leaving posts; participant lack of engagement with intervention; difficulties with delivery of supervision; difficult group dynamics; lack of time to deliver the intervention; and lack of adherence to the intervention and its ethos.

CONCLUSION

We provide guidance for researchers involved in the trialing of other complex interventions in how these challenges might be overcome. These include: recruiting additional staff to deliver the intervention; having clear protocols in place for managing staff absences; using supervision to problem solve participant attendance at intervention sessions and difficult group dynamics; monitoring staff engagement in supervision and addressing problems with engagement with staff and managers when this occurs; giving staff ring-fenced time to deliver the intervention and engage in supervision; and regular monitoring and feedback in relation to the content of the intervention to ensure that it is consistent with ethos and content of the intervention manual.

Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review

OBJECTIVES

We aimed to review the international literature to understand the enablers of and barriers to effective clinical supervision in the workplace and identify the benefits of effective clinical supervision.

DESIGN

A rapid evidence review.

DATA SOURCES

Five databases (CINAHL, OVID Embase, OVID Medline, OVID PsycInfo and ProQuest) were searched to ensure inclusion and breadth of healthcare professionals.

ELIGIBILITY CRITERIA

Studies identifying enablers and barriers to effective clinical supervision across healthcare professionals in a Western context between 1 January 2009 and 12 March 2019.

DATA EXTRACTION AND SYNTHESIS

An extraction framework with a detailed inclusion/exclusion criteria to ensure rigour was used to extract data. Data were analysed using a thematic qualitative synthesis. These themes were used to answer the research objectives.

RESULTS

The search identified 15 922 papers, reduced to 809 papers following the removal of duplicates and papers outside the inclusion criteria, with 135 papers being included in the full review. Enablers identified included regular supervision, occurs within protected time, in a private space and delivered flexibly. Additional enablers included supervisees being offered a choice of supervisor; supervision based on mutual trust and a positive relationship; a cultural understanding between supervisor and supervisee; a shared understanding of the purpose of supervision, based on individual needs, focused on enhancing knowledge and skills; training and feedback being provided for supervisors; and use of a mixed supervisor model, delivered by several supervisors, or by those trained to manage the overlapping (and potentially conflicting) needs of the individual and the service. Barriers included a lack of time, space and trust. A lack of shared understanding to the purpose of the supervision, and a lack of ongoing support and engagement from leadership and organisations were also found to be barriers to effective clinical supervision.

CONCLUSIONS

This review identified several enablers of and barriers to effective clinical supervision and the subsequent benefits of effective clinical supervision in a healthcare setting.

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

Background

Internationally, health and social services are undergoing creative and extensive redesign to meet population demands with rationed budgets. This has critical implications for the health workforces that serve such populations. Within the workforce literature, few approaches are described that enable workforce development for health professions in the service contexts that emerge from large scale service redesign in times of industry shift. We contribute an innovative and robust methodology for workforce development that was co-designed by stakeholders in allied health during the personalisation of disability funding in Australia (the introduction of the National Disability Insurance Scheme).

Methods

In the context of a broad action research project, we used program logic modelling to identify and enact opportunities for sustainable allied health education and workforce integration amidst the changed service provision context. We engaged with 49 industry stakeholders across 92 research engagements that included interviews (n = 43), a workshop explicitly for model development (n = 8) and a Project Advisory Group (n = 15). Data from these activities were inductively coded, analysed, and triangulated against each other. During the program logic modelling workshop, we worked with involved stakeholders to develop a conceptual model which could be used to guide trial and evaluation of allied health education which was fit-for-purpose to emerging workforce requirements.

Results

Stakeholder interviews showed that drivers of workforce design during industry shift were that (1) service provision was happening in turbulent times; (2) new concerns around skills and professional engagement were unfolding for AHP in the NDIS; and (3) impacts to AHP education were being experienced. The conceptual model we co-designed directly accounted for these contextual features by highlighting five underpinning principles that should inform methodologies for workforce development and AHP education in the transforming landscape: being (1) pedagogically sound; (2) person- or family-centred; (3) NDIS compliant; (4) informed by evidence and (5) having quality for all. We use a case study to illustrate how the co-designed conceptual model stimulated agility and flexibility in workforce and service redesign.

Conclusions

Proactive and situated education of the emerging workforce during policy shift is essential to realise future health workforces that can appropriately and effectively service populations under a variety of changing service and funding structures – as well as their transitions. We argue that collaborative program logic modelling in partnership with key stakeholders including existing workforce can be useful for broad purposes of workforce (re)design in diverse contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06711-x.

A Systematic Review of Clinical Practice Guidelines for Physical Therapist Management of Patellofemoral Pain

OBJECTIVE

The purpose of this study was to conduct a systematic review to evaluate clinical practice guidelines for the physical therapist management of patellofemoral pain.

