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

Supervising community health workers in low-income countries--a review of impact and implementation issues

Background

Community health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention.

Objective

To determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs.

Design

A search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature.

Results

A total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak.

Conclusion

Few supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose from and, while choices should be context specific, our findings suggest that high-quality supervision that focuses on supportive approaches, community monitoring, and/or quality assurance/problem solving may be most effective.

Content of clinical supervision sessions for nurses and allied health professionals

Purpose

The purpose of this paper is to evaluate the current evidence regarding the content of clinical supervision for nursing and allied health professionals.

Design/methodology/approach

The authors searched CINAHL, Medline, PsychINFO and Cochrane Database. Studies were included if the participants involved were nursing, medical or allied health practitioners, but not students, and if the studies contained discussion regarding the content of clinical supervision. Critical analysis of the articles was carried out by two independent researchers to ensure consistency and thematic analysis was applied.

Findings

Twenty included articles were in three main categories: cross‐sectional studies (n=9), including interview, survey and focus group methods of data collection; literature reviews (n=2); and nine published opinion pieces. Themes related to the content of clinical supervision that were identified were reflective practice; task oriented content; diversity of content; and stress management. The results indicated that current research into the content of clinical supervision for nursing and allied health practitioners is limited and of low quality and that further research is needed to determine what content in clinical supervision is associated with better quality and safety, particularly for health professions other than nursing and psychology.

Originality/value

This is the first review of the current evidence for what constitutes the most appropriate content of clinical supervision for health professionals. Clinical supervision is an important component of quality assurance and clinical governance frameworks and it is essential that health care organizations are assured that effective clinical supervision is in place.

Clinical supervision: what do we know and what do we need to know? A review and commentary

AIMS

This study is addressed to nurses but the issues are of equal concern to both midwives and health visitors. Clinical supervision ideally both challenges nurses as well as help their practice. There is need to identify critical elements that help professional practice and understand more clearly the changing nature of supervisory relationships.

BACKGROUND

Clinical supervision in nursing is over a decade old in the UK and yet emerging nursing literature suggests that many ideas remain unfamiliar to nursing practice. The resistance shown by nurse towards clinical supervising remains perplexing. Moreover, ideas concerning clinical supervision have been applied without a substantive evidence base.

METHODS

The discussion draws on varied ideas concerning supervision, including those outside of nursing, to ask what do we know and still need to know about clinical supervision. This study suggests that, a single approach to clinical supervision could be unhelpful to nursing.

FINDINGS AND CONCLUSION

Nursing knowledge concerning many aspects of clinical supervision is increasing because of research. Much of the literature suggests that clinical supervision is scholarly activity requiring much the same attention to relationships as the therapeutic activities it supports. This discussion concludes with the idea that clinical supervision might work at its best as a quiet activity allowing nurses to think about nursing work in ways that suit individual learning styles.

Supervision as Professional Development for Psychiatric Mental Health Nurses

Clinical supervision is an essential element in the professional development of advanced practice psychiatric mental health nurses, and many interpersonal approaches exist to facilitate this process. This article discusses the issues underlying supervision, the key elements of the supervision process, and the current literature focused on the development of best practices in the conduct of clinical supervision. Recommendations for the implementation of supervision are identified.

Student nurses' use of their interpersonal skills within clinical role-plays

Heron's six-category intervention analysis is a component of many counselling courses and is used extensively by teachers of interpersonal skills within nursing curricula. In addition, researchers have used six-category intervention analysis as a theoretical framework for exploring nurses' perceptions of their interpersonal skills. This study aimed to advance previous research by using Heron's framework to analyse student nurses' actual skills, as deployed in clinical role-plays, and then to compare them to earlier findings. Analysis of the data produced the following rank order of interventions based on Heron's framework: catalytic, prescriptive, supportive, informative, confronting and cathartic. The findings both challenge and support previous findings on nurses' perceptions of their interpersonal skills. The paper discusses these findings and their implications for clinical practice.