METHODS

Five electronic databases (CINAHL, Embase, Medline, Psychinfo, Cochrane Library) were searched from January 2013 to October 2019. Additional search methods included searching websites that publish clinical practice guidelines containing recommendations for physical therapist management of patellofemoral pain. Characteristics of the guidelines were extracted, including recommendations for examination, interventions, and evaluation applicable to physical therapist practice. Quality assessment was conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, applicability of recommendations to physical therapist practice was examined using the AGREE Recommendation Excellence instrument, and convergence of recommendations across guidelines was assessed.

RESULTS

Four clinical practice guidelines were included. One guideline evaluated as higher quality provided the most clinically applicable set of recommendations for examination, interventions, and evaluation processes to assess the effectiveness of interventions. Guideline-recommended interventions were consistent for exercise therapy, foot orthoses, patellar taping, patient education, and combined interventions and did not recommend the use of electrotherapeutic modalities. Two guidelines evaluated as higher quality did not recommend using manual therapy (in isolation), dry needling, and patellar bracing.

CONCLUSION

Recommendations from higher-quality clinical practice guidelines may conflict with routine physical therapist management of patellofemoral pain. This review provides guidance for clinicians to deliver high-value physical therapist management of patellofemoral pain.

IMPACT

This review addresses an important gap between evidence and practice in the physical therapist management of patellofemoral pain.

LAY SUMMARY

If you have kneecap pain, this review offers guidance for your physical therapist to provide examination processes, treatments, and evaluation processes that are recommended by high-quality guidelines.

Clinical supervision in frontline health care: A survey of social workers in Ontario, Canada

Researchers have documented diminishing staff supervision in health care settings, while noting the complexity and dynamic nature of health care systems. A secondary data analysis of a survey of the Ontario Association of Social Workers (N=666) explored the contemporary receipt of different types of supervision in frontline health care. Most social worker participants were involved in supervision, receiving administrative and supportive supervision. Only 52% engaged in clinical supervision, even though most spent over 50% of work time with clients with complex needs. Factors related to the receipt of clinical supervision included setting, experience, gender, and availability of clinical practice leaders.

Job satisfaction and its associated factors among optometrists in Ghana: a cross-sectional study

Background

Job satisfaction describes an employee’s motivation and/or feeling of satisfaction towards his/her work. Globally, healthcare professionals’ turnover and retention play a critical role in the delivery of essential health services. In Ghana, however, little has been done to ascertain job satisfaction levels among human resources for eye-health. The objective of this study therefore was to assess job satisfaction and its associated factors among optometrists in Ghana.

Methods

A cross-sectional survey was conducted among 304 registered and licensed optometrists of the Ghana Optometric Association between September 2018 and June 2019. A validated, well-structured questionnaire was used to elicit information on socio-demographic characteristics of participants and measures on job satisfaction. Scores from a five-point Likert scale was employed to examine job satisfaction and its associated factors. Linear regression analyses were used to evaluate the association between overall job satisfaction and its associated factors using Rasch logit scores.

Results

A total of 214 optometrists gave valid responses to the questionnaires used for the final analysis. The mean (± SD) score of the overall perception of job satisfaction among optometrists was 3.36 (± 1.00), with 74.3% of them being satisfied with their jobs. After statistical adjustment, Good work-life balance (Unstandardized co-efficient (β) = 0.288, p = 0.001), Salary (β = 0.222, p < 0.0005), Supervision (β = 0.117, p = 0.044), and Continuing Education Opportunities (β = 0.138, p = 0.017) were all significantly associated with higher levels of overall job satisfaction.

Conclusions

Most optometrists were satisfied with their jobs. Effective strategic planning and management of human resources for eye-health in Ghana are essential in the development of quality eye-health systems and the provision of high-quality eyecare services.

ANZAED practice and training standards for dietitians providing eating disorder treatment

INTRODUCTION

Dietitians involved in eating disorder treatment are viewed as important members of the multidisciplinary team. However, the skills and knowledge that they require are not well characterised. Therefore, as part of a broader project to identify the key principles and clinical practice and training standards for mental health professionals and dietitians providing eating disorder treatment, the Australia & New Zealand Academy for Eating Disorders (ANZAED) sought to identify the key practice and training standards specific to dietitians. An expert working group of dietitians was convened to draft the initial dietetic standards. After expert review, feedback on the revised standards was then provided by 100 health professionals working within the eating disorder sector. This was collated into a revised version made available online for public consultation, with input received from treatment professionals, professional bodies and consumer/carer organisations.

RECOMMENDATIONS

Dietitians providing treatment to individuals with an eating disorder should follow ANZAED's general principles and clinical practice standards for mental health professionals and dietitians. In addition, they should also be competent in the present eating disorder-specific standards based around the core dietetic skills of screening, professional responsibility, assessment, nutrition diagnosis, intervention, monitoring and evaluation.

CONCLUSIONS

These standards provide guidance on the expectations of dietetic management to ensure the safe and effective treatment of individuals with an eating disorder. Implications for professional development content and training providers are discussed, as well as the importance of clinical supervision to support professional self-care and evidence-informed and safe practice for individuals with an eating disorder.

Palliative care nurses' experiences of clinical supervision: a qualitative evidence synthesis

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.